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Home My WebLink About230384 03/26/14 coq- CITY OF CARMEL, INDIANA VENDOR: 365130 ONE CIVIC SQUARE MARK CROMLICH CHECK AMOUNT: $*****1,368.26 CARMEL, INDIANA 46032 12685 LANTERN RD CHECK NUMBER: 230384 FISHERS IN 46038 CHECK DATE: 03/26/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 568.26 EXTERNAL TRAINING TRA 1120 4357004 800.00 EXTERNAL INSTRUCT FEE i'v�i otvCgq�F! , CITY OF CARMEL Expense Report (required for all travel expenses) \!NDIANA�, EMPLOYEE NAME: �`g-��- C--��'�� DEPARTURE DATE: _z�, - N, \ TIME:y�.S DEPARTMENT. RETURN DATE: TIME: AM M REASON FOR TRAVEL: DESTINATION CITY: EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Transportation Gas/Tolls/ Meals Date Lodging Misc. Total Parkin Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem $0.00 3/11/14 $50.00 $50.00 3/12/14 1 $50.00 $50.00 3/13/14 $50.00 $50.00 3/14/14 $368.26 $50.00 $418.26 $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 0.00 Total $0.00 $0.00 $0.00 $0.00 $368.26 $0.00 $0.00 $0.00 $0.00 $0.00 $200.00 DIRECTOR'S STATEMENT: h reb .a ym at aU expenses listed conform to the City's travel policy and are within my department's appropriated budget. MAR 2 4 2014 Director Signature: Date: City of Carmel Form#ER06 Revision Date 3/21/2014 Page 1 3(6014 Mid-America OSHA Education-Courses A hazardous arc can occur in any electrical device in which the energy is high enough to sustain an arc. Arc flash hazards can result from many factors including: dropped tools, accidental contact with electrical systems, build up of conductive dust, corrosion, and improper work procedures. Every year, more than 2,000 workers are treated In bum centers with severe arc Flash injuries. The Flash is immediate, but the results can cause severe injuries that last months, years- even a lifetime. in some cases, they may cause death.This course is designed to inform you of the dangers of arc flashes, understand today's standards (NFPA 70E), performing live work, and selecting the appropriate PPE/Safety procedures as outlined in NFPA 70E. Arc Flash Compliance 03-10-2014 $205.00 Training 3/10/14 Sminaboro 08:00 AM-04:00 PM EST s. A hazardous arc can occur in any electrical device in which the energy is high enough to sustain an arc. Arc flash hazards can result from many factors including: dropped tools, accidental contact with electrical systems, build up of conductive dust, corrosion, and improper work procedures. Every year, more than 2,000 workers are treated in bum centers with severe arc Flash injuries.The Flash is immediate, but the results can cause severe injuries that last months, years- even a lifetime. In some cases, they may cause death.This course is designed to inform you of the dangers of arc flashes, understand today's standards(NFPA 70E), perfomring live work, and selecting the appropriate PPE/Safety procedures as outlined in NFPA 70E. OSHA 502 Undate 03-10-2014-03-12-2014 $600.00 Construction Outreach 08:00 AM-05:00 PM EST Trainers 3/12/14 Middleburg Heights,OH This course is designed for personnel in the private sector who have completed 500 Trainer Course in Occupational Safety and Health Standards for Construction and who are active trainers in the outreach program it provides an update on such topics as OSHA construction standards, policies, and regulations. Credit Awarded: 1.9 CEUs Note:Authorized OSHA Outreach trainers are required to attend this course once every four years to maintain their trainer status.Prior to registration,students must provide a copy of their current trainers card for validation. Prerequisites: Course 500. OSHA 511 OSHA Standards 03-11-2014-03-14-2014 $600.00 for General Industry 08:00 AM-05:00 PM EST 03/14/14 Jasper.IN This course for private sector personnel covers OSHA policies, procedures, and standards, as well as general industry safety, and health principles. Topics include scope and application of OSHA general industry standards. Special emphasis is placed on those areas that are most hazardous, using OSHA standards as a guide.Credit Awarded: 2.5 CEUs MIA7220 Hospital Hazardous 03-12-2014 $200.00 Materials-First Receiver 08:00 AM-05:00 PM EST Training 3/12/14 Springboro. OH OSHA 5600 Disaster Site 03-17-2014-03-20-2014 $750.00 Worker Train-the-Trainer 08:00 AM-05:00 PM EST 'Course 3/20/14 Springboro. OH httpsJ/Mdamericaosha.org/fags/courses 218 Hotels.com - Hotel rooms with reviews. Discounts and Deals on 85,000 hotels worldwide Page 1 of 2 Hotels.com Confirmation Number: 115902801731 Booked: Online- Sunday, March 9, 2014 8:43:00 AM EST 3 Your Receipt Billing Name: Mark Cromlich Billing Address: 46038 us i t i Booking Details Guest Name: Mark Cromlich Room Type: Two Queen Beds, Non- Smoking Check-in: Tuesday, March 11, 2014 Hotel Details: Holiday Inn Express Hotel& Check-out: Friday, March 14, 2014 Suites Jasper Number of Nights: 3 2000 Hospitality Dr Number of Rooms: 1 Jasper US +18124823344 Charges: USD $ Tuesday, March 11, 2014: $110.40 Wednesday, March 12, 2014: $110.40 Thursday, March 13, 2014: $108.00 Discount applied: $0.00 Sub-total: $328.80 Tax recovery charges and service fees: $39.46 $0.00 VAT: Total Price: $368.26 Amount paid: $368.26 Amount still due to Hotels.com: $0.00 Payment Method: Credit Card Number: XXXXXXXXXX; Cancellation Policy https://ssl.hotels.com/customer—care/print_recelpt.html 3/19/2014 Hotels.com - Hotel rooms with reviews. Discounts and Deals on 85,000 hotels worldwide Page 2 of 2 • If you change or cancel your booking after 6:00 PM, 03/09/14((GMT-05:00) Eastern Time (US&Canada)) you will be charged for 1 night(including tax) • If you change or cancel your booking on or before 6:00 PM; 03/09/14 ((GMT-05:00) Eastern Time(US& Canada))you will be charged for 1 night(including tax) We will not be able to refund any payment for no-shows or early check-out. Hotels.com has charged you for the full payment of this booking. Any additional charges and fees incurred during your stay will be charged to your hotel's local currency and may be subject to a foreign exchange fee. This receipt was printed on: Wednesday, March 19, 2014 8:33:38 AM EST Invoice number: 1395236018258-115902801731 This is not a VAT invoice. Retain this copy for statement verification. Please note that if you make changes in your booking, they could result in charges applicable by policy and availability. When you book a hotel located in the EU, Hotels.com, LP does not issue VAT invoices because it does not charge VAT on your bookings. This is due to the operation of a special EU VAT scherne for tour operators and travel agents which applies to Hotels.corn, LP (a limited partnership established in the United States). However, your booking confirmation does act as payment proof. Therefore, the"tax"charges referred to on your booking confirmation do not relate to VAT charged to you by Hotels.com, LP, but to any transaction taxes incurred by Hotels.com, LP (e.g. sales and use, hotel occupancy tax, excise tax, etc)that Hotels.com, LP pays directly to the hotel in relation to your booking. Please see the website for Terms and Conditions: http://www.hotels.com/customer—care/terms_conditions.html?pos=HCOM_US&locale=en_US Hotels.com, LP 10440 N. Central Expressway, Suite 400, Dallas,Texas 75231 USA https://ssl.hotels.com/customer_care/print_receipt.html 3/19/2014 VOUCHER NO. WARRANT NO. ALLOWED 20 Mark Cromlich IN SUM OF $ $568.26 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I I 43-430.02 I $568.26 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 BAR 2 4 2014 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 3rescribed by State Board of Accounts City Form No.201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 4n 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)) $568.26 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 5-11-10-1.6 120 Clerk-Treasurer Mid-America OSHA Education- Courses Page 3 of 9 This course provides an introduction to common health hazards that are encountered in the workplace.These health hazards will include exposure to chemicals, asbestos, silica and lead. The course will feature these topics: identification of hazard; sources of exposure; health hazard information; evaluation of exposure; and engineering and work practice controls.The course materials will include an instructor and student manual; workshops and group activities; and PowerPoint presentations.The course is designed as an awareness course for employers and employees. Credit Awarded: .7 CEUs c MA3210 Scaffold Safety '04-09-2014 1$99.00 94/9/14 RMS Indianpolis,IN 108:00 AM- 12:30 PM EDT ;OSHA 511 OSHA Standards !04-14-2014-04-17-2014 $800.00 Ifor General Industry '08:00 AM-05:00 PM EDT 14/17/14 Cincinnati OH Mg.M. Rml This course for private sector personnel covers OSHA policies, procedures, and standards, as well as general industry safety,and health principles. i Topics include scope and application of OSHA general industry standards. Special emphasis is placed on those areas that are most hazardous, using OSHA standards as a guide. Credit Awarded: 2.5 CEUs OSHA 501 Trainer Course in 04-14-2014-04-17-2014 $800.00 ?OSHA Stds.for Gen.Ind. 08:00 AM-05:00 PM EDT 04/17/14 Jasper.IN This course is designed for personnel in the private sector interested in teaching the 10- and 30-hour general industry safety and health outreach program to their employees and other interested groups. Special emphasis is placed on those topics that are required in the 10-and 30-hour programs as well as on those that are the most hazardous, using OSHA standards as a guide. Course participants are briefed on effective instructional approaches and the effective use of visual aids and handouts.This course allows the student to become a trainer in the Outreach Program and to conduct both a 10-and 30-hour general industry safety and health course and to issue cards to participants verifying course completion. Credit Awarded: 2.6 CEUs NOTE: Students in Course 501 who wish to participate as authorized trainers in the Outreach Program must prepare a one-hour presentation on an assigned OSHA General Industry Outreach topic individually or as part of a group and successfully pass a written exam at the end of the course.I Authorized OSHA Outreach trainers are required to attend Course #503 at least once every four years to maintain their trainer status. Prerequisites: Please note you will not be registered for this course until you've met the prerequisites: OSHA 511 and five years of general lindustry safety experience.To have your experience reviewed please complete our Prereauisite Form. Please email your completed Prerequisite 'Verification Form and a copy of your OSHA 511 completion certificate to inf6almidamericaosha.ora. A college degree in occupational safety and health,a Certified Safety Professional (CSP)or a Certified Industrial Hygienist(CIH)designation, in the applicable training area may be substituted for two(2)years of experience. OSHA 503 Update Gen 04-15-2014-04-17-2014 $600.00 Industry Outreach Trainers 08:00 AM-05:00 PM EDT 4/17/14 Madison,WI i https://midamericaosha.org/faqs/courses 3/24/2014 OSHA Training Institute Education Centers - Course Descriptions Page 1 of 1 OSHA#501- Trainer Course in Occupational safety and Health Standards for General Industry This course is designed for individuals interested in teaching the 10 and 30-hour general industry safety and health Outreach training program to their employees and other interested groups. Using the OSHA General Industry Standards as a guide,special emphasis is placed on those topics required in the 10-and 30-hour programs as well as those which are most hazardous.Students are briefed on effective instructional approaches and use of visual aids and handouts.This course allows the student to become a trainer in the OSHA Outreach Training Program,to conduct both 10-and 30-hour General Industry Outreach classes,and to issue cards to participants after verifying course completion. Students who wish to participate as authorized trainers in the OSHA Outreach Training Program must prepare a presentation on an assigned OSHA General Industry Outreach Training Program topic individually or as part of a group and successfully pass a written exam at the end of the course. Minimum student contact hours: 26 Prerequisites:Students must successfully complete the OSHA#511 Occupational Safety and Health Standards for General Industry and have five(5) years of safety and health work experience in general industry.A degree in occupational safety and health,a Certified Safety Professional(CSP)or a Certified Industrial Hygienist(CIH)designation may be substituted for two(2)years of work related experience.Students should obtain guidance on whether they meet this requirement from the OSHA Training Institute Education Center where they intend to receive the training.Authorized OSHA General Industry Outreach Training Program trainers are required to attend OSHA#503 Update for General Industry Outreach Trainers at least once every four(4) years to maintain their trainer status. https://www.osha.gov/dte/edcenters/course_description.html 3/4/20H Account Activity Printable View Page 1 of 2 Account Activity Printable View E] View Account Information I Account Number: Show Account Account Status: Active Number I Available Balance: Account Number: A5 Of: March 24,2014 08:44 AM CDT Statement Name(s): MARK A CROMLICH - '— - -- 1—Statement Name(s): Last Business Day Balance: Open Date: 10/12/2010 Pending Transactions ;The activity below shows pending transactions,scheduled transfers and up to 15 days of scheduled bill payments. ii Date Description Category Status Debit(-) Credit(+) 04/04/2014 ay. �i 03/28/2014 {i - I .i 03/24/2014 j �I 03/24/2014 ' 03/24/2014 II 1� 6 03/24/2014 Posted transactions between 01/23/2014 and 03/24/2014 SII �• Date Description Category Status Debit(-) Credit(+) Balance I 03/21/2014 ji 03/21/2014 - 03/21/2014 !zed d --11-"V011 Day i� POS PURCHASE PAYPAL 03/20/2014 OHIOVALLEYC 4029357733 Uncategorized %00 $800.00 h Card Debit 3136666088 i; 03/18/2014 y I 03/18/2014 03/17/2014PrW Di �i 03/17/2014 i! iI 03/17/2014 --- ---_ - j 03/17/2014 M1 !I 03/13/2014 _.. { 03/13/2014 �! 03/13/2014 03/12/2014 Ij ! 03/12/2014 _..---------- - �i 03/12/2014 https://www3.harrisbank.com/HOB/retail/protected/printPage 3/24/2014 VOUCHER NO. WARRANT NO. ALLOWED 20 Mark Cromlich IN SUM OF $ $800.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 I I 43-570.04 I $800.00 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 REAR 2 4 2014 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund rescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL kn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by Thom, 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)) $800.00 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