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Home My WebLink About235444 07/30/14 a°r.CLAM CITY OF CARMEL, INDIANA VENDOR: 186700 ONE CIVIC SQUARE TODD LUCKOSKI CHECK AMOUNT: $"""'443.78' CARMEL, INDIANA 46032 210 CONCORD LANE CHECK NUMBER: 235444 CARMEL IN 46032 CHECK DATE: 07/30/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4343002 443.78 EXTERNAL TRAINING TRA CITY OF CARMEL Expense Report (required for all travel expenses) EXHIBIT A EMPLOYEE NAME: oaD Ltwe.kosV--tl DEPARTURE DATE: 7-2 I--,0,1Z)1TIME: • ,J A /PM DEPARTMENT: > RETURN DATE:�"' —,2�f TIME: ,5 (0 AM/ M REASON FOR TRAVEL: ' ' 6wmaeDESTINATION CITY: Ve EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Transportation Gas/Tolls/ Meals Date Lodging Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner .Snacks Per Diem 7/21/14 $50.00 $50.00 7/22/14 $50.00 $50.00. 7/23/14 $50.00 $50.00 7/24/14 $243.78 $50.00 "1293.78 $0:00 $0:00 :,$0.00 $0.00 $0.00 ':$0.00 $0.00 $0.00 :'.$0.00 $0.00 $0.00 $0:00 :-.$0.0-0 0.00 Total $0i00]-:,:,:'1:: $0.00 " $0.00 $0.00 $243:78 $0.00 $0.00 $0.00 $0.06F7$200.001$200.00 $0.00001HUMM 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: b — City of Carmel Form 9 ER06 Revision Date 7/25/2014 Page 1 For advance payments, claim form must be submitted ten (10) business days in advance of travel. Claim will not be processed without the following documentation: 1) - Conference or course registration form, if applicable 2) Travel itinerary or car rental agreement, if applicable 3) Original itemized receipts for all expenses (or affidavits if appropriate), except for meal per diems (which require hotel receipt) Prorated meal allowance: For travel that commences before 1:00 p.m. (flight departure time, if traveling by air), $50 for in-state travel and $65 for out-of-state travel For travel that commences after 1:00 p.m. (flight departure time, if traveling by air), $25 for in-state travel and $32.50 for out-of-state travel For travel that ends before 1:00 p.m. (flight arrival time, if traveling by air), $25 for in-state travel and $32.50 for out-of-state travel For travel that ends after 1:00 p.m. (flight arrival time, if traveling by air), $50 for in-state travel and $65 for out-of-state travel EMPLOYEE ACKNOWLEDGEMENT OF MEAL ADVANCE AND OBLIGATION TO DOCUMENT EXPENDITURES: I hereby acknowledge receipt of$ such funds being advanced to me by the City of Carmel solely for the purpose of purchasing meals while traveling to participate in official business for the City. I accept responsibility'for these funds and agree to repay them if lost or stolen. I understand that within ten (10) business days of my return (as stated on opposite side), I am responsible to: 1) Submit original itemized receipts to the office of the Clerk-Treasurer documenting all meal expenditures; and 2) Return all unused funds to the office of the Clerk-Treasurer I further understand that failure to provide the required documentation shall result in the total amount of the advance being deducted from the first paycheck issued more than 30 days after the date of my return. Failure to return unused funds will result in the amount of the unused funds (total advance minus documented expenditures) being d cted from the first paycheck issued more than-30 days after the date of my return. Employee Signature: elsij e• Date: 5 �! City of Carmel Form#ER06 Revision Date 7/25/2014 Page 2 TRAVEL ACTION PLAN VR- 14 INCIDENT 07 . 21 . 2014 District 5 IMT Departure : 0700 Arrival : ^'0900 Radio Channel : SW ,, MA7 INCIDENT OBJECTIVES 1.Incident Name z.Date 3.Time VR-14 Mobilization 7.20.2014 1100hrs 4.Operational Period Monday,July 210700-0900 5.General Control Objectives 1. Mobilize D-51MT safely and effectively to Muscatatuk Urban Training Center(COB Panther Staging Area) 2. Move D-51MT from 7151 N. Perimeter Rd to COB Panther at North Vernon Airport 3. Ensure member accountability and safety during travel by using multiple drivers and partners 4. Collect information as needed for deployment 5. Ensure proper check-in with all members DEPLOYMENT RADIO CHANNEL:SW MA 7 6.Weather History Indianapolis Weather(Departure):Sunny with a high of 87. Calm Wind becoming east southeast around 5mph in the afternoon. North Vernon Weather(Arrival): Mostly Sunny with a high near 81. Light east wind. Source:htt ://forecast.weather. ov Ma Click. h 7CH Name=North+Vernon&state=IN&site=IND&textField1=39.0078&textField2=-85.6312&e=0#.U8vsGvldXzM 7.General Safety Message 1. Use spotters when backing 2. Ensure all drivers have a partner and a switching when tired 3. Ensure that lookouts are being used while loading vehicles 4. Unsure all PPE is worn while loading cache 5. Call for PAR at the before leaving any stop Attachments(mark if attached) X_Incident Objectives—ICS 202 X_Comm Plan—ICS 205 Safety Message—ICS 208 X_Organizational List—ICS 203 X_Tele. Contact-List—ICS 205 T X_ Maps&Traffic Plan Assignment List—ICS 204 Event Medical Plan—ICS 206 9.Prepared by(Planning Section Chief) 10.Approved by(Incident Commander) Thomas Sivak ICs 202 ORGANIZATION ASSIGNMENT LIST e:OPERATIONS SECTION,° 1.INCIDENT NAME" CHIEF Rob Gaylor Vibrant Response. DEPUTY1 Matt Hoffman(A)/Robin Nicoson(MONDAY) Z DATE PREPARED`` 3.TIME PREPARED a .BRANCH 7/20/2014 1:50 PM BRANCH DIRECTOR Nathan Kemper 4.OPERATIONAL PERIOD(DATE/TIME) Division Supervisor Division Supervisor 6:UNIFIED-COMMANDER AND STAFF, Incident Commander Steve Orusa(A) Deputy IC(T) Eric Funkhouser b.Branch PIO Mike Pruitt BRANCH DIRECTOR Matt Stewart(Mon/Tues) PIO TR Hagerty Thurs Division Supervisor Safety Mark Cromlich(Wed/Thurs) Division Supervisor 6:AGENCY REPRESENTATIVES LNO Jamie Burrows d.Branch LNO State Liaison Ben Esterline(County EOC) BRANCH DIRECTOR LNO Agencies Bill Brown Division Supervisor 7.PLANNING SECTION- CHIEF Tom Sivak DEPUTY Cary Slauter Situation Unit Adam Harrington(TB) Situation Unit Jay Gordnt Resource Unit Ann Cichocky d.AIR OPERATIONS'BRANCH Resource Unit BRANCH DIRECTOR REQUEST LIAISON Documentation Unit DEPUTY GIS TEAM Jon Milborn FIELD OBSERVER(GIS) Judy Lury 10:FINANCE SECTION ' -8:LOGISTICS SECTION CHIEF Joel Thacker CHIEF Mark Carman DEPUTY Orbie Bowes(TUES) Supply Unit Leader Wend Warren(Not Avail TIME UNIT Barbara Rogers Carl Erickson Facilities Chad Jenkins/Ryan COST UNIT Lise Crouch(WED ONLY) Tenneson Mon/Thurs Food Unit- MESS HALL Medical Unit Leader Casey Arkins Communications Unit Leader Steve Dirks Mobile Command Bus Ryan Horine Transportation /STHURS'S Reserves(MON' PREPARED BY(RESOURCE UNIT LEADER) Mobile Command Bus Todd Luckoski Ground Support Leader Bob Wagner Order Incident ID: Vehicle Types: Drivers ADV Team ADV Team Steve Orusa Fire.Dept Officers'-Vehicle Advanced Teem r Steve Orusa INK,AWT ADY Team , ;"Dave Warren s Vehicle Advanced Team Dave Warren .,«._..a.ca::_....'1'...:_..,.._rt.', ....._ .ai.:�_,.._-rTtr-`.,r....r.:h-?•'.....r....:._.n ..wh..::.,,... r..� rz.i..s,. :,-„y"i, .-,:-ri`-.:s....r,.r.'. 1 Vehicle#1 Fire Dept Officers'Vehicle Tom Sivak 2 Vehicle#2 1 Ton Pick-up Truck LW-94 Mark Carman Shelter-1 8'X 24'Shelter Trailer x�r � 3 Vehicle#3 15 Passenger Van Jamey Burrows 4 Vehicle#4 WRTFD-2D Extended Cab Truck Casey Arkins GIS Trailer 8'x 24'GIS Trailer ` + !�¢ h4 gik i3x Wmvu N§� 1a�� 4 5 Vehicle#5 F250 Pick-up Truck Chad Jenkins jrz�c -ice a �-fe�iwrff�r"�a MX-1 8'x 24'Drash Tent Trailer �� ' 6 Vehicle#6 F250 Pick-up Truck Carl Erickson Power Trailer 8'x 26'Power Distribution Trailer 7 Vehicle#7 Chevy 2500 Truck Steve Smith �{4k3lF�tb.n3xx' 5d'nT'W7i FoEit+-.i Fuel Trailer Fuel Trailer 7'x 17' � a 8 Vehicle#8 Fire Dept Officers'Vehicle Bill Brown 9 Vehicle#9 Chevy 2500 Truck Justin Hubbard 20 KW 7'x 21' 20 KW Generator on Trailer * 7� t v 10 Vehicle#10 3/4 ton Pick-up Truck Kurt Delong t ,fir: r $ MX-2 8'x 24'Drash Tent Trailer "�� 11 Vehicle#11 3/4 ton Pick-up Truck Justin Whitaker 200 KW Tx 21' 200.KW Generator on Trailer 12 Vehicle#12 8.5'x 38'Command Vehicle-Hamilton County Steve Dirks 13 -Vehicle#13 Chevy 2500 Truck Ryan Horine 14 Vehicle#14 9'x 39' Command Vehicle-Carmel E 15 Vehicle#15 Tahoe-Carmel Adam Harrington 16 Vehicle#16 Fire Dept Officers'Vehicle Todd Luckowski 17 Vehicle#17 Fire Dept Officers'Vehicle Robin Nicoson 18 Vehicle#18 Fire Dept Officers'Vehicle Ben Esterline Vibrant Response VR-14 Telephone List Unified Commander and Staff Position Name Cell Email Incident Steve Orusa(A) (317)908-9449 orusas@fishers.in.us Commander Deputy IC(T) Eric Funkhouser (Wed/THURS) (317)281-2359 efunkhouser(abcfd.net PIO Mike Pruitt 317-714-5637 Mike.Pruitt(&Wavnetwo.org PIO TR Hagerty(Tue,Wed,Thurs) thaaertRangolain.ora Safety Mark Cromlich(Wed/Thurs) 317-409-0909 mcromlich(a)carmel.in.aov Liaison Officer Position Name Cell Email LNO Jamey Burrows 765-208-1156 burrows*Rfishers.in.us LNO State Liaison Ben Esterline(County EOC) 317-694-1510 besterlinec@dhs.in.gov LNO Agencies Bill Brown 317-362-4971 wbrown anbrownsburofire.org Planninq Section Position Name Cell Email CHIEF Tom Sivak 317-716-1706 thomas.sivak(cDhamiIto ncounty.in.gov DEPUTY Cary Slauter 317-339-2612 cslauter(&�Afd.org Situation Unit Adam Harrington(TB) 317-442-3166 aharrington aacarmel.in.gov Situation Unit Jay Gordnt 260438-7834 Jay.gomdt .cityoffortwayng.org Resource Unit Ann Cichocky 317-519-1637 cichockvaal ishers.in.us Resource Unit Documentation Unit GIS TEAM Jon Milburn 317-364-6701 imilburn .hancockcoinaov.ora FIELD OBSERVER Judy DeLury Jdeluryl(&isdh.in.gov GIS Logistics Section Position Name Cell Email CHIEF Mark Carman 765-208-1981 carmanmCcDfishers.in.us Supply Unit David Warren(Not Avail Wed) 317-563-2790 dwarren(@co.hendricks.in.us Leader Carl Erickson 317-716-1957 Carl.erickson(@hamiltoncounty.in.gov Facilities Chad Jenkins 317-414-9993 chad.jenkins hamiltoncountv.in.gov Ryan Tenneson Mon/Thurs Food Unit MESS HALL Medical Unit Casey Arkins carkins wrtfd.org Leader Communications Steve Dirks 317-519-8583 Steven.dirks0hamiltoncounty.in.00v Unit Leader Mobile Command Ryan Horine 317-460-6174 Ryan.horine&hamiltoncounty.in.gov Bus Justin Hubbard 317-610-1113 Justin.hubbard@hamiltoncounty.in.gov Transportation Justin Whitaker 317-716-0926 Justin.whitakerehamiltoncounty.in.Qov Kurt Delon 317-532-1615 Kurt.Delongahamiltoncounty.in.gov Ground Support Bob Wagner 502-396-5834 wagnerrt@-umail.iu.edu Unit Mobile Command Todd Luckoski 317-710-6145 tluckoski cDcarmel.in.gov Bus Vibrant Response VR-14 Telephone List Position Name Cell Email CHIEF Rob Gaylor 317-776-2684 rgaylor@westfield.in.gov DEPUTY Matt Hoffman(A) Robin Nicoson MONDAY 317-373-4552 nicosonr@fishers.in.us Branch Position Name Cell Email BRANCH DIRECTOR Nathan Kemper 317-374-5689 nkempfer@cityoflawrence.org Branch Position Name Cell Email BRANCH DIRECTOR Matt Stewart(Mon/Tues) Matt.stewarfanwaynetwp.org Air Operations Branch Position Name Cell Email BRANCH DIRECTOR REQUEST LIAISON Finance Section Position Name Cell Email CHIEF Joel Thacker 317-339-2611 ithacker .brownsburgfire.orq DEPUTY Orbie Bowes(Tues) 317-714-8949 obowles@carmel.in.gov TIME UNIT Barbara Rogers 317-850-3868 blrassociatescDsbcglobal.net COST UNIT Lise Crouch(WED ONLY) 317-459-2472 (crouch co.hendricks.in.us I CREW TRAVEL TIME REPORT CREW/UNIT NAME CREW/UNIT NUMBER D5-IMT IMT or RESPONSIBLE AGENCY INCIDENT NAME INCIDENT NUMBER VR-14 7.21.2014 (6) (7) (8) (9) (10) REMAR NAME OF EMPLOYEE CLASSIFICATION DATE:7.21.2014- , DATE:-7.24.2014' KS NO. TO POSITION MILITARY TIME MILITARY TIME ON OFF ON OFF (11)REMARKS:T=TRAVEL L=LUNCH(half hour lunch was observed but not written down) (12)OFFICER-IN-CHARGE(Must include Supervisor Signature) (13)TITLE(Officer-in-Charge) SIGNATURE OF SUPERVISOR IN CHARGE IC (14)SUPERVISOR/OFFICER-IN-CHARGE(Print name) (15)DATE (16)FSC NAME(Signature of Person Posting to Emergency Time Report) (17)DATE r CREW TIME REPORT CREW/UNIT NAME CREW/UNIT NUMBER D5-IMT IMT or RESPONSIBLE AGENCY INCIDENT NAME INCIDENT NUMBER VR-14 (6) (7) (8) (9) (10) REMAR NAME OF EMPLOYEE CLASSIFICATION DATE: DATE: KS NO. TO POSITION MILITARYTIME MILITARYTIME ON OFF ON OFF (11)REMARKS:T=TRAVEL L=LUNCH (half hour lunch was observed but not written down) (12)OFFICER-IN-CHARGE(Must include Supervisor Signature) (13)TITLE(Officer-in-Charge) SIGNATURE OF SUPERVISOR IN CHARGE IC (14)SUPERVISOR/OFFICER-IN-CHARGE(Print name) (15)DATE (16)FSC NAME(Signature of Person Posting to Emergency Time Report) (17)DATE -DF F- (T�Q�-tc) Quality Inn (IN340) Account: 350244194 Date: 7/24/14 2075 East Tipton Street Room: 207 LAto Seymour, IN 47274 Arrival Date: 7/21/14 ® (812)519-2959 Departure Date: 7/24/14 BY CHOICE HOTELS GM.IN340@choicehotels.com Check In Time: 7/21/14 11:06 PM luckoski,todd Check Out Time: 7/24/14 11:18 AM 31 first ave nw Rewards Program ID: You were checked out by: KWhita Carmel, IN 46032 You were checked in by: lander _ Total Balance Due: 0.00 pPost Date � Description Comment--~� _. _.•---•-- Amountl 7/21/14 Room Charge #207 luckoski,todd 77.39 7121/14 State Tax --5-42- 7/21/14 Occupancy Tax 3,87 7/22/14 Room Charge #207 luckoski,todd 77.39 7/22/14 State Tax --6.4z- 7/22/14 Occupancy Tax 3,87 7/23/14 (173.36) XXXXXXXXXXX 7/23/14 ment (86.68) 7/23/14 Room Charge #207 luckoski,todd 77.39 7/23/14 Occupancy Tax 3.87 7/23/14 State Tax •.-5-4'£ 7/24/14 State Tax Tax Exemption Refund (16.26) 7/24/14 int tax exempt refund 16.26 XXXXXXXXXXX Folio Summary 7/21/14-7/24114 s Room Charge 232.17 State Tax 0.00 Occupancy Tax 11,61 Visa Payment (2 3.78) Balance Due: 0.00 This rate is eligible for partner rewards. If this rate is changed,you may no longer be entitled to partner rewards. x CHOICEprivileges- You could be earning free nights and other great rewards. Join Choice Privileges today,at www.choiceprivileges.com. Thank you for your stay.Visit ChoiceHotels.comNerified Reviews to post your comments about your recent experience(Click the'Write a Review'button) �-1�3 . 3� S46rd,0677e, �70. �� brAW c)wr9ed VOUCHER NO. WARRANT NO. ALLOWED 20 Todd Luckoski IN SUM OF $ 210 Concord Lane N. Carmel, IN 46032 $443.78 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1115 43-430.02 $443.78 I hereby certify that the attached invoice(s), or I I I 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 Monday, July 28, 2014 i Director 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)) 07/28/14 $443.78 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