183584 03/23/2010 a CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
0 ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $1,926.17
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033 -9501 CHECK NUMBER: 183584
CHECK DATE: 3/2312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 1,926.17 REIMBURSEMENT
OF Cq.gk'
CITY OF CARREL Expense Report (required for all travel expenses)
,Nn AnP EXHIBIT A
EMPLOYEE NAME: l�U ad DEPARTURE DATE: TIME: -ob AM PM
DEPARTMENT. RETURN DATE: TIME: pZ lS AM M
REASON FOR T RAVEL: L(� DESTINATION CITY: L�3�tf 11
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Gas /Tolls/ Meals
Date p Luggage Parkin Lodging Misc. Total
Taxi Tips Lu a e g Breakfast Lunch Dinner Snacks Per Diem
f !U b
b (a.
Total Pj J `6
DIRECTOR'S STATEM N.T: I hereby affi that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Form ER06 Revision Date 3/18/2009 Page 1
AFFIDAVIT FOR EXPENSES
I, Diana L. Cordray, incurred expenses while traveling to the NLC National
Congressional Conference where a receipt for the Skycap and Bellman are not
provided. The following non- receipted expense(s) are as follows:
March 12, 2010 $5.00
March 16, 2010 $6.00
$1.1.00
A
Diana L. Cordray
Clerk Treasurer
November 16, 2009
Aarnott. GUEST FOLIO
HOTELS RESORTS
5055 CORDRAY /DIANA 235.00 03/16/10 12:00 12625 20845
Room Name Rate Depart Time ACCT# GROUP
NSKG CITY OF CARMEL 93112/10 1P.
T ype
71
Clerk Address Payment M R#
PATE REFERENCE cHARGES-. CREDITS' BALANCE D UE
03/12 ROOM 5055, 1 235.00
03/12 ROOM TAX 5055, 1 34.08
03/13 STONE'S 93275055 4� -9r45-
03/13 ROOM 5055, 1 235.00
03/13 ROOM TAX 5055, 1 34.08
03/14 ROOM 5055, 1 235.00
03/14 ROOM TAX 5055, 1 34.08
03/15 ROOM 5055, 1 235.00
03/15 ROOM TAX 5055, 1 34
03/16 $1095.77
PAYMENT RECEIVED BY: CURRENT BALANCE .00
AS REQUESTED, A FINAL COPY OF YOUR BILL WILL BE EMAILED TO:
DCORDRAY @CARMEL.IN.GOV
SEE "INTERNET PRI VACY STATEMENT" ON MARKIOTT:COM
This statement is your only receipt You have agreed to pay in cash or by approved personal check or to authorize us to charge your credit card for all amounts charged to
you. The amount shown in the credits column opposite any credit card entry in the reference column above will be charged to the credit card number set forth above. (The
credit card company will bill in the usual manner.) If for any reason the credit card company does not make payment on this account, you will owe us such amount. If you
are direct billed, in the event payment is not made within 25 days after checkout, you will owe us interest from the checkout date on any unpaid amount at the rate of I -5
per month (ANNUAL RATE 18% or the maximum allowed by law, plus the reasonable cost of collection, including attorney fees.
Signature X
0 Contains 30% post consumer fibers To secure your next stay, go to Marriott.com
Page |uf2
Cordray, Diana L
From: Marianne VanDerSohans[Nohahna.VanDorSohanu@thetrame|agentinn.uon]
Sent: Wednesday, January 27.2O104:15PM
To: Cordnay, Diana
Subjec RN:Doket|eno Confirmation 'CORDRAY/D|ANAL'NCBT8B
Early Bird check-in purchased.
Belated Happy Birthday! Marianne
From; Southwest Airlines [mmiUo:SouthwestAidines@|uv.southwesL.com]
Sent: Wednesday, January 27 2010 4:13PM
To: Marianne VanDerSchans
Subject: Ticket|ess Confirmation '[ORDRAY/DIANAL NC8T613
To rcdacm,
;KO24723 in
SQUTMVyEST.COM^
Receipt and Itinerary ";o,o1mn1oa:1xpm
����B��
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Confirmation Number
NCBT6B A Mvm8mmwonhent
Way 7oTravel
Confirmation Date: 01/27/10
Received: VVN/O|ANACDRDRAY8YICBM
Be prepared when you get there!
Consult Travel <Guide for relevant
tips from rau| irava|a/o.
Passenger Information
Passenger Name Account Number Tioket# Expi,aUon i
CORDRAY/D|ANAL 00000387178842 5262178592014 01/27/11
All travel involving funds from this Confirmation Number must be completed by the expiration date,
Itinerary
y_
Depart: INDIANAPOLIS IN to BALTIMORE VVASHNTN (Travel Time: hrs25mino
Date Flight Routing Details
Fri Mar 12 #O598 Depart INDIANAPOLIS IN (|ND)at1:20PK8
Arrive in BALT|K4OREVVASHNTN (BVV|) at 2. PM W3
Return: BALTIMORE VVASHNTN to INDIANAPOLIS IN (Trowo/ Time: hcs 45m/hs)
Date Flight Routing Details
Tua Mar 1G 40174 Depart BALTIMORE VVASHNTN (BVV|)at12:3U PM
Arrive in INDIANAPOLIS IN (|ND) at 2:15 PM
Cost and Payment Summary
|/27/20lO
Page lof3
C0ydray Diana L
From: n|unegandhuusing@japurgo.uom
Sent: Thursday, February 25.2O1O2:18P&1
To: Cnndray, Diana L
Subject: Registration Confirmation and Receipt '1U1144
ON
Registration Confirmation and Receipt '101144
National League of Cities Congressional City Conference 2Nl0
March l3'17,2010
The Marriott Wardmuum Park Hotel
Washington, DC
Confirmation Number: 101144
Date ofRegistration: 81/21/2010
Name: |liunuCordruy
Title/Position: Carmel Clerk
Representing City: City n[Carmel
Address: l Civic 3q
City/Stute/Zip: Carmel, IN4dO32-25U4
Country: USA
Phone: (317)571-2414
Email: dcocdruy@cuzmcljn.gOv
Click the buLkz
reg istration m
This confirmation includes BOTH YOUR HOUSING AND REGISTRATION chan ges/can
information. This is your official confirmation for conference payment as well as
your hotel reservation. Please print this out and retain for your records.
Registration Information
REGISTRATION
Full Conference
$445.00
EVENTS
Everyone VVuntu to be Heard: The Discipline of Listening
[)uto: 03/13/10 Time: 1:30PM-5:AOPM
$120.00
Page 2 of 2
Base Fare $183.25
Excise Taxes $13.75
Advertised Fare $197.00
Segment Fee $7.40
Passenger Facility Fee $9.00
Security Feet $5.00
Total Payment: $218.4 0
Security Fee is the government
imposed September 11th Security Fee.
Current payment(s)
01 /27/10
Fare Rule(s)
All travel involving funds from this Confirmation Number must be completed by the expiration
date. Any change to this itinerary may result in a fare increase.
Fare Calculation:
IND WN BW1123.72M14NTNR WN IND59.53TD10NR 183.25 END ZPINDBWI XFIND4.5BW14.5 AY5.00$IND2.50 BW12.50
Important Checkin Requirement
Passengers who do not obtain a boarding pass and are not present and available for boarding in
the departure gate area at least ten minutes prior to scheduled departure time may have their
reserved space cancelled and will not be eligible for denied boarding compensation.
Southwest Airlines Co. Notice of Incorporated Terms
Air transportation by Southwest Airlines is subject to Southwest Airlines' Passenger Contract of
Carriage, the terms of which are incorporated by reference.
Not ice of Incorporated Terms
Additional Information for Travelers
Online Checkin I Free Baggage Allowance I Checkin Requirements
Inflight Service I Travel Tools I Refu Information I Privacy Policy I Southwest Airlines Destinations
We can notifv of fli departure or arrival status via text messa on your cell phone, pager, personal digital assistant
(PDA), or e -mail account. Or, use our automated phone service by calling 1- 888 -SWA- TRIP.
1J27/2010
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
(1 TO DR.
(Governmental Unit)
y M On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO
ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE 'S
20 Point Point Start Finish TRAVELED PER MILE
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Auto License No. TOTALS Q
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. v
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claim is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date
f�'larC/z 19,
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
incorrect
On Account of Appropriation No, for
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6 MILEAGE CLAIM
TO DR.
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On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE 05
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Auto License No. TOTALS Q i
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed s egally due, after
allowing all just credits, and that no part of the same has been paid.
Date t
Claim No Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
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incorrect
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
P ee �I
Lu Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
f Z
Total j
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.
ALLOWED 20
w IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
�T� q�bq 7(ke,
Board Members
D PTG# INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
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
20
Signature 6r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund