HomeMy WebLinkAbout184775 04/27/2010 CITY OF CARMEL, INDIANA VENDOR: 120950 Page 1 of 1
ONE CIVIC SQUARE DOUGLAS HANEY
CARMEL, INDIANA 46032 CIO DEPT OF LAW CHECK AMOUNT: $1,607.12
Cro DEPT OF LAW CHECK NUMBER: 164775
CHECK DATE: 4127/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343002 1,515.62 EXTERNAL TRAINING TRA
1180 4343004 91.50 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1988)
MILEAGE; CLAIM
TO C
(GOVERNMENTAL UNIT) J �/CiC!
ON ACCOUNT OF APPROPRIATION NO. �Q y FOR 11,Q�(...
(OFFICE, BOARD, DEPART T OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE
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POINT POINT START FINISH NATURE OF BUSINESS TRAVELED .5 x
PER MILE
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AUTO LICENSE NO. TOTALS
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 is legally due, after allowing all just credits
and that no part of the same has been paid.
Date 4 0/a
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
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 f correct
incorrect.
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A.E. ROYCE CO., INC- MUNCIE,
IN 01M iL
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Crc.t
Pt_EriSE P NT NT OR TYPE. Payment must accompany registration.
rliotel Reseevations A block of moms has been held at the following
tr T Y tyi y�-yJa
hotel These rooms will beheld as a block iJnless exhausted un#rl`Wednesday I Section. 1 983
February 24 2010 at which trrne they will be released tosthe general Y pubhc 0 To qualify for the early bird registration, registrations mu
Please be sure to mentcon the Gvrl Rights Lrtrgatrpn room block to receroe I be received by February 22, 20 10.
the room rate. below ti w
$89.5 Early._Brrd Registration
Hyatt Regency Washington on Capitol Hill
400 New�Jersey Avenue, f JW I $995 Regular Registration
1Nashrngton DC 20001 I X $795 Government Registration
(-?02)_737 or (800) 233 1234 t Publications
Room rate" $229 single /doufjle: I $75 39J? Edition Annuai Review of Crin ?rear Procedure
Disclaimer Speakers?are subject to' change: I twill be published tune ZO i Oj
Services for People with Special Needs or Dietary Resfrict,ons 1
(202) 662 .9890
1 Name: Mr. Ms. Douglas C. Hane
Call
Email address: dhaney @carmel.in.gov
Scholarships: Georgetown law CLE makes every effort tpossible to I (please prier dearly)
prwrde equal education .,opportunTbes to all. We pr`ovrde a.limrted number of 1
scholarships on a case b' =case basis. Apply online at www.law.georgetown,edu/cle 1 Firm/OrPanization: City of Carmel, Tnd ana
or submrt written request no laterthan 5:00 pm.on`,Friday,, Harch 4, 2010 to:. i Address: One Civic Square
Schola rgeto town Law CLE orrirnttee
Geo wn I City: Carmel State:IN Zip:46032
600 New Jersey Avenue, NW Phone: i 571 -2472
Washington, DC 20001 1 Fax: (3177 571 -2484
or fax to (202) 662-9691 1
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from states with mandatory I 1. ONLINE www.law.georgetown.edu /cle
Continuing Legal Education I 2. MAIL with check payable to Georgetown Law CLE to address below.
requirements for 10.0 CLE 1
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'rt, ft Check en
hour) and 12.0 CLE creditst
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CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: Douglas C. Haney DEPARTURE DATE: 03/24/10 TIME: 11:15 a.m.
DEPARTMENT: Law Department RETURN DATE: 03/27/10 TIME: 10:20 a.m.
REASON FOR TRAVEL: ALI -ABA Seminar DESTINATION CITY: Washington, D.C.
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Gas /Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
$0.00
March 24
27, 2010 $504.10 $14.76 $64.00 $705.32 .00 $1,548.12
$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
Totall $504.101 $0.00 $14.70 $64.00 $705.32 $0.001 $0.001 $0.00 $0.00 $260.00 $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:
City of Carmel Form ER06 Revision Date 4/8/2010 Page 1
STATE OF INDIANA
SS:
COUNTY OF HAMILTON
AFFIDAVIT
I, Douglas C. Haney, Carmel City Attorney, being first duly sworn upon my oath, state that while
on City business March 24 27, 2010, attending the ALI -ABA Section 1983 Seminar in Washington,
D.C., I expended Fourteen Dollars and Seventy Cents ($14.70) of my own monies for subway
transportation for which I need to be reimbursed.
f
Dated this r day of April, 2010.
aney
Subscribed and sworn to before me, the undersigned Notary Public, this day of April,
2010.
A. Elaine Bass, NOTARY P B IC
Resident of Marion County, Indiana
My Commission Expires:
October 23, 2016
feb:m word .zr�shuedlatrdavitslaffadivit subway semin -d-4 /8110]
2015 Massachusetts Ave. NW
h Washington, DC 20036
H lt®n Phone (202) 265 -1600 Fax (202) 328 -7526
W86}Li on Ernhass Y R oth Reservations
Name Address www.hilton.com or 1 800 HILTONS
HANEY, DOUGLAS Room 809/01 B
Arrival Date 3/24/2010 4:15:00PM
Departure Date 3/27/2010
CARMEL, IN 460339101
US Adult/Child 1/0
Room Rate 220.00
RATE PLAN L -AA
HH# 864254159 DIAMOND
AL: DL #6061240013
BONUS AL: CAR:
CONFIRMATION NUMBER: 3377006351
3/27/2010 PAGE 1
DATE REFERENCE DESCRIPTION AMOUNT
3/24/2010 1558958 GUEST ROOM $220.00
3/24/2010 1558958 ROOM TAXES $31.90
3/25/2010 1559640 GUEST ROOM $198.00
3/25/2010 1559640 ROOM TAXES $28.71
3/26/2010 1560297 GUEST ROOM $198.00
3126/2010 1560297 ROOM TAXES $28.71
WILL BE SETTLED TO $705.32
EFFECTIVE BALANCE OF $0.00
EXPENSE REPORT SUMMARY
1' 00 00 0T 12�0O.00AM 010° 12 00 OOAM STAY T.OTAL'`
ROOM TAX $251.90 $226.71
DAILY TC TAL $251.90 $226.71 $226.71 „$705.32
Hilton HHono s' stays are posted within 72 hours of checkout. To check you earnings for this or
any other sta at more than 3,000 Hilton Family hotels worldwide, please visit iltonHHonors.com.
Thank you fo choosing Hilton! Book your next stay at hilton.com and take adv ntage of our
internet -only. dvance Purchase Rates and limited -time special offers!
DATE OF CHARGE FOLIO NOJCHECK NO. X7
Z i p -Out Ch ec k Out 286561 A JL
Good Morning! We hope you enjoyed your stay. With Zip -Out Check -Out® AUTHORIZATION IN9TIAL
there is no need to stop at the Front Desk to check out.
Please review this statement. It is a record of your charges as of late last PURCHASES SERVICES
evening.
For any charges after your account was prepared, you may: TAXES
pay at the time of purchase.
charge purchases to your account, then stop by the Front Desk for an
updated statement. TIPS MISC.
or request an updated statement be mailed to you within two business days.
Simply call the Front Desk from your room and tell us when you arc ready to
depart. Your account will be automatically checked out and you may use this TOTAL An7ouNT 0.00
statement as your receipt. Feel free to leave your key(s) in the room.
Please call the Front Desk if you wish to extend your stay or if you have any
questions about your account.
C' INDIANA RETAIL TAX EXEMPT PAGE
o I' Carmel PURCHASE ORDER NUMBER
CERTIFICATE NO. 003120155 002 0 �..11�� �i
FEDERAL EXCISE TAX EXEMPT j
35- 60000972 r2
r
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AIP
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO PACKING SLIPS
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
VENDOR r v+ SHIP
TO
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
a d J 1
Ot) t t C 1
l ,j fJ f .r� A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
jI "L� t' NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS.APPROPRIATIONSUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED-
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO- r
2 1 7 40 CLERK- TREASURER
DOCUMENT CONTROL NO A.P.V. COPY SIGN AND RETURN TO CLERIC'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
I
ON ACCOUNT OF APPROPRIATION FOR
O
Board Members
PO# or 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
b 20
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund