208837 05/10/2012 \�f CITY OF CARMEL, INDIANA VENDOR: 354306 Page 1 of 1
ONE CIVIC SQUARE MICHAEL PITMAN
CARMEL, INDIANA 46032
CHECK NUMBER: 208837
CHECK DATE: 5/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 133.01 GASOLINE
1110 4343002 460.00 EXTERNAL TRAINING TRA
,piK
e N CITY OF CARMEL Expense Report (required for all travel expenses)
�NDIANP S
EMPLOYEE NAME: Michael Pitman DEPARTURE DATE: 4/27/2012 TIME: 8:00 RPM M
DEPARTMENT: Carmel Police Department RETURN DATE: 5/3/2012 TIME: :00
REASON FOR TRAVEL: Training DESTINATION CITY: St. Paul, Minnesota
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM (Yv
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
4/27/12 $35.00 $65.00 $100.00
4/27/12 $70.00 $70.00 a
4/28/12 $65.00 $65.00
4/29/12 $65.00 $65.00
4/30/12 $65.00 $65.00
5/1/12 $65.00 $65.00
5/2/12 $65.00 $65.00
5/2/12 $51.41 $51.41
5/2/12 $46.60 $46.60
$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 $0.001 $0.001 $203.011 $0.001 $0.00 $0.001 $0.00 $0.001 $390.00 $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 5/7/2012 Paso
Crowne P
Hot el Self Parking RS
i`�l amp: CJ
n ce
Zoom. t(
IPMBA C
Da t e: i�lo10 Aay 5, 2012 Registration Form Page 1 of 2
I /a I
h1 1' cur 2 uc -1 c of
tease check all boxes that apply and add
Re_ -sue'0 I I s up the right column for your total. You
Ra te pe r night 1 24, 2012 can register for just the pre- conference, just
J
the conference, or, ideally, both!
i��llei� b' posed
You must be a current member to attend any of the pre conference
training courses Join or renew below if you are not currently a member.
Home Address pp Bicycle Response Team Training $375
EMS Cyclist Course L3 $325
Sbe •l Add,••• IPMBA Instructor Course $550
c°y sur. o +eiCOd• county 1P 14BAlnstruCtor Application enclosed L3 $125
Home You must apply and be approved to attend Contact the IPUBA office with questions
Personal Telephone
Maintenance Officer Certification Course $525
E -Mail A� 0 r' P (A rn F- l IN b f MMR -IPMBA Core Skills Scenarios Clinic. $495
tco*m fmn. ,ib t coif „eta n•l 325
Dept. Name Police Cyclist Course
Dept. Address L d i IPMBA Member Fee $406
sa••t Add,•.:
LAO O y, j 5 MUST be current, you must provide this cunenf IPMBA membership
y VlJ 7 4 number on this form ar pmtenow with this regrsvatron
cdy svr. P °•+'c°d• c°unlry Non -IPMBA Member Fee $475
Dept. Telepho `s es
Fee for Pre- Conference Attendees O $350
�r ,eti It you are ahendrng any of the Pre- Conference training
IPMBA Membership Number f' courses this is the fee you pay to also attend the conference
(Morrdofoy /�unenl�nd rene� gmembersJ Bike Team Rate E) $350
IPMBA Instructor Numb 11 /A II See box in left column for details
Tee Shirt Size ❑M ❑L 117 L DXXL ❑XXXL
ty-u wdl LARGEd y°u don t chacA
Guest Fee (per guest) Guests x $50
y The guest too entitles your guest admission to the exhibit
hall end two lunches NAME(s)
L unches are included In the cost of each pre conference course During the Rush Fee 25
conference, lunches will be served on Thursday and Friday, please check the Ragrstratlons submntedarter March2t, 2012, must ;.clue• the rush tee
appropnate boxes on the reverse All other meals are on your own Exhibit Hall -Only Pass (Pre Registration Requxed) Free
MMI EM
Register three or more members from the same agency at a flat rate of New Renew 50
$350 per team member The following conditions apply
Applies to CONFERENCE fees only
Does NOT apply to Pre Conference Course Fees TOTAL ENCLOSE,) J`r7 5-Oro.
Can be used by both conference -only attendees and those attending both a CANCELLATfoNPOL1CY Refund requests must be made rnwntrng and postmarked by
pre conference course and the conference March 24, 2012 Refunds, less a $50 aontrnstration fee, will be Processed following the
Registrants MUST be IPMBA members (current, joining, or renewing)
conference bs7rtufeandsub hs/herregistration a 7orn umust canw a fter
esarg rcil24,youotgelsocafea and a letter
Registrations MUST be submitted together (offer not available online) MembersMp, cenl6cahon, and mstruclorOPOWtron fees are non-refundable
IF YOU ARE REGISTERING FOR THE CONFERENCE, HAVE
YOU COMPLETED PAGE 2 OF THIS FORM?
e
I I
Form of Payment
[MUST ACCOMPANY REGISTRATION] Purchase Order number
Check or money order (payable to IPMBA) enclosed or departmental equlvalent
C] Visa /MasterCard accepted (circle one)
Exp ire I I— _1., -1�j —_jam I D•W lmrnl l°whith lbe NW CB Shdub .OM
--_L— Signature
Name on card A
Email address for receipt
Contact Add eu
phone
Cey 1
%n ce rdF e, d
/rc
W
/2rriiopnno/ ,Wla 1
rt>riirr�aiirOi.Fe,lrrr
r r
Ilk/
1�
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))
05/07/12 reimbursement for gasoline $133.01
05/07/12 reimbursement for meals parking $460.00
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.
ALLOWED 20
Michael A. Pitman
IN SUM OF
$593.01
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1110 42- 314.00 $133.01 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1110 43- 430.02 $460.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, Ma 07, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
=z
Z
g
\ƒ .d
SSG' rvllday 3453k.
18#5 /BROADWAY M;Ao
2\
{a.
CIEDI CARD SALE>
SS#- HOLIDAY #3459/6
@4/27/£2 TIME: IW
Stare# 459
I■rminal :@@@1 »2
NCi
XXXX554l
#.Ot CREDIT /SbER
Un %■ads A 1@ $3.7 9Zp!
v0L UNE 9.212 AL
a
GA$ f07jAL $55
IOT�AL $35 e
w
I AGREE, TO PAY THE2 2
ABOVE TOTAL ANOUNTd'
p
AcpOR IMG TO THE r«
CAR AGREEMENT.
INVkT 155881283 !y
AP\ROVA 519838
I/2
PITMAN /MICHAEL
A2
ƒ .«k`ANK YOU
FOR YOUR BUSINESS
i,,E ]COME
TO
GROMANNS
688121
GRO MANNS PLAZA
1362 RAYMOND
MEHDOTA IL
DA" E OE /02i 12 20:37
PUP1P 02
PRODUCT: BLUE
GALLONS: 12.288
PR::CE /C g :3.786
FUEL SALE S 46.60
Flui'.h 6c7S26
Rei' 2667SO07
Re =.sp Code: 000
Stan: 06046SSO04
SI' E !D: SSS8121
Earn rebates
with BP Visa
Ta F, e application
and App 1 Today
THANK YOU
GOD BLESS
AMERICA
5 County Road A
Black River Falls Wi 54615
I -94 BP
5 County Road A
Black River Fall, Wi
54615
65/82/2812 84:42:29 PM 157983628
PUMP# 5
BLUE 13.899
PRICE /GAL 3.699
FUEL TOTAL 51.41
Subtotal 51,41
Tax 0.00
TOTAL 8 51.41
CREDIT 51.41
XXXXXXXXXXXX5541
Auth 679538
Ref: 38672881
Resp Code: 888
Stan: 384745291293
SITE ID: 6591937
Earn rebates
with BP Visa
Take application
and Apply Today
Thank You!!
Please Stop Again!!