HomeMy WebLinkAbout322554 03/12/18 y u,G4q�
'> CITY OF CARMEL, INDIANA VENDOR: 364386
�S ONE CIVIC SQUARE KURT ANDERSON CHECK AMOUNT: $********13.00*
CARMEL, INDIANA 46032 C/O ENGINEERING CHECK NUMBER: 322554
CHECK DATE: 03/12/18
DEPARTMENT _ ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4231400 13.00 GASOLINE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 364386 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
KURT ANDERSON IN SUM OF$ CITY OF CARMEL
C/O ENGINEERING 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
$13.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Engineering
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
0 42-314.00 $13.00 1 hereby certify that the attached invoice(s),or 3/7/18 0 Gas-Road School Purdue $13.00
2200 2200 2200 2200
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, March 12,2018
Jeremy Kashman
Director
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
\�y of ctigy
y CITY OF CARMEL Expense Report (required for all travel expenses)
«. ko�ANp.f' EXHIBIT A
EMPLOYEE NAME: DEPARTURE DATE: , �-7-12 TIME: AM/PM
DEPARTMENT: >7 RETURN DATE: 3-2-1,0PTIME: AM/PM
REASON FOR TRAVEL: lqc)-Ot Oa / DESTINATION CITY: e,S f �Q"�a C-11L
EXPENSES ARE FOR(check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT i TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total :<
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
3/7/18 $13.00
$0'.00
I $0:00
$0;00
$0:00
$0.00
i $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 ",'x$0.00 $1.3.00 $0;00 $0:00 $0.00, " ";$0.:00 .. . $0;00 `$0.00 , $000
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.
Wrecto'RSig at Dater
City of Carmel Form#ER06 Revision Date 3/8/2018 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#ERO6 Revision Date 3/8/2018 Page 2
WELCOME TO
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00000191981-01 ROMNEY FOODMART
4 SR 28 WEST ROMNEY IN
DUPLICATE OUTDOOR RECEIPT
VISA
ANDERSONAURT
AU1H# 00 DOC# 63022
DATE 03/07/18 14:54
PUMP # 01
PRODUCT: UNLD
APPROVAL # 003218
GALLONS: 4.817
PRICE/G: $ 2.699
FUEL SALE $ 13.00
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- ,r