176711 09/02/2009 "c. CITY OF CARMEL, INDIANA VENDOR: 00352429 Page 1 of 1
ONE CIVIC SQUARE MINDY COLLINS CHECK AMOUNT: $772.62
CARMEL, INDIANA 46032 C/o Cccc
y <:o C/o CCCC CHECK NUMBER: 176711
CHECK DATE: 9/2/2009
DEP ARTME NT ACCOUNT PO NUMBER INVO NU MBER AMOUNT DES CRIP TI ON
1115 4343002 REIMB 376.32 EXTERNAL TRAINING TRA
`1115 4343004 REIMB 396.30 TRAVEL PER DIEMS
oF.cAa
CITY OF CARMEL Expense Report (required for all travel expenses)
\INDIAN P.
NAME lam` nc' START DATE L p z b •tj TIME: s AM// PM
Carmel Clay Communicati n" s Center RETURN DATE: b' Z Z TIME: AM M
V� LOCATION (ate rV.. j1
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT x
Transportation Gas /Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
8/17/09 6 $50.00
8/18/09 rV $50.00
8/19/09 0 $50.00
8/20/09 �p $50.00
8/21/09 �r? $50.00
$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 $0.001 $0.001 $0.001 $0.001 $0.001 $0.00 $0.00 .00 $0.00
0 2 50•
DIRECTOR'S STATEMENT: I that all expenses li ted conform to the City's travel policy and are within my department's appropriated budget.
a 0 �4�r
Director Signature: z Date:
City of Carmel Form ER06 Revision Date 8/24/2009 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 $60 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 $30 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 $30 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 $60 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 ded c d from the first paycheck issued more than 30 days after the date of my return.
2 ,5-7
Employee Signature: Date:
City of Carmel Form ER06 Revision Date 8/24/2009 Page 2
a GR.AD OF ACCOUNTS GE-N FORM NO. 101 (1986)
MILEAGE CLAIM
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AUTO LICENSE NO. TOTALS
DOMETER READING cclumns ar to be used only when distance between ocints cannot be determined by fixed mileage cr cfficial highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account i just and correct, thai the amount claimed is all due, after a1' wing all just credits
that no part of the same has been paid.
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HOME'WOOD 1399 Liberty Drive Bloomington, IN 47403
S g Phone (812) 323 -0500 Fax (812) 323 -4681
Reservations
Name Address Hilton homewoodsuites.com or 1- 800- CALLrHOME
COLLINS, MINDY Room 204 /KSTN
547 GRABELL DR Arrival Date 8/17/2009 5:10:OOPM
Departure Date 8/21/2009
WESTFIELD, IN 46074
US Adult/Child 1/0
Room Rate $84.00
RATE PLAN C -EM6
HH#
AL
BONUS AL CAR
Confirmation: 84153195
8/21/2009 PAGE 1
DATE REFERENCE DESCRIPTION AMOUNT
8/17/2009 190264 GUEST ROOM $84.00
8/17/2009 190264 RM STATE TAX $5.88
8/17/2009 190264 Rivt- TOURISM TAX $4.20
8/18/2009 190390 GUEST ROOM $84.00
8/18/2009 190390 RM STATE TAX $5.88
8/18/2009 190390 RM- TOURISM TAX $4.20
8/19/2009 190550 GUEST ROOM $84.00
8/19/2009 190550 RM STATE TAX $5.88
8/19/2009 190550 RM- TOURISM TAX $4.20
8/20/2009 190771 GUEST ROOM $84.00
8/20/2009 190771 RM STATE TAX $5.88
8/20/2009 190771 RM- TOURISM TAX $4.20
WILL BE SETTLED TO VS *3474 $376.32
EFFECTIVE BALANCE OF $0.00
ESTIMATED CURRENCY TOTAL
DATE OF CHARGE FOLIO NO. /CHECK NO.
E "RES',S' CHECK -OUT
Good Morning We hope you enjoyed your stay. With Express Check -Out
AUTHORIZATION 4NITIAL
there is no need to stop at the Front Desk to check out
C Please review this statement. It is a record of your charges as of late last
evening. PURCHASES SERVICES
For any charges after your account was prepared, you may:
pay at the time of purchase. TAXES
charge purchases to your account, then stop by the Front Desk for an 0
updated statement.
or request an updated statement be mailed to you within two business days. TIPS MISC.
Simply call the Front Desk from your room and tell us when you are ready to
depart. Your account will be automatically checked out and you may use this
statement as your receipt. Feel free to leave your key(s) in the room. TOTAL AMOUNT
0.00
Please call the Front Desk if you wish to extend your stay or ijyou have any
questions about your account
PAYMENT DUE UPON RECEIPT 1.59 PER MONTH INTEREST CHARGE WILL BF. APPLIED TO ALL PAST DUE INVOICES.
r
HOME WOOD 1399 Liberty Drive Bloomington, IN 47403
S� i r.7 Phone (812) 323 -0500 Fax (812) 323 -4681
i .7 Reservations
Name Address Huron homewoodsuites.com or 1- 800- CALLrHOME
COLLINS, MINDY Room 204iKS.T N
547 GRABELL DR Arrival Date 8/17/2009 5:10:OOPM
Departure Date 8/21/2009 8:32:OOAM I
WESTFIELD, IN 46074
US Adult/Child 1/0
Room Rate 84.00
RATE PLAN C -EM6
HH# Z
AL:
CAR:
CONFIRMATION NUMBER: 84153195
8/21/2009 PAGE 1
DATE REFERENCE DESCRIPTION AMOUNT
eilll)lfinlly
8/17/2009 190264 GUEST ROOM $84.00
8/17/2009 I 190264 RM STATE TAX $5.88
8/17/2009 130264 Rif -TOUn $ivi I AX Mori
8/18/2009 190390 GUEST ROOM $84.00
8/18/2009 190390 RM STATE TAX $5.88
8/18/2009 190390 RM- TOURISM TAX $4.20
8/19/2009 190550 GUEST ROOM $84.00 CON RAD
8/19/2009 190550 RM STATE TAX $5.88
8/19/2009 190550 RM- TOI.IRISM TAX $4.20
8/20/2009 190:771 GUEST ROOM $84.00
8/20/2009 190771 RM STATE TAX $5.98
8/20/2009 190771 I RM- TOURISM TAX $4.20 Dou BLETREV
8/2112009 i 190897 VS *3474" ($376.32)
BALANCE $0.00
Hilton
Gardenhur
I I
ACCOUNT NO. DATE OF CHARGE FOLIO NO. /CHECK NO. Hilton
Grand Vacations Club
VS *3474 08/17/09 17:10:00 57807 A
CARD MEMBER NAME AUTHORIZATION INITIAL t,
COLLINS MINDY 08799R HOMEWOOD
SUITES
ESTABLISHMENT NO. &LOCATION ESTABLISHMENT AGREES TO TRANSMIT TO CARD HOLDER FOR PAYMENT PURCHASES SERVICES ahem
THANK YOU FOR STAYING WITH THE HOMEWOOD TAXES
TIPS MISC. U S A
TOTAL AMOUNT 376.32
Official Sponsor
MERCHANDISE ANDIOR SERVICES PURCHASED ON THIS CARD SHALL NOT BE RESOLD OR RETURNED FOR A CASH REFUND. PAYMENT DUE UPON RECEIPT
Page 1 of 2
Collins, Mindy L
From: Homewood Confirmed [homewood @res.hilton.com]
Sent: Wednesday, January 07, 2009 10:41 PM
To: Collins, Mindy L
Subject: Homewood Confirmation #84153195
t om Homewood Suites by Hilton Bloomington
1399 Liberty Dr.
Bloomington, IN
United States, 47403
Tel: 812- 323 -0500
Fax: 812- 323 -4681
Confirmation Number: 84153195
Make the Most of Click here to view or edit your reservation.
Your Stays Name: Mindy Collins
Join Hilton HHonors' Corporate ID Number: 0002684771
for free and whenever
you stay at a Arrival Date: 17 Aug 2009
participating Hilton Departure Date: 21 Aug 2009
Family hotel
worldwide, you'll earn Check -in Time: 4:00 PM
both HHonors points
AND airline miles for Check -out Time: 12:00 PM
your stay.
JoinNow ,.r.. w..... M....
Rate Information:
Rate Type:
EMT CLASS
Rate per night: 84.00 USD
Earn 15,000 Total for Stay per Room:
Rate 336.00 USD
HHonors points Taxes 40.32 USD
after making $150 in Total 376.32 USD
purchases within two
months with the no Total for Stay: 376.32 USD
annual fee Citi® Hilton Includes estimated taxes and service charges.
HHonors Visa@
Signature Card Card Tax Service Charges:
benefits let you earn There is a 12.00% Per Room Per Night tax.
HHonors points faster
toward free nights! Additional Charges:
Self parking: 0,00/night
Rate Rules and Cancellation Policy:
Your reservation is guaranteed for late arrival.
Points Miles Should you need to cancel please contact us 24 hours prior to 17
No Blackout Dates. Aug 2009 local property tirne to avoid cancellation penalties.
Only Hilton Room Information:
HHonors. Rooms: 1
Click here to learn Clients: 1 Adult
more and book your Room Type: STUDIO SUITE 1 KING NOSMOK
next trip or reward.
About Us
Spacious suites with complimentary high -speed internet access and
fully equipped kitchens, hot breakfast on the house each morning,
8/15/2009
Page 2 of 2
plus beveragest and a light meal on us, Monday- Thursday evenings.
Our Hotel:
Tour the Hotel
Accommodations
Visit SuiteLiving.com!
An exciting place created specifically for travelers like you! Find the
latest hotel happenings, pick tip travel tips, get help with group travel,
and much more!
pp z^
t Subject to state and local laws.
If you need to MODIFY or CANCEL your reservation, click here
Any change to the arrival date, departure date or room type of this reservation is subject to the hotel's availability at the time the
change is requested and may result in a possible rate change.
Please do not reply to this email. If you have questions regarding your reservation, please contact Hilton Reservations and
Customer Care at 1- 800 -CALL -HOME (225 -5466) visit us at wmv.homewoodsuites.com or email us at
homewoodhalp@ hiltonres.com.
For more information, please click here to see all the rules and restrictions applicable to this reservation.
A listing of all Hilton Reservations and Customer Care phone numbers can be found at:
http: tvw w. homewood- suites .coniren /hnvfone. htmI
Notice of Confidentiality: This message and any attachments may contain confidential information. If it has been sent to you in
error, please reply to advise the sender of the error and [her, immediately delete this message.
n2009 Hilton Hotels Corporation
Hilton Reservations and Custorer Care 12050 Chennault Drive I Carrollton, Texas 75006, USA
`J
Lti•..t3••1�r¢:
8/15/2009
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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))
08/25/09 $376.32
08/25/09 $250.00
08/25/09 $146.30
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
Mi -ndy Collins
IN SUM OF
11429 Pegasus Drive
Noblesville, IN 46060
$772.62
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1115 43- 430.02 $376.32 I hereby certify that the attached invoice(s), or
1115 43- 430.04 $250.00
bill(s) is (are) true and correct and that the
1115 43- 430.04 $146.30
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday, August 26, 2009
4 0 1m e
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund