157942 04/01/2008 CITY OF CARMEL, INDIANA VENDOR: 358789 Page 1 of 1
ONE CIVIC SQUARE RALPH GRUWELL
CARMEL, INDIANA 46032 9035 MT SHASTA SOUTH CHECK AMOUNT: $104.52
W. GLENN VILLAGE CHECK NUMBER: 157942
INDIANAPOLIS IN 46234
CHECK DATE: 4/1/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 031108 104.52 OTHER EXPENSES
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CITY OF CARMEL Expense Report (required for all travel expenses)
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2008 mileage reimbursement rate is 50.5 cents /mile
EMPLOYEE NAME: RALPH GRUWELL 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 $26.18 1 $26.18
3/11/08 $11.041 $11.04
3/12/08 $8.601 $8.60
3/13/08 $6.34 $6.34
$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 l $0.00 $0.001 $0.00 $78.54 $0.00 $0.00 $25.98 $0.001 $0.00 $0.00 $0.00 1=11
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
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0 +SPEEDOMETER READING columns are to be Lined only when distance between points cannot bs delermined by fixed mileage or official highway map.
c Pursuant to the providons and penal0e8 of Chopier 155. Acts 1653. 1 hereby certify that the 1cmaing account is just and correct. that the amount claimed is legally due. after allowing oU just I
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IN S ,..F WASTEWATER OPERATOR CONTINUING EDUCATION To ensure proper credit, the wastewater approval
CREDIT REPORT
number MUST be provided.
State Form 51139 (R 1 -06) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Technical Contact Hours Earned:
General Contact Hours Earned:
�RU �i,T {O{�{.� S-ri'
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 op erator continuing education course.
1. V
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2. AQD tom' nRESS (number and street):
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City: State: ZIP code: Telephone number:
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Email Address:
Check here if this is an address change
�COU.F sE 1�VFORIV�A Ns x, F x�
3. NAME OF TRAINING COURSE:
lb A5f le toY+f eI' r?eRf me 17' 0Pe /dla ��1J�/1rC��ist� W10 ref -P 1�
4. NAME OF ORGANIZATION SPONSORING COURSE:
5. DATE(S) ATTENDED: LOCATION ATTENDED:
r T-oopi.5, 3 1 1 TIA
6. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE
PROVIDER:
Technical Contact Hours: General Contact Hours:
IS
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. SIGNATURE OF INSTRUCTOR: 9. PRINTED NAME OF INSTRUCTOR:
14 V yl B _4i S kl f ce
10. 4 GNATU1RE 0 CERTIFIED OPERATOR: 11. PRINTED NAME OF CERTIFIED OPERATOR:
12. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification number. Class: Expiration date:
W
Operator certification number: Class: Expiration date:
VOUCHER 085115 WARRANT ALLOWED
T1025 IN SUM OF
GRUWELL, RALPH
WWTP
N
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
031108 01- 7042 -06 $104.52
A
t Voucher Total $104.52
Cost distribution. ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1025
GRUWELL, RALPH Purchase Order No.
WWTP Terms
Due Date 3/19/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/19/2008 031108 $104.52
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 fficer