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HomeMy WebLinkAbout213963 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 366534 Page 1 of 1 ONE CIVIC SQUARE INDIANA POLICE CANINE WORKSHOP CARMEL, INDIANA 46032 MIKE MCHENRY CHECK AMOUNT: $500.00 +� ? 52677 COUNTY ROAD 11 „o CHECK NUMBER: 213963 ELKHARTIN 46514 CHECK DATE: 10/23/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 25478 12-1013 500 . 00 TRAINING WM C E FAUS K-9 SPECIALTIES LLC 52677 CR 11 N INVOICE # 12-1013 ELKHART, IN. 46514 DATE: OCTOBER 12, 2012 PHONE 574-262-2019 FAX 574-266-2088 EMAIL WLF059@AOL.COM TO Carmel Police Department 3 Civic Square Carmel, In 46032 PURCHASE CONTACT PERSON PAYMENT TERMS TAX ID NUMBER ORDER# 25478 Teresa Anderson Due on receipt 37-153-5932 QTY DESCRIPTION UNIT PRICE LINE TOTAL 4 Officers attending the Indiana Police K-9 Workshop $125.00 $500.00 Please make check payable to: Indiana Police K-9 Workshop 52677 CR 11 North Elkhart, In 46514 TOTAL $500.00 2012 INDIANA ST'A'TE WORKSHOP September 24th through September 28th, 2012 REGISTRATION FORM(PLEASE PRINT LEGIBLE) Name: C"AALE 5 Home Address: S1,6 k(-,,;►1A2 b t,;ft6 City: 1UE si;i:=E0A State: -_„i Zip Code: 6o-iq E Mail: 4 c me Ae.(, Agency: C mLL Q© zza- Agency Address: 3 C�uxc 5 Q,xaaL City: State: -;r _Zip Code: y t.o3Z Work Phone: 311 .5-11-2-5-So Home Phone: ( f std• 13 q�1 NAPWDA Workshop Waiver: The undersigned participant recognizes the possibility of injury occurring as a result of his/her participation in the K9 Workshop. I furthermore state that my canine and I are in a physical condition necessary to be able to participate in the events, as needed for training and certification purposes. I hereby waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA, the Elkhart County Sheriff Department and the County of Elkhart, their employee's, affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical, to myself or my canine. I also agree to abide by all rules and regulations as set forth by NAPWDA and the event organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any and all property, persons and to include the hotel accommodations and or any tr ' g venue r Date: 69 _c,)—/ 20t2 Sign Name: Print Name: Ga�2«s �sa4�2 Current NAPWDA Member? Yes No e K9 Breed: K9 Name: WA-i.1—&- K9 Age: Type of K9 (check appropriate descriptions Patrol_ Narcotic Cadaver Dual Purpose K9'S Workin2 Ability Beginner_ Intermediate g Advanced Handler's Ability: Beginner_X Intermediate Advanced Purpose(s) of Attending Workshop (check at least one): Training— Certification (New) k Certification (Renewal) If certifying, which areas of certification you will be attempting: Registratioi�'Eorm-Page;lof 2 * * NOTE: **�� Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. NAPWDA Membership Dues (must be a member to test for certification): Membership dues are $45.00peryear. ���-PPfkb raie ehe&k same;clieck 4s1hFJW6 op Civilian SAR Handlers applying for Associate Membership must be sponsored by a current NAPWDA Regular member and provide a current Criminal History Records Check at the time they initially join and upon renewing yearly. This record check must be obtained from a Law Enforcement Agency and cover that person for the entire United States or entire State that they live in (not just a city or county level). Associate Membership Info &Application may be printed out from the NAPWDA web site (Membership Information tab). View Certification Test Rules at www.napwda.com/about Workshop Fee: The cost of the workshop is $125.00 per K9 team. A K9 team is I handler with I dog. There is an additional workshop fee of$75.00 Per additional dog for any K9 Handler wishing to train or test with an additional dog. Make workshop fee checks Payable to Indiana Police Canine Workshop, Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams-Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Mail Registration to: Indiana Police Canine Workshop 52677 CR 11 Elkhart, In 46514 Attention: Mike McHenry Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams - Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Workshop Coordinator/Contact: Sgt. Michael McHenry Cell: 574-320-7419 E-mail: mmchenrygelkhartcountysheriff.com Reeistration'jFo_r�m.'Pagc 2"of 2 NOTE: Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. 2012 INDIANA ST'AT'E WORKSHOP September 24th through September 28th, 2012 REGISTRATION FORM(PLEASE PRINT LEGIBLE) Name:_Brian E. Schmidt Home Address:_13983 Marilyn Court City: Carmel State:_IN Zip Code:_46032 E Mail:—bschmidt @carmel.in.gov Agency:_Carmel Police Department Agency Address:_3 Civic Square City:_Carmel State:_ N Zip Code:_46032 Work Phone: (317_)_571-2500 Home Phone: (317__428-8074 NAPWDA Workshop Waiver: The undersigned participant recognizes the possibility of injury occurring as a result of his/her participation in the K9 Workshop. I furthermore state that my canine and I are in a physical condition necessary to be able to participate in the events, as needed for training and certification purposes. I hereby waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA, the Elkhart County Sheriff Department and the County of Elkhart, their employee's, affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical,to myself or my canine. I also agree to abide by all rules and regulations as set forth by NAPWDA and the event organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any and all property,persons and to include the hotel accommodations and or any training venue. Date: _08 /_31_/_2012_Sign Name: —f Print Name: �ei4,j c : 55,..k," -7-- Current NAPWDA Member? Yes No_X_ K9 Breed:_Lab/Bull Terrier Mix K9 Name:_Leo K9 Age:_1.5 Type of K9 (check appropriate descriptions): Patrol_Narcotic_X_Cadaver—Dual Purpose_ K9'S Working Ability: Beginner_X_Intermediate_Advanced Handler's Ability: Beginner_X_Intermediate_Advanced_ Purpose(s) of Attending Workshop (check at least one): Training,Certification(New)_X_Certification (Renewal)_ If certifying,which areas of certification you will be attempting:_Narcotics detection and tracking_ Registration Form Page 1 of 2 **** NOTE: **** Reminder: Registration Form is a two (2) page document, 2012 INDIANA STATE WORKSHOP September 24th through September 28th, 2012 REGISTRATION FORM PLEASE PRINT LEGIBLE Name: Too��7 Home Address: 1 y1 0 AJ61MV City: Cam ( State:—J�j Zip Code: V Q E Mail: .StllrA ' Q ccip%1P /-«?, qa/ Agency: Agency Address: QwI` ' QI rm p y City: C State: Zip Code: Work Phone: (A_) _a�,CQ() Home Phone: (X/ ) -213-33A3 NAPWDA Workshop Waiver: The undersigned participant recognizes the possibility of injury occurring as a result of his/her participation in the K9 Workshop. I furthermore state that my canine and I are in a physical condition necessary to be able to participate in the events, as needed for training and certification purposes. I hereby waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA, the Elkhart County Sheriff Department and the County of Elkhart, their employee's, affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical, to myself or my canine. 1 also agree to abide by all rules and regulations as set forth by NAPWDA and the event organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any and all property, persons and to include the hotel accommodations and or any ra ning venue. Date: Sign Name: Print Name: Current NAPWDA Member? Yes No K9 Breed: G b K9 Name: K9 Age: Type of K9 (check appropriate descriptions): Patrol t - Narcotic Cadaver Dual Purpose K9'S Working Ability Beginner Intennediate Advanced Handler's Ability: Beginner Intermediate Advanced Purpose(s) of Attending Workshop (check at least one): Training Certification (New)_ Certification (Renewal) If certifying, which areas of certification you will be attempting: Air coli� Registration Form Page I of 2 **** NOTE: **** Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. NAPWDA Membership Dues (must be a member to test for certification): Membership dues are $45.00 per°year. Make NAPWDA Membership dues a separate check F ayable to NAPWDA. Do not include this money in the same checkas.the workshop 'rezistration fee. Civilian SAR Handlers;applying for Associate Membership must be sponsored by a current NAPWDA Regular member and provide a current Criminal History Records Check at the time they initially join and upon renewing yearly. This record check must be obtained from a Law Enforcement Agency and cover that person for the entire United States or entire State that they live in (not just a city or county level). Associate Membership Info & Application may be printed out from the NAPWDA web site (Membership Information tab). View Certification Test Rules at www.napwda.com/about Workshop Fee: The cost of the workshop is $125.00 per K9 team. A K9 team is 1 handler with 1 dog. There is an additional workshop fee of$75.00 per additional doz for any K9 Handler wlshine to train or test with an additional do,-. Make workshop fee checks payable to Indiana Police Canine Workshop, Mail checks and completed Re,-istrati.on Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams-Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Mail Registration to: Indiana Police Canine Workshop 52677 CR 11 Elkhart, In 46514 Attention: Mike McHenry Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams - Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Workshop Coordinator/ Contact: Sgt. Michael McHenry Cell: 574-320-7419 E-mail: mmchenrygelkharteountysheriff com Registration Form Page,2_of 2 * * NOTE: ** Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. 2012 INDIANA STATE WORKSHOP September 24th through September 28th, 2012 REGISTRATION FORM(PLEASE PRINT LEGIBLE) Name: 1�'6tr;'e tA'I101 Home Address: M 11 Vic" F_,�b�e� 7 City: N",tes.olt State: Zip Code: q�0 0 E Mail: k#1,%,Ip, Cart'V16 Agency: Carl _h 1;cA `I'wQ r Agency Address: City: C'�-Mel State: 1�= Zip Code: Ll(co 3 Z Work Phone: Irt J 5-+i-Z5c0 Home Phone: L1T -313---+151 NAPWDA Workshop Waiver: The undersigned participant recognizes the possibility of injury occurring as a result of his/her participation in the K9 Workshop. I furthermore state that my canine and I are in a physical condition necessary to be able to participate in the events, as needed for training and certification purposes. I hereby waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA, the Elkhart County Sheriff Department and the County of Elkhart, their employee's, affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical, to myself or my canine. I also agree to abide by all rules and regulations as set forth by NAPWDA and the event organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any and all property, persons and to include the hotel accommodations and or any training venue. Date: Uc� / of / 2v�2 Sign Name: � Y Print Name: IAA+her,m [. 1-' O\ol Current NAPWDA Member? Yes No K9 Breed: k,, SV,4 p K9 Name: {Cq e K9 Age: '6 Type of K9 (check appropriate descriptions) / Patrol Narcotic Cadaver Dual Purpose ✓ K9'S Working Ability / Beginner Intermediate Advanced ✓ Handler's Ability: / Beginner Intermediate ✓ Advanced Purpose(s) of Attending Workshop (check at least one): Training ✓ Certification (New)_ Certification (Renewal) If certifying, which areas of certification you will be attempting: PC'rc 0A t S Registratiori:Eorm Page-4 of 2 **** NOTE. **** Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. NAPWDA Membership Dues (must be a member to test for certification): Membership dues are $45.00 per year. i44i ;�aie`check reQistralioii fee: Civilian SAR Handlers applying for Associate Membership must be sponsored by a current NAPWDA Regular member and provide a current Criminal History Records Check at the time they initially join and upon renewing yearly. This record check must be obtained from a Law Enforcement Agency and cover that person for the entire United States or entire State that they live in (not just a city or county level). Associate Membership Info & Application may be printed out from the NAPWDA web site (Membership Information tab). View Certification Test Rules at www.napwda.com/about Workshop Fee: The cost of the workshop is $125.00 per K9 team. A K9 team is I handler with I dog. There is an additional workshop fee of$75.00 per additional dog for any K9 Handler wishing to train or test with an additional dog. Make workshop fee checks Payable to Indiana Police Canine Workshop, Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams-Please respond by September 1, 2012, so that we"tay make the necessary arrangements for this phase. Mail Registration to: Indiana Police Canine Workshop 52677 CR 11 Elkhart, In 46514 Attention: Mike McHenry Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams - Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Workshop Coordinator/Contact: Sgt. Michael McHenry Cell: 574-320-7419 E-mail: mmchenrykelkhartcountyshen*ff.com -2 NOTE: Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. c " INDIANA RETAIL TAX EXEMPT PAGE ily ®f Ca' rmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 12U78 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Indiana Police Canine Wofthop Carmol Police Department VENDOR Mike McHenry SHIP 3 CIVIC SgUaFg 52977 CIS'i i TO Cannot, IN 4 Elkhart, IN 4W4 (317)571 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 00Z70.00 4 Each training $125.00 $500.00 Sub Total: $500.00 ej r� � •1 y'.S' Ji ' ` .,... y a ~�5 �... _.�^ �•' �'. :," ®De's ,Y 2012 Inlna Sgf@,bltatl1pr ClOir ! � ®, arrSaf '3i Sapt 24 -211,2012 in Elkhart, IN Send Invoice To: e r •Yk ; I Cannel Pollee Depattme t Attn:Teresa Anderson 3 Civic Square Carry @l, IN 40 ° PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT Carmel Police Dept. PAYMENT $500.00 • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SWFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ..'" •N"`°�:4 •PURCHASE ORDER NUMBER MUST APPEAR ON ALL .7 SHIPPING LABELS. LABELS. Chlopf o$f Pohl@ •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2,5,•,47 8 CLERK-TREASURER DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO.....-....-._.-._..__- WARRANT NO,._..._..... _-..-.-_.. ALLOWED 20 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except............ -._..... -- - - --- - - 20 ......................................................................................................................................................................-......----.._--- Signature ............................................................................................................................................. .. .. ..................................... Title Cost distribution ledger classification if claim paid motor vehicle highway fund VOUCHER NO. WARRANT NO. Indiana Police K-9 Workshop ALLOWED 20 Mike McHenry IN SUM OF $ 52677 CR 11 Elkhart, IN 46514 $500.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 25478 I 12-1013 I -570.00 I $500.00 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thursday, October 18, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No 201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 10/12/12 12-1013 K-9 training $500.00 1 hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer