170485 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 360083 Page 1 of 1
ONE CIVIC SQUARE PAMELA LUX
CARMEL, INDIANA 46032 684 YORK PLACE CHECK AMOUNT: $160.00
FISHERS IN 46038
CHECK NUMBER: 170485
CHECK DATE: 4/1/2009
DEP ARTMENT ACCOU PO NUMB INV OICE NUMBER A DESCRI
1192 4343004 160.00 TRAVEL PER DIEMS
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CITY OF CARMEN Expense Report (required for all travel expenses)
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EMPLOYEE NAME: Pam Lux DEPARTURE DATE: 1 TIME: 1 AM
DEPARTMENT: GS RETURN DATE: TIME: Oa AM 1 PM
REASON FOR TRAVEL: aWC6 ShC DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM X
Transportation Gas /Tolls/ Meals
Date Lodging Misc. Total
Parkin
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
3/24/09 $30.00 $30.00
3/25/09 $65.00 $65.00
3/26/09 $65.00 $65.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
.$0.00
$0.00
$0.00
.10.00
$0:00
$0.00
$0.00
�o.00
$01:00
Total $0.00 $0.00 :$0:00 $0.00. $0.00 $0.00 $0.00 $0:00 woo ::..$160.00 $0,04lff�
DIRECTOR'S STATEM eb m hat II xpen s 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 3/30/2009 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 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 3/30/2009 Page 2
e�SGf.tt0f2
ace Hotel
Ms Pam Lux Room Number 0606
1 Civic Street Arrival Date 03 -24 -09
Carmel IN 46032 Departure Date 03 -26 -09
United States
Page 1 of 1
Folio Number
INFORMATION INVOICE Confirmation 14550229
Cashier 579
Video Checkout
Company Name Government USA 03 -26 -09
Date Description Charges Credits
03- 24 -09 US Governs lent Rate 5
1 7.ca
03 -24 -09 Room State Tax 18 -68
03 -24 -09 Room City Tax 5.50
03 -25 -09 US Government Rate 157.00
03 -25 -09 Room State Tax 18.68
03 -25 -09 Room City Tax 5.50
03 -26 -09 Check Check No- 170120 Approval Code 6230 362.36
Tota 1 362.36 362.36
Balance 0.00 USD
�I
1 agrcc th.0 I am personally liable for the final disposition and payment of any services rendeffd or goods SlIpplicd by "ncV Suwon I'lacc Iloiel and further
❑ut1101 the use of nw credit card to facilitate hill payment. I accept responsibility in the cvcm the indicated third party, company or association fails to rclider
Ii111 paymrnt of this account, and also for 1111)- loss or d:mta_e to the premises or its contents.
Guest Signature:
A MEMBER OF THE SUTTON PLACE GRANDE HOTELS GROUP CHICAGO, EDMONTON, TORONTO. VANCOUVER
21 E. Bellevue Place Chicago, IL 60611 Tel. 312 -266 -2100 Fax 312 266 -1167 1.8663.SUTTON (1.866.378.8866)
email: info_chicago @suttonplace.com websile: www.chicago.suttonplace.com
Ms Pam Lux Room Number 0606
1 Civic Street Arrival Date 03 -24 -09
Carmel IN 46032 Departure Date 03 -26 -09
United States page 1 of 1
Folio Number
INFORMATION INVOICE Confirmation 14550229
Cashier 1 579
Video Checkout
Company Name Government US* 03 -26 -09
Date:
Descrltlon Charges Credits
u 3 -24.09 US Govei i n m gent Rate 157.00
03 -24 -09 Room State Tax 18.68
03 -24 -09 Room City Tax 5.50
03 -25 -09 US Government Rate 157.00
03 -25 -09 Room State Tax 18.68
03 -25 -09 Room City Tax 5.50
03 -26 -09 Check Check No. 170120 Approval Code 6230 362.36
Total 362.36 362.36
Balance 0.00 USD
1 agree that am personally liable for the final disposition and paymcni of any services rendered or goods supplied by The Suwon ]'lace Hotel mtd further
.atdtarize the use of my eredil card to facilitate full payment- I accept responsibility in the event the indicated third party, company or association fails to render
full paymew of this account, twin also for any loss ar datna,e to the premiscS or its contents.
Guest Signature:
A MEMBER OF THE SUTTON PLACE GRANDE HOTELS GROUP CHICAGO, EDMONTON, TORONTO, VANCOUVER
21 E. Bellevue Place Chicago, IL 60611 Tel. 312 266 -2100 Fax 312- 266 -1167 1.8663.SUTTON (1.866.378 -8866)
email: info_chicago @suttonplace.com website: www.chicago.suttanplace.com
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))
03/30/09 I I 160.00
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
VOU N WARRANT NO.
ALLOWED 20
Pamela Lux
IN SUM OF
c/o One Civic Square
Carmel, IN 46032
$160.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1192 43- 430.04 $160.00 1 hereby certify that the attached invoice(s), or
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
only, NMch 30
Director, DOCS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund