250840 10/21/15 4�(CAH f
CITY OF CARMEL, INDIANA VENDOR: 369823
ONE CIVIC SQUARE CATHERINE SCHOENHERR CHECK AMOUNT: $*******268.64*
CARMEL, INDIANA 46032 552 ABACCUS LN CHECK NUMBER: 250840
WESTFIELD IN 46074 CHECK DATE: 10/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343004 268.64 TRAVEL PER DIEMS
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CITY OF CARMEL Expense Report(required for all travel expenses)
NDIPNP
DEPARTURE DATE: 10/7/2015 TIME: 15:00
RETURN DATE: 10/9/2015 TIME: 17:30
\ DESTINATION CITY: South Bend,Indiana
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
10/7/15 $25.00 $25.00
10/8/15 $50.00 $50.00
10/9/15 $50.00 $50.00
$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
0.00
Total
$0.001 $0.001 $0.00 $0.00 $0.001 $0.001 $0.001 $0.00 $0.00 $125.00 $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:
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: /at
City of Carmel Form#ER06 Revision Date 10/14/2015 Page 1
DOUBLETREE BY HILTON SOUTH BEND
49 123 N ST.JOSEPH ST.
SOUTH BEND,IN 46601
DOUBLETREE United States of America
BY N®6Taar- TELEPHONE 574-234-2000 •FAX 574-234-2252
Reservations
www.hilton.com or 1 800 HILTONS
Schoenherr,Catherine Room No: 731/NK1
Arrival Date: 10/7/2015 5:38:00 PM
552 ABACCUS LN Departure Date: 10/9/2015
Adult/Child: 1/0
WESTFIELD IN 46074 Cashier ID: SCOOKS71/STEVE
UNITED STATES OF AMERICA Room Rate: 119.00
AL:
HH#
VAT#
Folio No/Che 224547 B
Confirmation Number:84395924
DOUBLETREE BY HILTON SOUTH BEND 10/8/2015 1:50:00 AM
DATE IDESCRIPTION ID I REF NO CHARGES CREDIT BALANCE
10/712015 GUEST ROOM CWISE5 776363 $119.00
10/7/2015 RM-STATE TAX CWISE5 776363 $8.33
10/7/2015 RM-CITY TAX CWISE5 776363 $7.14
10/8/2015 GUEST ROOM SCOOKS7 777015 $119.00
1
10/8/2015 RM-STATE TAX SCOOKS7 777015 $8.33
1
10/8/2015 RM-CITY TAX SCOOKS7 777015 $7.14 -
1
WILL BE SETTLED TO $268.94
EFFECTIVE BALANCE OF $0.00
Page:1
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Catherine Schoenherr
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IN SUM OF$
C/O One Civic Square
Carmel, IN 46032
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$125.00 j
ON ACCOUNT OF APPROPRIATION FOR j
Carmel DOCS
PO#/Dept. INVOICE NO. ACCT#IrITLE AMOUNT Board Members
1192 43-430.04 $125.00 �
� I hereby certify that the attached invoide(s), or
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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
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Thursday Octo er P,2015
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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))
10/15/15 Cat conference South Bend $125.00
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
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Planning Prosperity
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10/14/2015 1 Civic Square to 123N St Joseph St,South Bend,IN 46601-Google Maps
Google Flaps 1 Civic Square to 123 N St Joseph St, South Drive 126 miles, 2 h 8 min
Bend, IN 46601
1 Civic Square
Carmel,IN 46032
Get on Keystone Pkwy from E Carmel Dr
--- ------ - ------- - ------- -------- - --------- --- - 4 min(1.3 mi)
t - 1. Head east toward Veterans Way
--- --- --- -_ - ---- ---- - ------------ - - --- ------- ---.... ---- - 105 ft
r► 2. Turn right onto Veterans Way
--- --—----- �,_ ---------------- - ------------------ - -- 0.1 mi
r► 3. Turn right onto S Rangeline Rd
---- - --- ---- _--------------- --- — 0.2 mi
4. Turn left onto E Carmel Dr
----------------------- ----- --- ----- ------------_ --- ---- -- - 0:7 mi
5. At the traffic circle,take the 3rd exit onto the Keystone Pkwy ramp to N. Keystone Pkwy.
----------- ------ ----- --------- -- - --- - ------- - --- ----------------- 0.3 mi
Follow US-31 N to S Michigan St in South Bend
--------- _.._ __...--_ --------.__---.___.____---_--_.__-_.__.------__--_- 1 h 57 min(121 mi)
6. Merge onto Keystone Pkwy
— ---------- - ---------- ----- - ------- ---- __.-- - ------------------ 2.6 mi
7. Merge onto US-31 N
------ - ------ ------ - -- �_.. ---- - -.. ------- --- -- -- -------------- - 119 m i
Follow S Michigan St to S St Joseph St in Portage Township
_- -- --- -.____._.._..-----___---------____---- 8 min 3.6 mi
J ---8.—Continue-straight onto S Michigan-St
----- - -- -------- - --- - - - - .. -------- - -- ---- ------------- --------- - - 3.3 mi
t 9. Continue onto S St Joseph St
0 Destination will be on the left
-- --------- -- -------- - - - - - - - ..__.------- ----- - ----- -- - 0.3 mi
123 N St Joseph St
South Bend, IN 46601
These directions are for planning Pur oses only.You may
find that construction
projects,traffic,weather,or other events may cause conditions to differ from the
map results,and you should plan your route accordingly. You must obey all signs or
notices regarding your route.
Ihttps://www.google.conVmaps/dir/1+Civic+Square,+Carmel,+IN+46032,+USA/123+N+St+Joseph+St,+South+Bend,+IN+46601/@40.8167406_87.9819925,8z/... 1/2
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1955)
MILEAGE CLAIM
City of Carmel TO
(GOVERNMENTAL UNIT)
DOCS ON ACCOUNT OF APPROPRIATED NO. FOR
(OFFICE,BOARD,DEPARMTNE OR INSTITUTION)
DATE FROM TO ODOMETER MILEAGE
READING+ NATURE OF BUSINESS AUTO MILES @$57.5
POINT POINT
START FINISH TRAVELED PER MILE
10/7 2015 1 Civic Square 123 N St. Joseph St., 2855 2981 Travel to Indiana APA Conference 126 71.82
South Bend, IN
10/9 2015 123 N St. Joseph St., 1 Civic Square 2981 3107 Travel home from Indiana APA Conference 126 71.82
South Bend, IN
AUTO.LICENSE NO. 424HY TOTALS 143.64
+ODOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953;I hereby certify that the foregoing account is just and correct;that the amount claimed is legally due,after allowing all
Just credits,and that no part of the same has been paid.
Date ��� 6I ,20-
Claim No. Warrant No.
I have examined the within claim and
IN FAVOR OF hereby certify as follows:
That it is in proper form.
_A6 That it is duly authenticated as required by law.
That it is based upon statutory authority.
That it is apparently{correct} {incorrect}
On Account of Appropriation No. Disbursing Officer
For
I CERTIFY that the within bill is true and correct;
that the mileage therein itemized and for which
charge is made was ordered by me and was
Allowed 120 necessary to the public business;and that the rate
per mile is in accordance with statutes or governing
In fire sum of$ ordinances,except
(Board or Commission)
FILED AV
Signatur
1
Date 0
(Official Title)
i
BOYCE FORMS—SYSTEMS 1-800-382-8702 01136
1