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300821 07/21/16
0J`%��pM CITY OF CARMEL, INDIANA VENDOR: 365130 ONE CIVIC SQUARE MARK CROMLICH CHECK AMOUNT: $*****1,213.60* �� CARMEL, INDIANA 46032 12685 LANTERN RD CHECK NUMBER: 300821 ��TON�� FISHERS IN 46038 CHECK DATE: 07/21/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4128000 071816 1,213.60 TUITION REIMBURSEMENT VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) MARK CROMLICH ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 12685 LANTERN RD IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service FISHERS, IN 46038 rendered,by wham,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $1,213.60 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT /� 11 0 41-280.00 $1,213.60 1 hereby certify that the attached invoice(s),or 7/18/16 0 $1,213.60 1120 v�( 101 1120 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 Monday,July 18,2016 v4v®r- '_Z�_ David Haboush Fire Chief 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 . Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer City Of Carmel Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Headnp for to commencement of course.) Employee Name Mark Cromlieh Department Fire Hire Date 6-18-94 Educational Institution* Ball State University Name of Course** EMHS 550 - .Hazardous Materials Health and Safety Credit Hours 3 Starting Date of Course(month/day/year) May 9-13 2016 By signing below, I 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, I 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 (I) 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 subject to federal law, which may change from time to time. Mark C ro m(i ch Digitally signed by Mark Cromlich 4/25/16 Employee Signature Date:2016.04.25 11:58:09-04'00' Date Part H (to be completed by Department Head) (Submit to Human Resources) By signing below, I certify that the applicant will have been employed full-time by the City for at least one (1) year prior to the commencement o e course, and has not been subject to a disciplinary probation, suspension or demotion within 90 days prio t the beginning of th course. The final claim will be paid from my department's budget,subject to th to Se 'on 2-58/o armel ity Code. Department Head Signature �'("-'I Date Part III (to be completed b Director of Human Resources) 71110� Final Approval Date S� 5 , If denied,reason for denial * The tuition reimbursement program covers only full-semester 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. CASHNet Page 1 of 1 Ball State U. niversity Bursar and Loan Administration - eBill System Receipt Number: 620719 Customer: CROMUCH, MARK BSU ePayment Current Date: 05/09/2016 Description Amount Balance (2015301MA12) $1,517.00 DESC: Hazardous Material Health and Safety Course Total $1,517.00 Payment Submitted Amount BSU ePayment ACH $1,517.00 Checking Account XXXXXX7459 Routing # 074908594 FIFTH THIRD BANK; CINCINNATI, OH Total $1,517.00 Thank you for the payment. https://commerce.cashnet.com/cashnetk/selfserve/PrintableReceipt.aspx?IRDS=O&Z=VP 7/18/2016 ® Statement Period Date:4/23/2016-5/23/2016 Account Type: 5/3 Essential Ckg FIFTH THIRD BANK CITY OF CARMEL Benefits (CENTRAL INDIANA) Account Number:7655957459 P.O.BOX 630900 CINCINNATI OH 45263-0900 Banking Center:Fishers Corner MARK A CROMLICH 12685 LANTERN RD 0 Customer Service:800-972-3030 FISHERS IN 46038-1040 Internet Banking&Bill Payment:www.53.com 1408 STAY ORGANIZED AND HELP THE ENVIRONMENT WITH PAPERLESS STATEMENTS.VISIT 53.COM/GOPAPERLESS TO LEARN MORE.MEMBER FDIC Account Summary =7655957459 CITY OF.CARMEL Benefits 04/23 Beginning Balance $8,916.21 Number of Days in Period 31 3 Checks $(360.00) 14 Withdrawals/Debits $(9,179.27) 5 Deposits/Credits $3,682.54 05/23 Ending Balance $3,059.48 Fee Summary 'This Period 2016 Year To Date 2015 Fee Totals Total Overdraft Fees $0.00 $0.00 ($25.00) Total Return Item Fees $0.00 ($37.00) $0.00 Total Reversed,Overdraft $0.00 $0.00 $0.00 and Return Item Fees Monthly service charge to be withdrawn on first business day after this statement: $0.00 The monthly service charge associated with your 5/3 ESSENTIAL CKG account is$11.00 Your monthly service charge was WANED or DISCOUNTED$11.00 because: EMPLOYER'S 5/3 BANKING PROGRAM REMEMBER,NO MONTHLY SERVICE CHARGE IF: You maintain a total monthly average balance of$1,500 across your (Statement Period:04/23/16-05/23/16) checking,savings,and investment accounts. OR you are.a current or.former U.S.military member with a monthly Your Accounts Monthly Avg.Bal. direct deposit totaling$500 or more. CHECKING X7459 $6,705.78 OR you are a student. SAVINGS X9233 $46.92 SAVINGS X3796 $471.77 SAVINGS X9841 $610.43 Total Combined•Monthly Average Balance $7,834.90 OR you have any existing Fifth Third personal mortgage,auto loan, Fifth Third Loan? No or line of credit with an outstanding balance. OR you can.spend at least$500 per month on a Fifth Thirdcredit $500 Credit Card Spend? No card.. For additional information and account disclosures,please visit www.53.com Page 1 of 2 FIFTH THIRD BANK Checks 3 checks totaling$360.00 *Indicates gap in check sequence i= Electronic Image s=Substitute Check Number Date Paid Amount Number Date Paid Amount Number Date Paid Amount 9001 i 05/09 120.00 9002 i 05/13 120.00 9003 i 05/20 120.00 Withdrawals/ Debits 14 items totaling$9,179.27 Date Amount Description 04/26 72.74 5/3 ONLINE PYMT TO COMCAST--ACCT X)00000000(4061 04/27 48.47 5/3 ONLINE PYMT TO INDIANA GA-ACCT)0000000000(9049 04/29 25.00 5/3 ONLINE TRANSFER TO SV:) 0000(3796 REF#00426695492 05/02 2,373.13 WEB INITIATED PAYMENT AT CAPITAL ONE MOBILE PMT 612039809380649 050216 05/09 1,651.11 WEB INITIATED PAYMENT AT CAPITAL ONE MOBILE PMT 612839809215926 050916 05/10 1.00 WEB INITIATED PAYMENT AT JPMorganFee PropTaxFee HCTTAX000144151 051016 05 0 07.42 WEB N D P Y E. T amilton-County ropertyT CTTAX000144150 0 0 6 05/12 1,51►7.00 WEB INITIATE©PAYMENT AT BALL STATE UNIV SCHOOLFEE-S 900973497 0501216. 05/13 5-00=15MN5/3ONLINEITM5FER 0 S c 79 RE 00428394529 05/18 864.30 RETURN DEPOSIT ITEM(S)ADVICE:101957 05/18 15.00 RETURN DEPOSIT ITEM(S)FEE 05/23 513.60 WEB INITIATED PAYMENT AT CAPITAL ONE MOBILE PMT 614139809177319 052316 05/23 60.00 5/3 ONLINE PYMT TO INDIANA GA-ACCT)0000000000(9049 05/23 105.50 5/3 ONLINE PYMT TO DUKE ENERG-ACCT XXXXXXX7037 Deposits/ Credits 5 items totaling$3,682.54 Date Amount Description 04/25 292.00 IRS TREAS 310 TAX REF 304195115200909 042516 04/29 1,529.32 Carmel Pay7838 DR DEPOSIT 539 042916 05/13 132.07 KHI SOLUTIONS IN PAYROLL 66211100000446X 051316 05/13 795.08 Carmel Pay7838 DR DEPOSIT 539 051316 05/13 934.07 DEPOSIT Daily Balance Summary Date Amount Date Amount Date Amount 04/25 9,208.21 05/02 8,218.19 05/13 4,737.88 04/26 9,135.47 05/09 6,447.08 05/18 3,858.58 04/27 9,087.00 05/10 4,538.66 05/20 3,738.58 04/29 10,591.32 05/12 3,021.66 05/23 3,059.48 THANK YOU VETERANS AND ACTIVE SERVICE MEMBERS. WE APPRECIATE YOUR SERVICE! Page 2 of 2 Registration History Page 1 of 2 Registration History The following shows completed registrations, withdrawals and waitlisted courses. Look under the status column to determine course status. Summer 2016 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 181 EMHS 550 Haz Mat Health and 3000 Gradual Registers ''May , A Safe 201'6gill Spring 2016 CRN Course Course Title. Credits Level Status Midterm Final Grade Grade 25487 BED 616 Research Methods 3.000 Graduate "Web Registered"Dec A 17,2015 25549 EDPS 520 Intro Gifted Talented 3.000 Graduate "Web Registered"Jan A 05,2016 Fall 2015 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 14222 EMHS 589 Emergency Response 3.000 Graduate "Web Registered—Aug A WMDs 07,2015 Summer 2015 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 30371 TEDU 550 CTE Student 3.000 Graduate "Web Registered"May A Organizations 11,2015 30373 TEDU 696 Coordinating Coop 3.000 Graduate "Web Registered—Mar A Programs 27,2015 34607 TMFG 560 Occupational Safety 3.000 Graduate "Web Registered"Mar A and Health 27,2015 Spring 2015 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 20587 TEDU 569 Organization 3.000 Graduate "Web Registered"Nov A Coordination CTE 13,2014 Fall 2014 CRN Course Course Title Credits Level Status Midterm Final Grade Grade - 15158 TEDU 552 Strategies and 3.000 Graduate "Web Registered"Aug A Materials CTE 17.2014 15159 TEDU 568 Principles and 3.000 Graduate "Web Registered"Aug A Philosphy CTE 17,2014 https://prodssb.bsu.edu/PROD/bwskhreg.p_reg_hist 7/18/2016