HomeMy WebLinkAbout188944 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 363329 Page 1 of 1
ONE CIVIC SQUARE KENT PAULIN CHECK AMOUNT: $134.33
�o CARMEL, INDIANA 46032 C/O COMM CENTER
CHECK NUMBER: 188944
CHECK DATE: 8/18/2010
D EPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
1115 4343002 8.83 EXTERNAL TRAINING TRA
1115 4343004 125.50 TRAVEL PER DIEMS
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4'
4` p,Arn EA
CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: r4 j DEPARTURE DATE: S� 0 TIME: O 0/ PM
DEPARTMENT: Communications RETURN DATE: 5 y TIME: 7" 0 0 AM 0
REASON FOR TRAVEL: Sc L� o� DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT_
Transportation Gas /Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
8/5/10 $3.43 $5.40 $8.83
$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
$0.00
$0.00
$0.00
0.00
Total $0.00 $0.00 $0.00 $0.001 $0.00 $3.43 $5.40 $0.00 $0.00 $0.001 $0.00
DIRECTOR'S STATEMENT: I he ff that all exp ses I' onform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date: 8/612010
City of Carmel Form ER06 Revision Date 8/6/2010 Page 1
I
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:
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 ER06 Revision Date 8/6/2010 Page 2
Prescribed by State Poard of Accounts General Form No 101 (1955)
MILEAGE CLAIM
e Idey— TO DR.
(Governmental Unit)
On Account of Appropriation No. for
,O ice, card. Department or Insti[ution)
DATE FROM TO
ODOMETER READING NATURE OF BUSINESS iAJT 01MILES ivliLEi GC C ISV
20 Point Point Start Finish TRAVELED PER MILE
91 C C C C 4 1 tV r1 v e /a i (O 3 v r' a u, S r vic
I 11 H I
i
I
I
Auto License No. TO I A! S
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 legal] due, a ter
allowing all just cre ts, and that no part of the same has been paid.
'Date
>d
Clcdm N o Warrant No. I have examined the withui
hereby certify as follows:
IN FAVOR OF
'That it is in proper form;
That it is duly authenticate
That it is based upon statutory authority;
That it is apparently correct
12—S SC7 incorrect
On Account of Appropriation No "7 G for
Disbuising Officer
cD
Allowed 20 t o
in the sum of
0
m m r-
ro
o ro�R.
(Bomd or Commission) f O
M
K
FILED
(D
om
c m
(Official Title)
N O
O N Q-
TRAINING CONFIRMATION *DOTE* PLEASE FAX
COPY OF PO TO NUMBER INDICATED BELOW.
Original Message----
From: info @powerphone.com [mailto:info @powerphone.com]
Sent: Friday, April 30, 2010 6:14 PM
To: Heinzman, Mike D
Subject: Your order is confirmed
This confirms your PowerPhone Order!
Thank you for choosing PowerPhone!
Below are the details of your order. Please review them
carefully. If any changes are necessary, please call us at
1 -800- 537 -6937 (outside the U.S., please call +1 203 245 8911).
F 1RLAlYP: PLEASE FAX US YOUR PURCHASE ORDER
To complete your order, please fax a copy of an official agency
prchase order to PowerPhone at 203- 245 3022, *AWM: Order Processing.
Seats in PowerPhone classes will not be held and products will not
ship until we have received a copy of your purchase order.
ORDER DETAILS
order Number; Number: 427064666
Date of Order: Apr 30, 2010
BILLING CONTACT
D MIKE HEINZMAN JR
TRAINING COORDINATOR
CARMEL CLAY COMMUNICATIONS
31 1ST AV NW
CARMEL, IN 46032
Phone: (317) 571 -2586 1 Fax: (317) 571 -2585
E -mail: MHEINZMAN@CARMEL.IN.GOV
COURSE REGISTRATIONS
Below you will see the course(s) you registered for, and the
Farm "Training Request Form 2- 2003"
student(s) you signed up to attend_
Course Number: 10 -1003
Course Type Suicide Intervention
Date Aug 5, 2010
Host Agency New Haven Police Department
Class Location New Haven Police Department
815 Lincoln Highway East
New Haven, IN 46774
Class Hours 08:30 AM 04:30 PM
Price $189.00 (Special pricing applies)
No. of Seats 4
Students Attending
LAVERNEZETTA MOORE
KENT PAULIN
ELIZABETH EARLYWINE
BILL MCGEE
Sub Total $756.00
PAYMENT INFORMATION
You paid by Purchase Order.
Name on Purchase Order: JANET ARNONE
Purchase Order Number: 26866
IMPORTANT: PLEASE FAX US YOUR PURCHASE ORDER
To complete your order, please fax a copy of an official agency
purchase order to PowerPhone at 203- 245 -3022, ATTN: Order Processing.
Seats in PowerPhone classes will not be held and products will not
ship until we have received a copy of your purchase order.
Order Totals
Subtotal $756.00
Shipping $0.00
Total $756.00
Form "Training Request Form 2- 2003"
V OUCHER NO. WARRANT NO.
ALLOWED 20
Kent Paulin
IN SUM OF
1300 Woodpond Roundabout
Carmel, In 46033
$134.33
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 43- 430.04 $125.50 1 hereby certify that the attached invoice(s), or
1115 43- 430.02 $8.83
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 $125.50
08/09/10 $8.83
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