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Home My WebLink About224873 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 363862 Page 1 of 1 ONE CIVIC SQUARE JASON FORCE CARMEL, INDIANA 46032 30 SLEEPY HOLLOW COURT CHECK AMOUNT: $292.50 WESTFIELD IN 46074 CHECK NUMBER: 224873 <ION 40 CHECK DATE: 10/8/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 292 . 50 EXTERNAL TRAINING TRA 0R\0 PSSOCIATION Eh}EAGF�O� Ohio Association of Emergency Vehicle Technicians P.O. Box 303 Avon, OH 44011 CLE TECHNICIANS' NOTICE OF REGISTRATION CONFIRMATION To: Bob Phone Number: You have been registered for the following classes to be held during our 2V Annual Maintenance Symposium on September 23-27, 2013, at the Ohio Fire Academy in Reynoldsburg, Ohio. Date Class No. Class Name 9-24 200 Fire Pumps 9-25 108 F- 1 EVT Prep 9-26 116 EVT M - 1 Prep 9-27 120 Fire Pump Familiarization 9-28 You have XX have not registered for the O.A.E.V.T. banquet at Tall Timbers Banquet Center 13831 St Rt. 40 on Wednesday, September 25, at 5:30 p.m. If you have any questions, please contact Patrick Guhde (440-476-8707 or pguhde @aol.com) Please hying this form with you. vNTAAT\v.oaevt.org QF MN 1N \. CITY OF CARMEL Expense Report (required for all travel expenses) NOIANp% EMPLOYEE NAME:, DEPARTURE DATE: q-'ts� TIME: AM DEPARTMENT. �uy- RETURN DATE: TIME: \ AM REASON FOR TRAVEL: DESTINATION EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Transportation Gas/Tolls/ Meals Date Lodging Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem $0.00 9/22/13 $32.50 $32.50 9/23/13 1 1 $65.00 $65.00 9/24/13 $65.00 $65.00 9/25/13 $65.00 $65.00 9/26/13 $65.00 $65.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0.00 Total $0.00 $0.00 $0.00 $0.00 $0.001 $0.001 $0.00 $0.00 $0.00 $292.50 $0.00 DIRECTOR'S STATEMENT: irm at I expenses listed conform to the City's travel policy and are within my department's appropriated budget. Director Signature: Date: OCT ®? 2013 City of Carmel Form#ER06 Revision Date 10/1/2013 Page 1 BW PLUS EXECUTIVE SUITES COLUMBUS (614) 860-9804 1899 Winderly Lane 36128@ hotel.bestwestern.com Pickerington, OH 43147 www.bestwestern.com/prop_36128 C/O 09/26/2013 07:25 AM BG Room # 303-A Conf# 95392 Registered To: Arrival 09/22/13 Departure 09/26/13 Vanvoorst, Bob Group OAEVT 23402 mule barn rd SHERIDAN, IN 46069 Room Type DDSN-2 double Guests 2 / 0 ` Payment p �:. cctCo:�f;.,Descr.� tion� ��_. :�;.� 'From. Refei=ence 09/22/13 CG RC ROOM CHG 14% $59.00 09/22/13 CG 9 STATE SALES TAX $3.98 09/22/13 CG 90 CITY TAX $1.77 09/22/13 CG 91 COUNTY TAX $2.66 09/23/13 CG RC ROOM CHG 14% $59.00 09/23/13 CG 9 STATE SALES TAX $3.98 09/23/13 CG 90 CITY TAX $1.77 09/23/13 CG 91 COUNTY TAX $2.66 09/24/13 CG RC ROOM CHG 14% $59.00 09/24/13 CG 9 STATE SALES TAX $3.98 09/24/13 CG 90 CITY TAX $1.77 09/24/13 CG 91 COUNTY TAX $2.66 09/25/13 CG RC ROOM CHG 14% $59.00 09/25/13 CG 9 STATE SALES TAX $3.98 09/25/13 CG 90 CITY TAX $1,77 09/25/13 CG 91 COUNTY TAX $2.66 09/26/13 BG VS PAYMENT $269.64- Balance Due $0.00 THE UNDERSIGNED GUEST AGREES TO PAY THE AMOUNT INDICATED ON THE BALANCE DUE PORTION OF THIS INVOICE. IF THE CHARGES ARE TO BE BILLED TO A THIRD PARTY, THE UNDERSIGNED AGREES TO BE PERSONALLY LIABLE FOR PAYMENT OF THE CHARGES IN THE EVENT THAT THE INDICATED THIRD PARTY, PERSON, COMPANY OR ASSOCIATION FAILS TO PAY FOR ANY PART OR THE FULL AMOUNT OF SUCH CHARGES.THIS PROPERTY IS INDEPENDENTLY OWNED AND OPERATED. X GUEST SIGNATURE Signature E1/T C+ertrifi�atri�n Cc�snZml i siIn ins. Ex�arn �e�istrrati�t� F�rrra Have you ever registered for an EVT Certification exam before? Yes 1_1 No I Xxx-xx- 13-11 I -1-1-4J 9101-61?I$131 Last 4 Digits of Social Security# Home phone Work Phone IFL—VLP—,I c I F I I I I—L—L—II—L—L—I IL ILL21A—L—L—L—u ICI Last Name First Name MI ISIC)i ISIoElElhlyl IdIoI1--ILlbl&J l ��ITL_ I I I I 1 _I Home Address or P.O. Box Number 101E 15 I-T I F1 I I g I I DL-1 I I L."L_LLJ L&I LL&la l-�111`1 I—I—I—I I City State Zip Postal de / Email Address: CC C�/'rn69 • !� �1OV Date of Birth I�I�I II I �Sex: I(Mule 1�IFemale Yea of education completed: years. Employer Name: I�Ri2M 5i.— F'1 rZ E b97i>,'91 FME7NT Which of the below list best describes your current employer? �.1. Fire Department Garage U 3. Manuf.Dealer or Service LI 5. Military U 7. Independent Service Center JJ 9.Other U 2. Municipai Garage U 4_ Fleet SerAm Shop U 6. Manufacturer Ll S.Volunteer FD or Rescue Service — DATE OF EXAM: 9 2 (c I—� 21 Day Advance Registration Required TEST SITE# 11 CITY: E YIJOi--6S?Q feG STATE: 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 Re•certifitatlaW $50.00 $30.00 Fire 6pparatus Exams EVT Certification reserves the right to affirm to interested F1 11 F-� Maintenance,Inspection,&Testing parties the areas in which a technic) is Certified.Inspection, Fz IJ IJ F-z Design 8 Performance Applicant's Sign -- 'at re. F3 Vj IJ F3 Fire Pumps 8 Accessories Date: F4 L-1 IJ F-4 Electrical Systems FA4 Ll Ll FA-0 AdYyanted Electra 1 Systems Fees: to take rho FA-4 you must%,I F4 or E2 Number of: FS U u F-6 Aerial Fire Apparatus F6 1_I U F-6 Allison Automatic Transmission Regular exams: t- X $50.00=$ �o •� F7 JJ 1_I F-7 Foam Systems Fe U LI F-6 Hydraulic Systems Re-certification exams: X $30.00=$ Ambulance Exams Ell Ll E-0 Maintenance,Inspection a Testing Registration Fee:one-time fee for E1 U U E-1 Design&Performance NEW registrants only $20.00=$ a° E2 u u E-2 Electrical systems E3 1J JJ E3 HVAC Total Fees =$ E4 u 1J E-4 cab,Chassis and Powertrain Confirmation letter and a picture ID is required at exam site Airport Rescue a Firefi hy_ting Vehicle Exams We will mail a Confirmation letter within 2 business days of Al u Li A-1 Design a Performance receiving it. If you do not receive one,please call the EVT A2 U A-2 chassis s components office immediately. A3 JJ 1_1 A3 Extinguishment Systems Online registration is available at www.evtcc.orq L1 JJ LI L-1 Law Enforcement Vehicle Installation M1 U IJ M-1 Management Level I Supervisor M2 LJ U M-2 Management Level 11 Supervisor to take the M-2 you must be certified in M1 Method of Payment: "Visa 1_1 Master Card 1_1 Money Order IJ 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 I_I_I_I Expiration Datel_l_I 1_I_I (from back of card) Month Year Please print the name on credit hard 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 ATTENDEE REGISTRATION FORM 2013 OHIO ASSOCIATION OF EMERGENCY VEHICLE TECHNICIANS EMERGENCY APPARATUS MAINTENANCE SYMPOSIUM NOTE. PLEASE PRINT or TYPE all information. This form must be filled out completely or it will be returned to you. DEADLINE for registration is September 13, 2013. All late registrations after 9-13-13 will be required to pay a fee of$20 per day/class or $100 total for the week. Full registration refund prior to 8-31-13. 50% refund prior to 9-6-13. No refund after 9-6-13. Name Preferred Address 30 EF�/ /7bcLow C-� City L-ESI rl EL A A/ State /W Zip D 7 Cell Phone (31-3) tEqd ' L4293 Work Phone (317) S l 2 6 00 E-mail 1 CQ,-P10 /7. QO✓ Fire Dept./ Agency / Company l�A2114EL t-� i7C l�El'alM �tJ 7r Address I9 ra C► r I I C -(�Q U A I?E �A P EEL , �� Zip q(0 O3 Do you plan to attend Wednesday night Banquet? ( ) Yes ( ) No T-shirt size L4,267E REGISTRATION Carefully fill out the registration form and send it along with full tuition or payment verification: (for example purchase order number from your employer) Ohio Association of Emergency Vehicle Technicians, Inc. P.O. Box 303 • Avon, Ohio 44011 Use class selection number — PLEASE indicate second choice! Monday Tuesday Wednesday Thursday Friday First 1_11ZC i� Mp F- 0 A7CP. J? 1/oLT FI RE nnf� Choice 1'101A1T-EA)AUC F I ELECT'R1C/7y FAMIL1A2 • . . UD I o 1 ! p I Second xu55n'404_ F'7E ,7C PvM � Choice M.41 01r-06)(E rAM, L/AZ ' io s Gov 1 1 , 3 1a � Form may be photocopied as needed. 3 TUITION INFORMATION REGISTRATION CLOSES SEPTEMBER 13, 2013 Late registration rate will be required. $20 per day/class. FULL PACKAGE Includes the 5 day symposium, daily lunch, and the Wednesday night Banquet: $385.00 8� Daily Rate - Any Cl ass...........................................:.... $130.00 The Wednesday Night Banquet- ADDITIONAL TICKETS ...................... $25.00 TOTAL ENCLOSED Late Registration after 9-13-13 Full Week.................. $100.00 Per Day/Class...................................... $20.00 TOTAL INCLUDING LATE REGISTRATION Send registration form along with full tuition or payment verification: r (for example, purchase order number from your employer) ''yy4;vk'a.,t3 Ydt,:FZr',. Y�9�F �Y:me6le:m Registration: Monday 7:30 AM Welcome & General Assembly: Monday 8:30 AM Class Times: Classes are Tuesday thru Thursday from 9 AM to 4 PM, with one hour for •a lunch and two 15 minute breaks. Friday 9 AM - 12 PM Lunch will be in the Ohio Fire Academy cafeteria. Meal tickets will be issued to each student. ° Some classes are limited in size due to hands-on trainin g, Register early, classes will be filled on `n a first come, first served basis. Atkky E p1A `r Class registrations must be postmarked by September 13, 2013. ' Certificates of attendance will be awarded upon payment of all fees and verification of attendance. r Students are responsible for providing suitable personal protective equipment, i.e., eye protection, hearing protection, as may be needed for the hands-on portion of any class. O.A E N.T. reserves the right to cancel or substitute classes due to conditions beyond our control. Reasonable efforts have been made to confirm the classes and instructors scheduled. Please call Pat Guhde (440) 476-8707 or E-mail at pguhdeCAOL.com 4 �M 1' - t r 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)) $292.50 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 Jason Force IN SUM OF $ $292.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1120 I I 43-430.02 I $292.50 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 OCT - 7 2013 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund