246397 06/17/15 `� 4'''� CITY OF CARMEL, INDIANA VENDOR: 355319
`� CHECK AMOUNT: $*******100.00*
. ® �,• ONE CIVIC SQUARE MICHAEL KLITZING
�?a; CARMEL, INDIANA 46032 1550 REOSUNSET
IN DRIVE CHECK NUMBER: 246397
''�ioN�° CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4344100 100.00 CELLULAR PHONE FEES
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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
Use of personal phone for
4/12/2015 Verizon Wireless 101 1125-1-00-4344100 Cellular Phone Fees $50.00 Department business
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $50.00
Employee Name(print) Michael Klitzing
Address 1550 Redsunset Dr.
Check
payable to: City, St, Zip Brownsburg, IN 46112
Signature: Approved by:
Date: rT,�1�6/1120115 Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request
Manage Your Account Account Number Date Due
P.O.BOX 4002 480,873963-000011
ACWORTH,GA 30101
Change your address at Invoice Number 3231533595
vzw.com/changeaddress
0 105806 01 AV 0.378 "AUTO T62401246112.773450 -C07-PO5921-1 Quick Bill Summary Mar 13—Apr 12
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MICHAEL W KLITZING Previous Balance(see back for details) $118.74
1550 REDSUNSET DR Payment—Thank You —$118.74
BROWNSBURG,IN 46112-7734
Balance Forward - $.00
Monthly Charges $83.99
Usage and Purchase Charges
Voice $.00
Messaging $.00
Data $.00
Equipment Charges $27.08
Verizon Wireless'Surcharges
Verizon Wireless News,"
and Other Charges&Credits $3.54
Get Rewarded ForGoingTaxes,Governmental Surcharges&Fees $4.20
Paperless Total Current Charges $118.81
Did you know you can receive 2,500
Smart Rewards points when you sign up
for paperless billing?Plus,earn points Total Charges Due by May 07, 2015 $118.81
each month as long as you remain
paperless.Learn more at
go.vzw.com/gogreen.
Get the latest deals on
THE LATEST ACCESSORIES.
Visit go.vzw.com/deals
Pay from Wireless Pay on the web Questions:
.: 1.800.922.020.4
or*611 from your wireless
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Bill Date Aril 12 2015 -�
Ver1�wireless p � 1�+-
Account Number 480873963-00001
Invoice Number 3231533595 Please Recycle
MICHAEL W KLITZING
1550 REDSUNSET DR Total Amount Due by May 07, 2015
BROWNSBURG,IN 46112-7734
Make check payable to Verizon Wireless. 8.8�
Please return this remit slip with payment. $11v v
$ E
Scan To Pay.Or Go Paperless
Pay your bill online,or enroll in Paperless Billing P.O.BOX 25505
or Auto Pay.Simply scan the QR code with your a- LEHIGH VALLEY, PA 18002-5505
mobile device or visit vzw.com/myverizon.
❑ Check here and fill out the back of this slip if your billing address II"'Jill'll11111111'1III1 11IIJ111IIII l�lll�ll�l'I'll�lll��'�l"I
has changed or you are adding or changing your email address.
32315335950104808739630000100000011881000000118818
NOTICE:Bank account and routing numbers will be retained to enable future payments by phone or online.To opt out,call 1-866-544-0401.
verlLnwireless Invoice Number Account Number Date Due Page
3231533595 480873963 00001 05/07/15 2 of 5
Get Minutes Used Get Data Used Get Balance
1 #DATA+SEND :A1
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $118.74
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges we pay including Payment—Thank You
government number administration and license fees); (ii) a Payment Received 04/07/15 —118.74
Federal Universal Service Charge (and, if applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments —$118.74
the government to support universal service; and (iii) an Balance Forward $.��
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers;fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations. Please note that these are Verizon
Wireless charges,not taxes.These charges,and what's included,
are subject to change from time to time.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers. These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Correspondence Address:Verizon Wireless Attn:Correspondence Team PO:Box 5029 Wallingford;CT 06492
Automatic Payment Enrollment for Account:480873963-00001 MICHAEL W KLITZING.
By signing below,you authOTize Verizon Wireless to electronically debit yourbank account each month for the total balance due on your account.The check you send will be used to
setup Automatic Payment.You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms. This
agreement does not alter the terms of your existing Customer Agreement.I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account.To
withdraw your authorization you must call Verizon Wireless.Check with your bank for any charges.
1.Check this box. 2.Sign name in box below,as shown on the bill and date. 3.Return this slip with your payment.Do not send a voided check.
■ ❑ ■
Changing your billing address for Account:480873963-00001 MICHAEL W KLITZING
Use this space or sign in to My Verizon at vzw.com/changeaddress to change the mailing address where we send your bill.If we do not have your most recent email address,provide it
below and we'll use it to tell you important information about your Verizon Wireless service.Allow 2 billing cycles for the address change to take effect.
New Address Confirming or changing your service address
For each of your mobile numbers,in order to bill taxes and
City surcharges correctly we need a service address-which is a.
street address(not a PO Box)that is the home or primary
State/Zip business address of the person who uses that number.To
Work Phone Home Phone confirm or change the service address for any of your mobile
numbers,sign in to My Verizon at vzw.com/serviceaddress.
Email
0105806-0399545-0000002 of 0000006-C07-LT4012-05921
verrZ nwireiess Invoice Number Account Number Date Due Page
3231533595 ` 480873963 40001 65/07/15 3 iA 5
Summary for Michael Klitzing: 317-450-1250
Your Plan Monthly Charges
Nationwide Talk 450 04/13—05/12 39.99
Nationwide Talk 450 15%Access Discount 04/13—05/12 —6.00
$39.99 monthly charge Verizon Max 6GB 04/13—05/12 30.00
450 monthly allowance minutes 500 MSG Allowance+UNL IN MSG 04/13—05/12 10.00
$.45 per minute after allowance Total Mobile Protection Asurion 04/13—05/12 10.00
Verizon Max 6GB $83.99
$30.00 monthly charge Equipment Charges
6 monthly gigabyte allowance
$10.00 per GB after allowance Verizon Edge Agreement 1200510859—Device Installment 16 of 24 27.08
Verizon Edge Paid 406.27
Unlimited Night&Weekend Mins Verizon Edge Past Due .00
Verizon Edge Balance(after this month's current installment) 216.64
Beginning on 07/07/10: $27.08
15%Access Discount
Usage and Purchase Charges
M2M National Unlimited
Unlimited monthly Mobile to Mobile Voice Allowance Used Billable Cost
Calling Plan minutes 450 248 -- --
UNL Night&Weekend Min Promotional minutes 44 -- --
Unlimited monthly OFFPEAK Mobile to Mobile minutes unlimited 668 -- --
Night/Weekend minutes unlimited 36 -- --
500 MSG Allowance+UNL IN MSG Total Voice $.00
$10.00 monthly charge
Unlimited monthly M2M Text Messaging
Unlimited monthly M2M PIX&Video Unlimited M2M Text messages unlimited 23 -- --
500 monthly message allowance UNL M2M Picture&Video messages unlimited 18 -- --
$.10 per message after allowance Text,Picture&Video messages 500 14 -- --
Total Messaging $.00
Have more questions about your charges? Data
Get details for usage charges at Unbilled Usage from-Previous Months
www.vzw.com,Sign into My Verizon to (Data usage is applied against any remaining allowance for the month in which the usage occurred),
View Online Bill and click on Calls, Gigabyte Usage gigabytes .001 -- --
Messages&Data. Current Data Usage
Gigabyte Usage gigabytes 6.000 .708 -- --
it
Total Data $.00
Total Usage and Purchase Charges $.00
s
Q
Verizon Wireless'Surcharges
Fed Universal Service Charge 1.50
0 Regulatory Charge .18
Administrative Charge .95
0
IN Utility Receipts Surcharge .63
0
IN Telecom Relay Surcharge .03
0
IN Universal Service Fee .21
IN State PUC Fee .04
0
C
$3.54
v✓er�Onwireless Invoice Number Account Number Date Due Page
3231533595 480873963-00001`„05/07/15 4 of'5
Monthly Charges, continued
Taxes,Governmental Surcharges and Fees
IN State 911 Fee .90
IN State Sales Tax—Telec 3.26
IN State Sales Tax .04
$4.20
Total Current Charges for 317-450-1250 $118.81
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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
- / June reimbursement for use of
5/12/2015 Verizon Wireless 101 1125-1-00-4344100 Cellular Phone Fees $50.00 V personal phone for Department
business
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $50.00
Employee Name(print) Michael Klitzing JUS
i -4 2015
Address 1550 Redsunset Dr.
