HomeMy WebLinkAbout180248 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 353873 Page 1 of I
ONE CIVIC SQUARE NORMAN RILEY CHECK AMOUNT: $48.76
CARMEL, INDIANA 46032 CHECK NUMBER: 180248
CHECK DATE: 12/8/2009
DEPARTME14T ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 48.76 OTHER EXPENSES
of C
CITY OF CARMEL Expense Report (required for all travel expenses)
\MDIAN�
2008 mileage reimbursement rate is 58.5 cents /mile
EMPLOYEE NAME: DALE RILEY DEPARTURE DATE: 11/18/2009 TIME:
DEPARTMENT: Utilities /Sewer RETURN DATE: 11/18/2009 TIME:
REASON FOR TRAVEL: IWEA ANNUAL CONF. DESTINATION CITY: INDPLS
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT _X_ TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
11/18/09 $7.18 $7.18
$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
0.00
Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.18 $0.00 $0.00 $0.00 $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 11/24/2009 Page 1
Submit by Email Print Form
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
Utilities /Sewer TO Dale Riley 6775 E. 241st street, Cicero, In 46034 DR.
(G overnmental Uni
On Account of Appropriation No. for
ice, Board Department or Institu hon
DATE FROM TO ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE @58.5
20 Point Point Start Finish TRAVELED PER MILE
11/17/09 wwtp marriott east IWEA annual conf. 11) a 7 37
11/17/09 marriott east wwtp IWEA annual conf. 12.6 7 37
11/18/09 wwtp marriott east IWEA annual conf. 12.6 7 37
11/18/09 marriott east wwtp IWEA annual conf. 12.6 7 37
11/19/09 wwtp marriott east IWEA annual conf. 12.6 7 37
11/19/09 marriott east wwtp IWEA annual conf. 12.6 7 37
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date l a 4(- of U�- r- e- io 4,1('
Page 1 of 2
M AD OU E'ST Notes
Trip to Marriott
7202 E 21st St, Indianapolis, IN 46219 i
(317) 352 -1231
12.60 miles about 20 minutes
9609 Hazel Dell Pkwy, Indianapolis, IN 46280 -2935
1. Start out going SOUTH on HAZEL DELL PKWY toward E 96TH ST. 0.0 mi
2. Turn LEFT onto E 96TH ST. 0.7 mi
3. Turn RIGHT onto ALLISONVILLE RD. 1.5 mi
-1 4. Merge onto 1-465 E /US -421 S /US -52 E via the ramp on the LEFT. 8.2 mi
5. Take the 1 -70 W exit, EXIT 44, toward INDIANAPOLIS. 0.2 mi
6. Take the SHADELAND AVE. exit. 0.6 mi
7. Take the SHADELAND AVE exit. 0.2 mi
j 8. Keep RIGHT at the fork to go on N SHADELAND AVE. 0.5 mi
9. Turn LEFT onto E PLEASANT RUN PKY SOUTH DR. 0.4 mi
10. Turn LEFT onto ARLENE DR. 0.0 mi
11. Turn LEFT onto MARIANNE AVE. 0.2 mi
12. Turn LEFT onto E 21ST ST. 0.0 mi
11/24/2009
Page 2 of 2
13. 7202 E 21 ST ST is on the RIGHT. 0.0 mi
40 Marriott, 7202 E 21st St, Indianapolis, IN 46219 (317) 352 -1231
Total Travel Estimate 12.60 miles about 20 minutes
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11/24/2009
�e s` °'e WASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit, the
EDUCATION CREDIT REPORT wastewater approval number
MUST be provided.
8 s State Form 51139 (R3 4 -08) Training Course Approval Number:
isle i' INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT WWT09- 9267- T27.5 -G14.5
Technical Contact Hours Earned: �70perator ❑Apprentice 27.5
General Contact Hours Earned
14.5
INSTRUCTtOIV 5 0 H
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) days of the
conclusion of the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65-42
Indianapolis, IN 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a three (3) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator/apprentice attendin the entire wastewater operator continuing education course.
C _91 OP�i A 'fOR%APPRENTICE�INF�ORAA�A�LOM�
1. NAME.
2. ADDRESS (number and street):
City: State: ZIP code: Telephone number:
E Work: GI
Home /Cell:
Check here if this is an address change E -mail Address:
.a'&'COURSEINFORMATION"�`
IN
3. NAME OF TRAINING COURSE:
Indiana Water Environment Association 73rd Annual Conference
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
Indiana Water Environment Association
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
November 17 -19, 2009 Marriott East, Indianapolis
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
I, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentation
may reqlt in the denial o ontinuing education credit for this course.
10. G UR O IINS U OR: 11. PRINTED NAME OF INSTRUCTOR:
1�. GNATURE OF•CE IFIED OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
14. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
Operator certification /apprentice number: Class: Expiration date:
y TALLconference Information
I I R� istration F og. are required for
related
i dater CC o timizati ®n innovdgtion"
re gistrants must check in
Environment rd Annual IWEA Conference Registration All
November 17 -19, 2009, Marriott East Hotel, 7202 E. 21st Street at the registration desk prior
Association Indianapolis, IN 46219 to attending any sessions.
will be
Conference materials w'
A available at check in.
.�w.. `_h.,,. r. F, -_tl a'.... r ,.N s.i.�'_. e S O
Conferenc Fee d not
include hotel reservations.
Nam Please contact the hotel for
conference rates or refer to the
zes. 1.
�J hotel reservation form posted
0 1 l on IWEA website
www.indianawea.org.
tae zip
L A
Payment Information
one Email
30 ,2 U 1 0 Make checks payable to IWEA
cerrija cation Qrade "lass canon ate
Municipalities may enclose
I am
(Please check all that apply) purchase order in lieu of
a New Member of 1VdEA a Student =Elected official" payment
a 1st -time Conference Attendee the Spouse of an Attendee an Honorary Member" To pay be credit card, you may
a Life Member" IWEA Member a Young Professional register online or call the
(smdmu znerzofe lnthelad=trywho IWEA office with your credit
a 2009 IWEA Award Winner A Tumb ebu under `b "g` or 35)
(Re,dved notice Go o rWEAiu 1009) g card information.
not as IWEA Member
**free conference registration Before October 24th After October 24th Return completed registration
Full Conference Registration........... $250.00 $300 form along with payment to:
(Includes registration for Tuesday Thursday, IWEA Office
buffet lunch on Tuesday and access to the Exhibit 74$9 Woodland Drive, Ste 200
Hall. Meals are not included on Wednesday and Indianapolis, IN 46278
Thursday, please see below to purchase meals.) Phone: 317.328.2151
Daily Registration Fax 317.328.2545
aherbertz @indianawea.org
(Choose the day(s) you want to attend. Daily
registration includes Buffet Lunch for Tuesday
and access to the Exhibit Hall. Meals not Please Note
included on Wednesday and Thursday)
If particular accommodations
Tuesday, November 17, 2009 [1.$125.00 $150 .00 are needed to fully benefit
Wednesday, November 18, 2009 $125.00 $150.00 from this conference, please
Thursday, November 19, 2009 $125.00 $150.00 contact the IWEA office at
least one (1) week prior to the
Meals event so that appropriate.
IWEA. Business WEF Awards Luncheon........... $30.00 o$30.00, arrangements may be made.
Wednesday, November 18, 2009 If you are interested in
IWEA Awards Luncheon $30.OQ $30.00 Y
Thursday, November 19, 2009 sponsoring or exhibiting at the
conference please contact the
h TOTAL: IWEA office or find
(Confrnnce .lees do nor include hotel zmervatiam.) information online at
www.indianawea.org
'Please copy this form for additional registrations'
To pay for registration by credit card, visit the IWEA website on the annual conference page to register online
or call the IWEA office with your credit card information
B d 9E9a_ T LS —LIE Jao1000 jjar e91r :O T 60 Oa AON
Prescribed by State Board of Accounts a
ACCOUNTS PAYABLE VO
CITY OF CARMEL
rt h
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T9959
RILEY, NORMAN Purchase Order No.
WASTEWATER Terms
Due Date 11/30/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/30/200i 111809 $51.40
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
Date Officer
4�pA* k
ALLOWED
IN SUM OF
o�
3'
0
IN FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
111809 01- 7042 -06 -s
Voucher Total $51.40
Cost distribution ledger classification if
claim paid under vehicle highway fund