249116 09/02/15 CITY OF CARMEL, INDIANA VENDOR: 027850
V
j 3 ONE CIVIC SQUARE JAMES BRAINARD CHECK AMOUNT: $"""1,089.46'
CARMEL, INDIANA 46032 CHECK NUMBER: 249116
CHECK DATE: 09/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343001 755.42 TRAVEL FEES & EXPENSE
1160 4343003 204.04 TRAVEL & LODGING
1160 4343004 130.00 TRAVEL PER DIEMS
of C4%
CITY OF CARMEL Expense Report (required for all travel expenses)
ND1016 EXHIBIT A
EMPLOYEE NAME: James Brainard DEPARTURE DATE: 8/25/2015 TIME: 10 : 15 AM PM
DEPARTMENT: Mayor RETURN DATE: 8/26/2015 TIME: 3 : 41 AM PM
REASON FOR TRAVEL: Federal funding for city DESTINATION CITY: Washington, D.C.
project and city promotional
EXPENSES ARE FOR(check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM X
Transportation Gas/Tolls/ Meals
Date Air-fare Car Rental Other Parking Lodging Breakfast Lunch Dinner Snacks Per Diem Misc. Total
8/25/15 $682.20 $17.22 $65.00 $764.42
8/26/15 $20.00 $36.00 $204.04 $65.00 $325.04
$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
$0.00
$0.00
$0.00
$0.00
Total $682.201 $0.001 $37.22 $36.00 $204.041 $0.001 $0.00 $0.00 $0.00 $130.00 $0.00
DIRECTOR'S STATEMENT: hereb affirm that 11 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 8/27/2015 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 $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 deducted from the first paycheck issued more than 30 days after the date of my return.
Employee Signature: Date:
City of Carmel Form#ER06 Revision Date 8/27/2015 Page 2
Page 1 of 1
Transaction DetailsPrepared for
,irewow James C Brainard
. awarss .Account Numb-r
ATE DESCRIPTION CARD MEMBER AMOUNT
IAUG242015 US AIRWAYS 800.428-4322 AZ JAMES C BRAINARD $682.20
-- -- T
Doing business as:
Flight Details
US AIRWAYS WEB SALES `
ATTN RWESTX INDIANAPOLIS,IND. ►� WASHINGTON NATIONA
4000 E SKY HARBOR BLVD
PHOENIX
WASHINGTON NATIONA INDIANAPOLIS,INAZ
DI
85034
UNITED STATES
Additional Information:03724146238 800428-4322 Passenger Name:BRAINARD/MARTHAELLEN
US AIRWAYS Date of Departure:08/25
Reference:320152370160815082 Ticket Number.0372414623881
Category:Travel-Airline
Document Type:PASSENGER TICKET
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Passenger summary
Passenger name Frequent flyer#(Airline) Ticket number Special needs
James C Brainard OW9HW94(American Airlines) 03724145323360
Day of departure phone: (317)431-7477 Email for receipt: brainardic(o)aol.com
Trip details i Download to Outlook
IND DCA Indianapolis, IN to Washington, DC (Reagan National)
Tuesday,August 25,2015
FLIGHT#4531 ='x Operated by Republic Airlines dba US Airways Express
DEPART 10:15 AM IND AIRCRAFT E170 2WF;
ARRIVE 11:54 AM DCA CABIN Coach
TRAVEL TIME 1h 39m MEAL --
SEATS 15F
DCA �Y., IND Washington, DC (Reagan National) to Indianapolis, IN
Wednesday,August 26,2015
FLIGHT#4509 =yx Operated by Republic Airlines dba US Airways Express
DEPART 01:55 PM DCA AIRCRAFT E170 W,F;
ARRIVE 03:41 PM IND CABIN Coach
TRAVEL TIME 1h 46m MEAL --
SEATS 16C
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:ASH RECEIP''
VIER:
#:
08/25/;-'
13:06-13:
8/25/;-
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Gate:_
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Origin of trip:
pestination: /
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Page 1 of 1
Transaction DetailsPrepared for
.:en wu James C Brainard
owacss Account Number
XXXX-xxxxxx-
DATE DESCRIPTION CARD MEMBER AMOUNT
AUG252015 THE CAPITAL HILTON JAMES C BRAINARD $279.04
Doing business as:
Sometimes businesses like hotels and gas stations place a temporary charge on your
THE CAPITAL HILTON Card,so please check the charge amount after the transaction posts.
1001 16TH STREET NW
WASHINGTON
DC
20036
UNITED STATES
I
Category:Travel-Lodging
https://online.americanexpress.com/myca/shared/summary/estatement/print_doc20l 5-R3.h... 8/26/2015
CAPITAL HILTON
1001 16th Street I Washington,DC 20036
Capital Hilton T: 202 393 1000 I F: 202 639 5784
W:capital.hilton.com
NAME AND ADDRESS:
Brainard James Room: 583/Q1 D
Arrival Date: 8/25/2015 5:56:00 PM
12662 ROYCE COURT Departure Date: 8/26/2015
CARMEL IN 46033 Adult/Child: 1/0
UNITED STATES OF AMERICA Room Rate: 178.20
Rate Plan: PGGV10
HH# 928398206 SILVER
AL:
Car:
Confirmation Number:3198857732
8/25/2015
DATE DESCRIPTION ID REF.NO CHARGES CREDITS BALANCE U
n.
HILTON
8/25/2015 GUEST ROOM KRYAN1 7086503 $178.20 HHONORS
8/25/2015 ROOM TAX KRYAN1 7086503 $25.84
WILL BE SETTLED $204.04
TO — %
EFFECTIVE BALANCE $0.00 WALDORF
A40RIA'
OF "�
Hilton HHonors(R)stays are posted within 72 hours of checkout.To check your earnings or book your next stay at more than 3,900
CONRAD
hotels and resorts in 91 countries, please visit HHonors.com.
Thank you for choosing Hilton.You'll get more when you book directly with us-more destinations, more points,and more value.Bookyour next stay at hilton.com.
Hilton
DOUeLETAEE
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Capital Hilton GardDntnn
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ACCOUNT NO. I FOLIO NO./CHECK NO.
old foffow eje Pyl7e ts. 1281912 A
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CARD MEMBER NAME INITIAL 5
ESTABLISHMENT NO.&LOCATION ESTABLISHMENT AGREES TOTMNSMIT TO CARD HOLDER FOR PAYMENT PURCHASES&SERVICES
I
HOME
TAXES ........•,...
TIPS&MISC.
Hilton
CARD MEMBER'S SIGNATURE TOTAL AMOUNT Grand Vacations
MERCHANDISE AN D/OR SERVICES PURCHASED ON THIS CARD SHALL NOT BE RESOLD OR RETURNED FOR A CASH REFUND. PAYMENT DUE UPON RECEIPT
Capital Hilton
The entire.Capital Hilton team would like to thank you for staying with us. We trust you
Will have an enjoyable stay and hope that you will come visit us again in the near firiure.
The hotel's Check Out time is 11:00 A.M. Should you need assistance with your
luggage please dial Ext: 77 and we will be delighted to assist you.
In an effort to expedite your check-out we offer you the following options to best
facilitate'your departure:
e If everything is correct with this receipt then it is not necessary to stop by the
front desk to check out. If the applied charges are correct,you may call our.Zip-
Out Check-Oat Line by simply use the Zip Check Out button on your guest
room phone and follow the prompts to check-out. Please keep the attached
receipt and Leave the room keys in your room. Your charges will be applied to the
credit card on file.
e You may also choose to cheek-out via the Television. Choose "check-out"from
the Guest Service Menu options. Please keep the attached receipt and leave the
room keys in your room. Your charges will be applied to the credit card on file.
Should you have any questions or concerns,please do not hesitate to contact the Guest
Service Hotline at Extension 22 or stop by the Front Desk for assistance.
Again,thank you for staying with us and on behalf of the entire Capital Hilton we hope to
see you soon!
incent Howard
Director of Front Office Operations
Capital Hilton
CAPITAL HILTON
100116th Street NW I Washlnston,DC 20036
Page 1 of 1
Transaction DetailsPreparedfor
ni:ewuw James C Brainard
owucss Account Numb(
xxxx-xxxxxx
DATE DESCRIPTION CARD MEMBER AMOUNT
AUG262015 INDIANAPOLIS INTERNATIONAL AIRPORT JAMES C BRAINARD $36.00 1
Doing business as:
INDIANAPOLIS INTERNATIONAL AIRPORT
7800 COL H WEIR COOK MEM
STE 38
INDIANAPOLIS
IN
46241-8004
UNITED STATES
Category:Other-Government Services
i
,.�' a "a
Indianapolis International Airport
indianapolisairport.com
RECEIPT
TRAN IN TIME OUT TIME FEE CC#
I'i
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VOUCHER NO. WARRANT NO.
-
Mayor Jim Brainard ALLOWED 20
IN SUM OF$
One Civic Square
Carmel, IN 46032
$1,089.46
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1160 Expense Report 43-430.04 $130.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1160 Expense Report 43-430.03 $204.04 �
materials or services itemized thereon for
1160 Expense Report 43-430.01 $36.00 which charge is made were ordered and
1160 Expense Report 43-430.01 $37.22 received except
1160 Expense Report 43-430.01 $682.20
Thursday,August 27, 2015
Mayor
i
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))
08/27/15 Expense Report $130.00
08/27/15 Expense Report $204.04
08/27/15 Expense Report $36.00
08/27/15 Expense Report $37.22
08/27/15 Expense Report $682.20
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