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Home My WebLink About228811 1/29/2014 CITY OF CARMEL, INDIANA VENDOR: 360710 Page 1 of 1 ONE CIVIC SQUARE LIFESAVERS CONFERENCE INC CARMEL, INDIANA 46032 PO BOX 30045 CHECK AMOUNT: $700.00 ALEXANDRIA VA 22310 CHECK NUMBER: 228811 CHECK DATE: 1/29/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 41200 350 . 00 TRAINING SEMINARS 210 4357000 41202 350 : 00 TRAINING SEMINARS Mates, Luann From: Lifesavers Conference Registration Staff <csl@blueskyz.com> Sent: Friday, January 24, 2014 10:46 AM To: Mates, Luann Subject: 2014 Lifesavers Conference Registration INVOICE INVOICE - Please forward this invoice to your accounts payable department for payment Dear Leeland Goodman, Thank you for submitting your registration for the Lifesavers National Conference,April 27-29, 2014, at the Gaylord Opryland in Nashville,TN. If you have not already done so, please send a copy of your purchase order one of the following ways: email us at Lofgren@meetingsmgmt.cc to 703-922-7780;or mail to: Lifesavers Conference, Inc., PO Box 30045,Alexandria,VA 22310. The details of your registration via check payment appear below: Name of Attendee: Leeland Goodman Payment authorization by: Pay by Check-Mail Check Amount:$350.00 Total Event Fees Due: $350.00 Registration Confirmation#:41202 Please note: you are not considered registered until we receive your purchase order. ITEM(S)ON INVOICE#41202 QTY DESCRIPTION PRICE TOTAL 1 Early-Bird Special $350.00 $350.00 Checks are made payable and sent to: Lifesavers Conference, Inc. PO Box 30045 Alexandria, VA 22310 Federal Tax ID is 52-1648356 This email serves as your invoice and commitment for check payment for the total registration amount listed above. Please retain this email fo reference. If you have any questions regarding your registration, please contact Customer Service at cs1 _blueskyz.com. If you have specific questions i the Lifesavers Conference,email lofgren@meetingsmgmt.com or call 703-922-7944. Check www.lifesaversconference.org for updates. Looking forward to seeing you in Nashville! 1 Mates, Luann From: Lifesavers Conference Registration Staff <csl@blueskyz.com> Sent: Friday, January 24, 2014 10:43 AM To: Gallagher, Ann; Mates, Luann Subject: 2014 Lifesavers Conference Registration INVOICE FF 0 INVOICE - Please forward this invoice to your accounts payable department for payment Dear Ann Gallagher, Thank you for submitting your registration for the Lifesavers National Conference,April 27-29, 2014,at the Gaylord Opryland in Nashville,TN. If you have not already done so, please send a copy of your purchase order one of the following ways: email us at Lofgren(c).meetingsmgmt.cc to 703-922-7780; or mail to: Lifesavers Conference, Inc., PO Box 30045,Alexandria,VA 22310. The details of your registration via check payment appear below: Name of Attendee:Ann Gallagher Payment authorization by: Pay by Check- Mail Check Amount:$350.00 Total Event Fees Due: $350.00 Registration Confirmation#:41200 Please note: you are not considered registered until we receive your purchase order. ITEM(S)ON INVOICE#41200 QTY DESCRIPTION PRICE TOTAL 1 Early-Bird Special $350.00 $350.00 Checks are made payable and sent to: Lifesavers Conference, Inc. PO Box 30045 Alexandria,VA 22310 Federal Tax ID is 52-1648356 This email serves as your invoice and commitment for check payment for the total registration amount listed above. Please retain this email fo reference. If you have any questions regarding your registration, please contact Customer Service at cs1(cDblueskyz.com. If you have specific questions r the Lifesavers Conference, email lofgren(c)meetingsmgmt.com or call 703-922-7944. Check www.lifesaversconference.org for updates. Looking forward to seeing you in Nashville! 1 PACE 1 SAVERS April 27.20, 2014 t 204 Gaylord Opryland I Nashville REGISTRATION FORM NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES AufTENDEE INFORMATION First name: 9i✓r✓ Last name: Privacy Disdaimer. Preferred first name for badge: ��`� �t By registering for this conference Organization: %��r'YJ e I/(� �� you acknowledge that your contact Ginformation will be included on the Address: `1 t ,r Q Oe' attendee list made available to V0 U3L all meeting registrants,including City: N1c-r State�`"- Zip: exhibitors. Only exhibitors have Telephone: ( 3i 7 ) S7f_0600 Cell: ( ) the opportunity to purchase p , ` For updates only will not be printed in program materials the attendee list. Attendee Email: /T C>h�°✓ �el�I t"e/-_;LAj- t&11 Initial here if you do not Email a copy of registration to(Alternate email only): want S C f�/ ��'f'-�11- �Tl l/ want your contact information included in conference materials. Special Requests: Emergency Contact Name(required): Day Phone:( ) Cell Phone: ( ) shave read and accepted the Cancellation Policy and Liability/Photography Waiver on page 2 of this registration form. Please check food functions you will be attending: Sunday: ox unch ning Reception I Monday:-Q-eontinental Breakfast [�- TSA Awards Luncheon I Tuesday osing Luncheon Plenary Will you be staying at the Gaylord Opryland? s ❑No If not,where will you be staying? Is this your first Lifesavers Conference? ❑Yes What field do you work in? ❑Consultant/Researcher Ll Community Programs LJ Local Government ❑Advocac onsumer Group ❑Insur e Industry ❑EMS/Fire ❑State/Federal Govt. ❑Judge/Prosecutor ild Passenger Safety ild Restraint Manufacturer ❑Auto Industry Law Enforcement ❑Public Health/Medical ❑Student Which workshop track(s)will you most likely be attending? (Check all that apply) ❑Distracted Driving ❑Teen Traffic Safety ❑Impaired Driving cupant Protection for Children ❑Other Highway Safety Priorities ❑Criminal Justice/Law Enforcement ❑Adult Occupant Protection/Vehicle Technology ❑Communications ❑Vulnerable Populations(Bicyclists/Motorcyclists/Pedestrians/Older Drivers) PRE®C®NIFERENCE 'i ORIKSIK®PS (Details provided on website) am registering for: Ll Strategic Communication Training L1CarFiitt Technician Training Vcout Curriculum Revision and Rollout(for State OP/OPC Coordinators only) p-e S� Latest Technology Workshop of Boosters-The New Frontier:Extending Occupant Protection to Reach Kids 8-15 REGESTRALTION 1F EES (Check one) Your registration fee includes an opening reception,a breakfast,three lunches, refreshment breaks,exhibits,workshops,and program materials. Xrly-Bird Special-Until January 24,2014 $350 ❑ Regular Registration-January 25 until March 14, 2014 $400 ❑ Late/On-Site Registration-After March 14,2014 $500 ❑ Moderator/Speaker $350 ElModerator/Speaker(attending day of presentation onl} Indicate day: $0 paying credit card or e purchase ordet-9 ❑ Poster Presenter $350 El Approved Undergraduate/Graduate Student-Registration Code: $75 You can also securely register online at Note:Additional exhibit personnel-please use the exhibit registration form. Total Amount Due $ 3 0100 www.lifesaversconference.org PAGE 2 REGISTRATION FORM NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES PAL'YMENT WETIM®D -- Choose one of 3 options below Total Amount Due from Pagel:$ 5 - ............................................................................................................................. ❑Check(must be included with this form) ............................................................................................................................. ❑visa or ❑MasterCard / Card Number Expiration Date CW2 Code Name of Cardholder Signature Credit Card Billing Address: If different from registrant information address,please complete the credit card billing address: Address City/State/Zip By signing I authorize my credit card to be charged the above amount. ............................................................................................................................. chase Order Purchase Order# ��'170 To process your registration,a purchase order must be attached. PO Billing Address: If different from registrant information address,please complete the PO billing address: Attention Address City/State/Zip ]PALIT LENT TEIRDIS El Registration fees must be paid by check in U.S.dollars payable to Lifesavers Conference,Inc.,credit card(Visa or MasterCard—Lifesavers does not accept American Express)or attached purchase order. ® Registrations received without payment or purchase order number will not be processed. 11 Registration must be mailed by April 17,2014.After that date,register on-site only. Lifesavers Fed.ID#:52-1648356 Mail form with payment or purchase order to: Or Fax: Lifesavers Conference,Inc. (703)922-7780 Do not mail form after faxing. Conference Registration P.O.Box 30045 Alexandria,VA 22310 NOTE:If you do not receive a confirmation via email or U.S.mail within 14 days,please contact us at(703)922-7944 or email to lofgren@meetingsmgmt.com CONFE3MENCE LODGING El Headquarters: Gaylord Opryland Hotel Rate:$194(+15.25%+$2.50 city tax) Reserve your room online via a link on the Travel/Hotel page at wvvw.lifesaversconference.org. CALNCELLATION POLICY Lifesavers does not accept cancellations by phone.Cancellations must be mailed to Lifesavers Conference,or emailed to Lofgren@meetingsmgmt.com.You will receive a confirmation of your cancellation.Requests received by April 4,2014 will be refunded less a$35 administration fee.Refunds will be issued after the conference.Requests made after April 4,2014 or"no-shows"are not eligible for a refund.If you have not yet made payment when cancelling,you are still responsible for the$35 cancellation fee. LIALDILETTS/IPN®T®GRALlIM-9 WAkIVER By registering for the Lifesavers 2014 Conference,you agree and acknowledge that you are participating in Lifesavers Conference events and activities on your own free and intentional will.You acknowledge this freely and knowingly and that you are,as a result,able to participate in Lifesavers Conference events and hereby assume responsibility for your own well-being.This acknowledgement includes your guest(s)participation in any tours and evening events. The Lifesavers Conference plans to take photographs during the 2014 conference and reproduce them in Lifesavers educational,news,or promotional material,whether in print, electronic or other media,including the Lifesavers website.By participating in the Lifesavers 2014 Conference,you grant Lifesavers the right to use your name and photograph for such purposes.All postings are the property of Lifesavers and may be displayed or used by Lifesavers for any purpose. wwm ifesaversconference.oll lift IN, * * * PAGE 1 ERB April 21-29, 2014r zU14 Gaylord Opryland I Nashville REGISTRATION FORM NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES ATTENDEE INFORMATION First name: 1—F..4 .) Last name:�� Preferred first name for badge: L_tom Privacy Disdaimer: By registering for this conference Organization: /I?� (� f�//'I{!L- you acknowledge that your contact information will be included on the Address: tl"C_ attendee list made available to all meeting registrants,including City: State Zip: �.03�IN exhibitors. Only exhibitors have f the opportunity to purchase Telephone: ( 3 I� ) /' Cell: ( ) the attendee list. For updates only—will not be priinted in program materials Attendee Email: ��—UUd'11.9C—t4r YID I. SIt/- LVV r // __ Initial here if you do not e-/, 6-o Email a copy of registration to(Altemate email only): /� i LS C��}r m �, ry t./ want your contact information included in conference materials. Special Requests: Emergency Contact Name(required): ! AJPJPr 6oi)Nw./ ,^J Day Phone:( ) Cell Phone: ( 31 I have read and accepted the Cancellation Policy and Liability/Photography Waiver on page 2 of this registration form. Please chec�,food functions you will be attending: Sunday: Q'Box Lunch ❑Opening Reception 1 Monday: Xcontinental Breakfast ❑NHTSAAwards Luncheon I Tuesday: ❑Closing Luncheon Plenary Will you be staying at the Gaylord Opryland? Gd'Yes ❑No If not,where will you be staying? Is this your first Lifesavers Conference? VYes ❑No What field do you work in? ❑Consultant/Researcher ❑Community Programs ❑Local Government ❑Advocacy/Consumer Group ❑Insurance Industry ❑EMS/Fire ❑St to/Federal Govt. ❑Judge/Prosecutor 11 Child Passenger Safety El Child Restraint Manufacturer ❑Auto Industry Caw Enforcement ❑Public Health/Medical ❑Student Which workshop track(s)will you most likely be attending? (Check all that ) t )istracted Driving C�'� Traffic Safety Impaired Driving ❑Occupant Protection for Children �ther Highway Safety Priorities riminal Justice/Law Enforcement ❑Adult Occupant ProtectionNehicle Technology ❑Communications &<uInerabie Populations(Bicyclists/Motorcyclists/Pedestrians/Older Drivers) ]PRE-CONFERENCE W®RffiS3EK®!S (Details provided on website) 1 am registering for: ❑ Strategic Communication Training ❑ CarFit Technician Training ❑ CPS Curriculum Revision and Rollout(for State OP/OPC Coordinators only) ❑ CPS Latest Technology Workshop ❑ Out of Boosters—The New Frontier:Extending Occupant Protection to Reach Kids 8-15 MOORE— REGISTRATION FEES (Checkone) Your registration fee includes an opening reception,a breakfast,three lunches,refreshment breaks,exhibits,workshops,and program materials, Early-Bird Special—Until January 24,2014 $350 ❑ Regular Registration—January 25 until March 14, 2014 $400 ❑ Late/On-Site Registration—After March 14,2014 $500 ❑ Moderator/Speaker $350 ❑ Moderator/Speaker(attending day of presentation on1k Indicate day: $0 Paying by credit card or ❑ Poster Presenter $350 purchase order? ❑ Approved Undergraduate/Graduate Student—Registration Code: $75 You can also securely register online at Note:Additional exhibit personnel—please use the exhibit registration form. Total Amount Due $ �� 'aD www.lifesaversconference.org PAGE 2 REGISTRATION FORM NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES' PAL'YNNNT METHOD Choose one of 3 options below Total Amount Due from Page 1:$ ............................................................................................................................. ❑Check(must be included with this form) .............................................................................................................................. ❑visa or ❑MasterCard / Card Number Expiration Date CW2 Code Name of Cardholder Signature Credit Card Billing Address: If different from registrant information address,please complete the credit card billing address: Address City/State/Zip By signing I authorize my credit card to be charged the above amount. ..... ................................................................................................................... Purchase Order Purchase Order# To process your registration,a purchase order must be attached. PO Billing Address:If different from registrant information address,please complete the.PO billing address: Attention Address City/State/Zip PALISMEYNT TERRIS ® Registration fees must be paid by check in U.S.dollars payable to Lifesavers Conference,Inc.,credit card(Visa or MasterCard—Lifesavers does not acceptAmerican Express)or attached purchase order. ® Registrations received without payment or purchase order number will not be processed. ® Registration must be mailed by April 17,2014.After that date,register on-site only. Lifesavers Fed.ID#:52-1648356 Mail form with payment or purchase order to: Or Fax: Lifesavers Conference,Inc. (703)922-7780 Do not mail form after faxing. Conference Registration P.O.Box 30045 Alexandria,VA 22310 NOTE:If you do not receive a confirmation via email or U.S.mail within 14 days,please contact us at(703)922-7944 or email to lofgren@meetingsmgmt.com CONFERENCE LODGING ® Headquarters: Gaylord Opry/and Hotel Rate:$194(+15.25%+$2.50 city tax) Reserve your room online via a link on the TraveVHotel page at www.lifesaversconference.org. CALNCELLATI®IN POLIC7 Lifesavers does not accept cancellations by phone.Cancellations must be mailed to Lifesavers Conference,or emailed to Lofgren@meetingsmgmt.com.You will receive a confirmation of your cancellation.Requests received by April 4,2014 will be refunded less a$35 administration fee.Refunds will be issued after the conference.Requests made after April 4,2014 or"no-shows"are not eligible for a refund.If you have not yet made payment when cancelling,you are still responsible for the$35 cancellation fee. LIABILIT'T/PNOTOGRALPIE3 WALIVER By registering for the Lifesavers 2014 Conference,you agree and acknowledge that you are participating in Lifesavers Conference events and activities on your own free and intentional will.You acknowledge this freely and knowingly and that you are,as a result,able to participate in Lifesavers Conference events and hereby assume responsibility for your own well-being.This acknowledgement includes your guest(s)participation in any tours and evening events. The Lifesavers Conference plans to take photographs during the 2014 conference and reproduce them in Lifesavers educational,news,or promotional material,whether in print, electronic or other media,including the Lifesavers website.By participating in the Lifesavers 2014 Conference,you grant Lifesavers the right to use your name and photograph for such purposes.All postings are the property of Lifesavers and may be displayed or used by Lifesavers for any purpose. wwwAlfesaversconference.org l , PAGE 2 REGISTRATION FORM NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES rA'YMENT NETZOD 350..E Choose one of 3 options below Total Amount Due from Page 1:$ ............................................................................................................................. ❑Check(must be included with this form) ............................................................................................................................. ❑Visa or ❑MasterCard / Card Number Expiration Date CW2 Code Name of Cardholder Signature Credit Card Billing Address:If different from registrant information address,please complete the credit card billing address: I Address City/State/Zip i By signing I authorize my credit card to be charged the above amount. [./purchase Order Purchase Order# To process your registration,a purchase order must be attached. PO Billing Address: If different from registrant information address,please complete the PO billing address: Attention Address City/State/Zip FA'%S MNT TERIKS m Registration fees must be paid by check in U.S.dollars payable to Lifesavers Conference,Inc.,credit card(Visa or MasterCard—Lifesavers does not accept American Express)or attached purchase order. w Registrations received without payment or purchase order number will not be processed. a Registration must be mailed by April 17,2014.After that date,register on-site only. Lifesavers Fed,ID#:52-1648356 Mail form with payment or purchase order to: Or Fax: Lifesavers Conference,Inc. (703)922-7780 Do not mail form after faxing. Conference Registration P.O.Box 30045 Alexandria,VA 22310 NOTE:If you do not receive a confirmation via email or U.S.mail within 14 days,please contact us at(703)922-7944 or email to lofgren®meetingsmgmt.com CONFERENCE LODGIWG ® Headquarters:Gaylord Opryland Hotel Rate:$194(+15,25%+$2.50 city tax) Reserve your room online via a link on the Travel/Hotel page at www,lifesaversconference.org, CANCELLATION P®LICT Lifesavers does not accept cancellations by phone.Cancellations must be mailed to Lifesavers Conference,or emailed to Lofgren@meetingsmgmt.com.You will receive a confirmation of your cancellation.Requests received by April 4,2014 will be refunded less a$35 administration fee.Refunds will be issued after the conference.Requests made after April 4,2014 or"no-shows"are not eligible for a refund.It you have not yet made payment when cancelling,you are still responsible for the$35 cancellation fee. LIA]3ILITMr/P1lX0T0GRA3P3E1'T WAIVER By registering for the Lifesavers 2014 Conference,you agree and acknowledge that you are participating in Lifesavers Conference events and activities on your own free and intentional will.You acknowledge this freely and knowingly and that you are,as a result,able to participate in Lifesavers Conference events and hereby assume responsibility for your own well-being.This acknowledgement includes your guest(s)participation in any tours and evening events. The Lifesavers Conference plans to take photographs during the 2014 conference and reproduce them in Lifesavers educational,news,or promotional material,whether in print, electronic or other media,including the Lifesavers website.By participating in the Lifesavers 2014 Conference,you grant Lifesavers the right to use your name and photograph i for such purposes.All postings are the property of Lifesavers and may be displayed or used by Lifesavers for any purpose. www.litesaversconfepence.org INDIANA RETAIL TAX EXEMPT PAGE City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT M61 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 1 SHIPPING LABELS AND ANY CORRESPONDENCE. 'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION M3014 Llfosavws Conference, Inc. Carmel Policia Department VENDOR SHIP 3 CIVIC Oqu2m P.D. Box 30046 TO Carmel, IN 466 Alexandria, VA 23190 (W)671-209 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT Account �+e�UNITOFMEASURE DESCRIPTION UNIT PRICE � EXTENSION Account 00�a70.00 2 Each training $350.00 $700.00 Sub Total: $700.00 Ilk, 0 il z c • - 3 � I y y 2014 Naflond Lilbs�e�es Conf.4/26-4120 M46 downtqr #Na llle TN Send Invoice To: ' ' Carmial Pollce Depr#moni: Attn: Pat Young 3 Civic squam Camel, IN PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Cannel Police Dept. PAYMENT $700'00 • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY TH.AT/�HERE IS AN UNOBLIGAT.ED-BALANCE IN •SHIP REPAID. THIS APPROPRIATI• ISU FICIENT TO PAY ORTH, ►E ABOVE ORDER. •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. •PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �f/ SHIPPING LABELS. THIS �f ®Ii�i� •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 11 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 31461 A.P.V. COPY-SIGN AND RETURN TO CLERIC'S OFFICE VOUCHERWARRANT NO ....... ALLOWED 20___ |NTHE SUM OF$ ' �u ONACCOUNT[}FAPPROPRIATION FOR Board Members PO#or OE | hereby certify that the attached invoiuo(s), or bill(s) is (ave) hue and correct and that the materials o[services itemized thereon for which charge iomade were ordered and received except . - ` 2O_^__ , . , Signature. ` ' ' � Title ' � ` . Cost distribution ledger classification if claim paid motor vehicle highway fund ' VOUCHER NO. WARRANT NO. ALLOWED 20 Lifesavers Conference, Inc. IN SUM OF $ P.O. Box 30045 Alexandria, VA 22310 $700.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 31461 41202 -570.00 $350.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 31461 41200 -570.00 $350.00 materials or services itemized thereon for which charge is made were ordered and received except Friday, If uary 24, 2014 01 Chief of Police 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)) 01/24/14 41202 Major Goodman Lifesavers conf. $350.00 01/24/14 41200 Ann Gallagher Lifesavers conf. $350.00 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