162364 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 359025 Page 1 of 1
ONE CIVIC SQUARE DAVID HUMPAL CHECK AMOUNT: $60.00
1 CARMEL, INDIANA 46032 7131 N OAKLAND AVENUE
INDIANAPOLIS IN 46240 CHECK NUMBER: 162364
CHECK DATE: 8/7/2008
DEPARTMENT ACCOUNT PO NUM I NVOICE NUM A DESCRI
;551 5023990 60.00 EMPLOYEE PENSIONS B
I
C
CITY OF CARMEL Expense Report (required for all travel expenses)
2008 mileage reimbursement rate is 50.5 centslmile
EMPLOYEE NAME: DAVID HUMPAL DEPARTURE DATE: TIME: AM PM
DEPARTMENT: Utilities /Sewer RETURN DATE: TIME: AM/PM
REASON FOR TRAVEL: DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
6124108 CONTINUING EDUCATION $60.00 $60.00
$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
.00
Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.001 $0.001 $0.00 $0.001 $0.00 $60.00
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 6/2512008 Page 1
Approved Environment, Inc.
P.O. Bog 42744
Indianapolis, IN 46242
Phone: 1 -800- 631 -9747
www.aPpi
June 23, 2008
Receipt
Dave Humpal
City of Carmel
7131 N Oakland Ave
Indianapolis, IN 46240
317 -257 -1208
humpal @sbcxglobal. ne
Item Item Name Quantity Unit Price Amount
1 Online Course 2 $30,00 $60.00
Activated Sludge I
Activated Sludge Ii
TOTAL $60.00
Paid By:
Thank you,
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
ww v.approvedee.coni
PTA
WASTEWATER OPERATOR CONTINUING EDUCATION To ensure proper credit, the wastewater approval
CREDIT REPORT number MUST be provided.
State Form 51139 (R 11-06) Training Course Approval Number.
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT tvwTO� —Seno I
Technical Contact Hours Earned:
1.0
General Contact Hours Earned:
0
In accordance with 327 IAC 5-22-17(c), the training provider must submit this form within thirty (30) days of the conclusion of
the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65-42
Indianapolis, IN 46204-2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a five (5) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator attending the entire wastewater operator continuing education course.
1. NAME: Ila L/ I d tj 1 LA
2. ADDRESS (number and street):
2 0,:7 IU c;i I L) -e
City: Ate: ZIP code: ITelephone number:
Work: jwr 3 0 511 .2 6
Email Address:
Check here If this Is an address change 2 /1 X J—h
7 7- 377 7 qggg
7
3, NAME OF TRAINING COUftSE:
A 6- to
4. NAME OF ORGANIZATION SPONSORING COURSE:
Approved Environment, Inc.
5. DATES) ATTENDED: 16. LOCATION ATTENDED:
6/2 9 /6 g J&PAW.approveftexorn
6. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE
PROVIDER:
Technical Contact Hours: General Contact Hours:
1.0 0
1, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentations may
result in the denial of continuing education credit for this course.
9. SIGNATURE OF INSTRUCTOR: 9. PRINTED NAME OF INSTRUCTOR;
Ann Bersbach
10. SIG OF RTIFIED OPER� 11. PRINTED NAME ME OF CERTIFIED OPERAT
T C 07
66 V? Aj
TO
CRE H
12. 0 !1 OURS ARE TO BE APPLIED TO:
Operator certification number Class: Expiration dat
6 3 ;Qz: 7Xd/2 C) C) 'S
peratorcertification number. Class: Expiration date:
WASTEWATER OPERATOR CONTINUING EDUCATION To ensure proper credit, the wastewater approval
CREDIT REPORT number MUST be provided.
State Form 51139 (R 11-06) Training Course Approval Number.
4+ rar INDIANA DEPARTMENT OF ENVIRONMENTAL- MANAGEMENT
t
Technical Contact Hours Earned:
1.0
General Contact Hours Earned:
0
In accordance with 327 IAC 5-22-17(c), the training provider must submit this form within thirty (30) days of the conclusion of
the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65-42
Indianapolis, IN 46204-2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a five (5) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator attending the entire wastewater operator continuing education course. G121I�D 2 0P ATOKII
7
.1, 1 R
._R
1. NAME: W AA
2. ADDRESS (number and t
3 )7 0,, J A
City: State: ZIP code: iTelephone number: 3 4)
Tt4' e 1 6 2 41'& lWork: .2r.
Email Address:
Check here ff this is an address change
�7 77
.7-57F -'Toe 7 .7— T 77 777"77
7 7- 77 77� 77.7 7,77 OQ
3. NAME OF TRAINING COURSE, /L4 JD -0
A-_I� 6
4. NAME OF ORGANIZATION SPONSORING COURSE:
Approved Environment, Inc.
5. DATE(S) ATTEND
6. LOCATION ATTENDED:
0,
3 1 www.approvedce.com
S. TOTAL NUMBER OF CONTACT HOURS ATTENDED 13Y CERTIFIED OPERATOR AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE
PROVIDER:
enerall Contact Hours: 0
1.0 7
Technical Contact Hours:
1, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my dirertion or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentations may
result in the denial of continuing education credit for this course.
8. SIGNATURE OF INSTRUCTOR: 9. PRINTED NAME OF INSTRUCTOR:
Ann Bersbach
10. SIG7 RAT
P RINTED NAME OF CERTIFIED OPERATOR:
_7RTIFIED OPE 11. bo V,
12. COWTINUING EDUcAT16N CREW HOURS ARE TO BE APPLIED TO:
Operator certification number. Class: Expiration date
0/1 VOT
Operator certification number Class: Expiration date:
Certificate of Completion Approved Eriviro Inc. Page I of I
Approved Envil h1c.
P.O.'3w,4789;
indiatiapOis, IN 46247-089,5
1 -800- 6;11 -)7$7
Emaih hu'c Pak
Coertificate of Completion
coill are approved ill tile following states: Indiana, 1111.tiols, Ohio, Alabama, Delaware, SoLffll
Carolina. North Carofitia 1 and Oritwio, Can-'Ida,
Name: Dave Humpal
Address: 7131 N Oakland Ave, Indianapolis, IN 46240
Course Title: Activated Sludge I
Course Value: I Contact Hour
Approval Number: IN WWT07-5907 TOI GOO,, OH OEPA-5296727-OK NC
CEO 113 0402, MID 3466 -05 -06
Date: 6/24/08
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: 16380
Operator Class Level: W
License Expiration Date: 06/30/2008
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc,
Collynght 2002 Appl'�'k;d
http://www.approvedee.com/onlineCEUs/ceuCerfificateOfCompletion.asp 6/24/2008
Certificate of Completion Approved Environment, Inc. Page I of I
Approved Environment, Vi e®
P.O. Box 47895
Indianapolis, IN 40247-08
1-800-6,31-9
Entail:
Certificate of Completion
a pproved its the following states- Indlan-,i, iflinols, Ohilo. Alabapna,"Delaw,-,i Sotifl
Czirohna,.Norih -Mari-land and Owario, Cavil la.
Name: Dave Hurnpal
Address: 7131 N Oakland Ave, Indianapolis, IN 46240
Course Title: Activated Sludge 11
Course Value: I Contact Hour
Approval Number: IN WWT07-5908 TOI GOO,, OH OEPA-S296730-OK NC
CEO 1 130404, NM 3467-05-06
Date: 6/24/08
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: 16380
Operator Class Level: IV
License Expiration Date: 06/30/2008
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002 Apll'iW'"Ud Inc., i nt. ian:Mol�s
http://www.approvedce.com/ontineCEUs/ceuCerti 6/24/2008
Jul 25 08 07:42a Jeff Cooper 317 571 -2636 p.1
Opening/Closing Date: W2=6- u114arvo GusIvrOt" stnv
CHA Payment Due Date: 08/13108 In U.S_ 1- 800 -946 -2000
Minimum Payment Due: $10,00 Espanol 1 -888- 446 -3308
TOD 1- 800 955 -8060
Pay by phone 1 -8DD- 436 -7958
Outside U.S. call collect
1- 302 -594 -8200
M ASTERCARD CARD SUMMARY Account Number ACCOUNT INQUIRIES
Previous Balance $729 -73 Total Credit Line $23,700 P.O. Box 15298
Payment, Credits $1,032.93 Available Credit $23,264 Wilmington, DE 19850 5296
Purchases, Cash, Debits +$739.17 Cash Access Line $23.700
New Balance s4g5,97 Available for Cash $23,264 PAYMENT ADDRESS
P.O. Box 94014
Palatine, IL 60094 -4014
VISIT US AT:
v e H L, 1M www.c ase.corn/ reditca s
CHASE PERFECTCARD REWARDS SUMMARY For questions about your account please call
Previous balance $14.39 Cardmember Services at 1- 800.945 -2000.
Rebates earned from gas purchases $6.08
Bonus rebates earned from gas purchases $0:00
Rebates earned from purchases $5.20
Rebates redeemed this period $14.33
Total remaining rebates $1128
With PerfectCard, earn a 3 rebate on eligible gas purchases and a 1% rebate on
all other purchases. Rebates are automatically credited to your account. See
Program terms for details.
TRANSACTIONS
Amount
Trans
Data Reference Number Merchant Name or Transaction Description Credit Debit
06/21 05416018173141020545622 SAIWISCLUB #8168 FISHERS IN
06/23 5546029B176b1217501002 APPROVED ENVIRONMENT I iNDIANAPOLIS IN
06124 05444718176353400267 KROGER #086 SL9 INDIANAPOLIS IN 51.48
06/24 8548396817629091282339 HEALTH/PROF LIC BUREAU 800 236 -5446 IN 34.17
06127 054447181793573066036 KROGER #2086 068 INDIANAPOLIS IN 39.60
06129 D541601 B1 81 141018841 8 1 9 SAMSCLUB #8168 FISHERS IN 56
06/29 05416018182141016364009 SAMSCLUB 8168 GAS FISHERS IN `'6'25
07/01 65432868183000534613436 DRL'DR LEO NARDS HEALTH 800- 455 -1918 NJ 25.88
07/01 05444008184363473199350 COSMOPROF #9814 IfipIANAPOLIS IN 45.74
29.07
07103054447181B536520880Q553 KROGER #086 SL9 INDIANAPOLIS IN
07106 11881880300000594511837 Pa ment Thank You Electronic Chk 1,000.00
67.86
07107 5641731, 900876673 8190591 MENARDS FISHERS 1NDIANAPOLISaN
ERSS DIANAPOLIS I N S.IN 6623..
......_07108 054160ig1 901 4 1 009192486- ...1NAL =MART #27.
18.fi0
07109 55417348192691920821301 MENARDS 3171 FISHERS INDIANAPOLIS IN
10.24
07110 5541734819369193079655 .MENARDS FISH
07111 25536068194030D1077i582 SULLIVAN fiARDWARE.INDIANAPO IN 0 g
07111 054447181933751194450 KROGER #2085 066 INDIANAPOLIS IN. 20.50
07111 05416194141018567054 SAMSCLUB 8168 GAS FISHERS IN 48.57
018
07/11 554838281953300093283 SAMS GAS STATION WAX INDIANAPOLIS IN 37.20
07118 PAYMENT PROTECTOR 1 -888- 314 -4371 3.98
07118 PERFECTCARD REBATE CREDIT 14.33
0000001 F1533335 D 8 000 N Z 19 08!07118 Pago 1 or 2 05886 MA MA 84343 20010000060438434307
t X OM INS13292
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1024
HUMPAL, DAVID Purchase Order No.
WWTP Terms
Due Date 6/27/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/27/2008 062408 $60.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance with IC 5- 11- 10 -1.6 t
Date Offic
VOUCHER 085812 WARRANT ALLOWED
71024 IN SUM OF
HUMPAL, DAVID
WWTP
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
062406 01- 7042 -05 $60.00
Voucher Total $60.00
Cost distribution ledger classification if
claim paid under vehicle highway fund