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304253 10/20/16
CITY OF CARMEL, INDIANA VENDOR: 365288 ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $*******173.34* CARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD CHECK NUMBER: 304253 WESTFIELD IN 46074 CHECK DATE: 10/20/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4343000 100416 123.34 TRAVEL FEES & EXPENSE 1091 4344100 100416 50.00 CELLULAR PHONE FEES Voucher No. Warrant No. 365288 Baumgartner, Kurtis Allowed 20 16930 Kingsbridge Blvd Westfield, IN 46074 In Sum of$ $ 173.34 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 Reimb 4344100 $ 50.00 1 hereby certify that the attached invoice(s), or 1091 Reimb 4343000 $ 123.34 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 October 12, 2016 Signature $ 173.34 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 365288 Baumgartner, Kurtis Terms 16930 Kingsbridge Blvd Westfield, IN 46074 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 10/4/16 Reimb Cell Phone Reimbursement Sep'16 $ 50.00 10/10/16 Reimb Travel Expenses for NRPA Conference $ 123.34 Total Is 173.34 1 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 DUE BY .Oct 1%2016 5113.71 . _ KURTIS BAUMGARTNER ata Account Number 243007377604 16930 KINGSBRIDGE BLVD �6001 WESTFIELD,IN 46074-7800 - Please include account number on your check. Make checks payable to: CHECK FOR AUTO PAY AT&T MOBILITY (SEE REVERSE) PO BOX 6416 CAROL STREAM IL 60197-6416 9740024300737760400000D0001137100000011371002 3763.5.168.34999 2 AV 0.376 6n AutoPay Enrollment If i enroll in AutoPay,I authorize AT&T to pay my bill monthly III'�I��I'I�'IIIIIII��IIIIIII'II'�'�II'�I�II'I"IIIIIIII�I�I"�� by electronically deducting money from my bank account.I can cancel authorization by notifying AT&T at www.att.com or by KURTIS BAUMGARTNER calling the customer care number listed on my bill.Your 16930 KINGSBRIDGE BLVD enrollment could take 1-2 billing cycles for AutoPay to take WESTFIELD IN 46074-7800 effect.Continue to submit payment until page one of your Invoice reflects either AutoPay will Debit Your Bank Account by or AutoPay will Debit Your Credit Card by. Bank Account Holder Signature: Date: a Carmel • Clay Parks&Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense 10/15/2016 . AT&T '1091 4344100 Cellular Phone Fees $ 50.00 Sept Cell Phone Charges All receipts should be.attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: $5000 Employee Name(print) Kurtis"Baumgartner - Address 1693Q�Kngsbrdge Bivd . Check payable to: City, St, Zip Signature: . Approved by: Date: 1.0/A/`201:6-}-- Date: Ll� // 1�ECEIVE;D Business Services Division,Revised 7-7-08 FILE: Shared\Forms\Business Services\Employee Exp Reim,b Request O C T 11 2016 BY: Carmel a Clay Parks&Recreation Employee Expense Reimbursement Request Colr��or)cc Date of Fund Account Account Cp Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense 10/4/2016 Bandana's Bar-B-Q 1091 4343000 Travel Fees& Expenses $ 31.18 Food &Beverage 10/4/2016 Ordners BP 1091 4343000 Travel Fees& Expenses $ 2 3.83 Food& Beverage 10/4/2016 Starbucks 1091 4343000 Travel Fees& Expenses $ 3 5.11 Food& Beverage 10/4/2016 Jack Patricks Bar&Grill 1091 4343000 Travel Fees&Expenses $ 21.00 Food &Beverage 10/5/2016 Monty's Sandwich Co. 1091 4343000 Travel Fees&Expenses $ 10.44 Food & Beverage 10/6/2016 Bailey's Range 1091 4343000 Travel Fees& Expenses $ ISO 30.89 Food& Beverage 10/7/2016 Marriott Starbucks 1091 4343000 Travel Fees& Expenses $ 5.45 Food &Beverage 10/7/2016 Park Avenue Coffee 1091 4343000 Travel Fees&Expenses $ g 6.39 Food& Beverage 10/7/2016 Love's 1091 4343000 Travel Fees &Expenses $ 9.05 Food &Beverage All receipts should be attached in the same order as listed above. / No sales tax will be reimbursed. TOTAL: $123.34 v Employee Name(print) Kurtis Baumgartner Address 16930 Kingsbridge Blvd. Check payable to: City, St, Zip ftstfield, IN 46074 Signature: Approved by: 1 Date: 10/10/2016 Date: Business Services Division,Revised 7-7-08 - DECEIVED FILE: Shared\Forms\Business Services\Employee Exp Reimb Request OCT 11 2016 BY: BANOAiR 6-Q 3060 HWY 41 Terre IN 47802 ,4.4601 10/04/2016 Server; Taylor - 1;07 PM le 24/2 10004 6 2.49 12.99 via to We � re.OltPnift'n9" Q,c�dQ• 'Wit10 60 - �� 40 o� ,•mss WELCOME TO I ORDNERS BePr Avenue Coffee I1���Ln N OkDNERS BP 417 N. 10th Street i -'"�'_ N c.RINGOF'EEK M:ONTROSE IL Downtown St. Louis, MO 63101 STORE 0584 Phone (314) 231-5282 1900 South State Rt 127 Greenville, IL 62246 I Desuro ;ty amount 10/7/2016 Phone: (618) 664-9287 ------ --- ----- Order Id: AAB6AFTJACDZ 10.22'22 AM i Prep t 1070 119 - Take Out 10/07/2016 Tkt #1857819 �or0 ---------------------------------------- T POP' ? Employee: Cara E. Type: SALE (ORIGINAL) ---------- 16oZ Strawberry Qty Name Price Total `l;C� 101_,31 3.60 rry Banana -------==------------------------------- Tax3 $5.80 1 12.,SC`! ITALN 6.00 6.00 TOTAH 3-6.3 I Sub Total 1 VM CHIPS 0.91 0.91 Cf'EDIT $ -.@7 $5.80 1 Large Upsize 0.20 0.2:0 Sales Tax 1 Fountain Small 1.29 1.2:9 EISA $ vC, ---------------------------------------- I Order Total $0.59 Subtotal 8.40 Acct/Card 4_ XXXXXXX;�;XE':??� $6.39 Sales Tax 0,65 Auth #° 0100916 Visa I Total 9.05 s fo /6707050 i ---------------------------------------- Card#: ************ $6.39 Received: -P Dde. 000 9171 VISA 9.05 I %1 D= 00100 Authorization: 017022 9171 SWIPED 4 se�e�c�e�r�c�c�rrcir:rx e ': �'.357?F,� Auth No: 417084 INVO84176 --> Order Closed <-- ---- �6�7 MERChi,!\T COPY ------------------------------------- IIIIIIReg:1 Cl erk:Chr;st;an AI1111IIIIIIIIIIIIIiIIIIIIIIIIIIIIIIIIIIIIIIIIlIIiIIIIIIIIIIII F 1 6AFTJACDZ * � Visit our newest location: ' ACLC /Card 4! X.XXXXXXXXXXXVQ22 4240 Duncan Ave Stan. 03�,.g7%0 One Block West ' of II(EA F'EG# 000E COIR ODI DDR 01 THAN .14760 Today's WiFi Code: 1O/r�4/1�: 1=x-08-37 .9T# I PAC89ZXY I & & & 430 & & & ***** CREDIT CARD VOUCHER ***** MARRIOTT ST. LOUIS GRAND HOTEL ST. LOUS, MO Baileys' Range **** STARBUCKS Baileys' Range Burgers and Shakes Burgers and Shakes 7 OCT'16 7:48 AM 920 Olive 920 Olive St. Louis, MO 63101 Check: 6050 St. Louis, MO 63101 314-241-8121 Server: 37054 L'ATICE 314-241-8121 Card Type: VISA Server: Alex DOB: 10/06/2016 Acct Num: ************9171 Server: Alex 10/06/2016 07:31 PM Auth Code: 707084 10/06/2016 801/2 7:26 PM 801/2 Customer: KURTIS BAUMGARTNER Guests: 1 70019 7/70019 Large Shake 5.50 SALE Amaunt : $5 . 4-9 add banana 1.00 VISA Strawberry Card #XXXXXXXXXXXX9171 7340072 Pretzels 6.00 Magnetic card present: BAUMGARTNER KURTIS GRATUITY $ I Going B to Cali 11 .00 Card Entry Method S Subtotal 23.50 Approval: 916013 TOTAL $ Tax 2.39 SIGNATURE________.__ Total 25.89 Amount: $ 25.89 a� Balance Due 25 . 89 + Tip: �� please leave signed copy Thank you for joining us! = Total: JAG, _ with your server _ Please Visit Us at Our Sister Restaurants Bridge Tap House I agree to pay the above Rooster crepe.sandwich.cafe total amount according to the Baileys' Chocolate Bar card issuer agreement. The Fifth Wheel at Four Hands Brewery X Customer Copy & & & 430 & & & MARRIOTT ST. LOUIS GRAND HOTEL Monty's Sandwich Co. ! ,i ** * STARBUCKS **** 200 N, Broadway, ste 110 ccon 49842 REGGIE 314-241-7900 ----------------------- - ------------ C H K 6320 102 Jodi M CL o -------------------------------- V a ----- - - 4 OCT'16 4:17 PM ' a,------------ AS ------------------------ Chk 335 18 Gst 0 CO 1 GRND PUMPKIN SPICE 4.55 0ct05'16 1.2:50PM = o ---------------- ==-------------- C* y... v 0a ? Subtotal: $4.55 He r e` m + >` Tax: $0.56 1 Americas Club— 7.49 CMC3 m E , Tota 1_: 1 32oz Soda 1 .99 E v cc ; Change Due $0 . 00 Credit Card 10.44 `° _ m VISA $5.11 N w x c ************6222 Subtotal 9.48 LL a aw E CLco E -- Check Closed ----------- Tax ' 0.96 < 4 OCT'16 4:18 PM Paym�nt 10.44 15 a ---------.--.---.--..-.--.--•----- PA - Thank you for your Business! �Uw t f www.STLmontys.com © .I d ^ N mF� rn I � n �V 1 �1 J 1 lP M I Ql � ice• i 11 U' 1 N IL Yk 40 40TN Q Cn cfl n to 1 bLU W �^ d m I -r ic 6 V - fn J H C" 04W } cmX Ln /� H m O V I {!f LCm CDnnL F. a H M o i � -Xk W,°oo Ln �y N :c 00 U h[ to f0 I tD •• � Yk F 1". •E 1 �t Q�� '" U � J BANDANA'S BAR-B-a 3060 S US Hwy 41 Terre Haute, IN 47802 BANOANq'S BqR B O 812.914.4601 3060 S US Huy 41 Terre Haute, IN 47802 Server: Taylor 10/04/2016 812.814.4601 Table 24/2 1 :07-PM Guests: 6 10004 Server: Taylor 008: 10/04/2016 Reprint #: 1 01:07 PM Table 24/2 10/04/2016 / 1/10004 — ----— - — SALE PEPSI / 2.49 TURKEY DINNER 12,99 VISA LG NACHOS 839 99 Card gXXXXXXXXXXXX9171^ 1048584 Nagnetic card Present: BAUNOARTNER KORTIS Card Entry Method: s We value your opinion Please respond to 2 quick questions Approval,:-049800 about your dining experience for a chance to win a,$100 Gift Card Amount: $ 26.18 Please visit: bandanasbbq.com/survey and enter in your 20 digit code. — + Tip: 1020 000 100 140 010 325 BO = fetal: 3/ I agree to pay the above Subtotal 24,47 total amount according to the Tax - 1 .71 card issuer agreement. Tota l 26.18 X—_ w - - VISA #XXXXXXXXXXXX9171 26,18 Auth:049800 1 Guest Copy Ba 1 ante Dtje p . 00 "SMELL THAT SMOKE" Have an upcoming event? Give our Catering -Offioe a call at: - -- 636.537.8200 -- --- Check C1nGD-' c