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Home My WebLink About177399 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 363335 Page 1 of 1 ONE CIVIC SQUARE NICK SOUTHERLAND CHECK AMOUNT: $260.00 CARMEL, INb ANA 46032 C/O COMM CENTER ;r CHECK NUMBER: 177399 X4 1 0 _.�0.. 4 CHECK DATE: 9115/2009 DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBE AMOUNT DESCRIPTION 1115 4343004 260.00 TRAVEL PER DIEMS oe CAA QTpTVF.[S CITY OF CARMEL Expense Report (required for all travel expenses) \NOIPNP NAME Southerland, Nicholas START DATE SE 2-00 C-( TIME: /,2-n O AM PM Carmel Clay Communications Center RETURN DATE: TIME: 2-006 AM M LOCATION Urta gym N1 C i RA':;. J EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT x Date Transportation Gas/Tolls/ Lodging Meals Misc. Total Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 9/1/09 $65.00 $65.00 9/2/09 $65.00 $65.00 9/3/09 $65.00 $65.00 9/4/09 $65.00 $65.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $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 $0.00 $0.00 $0.001 $260.001 $0.00 DIRECTOR'S STATEMENT: I hereb at 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 9/6/2009 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 GO. U 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: S EPT 2 opQ City of Carmel Form ER06 Revision Date 9/6/2009 Page 2 COURTYARD' Courtyard by Marriott Grand Rapids,mi 49503 Grand Rapids Downtown T 616.242.6000 AarnOtt 38s AL N southerland Room: 420 ;Room Type: GENR -Number of Guests `1 Rate $0 Clerk Arnve �U'! Sepp9 Time t14 25Pf��s�� p @part p4SepQgy erne `��gltA�hlt#rtt�bet" 94778 4 'e..€r4fF,z��; ��,�,..,:.�xt`a£ .,:.a.:�` d��`i: ��<4�� ".V.,.:..::•.,_...:. �r.,i�..cw .3 ",;;.,,,3 s €k, ,v.:;c:.0 �.�"..'.�ar�3�z�.,�o,,, �,....kn<iss .gym ._....m. 11Aug09 Advance Deposit 287.28 01Sep09 Room Charge 84.00 01 Sep09 Room Tax /Assessment 11.76 02Sep09 Room Charge 84.00 02Sep09 Room Tax /Assessment 11.76 03Sep09 Room Charge 84.00 03Sep09 Room Tax /Assessment 11.76 Balance: 0.00 As a Marriott Rewards member, you could have earned points towards your free dream vacation today. Start earning points and elite status, plus enjoy exclusive member offers. Enroll today at the front desk, MarriottRewards.com, or 801 468 -4000. As requested, a final copy of your bill will be emailed to you at: MHEINZMAN @CARMEL.IN.GOV. See "Internet Privacy Statement' on Marriott.com. RE: Courtyard Chicago Arlington Heights /South Reservation Confirmation #87292046 Page 1 of 5 Arnone, Janet R From: Collins, Mindy L Sent: Tuesday, July 21, 2009 12:05 PM To: Arnone, Janet R; Heinzman, Mike D Subject: RE: Courtyard Chicago Arlington Heights /South Reservation Confirmation #87292046 Detail for Course 15307 Back Start Date: 09/02/2009 End Date: 09/04/2009 I Start Time: 8:00 AM End Time: 5:00 PM Site: AMR of Grand Rapids Location: Grand Rapids, MI 517 South Division Address: Grand Rapids, MI 49503 Register for this course' From: Arnone, Janet R Sent: Tue 7/21/2009 7:02 AM To: Heinzman, Mike D; Collins, Mindy L Subject: RE: Courtyard Chicago Arlington Heights /South Reservation Confirmation #87292046 Do you have anything from EMD that proves there is a class on these dates? The Clerk's office will need something. Janet R. Arnone Office Administrator Carmel Clay Communications Center 31 1 st Avenue N.W. Carmel, Indiana 46032 (317) 571 -2586 Original Message---- From: Heinzman, Mike D Sent: Monday, July 20, 2009 5:08 PM To: Arnone, Janet R; Collins, Mindy L 7/21/2009 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)) 09/08/09 I I I $260.00 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 VOUCHER NO. W N Ni;;k Southerland ALLOWED 20 IN SUM OF 467 Vernon Place .Westfield, In 46074 $260.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1115 43- 430.04 $260.00 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 Thursday, September 10, 2009 ��l�— Dir ector Title Cost distribution ledger classification if claim paid motor vehicle highway fund