195617 03/16/2011 ±.f CITY OF CARMEL, INDIANA VENDOR. 359024 Page 1 of 1
ONE CIVIC SQUARE TARA POLOVICK CHECK AMOUNT: $51.55
�q CARMEL, INDIANA 46032 14418 SIMPLICITY PKVVY APT 3D
CARMEL IN 46033 CHECK NUMBER: 195617
CHECK DATE: 3/16/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4343002 15.49 EXTERNAL TRAINING TRA
1115 4343004 36.06 TRAVEL PER DIEMS
b�tii oc C4gy�
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CITY OF CARMEL Expense Report (required for all travel expenses)
�N EXHIBIT A
EMPLOYEE NAME: Tara Polovick DEPARTURE DATE: 03/09/2011 TIME: 0715 AM
DEPARTMENT: Communications RETURN DATE: 03/09/2011 TIME: 1730 PM
REASON FOR TRAVEL: Suicide Training DESTINATION CITY: Greenwood, IN
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM
Date Transportation Gas /Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
319111 $5.45 $10.04 $15.49
$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 $0.001 $0.001 $0.001 $0.001 $0.001 $5.45 $10.04 $0.001 $0.00 1 $0.00 1 $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 3/11/2011 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.
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.
Employes Signature. Date: c 1 l 1
City of Carmel Form ERO6 Revision Date 3/11/2011 Page 2
Arnone, Janet R
From: Thalia Savakis [thalia @powerphone.comj
Sent: Tuesday, October 26, 2010 9:00 AM
To: Arnone, Janet R
Subject: PowerPhone Registration Confirmation �n
f
This confirms your PowerPhone Course Registration
Thank you for choosing PowerPhone!
Below is your confirmation for the PowerPhone course listed below. Please review this
information carefully, including all student names. If any information needs to be
changed, please reply to this e -mail as soon as possible and let us know what needs to be
changed.
Billing Information
You will receive a separate invoice or receipt for your order from PowerPhone's accounting
department.
Date: 10/26/2010
YOUR INFORMATION
Carmel Clay Communications
Contact: Mike Heinzman
31 First Ave Nw
Carmel, IN 46032
Phone: (317) 571 -2586
Fax: (317) 571 -2585
E -mail: mheinzman@carmel.in.gov
COURSE INFORMATION
Course 10 -1098
Course Type: Suicide Intervention
Course Date: Mar 9, 2011
Course Hours: 08:30 AM 04:30 PM
Course Location:
Greenwood Police and Fire Department
736 Loews Boulevard
Greenwood, IN 46143
Host Agency and Contact:
Host. Agency: Greenwood Police Department
Contact: Mr. Jason Holtzleiter
Phone: {317) 859 -4488
_marrAddr- ss: holtzle3 @greenwood.in.gov
For additional information regar ing course location or local directions, please call the
host agency's contact person at the above number. With any other questions, or to make
1
additional registrations, please contact PowerPhone at 1- 800 537 -6937 (outside the U.S.,
please call +1 203 -245- 8911).
STUDENTS REGISTERED
Total Students Registered: 2
Polovick, Tara
Reed, Michele
PAYMENT TERMS
Payment in full is due upon receipt of order. All course registrations must be paid in
full prior to the start of class for students to attend.
CANCELLATION POLICY FOR COURSE REGISTRATIONS
If you cancel up to 30 days before the start of a program, there is no penalty. For any
cancellation, you must call PowerPhone at 1- 800 537 -6937 and obtain a cancellation number.
Outside the U.S., please call +1 203 245 -8911.
The agency or individual is responsible for full payment to PowerPhone for any
registration cancelled less than 30 days before a program, or for any student who is
registered but does not attend. Student substitutions may be made at any time.
PowerPhone, Inc.
9 -1 -1 Calls Us(TM)
2
REGISTRATION CONFIRMATION
COURSE INFORMATION YOUR INFORMATION
Course 10 -1098 Carmel Clay Communications
Type: Suicide Intervention TM Contact: Mike Heinzman
Location: Greenwood Police and Fire Department 31 First Ave Nw
736 Loews B ulevard Carmel, IN 46032
r�s Phone: (317) 571 -2586
w0
Green Indiana 46143 Fax: (317) 571 -2585
Dates: Oct 2010 E -mail: mheinzman @carmel.in.gov
H ours: 0 .30 AM 04:30 PM W 310
Host: Greenwood Police Department Total Students Registered: 3
Contact: Mr. Jason Holtzleiter
Phone: (317) 859 -4488
E-mail-: holtzlej @greenwood.in.gov
STUDENTS REGISTERED.
Please call PowerPhone immediately with any changes or substitutions.
1. Polovick, Tara
2. Reed, Michele
3. Southerland, Nichoias, ckkA u atk
Directions and Local Information:
For additional information regarding course location or local directions, please call the host agency's contact person at the above
number. With any other questions, or to make additional registrations, please contact PowerPhone,
Payment Terms:
Payment in full is due upon receipt of order. All course registrations must be paid in full prior to the start of class for students tc
attend.
Cancellation Policy:
If you cancel up to 30 days before the start of a program, there is no penalty. For any cancellation, you must call PowerPhone at
1 -800- 537 -6937 and obtain a cancellation number.
Outside the U.S., please call +1203-245-8911.
The agency or individual is responsible for full payment to PowerPhone for any registration cancelled less than 30 days before a
program, or for any student who is registered but does not attend.
Student substitutions may be made at any time.
Here is a selection of courses now scheduled in your area.
For a complete list, visit www.powerphone.com or call us for more information.
Aug 5, 2010 Suicide Intervention TM New Haven, IN $209.00
Oct 28, 2010 Suicide Intervention TM Greenwood, IN $209.00
Prescribed ;y State Beard cf Accounts General Farr No. 1 10 1 (1955;
MILEAGE CLAIM
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On Account of Appropriation No.
for
(Office, 130a rd. Department or Ins55
DATE FROM TO 57
ODOMETER READING` NATURE OF BUSINESS it AU T u [MILES I MILEAGE C
201 Point Point Start Finish J TRAVELED PER MILE
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3 11 1: y o F 3 (o c s
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Auto License No. TOTALS t
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined b, y 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
C"lctirrl No. Warrant No. I have examined the within claim and
hereby certify as follows:
TN FAVOR OF
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 correct
incorrect
On Account of Appropriation No. for
Dmbursng Officer
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ALLOWED 20
Tara Polovick
IN SUM OF
13154 Dunwoody Lane
Carmel, In 46033
$51.55
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# I Dept. INVOICE NO. I ACCT #rrITLE AMOUNT Board Members
1115 43- 430.04 $36.06 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
1115 43- 430.02 $15.49
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, March 14, 2011
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))
03/14/11 $36.06
03/14/11 $15.49
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