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Home My WebLink About231999 04/30/14 S' - CITY OF CARMEL, INDIANA VENDOR: 365130 ;; ® Y. ONE CIVIC SQUARE MARK CROMLICH CHECK AMOUNT: S""""731.44' CARMEL, INDIANA 46032 12685 LANTERN RD CHECK NUMBER: 231999 '`a„�roN-�r FISHERS IN 46038 CHECK DATE: 04/30/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 731.44 EXTERNAL TRAINING TRA Q.OF CA9!4, ATRON CITY OF CARMEL Expense Report (required for all travel expenses) /NDIANa EMPLOYEE NAME: ��-��-- C--ro��`�� DEPARTURE DATE: TIME: AM /tDl DEPARTMENT: RETURN DATE: ��- ��-�� TIME: AM REASON FOR TRAVEL: DESTINATION CITY: � ai r �� 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 4/13/14 $25.00 $25.00 4/14/14 1 $50.00 $50.00 4/15/14 $50.00 $50.00 4/16/14 $50.00 $50.00 4/17/14 $506.44 $50.00 $556.44 $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 $506.44 $0.00 $0.00 $0.00 $0.00 $225.00 $0.00 DIRECTOR'S STATEMENT: I er b m that albexpenses listed conform to the City's travel policy and are within my department's appropriated budget. Director Signature: Date: APR Z 8 2014 City of Carmel Form#ER06 Revision Date 4/25/2014 Page 1 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 MA3210 Scaffold Safety 04-09-2014 $99.00 4/9/14 RMS Indianpolis.IN 08:00 AM- 12:30 PM EDT IMM OSHA SII OSHA Standards 04-14-2014-04-17-2014 $800.00 for General Industry 08:00 AM-05:00 PM EDT 4/17/14 Cincinnati.OH 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 OSHA x,501 Trainer Course in 04-14-2014-04-17-2014 $800,00 OSHA SIds.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. 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 industry safety experience.To have your experience reviewed please complete our Prerrpeisite form. Please email your completed Prerequisite Verification Form and a copy of your OSHA 511 completion certificate to infoOmidamericaosha.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 https://midamericaosha.org/faqs/courses 3/24/2014 355 THIRD AVENUE JASPER,IN 47546 / •� TELEPHONE(812)481-1888 • FAX(812)481-1811 ® RESERVATIONS NAME&ADDRESS ® www.hamptoninn.com or 1 800 HAMPTON CROMLICH,MARC ROOM 205/SXBL 12685 LANTERN RD ARRIVAL DATE 4/13/2014 9:07:OOPM FISHERS,IN 46038 US DEPARTURE DATE 4/17/2014 1:37:OOPM ADULT/CHILD 2/0 I ROOM RATE $113.05 RATE PLAN S-ARP Hhonors# AL: CONFIRMATION NUMBER: 88015078 4/22/2014 PAGE 1 DATE DESCRIPTION ID REF NO CHARGES CREDITS BALANCE 4/13/2014 GUEST ROOM PSM 887394 $113.05 4/13/2014 STATE TAX PSM 887394 $7.91 4/13/2014 LOCAL TAX PSM 887394 $5.65 4/14/2014 GUEST ROOM PSM 887517 $113.05 4/14/2014 STATE TAX PSM 887517 $7.91 4/14/2014 LOCAL TAX PSM 887517 $5.65 4/15/2014 GUEST ROOM PSM 887674 $113.05 4/15/2014 STATE TAX PSM 887674 $7.91 4/15/2014 LOCAL TAX PSM 887674 $5.65 4/16/2014 GUEST ROOM PSM 887814 $113.05 4/16/2014 STATE TAX PSM 887814 $7.91 4/16/2014 LOCAL TAX PSM 887814 $5.65 4/17/2014 MC*3136 RFT1 887948 $506.44 0 BALANCE $0.00 L ACCOUNT NO DATE OF CHARGE FOLIO MC '3136 04/13/14 9:07:OOPM 266172 A CARD MEMBER NAME AUTHORIZATION INITIAL CROMLICH,MARC 000714 ESTABLISHMENT NO& ESTABLISHMENT AGREES TO PURCHASES&SERVICES LOCATION TRANSMIT TO CARD HOLDER FOR IT HAS BEEN A PLEASURE HAVING YOU STAY WITH US! TAXES 2012 LIGHTHOUSE AWARD WINNER AND 2013 TRIPADVISOR TIPS&MISC -r- TOTAL ANOU\T MERCI IANDISE AND/OR SERVICES PURCHASED ON THIS CARD SHALL NOT 131:RE TURNED FOR A CASI I RI:IUND PAYMENT DUE UPON RECEIPT Account Activity Printable View Page 1 of 2 Account Activity Printable View —i View Account Information Account Number.. Show Account Account Status: Normal Number Available Balance: $1,863.12 Account Number: 2708 As Of April 22.2014 10:40 AM CDT Statement Name(s): MARK A CROMLICH Last Business Day Balance: $1,883.17 Statement Name(s): Open Date: 10/12/2010 Pending Transactions 'he acti%rty be ow shows pending transactions,scheduled uansfers and LID i 5 days of scheduled ball paymeras. Date Description Category Status Debit(-) Credit(+) 05/02/2014 Bill Pay To Indiana State Central Collection child support ® $120.00 ` BMO Harris Bill Pay 9106 04/2512014 Bill Pay To Indiana State Central Collection child support ® $120.00 BMO Harris Bill Pay 9105 I 04/22/2014 `0290 E 131ST ST $20.05 Card Debit 0000000000 Posted transactions between 02/21/2014 and 04/22/2014 Date Description Category Status Debit(-) Credit(+) Balance - POS.HURCHASE-MYFAX PROTUS IF 04/21/2014�S—OLN 866 563 9212 Uncategorized ✓ $10.00 $1,883.17 Card Debit 3136350555 -POS PURCHASE HAMPTON INNS 04/1812014 JASPER - Uncategorized ✓ $50 .44 $1,893.17 Card Debit 3136873750 ACH DEPOSIT PPD CARMEL 04/18/2014 PAY78381408 Uncategorized ✓ $1,435.50 $2,399.61 ACH Deposit-Credit 539 POS PURCHASE YMCA OF GRTR 04/17/2014 INDIANAPO 03177138532 Uncategorized ✓ $58.80 $964.11 Card Debit 3136017480 04/17/2014 REQUESTED WITHDRAWAL Uncategorized ✓ S1,500.00 $1,022.91 Debit POS PURCHASE NETFLIX COM 04/15/2014 NETFLIX COM Uncategorized ✓ $7.99 $2,522.91 Card Debit 3136317910 04/14/2014 REGULAR CHECK Uncategorized ✓ $120.00 $2,530.90 Check 9103 04/09/2014 REGULAR CHECK Uncategorized ✓ $31.50 $2,650.90 Check 9102 POS PURCHASE VZWRLSS BILL PAY 04/09/2014 VN FOLSOM Uncategorized ✓ $119.33 $2,682.40 Card Debit 3136936544 04/08/2014 REGULAR CHECK Uncategorized ✓ $120.00 $2,801.73 Check 9101 ACH DEPOSIT PPD CARMEL 04/04/2014 PAY78381407 Uncategorized $1,448.09 $2,921.73 ACH Deposit-Credit 539 POS PURCHASE RAPID ROBERTS 04/02/2014 112 SPRINGFIELD Uncategorized ✓ $62.08 $1,473.64 Card Debit 3136378305 04/01/2014 REGULAR CHECK Uncategorized ✓ $120.00 $1,535.72 Check 9100 POS PURCHASE HILTON HOTELS 04/01/2014 CONV CTR BRANSON Uncategorized ✓ $14.00 $1,655.72 Card Debit 3136087301 POS PURCHASE HANNAH INC DBA 03/31/2014 GASM AR SAINT LOUIS Uncategorized Vol $50.66 $1,669.72 Card Debit 3136364664 POS PURCHASE SUBWAY 00013516 _ 03/31/2014 CARMEL Uncategorized ✓ $5.67 $1,720.38 Card Debit 3136173425 POS PURCHASE BIG CEDAR LODGE 03/28/2014 04173352777 Uncategorized ✓ $374.01 $1,726.05 Card Debit 3136900353 POS PURCHASE MACKENZIE RIVER 03/28/2014 PIZZA CARMEL Uncategorized ✓ $119.92 $2,100.06 Card Debit 3136300613 i. 03/27/2014 Uncategorized ,/ $50.16 $2,219.98 littps://www3.harrisbank.com/HOB/retail/protected/printPage 4/22/2014 Account Activity Printable View Page 2 of 2 Date Description Category Status DebitCredit{+) Balance POS PURCHASE HOTELS COM 800 246 8357 Card Debit 3136042796 POS PURCHASE ARBYS 5497 03/27/2014 CARMEL Uncategorized ✓ $3.80 $2.270.14 Card Debit 3136400276 https://www3.harrisbank.com/HOB/retail/protected/printPage 4/22/2014 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)) $731.44 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 Mark Cromlich IN SUM OF $ $731.44 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 43-430.02 $731.44 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 APR 2 8 2014 �M Y 66 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund