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HomeMy WebLinkAbout188765 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 00352429 Page 1 of 1 0 ONE CIVIC SQUARE MINDY COLLINS CHECK AMOUNT: $652.12 CARMEL, INDIANA 46032 CIO cccc CIO cccc CHECK NUMBER: 188765 CHECK DATE: 8/1812010 DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION 1115 4343002 559.12 EXTERNAL TRAINING TRA 1115 4343004 93.00 TRAVEL PER DIEMS 0 A441 CITY OF CARMEL Expense Report (required for all travel expenses) !NOIANP.. EMPLOYEE NAME: y l/l >7 t>� V� 6 1 �I S DEPARTURE DATE: by— b�- z b D TIME: b S3 Q CAM)/ PM DEPARTMENT: CI?Tbty Ck-h vt S RETURN DATE: 6 Y 61I 2 J b TIME: 3 b AM I REASON FOR TRAVEL: V L A VVJ 2UKPVtL tom( DESTINATION CITY: l bt d EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Transportation Gas /Tolls/ Meals Date Lodging Misc. Total 3 Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 812110 $50.00 $50.00 813/10 $50.00 $50.00 814110 $50.00 $50.00 815110 $50.00 $50.00 8/6/10 0 9, /2 $50.00 460-00 .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 0.00 Totall $0.00 $0.001 $0.001 $0.00 $0.00 $0.00 $o.001 $0.001 $250.001 $0.00 DIRECTOR'S STATEMENT: I hereby ffir at all expenses listed conform to the City's travel policy and are within my department's appropriated budget. i Director Signature: s Date: City of Carmel Form ER66 Revision Date 8/7/2010 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 $60 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 $30 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 $30 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 $60 for out -of -state travel EMPLOYEE ACKNOWLEDGEMENT OF MEAL ADVANCE AND OBLIGATION TO DOCUMENT EXPENDITURES: 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: 6 City of Carmel Form ERO6 Revision Date 8/7/2010 Page 2 n TownePlace Suites by Marriott 105 South Franklin Road I Bloomington, IN 47404 ownePlace Bloomington phone 812.334.1234 SUITES' >Jarnott, Now W RE N. L Mindy Collins room 214ffi� a r 547 Grdbi Drive, room type STQT Westfield �INF4fi074� number of guestsl, clerk SSH Pelham gate $59 p0 r E; R bP.. m F Y arrive 02Aug1,© i time 44 56PM 'w depart 06Aug10 a time 08 30AM folio number 87838 Date Descnpt�on ��H Charge g Cred�ts��k 02Aug10 room charge 69.00 02Aug10 state occupancy tax 4.83 02Aug10 city tax 3.45 03Aug10 room charge 69.00 03Aug10 state occupancy tax 4.83 03Aug10 city tax 3.45 04Aug10 room charge 69.00 04Aug10 state occupancy tax 4.83 04Aug10 city tax 3.45 05Aug10 room charge 69.00 05Aug10 state occupancy tax 4.83 05Aug10 city tax 3.45 06Aug10 VIXXXXXXKXXXKX34741XXXX amount: 309.12 Guth: 08261b signature on file this card was electronically swiped on 02aug10 balance: 0,00 As a Marriott Rewards member, you could have earned points towards your free dream vacation today. Start earning points and elite status, plus enjoy exclusive member offers. Enroll today at the front desk, MarriottRewards.com, or 801 -468 -4000. Want your final hotel bill by email? Just ask the Front Desk! See "Internet Privacy Statement" on Marriott.com. r [�(�°n'i� M�15, SS \h •?ziroFt� -,..'Y tYat P:+K.�;1 �—y '�1`fll� ,gt�°,t:cEx:�'n� 1�1 �llq; rf �I I I m..> .r: a —1 relh Tr 1 hereby D C s complete has successfully a 4: hour t in accordance with the 11 standard 08/02/2010 08/06/2010 '['his continuing education activity is approved by the Continuing Education Coordinating Board for Ernergency Me-dical Scry cs ic $4 y" CEC B EA1S 48 Flour Paramedic Refresher �4 You have participated in a continuing 1 pr ogram any comments regarding the qpali� of this a 1 rr a `ice a s I BI S y a 1 `d� \Tl/ �l.Ji "�j I {1 Af liw kl.� .i K1 1 vr: Pelham Training Bloomington, IN Paramedic Refresher August 2 nd th 2010 Mandatory Core Content (24hrs) Airway, Breathing and Cardiology 8 hours Provide ventilatory support for a patient Attempt to resuscitate a patient in cardiac arrest Provide care to a patient experiencing Cardiovascular compromise Provide past resuscitation ears to a cardiac arrest patient Medical Emergencies 3 hours Assess and provide care to a paticm experiencino an allergic reaction Asses a patient with possible overdose ;1ssr s and provide' care lU a near= diov+rtin_ patient Trauma 5 hours Pet torrn a rapid trauma assessment Asscss a patient with a head injury Assess and provide care to a patient with suspected spinal injury Provide care to a patient with a chest injury ,Provide care to a patient N an open injur� 1 care to a patient with shocklhypoperfusion Obstetrics and Pediatrics 8 hours Asscss and provide care to an infant or child with cardiac arrest .Assess and provide care to an infant or child w ith respiratory distress \ssess and provide care to ari infant or child with shock;hypoperfusion :.Assess and provide care to an infant or child with trauma Flexible Core Content (24hrs) Airway, Breathing and Cardiology 8 hours Assess and provide care ii3r respiratory distress in an adult patient tisc oxvgen delivery system components Pcrfiarni tcchniyucs to assure a patent airway :Assess and provide care to a patient experiencing non traumatic chest pain /discomfort Medical Emergencies 5 hours Assess and provide care to a patient with an altered mental status Assess and provide care.to -a- patient with a history of diabetes Assess and provide care to a patient experiencing a seizure .Assess and provide care to a patient exposed to heat or cold Axes and provide care to a patient experiencing a behavioral problem .-Assess and provide care to a patient with suspected communicable disease Trauma- 1 hour provide care to a patient with a painful_ swollen. deformed extremity ,Asses and provide care io a patientvrith burn injury Obstetrics and Pediatrics 8 hours Assess and provide care to an infant or child with suspected abuse or neglect .,Asses., and provide care to an infant or child with a fever r.Asscss and provide care for the obstetric patient .Provide care w the newborn Provide care tp the mother inimedialcly fallowing deliver) of a newborn Operational Tasks 2 hour Jkw bode mechanics when lifting and moving a patient. Communicate with a patient while providing care Prescribed by State Heard of Accounts General Form No C 955) MILEAGE CLAP C Qk VIALt i YL I C A fi M S Y TO m I J L r� D 1 DR. �j (Gavernmen,al Unit) 0 4 w On Account of Appropriation No. for ice, 8oard, Department or Insticition) DATE FROM TO ODOMETER READING `v.ATUIRE OF BUSINESS IH,U T v MILES iv1iLEAGE !V 0 20 Point Point Start Finish TRK, /ELED PER MILE ti tl I q r� t l f rrvG— S� t l Wta 1? sk t( 1 IJ 4 o n M1 4 cb2 f o YLSI vctt Lk lutwl YU �s X1 °J a t 4 >ht Y i e t, I ST AL !Z Y ,t t i a j t 1 Auto License No. TOTALS p (7 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 acccunt is just and correct, that the amount clai Ily due, after y allowing all just credits, and that no part of the same has been paid. Date 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 cis required by law; That it is based upon statutory authority; That it is apparently correct. incorrect On Account of Appropriation No. y for Disbursing Officer Allowed O,� in the sum of a r� mom( n. Cr ID t✓ CD a b mm( m a (Bond or Commnslon) I O t FILID (D 6 R m C� N C) 0 CD c m (Official Title) ro (D r O a VOUCHER NO. V`IARRF:NT NO. ALLOWED 20 Mindy Collins IN SUM OF 11429 Pegasus Drive Noblesville, IN 46060 $652.12 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1115 43- 430.04 $93.00 1 hereby certify that the attached invoice(s), or 1115 43- 430.02 $559.12 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 Wednesday, August 11, 2010 Director Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER 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. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/09/10 $93.00 08/10/10 $559.12 1 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