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HomeMy WebLinkAbout233080 05/28/14 (9, CITY OF CARMEL, INDIANA VENDOR: 368259 ONE CIVIC SQUARE SHAUNA LEWALLEN CHECK AMOUNT: $*******917.74* CARMEL, INDIANA 46032 17317 PINE WOOD LANE CHECK NUMBER: 233080 WESTFIELD IN 46074 CHECK DATE: 05/28/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4344100 REIMB 25.00 CELLULAR PHONE FEES 1091 4359000 REIMB 892.74 SPECIAL PROJECTS I Carmel • Clay Parks&Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense 5/6/2014 Republic Wireless 1091 4344100 Cellular Phone Fees $ 25.00 Aril's Cell Phone All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: �$25,00 Employee Name(print) Shauna Lewallen Address 17317 Pine Wood Lane Check payable to: City, St,Zip Westfield, IN 46074 Signature: /((/Itit.(/t 6l l�ALLVVL Approved by: Date: 5�Le `'1 Date: S 7 l 1 C i Revised 3-2-07 by Business Services; Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3 MAY 0 9 2014 BY: Republic Wireless Page 1 of 1 Help(https://help.republicwireless.com) Community(https://community.republicwireless.com) Blog(https://community.republicwireless.com/blogs/republic) Shop(/shop) g My Account(/myaccount/) Invoice INVOI267948 Billing Address April 25,2014 Shauna Lewallen Account:A00118873 24543 OLDE ORCHARD ST NOVI,MI 48375-2977 Summary Description Total __... _..., ......__....... _... Monthly Total: $25.00 One-Time Total: $0.00 °Taxes: $3.68 ...................... . ......:-... .. ........ .. ........ .... ....._; t Invoice Total: $28,68 Payment:(Includes any available account credits) ($28.68): _.. _ ._..................................... Balance Due:_ — $0.00' Monthly Charges Charge Detail Moto X Wi-Fi+Cell+3G Service Plan $25.00, E911(Wireless)-County(200096) $0.20 --- E911(Wireless)-State(t9.00v5)W~ -- ----$0.19K State Universal Service Fund-State(o5496) $0.14' _4; Sales Tax-State(coo%) $1,59 _..._ . _. _...._.. .................. ..._.......... Fed USF Cellular-Federal Osco%J $1.54; FCC Regulatory Fee(Wireless)-Federal(tsosa) $0.02, ....___... .......... Monthly Subtotal: $25.00. __._._._ _.. ............. ._.............. ___.. ............ ---------- Monthly __Monthly Taxes: $3.68 _.__... ............ _ ........... ............._....... MEET REPUBLIC PHONES(/PHONES) RESOURCES SUPPORT FOLLOW US KEEP UP WITH US (/MEET-REPUBLIC) Moto X(/phones/moto-x) (HTTPS://REPUBLICWIR41EISWEfl1fAE@061[111EUOWIM�sC %%'19&#k h Dlicwirele Our Mission(/our- Moto G(/phones/m0t0-g) Get Started(/start) Meet the Team(/support- g mission) Activate Your Phone Press Room(/press-room) team) ) Our Story(/our-story) (https://republicwireless.corR&@VWFVDend Community (http://(Jattelnt�ihtt�$b p�r�-'.r ,+•,"�,y'u�$55) How We Dolt(/how-we- (https://republicwireless.Cor(titt))athmpWtideiirdisls.com/community) Submit do-it) Affiliates(/affiliates) FAQs(/fags) Reviews(/reviews) Blog Help (http://republicwireless.corrOW4U)//republicwireless.com/help) ©2014,Republic Wireless,a division of Bandwidth,Inc. Legal(/legal) (http://bandwidth.com/peo(Wa!m uO{ Q1 Motare[a,MamXMato 6and1he S[y[iredM[agoam registeredvade ,1 o/Mot 1,rmdemakHa[dinA LLC.SOL REPUBLICAaregir'f!)8tfe�� �9CY BL1�fi;Y�i7pli]�I�� '��y�ppor[are vademar.(s a/thef retpnWe comers. wwd. USI Ihttps://republiewireless.com/myaccount/invoices/invoice_details/2c92aO9445922eb1014598... 5/6/2014 Carmel a Clay Parks&Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt # /' Line# Budget Description Amount Purpose of Expense 4/16/2014 Uhaul/Novi Feed &Supplyfoci i 435w00 $ 417.64%/ moving reimbursement 4/16/2014 Sovels Service Center $ 45.50 moving reimbursement 4/16/2014 Michigan Fuels 688 $ 47.00 -/ moving reimbursement 4/17/2014 Speedway $ 150.00 moving reimbursement 4/18/2014 Speedway $ 60.59 moving reimbursement n 4/18/2014 Speedway $ 172.01 moving reimbursement All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: Employee Name(print) Shauna Lewallen Address 17317 Pine Wood Lane Check payable to: City, St, Zip Westfield, IN 46074 Signature: 2/ A�V(/iLA LmA,6" Approved by: Date: 5/9/2014 Date: 2W �.. Business Services Division,Revised 7-7-08 FILE: Sharefforms\Business Services\Employee Exp Reimb Request -) MAY 2 0 2014 BY: WebBEST Receipt Page 1 of 3 One-Way Rental(OUT)-Wednesday,4/16/2014 10:30 AM Contract No.:91373434 ROADSIDE ASSISTANCE:mvuhaul.com or 1-800-528-0355-JH 14366 IIII IIII IIIIIIItIIIIlllll II I II IIIIIIIIII Dispatched From:025456-Safe-Protection:(NO) Customer: 812-345-3305 Renting Location: Shawn Lewallen DL:xxxxxxxxxxx247=,MI, Novi Feed&Supply Inc-(025456) 24543 olde orchard st 0316 43963 Grand River Ave Novi,MI 48375 slewallen@yahoo.com NOVI,MI 48375(248)344-7526 Towing Vehicle: U-Haul Truck •I agree that only the"Towing Vehicle"listed on this contract will be used to tow U-Haul Equipment. Destination:INDIANAPOLIS,IN Due Date/Time:4/19/2014 10:30 AM Call(800)382-9451 when you arrive in INDIANAPOLIS,IN Days Allowed:2 Extra Days Allowed: 1 MI Allowed:335.0 Extra MI Allowed: 16,0 Extra Day Rate for the JH.$40.00 Per Day $0.40 Per MI Equipment - I Out . [Coverage Rental Charge otal Charge H 1436B 1727.0 $0.00 D59512 AZ $340.00 $340,00 Furniture Pads ty Rented: 58 $49.001 $49.00 REGULAR CHECK-IN - EMAIL ON FILE Environmental Fee: $5.00 SubTotah. $394.00 FUEL TANK CAPACITY: 57 GALLONS Rental Tax: $23.64 Rental Deposit Paid: $0.00 Total Rental Charges(including $417.64 E i/a 'A $ 1/2 X18 3/4 .7 $417.64 F Deposit): fI r l r. I r r I . r I I l r . ( r 11 9.5 8 6.5 5 3 Estimated gallons needed to return to dispatched level of 3/8 Auth- Credit Card Payment: $417.64 Net Paid Today: $417.64 SafeMove Declined for Equipment JH 14366\ •I agree to verify my truck's fuel level is 3/8QF&e leaving the premises.I agree to return this truck with this amount of fuel or pay a$30.00 fueling fee and a minimum of$5.00 per gallon for fuel used.U-Haul does not reimburse if this truck is returned with more fuel than when it was dispatched. U-Haul pays for oil(save receipts). U-Haul liability for injury or death is limited to$20,000 per person up to$40,000 per accident and only if the vehicle is operated by the lessee or the lessee's immediate family member.The lessee may be liable to U-Haul and the injured person/estate for any amount awarded because of injury or death. •U-Haul provides the Customer with minimum limits of protection required by that state or province where arises any claim,suit or cause of action. This provided protection is in excess or secondary to any insurance coverage(s)of the Customer.Customer assumes Sole Responsibility for any and all liability that exceeds the applicable minimum limits of protection for that state or province. •I understand that this equipment must be returned to one of the U-Haul drop-off locations listed on this contract or I must call the drop-off number. •I understand that the equipment rented is water resistant and not water proof. •I acknowledge that I have received the appropriate User Instructions and acknowledge my responsibility to fully read and understand these User Instructions before operating the equipment. •I understand that I am financially responsible for all damages to equipment. •I agree to submit all claims against U-Haul in accordance with the U-Haul Arbitration Agreement,incorporated by reference,and available at uhaul.com/arbitration or from your local U-Haul representative. •I agree that distracted driving is dangerous and that driving while distracted is likely to lead to an accident/crash causing serious injury or death.I agree.not to use a hand held mobile phone(other than for an emergency call)and not to text while driving ary U-Haui truck or towing any U-Haul Trailer,Tow Dolly-or Auto Transport.My agreement not to do so is material to U-Haul's decision to enter into this A ement. My failure to comply is material breach of this Agreement. •The following shall-be admissible as evidence of negligence and breach of contract in any lawsuit or ar ' a i th he driver of the U-Haul truck,or vehicle towing any U-Haul Trailer,Tow Dolly or Auto Transport was texting while driving; i er he U-Haul truck,or ehicle Ker. towing any U-Haul Trailer,Tow Dolly or Auto Transport,was using any mobile phone(o t u a s a em c riving. •I acknowledg th t I have re eived nd agree to the terms and conditions of this R ntra to o act X . ter .. Customer Signature 11-(Shams-wn Lewallen) Agent Si a e (UHAULAL) Discount Savings on Motel and Hotel Rooms.Advanced Reservations Required at Some Locations. 10°/ FF at Lq, uinta Inns and Suites: 1-800- 753-3757 Online @ www.lq.com/uhaul 20%OFF at Days Inn,Ramada and Super 8 Motels: 1-877 67 -7088 Online @ www.wyndha rewards.com/uhaul Q dos dl help? Call me. (248)344-7526 file:///C:/Users/AleAgee/AppData/Local/Temp/6GZMHFAH.htm 4/16/2014 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. Lewallen, Shauna Terms 17317 Pine Wood Lane Westfield, IN 46074 Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s)) PO# Amount 5/6/14 Reimb Cell phone Apr'14 $ 25.00 5/9/14 Reimb Moving fees $ 892.74 Total $ 917.74 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 5-11-10-1.6 120— Clerk-Treasurer Voucher No. Warrant No. Lewallen, Shauna Allowed 20 17317 Pine Wood Lane Westfield, IN 46074 f In Sum of$ $ 917.74 ON ACCOUNT OF APPROPRIATION FOR f 109 -Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 Reimb 4344100 $ 25.00 1 hereby certify that the attached invoice(s), or 1091 Reimb 4359000 $ 892.74 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 22-May 2014 Signature $ 917.74 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund