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Home My WebLink About223905 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 367119 Page 1 of 1 ONE CIVIC SQUARE EVERGREEN MOUNTAIN,LLC CHECK AMOUNT: $600.00 �? CARMEL, INDIANA 46032 PO BOX 1169 o�ab TAOS NM 87571-1169 CHECK NUMBER: 223905 CHECK DATE: 9/1012013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4357002 25401 128 600 . 00 TRAINING Ai EGM INVOICE 1ff1�rEmG11m» rsoTJI=Ajal�z. > DATE: August 28, 2013 Evergreen Mountain, LLC PO Box 1169 Taos NM,87571-1169 INVOICE# 128 Phone(910)635-2217 FOR: SHOOT HOUSE BILL TO: INSTRUCTOR CARMEL POLICE DEPARTMENT THREE CIVIC SQUARE CARMEL INDIANA 46032 317-571-2500 ATTN: FOR MARK PARIS DESCRIPTION #of STUDENTS RATE per Student #DAYS of TRAINING AMOUNT THREE DAY SHOOT HOUSE 1 $200 3 $ 600.00 INSTRUCTOR COURSE TRAINING LOCATION;CAMP ATTEBURY, IN 2-4 OCTOBER,2013 SUBTOTAL $ 600.00 TAX RATE 0.00% SALES TAX - OTHER - TOTAL $ 600.00 Make all checks payable to Evergreen Mountain,LLC THANK YOU FOR YOUR BUSINESS! I Jtk EGM Evergreen Mountain, LLC COURSE EGIS.�RTION NAME OCCUPATION 1 RANK/AS51 ENT/TITLE L I Enforcement O Military 0Other '�w/ PREFERRED ADDRESS CITY STATE ZIP CODE PREFERRED TELEPHONE NUMBER PREFERRED EMAIL ADDRESS AGENCY/BASE ADDRESS CITY - --- STATE- - - - ZIP CODE -- - S_ AGENCY/BASE TELEPHONE NUMBER EXTENSION AGENCY/BASE E-MAIL ADDRESS Evergreen Mountain, LLC requires the submission, with this form, one of the following documents: JdCurrent active duty/reserve Law Enforcement ID OR ❑ Current Military ID OR ❑ Current Drivers Lic A COURSEISEMINAR SELECTION: Price is per student n U ❑ Basic Night Vision Course(3 Day)($6o0) ructor Shoothouse(3 Day)($6o0) ❑ Principles of Urban Conflict(3 Day)($600)(4 Day)($800) ❑Carbine/Pistol Course($zoo/day) `r ❑ Rural Area Small Unit Tactics($zoo/day) ❑ Sniper Course($zoo/day) `u U ❑Team Leader Planning& Decision Making(5 Day)($i,000) ❑ Leadership Seminar($85) Ear COURSE LOCATION COURSE DATE(S) A 0 � Q By signing and submitting this registration form, I understand and agree to the following: �3 -That the credentials included with this registration form meet the requirements as specified by Evergreen Mountain,LLC,and n Q that I will be required to show proof of identi fication'on the first day of the course/seminar. Q Where applicable, that Evergreen Mountain, LLC courses will depend upon the careful control of deadly weapon(s) by me; therefore, I understand and agree that my participation may be terminated at any time during the course if the staff/ instructor deems my behavior,conduct or weapon handling skills to be unsatisfactory. a q -That I will abide meticulously by any and all safety procedures as outlined and specified by Evergreen Mountain,LLC and tha t I will agree to signing a liability waiver form releasing Evergreen Mountain,LLC from any injury I may sustain during the course. rl VU •1 understand that my deposit is non-refundable and non-transferable. However, in the case of an emergency, I understand d V that Evergreen Mountain,LLC will work to provide a fair and equitable solution for both parties. SIGNATURE �� ✓ /�/] DATE ' i3 if paying by credit card,please complete the following. ❑ r', ❑ VISA NAME AS IT APPEARS ON CREDIT CARD AUTHORIZATION SIGNATURE DATE CREDIT CARD NUMBER EXPIRATION DATE i 3 DIGIT AUTHORIZATION CODE IMPORTANT. Your credit card will be charged the day your registration form is received. Please include the bill- ing address where the monthly statement is sent. ADDRESS CITY STATE ZIP CODE I I 0 0 0 0 • • 0' 0' 0 9 0 INDIANA RETAIL TAX EXEMPT PAGE City of C CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 2U09 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 81MM3 Evergreen Mountain LLC Carmel Police Department VENDOR SHIP 3 CIVIC squam TO P.O. Box M9 Carmol, IN 40032 Taos, NM 8757MM (317)5792559 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 00-670.00 4 Each training $600.00 $600.00 Sub Total: $600.00 Isetfudar S Tolhou$e training for Officer Ma f tC � � ®•� 4 _mp Attorbrrry { Cgmiol Pollee Department Attn: Teresa Anderson 3 CIVIC Squam Carmel, IN 46=- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT ,armel Police Dept. PAYMENT 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'SUFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. / • ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. � I�l �I P'�II�@ •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE y AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. x'5401 CLERK-TREASURER )OCUMENT 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 ' _ s Board Members PO#or INVOICE NO. ACCT#ITITLE 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 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)) 08/28/13 128 training $600.00 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 Evergreen Mountain LLC IN SUM OF $ P.O. Box 1169 Taos, NM 87571-1169 $600.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 25401 128 -570.00 $600.00 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 Thursday, September 05, 2013 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund