177241 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 00352767 Page 1 of 1
ONE CIVIC SQUARE WILLIAM HOHLT
CARMEL, INDIANA 46032 CHECK AMOUNT: $164.00
cio oocs
ti o cio cOCS CHECK NUMBER: 177241
CHECK DATE: 9/15/2009
DEP ARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM OUNT D
1192 4343001 89.00 TRAVEL FEES EXPENSE
1192 4343004 75.00 TRAVEL PER DIEMS
OF CA
CITY OF CARMEL Expense Report (required for all travel expenses)
/NOIPNP
EMPLOYEE NAME: william hohlt DEPARTURE DATE: TIME: 4 4'90 AM
DEPARTMENT: Building and code services RETURN DATE: Q Q TI E: S AM P
REASON FOR TRAVEL: Training DESTINATION CITY s�
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REI U SEMENT TR PER DIEM
Transportation Gas /Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
8/27/09 $89.00 $89.00
8/26/09 $30
8/27/09 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 $89.001 $0.001 $0.00 $0.00 $0.00 .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 8/31/2009 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 $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 $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 ER06 Revision Date 8/31/2009 Page 2
SOUTH BEND, IN 46637
TELEPHONE 574 277 -9373 FAX 5742430128 U S A
official sponsor U.S. Olympic Team
HOHLT, WILLIAM 326 /KXPL
X name room number: 8/26/2009 4:33:OOPM
address arrival date: 8/27/2009
X, PA 55555 departure date:
US adult/child: 1/0.00
room rate:
t the debWcredit card you are using for check -in is attached to a bank or checking account, a hold will RATE PLAN L -GVT
be placed on the account for the full anticipated dollar amount to be owed to the hotel, including HH#
estimated incidentals, through your date of check -out and such funds will not be released for 72 business AL:
ivours from the date of check out or longer at the discretion of your financial institution. BONUS AL: CAR:
CONFIRMATION NUMBER: 87537938 Rates subject to applicable sales, occupancy, or other taxes. Please do not leave any money or items of value unattended in
your room- A safety deposit box is available for you in the lobby. I agree that my liability for this bill is not waived and agree
to be held personally liable in the event that the indicated person, company or association fails to pay for any part or the
8/27/2009 PAGE 1 full amount of these charges. I have requested weekday delivery of USA TODAY- If refused, a credit will be applied to my
account. In the event of an emergency, 1, or someeQpeeiin my party, require special evacuation due to a physical disability,
Please indicate yes by checking here:
signature:
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8/26/2009 792870 ADVANCED DEPOSIT CASH ($89.00)
8/26/2009 792959 GUEST ROOM EXEMPT $89.00
WILL BE SETTLED TO CASH $0.00
EFFECTIVE BALANCE OF $0.00
EXPENSE REPORT SUMMARY
09 00:00:00 STAY TOTAL
ROOM TAX $89.00 $89.00
DAILY TOTAL $89.00 $89.00
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL n
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))
08/26/09 One night hotel stay $89.00
08/26/09 Travel Per diem $90.00
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
William Hohlt
IN SUM OF
c/o One Civic Square
Carmel, IN 46032
$179.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1192 43- 430.01 0 --$69.00 1 hereby certify that the attached invoice(s), or
1192 43- 430.04 5..00 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, September 14, 2009
Director, DOCS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund