214333 11/07/2012 °�. CITY OF CARMEL, INDIANA VENDOR: 00351400 Page 1 of 1
it '! ONE CIVIC SQUARE INDIANA FIRE CHIEFS ASSN. CHECK AMOUNT $525.00
:. CARMEL, INDIANA 46032 P 0 BOX 364
o� ZIONSVILLE IN 46077 CHECK NUMBER: 214333
CHECK DATE. 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355300 525 00 ORGANIZATION & MEMBER
2013 IFCA Membership Invoice Summary �P6 CHIEFg '
INDIANA FIRE CHIEFS ASSOCIATION -
9
To Carmel Fire Department O,�rFD BEPTEMO�P`mry
2 Civic Square
Carmel, IN 46032
Phone: 317-571-2600 Fax: 317-571-2615
i
Population Served Dept. Type and Size (Career/Vol/Combin). Member Type Dues
State Senate District: US Congress District: Department Budget: Active(1st two Chiefs, any rank) $75 each
State Rep District: IDHS District 5 Active(Addt'I Chiefs, any rank) $50 each
Departmental (<30 in Dept,all ranks) $100 total
In 2012, the individuals listed below with your department were members of the Indiana Fire Chiefs Departmental
Non Chief t, Other) $50 each
Association. We certainly hope those of you who were 2012 members will renew and encourage others in Section Dues(EMS,Aviation, Public $50 each
your department to join as well in 2013 Please call with any questions concerning membership rates. Safety Educators,Technical Rescue)
Note We request that you review and correct this summary(especially blanks above). Mutual Aid Section-no charge
Please change online or fax, email or mail to Terry Rake, Executive Director IFCA.
g o .
1. Fire Chief Keith Smith ksmith @carmel in.gov Active $000 $75.00
Section(s)
2. Assistant Fire Chief David Haboush dhaboush @carmel.in.gov Active $000 $7500
Section(s)
To Add A New Member* To Remove A Member- To Change Data
Please add on this form the new members name, rank and Please note on the summary which member will not be Please change or add information to
email address and determine any additional dues that may be renewing and adjust the amount due by referring to the the data fields on this form. Attach
owed membership dues structure. sheet if several changes
IFCA Membership Application I P 0 Box 364 1 Zionsville, IN 46077 1 rake @indfirechiefs.org
T E L 1- (877 ) 733 - 1850 1 FAX ( 3 1 7 ) 733 - 4212 1 www.indfirechiefs.org
2013 IFCA Membership Invoice Summary PE CHiEFg
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i me
INDIANA FIRE CHIEFS ASSOCIATION -
09
To Carmel Fire Department �''zgo aEateMe�POM1
2 Civic Square
Carmel, IN 46032
3. Assistant Fire Chief Matt Hoffman mhoffman @carmel in.gov Active $000 $5000
Section(s).
4 EMS Chief Mark Hulett mhulett @carmel in.gov Active $2500 $50.00
Section(s) EMS
5. Public Education Keith Freer kfreer @carmel in.gov Active $2500 $50.00
Director
Section(S) Public Safety Education
6. Fire Marshal Bruce Knott bknott @carmel in gov Active $2500 $50.00
Section(s). Public Safety Education
7 Safety Chief Steve Reeves sreeves @carmel in.gov Active $000 $50.00
Section(s)-
To Add A New Member, To Remove A Member, To Change Data
Please add on this form the new members name, rank and Please note on the summary which member will not be Please change or add information to
email address and determine any additional dues that may be renewing and adjust the amount due by referring to the the data fields on this form. Attach
owed membership dues structure. sheet if several changes
IFCA Membership Application I P O Box 364 1 Zionsville, IN 46077 1 rake @indfirechiefs.org
T E L 1- (877 ) 733 - 1850 1 FAX ( 3 1 7 ) 733 -4212 1 www indfirechiefs.org
2 013 IFCA Membership Invoice Summary �PE CH,EPB ,s
iS
P
n
INDIANA FIRE CHIEFS ASSOCIATION -
o
To Carmel Fire Department o'HZfo eEO,E e�"'mom
2 Civic Square
Carmel, IN 46032
8. Battalion Chief Jeff Steele jsteele @carmel in.gov Active $000 $50.00
Section(s)
Please Send Receipt: ❑ Check(payable to IFCA) #- Renewal Total $45000
Section Dues. $7500
Visa Mastercard Card Number +
New Members
Name on Card Exp Date Total Due:
Signature i�;S-'S `�`�
Online Payment Option -Visit.www.indfirechiefs.org under the membership tab :3
New Members (write name, rank, email and any section changes below or submit changes online)
To Add A New Member- To Remove A Member- To Change Data
Please add on this form the new members name, rank and Please note on the summary which member will not be Please change or add information to
email address and determine any additional dues that may be renewing and adjust the amount due by referring to the the data fields on this form. Attach
owed. membership dues structure. sheet if several changes
IFCA Membership Application I P 0 Box 364 1 Zionsville, IN 46077 1 rake @indfirechiefs.org
T E L 1- (877 ) 733 - 1850 1 FAX ( 3 1 7 ) 733 -4212 1 www indfirechiefs.org
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))
$52500
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
VOUCHER NO WARRANT NO
ALLOWED 20
I FCA
Indiana Fire Chiefs Association
IN SUM OF $
P O Box 364
Zionsville, IN 46077
$52500
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO ACCT#/TITLE I AMOUNT Board Members
1120 I I 43-553 00 I $525 00 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
NOV - 5 2012
✓may '.'"
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund