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Home My WebLink About232477 05/13/14 y or,C�q3 i! \� CITY OF CARMEL, INDIANA VENDOR: 00351098 " i• ONE CIVIC SQUARE SHANE P COLLINS CHECK AMOUNT: $*******164.00* '' ® a CHECK DATE: 05/13/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 164.00 TRAINING SEMINARS CITY OF CARMEL Expense Report (required for all travel expenses) EMPLOYEE NAME: Shane Collins DEPARTURE DATE: 5/4/2014 TIME: 11:30 (91 PM DEPARTMENT: Police RETURN DATE: 5/6/2014 TIME: 6:00 AM/01 REASON FOR TRAVEL: ISOA training conference DESTINATION CITY: Fort Wayne Indiana EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM Transportation Gas/Tolls/ Meals Date Parkin Lodging Misc. Total Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem 5/4/14 $7.00 $50.00 $57.00 5/5/14 $7.00 $50.00 $57.00 5/6/14 $50.00 $50.00 $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 $0.00 $0.00 0.00 Total $0.00 $0.00 $0.001 $14.001 $0.001 $0.001 $0.00 $0.00 so-001 $150.00 $0.00 DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget. Director Signature: Date: City of Carmel Form#ER06 Revision Date 5/8/2014 Page 1 HILTON FORT WAYNE AT THE GRAND WAYNE CONVENTION CENTER •1+ 1020 South Calhoun Street I Fort Wayne,IN 46802 u e 1 1 i l Lmi T: 260 420 1100 1 F: 260 424 7775 FORT WAY NF.A'n+f C.r.:.•a F1 WAYINE mmEECONVEN11011CLUI(R W:hilLOn.COm MIER�, Bf l�0 1' Room: 309/D2 3 CIVIC SOL1APF Arrival Date: 5/4/2014 2:42:00 PM Oen:+ hlrD r',:c' 5/6/2014 CARMEL IN 4uC,;: UNITED STATES OF AMERICA Adult/Child: 2/0 Room Rate: 87.00 Rate Plan: ISO HH N AL: Car: Confirmation Nurrlhe:r:3119011026 5/6/2014 ;e: 1 U n. HILTON HHONORS DATE REFI LINCE DESCRIP1ION AMOUNT 4/11/2014 2192489 Advance Deposit CHECK-(number 231260) ($198.36) 5/4/2014 2206824 *PARKING $7.00 5/4/2014 2206825 GUEST ROOM $87.00 AL4ORr 5/4/2014 2206825 STATE TAX $6.09 5/4/2014 2206825 OCCUPANCY TAX $6.09 5/5/2014 2207518 *PARKING $7.00 5/5/2014 2:017519 : GUEST ROOM $87.00 CONRAD 5/5/2014 2207519 STATE TAX $6.09 5/5/2014 2707519 OCCUPANCY TAX $6.09 WILL BE SETTLED TO $14.00 EFFECTIVE BALANCE OF $0.00 Off DOCRLS7'RY'...L ' EJf UA B;I' 9 t3lTl'6' ttiilnn 4(itlt't'3CIIdt1Lf ACCOUNT NO. ' DAIE OF CHARGE FOLIO NO./CHECK NO. 490184 A CARD MEMBIH NAME: AUTHORIZATION INITIAL HOM;EE VOOD �SIilTF5 ESTABLISHMENT NO.R IO INA-1170 CARO VOIDER FOR PAYMENT PU RCI IASES&SERVICES I AXIS SIVS+�L 11115 R MISC. CARD MEMBER'S 51 GiNATUL°E TOTAL AMOUNT -198.36 �f Hilton MERCHANDISE AND/OR SERVICI.S PURCHASED ON THISCARD SMALL NOT BE RESOLD OR RETURNED FOR A CASH REFUND. PAYMENT DUE UPON RECEIPT Grand VACatious FOR OFFICIAL USE ONLY ATTENDEE REGISTM TION . 11th Annual Conference May 4th-6th 1 $175 Conference Fee 0$20"Junkyard Shootout"Match ❑$25 Late Fee(After April 18,2014) Total:$ 00 ❑Additional Banquet Tickets @$50 each An application form must be submitted for each and every attendee FIRST NAME .- -_.. .-.._^ M.1. I LAST NAME I;ns AGENCY ASSIGNMENT/RANK/TYRE Cor Oe j Pa Ii 4•e AGENCY ADDC1 'CITY � STATE _121PCODE�� MAILING ADDRESS(OTHER THAN AGENCY ! CITY STATE'r ZIP CODE PHONE ' SCoI G nS�Cme�, r1 . Sov- - I affirm that the above information is true and accurate. Further, I authorize the Indiana SWAT Officers Association to contact my employer and verify my employment and assignment if necessary. SIGNATURE DATE IMPORTANT. Will you be attending the banquet? ❑N0 Number of additional tickets requested._ Federal Tax 1D Number: 57-1177923 You are considered pre-registered if your registration form' and payment (agency purchase order, check, credit card', DOJ voucher,or money order) are received prior to April 18, 2014. Any registration form received after April 18, 2014,will result in a $25.00 late fee. NOTE: We WILL NOT accept registrations on the day of the Conference. Additional banquet tickets can be purchased for$50.00 per ticket(limited quantity available). 'Registration fee includes: Attendance at Conference, Vendor Appreciation Day,lunch and banquet dinner on Monday,May 5th, and lunch on Tuesday,May 6th *There will be a$3.00 additional processing fee for credit card payments if you are pre-registered and cancel prior to April 18, 2014, your registration fee will be refunded less a $50.00 administrative charge. No refunds will be issued after April 18, 2014. However, suitable substitutions will be allowed. If paying by credit card,please complete the following: p VISA 0 0 CREDIT CARD NUMBER EXPIRATION DATE 3 DIGIT AUTIMUTION CODE HAMS ON CREDIT CARD AUTHORIZATION SIGNATURE ADDRESS CITY - STATE 211 CODE IMPORTANT., your credit card will be charged the day your registration form and payment are received by the ISOA. ��Please include the billing address where the monthly statement is sent. PLEASE CHECK. .IBFULL-TIME ❑PART-TIME ❑RETIRED ❑AUXILIARY/RESERVE ❑ACTIVE MIUTARY ❑RESERVE MILITARY SUBMIT REGISTRATION FORM AND PAYMENT TO: • • P.O. Box 1016 CROWNPOINT, 1 VOUCHER NO. WARRANT NO. ALLOWED 20 Shane P. Collins IN SUM OF $ J $164.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 210 -570.00 $164.00 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 Friday Y!x 09, 2014 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 bero erl itemized must show: kind of service,where performed, dates service rendered, by P P Y 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)) 05/09/14 Travel Expenses $164.00 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