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Home My WebLink About225134 10/08/2013 *F CITY OF CARMEL, INDIANA VENDOR: 00350735 Page 1 of 1 ONE CIVIC SQUARE BOB VANVOORST CARMEL, INDIANA 46032 23402 MULE BARN ROAD CHECK AMOUNT: $562.14 SHERIDANIN 46069 CHECK NUMBER: 225134 CHECK DATE: 10/8/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 562 . 14 EXTERNAL TRAINING TRA CITY OF CARMEL Expense Report (required for all travel expenses) \NDIANP-' EMPLOYEE NAME:r DEPARTURE DATE: TIME: `\ AM/C I� DEPARTMENT. RETURN DATE: r�.�-\3 TIME: \\ AM PM REASON FOR TRAVEL: �V ��o\ DESTINATION CITY EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM ✓ Transportation Gas/Tolls/ Meals Date Parkin Lodging Misc. Total Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem $0.00 9/22/13 $32.50 9/23/13 $65.00 $65.00 9/24/13 $65.00 $65.00 9/25/13 ,$65.00 $65.00 9/26/13 $269.64 $334.64 $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 1 $0.001 $0.00 $0.00 $0.00 $269.64 $0.00 $0.00 $0.00 $0.00 $292.50 $0.00 DIRECTOR'S STATEMENT: I here y ffirm at exp nses listed conform to the City's travel policy and are within my department's appropriated budget. OCT=7 2013 Director Signature: Date: 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 (317) 664-0958 Acct XXXX-XXXX-XXXX Posting ' ' Oper 'AectCo Descr�ptuln s ? �s ,.r �.�. . a - Fromm Reference Amount .:: . ....H ,.. . 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 09/25113 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 �iii �on ilsi>r�, E « r i1lr�t cr 9R RUN N Have you ever registered for an EVT Certification exam before? Yes 1_1 No 1 xxx-xx-1_1_l_1,1 1_1e _1-I_I_►_I-1_I_u_1 13 I, a I-1�161 yl-10 S La t 4 Digits Social Security# Home phone Work Phone Iziuq L I n 10 1 P I`.�- till-1_l_ I I I L L I_TL_I-I_._LI 1_I Last Name First Name MI &30-101A -1 1 1 1 Home Address or P.O. Box Number City State Zi or Postal Code n Email Address: A V �1 ec"o Me 1).J�✓ Date of Bin.. Sex:1AMale (_IFemale Years of education completed:-- —years. Employer Name: Which of the below list best describes your current employer? U 1. Fire Department Garage t_I 3. Manuf.Dealer or Service U S. Military I_I 7. Independent Service Center IJ 9.other LJ 2. Municipal Garage L_1 4. Fleet Service Shop IJ 6. Manufacturer t_I a.Volunteer FD or Rescue Service DATE OF EXAM: — Z S 21 Day Advance Registration Required TEST SITE#D H 1 ZG3 I Z _ CITY: Ri YI�� 7 STATE: O H 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 reoerts may be taken. `Note: Re-certification exams are for technicians whose certification is expiring. Regular Re-certlflcition" Regular fl Fire Apparatus EVT Certification reserves the right to affirm to interested parties the areas in which a technician Is EVT Certified. F1 K F-1 Maintenance,Inspection,&Testing F2 I_I Li F-2 Design&Performance Applicant's Signature: F3 IN 1-1 F3 Fire Pumps&Accessories Date: F4 (_j IJ F4 Electrical Systems FA4 IJ l_I FA 4 Advan�ed EIBCtricel S�s�gms Fees: to take the FA you must hav or E2 Number of: FS t_l I�1 F-5 Aerial Fire Apparatus F6 I_I t_I F-6 Allison Automatic Transmission Regular exams: X $50.00=$ ao-oC2 F7 IJ Li F-7 Foam Systems FB LI I—I F-8 Hydraulic Systems Re-certification exams: X $30.00=$ Ambulance Exams Eo I_I EA Maintenance,Inspection&Testing Registration Fee:one-time fee for E7 IJ IJ E-9 Design 8 Performance NEW registrants only $20.00=$a - CFJ E2 U 1_I E-2 Electrical Systems E3 1-1 U E-3 HVAC Total Fees =$ E4 Lj U E-4 Cab,Chassis and Powerbvin Confirmation letter and a picture ID is required at exam site Airport Rescue a Firefighting vehicle Exams We will mail a confirmation letter within 2 business days of Al LI u A-1 Design s Performance receiving it. If you do not receive one, please call the EVT A2 I_I L_I A-2 chassis s Components office immediately. A3 I_I L_I A-3 Extinguishment Systems Online registration is available at www_,e_v_tccor-g Ll U I L-1 Law Enforcement Vehicle Installation Mt I_I L_I M-1 Management Level I Supervisor M2 I_I t_I M-2 Management Level Il Supervisor to take the W2 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_1_I_I-1_I_I�I_I-I_I_I_I_l-I_I_I_L_I Security Code 1._1,1_1 Expiration Date1_1_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 payment to: EVT Certification Commission, Inc. PO Box 894 Dundee,IL 60118 February 22.2413 Phone: 847-426-0075 FAX: 847- 426-4076 ATTENDEE REGISrRArION 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 Sd6 UAPJ OoofZS T Preferred Address i c>l L J 90AIZ 1E City CAR- 1 'C_ State Z jJ. Zip 1/6<::> 32 Cell Phone (317) j� cy - o S.S'25 Work C Phone (3i7) E-mail UAA)400 s� AZm6 Z/0, La l/ Fire Dept./ Agency / Company 17'1 Address QCjj)IC C�21.E(_ .1-) Zip 6 32 Do you plan to attend Wednesday night Banquet? Yes ( ) No T-shirt size LP2(,-F 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! �1 Monday Tuesday Wednesday Thursday Friday First goo log 1 f'6 l a 0 Choice �i2 pomto' fv �vl fp_ P plc P Second �C�SS/nq�sc. .a o0 / 1 '� Choice �j�� f'J�'P fljz� PL),gZA 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 <0 Daily Rate - Any Class................................................ $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 S, C39 Send registration form along with full tuition or payment verification: (for example, purchase order number from your employer) 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 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 training. Register early, classes will be filled on a first come, first served basis. Class registrations must be postmarked by September 13, 2013. Certificates of attendance will be awarded upon payment of all fees and verification of attendance. 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.V.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 pguhde@AOL.com 4 VOUCHER NO. WARRANT NO. ALLOWED 20 Bob VanVoorst IN SUM OF $ $562.14 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I I 43-430.02 I $562.14 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 s Fire Chief 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)) I $562.14 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