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HomeMy WebLinkAbout172353 05/13/2009 s CITY OF CARMEL, INDIANA VENDOR: 120950 Page 1 of 1 0 ONE CIVIC SQUARE DOUGLAS HANEY CHECK AMOUNT: $1,412.16 CARMEL, INDIANA 46032 C/O DEPT OF LAW C/O DEPT OF LAW CHECK NUMBER: 172353 CHECK DATE: 5/13/2009 D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION 1180 4343002 1,316.34 EXTERNAL TRAINING TRA 1180 4343003 18.82 TRAVEL LODGING 1180 4343004 77.00 TRAVEL PER DIEMS STATE OF INDIANA SS: COUNTY OF HAMILTON AFFIDAVIT I, Douglas C. Haney, Carmel City Attorney, being first duly sworn upon my oath, state that while on City business April 1S 21, 2009, attending the IMLA Mid -Year Seminar in Washington, D.C., I expended Thirty -Four Dollars and Five Cents ($34.05) of my own monies for shuttle and subway transportation for which I need to be reimbursed. Dated this day of May, 2009. J Douglas C. Haney Subscribed and sworn to before me, the undersigned Notary Public, this day of May, 2009. A. Elaine Bass NOTARY PUBLIC 7 J. l j F`.' Resident of Marion County, Indiana My_ Carrini ssioin Expires: October 23 ?,;2016 [eb:msword:z:\shuMd affidavits�af7adivit subway seminar.daa:5/ 1 q /p9] ,..A of Cgq CITY OF CARMEL Expense Report (required for all travel expenses) NDIANp EMPLOYEE NAME: Douglas C. Haney DEPARTURE DATE: 04/18/09 10:35 a.m. DEPARTMENT: Law Department RETURN DATE: 04/21/09 TIME: 8:38 p.m. REASON FOR TRAVEL: IMLA's Mid -Year Seminar DESTINATION CITY: Washington, DC EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Transportation Gas /Tolls/ Meals Date Lodging Misc. Total Air -fare Car Rental Other Parking Breakfast Lunch D inner Snacks Pe Diem April 18 April 21, 2009 $376.50 $34.05 $64.00 $581.79 1 $260.00 $1,316.34 $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 s $0.00 $0.00 $0.00 $0.00 0.00 Total $376.501 $0.001 $34.051 $64.00 $581.79 $0.00 $0.00 $0.00 $0.00 $260.00 $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. &T14Way%W* F9i on Date 5 /4 /2Q @te: O Page 1 ry 8727 Colesville Road Silver Spring, MD 20910 Phone (301) 589 -5200 Fax (301) 563 -3832 Reservations Name Address Washington DC/Silver Spring www.hilton.com or 1 800 HILTONS HANEY, DOUGLAS Room 828 /D2RRU1 13828 SMOKEY RIDGE DR Arrival Date 4/18/2009 2:18:OOPM Departure Date 4/21/2009 CARMEL, IN 460339101 US Adult/Child 2/0 Room Rate 161.00 RATE PLAN L -AA HH# 864254159 DIAMOND AL: NW #061240012 BONUS AL: CAR: CONFIRMATION NUMBER: 3326649594 4/21/2009 PAGE 1 DATE REFERENCE DESCRIPTION AMOUNT 4/18/2009 2292113 PARKING $12.00 4/18/2009 2292114 GUEST ROOM $161.00 4/18/2009 2292114 STATE TAX $9.66 4/1812009 2292114 LOCAL TAX $11.27 4/19/2009 2292960 PARKING $12.00 4/19/2009 2292961 GUEST ROOM $161.00 4/19/2009 2292961 STATE TAX $9.66 4/19/2009 2292961 LOCAL TAX $11.27 4/20/2009 2294088 PARKING $12.00 4/20/2009 2294089 GUEST ROOM $161.00 4/20/2009 2294089 STATE TAX $9.66 4/20/2009 2294089 LOCAL TAX $11.27 WILL BE SETTLED TO $581.79 EFFECTIVE BALANCE OF $0.00 EXPENSE REPORT SUMMARY 0 00:00:019 12:00:OOAM 009 12:00:OOAM STAY TOTAL ROOM TAX $181.93 $181.93 $181.93 $545.79 MISCELLANEOUS $12.00 $12.00 $12.00 $36.00 DAILY TC 1TAL $193.93 $193.93 $193.93 $581.79 DATE OF CHARGE FOLIO NO. /CHECK NO. 7V Zip -Out Check -Out 277158 A Good Morning We hope you enjoyed your stay. With Zip -Out Check -Out® AUTHORIZATION INITIAL there is no need to stop at the Front Desk to check out. Please review this statement. It is a record of your charges as of late last PURCHASES SERVICES evening. For any charges after your account was prepared, you may: TAXES pay at the time of purchase. charge purchases to your account, then stop by the Front Desk for an updated statement. TIPS MISC. or request an updated statement be mailed to you within two business days. Simply call the Front Desk from your room and tell us when you are ready to TOTAL AMOUNT depart. Your account will be automatically checked out and you may use this 0.00 statement as your receipt. Feel free to leave your key(s) in the room. Please call the Front Desk if you wish to extend your stay or if you have any questions about your account ePromo Standard Promotions Template Page 1 of 2 Haney, Douglas C From: Northwest Airlines [webuser @lists.nwa.com] Sent: Thursday, April 16, 2009 6:07 AM To: Haney, Douglas C Subject: Travel Planner Email via kome My NWA Wo woAdw9de Sites Q AskA 0umtFon Gb9' Y rd ReervatlonsCenter� Travel�ools Proeotton� 6e Products tPtitbrldPerks War i s d f Travel Planner E-mail WorldPerksoEIite2'0 Dear DOUGLAS HANEY, Reservations Center Shop for Fligbts Thank you for choosing Northwest Airlines& Award Travel Reservations n se e s Manage My Reservati Use the confirmation number below to check in for your flight on Man h M y R Re se rvati o ns ra s nwa. com within 24 hours of flight departure. Select your seats, print or fax your boarding passes available with or without luggage. Refunds E xchanges If your travel plans have changed, please go to _Manage My Reservations. Your Reservation Confirmation Number: 7V8MHX E- Ticket Numbers: Frequent Flyer Number 0122171002058 HANEY /DOUGLAS.0 NW061240012 Silver Elite Date: Saturday, April 18, 2009 Flight: NW 2190 Departs: IND Arrives: DCA Scheduled Departure: 10:35 AM Scheduled Arrival: 12:12 PM Class of Service: Economy More Info: Seats ,_flig ht d Flight Status posted day before departure Sign up for Flig St atus Notifica nwa.com check -in Note: "Operated by PINNACLE AIRLINES /NWA AIRLINK Date: Tuesday, April 21, 2009 Flight: NW 235 Departs: DCA Arrives: D Scheduled Departure: 4:25 PM Scheduled Arrival: 6:01 PM Class of Service: Economy More Info: Seats ,_flig de tails Flight Status posted day before departure Sign up for Flight Statu Not Notes 'Operated by Northwest Airlines; Departs from Terminal A Date: Tuesday, April 21, 2009 Flight: NW 1603 4/17/2009 ePromo Standard Promotions Template Page 2 of 2 Departs: DTW Arrives: IND Scheduled Departure: 7:17 PM Scheduled Arrival: 8:38 PM Class of Service: Economy More Info: S eats flight de tails Flight Status posted day before departure Sign up for RghtStat N otification Notes *Operated by Northwest Airlines; Departs from E.H. McNamara Terminal Note: Some flights may be operated by our alliance partner, KLM Royal Dutch Airlines, Northwest designated affiliate partners, or Northwest Airlink. Click underlined items for additional information. Time shown is local time, corresponding to departure city. Destination Information Weather for Washington- Reagan National, DC Forecast Thursday Friday Saturday Sunday Monday 4/16/2009 4/17/2009 4/18/2009 4119/2009 4/20/2009 Warmer Sunny Mostly sunny Not as warm Chance for High: 62 F warmer High: 75 F High: 66 F rain Low: 42 F High: 73 F Low: 51 F Low: 50 F High: 63 F Low: 49 F Low: 49 F ©2009AccuWeather, Inc. Get dr dire and maps for Washington, DC. nwa.com Travel Tools Se lf- service Check -in o Get information about nwa.com check -in or Northwest Self- service Check -in Kiosks dress Security Che for Elite Memb ers o Expedited security processing for Platinum and Gold Elite members available at many airports My NW Info Trave Alerts Set up automatic flight notifications for all of your trips Luggage Infor o Frequently asked questions about checked carry-on luggage and lost luggage tracking Travel Tips Get details about required travel documents and other special travel needs WorldClubs A Lo unges o See a list of locations, hours and amenities Meal Available for Pur chase o Sele Flia o Get information about meals available for purchase on select Northwest flights Ask a Question You should arrive at the airport 75 minutes prior to departure for your trip to Washington, DC. DOUGLAS HANEY, we look forward to welcoming you on your upcoming trip to Washington, DC. Enjoy your travels! Thank you for flying with Northwest Airlines. About North►rest C0rrtact Us Terms of Use Privacy 1 Customers First Site Map i Travel Agents 1 4 0 Northwest Airlines 2001) 4/17/2009 of INDIANA RETAIL TAX EXEMPT PAGE Ci ty Carmel. CERTIFICATE NO.003120155 002 0 o li PURCHASE ORDER NUMBER a ?f1w7'n �t� Ike-, FEDERAL EXCISE TAX EXEMPT 35- 60000972 t� ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF-ACCOUNTS FOR CITY OF CARMEL 1997 PURCHASE OR D E ER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION t VENDOR SHIP TO CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY 71 UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION 04� Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT t PAYMENT `3 r t A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND 7T e�✓_ �V q f, :,(�KJ'�y VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE A J AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 'i 1 CLERK TREASURER DOCUMENT CONTROL NO A. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER N{) ND`____ ALLOWED 20 |N THE SUM OF$ ON COUNT DFAPP R|AT|ONR3R Board Members PO# or INVOICE NO. ACCT#/TITLE AMOUNT hereby certify that the attached invoioe(e),or biU(s)ia(ao) true and correct and that the materials or services itemized thereon for which charge ie made were ordered and received except %Title r Cost distribution ledger classification if claim paid rnotor vehicle highway fund PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986) MILEAGE CLAIM 4,A, TO (GOVERNM UN' Af 1711 TAL ON ACCOUNT OF APPROPRIATION NO. FOR Ji (OFFICE, BOARD, DEP ENT OR INSTITUTION) SPEEDOMETER DATE FROM TO READING AUTO MILEAGE 1 NATURE OF BUSINESS MILES x POINT POINT START FINISH TRAVELED PER MILE o v 7. w I 6 79 1 -413 a AUTO LICENSE NO. TOTALS SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits end that no part of the same has been paid. Date Claim No. Warrant No. I have examined the within claim and hereby IN FAVOR OF certify as follows: That it is in proper form. That it is duly authenticated as required by law That it is based upon statutory authority. That it is apparently correct f incorrect 41 30 Disbursing Officer Ori Account of Appro riation No. for o b' a 0 axe. Allowed 19 O a in the sum of Cr m a m m E a m o m y' M m a p 0 n �e 0 (Board or Commission) a A m FILED a a a rA w a a m (Official Title) O 0 O tv M A.E. BOYCE CO., INC. MUNCIE, IN 01136 0 VOUCHER NO. WARRANT NO. ALLOWED 20 Douglas C. Haney IN SUM OF 13828 Smokey Ridge Drive Carmel, Indiana 46033 F $18.82 ON ACCOUNT OF APPROPRIATION FOR Department of Law 430 -43003 Travel Lodging Non Training Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 180 18.82 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 20 ig uxe Cost distribution ledger classification if Title claim paid motor vehicle highway fund 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. Douglas C. Haney Payee Purchase Order No. 13828 Smokey Ridge Drive Terms Carmel, Indiana 46033 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5 -5 -09 Reimburse Douglas C. Haney for monies he personally expended while on City business: 03 18 09 1 AGT 1 MLA Leg Gernm Meeting $13. 2 03 -19 -09 Speaker at Town Hall meeting in Fishers $5.40 dinner er the attached receipts Total $18.82 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer Passenger Receipt Depart Arrive Date Cabin Fare Code E- Ticket 0122171002058 Indianapolis, IN Washington- Reagan Na 18APR09 Coach T141J8N Issue Date: 030CT08 j Washington Reagan Na Detroit. MI 21APR09 Coach T14USN Name /Place of Issue: NWA.COM US E- TICKET T Detroit. MI Indianapolis, IN 21APR09 Coach T141J8N AR MPLS /ST PAUL MN Endorsements/ Restrictions: NON REFUNDABLE /PENALTY FOR CHANGES HANEY /DOUGLAS.0 Transportation subject to terms of carriage Total Fare This Ticket: USD 376.50 printed inside ticketjacket FARE 320.93 Form of Payment: AIR TRAVEL CARD US TAX 24.07 Card 4: XXXXXXXXXXXX7853 DOM SEGMENT FEE 10.50 E- Ticket n: 0122171002058 OTHER TAX 21.00 Confirmation 7V8MHX TOTAL USD 376.50 Rag Tag NW sl.9G 8// i9 Page 1 of n I 111 '25�i�q -�2 Thank You For Eating At MCDONALD'S FISHERS 8990 EAST 116TH STREET FISHERS, IN 46038 THANK YOU TEL# 3178420013 Store# 684+0 KS #13 Mar.18'09 (oe.7, 22:12 MFY side 1 KVS oraer :Z'yjG (QTY ITEM TOTAL 1 QTR POUNDER CHEESE 3.00 1 VANILLA CONE 1.00 1 MED DIET COKE 1.00 Subtotal 5.00 Tax 0.40 Take -Out Total 5.40 Cash Tendered 10.00 Change 4.60 RECEOPT 01 WORLDWIDE PARKING SOLUTIONS KEEP THUS RECEOPT Em 19 EM MM M WORLDWIDE PARKING SOLUTIONS KEEP 7HUS RECEIPT Welcome to: INDIANA SQUARE GARAGE Management, Hy: Denison Parking, Inc. INSER -1 HAH CIIDE IIP WHEN PAVINI: nl PAY SIAIIIIN Entered: 21109/03/18 10:33 I 6-..lcvr #:lJl1401SHH39 Dur:16IL04 Paid tin: 211119Y10/18 '13:13 PaIA•: 7.1111 lil'^iginal Fee 1.00 CSI:$ 0.0U PSI:$ 11:00 Change H. 11 SC:$ H.110 Merchant ID: 11113 5 1 3 9 5 +u+t+trr Swilled Pur'cha 119/03 /1H 13:13:16 Seq# POE Auth# 111535n 1100 APPHIIUED I Indianapolis International Airpoat indianapolisairport.com RECEIPT Toledo Ticket Co., Toledo, ON TRAN IN TIME OUT TIME FEE CC# Q� 1 }:j 1 f�A= _�i rti =Q!Vi b I♦ I �r nr �n Return this receipt to a participating P=3 BURGER KINGO restaurant to receive offer. M Food purchase required. Validated receipt 0 good for one month from date of purchase. Not valid with any other offer, including senior or value meal pricing. Not available to IQ employees their families. One survey per guest per month. Cash value 1 /100. Q� �1 LLame gratis al 1- 866 425 -4745 y siga Id's in_tccfones. One free WHOPPERG sandwich or Or(ginal Lo Chicken sandwich with purchase of a y size drink and fries after completing our brief survey. p y� 1. Call toll free 1- 866 425 -4745 anytime within 48 hours. N 2. Complete survey and get C� validation code. 3. Write code here 3 3 2� ?a- 3 e Return this receipt to participator G= BURGER KINGS restaurant to receive offer. Ab M Food purchase required. Validated receipt, O good for one month from date of purchase. Not valid with any other offer, including D;b ty senior or value meal pricing. Not available to s' employees their families. n -1 1 CF PUS 3 C. EXPEDITER F i"NG 7 'f'Yt�� 1 C L R G 0 r\l t: 01\4 f= i_ 1\1 3 Lf?G D i_ F G0KE: ever: LIZ fiAR 18 01:49 RM O 53 Au S�L qZ� 998 -i I �pzs amD —ES__ tl 7�OOi /I enlp ysD n st 71 •yluow iad isan &sad h