193042 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
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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