HomeMy WebLinkAbout239310 11/19/14 �/ F CITY OF CARMEL, INDIANA VENDOR: 356653
k ONE CIVIC SQUARE ALEXIA LOPEZ CHECK AMOUNT: $********45.00*
49, ,=Q CARMEL, INDIANA 46032 230 W 49TH ST CHECK NUMBER: 239310
y«oN,�o, INDIANAPOLIS IN 46208 CHECK DATE: 11/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343001 45.00 TRAVEL FEES & EXPENSE
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CITY OF CARMEL Expense Report (required for all travel expenses)
?&D1ANP.
EMPLOYEE NAME:Alexia Donahue Wold DEPARTURE DATE: 10/21/2014 TIME: 1:22 PM
DEPARTMENT: DOCS RETURN DATE: 10/25/2014 TIME: 10:12 PM
REASON FOR TRAVEL: USGBC Greenbuild Conference DESTINATION CITY: New Orleans, LA
EXPENSES ARE FOR(check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total
Parkin
Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
10/21/14 $9.00 $9.00
10/22/14 $9.00 $9.00
10/23/14 $9.00 $9.00
10/24/14 $9.00 $9.00
10/25/14 $9.00 $9.00
$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
ma
0.00
0.00
Total $0.00 $0.00 $0.00 .$45.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 � i
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.
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Director Signature: Date:
City of Carmel Form#ER06 Revision Date 11/17/2014 Page 1
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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 registratioin 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)
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Prorated meal allowance:
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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 $30 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 $30 for out-of-state travel
For travel that ends after 1:00 p.m. (flight arlival time, if traveling by air), $50 for in-state travel and $65 for out-of-state travel
EMPLOYEE ACKNOWLEDGEMENT OF MEAL ADVANCE AND OBLIGATION TO DOCUMENT EXPENDITURES:
I hereby acknowledge receipt of$ I , 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 deducted from the first paycheck issued more than 30 days after the date of my return.
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Employee Signature: Date:
City of Carmel Form#ER06 Revision Date 11/17/2014 Page 2
11/17/2014 Gmail-eTicket Itinerary and Receiptfor Confirmation LLXCQ5
COCT d. 1.29s EMAIL R11HtPi1P�P6fECdfNTEtReCTNE.�M
I Alexia Lopez <adonahuewold@gmail.com>
txr 4 00,1 11
eTicket Itinerary and Receipt for Confirmation LLXCQ5
United Airlines, Inc. <unitedairlines @united.com> Thu, Sep 11, 2014 at 12:28 PM
To: ADONAHUEWOLD@gmail.com
Confirmation:
.1 T..E..D. A STAR ALLIANCE MEMBER V�
LLXCQ5-
Check-In
Issue Date: September 11, 2014
_Traveler-- _ _ =eTicket^Number ,._Frequent_Flyer_ ____Seats_
LOPEZ/ALEXIAKMRS 0162421715066 8A/32F/30A/18A
FLIGHT INFORMATION
Day, Date Flight Class Departure City and Time Arrival City and Time Aircraft Meal
Tue, 21OCT14 UA6125 W INDIANAPOLIS, IN CHICAGO, IL ERJ-145
(IND) 1:22 PM (ORD-O HARE) 1:25 PM
Flight operated by EXPRESSJET AIRLINES INC.doing business as UNITED EXPRESS.
Tue., 21 OCT14 UA608 W a-_CHICAGO, IL - NEW ORLEANS, LA A-319 - Purchase 1
L_-_______Tw__---__ __(ORD-O'HARE)2ti55 PM -(MSY)_5_12 PM
Sat, 25OCT14 UA1156 Q NEW ORLEANS, LA HOUSTON, TX 737-900
(MSY)4:55 PM (IAH -BUSH INTL) 6:09 PM
Sat, 25OCT14�UA3449 Q� HOUSTON,TX-- -�� INDIANAPOLIS, .IN — ^ ERJ,170 Purchase
j (IAH -BUSH INTL)6:55,PM (IND) 10:12 PM
Flight pperated by SHUTTLE AMERICA AIRLINES doing business as UNITED EXPRESS._
FARE INFORMATION
Fare Breakdown Form of Payment:
Airfare: 383.54USD
U.S. Federal Transportation Tax: 28.77 Last Four Digit:
U.S. Flight Segment Tax: 16.00
September 11th Security Fee: 11.20
U.S. Passenger Facility Charge: -16.50
Per Person Total: 456.01 USD
eTicket Total: 456.01 USD
The airfare you paid on this itinerary totals: 383.54 USD
The taxes, fees, and surcharges paid total: 72.47 USD
Fare Rules: Additional charges may apply for changes in addition to any fare rules listed.
NONREF/OVALUAFTDPT/CHGFEE
Cancel reservations before the scheduled departure time or TICKET HAS NO VALUE.
Baggage allowance and charges for this itinerary.
Baggage fees are per traveler
httpsJ/mai l.google.com/mai I/u/0/?ui=2&i k=75ccd728b4&view=pt&q=flight&qs=true&search=query&msg=148658bl e2d54046&siml=148658ble2d54046 1/4
VOUCHER NO. WARRANT NO.
'
Alexia Lopez ALLOWED 20
IN SUM OF $
One Civic Square
Carmel, IN 46032
$45.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
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I hereby certify that the attached invoice(s), or
1192 I I 43-430.01 I $45.00
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
1
i� which charge is made were ordered and
'1 received except
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1!
Monday, November 17, 2014
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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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))
10/21/14 Parking Indianapolis Airport $45.00
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
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Clerk-Treasurer