HomeMy WebLinkAbout166766 12/10/2008 F CITY OF CARMEL, INDIANA VENDOR: 00352774 Page 1 of 1
ONE CIVIC SQUARE JORDAN KLEINSMITH
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CARMEL, INDIANA 46032 C10 WASTEWATER CHECK AMOUNT: $37.51
C!0 WASTEWATER CHECK NUMBER: 166766
CHECK DATE: 12110/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION
651 5023990 111808 37.51 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 58.5 cents /mile
EMPLOYEE NAME: JORDAN KLEINSMITH DEPARTURE DATE: 11/18/2008 TIME: 8:30AM
DEPARTMENT: Utilities /Sewer RETURN DATE: 11/20/2008 TIME: 4:30PM
REASON FOR TRAVEL: 2008 INDIANA WATER ENVIR. ASSOC. CONF. DESTINATION CITY: INDPLS, IN
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
11/18/08 $21.75 $21.75
11/19/08 $15.76 $15.76
$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 .001 $0.00 $37.51 $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 11/24/2008 Page 1
06 ST4Tp
WASTEWATER OPERATOR CONTINUING EDUCATION To ensure ep cr number
CREDIT REPORT MUST be provided.
State Form 51139 (R I 1-06) Training Course Approval Number:
ia1 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT WU11T08 8140- T14 -G11.5
Technical Contact Hours Earned:
29.5
General Contact Hours Earned:
15
INSTRIJ_CTIOIVS��'
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.
X y J �CERl IFIEDOPERr4TORINF "t ;p
1. NAME:
Ty
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2 ADDRESS (number and street):
338 o Rt A NI)
City: State: ZIP code: Te[ephone number:
Work:
T ,g.
W "Y Homelydl: ID 3/1
'Check here if this is an address change Email Address:
%1_104 CO.URSE INFORINI�ATIOIV 's6
3. NAME OF TRAINING COURSE:
Annual Conference 202*; ti
4. NAME_ OF ORGANIZATION SPONSOR ING
Indiana Water Environment Association'
5. DATE(S) ATTENDED: fi. LOCATION ATTENDED:
November 18 -20, 2008 Marriott East, Indianapolis
7. TOTAL NUMBER OF CONTACT HOUR ATTENDED BY CERTIFIED OPERATOR AND VERIFIED BY INSTRUCTOR AND TRAINING
COURSE PROVIDER:
Technical contact Hours: General Contact Hours: o
m
I, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or
supervision,a d that the information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand
that any O sions or misrepresentations may result in the denial of continuing education credit for this course.
S. SIGR TUREr`OF IN ST Afi, 9. PRIP1 ED NA qd OF -MT TRUCTOR:
r .1 SIGNATU OF CERT FEED OPERATOR: 11. PRIN NAME OF CERTIFIED OPERATOR:
1. t_ r Ash., j 1 I t J _7/1 c f' T
1� ONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
`Operator certification number: Class: Expiration date:
Operator certification number: Class: Expiration date:
VOUCHER 086763 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
111808 01- 7042 -06 $37.51
Voucher Total $37.51
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
T9971 s
KLEINSMITH, JORDAN Purchase Order No.
WASTEWATER Terms
Due Date 12/112008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/1/2008 111808 $37.51
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC ::;k,
Date r