HomeMy WebLinkAbout179165 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 00351097 Page 1 of 1
ONE CIVIC SQUARE TODD C CLARK
CARMEL, INDIANA 46032
CHECK NUMBER: 179165
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NUM BER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 REIMB 150.00 TRAINING SEMINARS
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CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: Todd Clark DEPARTURE DATE: 10/20/2009 TIME: AM PM
DEPARTMENT: Police RETURN DATE: 10/22/2009 TIME: AM/PM
REASON FOR TRAVEL: SWAT Training DESTINATION CITY: Camp Atterbury Edinburgh
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM XXXX
Transportation Gas /Tolls/ Meals
Date Lodging Misc. Tot I'm
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
10/20/09 $50.00 $50.00
10/21/09 $50.00 $50 00
10/22/09 $28.00 $50.00 178.00
$0 00
$0;00
$0.00
$0.00
$0..00
$0:00
$0.00
$0:00
$0.00
$0.00
:$0:00
$O, .Q0
0 `00
Total ..,:$0.00 $p,'00
:$600', $0:00 $28 00 $000'$0 00 $0 00 $0:00, $150.00 $0:00
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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:
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City of Carmel Form ER06 Revision Date 10/28/2009 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:
I 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.
I 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 ERO6 Revision Date 10/28/2009 Page 2
A,
Camp Atterbury Folio
ATTN: Billeting Office Building #433
Edinburgh, IN 46124 Dated Iiivolee,
Phone: 812 -526 -1128 10/22/09 046045
MAJ JIM BARLOW 1F61io
CARMEL PD 1 098663
SWAT TEAM
Date Room Q ty Code Descri Payment Char Tar; Balanc
10/20 22 -01 1 ROOM Room Char 20.00 20.00
10/21 22 -01 1 ROOM Room Charges 20.00 4 0.00
10/22 22 -01 1 LATE Lost Ke Fee 28.00 68.00
f 10/22 22 -01 l CASH Cash 28.00 40.001
Check -in: 10/20/09 0: l7pm
Printed: 10 /22/09.- 08.28am
Totals $28.00`= $68.00:_ $0.00 c- 4 0.00
Camp Atterbury =Tota due $40
All room rentals payable in advance. A late fee is charged for all keys returned 1100 hours.
I hereby assume responsibility for the quarters and property in the above listed buildings /rooms.
Signature
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
Todd C. Clark Purchase Order No.
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/5/09 reimburse Officer Todd Clark for meals and lost key 178.00
while attending SWAT training on October 20 22 200
at CaMD Atterbur
Total
I 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
T odd C. Clark IN SUM OF
5864 South 775 West
Tipton, IN 46072
c 0
178
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund cont ed fu
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
210 570 150.00 which charge is made were ordered and
received except
November 5 20 Og
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund