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Home My WebLink About258247 05/06/16 CITY OF CARMEL, INDIANA VENDOR: 027850 I 2j ONE CIVIC SQUARE JAMES BRAINARD CHECK AMOUNT: $*****1,491.39* CARMEL, INDIANA 46032 CHECK NUMBER: 258247 CHECK DATE: 05/06/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1160 4343001 042816 751.10 TRAVEL FEES & EXPENSE 1160 4343003 042816 610.29 TRAVEL & LODGING 1160 4343004 042816 130.00 TRAVEL PER DIEMS VOUCHER NO. WARRANT NO. ALLOWED 20 JAMES BRAINARD IN SUM OF$ $751.10 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Membei I EXPENSE I 43-430.01 I $751.10 1 hereby certify that the attached invoice(s), or REPORT 1160 N�ll0 101 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 Friday, May 06, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 05/05/16 EXPENSE $751.10 REPORT 1160 101 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 IN qqoF! s CITY OF CARMEL Expense Report (required for all travel expenses) V ,No,aNa EXHIBIT A EMPLOYEE NAME: Jim Brainard DEPARTURE DATE: 4/28/2016 TIME: 4 :23 AM/(PM DEPARTMENT: Mayor RETURN DATE: 4/30/2016 TIME: 12 : 39 AM PM Fundraising for the Center REASON FOR TRAVEL: - DESTINATION CITY: Washington, D.C. reffietional 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 $0:00 4/28/16 $578.00 $578.00 4/28/16 $22.11 $22.11 4/28/16 1 $32.50 $32.50 4/29/16 $14.54 $14.54 4/29/16 $10.00 $10.00 4/29/16 $12.62 $12.62 4/29/16 $14.57 $14.57 4/29/16 $22.70 $22.70 4/29/16 $65.00 $65.00 4/30/16 $610.29 =-$610.29 4/30/16 $40.56 $40.56 4/30/16 $36.00 $32.50 $68.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total $578.001 $0.001 $137.101 $36.001 $610.29 - $0.001 $0.001 40.001 $0.001 $130.001 $0.00 ' DIRECTOR'S STATEMENT:4,1 ereb affirm that II expenses listed conform to the City's travel po' and are within my department's appropriated budget. Director Signature: r Date: City of Carmel Form#EROS Revision Date 5/5/2016 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 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 5/5/2016 Page 2 Page 1 of 1 Transaction Details Prepared for zv-Ewtwv James C Brainard 75amEss Account Number XXXX-XXXXXX-37009 DATE DESCRIPTION CARD MEMBER AMOUNT PR282016 AA AIR TICKET SALE 4610774.DALLAS,TX JAMES C BRAINARD $576.00 Doing business as: Flight Details AMERICAN AIRLINES E TKT (� View Details on Merchant Website �� INDIANAPOLIS,INDI WASHINGTON NAT10NA AMERICAN AIRLINES-CC STE 600 TULSA OK Passenger Name:BRAINARD/JIM 74133 Date of Departure:04/28 UNITED STATES OF AMERICA(THE) Ticket Number:0012370379206 Additional Information:00123703792 AA.COM Document Type:PASSENGER TICKET AMERICAN AIRLINES Reference:320161200291292490 Category:Travel-Airline https://online.americanexpress.com/myca/shared/summary/estatement/print_doe2016-R1.html 5/4/2016 v i BRAINARD American fj. Boarding Pass Record Locator:YQMWBP JIM Record Locator:YQMWBP BRAINARD/JIM TSAPref T&I seat:7D Frequent Flyer Number:8CISR24 AAdvantage®Member DCA4IND Washington to Indianapolis Departing:Saturday,April 30,2016 Gate Flight Seat Boarding Time(EDT) --- AA3 822 7D 9:47 AM = � Terminal— Departing at 10:17AM(EDT) GROUP More Flight Details G 1h 56m Arriving at ---_.----- _--- ,2:13PM(EDT) Ticket 0012370379206 For gates,terminals and flight status,please check with us at aa.com/gates or call 1-60D-033.7300. Doors Gose 10 minutes before departure Need a hotel or rental car? Earn 250 AAdvantage®miles by booking your hotel on aa.com and rest easy with our price match guarantee. Plus,check out our great deals on rental cars.Visit aa.com/carhotel for details. Refund I Document Lookup Page 1 of 1 Search aa.com 0 American Airlines Refunds-Start Over Help Start „Document Lookup ,,Refund Eligibility Contact Information Review and Submit Finish Passenger Information Passenger Name Document Number Issue Date Total Sale Amount BRAINARD,JIM 0012370379206 04/28/2016 686.20 USD Payment Information Sale Form of Payment Payment Type Number Sale Date Sale Amount Document Description Exchange Ticket 0012199965290 04/28/2016 686.20 USD TRANSPORT Passenger Itinerary Status' Coupon Departure Date Flight Number Departure City Arrival City Description Eligible For Review 1 04/282016 4509 IND LV;j 3 DCA Transport f �� Eligible For Review 2 04/302016 3822 DCA la�u,M IND Transport j;ii-CR 4�ti1, 'Hover over text for more information. Cancel Continue More About American Products&Services Customer Service About Us Travel Insurance Contact American Corporate Information Email Subscriptions Contact Refunds Investor Relations Enhance Your Travel FAQs Corporate Responsibility Low Price Guarantee Refunds Join Us Group&Meeting Travel Agency Reference Environmental Footprint Business Programs American Travel Centers Diversity&Inclusion Cargo Baggage&Optional Service Charges Newsroom American Airlines Credit Card Customer Service Plan&Flight Airline Museum Gift Cards Irregularities Careers Deal Finder Privacy Policy RSS Legal Five Star Service Copyright Timetables&Downloads Site Map Last Minute Packages Browser Compatibility YL�® FEEDBACK https://prefimds.aa.com/ref-tmds/lookup 5/4/2016 Page 1 of 1 Transaction Details Prepared for C JamesCBrainard Account Number XXXX-XXXXXX-37009 DATE DESCRIPTION CARD MEMBER AMOUNT PR282015 DC VIP TAXI CAB-WASHINGTON,DC JAMES c BRAINARD $22.11 Doing business as: Transaction Details DC VIP TAXI CAB Description Price 2606 BLADENSBURG RD NE TAXI&LIMO SERVICE $22.11 WASHINGTON DC 20018-1423 _ UNITED STATES OF AMERICA(THE) Additional Information:428363161 2022699000 2022699000 Reference:320161200294535797 .(^' U'a� Lri� tli 4;. Category.Transportation-Taxis&Coach 202-269-3000 TAXI GAB D337 1EKONNa N GHEEIRE ;ace ID: 50847 Taa #: 01985H i=ASSEN5ER COPY RECEIPT 2S?2016 Trip ICS: 7890 3tart�` 07:15PM 5 Aviation Cir A nd 07:33PM i_;sj.l lhth 8t w 3.8010i ra't`e: $14.86 E .eras $3,25 -$4,00 Total:'---$22.11 i• c0riature :k:1: *700'� EXF:. ,. 20/2 'j0 Chet: 74116'.: HUf h: .y_ 58746' 1. 7.; ,TH41K YOU FASS,5i3ER COPY -----' i:TC_-_umplaints https://online.americanexpress.com/myca/shared/summary/estatement/print_doc2O 16-Rl.h... 4/30/2016 Page 1 of 1 Transaction Details Prepared for iuv+Ewwv Jamas C Brainard ERPAEss Account Number XXXX-XXXXXX37009 DATE DESCRIPTION CARD MEMBER AMOUNT I r- APR292016 DC TAXI D061 09024010019-LONG ISLAND C,NY JAMES C BRAINARD $14.54 Doing business as: CREATIVE MOBILE TECHN TAXI 1151 47TH AVE LONG ISLAND CITY NY 11101-5418 UNITED STATES OF AMERICA(THE) Additional Information:000907872 718-9374444 718-9374444 Reference:320161200285485579 i Category:Transportation-Taxis&Coach Cab # DOE-1 CUSTOMER MER COPY I14f29.1 IR 11 TART END MILE�1 11:57 12:11 2-S Regular- Fare Extra: $ Toll: tt,C1C - TiP: 2.4C: TOT $ 414.5 Card: 700Li RUTH: 5111.061 DC.1,C COMPLAI[17. LIhI AND r,r• •r'r ry .rr•r• �lIECIO Jr- ADDREc,., FH: 855-41D'4- 4967 TTY 711 https://online.americanexpress.com/myca/shared/summary/estatement/print_doc2O l 6-Rl.h... 4/30/2016 Page 1 of 1 Transaction Details Prepared for ni\+:ew,uwJames C Brainard omacss Account Number XXXX-XXXXXX-37009 ATE DESCRIPTION CARD MEMBER AMOUNT PR292016 UBERUBER-866.576.1039,CA JAMES C BRAINARD $10,00 Doing business as: LIBER Vew Details an Merchant Website 1455 MARKET ST 4TH FLOOR SAN FRANCISCO CA 94103 UNITED STATES OF AMERICA(THE) Reference:320161210301467440 Category:Transportation-Taxis&Coach — --� https://online.americanexpress.com/myca/shared/summary/estatement/print_doc2016-R1.html 5/4/2016 Page 1 of 1 Transaction Details Prepared for nrnewow James C Brainard oa+a�ss Account Number XXXX-X)DXXX-37009 DATE DESCRIPTION CARD MEMBER AMOUNT APR292016 HITCH TAXI DC-WASHINGTON,DC JAMES c BRAINARD $12,62 Doing business as: Transaction Details ONLINE PAYMENT PROCESSED BY STRIPE.COM Description View Details on Merchant Website HITCH TAXI DC 318018TH ST #100 SAN FRANCISCO CA 94110-2043 UNITED STATES OF AMERICA(THE) Additional Information:00029802 650-427-9276 650427-9276 Reference:320161210301913383 Category.Merchandise&Supplies-Internet Purchase https:Honline.americanexpress.com/myca/shared/summary/estatement/print_doe2016-R1.html 5/4/2016 Page 1 of 1 Transaction Details Prepared for n+nenrwv James C Brainard owa�ss Account Number XXXX-XXXXXX-37009 DATE DESCRIPTION CARD MEMBER AMOUNT APR292016 HITCH TAXI DC-WASHINGTON,DC JAMES C BRAINARD $14.57 Doing business as: Transaction Details ONLINE PAYMENT PROCESSED BY STRIPE.COM Description View Details on Merchant Website HITCH TAXI DC 318018TH ST #100 SAN FRANCISCO CA 94110-2043 UNITED STATES OF AMERICA(THE) Additional Information:00505345 650427-9276 650427-9276 Reference:320161200300999926 Category:Merchandise&Supplies-Internet Purchase https://online.americanexpress.com/myca/shared/summary/estatement/print_doc2016-R1.h... 4/30/2016 TAXICAB RECEIPT 71 17 Time: ------------ --~ - Date: Origin of trip: Destination: _ HOLIDAY # 444 Fare: TAG # H99964 FACE ID # 65955 04/29/16 TR 7147 START END MILES 09:57 10:09 2.5 RATE #1 TARE : $ 10,27 EXTRA: $ 0.25 TOTAL: $ 10.52 DC TAXICAB COMM TEL�655-464-4967' WW.DCTAXI:DC.GOV HAVE A NICE DAY! Page 1 of 1 Transaction Details Prepared for PATER . James C Brainard owREss Account Number XXXX-XXXXXX-37009 DATE DESCRIPTION CARD MEMBER AMOUNT PR292016 UBER UBER-866.576.1039,CA JAMES C BRAINARD $22,70 Doing business as: USER Yew Details an Merchant Websile 1455 MARKET ST 4TH FLOOR SAN FRANCISCO CA 94103 UNITED STATES OF AMERICA(THE) Reference:320161230318008605 Category.Transportation-Taxis&Coach https://online.americanexpress.com/myca/shared/summary/estatement/print_doc2016-R1.html 5/4/2016 Kibbe, Sharon From: brainardjc@aol.com Sent: Friday,April 29, 2016 9:28 PM To: Kibbe, Sharon Subject: Fwd:Your Friday evening trip with Uber Sent from my iPhone Begin forwarded message: From: Uber Receipts<nore uber.com> 21y&- Date: April 29, 2016 at 6:08:19 PM EDT To: Brainardjckaol.com Subject: Your Friday evening trip with Uber APRIL 29,2016 22.70$ Thanks for choosing Uber, Jarn( q [I r; ,wasti lt6hj� FARE BREAKDOWN t2 29 _2 Base Fare 7.0( Distance 9.1 D S t S E L�M.�Y.ia62016 Google 05:49pm Time 6.2f 1001-106916th St NW,Washington,DC 06:05pm Subtotal $22.41 204-214 Independence Ave SE,Washington, DC DC Taxicab Commission Fee 0.2'A CAR MILES TRIP TIME BLACK CAR 2.71 00:15:37 CHARGED �'ersonal••••6001 �22.7� YOU'VE EARNED 2X POINTS MEMBERSHIP REWARDS® RATE YOUR DRIVE[ You rode with Imran Issued by Drinnen on behalf of ALL-LIMO SEDAN-SERVICE LLC Receipt ID#60679bec-78b1-48fd-ae20-964a3ad1419c E4Need help?Tap Help in your app to contact us with Free Rides questions about your trip. Leave something behind?Track Share code:8g LjhOEIM it down. 2 Page 1 of 1 Transaction Details Prepared for tiHewwv James C Brainard o"Ei;s Account Number XXXX-XXXXXX-37009 (DATE DESCRIPTION CARD MEMBER AMOUNT PR302016 UBER USER-866-676-1039,CA JAMES C BRAINARD $40,56 Doing business as: UBER View Details on Merchant Website 1455 MARKET ST 4TH FLOOR SAN FRANCISCO CA 94103 UNITED STATES OF AMERICA(THE) Reference:320161230318132925 Category:Transportation-Taxis&Coach https://online.americanexpress.com/myca/shared/summary/estatement/print_doc20l 6-R1.html 5/4/2016 Kibbe, Sharon From: brainardjc@aol.com Sent: Monday, May 02, 2016 6:20 AM To: Kibbe, Sharon Subject: Fwd:Your Saturday morning trip with Uber -----Original Message----- From: Uber Receipts <noreply@uber.com> To: Brainardjc<Brainardjc@aol.com> Sent: Sat, Apr 30, 2016 9:23 am Subject: Your Saturday morning trip with Uber �= APRIL 30,2016 $40.56 Thanks for choosing Uber,James �� -r \20 309 =Was ,;gtori �` FARE BREAKDOWN r 29 -- Arlington `l 295 27 , 0-.1` '� - ^.I_• `\ Base Fare 7.00 Distance 20.93 Map data©2016 Google 09:O1am 100116th St NW,Washington,DC Time 8.27 09:22am 5 Aviation Cir,Arlington,VA Subtotal $36.20 DC Taxicab Commission Fee(?) 0.36 CAR MILES TRIP TIME BLACK CAR 6.16 00:20:40 DCA Airport Surcharge(?) 4.00 1 CHARGED �'ersonal••••6001 �4�.56 YOU'VE EARNED 2X POINTS MEMBERSHIP REWARDS® RAPE-YOUR DRIVER You rode with Solomon 0 0 0 0 Issued by Drinnen on behalf of solomon limo Receipt ID#f780eOae-c961-4276-9690-2ddf49942484 Need help?Tap Help in your app to contact us with � Free Rides questions about your trip. Leave something behind?Track _ Share code:S 4jh it down. 2 Page 1 of 1 Transaction Details Prepared for n veww James C Brainard o�acss Account Number XXXX-XXXXXX-37009 F DATE DESCRIPTION CARD MEMBER AMOUNT AIR31INDIANAOPOLIS AIRP 542929805342714-INDIANAPOLIS,IN JAMES C BRAINARD $36.00 Doing business as: F Transaction Details INDIANAPOLIS INTERNATIONAL AIRPORT Description Price 7800 COL H WEIR COOK MEM AUTO PARKING LOTS A $36.00 STE 38 INDIANAPOLIS IN 46241-8004 UNITED STATES OF AMERICA(THE) Additional Information:430003746 3174879594 3174879594 Reference:320161220325984513 Category Other-Government Services Indianapolis International Airport indianapolisairport.com RECEIPT TRAM IN TIME OUT TIME FEE CC# 689 041`22-8 13:54 0.11 30 12/:39 $36.00 7009 https://online.americanexpress.com/myca/shared/summary/estatement/print_doc20l 6-R1.html 5/4/2016 VOUCHER NO. WARRANT NO. ALLOWED 20 JAMES BRAINARD IN SUM OF$ $610.29 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Member: I EXPENSE I 43-430.03 I $610.29 1 hereby certify that the attached invoice(s), or REPORT 1160 0LAI�: Z 101 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 Friday, May 06, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s) or bill(s)) 05/05/16 EXPENSE $610.29 REPORT 1160 101 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 ri CqqVrRs�F! CITY OF CARMEL Expense Report (required for all travel expenses) Y NnlaNp EXHIBIT A EMPLOYEE NAME: Jim Brainard DEPARTURE DATE: 4/28/2016 TIME: 4 :23 AM/PM DEPARTMENT: Mayor RETURN DATE: 4/30/2016 TIME: 12 :39 AM PM Fundraising for the Center REASON FOR TRAVEL: DESTINATION CITY: Washington, D.C. EXPENSES ARE FOR(check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM X Transportation Gas/Tolls/ Meals Date Lodging Misc. Total' Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem $0.00 4/28/16 $578.00 $578.00 4/28/16 $22.11 $22.11 4/28/16 $32.50 $32.50 4/29/16 $14.54 $14.54 4/29/16 $10.00 $10.00 4/29/16 $12.62 $12:62 4/29/16 $14.57 $14:57 4/29/16 $22.70 ....$22:70 4/29/16 $65.00 . $65:00 4/30/16 $610.29 $61029 4/30/16 $40.56 ` ` $_.40.:56 4/30/16 $36.00 $32.50 .,$68-.50 $0.00 ;:$0;,00 $0:00 ;,$0.00 $0.00 ;$0.00 Total $578.00 . . $0.00 $.137.10 $36:00.; :;$610:2 '$0:00 : $0.00 $0.00 '` $0:00. ;$130:00 >_ .$0.00 DIRECTOR'S STATEMENT: iereba affirm that II expenses listed conform to the City's travel po' and are within my department's appropriated budget. Director Signature: Date: �� City of Carmel Form#ER06 Revision Date 5/5/2016 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. 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 5!5!2016 Page 2 Page 1 of 1 Transaction Details Prepared for awewwv James C Brainard owar'ss Account Number XXXX-XXXXXX-37009 ATE DESCRIPTION CARD MEMBER AMOUNT MAY12016 HILTON CAPITAL-WASHINGTON,DC JAMES C BRAINARD $610.29 Doing business as: Itinerary Details i THE CAPITAL HILTON 1001 16TH STREET NW Arrival WASHINGTON Dc I 04/28/16 20036 h UNITED STATES OF AMERICA(THE) Departure Additional Information:00013601 LODGING 04/30/16 —� Reference:320161220323668116 Category:Travel-Lodging LODGING https://onae.americanexpress.com/myca/shared/summary/estatement/print_doc2016-R l.html 5/4/2016 THE CAPITAL HILTON 1001 16TH STREET NW WASHINGTON,DC 20036 Hilton United States of America TELEPHONE 202-393-1000 •FAX 202-639-5784 HOTELS&RESORTS Reservations www.hilton.com or 1 800 HILTONS BRAINARD,JAMES Room No: 723/K1 D Arrival Date: 4/28/2016 7:35:00 PM 12662 ROYCE CT Departure Date: 4/30/2016 8:56:00 AM AdulttChild: 1/0 CARMEL IN 460332477 Cashier ID: FPOKUI/FRANK UNITED STATES OF AMERICA Room Rate: 274.00 Al: HH# 928398206 SILVER VAT# Folio No/Che 1360185 A Confirmation Number:3242986158 THE CAPITAL HILTON 4/30/2016 8:55:00 AM DATE IDESCRIPTION ID REF NO I CHARGES CREDIT BALANCE 4/28/2016 GUEST ROOM LQUEEN 7357636 $274.00 4/28/2016 ROOM TAX LQUEEN 7357636 $39.73 4/29/2016 GUEST ROOM KRYANI 7358789 $259.00 4/29/2016 ROOM TAX KRYANI 7358789 $37.56 4/30/2016 AX*7009 FPOKUI 7359176 ($610.29) "BALANCE— $0.00 You have earned approximately 6452 Hilton HHonors points and approximately 561 Miles with Delta Air Lines for this stay.Hilton HHonors(R) stays are posted within 72 hours of checkout.To check your e Thank you for choosing Hilton.You'll get more when you book directly with us-more destinations,more points,and more value.Book your next stay at hilton.com. THANK YOU FOR STAYING WITH US AT THE CAPITAL HILTON. CREDIT CARD DETAIL APPR CODE 548574 MERCHANT ID 4410109011 CARD NUMBER AX"7009 EXP DATE 10/20 TRANSACTION ID 7359176 TRANS TYPE Sale Page:1 VOUCHER NO. WARRANT NO. ALLOWED 20 JAMES BRAINARD IN SUM OF$ $130.00 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Member EXPENSE 43-430.04 $130.00 1 hereby certify that the attached invoice(s), or I REPORT I 1160yC.Q, l Ln 101 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 Friday, May 06, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 05/05/16 EXPENSE $130.00 REPORT 1160 101 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 0 of C04,6 *QNTNFuz pC CITY OF CARMEL Expense Report (required for all travel expenses) �NOtANa EXHIBIT A EMPLOYEE NAME: Jim Brainard DEPARTURE DATE 4/28/20 16 TIME: 4 :23 AM/PM DEPARTMENT: Mayor RETURN DATE: 6 TIME: 12 :39 AM PM Fundraising for the Center REASON FOR TRAVEL: DESTINATION CITY: Ti�ashin ton, D.C. EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM I X Date Transportation Gas/Tolls/ Lodging Meals Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 4/28/16 $578.00 $5780.0 4/28/16 $22.11 $2211 4/28/16 $32.50 "$3.2.60 4/29/16 $14.54 $14:.54 4/29/16 $10.00 ~ $10.':_00 4/29/16 $12.62 $120 4/29/16 $14.57 $14:57 4/29/16 $22.70 $22.70 4/29/16 $65.00 46500 4/30/16 $610.29 ;-$010.29 4/30/16 $40.56 $40-50 4/30/16 $36.00 $32.50 =:$68':60 $0:00 $0:00 $0'00 $0`:00 $0':00 $0:0.0 Total $578.00 „ $0:00 $137:'1,0 $36 00 = $61:0 29 $0:00 $0"00 ' $0:00 2,, $0.:00 $130 00 ' $0:00 DIRECTOR'S STATEMENT: ere b affirm that II expenses listed conform to the City's travel po' and are within my department's appropriated budget. Director Signature: Date: �� City of Carmel Form#ER06 Revision Date 5/5/2016 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. 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 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 5/5/2016 Page 2