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Home My WebLink About199380 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 027650 Page 1 of 1 ONE CIVIC SQUARE JAMES BRAINARD CHECK AMOUNT: $276.05 CARMEL, INDIANA 46032 CHECK NUMBER: 199380 CHECK DATE: 7/2012011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1160 4343003 276.05 TRAVEL LODGING G OF CA �eNTrv�ts CITY OF CARMEL Expense Report (required for all travel expenses) `UIPHp� EXHIBIT A EMPLOYEE NAME: James Brainard DEPARTURE DATE: 6/ TIME: AM/PM DEPARTMENT: Mayor's Office RETURN DATE: 6/22/11 TIME: AM PM REASON FOR TRAVEL: USCM Conference DESTINATION CITY: Baltimore, MD 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 4/29111 $276.05 $276.0 $0.00 $0.00 $0.00 $o.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 $0.0 $0.00 $0.00 0.00 Total $0.001 $0.001 $0.00 $0-001 $276.05 $0.001 $0.001 $0.001 $0.001 $0.001 $0.00 DIRECTOR'S STATEMEN I hereby affirm that all expenses listed conform to the City's travel policy a are within my department's appropriated budget. Director Signature: Date: r i City of Carmel Form ER06 Revision Date 7/18/2011 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: 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 EiR06 Revision Date 7/18/2011 Page 2 Page 1 of 1 Transaction Date: 04/2912011 Fri 4� Transaction Description: HILTON BALTIMORE BALTIMORE MD Arrival Date Departure Date 04/28/11 04129/11 00000000 LODGING CARDEPOSIT Cardmember Name: JAMES C BRAINARD Amount 276.05 Doing Business As: HILTON BALITMORE Merchant Address: 401 W PRATT ST BALTIMORE MD 21201 -1629 UNITED STATES Reference Number: 320111200182270634 Category Travel Lodging https: online. americanexpress. com /myca /estmt/us /docs /print_doc.html 7/7/2011 401 WEST PRATT STREET rM BALTIMORE, MD 21201 Hilton FTELEP14ONE(443)573-8700 FAX(443)683-8R41 NAME &ADDRESS www.hilton.00m or RESERV 800 HILTONS BRAINARD, JAMES ROOM 701/K1 CITY OF CARMEL 12662 ROYCE CT ARRIVAL DATE 6/16/2011 2:06:OOPM CARMEL, IN 46033 -2477 DEPARTURE DATE 6/22/2011 3:28:OOPM US ADULT /CHILD 1/0 ROOM RATE $239.00 RATE PLAN C -UCM Hhonors 92839820 SILVER AL: DL #070913146 CONFIRMATION NUMBER: 3428219030 6/2712011 PAGE 1 DATE DESCRIPTION ID REF NO CHARGES CREDITS BALANCE 4128/2011 CKNIGHT 1321758 $276.05 6/16/2011 GUEST ROOM BRITNEYM 1396025 $239.00 6116/2011 CITY TAX (R) BRITNEYM 1395025 $22.71 6/16/2011 STATE TAX (R) BRITNEYM 1396025 $14.34 611 712 01 1 GUEST ROOM TMEGGIN 1397908 $239.00 6/17/2011 CITY TAX (R) TMEGGIN 1397908 $22.71 6/1712011 STATE TAX (R) TMEGGIN 1397908 $14.34 6/1812011 GUEST ROOM BRITNEYM 1399444 $239.00 6/18/2011 CITY TAX (R) BRITNEYM 1399444 $22,71 6/18/2011 STATE TAX (R) BRITNEYM 1399444 $14.34 6/19/2011 GUEST ROOM BRITNEYM 1400795 $239.00 6/1 912 01 1 CITY TAX (R) BRITNEYM 1400795 $22.71 6/19/2011 STATE TAX (R) BRITNEYM 1400795 $14.34 611 912 01 1 TELEPHONE -LOCAL LfNTR 1400929 $1.00 6/20/2011 GUEST ROOM TMEGGIN 1402200 $239.00 6/20/2011 CITY TAX (R) TMEGGIN 1402200 $22.71 6/20/2011 STATE TAX (R) TMEGGIN 1402200 $14.34 6/21/2011 GUEST ROOM BRITNEYM 1403983 $239.00 6/21/2011 CITY TAX (R) BRITNEYM 1403983 $22.71 STATE TAX R O BRITNEYM 1403983 $14.34 6/22/2011 ANCA 1404716 f BALANCE $1,381.25 $0.00 4 �l (RT NO l w DATE OF CHARGE FOLIO E` 294053 A 1+IBER NAME AUTHORIZATION J 4 LAMENT NO ESTABLISHMENT AGREES TO PURCHASES &SERVICES J. TRANSMIT TO CARD HOLDER FOR E TAXES TIPS MISC at h, y TOTALAMOUIYT i `�SERVICES PURCHASED ON mrs CARD SHALL NOT BE RETURNED FOR A CASH REFUND j PAYMENT DUE UPON RECEIPT HOTEL, ACCOMMODATIONS RESERVATION REQUEST I DO NOT REQUIRE HOTEL ACCOMMODATIONS Please circle room type: Executi $264 Exec -Level One Bedroom suite F 401 he Hilton Baltimore sin le uble 4 $499 West Pratt Street Baltimore, MD 21201 D King Bed Q Two Double Beds (443) 573 -8700 (Headquarters Hotel) Taxes: 13.5% Reservations must be cancelled 72 hours prior to arrival to avoid penalty. :equal to one night's stay shall be charged at the tim==thereservation A :deposit q Name on Reservation: Jim Brainard Arrival Date: 6/16/11 Departure Date: 6 22 11 Guarantee room to the following Credit Card (Check One): Visa MC Other (specify): Signature of Cardholder: Reservation Information I Do not call the hotels direct) as the hotels will acce t ONLY reservations fbrrnarded b The U.S. 7 Co nference of Mayors' office in Washin ton DC 2. Hotel accommodations cannot be assured.. at the above hotels after May 13, 2011. 3, All reservations must be guaranteed by credit card or t U.S.aConference of Mayors. Please payab to el he hotel Do not make checks for room deposits pay i deposit check with registration form. es and cancellation of hotel reservations must be submitted in writing to g Changes in arrival or departure dat USCM, not the hotel• 5, In the event that you check oC�a efo ralyour nges to checkout must be�made you cinout fee to your account. To avoid this g 6. Check -in time is 3:00 p.m. and checkout time is .12:00 noon. dr A 0 s� �4°i 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)) 04/29/11 Expense Report $276.05 1 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Mayor Jim Brainard IN SUM OF One Civic Square Carmel, IN 46032 $276.05 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1160 Expense Report 43- 430.03 $276.05 1 hereby certify that the attached invoice(s), or 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, July 15, 2011 r 1/7 Mayor Title Cost distribution ledger classification if claim paid motor vehicle highway fund