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Home My WebLink About214886 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 362146 Page 1 of 1 ONE CIVIC SQUARE C P E S C CARMEL, INDIANA 46032 CHECK AMOUNT: $100.00 ��0 49 STATE STREET MARION IN 28752 CHECK NUMBER: 214886 CHECK DATE: 11/2012012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462838 THOMAS 100 . 00 STORM WATER PHASE II PROFfSS,0y91 0 0 CPESC Renewal Notice Z po CPESC® z 2012 - 2013 s/O�ANDSEDIM0 JOHN GHARRITYTHOMAS Amount Due: $100.00 11576 CREEK SIDE LANE Date Due: December 31, 2012 CARMEL, IN 46033 RETURN THIS FORM WITH YOUR PAYMENT Renewal Fee Details: CPESC#3668..............Annual Rate:$100.00..............Years: 1...............Amount Due:$100.00...........................Status:Active Professional Development Affirmation: Current Period: 12/31/2011-12/30/2014.......................Requirement:60 PDUs per 3 Year Period-Minimum of 2 Categories Due Date for PDUs: 12/31/2014 Review your training records and select either YES or NO in response to the following statement: I HAVE COMPLETED PROFESSIONAL DEVELOPMENT REQUIREMENTS FOR THE CURRENT PERIOD: ❑ YES _L {NO Sign and date in the space below. (See back page for explanation.) John....... yThomas Date Information Update: (Please mark this notice with any changes to your contact information.) Business Phone: (317)571-2314 Ext. Fax: (317)571-2439 Home Phone: (317)815-1196 Email: jthomas @carmel.in.gov Please list any professional titles that you currently hold (for example, PE, RLA): 6— AA � Payment Information ENTER YOUR PAYMENT INFORMATION ON THE REVERSE SIDE OF THIS NOTICE. 49 STATE STREET MARION, NC 28752 PHONE: 828.655.1600 FAX: 828.655.1622 WWW.CPESC.ORG CPESC,INC.IS AN ENVIROCERT INTERNATIONAL,INC.AFFILIATED ORGANIZATION John Gharrity Thomas CPESC # 3668 11576 Creek Side Lane Carmel, IN:.460'33.. Payment Information (Please write legibly) RETURN THIS SHEET WITH YOUR PAYMENT. Payment amount: /00 00 (in US dollars) Payment method: ,Check/Money Order ❑Visa ❑American Express ❑ MasterCard ❑ Discover Make check payable to CPESC, Inc. in US funds. Credit Card Number: - I I I - Expiration Date: F Card Security Code:.---- Name of Card Holder Signature of Card Holder Address of Card Holder IMPORTANT! Check the reverse side of this form to ensure that the Professional Development Affirmation section has been signed and dated. Professional Development Affirmation Explanation Professional development is a fundamental component of the CPESC program. To complete renewal,you must sign the affirmation statement(on the reverse side of this notice)regarding your compliance with professional development requirements. Failure to renew your certification by paying the renewal fee AND signing the affirmation statement is a basis for suspension of your certification. Checking YES means that you have completed the PDU requirements for the current period. We will advance your PDU period to the next three-year block and issue a new ID card. Checking NO means that you have NOT completed the requirements for the current PDU period. Your CPESC certification will remain Active and a new ID card will be issued. However,we will NOT advance your PDU period to the next three-year block. If you need assistance in determining whether you have met the PDU requirements, please contact our office as shown on the reverse side of this notice. Remember, it is a violation of the Code of Ethics to knowingly provide false information to the CPESC Administrative Office. (See CPESC Certification Procedures and Standards,Article II, Section 4, Item B.2 for details.) 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 EnviroCert International Purchase Order No. 49 State Street Terms Marion, NC 28752 Date Due Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s) Amount 1/0/1900 0 CPESC Renewal-John Thomas $ 100.00 Total $ 100.00 I 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 49 State Street IN SUM OF$ Marion, NC 28752 $ 100.00 ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or DEPT# INVOICE NO. ACCT#/TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or 0 0 211-4462838 s 100.00 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 11/19/2012 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund