178311 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 356305 Page I of 1
ONE CIVIC SQUARE DARRELL D NORRIS
CHECK AMOUNT: $232.30
CARMEL, INDIANA 46032 ion znlo AVE sw, #zc
CARMEL IN 46032 CHECK NUMBER: 17 8311
CHECK DATE: 10M4I2009
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOU DESCRIPTION
1160 4343003 75.00 TRAVEL LODGING
1160 4343004 157.30 TRAVEL PER DIEMS
TACT ANNUAL CONFERENCE EXHIBITIOiV
Sunday, October 4
9:00 a.m 5:00 p -m, Registration
009 IACT A n nual 10:00 a.m. —m p.m. Golf Outing
�f An nual 3:00 5:00 p.m. Executive Committee Meeting
7:00 '10:00 p.m. Welcome Party
011 rE'C1C c` lC .K ;l1�iC3i� Monday, Octobers Municipal Day
6:45 8:00 a.m. Nelson Steele Memorial RunANalk
7:00 a.m. 4:00 p.m. Registration
w 7:30 8:30 a.m. Continental Breakfast
1 8:30 9:30 a.m. Opening Business Session
9:45 10:45 a.m. Workshops
T 11:00 a.m. 12:00 p.m. Workshops
12:00 2:00 p.m. Annual Awards Luncheon
2:15 3:15 p.m- Workshops
3:30 p.m. Exhibit Hall Grand Opening
U r (�a Apr 0 0 S 3:30 5:30 p.m. Exhibit Hall Open
�J Ij LJ �J 4:00 4:30 p.m. Policy Resolutions Meeting
3:30 6:00 p.m. Affiliate Group IACT
Committee Meetings
(C
Tuesday, October 6
7:00 a.m. 2:30 p.m. Registration
q, II�� 7:00 8:30 a.m. Continental Breakfast
Public Policy Research Analyst 7:00 -9:30 a.m. Affiliate Group Breakfasts& Meetings
8:30 9:30 a.m. Workshops
9:45 10:45 a.m. Workshops
10:00 a.m. 1:30 p.m. Exhibit Hall Open
11:30 a.m. 1:00 p.m. Lunch in Exhibit Hall
1:30 P.M. Exhibit Hall Grand Prize Giveaway
2:00 3:30 p.m. Closing Business Session
7�ns
x' 3:30 5:30 p.m. IACT Affiliate Committee Meetings
3:30 6:00 p.m. Break
Q 6:00 7:00 p.m. Presidents Reception
p 7:00 p.m. 12:00 a.m. Annual Banquet
Wednesday, October 7
'Nk
8:00 9:30 a.m. Closing Breakfast
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM ,J
(21�f 0 C� �G TO 1� �iC� DR.
((3overnmental unit)
Va f G ��a On Account of Appropriation No. for
(Office, Board, Department or institution)
DATE FROM TO ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
O C pL �2 Gf Gf Cr �ylol xl C U• 1
u?L t �YL�iIJ
Auto License No. TOTALS H S
V X
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is Lecially due, after
allowing all just credits, and that no part of the same has been paid.
J
Date Q v
Claim No. Warrant No. I have examined the within clairn and
hereby certify as follows:
IN FAVOR OF
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
incorrect
On Account of Appropriation No. for
Disbursing Officer
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Allowed 20 (D M. o
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Norris, Darre O OW
From: Comfort Suites [gm|N3O4@cxnioehomb.nnn8
Sent- Friday, August 14.28O8o:22PM
To: Norris, Darrell o
Subject-. Reservation Confirmation
CHOICE HOTEB
121b me me me
H.- Choice Reward
Choice Privile I Reservations 1-877-424-6423 1 Customer Support
Comfort Suites (IN304)
9530 West State Road 56 French Lick, IN, US, 47432
be 13 7 6
erv: ta ry d
or I
We appreciate y our business. Thanks for traveling.s
Your Confirmation Number is: 136807086
Arrival Date: Monday, October 5, 2009 4—.1
Length of Sta 1 Night A-011
Number of Rooms: I
Rate Program: Government/Military Rate Government program rates are reserved for travel on official
g overnment business only for federal employees. Military personnel, their dependents
and members of several government/military oriented associations are extended the 0
rate for official and leisure travel.
do u/Monday
o need mcn cancel this reservat you may so
Oc 2009, before 4 PM local hotel time.
Estimated Total: 77.70 (US Dollar) includin taxes of: 11.00/a
Check In Time: 3:00 PM
Check Out Time- 11:00 AM Ae
OHlotel Alerts: Pet accommodation: 35.00 USD per night "cir
Room Rate Information:
From Chic�go-275 Miles-5 Hours: Route 90 Southeast to 1 65 South, to 1-465 South and West at Indianapolis.
Take Route 37 South to Paoli, Hw 56 west for 10 miles to French Lick and the hotel is located on State Road 56
Ql State and it will mer into SR-145 North, the hotel is located on Miles-7 Hours: A. 1-71 to Carrollton, Ky. 36 to Milton over bridge to Madison-west on 56 trou Paoli to French 0
Lick-travel west on Hw 56 through town and the hotel sits atop of the hill. B. Take 1-71 toward Louisville to 64
West, to Rt. 150 North, to Hw 56 West through Paoli to French Lick-the hotel is located on State Road 56 west of
town. From Detroit-397 Miles-6.5 Hours� 1-94 west to 1-69 near Battle Creek. South on 1-69 to 1-465, south and
east around Indianapolis to 37 south to Paoli-Hwy. 56 west to French Lick and the hotel is located on State Road
56 west of town. From Evansville-90 Miles-2 Hours: 1-64 East to U.S. 231 North to Hwy 56 East to French Lick an
Room Room Occupancy C"'ld'""' Nightly Ra
1 King Bed, Suite, Max Occupancy: 1 0 70.00
No Smoking 4 persons
1 Room Suite Partial Room Divider Sofabed-2Person Microwave Refrigerator Desk
I Night: 70.00 (US Dollar)
*Estimated Tax: 7.70 (US Dollar)
Make Another Reservation Estimated Total: 77.70 (US Dollar)
Guarantee Polic
Your room will be held until 7:00 AM the mornin following y our scheduled arrival date. If you do not arrive and do
not cancel y our reservation b the cancellation deadline, y our credit card will be charged 1 night's sta plus tax.
/3
r
CITY OF CARMEL Expense Report (required for all travel expenses)
�DIANP EXHIBIT A
EMPLOYEE NAME: h /z C� C.. /C�/�/� /J� DEPARTURE DATE: TIME:' I PM
DEPARTMENT: V19 J f� RETURN DATE: /C�IQ�� /,1�1 TIME: �f��� AM
REASON FOR TRAVEL: i(/ (J
DESTINATION CITY: EN C G" L CK .77 Z
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Ga oils/ Meals
Date p gg g arkin Lodging Misc. Total
Taxi Tips Lu a e g Breakfast Lunch Dinner Snacks Per Diem
1015109 $78.65 $50.00 $128.6
10!6/09 $78.65 $25.00 $103.6
$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
Totall $0.00 $0.00 $0.00 $157.30 $0.001 $0.00 $0.001 $0.00 $0.00 $75-001 $0.60 0
.t
DIRECTOR'S STATEMENT: b rm that all a penses listed conform to the City's travel policy and are within my department's appropriated budget.
4 Director Signature: Date Cam- 7
City of Carmefform Revision Date 10/7/2009 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.
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 10/712009 Page 2
Prescribed ly alate•Board of Accounts City Form No. 201 (Rev. 1995)
,r
o ACCOUNTS PAYABLE VOUCHER
10/12/09 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
Darrell Norris Purchase Order No.
One Civic Sq Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/7/09 Exp R t Gas Mileage IACT conference 10/5/09 10/6/09 $157.30
10/7/09 Exp R t Per Diem meals $75.00
Total $232.30
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.
10/12/09 ALLOWED 20
i Darrell Norris IN SUM OF
One Civic sq
Carmel IN 46032
232.30
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4343004 4343003
Travel per diem Travel lodging
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
Exp Rpt 4343003 75.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20() 7
i aturvJ
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund