HomeMy WebLinkAbout304861 11/03/16 VOID CITY OF CARMEL, INDIANA VENDOR: 00350224
CHECK AMOUNT: $*******497.76*
(9--
ONE CIVIC SQUARE NANCY HECKCARMEL, INDIANA 46032 CHECK NUMBER: 304861
CHECK DATE: 11/03/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4343001 102816 258.00 TRAVEL FEES & EXPENSE
1203 4343004 102816A 239.76 TRAVEL PER DIEMS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
NANCY HECK ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF$ 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.
$239.76 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Community Relations 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
MILEAGE CLAIM 43-430.04 $139.76 I hereby certify that the attached invoice(s),or 10/28/16 MILEAGE CLAIM $139.76
1203 101 1203 101
EXPENSE 43-430.04 $100.00 bill(s)is(are)true and correct and that the 10/28/16 EXPENSE $100.00
REPORT materials or services itemized thereon for REPORT
1203 101 1203 101
which charge is made were ordered and
received except
Monday, October 31,2016
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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
C`�Q RT.Y4.q,��FC
a_
CITY OF CARMEL Expense Report (required for all travel expenses)
V
N�IANI` EXHIBIT A
EMPLOYEE NAME: Nancy Heck DEPARTURE DATE: 10/4/2016 TIME: 11 :00 A PM
DEPARTMENT: Department of Community Relations&Econ Develop_ RETURN DATE: 10/6/2016 TIME: 10 :30 AM M
REASON FOR TRAVEL: IACT Annual Conf DESTINATION CITY: French Lick, Indiana
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
10/4/16 $129.00 $50.00 $179:00
10/5/16 $129.00 $50.00 $179;00
_,$0x00
$0:00
$0:00
$0:00
$0:00
$0:00
$0:00
$0.00
$0:00
$0,:00
Total $,0-00, $0;00 $0:00 . ; $0 00 $258 00 ,,`. _$0:00 , '$0 00 $0';00 ,„:,;$0:00;, , $100 00
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: ;>" AAA Date:
City of Carmel Form#ER06 Revision Date 10/28/2016 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
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 10/28/2016 Page 2
Prescribed by State Board of Accounts
MILEAGE
City of Carmel
(Governmental Unit)
Dept. of Community Relations & Economic Development
(Office,Board,Department or Institution)
DATE FROM TO ODOMETE
20 16 Point Point Start
10/4/16 Home French Lick Indiana
10/6/16 French Lick Indiana Home
Auto License No.
*SPEEDOMETER READING columns are to be used only when distance between points cannot be determir
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing accoun
allowing all just credits, and that no part of the same has been paid.
Date 10/28/2016
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
NANCY HECK ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF$ 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.
$258.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Community Relations 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
EXPENSE 43-430.01 $258.00 1 hereby certify that the attached invoice(s),or 10/28/16 EXPENSE $258.00
REPORT REPORT
1203 101 bill(s)is(are)true and correct and that the 1203 101
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, October 31,2016
IV?L
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
' A F
CITY OF CARMEL Expense Report (required for all travel expenses)
,Ao,gNP EXHIBIT A
EMPLOYEE NAME: Nancy Heck DEPARTURE DATE: 10/4/2016 TIME: 11 :00 A PM
DEPARTMENT: Department of Community Relations& Econ Develop_ RETURN DATE: 10/6/2016 TIME: 10 :30 AM M
REASON FOR TRAVEL: IACT Annual Conf DESTINATION CITY: French Lick, Indiana
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM X
Transportation Gas/Toils/ Meals
Date Lodging Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
10/4/16 $129.00 $50.00 $179.00
10/5/16 $129.00 $50.00 $179.00
$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
$0.00
$0.00
Total $0.00 $0.00 $0:00 $0.00 $258.00 $0.00 $0.00 $0.00 $0.001 , $100.001 $0.00
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date: (y P-
City of Carmel Form#ER06 Revision Date 10/28/2016 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
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 10/28/2016 Page 2
II III III II
FRENCH LICK
RESORT
Name: NANCY HECK Arrival Date: 10/04/2016 Cl Clerk KALOBATHAN
Address: Departure Date: 10/06/2016 CO Clerk LRUTHERFOR
Group Code: CMAB
24 1 of
1
4255008625
at ::s::>::::>:<:::>:::<::
...........Dale................Fie#rt..enEe....:........::...::....:..:....::::. ..::.:,Desai trnrx.:: :.........................................�Gh; r. ...s....... .::....:...:. .......:.::::.:..::.:::::.::.:::.
10/04/2016 426469100254 ROOM CHARGE FL 2408 129.00
TAX1 9.03
TAX2 7.74
10/05/2016 426479100237 ROOM CHARGE FL 2408 129.00
TAX 1 9.03
TAX2 7.74
10/06/2016 426482633353 FL FRONT DESK VISA 291.54
See a k fne�Lc4 3354
,00
Total Due .00
I agree to remain personally liable for the payment of this account if the corporation or other third party
fails to pay part or all of these charges. I also agree that all charges contained in this account are correct
and any disputes or requests for copies of charges must be made within five (5) days after my departure.
If you are using a credit card, the hold may last up to 3 business days past your check-out date. If you
are using a debit card, the hold on funds may last from 7-10 business days.after your check-out date.
Guest Signature:
French Lick Springs Hotel 8670 West St Road 56 French Lick, IN 47432
888.936.9360 frenchlick.com
1
II fIl I�I ��
FRENCH LICK
RESORT
Name: NANCY HECK Arrival Date: 10/04/2016 Cl Clerk KALOBATHAN
Address: ---- - Departure Date: 10/06/2016 CO Clerk LRUTHERFOR
Group Code: CMAB
Room#: FL 2408 Resv 425500862557 Page 1 of 1
Date Reference Description Charges Credits
10/11/2016 426532726996 FRENCH LICK ROOM CHARGE 33.54
FL RM CHG ADJ V
10/11/2016 426532726999 FL FRONT DESK VISA 33.54 P
41-01
Total Due .00
I agree to remain personally liable for the payment of this account if the corporation or other third party
fails to pay part or all of these charges. 1 also agree that all charges contained in this account are correct
and any disputes or requests for copies of charges must be made within five (5) days after my departure.
If you are using a credit card, the hold may last up to 3 business days past your check-out date. If you
are using a debit card,the hold on funds may last from 7-10 business days after your check-out date.
Guest Signature:
French Lick Springs Hotel 8670 West St Road 56 French Lick, IN 47432
888.936.9360 frenchlick.com