220813 06/04/2013 a CITY OF CARMEL, INDIANA VENDOR: 307600 Page 1 of 1
ONE CIVIC SQUARE TREASURER OF STATE
CHECK AMOUNT: $700.00
CARMEL, INDIANA 46032 CAMP ATTERBURY-DRM
s� Po Box 5000 CHECK NUMBER: 220813
EDINBURGH IN 46124-5000
CHECK DATE: 614/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 13053 700 . 00 TRAINING SEMINARS
CAMP ATTERBURY
Joint Maneuver Training Center
PO Box 5000 Bldg 245
Edinburgh, Indiana 46124-5000
INVOICE# 13053 20 May 2013
Reference MOA between MDI/CPD
Carmel Police Department
Attn: Michael Pittman
3 Civic Square
Carmel, IN 46032
TOTAL AMOUNT DUE$700.00
Description: Usage Fees for Camp Atterbury Facilities, 14-16 May 2013.
Enclosed is a copy of the facilities&strength report for your use at Camp Atterbury.
If you have any questions please call me at(812)526-1102.
Please make check payable to: TREASURER OF THE STATE OF INDIANA
TAX 1D#35-1286958
Please return a copy of this invoice with your payment.
REMITT TO:
Treasurer of the State of Indiana
Camp Atterbury-DRM
PO Box 5000,Bldg 245
Edinburgh,IN 46124-5000
AMa Carri
Accountant
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Camp Atterbury Utilization Report
Overhead Cost (OC)/Identifiable Incremental Cost (ICC) Checklist
Instructions: This form will be used for all units/organizations that may be charged OC/ICC costs and be filled out
after each unit/organization clears. This form and any other documentation will be forwarded to CA-DRM no more
than 5 working days after training event.
Unit/Organization Name: n
Training Date:
Unit/Organization Address:
("6))zKaj �AR 1h, S,
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Unit/Organization Telephone Number: N'I / 'D J Don
Unit/Organization Point of Contact:
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Unit/Organization POC E-mail Address:
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Questions Yes No
O Does the Unit/Organization have a current MOU? [VJ/ [ ]
j o Does the Unit/Organization have a current Certificate of Insurance? [ [ ]
io Does the Unit/Organization have an Event Release?
a Did the Unit/Organization submit the Liability Waivers?
9 Did the Unit/Organization use specialized ranges/facilities(special cost)?
f m Did the Unit/Organization use other ranges?
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• Did the Unit/Organization use training areas?
® Did the Unit/Organization submit a strength report?
o Does the Unit/Organization expect to have ICC charges?
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m Does the Unit/Organization have MIPR/other financial instrument on file? [I✓j [ ]
Documents to be attached: Yes No
m Strength Report [L
Approval for waiver of Overhead Costs [
a Documentation for ranges and training areas used ['t-J� [ ]
Date Forwarded to DRM: w ��
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j Caw ATTEP,3URY JONT MAwU-va`IAA m�,zG CoNITER
Daily Strength Re on
(fMLIUCtion for comoletng ih_s form on rcverse or may be obabiied fiom Schtdulin_v 3mZncb)
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4 CAS-MT C Form 14(25 MAY 2005 OBSOLETE) 23 OCTOBER2006
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PERSONNEL TRAINED REPORT BY UNIT
START DATE: 15/05/2013 INSTALLATION: CAMP ATTERBURY
ENID DATE: 15/05/2013 FIRE DESK: RANGE CONTROL
.........
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— ——
u nW F a d i I i ty/A i rs p a c e r ven
-., �-Numbecof Personnel Trained;
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JPD_CARMEL IRGO03 SNIPERTRNGJ 3
RG051 I RG051 STATION THREE LIVE FIREJ ill
Total For:PD_CARMEL 14
GRAND TOTAL: 14
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PAGE 1/1 PRINTED ON 16/0512013 15:24 PRINTED BY INNISIVIL FOR OFFICIAL USE ONLY-PRIVACY SENSITIVE RANGE FACILITY MANAGEMENT SUPPORT SYSTEM
START DATE: 16/05/2013 INSTALLATION: CAMP ATTERBURY
PERSONNEL TRAINED REPORT BY UNIT I
E i D DATE:
16/05/2013 FIRE DESK: RANGE CONTROL
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——---------------Unt
Facility/Airspace- Numbee,.of:Pe Fs.
onnel Trained!
u
PD—CARMEL IIRGO03 SN[PER TRNG 1 3
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JRG051 RG051 STATION THREE LIVE FIRE
Total For: PD-CARMEL 15
1-n GRAND TOTAL: 15
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PAGE 1/1
PRINTED ON 17/05/2013 08:24 PRINTED BY INNISMIL FOR OFFICIAL USE ONLY PRIVACY SENSITIVE RANGE FACILITY MANAGEMENT SUPPORT SYSTEM
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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
Treasurer of The State of Indiana
Camp Atterbury—DRM Purchase Order No.
PO Box 5000
Edinburgh, IN 46124-5000 Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/20/13 13053_1 Camp Atterbury usage fees 700.00
Total
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.
Treasurer of The State of Indiana ALLOWED 20
Camp Atterbury-DRM IN SUM OF $
PO Box 5000
Edinburgh, IN 46124-5000
$ 700.00
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed fund
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
210 13053 -570.00 700.00 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
May 2 , 2013
nature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund