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Home My WebLink About193042 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 027850 Page 1 of 1 q 0 ONE CIVIC SQUARE JAMES BRAINARD CHECK AMOUNT: $302.41 CARMEL, INDIANA 46032 CHECK NUMBER: 193042 CHECK DATE: 12/22/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1160 4343001 204.91 TRAVEL FEES EXPENSE 1160 4343004 97.50 TRAVEL PER DIEMS c� CITY OF CARMEL Expense Report (required for all travel expenses) NOIANP: EXHIBIT A EMPLOYEE NAME: Jim Brainard DEPARTURE DATE: 12/15/10 TIME: 3:00 AM /(PM_) DEPARTMENT: Mayor's Office RETURN DATE: 12/16/ TIME: 10:00 AM PM REASON FOR TRAVEL: City Promotional DESTINATION CITY: Chicago, Illinois EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT _J� TRAVEL PER DIEM Date Transportation Gas/Tolls/ Lodging Meals Misc. Total Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 12/15/10 -13- U $32.50 $36.10 12/16/10 $53.60 $147.71 $65.00 $266.31 $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 1 $0.001 $0.00 $0.001 $57.20 $147.711 $0.00 $0.00 $0.00 $0.00 $97.50 $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. ra l Director Signature: Date: City of Carmel Form ER06 Revision Date 12/17/2010 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 $65 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 $32.50 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 $32.50 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 $65 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. 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 12/17/2010 Page 2 0 INTERCONTINENTAL. HOTELS RESORTS 12/16/10 Jim Brainard Folio No. Cashier No. 50 Room No. 2242 2662 Warsaw Court A/R Number Arrival 12/15/10 Carmel Indiana Group Code Departure 12/16110 USA _0001 46033 Company Conf. No. 63722195 US Membership No. PC 251088863 Rate Code IMSTI Invoice No. Page No. 1 of 1 Date Description Charges Credits 12/15/10 Parking 44 -1151 53.00 12/15/10 *Accommodation .128.00 12115/10 City Hotel Room Tax 4.48 12/15/10 State Hotel Room Tax 15.23 12/15/10 American Express 200.71 Thank you for using your Priority Club Worldwide card. Your account will be credited with Total 200.71 200.71 the appropriate points miles for this stay. We look forward to welcoming you backl Balance 0.00 Guest Signature: I have received the goods and or services in the amount shown heron. I agree that my liablity for this bill is not waived and agree to be held personally liable in the event that the indicated person, company, or associate fails to pay for any part or the full amount of the_ se charges. If a credit card charge, I further agree to perform the obligations set forth in the cardholder's agreement with the issuer. InterContinental Chicago❑ 505 North Michigan Avenue❑ Chicago, IL 60611 -3807, USAF] Telephone: (312) 944 -4100 Fax: (312) 944 -1320 fi INTERCONTINENTAL. EXPRESS CHECK -OUT CHICAGO Dear Guest: It has been a pleasure serving you thus far, and we hope you have enjoyed your stay with us. You may bypass the Front Desk and avoid waiting in iine to checkout by taking advantage of one of the three following options: 1) Video Check out Allowyou to reviewyour bill in real time. Withyour TV remote press the `Menu" button. Scroll up to "Guest Services" and press "Select Scroll to your left by using the direction buttons and press "Select" on `Account Review Please press "Select" again to accept the terms. Revieavyour bill and press the "I button to check -out. Finally press "Select" to exit. 2) Quick Voice Mail Check -out Dial extension 3000 3) Express Check Out Box Ifyour final invoice is correct, simply drop off your k in our Ex press Check -Out box b the Front Desk. Luggage storage is available at our Bell Desk. Should you require luggage assistance, please press extension 8129 Thank you for staying at InterContinental Chicago. Please take a :moment to fill out the Guest Comment Card which you may leave in the room when completed. We do appreciate your feedback. Have a safe trip home, and we will look forward to welcoming you back. ayViri o •e Date: Room Number: Late check -out between 12.•00 PM— 6.•OO PM.- 50% of the prevailing dail ry ate* Email address: Fax Number: Late check -out after 6:00 PM.- Name: 100100% of the prevailing dailro rate* Address: *Please contact our Instant Service Center (Extension 0) for our daily rate Company: T. VOUCHER NO. WAR NO. ALLOWED 20 Mayor Jim Brainard IN SUM OF One Civic Square Carmel, IN 46032 $302.41 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1160 Expense Report 43- 430.01 $204.91 1 hereby certify that the attached invoice(s), or 1160 Expense Report 43- 430.04 $97.50 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 Friday, December 17, 2010 Ma or 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)) 12/17/10 Expense Report $204.91 12/17/10 Expense Report $97.50 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