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245189 5 /13/2015 �v!.Spey �/ CITY OF CARMEL, INDIANA VENDOR: 356653 ® ONE CIVIC SQUARE ALEXIA LOPEZ CHECK AMOUNT: $""""1,758.20` f9 tea; CARMEL, INDIANA 46032 230 W 49TH ST CHECK NUMBER: 245189 ,� co INDIANAPOLIS IN 46208 CHECK DATE: 05/13/15 t�rON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 4343001 1,403.20 TRAVEL FEES & EXPENSE 1192 4343004 355.00 TRAVEL PER DIEMS GeQ,,gigEq,S,G! � CITY OF CARMEL Expense Report (required for all travel expenses) y f' EMPLOYEE NAME:Alexia Lopez DEPARTURE DATE: 4/16/2015 TIME: 7:20 PM DEPARTMENT: DOCS--P&Z RETURN DATE: 4/22/2015 TIME: 6:44 PM REASON FOR TRAVEL:APA Conference DESTINATION CITY: Seattle, WA EXPENSES ARE FOR(check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT_X_ TRAVEL PER DIEM_x_ Date Transportation Gas/Tolls/ Lodging Meals Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem $0.00 4/16/15 $9.00 $30.00 $39.00 4/17/15 $3.00 $9.00 $269.04 $281.04 4/18/15 $9.00 $269.04 $65.00 $343.04 4/19/15 $269.04 $65.00 $334.04 4/20/15 $269.04 $65.00 $334.04 4/21/15 $269.04 $65.00 $334.04 4/22/15 $25.00 $3.00 $65.00 $93.00 $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 $25.00 $0.00 $6.00 $27.00 $1,345.20 $0.00 $0.00 $0.00 $0.00 $355.00 $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 5/6/2015 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 $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 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 deducted from the first paycheck issued more than 30 days after the date of my return. Employee Signature: Date: I City of Carmel Form#ER06 Revision Date 5/6/2015 Page 2 F f �+>s.n- �yi `.°► '�1�-y,��'"y sr • t��,t1M � '-gig v��$ ��-s�� .-a W4, Rte. t�` .�, 7A'• � '�.Y�J �,�,,.� _' _,.3��.r ;_.,✓�`_« r'.e• sus a Ana e .N 1 CONFERENCE Vim ,�"'•"�-,��q�� „�'�r�... a � �� - ' -Aft - -°�- 4 f 516/2015 Gmail-E-Ticket Confirm ation-QTUHSL 16APR Record11 Locator QTUHSLjjj&K'j�.N'1;jjjjj Itinerary Carrier Flight # Departing Arriving Fare Code INDIANAPOLIS DALLAS FT WORTH Vs 1382 THU 16APR O American 7:20 PM 8:43 PM Alexia Lopez Economy Food For Purchase DALLAS FT WORTH SEATTLE TACOMA 2254 THU 16APR O American 9:46 PM 12:05 AM Alexia Lopez Seat 29A Economy Food For Purchase AwwkSEATTLE TACOMA DETROIT METRO 953 WED 22APR U Delta Air Lines 9:46 AM 5:00 PM Alexia Lopez Economy DETROIT METRO INDIANAPOLIS '&,— 2633 WED 22APR U Delta Air Lines 5:40 PM 6:44 PM Alexia Lopez Economy eceipt Passenger Ticket # Fare-USD Taxes and Carrier- Ticket Total Imposed Fees r l Alexia Lopez 0012399474184 335.82 70.38 406.20 -$406 r Baggage Information Baggage charges for your itinerary will be governed by American Airlines BAG ALLOWANCE-INDSEA-No free checked bags/American Airlines BAG ALLOWANCE-SEAIND-No free checked bags/American Airlines 1 STCHECKED BAG FEE-INDSEA-USD25.00/American Airlines/UP TO 50 LB/23 KG AND UP TO 62 LINEAR IN/158 LINEAR CM 1 STCHECKED BAG FEE-SEAIND-USD25.00/American Airlines /UP TO 50 LB/23 KG AND UP TO 62 LINEAR IN/158 LINEAR CM 2NDCHECKED BAG FEE-INDSEA-USD35.00/American Airlines/UP TO 50 LB/23 KG AND UP TO 62 LINEAR IN/158 LINEAR CM 2NDCHECKED BAG FEE-SEAIND-USD35.00/American Airlines/UP TO 50 LB/23 KG AND UP TO 62 LINEAR IN/158 LINEAR CM ADDITIONAL ALLOWANCES AND/OR DISCOUNTS MAY APPLY hUps://mail.google.com/mail/ul0/?ui=28ik=ebbaO994O3&view=pt&q=flight&qs=true&search=query&th=14c2ef3da2464ee6&siml=14c2ef3da2464ee6 2/3 The Westin Seattle 1900 Fifth Avenue ESTIN Seattle,WA 98101 THE SEATTLE United States Tel:206-728-1000 Fax:206-728-2259 Alexia Lopez Page Number 1 230 W 49TH ST Guest Number 1817136 INDIANAPOLIS,IN 46208-3412 Folio ID A Arrive Date 17-APR-15 10:58 Depart Date 22-APR-15 07:46 No.Of Guest 1 Room Number 2761 Club Account SPG-Axxxxxxx6920 Tax Invoice The Westin Seattle 22-APR-15 07:46 KYLEARN •ae 17-APR-15 02:47 RT2761 Room Charge 231.00 17-APR-15 02:47 RT2761 State Tax 19.87 17-APR-15 02:47 RT2761 Seattle Tourism Assessment 2.00 17-APR-15 02:47 RT2761 - Occupancy Tax 16.17 18-APR-15 03:02 RT2761 Room Charge 231.00 18-APR-15 03:02 RT2761 State Tax 19.87 18-APR-15 03:02 RT2761 Seattle Tourism Assessment 2.00 18-APR-15 03:02 RT2761 Occupancy Tax 16.17 19-APR-15 02:00 RT2761 Room Charge 231.00 19-APR-15 02:00 RT2761 State Tax 19.87 19-APR-15 02:00 RT2761 Seattle Tourism Assessment 2.00 19-APR-15 02:00 RT2761 Occupancy Tax 16.17 20-APR-15 02:38 RT2761 Room Charge 231.00 20-APR-15 02:38 RT2761 State Tax 19.87 20-APR-15 02:38 RT2761 Seattle Tourism Assessment 2.00 20-APR-15 02:38 RT2761 Occupancy Tax 16.17 21 lkPR 15 na 2d 33c X59Refi �-FFtaT 21-APR-15 02:14 RT2761 Room Charge 231.00 Continued on the next page The Westin Seattle 1900 Fifth Avenue WESTIN Seattle,WA 98101 THE SEATTLE United States Tel:206-728-1000 Fax:206-728-2259 Alexia Lopez Page Number 2 230 W 49TH ST Guest Number 1817136 INDIANAPOLIS,IN 46208-3412 Folio ID A Arrive Date 17-APR-15 10:58 Depart Date 22-APR-15 07:46 No.Of Guest 1 Room Number 2761 Club Account SPG-Axxxxxxx6920 to e 21-APR-15 02:14 RT2761 State Tax 19.87 21-APR-15 02:14 RT2761 Seattle Tourism Assessment 2.00 21-APR-15 02:14 RT2761 Occupancy Tax 16.17 22-APR-15 07;46 VI -1354.52 •"Total 1354.52 -1354.52 NAL " Balance -0.00 `/�1345.ao BETTER BALANCE-The soothing scent of White Tea revitalizes and uplifts from the moment you step through our doors. environment by taking our signature scent home with you.Learn more at westin.com/store As a Starwood Preferred Guest you have earned at least 2327 Starpoints for this visit f Tell us about your stay.www.westin.com/reviews Signature VOUCHER NO. WARRANT NO. ALLOWED 20 Alexia Lopez IN SUM OF $ One Civic Square Carmel, IN 46032 $1,758.20 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1192 43-430.01 $1,403.20 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1192 43-430.04 $355.00 materials or services itemized thereon for which charge is made were ordered and received except Monday, May 11, 2015 Direct 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)) 05/05/15 APA Seattle $1,403.20 05/05/15 APA Seattle $355.00 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