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Home My WebLink About255469 02/19/16 0CITY OF CARMEL, INDIANA VENDOR: 365130 ONE CIVIC SQUARE MARK CROMLICH %� °l., CHECK AMOUNT: $*****1,338.90* ��; CARMEL, INDIANA 46032 12685 LANTERN RD CHECK NUMBER: 255469 9gj��TON�� FISHERS IN 46038 CHECK DATE: 02/19/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4128000 021716 6.38 TUITION REIMBURSEMENT 1120 4231400 021716 20.63 GASOLINE 1120 4343002 021716 1,311.89 EXTERNAL TRAINING TRA VOUCHER NO. WARRANT NO. ALLOWED 20 Mark Cromlich IN SUM OF $ $1,338.90 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 42-314.00 $20.63 1 hereby certify that the attached invoice(s), or 1120 43-430.02 $1,311.89 bill(s) is (are)true and correct and that the 1120 41-280.00 $6.38 materials or services itemized thereon for which charge is made were ordered and received except Q! Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund CITY OF CARMEL FIRE DEPARTMENT DATE: February 5,2016 TO: Patricia Brown FROM: David Haboush,Fire Chief Attached you will find a tuition reimbursement for Mark Cromlich. The initial tuition reimbursement has been taken care of,however the sales tax was deducted. The HR Director determined the employee does not have an option for tax exempt that we would reimburse tax on tuition reimbursements. With that being said, please reimburse Mark Cromlich an additional $6.38 which was the sales tax. If you have any questions, please feel free to contact me. Thank you. City Of Carmel Tuition Reimbursement Application Forme Part I (to be completed by Employee) ^A (Please print. Submit completed form to Department Headrip 'or to date.course begins.) Employee Name__/qGv-k (f1b1t1 iire Dfate6 I�,Zv 9y Department Job Title SG7�e�y ��►ve-T� Educational Institution* fv s.,'� Name of Course" U114-I)IS 4 2e,5. n5 e. IrMU5 S redit i lours 3 Starting Date of Course(month/day/year) N ki By signing below, 1 signify that I understand the following: • The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2-58. • To receive reimbursement for tuition, 1 must submit evidence of payment for the course and a copy of my final grade. To receive reimbursement for books, I must submit an.original itemized receipt or other proof of purchase that links these books to this particular course. • if I leave City of Carmel employment sooner than one (1) year after the end of this course, I will, repay.the City in full for its tuition and book reimbursements for this course. • The tax status of reimbursement payments is s bject.to federal law,which may change from time to time. Employee Signature : Date Part.H (to be completed by.Department Head) By signing below,I certify that: • 1 have read the course description attached to this application and believe this course will maintain or improve.the employee's job-related skills, in relation to either the employee's current position or potential career path within my department. • The applicant will have. been employed full-time by the.City .for at least one (1) year prior to the commencement of the course, and has not been subject to a disciplinary probation, suspension or demotion within 90 days prior to the beginning of the course. • The final claim will be 72AI�r my department's budget, subject to the terms of Section 2-58 of Carmel City Code. c Department Head SignatureDate 0 /2 /rJ Part III (to be completed by Director of Human Resources) Final Approval � Date If denied,reason for denial- The.tuition reimbursement program covers only courses offered through a degree-granting institution accredited by the North Central Association.of Colleges and Schools or an equivalent regional accreditor. *" An application will not be considered complete unless a course description from the school's literature is attached. 1 acardinal@flsbook.com !. Il 1�>s. VL6➢N'Iv1361r, �"L�Ptti.J►1�n ' � �p;4A�+ Order Number: 29011 Shipment: 1 of 1 8 �`� �FPocking List ID:�� Ordered by:. 2803545 Cromlich,Mark Shin to Address:- 12685 Lantern.Rd. Cromlich; Mark Fishers,IN 46038- 12685 Lantern Rd. Country:United States Ship Method: Pick up at Store Fishers, IN 46038- Phone#: 317-409=0909 Ship Date: 8/19/2O 15 9:10:.43 AM Email:.macromlich@bsu.edu .Country:United States Notes: yment.Information Card Number Exn.Date stercard($20.00) xx.,x-xxxx=max 3136 10115 der Items urse Materials arse HS 589 Section: 1 Course ID: Instructor: PICHTEL Update Action: Do.Not Add to Order IIS 389/589:COURSE PACKET Author: PICHTEL ISBN:_ Unknown -Discount:. $0.00 I I II i I I- III ge: REQUIRED Edition/Status: 62732 Price: $18.69 ; Extended: $18.69 in Shipment: l(New) Already Shipped: 0 Not Shipped: 0 ji 2111111811813110111111111.. 162732, der Summary n Summary Order Totals tbooks Ordered t Item Total $18.69 thooks Packed I Shipping $0.00 Handling $0.00 Grand Total $20.00 I ar aiiiiizomcom° IIIIIIIIIll1111111111111f1�l�lfllllilll Your order of August 12,2015(Order ID 104-4560497-111625a) Qty. item item price Total - i T&rorism and WMDs.Awareness and,Response 572.37 57237 pichtei,John---Hardcover 2-A75")1439851752 This.shipmenicompletes your order; Subtotal Have feedback on.howwe Tax,Coiiected packaged your order?Tell us at Order Total wwtv.amazon.comloackagtng. Saldwa creditJdeb t $77.444 , Ba+once due Sfi.00 Returns Are Easy'Most items can be iefunded..exchanged,or replaced.when returned n original and unopened cond tion..Visit-http:tiwwvv.amazon.com/returns to stark wow return,or http:[rwww.amazon.com/help for more.i*rmabon on return polices. . 111 III 111111.1111111111111111111111111111' i l DQ34tf'Jbl-4;of 9-/It?S-GCHtL=D/no-rush- A3 deitveryt92,16680/0817-19:00!0813-21;23' -v. -q -i-aid CITY OF CARMEL Expense Report (required for all travel. expenses) ■ !NDIANP. EMPLOYEE NAME: Mark Cromlich DEPARTURE DATE: \ - \, _\� TIME: A PM DEPARTMENT: FIRE RETURN DATE: TIME: ` VS A REASON FOR TRAVEL: FDSOA Conference DESTINATION CITY: EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM ✓ Transportation Meals Date Gas/Tolls/ Lodging Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem $0.00 $0.00 $0.00 $0.00 1/18/16 65.00 $65.00 1/19/16 a 65.00 ;,$65.00 1/20/16 65.00 $65.00 1/21/16 65.00 $65.00 1/22/16 $168.61 68.63 770.28 65.00 $1,07,12.52 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0.00 Total $0.00 $168.61. $0:00! $68. 3 $770.28 $0.00 $0.00 $0.00; $0.00 $325.00 $0.00 DIRECTOR'S STATEMENT: I here . at I expe"`r� es 'sted c q)fo rm to the City's travel policy and are within my department's appropriated budget. Director Signature: Date: City of Carmel Form#ER06 Revision Date 2/5/2016 Page 1 CROMLICH,MART(A Confirmation Number: 18609253-1 Room Number: 379 Room Type: KNGN No.of Guests: 1 TAX ID ARRIVAL DEPARTURi• RATE PLAN ACCOUNT 01/15/2016 01/22/2016 GPASC 86212 .DATE CODE DESCRIPTION ". COMMEN•T AMOUNT' 01/18/2016 SUITE Guest Suite 169.00 USD 01/18/2016 6100TX Suite Tax 23.52 USD 0111912016 SUITE Guest Suite 169.00 USD 01/19/2016 6100TX Suite Tax 23.52 USD 01/20/2016 GIFT Granada Gift Shop soda 2.50 USD 01/20/2016 6102TX Sales Tax 0.20 USD 01/20/2016 SUITE Guest Suite 169.00 USD 01/20/2016 6100TX Suite Tax 23.52 USD 01/21/2016 SUITE Guest Suite 169.00 USD 01/21/2016 6100TX Suite Tax 23.52 USD 01/22/2016 MC Mastercard (772.78)USD 0.00 USD TOTAL DUE: Signature: X Date: 01/22/2.016 13:14 Chaparral Suites Page 1 Capital One -Transactions & Details Page 1 of 1 capftc7johe�* Transaction Details Description: Chaparral Suites Scottsdale Transaction Date: 1/22/2016 Posted Date: 1/25/2016 Amount: $772.78 Category: Lodging Details: N/A https:Hservicesl.capitalone.com/ui/ 1/29/2016 1 In&v`apol is Fast Park 0550 Standsted Rd Indianapolis, 46241 Booth 01/22/16 23:53 - Cashier 21 Receipt 065590 Indi•aniapolis Fast Park 0550 Standsted Rd Short-term parking tkt Indianapolis, 46241 1 - No. 015001 01/15%16 09:20 Booth 01/22/16 23:53 01/2;%16- 23:53 Cashier 21 Period Mf034' Receipt 065598 (list,} $64.00 — ---- - Short-term parking tkt Sub Tot alX64.00 _ 1 - No. 015881 USt. 60.00 01/ 16 09:20 01/1"22'/16,23:53 Tot: l Period 7cf1-4h34' ��r (Ust.) .; $64.00 Payment Receivers Sub Total $64.00 MC $64.00 Ust.. $0.00 XX;\XXi i,XXXXX03-T3 Mer-ch:215051409997 Iota? _. 6111. Auth:'02055Ei Type: Swiped Payment Receivers Mc $64.00 XXXXXXXXXXXX0373 Includes 10% airport-fee; Merch:215051409997 AUthc0205E% Type: Striped Includes 10% airport fee, $qj I IP I r Capital One - Transactions & Details Page 1 of 4 Capp - Transactions & Details Platinum MasterCard ...8507 Current Balance: $2,830.11 Rewards: $56.52 cash Available Credit: $602.68 Date Description All Categories Cards Amount View Pending Transactions (2) Posted Transactions 1/27/16 CAPITAL ONE MOBILE Payment ...8373 -$1,300.00 PYMT 1/26/16 FISHERS DO-IT CENT Merchandise ...8373 $42.78 1/25/16 Mellow Mushroom Dining ...8373 $26.50 1/25/16 Walmart Merchandise ...8373 $53.02 1/25/16 Steak'n Shake Dining ...8373 $16.46 1/25/16 STAR CLEANERS Other Services ...8373 $7.56 i 1/25/16 ;=INDIANAPOLIS 3 Gas/Automotive=::--. ...8373 $64.0.0 .FASTPARK =�� 1/25/16 r=-Sixt:Rent',A Car-- Car Reptaha 8373 ($38481 1/25/16 kco�t6draa parl Suites s Lodging—=a --� ...8373 x$772 7 . 8' ale_ ; 1/23/16 Meijer Merchandise ...8373 $150.00 https://servicesl.capitalone.com/ui/ 1/29/2016 Snyder, Denise W Subject: FW: reimbursement From: Cromlich, Mark Sent: Friday, February 05, 2016 09:13 To: Snyder, Denise W Subject: reimbursement Denise, I would like to reimbursement for the FDSOA conference I attended in Scottsdale AR. The National Fallen Firefighters paid for a training the weekend before this event. They paid for my flight, hotel (while attending their training). Please contact me with any questions or concerns. thanks Mark Cromlich Safety Chief Carmel Fire Department 2 Civic Square,Carmel IN 46032 317-571-2600 Headquarters 317-571-2660 Fax mcromlich@carmel.in.gov i i CONFIDENTIALITY NOTICE:This transmission(including any attachments) may contain information which is confidential,attorney work-product and/or subject to the attorney-client privilege,and is intended solely for the receipient(s)named above. If you are not a named recipient,any interception,copying,distribution,disclosure or use of this transmission or any information contained in it is strictly prohibited,and may be subject to criminal and civil penalties under State or Federal law. If you have received this transmission in error, please immediately call us at (317)571-2600,delete the transmission from all forms of electronic or other storage,and destroy all hard copies. DO NOT forward this transmission.Any error in addressing or sending this e-mail is not a waiver of confidentiality or privilege and does not waive consent to copying or distribution of this e-mail or attachments.Thank You. 1 2/5/2016 2016 Annual Safety Forum-Fire Department Safety Officers Association 2016 Annual Safety Forum pEPARTiyEyl ETI- ' S FDSOA In partnership with the IAFC — Safety,health and Survival Section proudly presents the 2016 Annual Safety Forum January 18-22, 2016 Scottsdale, AZ Join safety officers from across the country for a week full of education, awareness and networking! All are welcome! Vendor Registration and Sponsorship Form Click here to Register Current Agenda Incident Safety Officer or Health &Safety Officer Academy (Mon &Tues, Jan 18-19) Dave Dodson and Shadd Whitehead will present the ISO class based upon Dave's 3rd Edition of the Incident Safety Officer released Summer 2015 Upon completion of the 16-hour Academy, you are eligible to-take the exam for National Certification onsite Tuesday or Wednesday evening, or by using an approved local proctor at a later date. Conference (Wednesday thru Friday, Jan 20-22) CEU credits will be awarded for each session Wednesday Opening General Session Keynote Speaker: Gordon Graham hitps://www.fdsoa.orglevents/2016-annual-safety-forum/ 1/2 215/2016 2016 Annual Safety Forum-Fire Department Safety Officers Association Friday Closing General Session Keynote Speaker: Billy Goldfeder 2015 FDSOA Member FDSOA Non-Member ISO or HSO 2-day Academy(includes Certification Exam) $395 $495 Conference Only $430 $530 Conference plus ISO or HSO Academy $700 $800 Chaparral Suites Hotel & Conference Center The airport shuttle instructions for those attendees staying at the Chaparral Suites&The Days Inn: 1.Once your attendees have landed and have their bags 2.Have them call the hotel at 480-949-1414 3.Have them identify themselves as being with the Fire Department Safety Officecs Association and that the airport shuttle has been contracted for the group and have them give their phone number to the driver to make it easier to locate them at the airport. 4.We will then coordinate with the attendee on when and where to meet the driver for pickup. MAKE YOUR ROOM RESERVATION ASAP! Chaparral Suites Hotel 5001 N. Scottsdale Road in Scottsdale, Arizona $169.00 single/double occupancy Call to book your room today! (800)528-1456 Or Link to hotel reservations Complimentary Hotel Amenities Include: Airport Shuttle Service (6am-9pm) Full American Breakfast each morning Evening Reception nightly USA Today delivered Mon-Fri Wired &Wireless Internet in guest suites Wireless Internet in meeting space Fitness Center Secondary Hotel—Right next store to Chaparral Suites Days Hotel Scottsdale Scottsdale,AZ Make your reservations today—ask for FDSOA Group Days Hotel Scottsdale 5105 N Scottsdale Rd. Scottsdale, AZ 85250 rate of$159/night reservationsO)dayshoteiscoftsdale.com call: (480) 945-4392 hftp://www.daysscoftsdale.com/ They do not have their own airport shuttle, but attendees can take the shuttle to the Chaparral and then walk next door to this hotel https.-/Awww.fdsoa.orglevents/2016-annual-safety-forum/ 2/2 Gmail -Trip Checked In- <Trip to Phoenix, AZ> Page 1 of 3 - G Mark Cromlich <mcromlich@gmail.com> Trip Checked In - < Trip to Phoenix, AZ > ------ -1-message--- - - -- - - - Deem-<notifier@us.deem.com> Thu, Jan 14, 2016 at 10:42 AM Reply-To: notifier@us.deem.com To: mcromlich@gmail.com deem Travel Itinerary Trip to Phoenix, AZ Friday, January 15, 2016 Traveler: MARK A CROMLICH Use this when contacting the travel agency Record locator: WZR1GG Trip ID: 660421448039781223 Agency: ATC TRAVEL MANAGEMENT LLC Flight from: Indianapolis, IN (IND) Southwesta* Southwest Airlines 406 Friday,January 15, 2016 Depart: 10:40 AM Indianapolis, IN (IND) Arrive: 12:45 PM Phoenix, AZ (PHX) Flight time: 4h 5m Non-stop Class: Restricted Coach Estimated Time: 4h 5m Non-stop Seat: MARK A CROMLICH: Unassigned Airline does not allow pre-assigned seats (Airport check-in only). Use this when contacting the airline Reservation number: RIGGWR Status: Checked In Boarding Info - - Passenger Name : MARK A CROMLICH Boarding Zone : B39 https://mail.google.com/mail/u/0/?ui=2&ik=46f4eab9l 8&view=pt&q=flight&gs--true&sear... 2/5/2016 Gznail--Trip Checked In'- <Trip to Phoenix, AZ> Page 2 of 3 Flight from: Phoenix, AZ (PHX) --- -------- ----- --- Southwest Airlines 2220 Friday,January 22, 2016 Depart: 5:55 PM Phoenix, AZ(PHX) Arrive: 11:15 PM Indianapolis, IN (IND) Flight time: 3h 20m Non-stop Class: Restricted Coach _ ---Estimated Time: 3h-20m Non-stop Seat: MARK A CROMLICH: Unassigned -Airline does not allow pre-assigned seats(Airport check-in only). Use this when contacting the airline Reservation number: RIGGWR Status: Confirmed Rules and Restrictions Flights: The air ticket must be purchased in advance. The air ticket is non-refundable. Checked baggage fees-for detailed baggage fee information, please go to the airline website: Southwest Airlines Trip Cost Subtotal Total Transportation Elam USD$370.96 �,r�iin`�i.rrrnn (Flights payment cgWu "Vill Estimated total cost for this traveler --USD-$370.96 _ Can't see the images in this email?Click here to sign in - - --- --- -- -- Responses to this email should be-directed to webmaster@atcmeetings.com.Do not directly respond to the sender of this email. Copyright @ 1999-2016 Deem,Inc.All rights reserved. powered bydeem https://mail.google.com/mail/u/0/?ui=2&ik=46f4eab9 l 8&view--pt&q=flight&gs--true&sear... 2/5/2016 n OMR--'--REFILIFE SAFEr.Y INITIATIVES PROGRAM'By THE NATIONAL FALLEN FIREFIGHTERS FOUNDATIQN 4 2016 EG H Advocate Summit January 15-18 • Scottsdale, Arizona Agenda Friday January 15, 2016 1:00-5:00 Registration Lobby 3:00-5:00 EGH Regional Advocate Meeting Siesta 1 and 2 6:00-8:00 Opening Reception Paloma Garden Saturday January 16, 2016 6:00-7:45 Breakfast Pavilion Please bring your room key to access the complimentary breakfast. 8:00-10:30 Welcome & NFFF Updates (Training-Advocates) Paloma 1 and 2 10:30-10:45 Break 10:45-12:30 Breakout sessions Please see the breakout schedule on page 3 for your room assignment today. 12:30-1:30 Lunch Paloma 3 1:30-3:00 Breakout sessions, continued 3:00-3:15 Break 3:15-5:00 Stress First Aid Paloma 1 and 2 6:00-9:00 Group Dinner Please meet in the lobby of the hotel at 5:45 for motor coach transportation to dinner at: Hall of Flame Museum 6101 East Van Buren Street Phoenix,Arizona 602-275-3473 www.hallofflame.org Sunday January 17, 2016 6:00-7:45 Breakfast Pavilion Please bring your room key to access the complimentary breakfast. 8:00-10:00 Breakout sessions 2 Please see the breakout schedule on page 4 for your room assignment today. 10:00-10:15 Break 10:15-11:15 Breakout sessions, continued. 11:15-11:30 Break 11:30-12:00 Group Train-the-Trainer for each class Paloma 1 and 2 (to cover paperwork, etc.) 12:00-1:00 Lunch Paloma 3 1:00-2:30 Round table discussion-Current Topics in the Fire Service 2:30-2:45 Break 2:30-3:30 Keynote Speaker Pam Peterson-Phoenix Society Pam Peterson, RN, BSN is the Program Director for The Phoenix Society for Burn Survivors. She began her career as a staff nurse at Spectrum Health Regional Burn Center in Grand Rapids, Michigan and also served as the Nurse Manager. Realizing a desire to serve and advocate for the burn community, Pam joined the Phoenix Society In 2001. She has worked with the Phoenix Society team to develop programs that have an impact on burn survivors, their families and caregivers. As the Program Director, Pam oversees all of the Phoenix Society's programs. She has been instrumental in the development of Phoenix SOAR®(Survivor's Offering Assistance in Recovery)and the continued growth of Phoenix World Burn Congress. 3:30-4:00 Closing(completion of evaluations and travel forms) 2 Saturday January 16, 2016 Courage to Be Safe° Paloma 1 and 2 Paul Melfi (Instructor) John Dixon Kevin Munson Joanne Rund (Instructor) Christopher Koretski Steve Shelton Donald Abbott Peter Leavitt Tony Sneidar Mark Cromlich Scott Low Brian Tobin Rick Dangerfield Sidney Lucas Eric Valliere LACK(Leadership,Accountability, Courage,and Knowledge) Siesta 1 and 2 Nick Perkins (Instructor) Kevin Cooney John Price Kevin Sehimeyer(Instructor) Craig Jeppson Steve Tullis Kevin Alexander Richard Jorgenson Ben West Gerald Barrett Andrew Kehl David Whiting Matthew Braunshweiger Brian McMahan Tim Zehnder Jennifer Chadwick Todd Miles Leadership So Everyone Goes Home® Coronado 1 and 2 Mike Novak(Instructor) Bill Guindon Mike Robertson John Oates (Instructor) Andrew Marsh Tom Wilcox Matt Biffen Joe Minogue Tim Cowan Kevin Quinn 3 Sunday January 17, 2016 LACK(Leadership,Accountability,Courage,and Knowledge) Siesta 1 and 2 Nick Perkins (Instructor) Peter Leavitt Steve Shelton Kevin Sehlmeyer(Instructor) Scott Low Tony Sneidar Donald Abbott Sidney Lucas Brian Tobin John Dixon Andrew Marsh Eric Valliere Bill Guindon Kevin Munson Christopher Koretski Kevin Quinn Leadership So Everyone Goes Home® Coronado 1 and 2 Mike Novak (Instructor) Kevin Cooney Brian McMahan John Oates(Instructor) Rick Dangerfield Steve Tullis Kevin Alexander Craig Jeppson Ben West Gerald Barrett Rick Jorgenson Tim Zehnder Matthew Braunshweiger Andrew Kehl Work Group Paloma 1 and 2 Mike Anderson (Group Tim Cowan Mike Robertson leader) Mark Cromlich David Whiting Rick Best(Group leader) Todd Miles Tom Wilcox Rick Mason (Group leader) Joe Minogue Matt Biffen John Price Fire Prevention and Safety Grants Assistance • • Firefighters • •• • 4 Capital One - Transactions & Details Page 2 of 4 1/23/16 Meijer Merchandise ...8373 $150.00 1/23/16 Circle K Gas/Automotive ...8373 $5.42 3/1"6 Circle.K �6as/Automofive :8373 2:6- 7 1/2 J �1/23f1:6 -1 Circle K Gas/Automotive =a .-8373__ ._ ,$179,6 • �� _ = - L. 1/23/16 PHX HUMBLE PIE S3- Dining ...8373 $5.73 F48 _. _ ....... _.._._... ........ _..... ..._. _. . Dining ...8373 $7.39 Dining 1/22/2016 3:22.:03 PM 0-der Number: 553174 _ Circle K 2708694 tSITYC Other 1945 E Van Buren Phoenix, AZ 85034 (602)25379445 Merchandise E +jai, 960rein 1 sister:100fur, - nixes Ae. b5e34 (DUPLICATE RECEIPT) �.�E}e2>a. -94 1 ( DUPLICATE RECEIPT ) Gas/Automotive r'ra38697195102 y . . 614446 ,/ at Pump Sale ................................ mp # 4 UNL-REG(005) rt& Bar Dining ��,� P on—mss~- 694 Gallons $1 .679/Gal $17. g 1 .s Sub. Total : $17 /FUEL Tax: $0. L_ 5aI_.r2., .,;. Total: $17, Merchandise er Card Discount Total: $0, Num • c S 3 Master- Card: Gas/Automotive r-f"1ange - — $0 . Oi 2/2616 15 : 18 : SALE paster Card Dining ;gree to Ray the Card Num : (S) .•e Total Amount. XXXXXXXXXXXX8373 i ear . .,,er er Agree Aggree eement . DBILE Payment THANK YOU )8-J AN =,SIE A NICE DAY 01/22/2016 15:21 :53 Dining ...837. I. agree to pay the ...................... .............. I above I-ota1 Amount i aco beii Dining 8373 $12.44 https://servicesl.capitalone.com/ui/ 1/29/2016 SIXT:PN Digital untersehrieben am 23.1.2016 22:35 Zertifikat(Herausgeber and Seriennummer) D-TRUST Qualified CA 2 2014:PN 162EC6 Sixt Rent a Car,LLC P.O.Box 460967,Fort Lauderdale,FL 33346-0967,United States Company/Mr/Ms CROMLICH MARK 12685 LANTERN RD FISHERS IN 46038-1040 USA Time out: INVOICE 01/15/2016/13:41 - City: Phoenix Sky Harbor 1 01/22/2016 ml: 7351 Document:9332887318/00/M/00/N Time in: Cust.:9332887318 VAT no.: 01/22/2016/15:40 - City: PHOENIX SKY HARBOR I ml: 7692 Vcr: Drivers name: CROMLICH MARK Rental days (perweek) 1 x 97.01 97.01 USD A8 Registration No: 0013176619 AZ-BPL8106 Extra days 1 x 13.86 13.86 USD A8 MB C300 SAL PET AUT MIs inclusive 341 Energy Surcharge 8 x 0.99 7.92 USD A8 Group: SFAR US027FL1 STANDARD OFFLI Customer Facility Charge 8 x 6.00 48.00 USD A8 Order no: Second Order Concess.Recoup 11.11% 27.69 USD A8 Third Order: Choice Upgrade 8 x 17.30 138.40 USD A8 Costc.Cu.: Payment EC"'—"-8373 Subtotal 332.88 USD Res No. 9834374824 A8 Sales Tax 15,60% 51.93 USD Total 384.81 USD Final amount 384.81 USD 'Tax includes 10.3%Sales Tax and 5%Rental Vehicle Surcharge. Thank you for booking Sixt I The service has been rendered between check out date and check in date. This amount will be charged to your MasterCard account.This is not a payment request. This is the invoice for your records. Branch Date Time Is/out misAn mis Plate CO2 GLP' PHOENIX SK 22.01.16 15:40 7351 7692 341 AZ-BPL8106 41030 � r, � `� � sr `, i L` I X t�•b /J I- In met,www.sixl.com E Mail:reservatiom,customerservice usa�sixt. Call* 888)749 8111 Fax +1(888)722-2980 I