HomeMy WebLinkAbout199551 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 00352774 Page 1 of 1
ONE CIVIC SQUARE JORDAN KLEINSMITH
CARMEL, INDIANA 46032 C/O WASTEWATER CHECK AMOUNT: $30.00
C/O WASTEWATER CHECK NUMBER: 199551
CHECK DATE: 7/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 30.00 EMPLOYEE PENSIONS B
40 OF
CITY OF CARMEL Expense Report (required for all travel expenses)
2010 mileage reimbursement rate is 50 cents /mile
EMPLOYEE NAME: Jordan Kleinsmith DEPARTURE DATE: na TIME:
DEPARTMENT: Utilities /Sewer RETURN DATE: na TIME:
REASON FOR TRAVEL: Wastewater Operator Certification Renewal DESTINATION CITY:
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 I arRentall Other Parking I Breakfastj Lunch Dinner Snacks Per Diem
6/3/11 Wastewater Operator Class IV renewal $30.00 $30.00
$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
0.00
Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.001 $0.00 $0.00 $0.00 $0.00 $30.00
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 7/1212011 Page 1
June 7. 2011
Your Wastewater Treatment .Plant Operator certification, number WW0155 t 5, is enclosed.
IMPORTANT CERTIFICATION INFORMATION
ADDRESS CHANGE: It is your responsibility to notify the Indiana Department of Environmental Management of any
change of address. You may e -mail us at tfullerw((c idem.in.00v or fax to (317) 232 -8637 or call (317) 233 -0479.
NAME CHANGE: A name change request must be submitted in writing. Mail to: Department of Environmental
Management, Office of Water Quality Mail Code 65-42, 100 N. Senate Ave., Indianapolis IN 46204 -2251 or you can
fax to (317) 232 -8637.
CONTINUING EDUCATION: Prior to renewing your certification, you are required to obtain at least the following
continuing education contact hours from IDEM- approved training courses based on the classification of your certification:
Classes I -SP and A -SO: 5 contact hours; at least 3.5 of which must be technical hours
Classes I, 11, A and B: 10 contact hours; at least 7 of which trust be technical hours
Classes III, IV, C and D: 20 contact hours; at least 14 of which must be teclnzical hours
i nt of En �rupment IMana�e�Rn[ .��a r Your certification will expire on 06/30/2013. If you have any
questions, please contact Tonja Fuller -White at (317) 233 -0479 or
1 y�l���ianu olisMlryryN 6204 y 22 ��^f� �'I email lfullerw(i6dem.in. oy
�t���trW <astewaier Operator Class IV x���i
Please retain this licensure information sheet so that you will have
Ceil�Gcalwn #,,c, i� LITect ve�geie t.xpir In naDutlli�i ll,t
y the program address, telephone number, and your certificate
Vi,A155]5 a 110 tD7/01/201�1� a, 1 P���06I3U /2013 number available should you need to contact the program office.
s�'�t����k 6 it 'Sr A l 4 ski t, i�p I �I�
hP�� �aiVt�
`9 d ��1-.
x
i d+ r Department of Environ mental Management
�m Office of V1'ati r Quality Mail Cade 65`42 0
4 ..l. Fridia "napolis; "Indiana 46204 -2251
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Wastewater, Operator Class IV
Certification Number Effective Date
WWO15515 07/0.1/2011
,or-d Censrr�ithu
Certificate of Competency
This certifies that the person named above has fulfilled the
requirements for certification as a wastewater treatment plant
operator an accordance •with `IC 0 18 1 1 acid xis 'her'eby Thomas W. Easterly
certified as a W, tewat6f Operator Class IV. Commissioner
JORDAN J. KLEINSMfTH -1 53 5366
CHASE r►
":
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
T9971
KLEINSMITH, JORDAN Purchase Order No.
WASTEWATER Terms
Due Date 7/15/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/15/2011 060311 $30.00
I 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 0 r
VOUCHER 115499 WARRANT ALLOWED
T9971 IN SUM OF
KLEINSMITH, JORDAN
WASTEWATER
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
060311 01- 7042 -06 $30.00
Voucher Total $30.00
Cost distribution ledger classification if
claim paid under vehicle highway fund