Checker
payable to: City, St, Zip Brownsburg, IN 46112,
Signature: Approved by:
Date: 6/4/2015 Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request
V
Manage Your Account Account Number Date Due
P.O.BOX 4002 ,m 48G873963-0000;1 0.
ACWORTH,GA 30101
Change your address at Invoice Number 3245227669
vzw.com/changeaddress
0106546 01 AV 0.378 "AUTO T7 2411246112-773450 -C07-PO6662-1 Quick Bill Summary Apr 13—May 12
III'IIIIIII IIIII I'III�III�I�IIIIIII II"II III'l 11 l�l'�I�III 1'11111
MICHAEL W KLITZING Previous Balance(see back for details) $118.81
1550 REDSUNSET DR Payment—Thank You —$118.81
BROWNSBURG,IN 46112-7734
Balance Forward $.00
-Monthly Charges $83.99
Usage and Purchase Charges
Voice $.00
Messaging $.00
Data $.00
Equipment Charges $27.08
Verizon Wireless'Surcharges
.Verizon Wit'eless News _ and Other Charges&Credits $3.54
�A New Look For My Verizon_ Taxes,Governmental Surcharges&Fees $4.20
We've redesigned the My Verizon Home Total Current Charges $118.81
page so managing your account is
easier.With a new look and simpler
navigation,it's easy to stay up-to-date
matTotal Char es Due b June 07, 2015 $118.81
on your usage,billing and whattmatter
s 9 . y
most to you.Visit vzw.com/myverizon.
Get the latest deals on
r THE LATEST ACCESSORIES.
Visit goxzw.com/deals
Pay from wireless Pay on the Web Questions:
.:) My Verizon at www.vzw.com800,922.02G4 or*611 from your wireless
VN
verlZffnwireless Bill Date May 12,2015 0 -
Account Number 480873963-00001
Invoice Number 3245227669 Please Recycle
MICHAEL W KLITZING
1550 REDSUNSET DR Total Amount Due by June 07, 2015
BROWNSBURG,IN 46112-7734
Make check payable to Verizon Wireless, 18.
Please return this remit slip with payment. $118 v v
0 $ Ell ■ ❑❑
Scan To Pay Or Go Paperless
Pay your bill online,or enroll in Paperless Billing P.O.BOX 25505
orAuto Pay.Simply scan the QR code with.your :. Y LEHIGH VALLEY, PA 18002-5505
mobile device or visit vzw.com/myverizon. o
F] Check here and fill out the back of this slip if your billing address I��IIIIIIIII'111111'IIIIIIII"ll"IIIIIIIIIIII'lllll'IIII'll'llll
has changed or you are adding or changing your email address.
32452276690104808739630000100000011881,000000118818
NOTICE Bank account and routing numbers will be retained to enable future payments by phone or online.To opt out,call 1-866-544-0401.
onwireless Invoice Number Account Number Date Due Page
3245227669 48Q873963-00Q01'` 06107175 2 of 5 �_
Get Minutes Used Get Data Used Get Balance
1 #DATA 8END C' 1
Explanation of Charges Payments-
Verizon Wireless'Surcharges Previous Balance $118.81
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges we pay including Payment—Thank You
government number administration and license fees); (ii) a Payment Received 05/08/15 —118.81
Federal Universal Service Charge (and, if applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments —$118.81
the government to support universal service; and (iii) an Balance Forward $.00
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
® customers; fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations. Please note that these are Verizon
Wireless charges,not taxes.These charges,and what's included,
are subject to change from time to time.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Correspontlence Address Venzon Wireless Attn:Gorrespondence Team PO Box 5029 WalUngford, CT 06492
dencess*�.. 'ss. tt ._..w..��. cll �_
Automatic Payment Enrollment for Account:480873963-00001 MICHAEL W KLITZING
By signing below,you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account.The check you send will be used to
setup Automatic Payment.You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms.This
agreement does not alter the terms of your existing Customer Agreement.I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account.To
withdraw your authorization you must call Verizon Wireless.Check with your bank for any charges.
1.Check this box. 2.Sign name in box below,as shown on the bill and date. 3.Return this slip with your payment.Do not send a voided check.
■
Changing your billing address for Account:480873963-00001 MICHAEL W KLITZING
Use this space or sign in to My Verizon at vzw.com/changeaddress to change the mailing address where we send your bill.If we do not have your most recent email address,provide it
below and we'll use it to tell you important information about your Verizon Wireless service.Allow 2 billing cycles for the address change to take effect.
New Address Confirming or changing your service address
For each of your mobile numbers,in order to bill taxes and
City surcharges correctly we need a service address-which is a
street address(not a PO Box)that is the home or primary
StatefZip business address of the person who uses that number.To
Work Phone Home Phone confirm or change the service address for any of your mobile
numbers,sign in to My Verizon at vzw.conVserviceaddress.
Email
0106546-0400901-0000002 of 0000006-C07-LT-4112-06662
ver►Lnwireiess Invoice Number Account Number Date Due Page
Summary for Michael Klitzing: 317-450-1250
Your r Plan Monthly Charges
Nationwide Talk 450 05/13—06/12 39.99
Nationwide Talk 450 15%Access Discount 05/13—06/12 —6.00
$39.99 monthly charge Verizon Max 6GB 05/13—06/12 30.00
450 monthly allowance minutes 500 MSG Allowance+UNL IN MSG 05/13—06/12 10.00
$.45 per minute after allowance Total Mobile Protection—Asurion 05/13—06/12 10.00
Verizon Max 6GB $83.99
$30.00 monthly charge Equipment Charges
month onthly.gigabyte allowance
6 mon per ig after allowance Verizon Edge Agreement 1200510859—Device Installment 17 of 24 27.08
Verizon Edge Paid 433.35
Unlimited Night&Weekend Mins Verizon Edge Past Due .00
Verizon Edge Balance(after this month's current installment) 189.56
Beginning on 07/07/10: $27.08
15%Access Discount
Usage and Purchase Charges
M2M National Unlimited
Unlimited monthly Mobile to Mobile Voice Allowance Used Billable Cost
Calling Plan minutes 450 262 -- --
UNL Night&Weekend Min Promotional minutes 8 --
Unlimited monthly OFFPEAK Mobile to Mobile minutes unlimited 831 -- --
Night/Weekend minutes unlimited 100 -- --
500 MSG Allowance+UNL IN MSG Total Voice $.00
$10.00 monthly charge
Unlimited monthly M2M Text Messaging
Unlimited monthly M2M PIX&Video Unlimited M2M Text messages unlimited 33 -- --
500 monthly message allowance UNL M2M Picture&Video messages unlimited 11 -- --
$.10 per message after allowance Text,Picture&Video messages 500 39 -- --
Total Messaging $.00
Have more questions about your charges? Data
Get details for usage charges at Gigabyte Usage gigabytes 6.000 .488 -- --
www.vzw.com,Sign into My Verizon to Total Data $.00
View Online Bill and click on Calls, Total Usage and Purchase Charges $.00
Messages&Data.
Verizon Wireless'Surcharges
N
Fed Universal Service Charge 1.50
0
Regulatory Charge .18
v Administrative Charge .95
IN Utility Receipts Surcharge .63
IN Telecom Relay Surcharge .03
IN Universal Service Fee .21
0
IN State PUC Fee .04
0
$3.54,
0
0
Taxes,Governmental Surcharges and Fees
IN State 911 Fee .90
IN State Sales Tax—Telec 3.26
0
0
verizonw;reiess Invoice Number Account Number Date Due Page .
3245227669 480873963-00001; 06/07/15 4 of 5x
Monthly Charges, continued
Taxes,Governmental Surcharges and Fees
1N State Sales Tax .04
$4.20
Total Current Charges for 317-450-1250 $118.81.
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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.
355319 Klitzing, Michael Terms
1550 Redsunset Dr Date Due'
Brownsburg, IN 46112
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
4/12/15 Reimb Cell phone May'15 $ 50.00
5/12/15 Reimb Cell phone Jun'15 $ 50.00
Total $ 100.00
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
i
Voucher No. Warrant No.
355319 Klitzing, Michael Allowed 20
1550 Redsunset Dr
Brownsburg, IN 46112
II Sum of$
$ 100.00
I
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 Reimb 4344100 $ 50.00 1 hereby certify that the attached invoice(s), or
1125 Reimb 4344100 $ 50.00 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
i
June 11, 2015
Signature
$ 100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund