Loading...
HomeMy WebLinkAbout251094 11/04/15 m.fin `% ��''f� CITY OF CARMEL, INDIANA VENDOR: 114500 `'` \. CHECK AMOUNT: $'•**'1,721.36' .� ® , ONE CIVIC SQUARE TIMOTHY J. GREEN s ;_� CARMEL, INDIANA 46032 CHECK DATE: 11/04/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 CHICAGO 1,721.36 TRAINING SEMINARS CITY OF CARMEL Expense Report (required for all travel expenses) \[N0111tlp%� EMPLOYEE NAME: Tim Green DEPARTURE DATE: 10/23/2015 TIME: 10:30AM AM/PM DEPARTMENT: Police Department RETURN DATE: 10/27/2015 TIME: 5:30PM AM/PM REASON FOR TRAVEL: IACP Conference DESTINATION CITY: Chicago, IL EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM Transportation Gas/Tolls/ Meals Date Lodging Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 10/23/15 $65.00 $05.00 10/24/15 $65.00 $65.00 10/25/15 $65.00 $65.00 10/26/15 $65.00 $65.00 10/27/15 $144.00 $1,252.36 $65.00 $1,461.36 $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 1 $0.001 $0.001 $0.00 $144.00 $1,252.36 $0.001 $0.001 $0.001 $0.0650t $325.00 $0.00 DIRECTOR'S STATEMENT: I her by 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 10/28/2015 Page 1 ADVANCE REGISTRATION FORM October • . Chicagor I L 1ACAPiN ° -ee - ' ° o - e _ PLEASE COMPLETE THE FOLLOWING QUESTIONS. The information is being requested to enhance your experience at conference and will be used by the IACP and exhibitors to better understand your interests. USE THIS FORM TO SAVE ON REGISTRATON FEES UNTIL SEPTEMBER 9,2015. 1.How many sworn officers in your agency? BEGINNING SEPTEMBER 10,2015 ONLY ONLINE REGISTRATIONS WILL BE ACCEPTED. ❑A. 1-5 m F. 100-249 ❑ B. 6-15 ❑ G.250-499 Discounted Advance Registration Deadline: Must be Postmarked by September 9,2015. ❑ C. 16-25 ❑ H.500-999 CHECK ONE ❑ D.26-49 ❑ I. 1,000&above ❑ E. 50-99 ❑J. N/A © I am an IACP Member;Membership Number 1682694 ❑ I am a Non-Member 2•What is the approximate population size of your city/ ❑ 1 am applying now for Membership(Use Box"B"below to Join) jurisdiction? ❑ A.Under 2,500 ❑ E. 100,000-249,999 ❑ I am the spouse or family member of Their Member# ❑ B.2,500-9,999 ❑ F. 250,000-499,999 Full Name Tim Green ❑ C.10,000-49,999 ❑ G.500,000&above D.50,000-99,999 ❑ H.N/A First Name for Badge Tim 3.What best describes your function/assignment? Title Chief of Police © A.Administration ❑ G.Fleet Management Carmel Police Department ❑ B.Field Operations ❑ H.Purchasing Agency/organization p ❑ C.Information Technology ❑ I. MedicaVPsychological Agency Address 3 Civic Square ❑ D.Patrol/Investigations/ ❑ J. Legal Tactical El K.Retired City Carmel State Indiana ❑ E. Communications ❑ L. Other(please specify) Zip/Postal Code 46032 Country US ❑ F. Training ❑ M.N/A Phone# 317-716-8549 Fax# 317-571-2512 4.What best describes your purchasing authority/? Z A.Approve purchases ❑ D.Make suggestions E-mail Address tgrecn@carmel.in.gov ❑ B.Evaluate&recommend to others purchases ❑ E. End user only FAMILY—complete a duplicate registration form if using different payment method.+ ❑ C.Develop specifications ❑ F. N/A Name for purchases Children(Under 18)Name(s)&Age(s) 5.Which best describes your Agency/Organization? 171 A.Local ❑ H.Medical/Psychological A.CHECK APPROPRIATE REGISTRATION TYPE 11 B.State El I. Non-profit ❑ C.County/Regional/ ❑ J. Consultant ❑ IACP Member':$350 ❑ Children 6-18`: $45 Special District ❑ K.Security ❑ First Time IACP Member':$295 ❑ Children 5&under`: FREE ❑ D.Tribal ❑ L. Legal ❑ Non-member':$525 ❑ Expo Pass for Public Safety Personnel:FREE ❑ E. College/University ❑ M.Training ❑ Family Member'+: $125 ❑ F. Transportation ❑ N.Company ❑ G.Federal Government ❑ 0.Other 1-DAY PASS&2-DAY PASS REGISTRATION WILL OPEN ON-LINE SEPTEMBER 10TH. Agency/Military ❑ P. N/A B.IACP DUES 6.In the next 12—24 months,which of these products or services does your organization plan to YES!I would like to join the IACP and take advantage of the First Timer Member Registration Rate of$295: purchase/lease?(Check ALLthatt ply): ❑Join ❑Renewal (See the IACP website for membership benefits and criteria) ❑ A.Aircraft Professional/Consulting ❑Active Member:$150 ❑Associate Member—Academic:$150 © B.Armor/Protective /Services ❑Associate Member—General:$150 ❑Associate Member—Service Provider:$250Z Equipment Publication/Trade ❑Associate Member—Leader of Tomorrow Sworn Officer:$75 VC.Awards/Badges/ --,journal Challenge Coins 01N straire D Communications F. estoing are C.(OPTIONAL)BANQUET&FOUNDATION GALA TICKETS EquipmentEquipment �/EducationfTraining rms ❑YES!I would like to Purchase Tickets for the 2015 ❑YES!I would like to Purchase Tickets for the Annual ivF. Investigation/ ❑ R.Unmanned Vehicles/ IACP Foundation Gala to be held on Saturday, Banquet to be held on Tuesday,October 27,2015. Surveillance/Detection o oti's October 24,2015. ess-Lethal Weapons ehicle Accessories Tickets$100 each#of tickets: ,Lighting Vehicles/Motorcycle/ Tickets$200 each#of tickets: No refunds.Pre-Conference ticket sales end October 21,2015 No refunds.Pre-Conference ticket sales end October 21,2015. and will continue on-site October 23,2015. ��obile Technology �TV ew Products U.Weapons/Firearms Dir K.Personal/Tactical ❑ V. N/A PAYMENT (No Registrations-will be processed unless accompanied by payment in full.) Equipment TOTAL AMOUNT TO BE CHARGED(Add A,B&C):$ 350.00 7.How did you hear about IACP 2015? Purchase order Po#33048 © A.Have attended in the past ❑ B.Received brochure ❑Check. Make checks payable to IACP(U.S.dollars,drawn on U.S.banks only)and mail full payment(no cash) ❑ C.Received an e-mail With completed form to: IACP Conference Registration,P.O.Box 62564,Baltimore,Maryland USA 21264-2564 ❑ D.A colleague told me about the conference ❑Please charge my credit card: 11 Visa ❑MasterCard ❑American Express ❑Discover ❑ E.Other(please specify) Acct.# Exp.Date 2 YES!I would like to receive e-mails from IACP exhibitors Cardholder's Name Billing Address regarding their conference activities and products. Signature 'Full conference registration fee includes access to all general assemblies,workshops, Fax completed form with credit card information to 703-836-4543.Do NOT mail and fax form—charges may be receptions,Expo Hall,and Chief's Night duplicated.Mail purchase order&registration form to:IACP Conference Registration,44 Canal Center Plaza, +Family refers to a spouse or family member,not a business associate or fellow law Suite 200,Alexandria,VA 22314 USA.E-mail forms to conf2015@theiacp.org. enforcement colleague.ONLY the family member's name,city,and state will appear on their badge.Family members do not receive certificates for workshops. Source Code:CFMJ Hyatt Regency McCormick Place ���--� 2233 S. Martin Luther King Drive #. REGENCY' Chicago, IL 60616 Tel: (312) 567-1234 Fax: (312)528-4000 INVOICE Payee Tim Green Room No. 0804 10293 North Meridian Street Arrival 10-23-15 Indianapolis IN 46290 United States Departure 10-27-15 Page No. 1 of-1 -- — - Confirmation No. 447636701 Folio Window 1 Group Name IACP-Indiana Police Chiefs Assn Folio No. 985766 Booking No. 32CQMMW4 Date Description Charges Credits 10-23-15 Parking Overnight- Self Room#0804 : 36.00 10-23-15 Group Room 269.00 10-23-15 State Occupancy Tax 11.89% 31.98 10-23-15 City Occupancy Tax 4.5% 12.11 10-24-15 Parking Overnight-Self Room#0804 : 36.00 10-24-15 Group Room 269.00 10-24-15 State Occupancy Tax 11.89% 31.98 10-24-15 City Occupancy Tax 4.5% 12.11 10-25-15 Parking Overnight-Self Room#0804 : 36.00 10-25-15 Group Room 269.00 10-25-15 State Occupancy Tax 11.89% 31.98 10-25-15 City-Occupancy Tax 4.5% 12:11 10-26-15 Parking Overnight-Self Room#0804 : 36.00 10-26-15 Group Room 269.00 10-26-15 State Occupancy Tax 11.89% 31.98 10-26-15 Citv Occupancy Tax 4.5% 12.11 10-27-15 XXXXXXXXX= (X/XX 1,396.36 Total 1,396.36 1,396.36 Guest Signature Balance 0.00 I agree that my-liability for this bill is not waived and I agree to be held personally liable in the event that the indicated Please remit payment to: person,company or association fails to pay for any part or Hyatt Regency McCormick Place the full amount of these charges. 2233 S Martin Luther King Jr. Drive Chicago, IL 60616 Hyatt Gold Passport Summary For inquiries concerning your bill please call 888-587-4589. — --No-Membership-to be-credited- --- -- - - We hope you enjoyed your stay at Hyatt Regency McCormick Place.Our goal is to Join Hyatt Gold Passport today and start provide each guest with an exceptional stay and we are interested in hearing your earning points for stays, dining and more. feedback regarding your visit. Visit goldpassport.com Please contact our consumer affairs office at aualitychimc(cbhyatt.com or dial 312-567-1234. Please visit www.mccormickplace.hyatt.com for the lowest rates. VOUCHER NO. WARRANT NO. ALLOWED 20 Timothy I Green IN SUM OF $ $1,721.36 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members 210 -570.00 $1,721.36 I hereby certify that the attached invoice(s), or I I 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 Thursd y, October 29, 2015 Chief of Police 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)) 10/30/15 travel expenses $1,721.36 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