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Home My WebLink About181809 02/03/2010 0 CITY OF CARMFL, INDIANA VENDOR: 363878 Page 1 of 1 ONE CIVIC SQUARE SUSAN BEAURAIN r b 3737 KNICKERBOCKER PLACE 2 D CARMEL, INDIANA 46032 CHECK AMOUNT: $2,000.00 ,+L INDPLS IN 46240 CHECK NUMBER: 181809 CHECK DATE: 2/3/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4359000 2,000.00 MOVING EXPENSES i Carmel 0 Clay Parks&Recreation Memo To: Cindy Sheeks, Finance Manager From: Carmel /Clay Board of Parks and Recreation Date: February 9, 2010 Re: Susan Beaurain's Relocation Allowance This memorandum is to certify that the Carmel /Clay Board of Parks and Recreation "Park Board authorizes Susan Beaurain to be reimbursed up to $2,000 for her documented relocation expenses from Clarkston, Washington. Ms. Beaurain's receipts for reimbursement totaling the full $2,000 allowance were included on the Claims Sheet approved by the Park. Board at its meeting on January 26, 2010. This action was ratified by the Park Board on February 9, 2010. Ai N.. 1 ,q KG Joseph R iller, President Attest: 1 Richard F 1aylor ecretary Carmel 6 Clay Parks &Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense 1/5/2010 Exxon Express 47 100- 100- 4359000 Special Projects 31.01 Moving Expense Fuel 1/5/2010 Big D Exxon 47 100- 100- 4359000 Special Projects 23.00 Moving Expense Fuel 1/6/2010 Sapp Brothers 47 100 -100- 4359000 Special Projects 15.50 Moving Expense Fuel 1/6/2010 1 -80 Cenex South 47 100 100 4359000 Special Projects 20.29 Moving Expense Fuel 1/6/2010 Kabredlo's Cony Store 47 100 100 4359000 Special Projects 27.07 Moving Expense Fuel 1/7/2010 TA TravelCenter 47 100 100 4359000 Special Projects 9.50 Moving Expense Fuel 1/7/2010 Bosselman Travel Center 47 100 -100- 4359000 Special Projects 17.26 Moving Expense Fuel 1/7/2010 Shell 47 100 -100- 4359000 Special Projects 19.50 Moving Expense Fuel 1/8/2010 Colonial 10 47 100 -100- 4359000 Special Projects 29.50 Moving Expense Fuel 192.63 All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: $520.54 Employee Name (print) Susan Beaurain Address 3737 Knickerbocker Place Apt 2D Check payable to: City, St, Zip Indianapolis, IN 46240 Signature: Approved by: Date: 1/13/2010 Date: Business Services Division, Revised 7 -7 -08 FILE: SharedlAdministrative \Forms\Staff Forms \E Dloyee Exp Reimb Request 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 1/4/2010 Motel 6 47 100- 100 4359000 Special Projects 55.63 Moving Expense Motel 1/5/2010 Motel 6 47 100 100 4359000 Special Projects 51.39 Moving Expense Motel 1/6/2010 Motel 6 47 100 100 4359000 Special Projects 51.51 Moving Expense Motel 1/7/2010 Motel 6 47 100 100 4359000 Special Projects 47.03 Moving Expense Motel 1/4/2010 Stinker Stores 47 100- 100 4359000 Special Projects 28.97 Moving Expense Fuel 1/4/2010 Jifi Stop 47 100 -100- 4359000 Special Projects 16.36 Moving Expense Fuel 1/5/2010 Town Pumo 47 100 -100- 4359000 Special Projects 22.01 Moving Expense Fuel 1/5/2010 Casey's Corner 47 100 100 4359000 Special Projects 27.00 Moving Expense Fuel 1/5/2010 Flying J 47 100 -100- 4359000 Special Projects 28.01 Moving Expense Fuel 327.91 I All receipts should be attached in the same order as listed above. N o sales tax will be reimbursed. I TOTAL: Employee Name (print) Address Check payable to: City, St, Zip Signature: Approved by: Date: l i I 3 ro Date: Business Services Division, Revised 7 -7 -08 FILE: Shared \Administrative \Forms \Staff Forms\Employee Exp Reimb Request 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 1/19/2010 Northwest Relocation 47 100- 100 4359000 Special Projects 1,479.46 Moving Expense Mover All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. I TOTAL I $11 4 Wh o V re cef 9 Employee Name (print) Susan Beaurain g 0 O Address 3737 Knickerbocker Place Apt 2D Check payable to: City, St, Zip Indianapolis, IN 46240 Signature Approved by: AIIII Date: 1/20/2010 Date: ii 2_0110 Business Services Division, Revised 7 -7 -08 ,4 FILE: Shared\AdministrativelForms \Staff FormslEmployee Exp Reimb Request L JAN 2 0 2010 Shipper: 544 Xt".®v /.w'r, Qa Shipper: e7 ''Wf J d z Address: 23?-25 ,e4/4., Apt: Address: .5 72"/ e r.'1• f!flyit+r 11 Apt: 2,; i J q p• o m E City: I� O/7 Stat /V /f Zi 1 4 1 i Ci ty:. I Q 'lt'Y-f .1 State: 11) Zi I/r 43U m 0 Tel. (1):.ri .Z- ,333 Tel. (2) -5 7.58-2'/ 11 (/1 i Tel. (1): Tel, (2) °zs Additio Pickup: 0„ Additional Pickup: y 9 �J o a Agent name: Address: Phone:, FORM OF PAYMENT: A non refundable deposit of 20% of the estimate is m SUMMARY OF' CHARGES t y x x required to book any job. On or before the pickup 50% of the total estimate is a.,= required to be paid in the form of cash, credit card (Visa, Mastercard. or Transportation 231Vi. bs )c.f- Q per Ib.lc.f. i e Amex), postal money order, or cashiers check. Personal checks will be ac- cepted only if there is at least 10 days between the pick up and delivery. The Addlt'I lbs. /cu.ft. per lb. /c.f. remaining balance due must be paid in the form of CASH or U.S. POSTAL Van Men Hrs. Per. Hr. MONEY ORDER only. Payment in FULL of all charges is required before d ivery and prior to unloading, subject to the 110% law is applicable. Stairs; (Origin) z rc nature: 1 J Date: Stairs: (Destination) g m G/ V l O I Long carry: (Origin) 2 O z° VALUATION F C A GE: Carrier provides two valuation options: Limited Long carry: (Destination) m r liability and full replacement value (FVP). Both plans cover furniture and boxes Total material and Packing (see attached price list): 111/ p Op packed /unpacked by Carrier. We suggest you purchase third party insurance o to protect your property. Full Packing Service: 0 D Shuttle: o fa+ a NOTE: Since Carrier cannot control whether proper packing methods are r i ob 0 i, used, on boxes packed by the owner as well as pressed wood (particle Extra pickup or delivery: w board) furniture, liability is waived. The carrier cannot be held liable for any j 4 N damage to Internal electronic or mechanical Items, whether they are packed or Storage charge (par month): VG 'r' unpacked by the carrier or by the shipper. Canter Is also not responsible for Fuel Charge: w sews z° fragile or brittle Items such as glass, china, omarnents, etc.The carrier has the F 2 0� V right to Inspect and repair any alleged damage and provides no coverage for Misc. Bulky Item Handling: m IM cosmetic damage to any flails, It is agreed that oarrier can't be held liable or cc v negligent for any damage to the interior or exterior of any residence including, Valuation Declared Value U but not limited to walls, floors, ceilings, landscaping, etc. Other: Option A: Limited Liability: As a licensed carrier with the U.S. D,O.T. we Other: are required to provide limited liability coverage at no charge to the customer. Flatrate: Under this option. the maximum liability is limited to $0.00 per pound per article, for all items indicated as damaged or missing at time of delivery. Ship- TV RECORD i 1 TOTAL HOURS per and/or agent has full authority to accept the shipment and enter into this Start 3 1M r•L'. (office use) eement. r iSsrstomer lnl Is ature: i r oats Finish 6:40 ej n 4 I f r t no,her lnelalr r C X _>C J TO BE SIGNED UPON PICKUP: Packing material and labor are not included tY and will be charged per items ordered and listed on the packing materials list. ur 0 0 Bys(g this foryou er wa Ing certain valuable coverage which protects Estimate is rate based oh the items that were estimated by you. Total charges y N co your property abovelh0 mi amounts set by law. Please read carefully. are based on the actual weight of your property or the actual cubic feet your E rn '9 r property occupied. The space reservation option, If selected by shipper, may ce m Option B: Replacement: Replacement value coverage (FVP) will pro- be used by the carrier to determine charges. Bill of Lading is the controlling r/) c) N cat vide repair, replacement, or reimbursement In the event of damage or loss. The shipping document. You will be notified of final charges prior to delivery and o rl) minimum declared value of a shipment under this option is $5,000 or $4.00 while in transit. All charges. Including additional services will be charged E Z m to times the actual total weight (in pounds) of the shipment, whichever is greater. based on the full tariff rates. (NW Relocation Tariff). Shipper or agent has full 8 t The approximate cost for FVP is $8.50 for each $1,000 of declared value FVP authority to order services and enter into agreement. I have received the zti o m m i w z N tl t- is offered with a $250, $500 or with no deductible. The amount of the deduct- booklet: Your Rights and Responsibilities When you Move and pamphlet I ible will affect the cost of your FVP coverage. Declared Value e dy to Move. Signature: Date: 'I tore: yJ J t 'i Date: i „C I Filing of claims: Carrier shall not be liable for the loss or destruction of or U GRAND TOTAL: )A 7 G j damage of the goods tendered hereunder or any part thereof unless claim is made in writing supported by proof of ownership, together with substations of PARTIAL PRE PAYMENT: i value, and weight. Moreover, as a condition precedent, all outstanding monies due to the carrier must be paid In full before any claim can bersubmiaed to the COLLECTED BY: DATE company. Claims must be filed within 9: rtkiiiiha of delivery or uerriand thereof is refused and must be limited to the dostinatton descriptions of, damages for BALANCE DUE: each item on the inventory logs. All damages and missing items must be noted on the inventory logs. A general reservation of rights or generic statement of PRICE ADJUSTMENT ON DELIVERY: damage. is not permitted. Damage Indications must specify each Itdm damaged at the time of delivery. Inspection of Carrier's Tariff: Tariff Is available for NEW BALANCE Vs G A F/9 inspection upon reasonable request by calling carrier, All rates end services are a tul ty is a ed. •c based on full tariff rates. Agreed pickup/Delivery periods: See reverse of this y e document for agreed pickupldellvery periods of the entire move. The first date DELIVERY ACKNOWLEDGMENT ;,0” C 7 4 indicated as available for delivery is first date of the delivery window and not the promised delivery date. Pick up and delivery dates are estimates and not guaran- The shipper hereby acknowledges that the shipment was 'ecetved in appar- teed. Notice of Maximum amount due upon delivery: Final charges will be end). good condition except as noted on the inventory list. Furthermore, the based on actual weight or cubic feet of property and services provided. Maximum shipper acknowledges that all the services that were ordered have been per- amount demanded upon delivery Is the amount of the non-binding estimate plus formed, have been fully satisfied, and the truck was Inspected and nothing IoW.: nr inn% of thn hindinn nnemntn. Shinn a nww voluntarily oev total actual has peen raft behind- Shioear and/or event has full authority to accent the i Purchase 7 Description Cc\ T�JC 3QS I t ti 'i5 �k5c'\ P�V t-'\ P.O. P or G.L.# L ill 0G. \Da. t gCCSO Budget of C CD' C Line 'b escr Purchaser Date Approval Date 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. Beaurain, Susan Terms 3737 Knickerbocker place Apt 2D Indianapolis, IN 46240 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 1/13/10 Reimb. Moving expenses 520.54 1/19110 Reimb. Moving expenses 1,479.46 Total 2,000.00 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 Voucher No. Warrant No. Beaurain, Susan Allowed 20 3737 Knickerbocker place Apt 2D Indianapolis, IN 46240 In Sum of 2,000.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #lTITL2 AMOUNT Board Members Dept 1091 Reimb. 4359000 520.54 I hereby certify that the attached invoice(s), or 1091 Reimb. 4359000 _1,479,46 bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 28 -Jan 2010 X1 Signature 2,000.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund