158101 04/01/2008 CITY OF CARMEL, INDIANA VENDOR: 353873 Page 1 of 1
e ONE CIVIC SQUARE NORMAN RILEY CHECK AMOUNT: $94.06
CARMEL, INDIANA 46032
CHECK NUMBER: 158101
CHECK DATE: 4/1 /2008
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 94.06 OTHER EXPENSES
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CITY OF CARMEL Expense Report (required for all travel expenses)
/N0I A
2008 mileage reimbursement rate is 50.5 cents /mile
EMPLOYEE NAME: DALE RILEY DEPARTURE DATE: 3/11/08 TIME: 9:OOAM
DEPARTMENT: Utilities /Sewer RETURN DATE: 3/13/08 TIME: 4:OOPM
REASON FOR TRAVEL: WASTEWATER WORKSHOP DESTINATION CITY: INDIANAPOLIS
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT _X TRAVEL PER DIEM
25.92 MILES ONE -WAY
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
3/11/08 $26.18 $26.18
3/12/08 $26.18 $26.18
3/13/08 1 $26.18 1 $26.18
3/11/08 $5.07 $5.07
3/12/08 $5.28 $5.28
3/13/08 $5.17 $5.17
$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
Totall $0.001 $0.00 $0.00 $78.54 $0.00 $0.00 $15.521 $0.00 $0.00 $0.00 $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 3/17/2008 Page 1
E ST; T
F To ensure proper credit, the wastewater approval
o WASTEWATER OPERATOR CONTINUING EDUCATION
number MUST be provided.
=1 CREDIT REPORT
State Form 51139 R 1 -0B
Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
eig
Technical Contact Hours Earned:
General Contact Hours Earned:
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.
h CSR fIF1ED, OPERA fOR
1. NAME:
D t; y
2. ADDRESS (number and street):
City: State: ZIP code: Telephone number:
9 Work: Q 3i 7 S 7!
Home /Cell: l7
Email Address:
:Check here if this is an address change
3. NAME OF TRAINING COURSE:
A, i 'sA 4 Trw -a 7 1, 60T�•'t�.�� ('4'�4f r ^ar�i�i C� as3L it c�3t Si
4. NAME OF ORGANIZATION SPONSORING COURSE:
A 9 P A 1 d= 5} �::it9 nr °i 11� w
5. DATE(S) ATTENDED: 6. LOCATION ATTENDED:
6. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE
PROVIDER:
Technical Contact Hours: General Contact Hours:
I, 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,
8. SIGNATUR INSTRUCTOR: 9. PRINTED NAME OF INSTRUCTOR:
10. SIGNATURE OF CERTIFIED OPERATOR: 11. PRINTED NAME OF CERTIFIED OPERATOR:
,(Z Xe► e'v I I� t L- r
12. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification number: class: Expiration date:
Operator certification number. Class: Expiration date:
TanOd 6, Olms Soa.d of 11-L. moral Serra Me
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AUTO LICENSE NO. TOTALS
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Purauant to the providons and penalties of Choptw 155. Acts 1959. I hereby cer* thnt the foregoing a=uni is Just and correct that the amount claimed is legally dum ofter allowing all Just I
and ghat no pad of tae same has been paid,
Date
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VOUCHER 085114 WARRANT ALLOWED
T9959 IN SUM OF
RILEY, NORMAN-
WAS,`TEWATER
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
031108 01- 7042 -06 $94.06
Voucher Total $94.06
N iedger classification if
hicle 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T9959
RILEY, NORMAN Purchase Order No,
WASTEWATER Terms
Due Date 3/19/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/19/2008 031108 $94.06
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
Date 1