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Home My WebLink About221485 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 367252 Page 1 of 1 ONE CIVIC SQUARE E V T CERTIFICATION COMMISSION INCCHECK AMOUNT: $240.00 f�? CARMEL, INDIANA 46032 PO BOX 894 DUNDEE IL 60118 CHECK NUMBER: 221485 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 EXAM 240 . 00 EXTERNAL INSTRUCT FEE EVT Certification Commission, Inc. Exam Registration Form Have you ever registered for an EVT Certification exam before? Yes 1_1 No INI I/ xxx-xx-I_I_I_I_I I_I—I_I-I—I_I—I-I_I_I—I_I 13-11-117_ 1-I�I-1_I-I� 2A1Ad1_eL0_LP_LT1_1_1_L_L_L_1 t 4 Digits of Social Security# Home phone Work Phone L D-Lg u A L-Tu_i_i_i Last Name First Name MI_ L !uaL-Aid kLL-&A.L�L-Lg pL-L_L-L-L_L-L-i Home Address or P.O. Box Number i L A£�!��0i_i_u_L_L-L-L_L-i_i Jai jt__j� u_L-L-i_i City State Zip or Postal Code n��t' [' Email Address: A VCD 257—U C(/I1he • �v✓ Date of Birth IlI_9 Ifgl$l I_ Sex: 1 1Male 1_1Female Years of education completed: years. Employer Name: Which of the below list best describes your current employer? I—I 1. Fire Department Garage LI 3. Manuf.Dealer or Service LI 5. Military LI 7. Independent Service Center LI g.Other i_I 2. Municipal Garage/; LI 4. Fleet Service Shop I—I 6. Manufacturer LI 8.Volunteer FD or Rescue Service DATE OF EXAM:II q,"1 — 2-(,p ^ ) � 21 Day Advance Registration Required TEST SITE# d H I ZAP 1 CITY: R E Y/J0 L TDS t3 V 12 C7 STATE: see list of test dates and test sites A maximum of 2 regular exams or 6 recertification exams or a combo of 1 reg&3 recerts may be taken. 'Note: Re-certification exams are for technicians whose certification is expiring. Regular Recertification" $50.00 $30.00 Fire Apparatus Exams EVT Certification reserves the right to affirm to interested parties the areas in which a technician is EVT Certified. F1 �I F-1 Maintenance,Inspection,&Testing F2 (�Y—I I—I F-2 Design&Performance Applicant's Signature: F3 JA I—I F-3 Fire Pumps&Accessories Date: F4 I—I I—I F-4 Electrical Systems Fees: FA4 I_I I—I to take the FA-4 you Imus haSystems r E2 Number of: F5 I—I I—I F-5 Aerial Fire Apparatus Regular exams: X $50.00 $ F6 I_I I_I F-6 Allison Automatic Transmission = `Op•off F7 I—I (—I F-7 Foam Systems I_I I—I Re-certification exams: X $30.00=$ FS F-8 Hydraulic Systems Ambulance Exams EO I_I E-0 Maintenance,Inspection&Testing Registration Fee : one-time fee for �Q E1 I—I I—I E-1 Design&Performance NEW registrants only $20.00=$ E2 I—I I—I E-2 Electrical Systems Total Fees =$ E3 I—I I_I E-3 HVAC E4 I—I I_I E-4 Cab,Chassis and Powertrain Confirmation letter and a picture ID is required at exam site Airport Rescue&Firefighting Vehicle Exams We will mail a Confirmation letter within 2 business days of Al I_I I_I A-1 Design&Performance receiving it. If you do not receive one, please call the EVT A2 I_I I—I A-2 Chassis&Components office immediately. A3 I—I I—I A-3 Extinguishment Systems Online registration is available at www.evtcc.org L1 U I—I L-1 Law Enforcement Vehicle Installation M1 LI I—I M-1 Management Level I Supervisor M2 l_I I—I M-2 Management Level II Supervisor to take the M-2 you must be certified in M1 Method of Payment: 1_1 Visa 1_1 Master Card 1_1 Money Order 1_1 Check# Credit Card#I.I—I—I—I-I_I_I_I_I-I_I_I_I_I-I_I_I_I�I Security Code 1_.1_1_1 Expiration Datel_I_I 1_1_I (from back of card) Month Year Please print the name on credit card and billing address(if different from applicant's name and mailing address) Signature of credit card holder: Date: Mail or fax this form and payment to: EVT Certification Commission, Inc. PO Box 894 Dundee, IL 60118 February 22,2013 Phone: 847-426-4075 FAX: 847- 426-4076 EVT Certification Commission, Inc.- ,:j Exam Registration Forrn f Have you ever registered for an EVT Certification exam before? Yes 1_1 No JA-I 131 3I-I�o LI_131 xxx-xx ? I y L I I Last 4 Digits of Social Security# Home phone Work Phone 16°I R LC I F I_I_I_I-L-L-I-L-I-I-I Lfl Last Name First Name MI LLE ICI`-I-I�'10 L-'-I L I ELII-LL-L-L-I_I_I_I Home Address or P.O. Box Number Ii E IILL LI 1 L_�IQI—u_I_I_I_L—I—L-I City State Zip Postal de > / ,Q Z Email Address: F'Ce C�/'rnL / � f , OV Date of Birth Id I I I�I I 1 113 Sex: 1 1Male 1_1Female Yea of education completed: years. Employer Name: Cg em F L 9-1 ►,F_ rte PTOA E 7 N T Which of the below list best describes your current employer? 1. Fire Department Garage 1-1 3. Manuf.Dealer or Service LI 5. Military 1-1 7. Independent Service Center L1 9.Other L_1 2. Municipal Garage L_I 4. Fleet Service Shop L1 6. Manufacturer LI 8.Volunteer FD or Rescue Service DATE OF EXAM /M::` �q- 2 (o - 1 21 Day Advance Registration Required TEST SITE# c// 72,613 CITY: (� E Y/)OL-69 I'3 U(Z��, STATE: fl see list of test dates and test sites A maximum of 2 regular exams or 6 re-certification exams or a combo of 1 reg&3 recerts may be taken. 'Note: Re-certification exams are for technicians whose certification is expiring. Regular Recertification* $50.00 $30.00 Fire Apparatus Exams EVT Certification reserves the right to affirm to interested parties the areas in which a technici is EMT Certified. F1 IA F-1 Maintenance,Inspection,&Testing F2 I—I I—I F-2 Design&Performance Applicants Signature. F3 �1 L1 F-3 Fire Pumps&Accessories Date: s F4 I_I IJ F-4 Electrical Systems Fees: FA4 I—I I_I FA4 Advanced Electrical Systems to take the FA4 you must havd F4 or E2 Number of: F5 I_I I_I F-5 Aerial Fire Apparatus F6 I—I I—I F-6 Allison Automatic Transmission Regular exams: X $50.00=$ ��a•oo F7 I—I I_I F-7 Foam Systems F8 I—I I—I F-8 Hydraulic Systems Re-certification exams: X $30.00=$ Ambulance Exams EO 1-1 E-0 Maintenance,Inspection&Testing Registration Fee : one-time fee for E1 l� I_I E-1 Design&Performance NEW registrants only $20.00=$ a o E2 1_1 I-1 E-2 Electrical Systems E3 1_I I_I E-3 HVAC Total Fees = E4 1_I L_I E-4 Cab,Chassis and Powertrain Confirmation letter and a picture ID is required at exam site Airport Rescue&Firefighting Vehicle Exams We will mail a confirmation letter within 2 business days of Al I_I I_I A-1 Design&Performance receiving it. If you do not receive one, please call the EVT A2 LI L_I A-2 Chassis&Components office immediately. A3 IJ I_I A-3 Extinguishment Systems Online registration is available at www.evtcc.org L1 U I-1 L-1 Law Enforcement Vehicle Installation M1 LI L_I M-1 Management Level 1 Supervisor M2 �l I—I M-2 Management Level II Supervisor to take the M-2 you must be certified in M1 Method of Payment: 1_1 Visa 1_� Master Card -1 Money Order 1_1 Check# Credit Card#I—I_I—I—I-I_I—I—I—I-I_I_I—I—I-I_I—I—I_I Security Code 1-1-1-1 Expiration Datel_I_I 1-1-1 (from back of card) Month Year Please print the name on credit card and billing address(if different from applicant's name'and mailing address) Signature of credit card holder: Date: Mail or fax this form and paymentto: -EVT Certification Commission, Inc. PO Box 894 Dundee, IL 60118 February 22,2013 Phone: 847-426-4075 FAX: 847- 426-4076 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)) EVT Testing-VanVoorst- Force $240.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 EVT Certification Commission, Inc, IN SUM OF $ P.O. Box 894 Dundee, IL 60118 $240.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 ( I 43-570.04 I $240.00 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 JUL .-1 2013 4=Wap�' Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund