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Home My WebLink About209289 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 00351760 Page 1 of 1 ONE CIVIC SQUARE BRAD OLIVER CHECK AMOUNT: $25.00 CARMEL, INDIANA 46032 C/O UTILITIES C/O UTILITIES CHECK NUMBER: 209289 CHECK DATE: 5/22/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 25.00 EMPLOYEE PENSIONS B OF f:gjp P CITY OF CA+RMEL Expense Report (required for all travel expenses) \ENO_ AO- 2010 mileage reimbursement rate is 50 cents /mile EMPLOYEE NAME: Harold Oliver DEPARTED na TIME: DEPARTMENT: Utilities /Sewer RETURN na TIME: REASON FOR TRAVEL: na DESTINATION CITY: na 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 5/3/12 Continuing Education $25.00 $25.00 $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 0.00 Total $0.001 $0.001 $0.00 $0.001 $0.00 $0.00 $0.001 $0.001 $0.00 $0.00 $25.00 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 5/3/2012 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 $32.50 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 $32.50 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: 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. i Employee Signature: Date: City of Carmel Form ER06 Revision Date 5/3/2012 Page 2 Certificate of Completion Approved Environment, Inc. Page 1 of 1 Approved Environment, Inc. P.O. Box 42744 Indianapolis. IN 46212 I- 877 2.31 -9858 Email: Support(t Certificate of Completion Courses are approved in the fbilowing states: Indiana. 1111nols, Ohio, Alabama, Delaware, South Carolina, North Carolina, (Maryland, Kentucky and Ontario, Canada. Name: Harold B. Oliver Address: 9609 Hazel Dell Parkway Indianapolis, Indiana 46280 Course Title: Ozone Disinfection Course Value: I Contact Hour Approval Number: IN WWT1 1 -5935 T01 -G00, PWST07 -3194, OH OEPA- B443664- OM, NC CEO 1040706, MD 3929- 07 -03, KY 10007 Date: 5/3/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WW018094 Operator Class Level: 1 License Expiration Date: 06/30/2012 Operator Signature: Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002, Approved Fm ironment. (tic., Indianapolis. Indiana http:// ww Nv. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/3/2012 I WASTEWATER OPERATORIAPPRENTICE CONTINUING To ensure proper credit, the dj° 1e wastewater approval number EDUCATION CREDIT REPORT M;__^y' MUST be provided. State Form 51139 (R3 14-08) Training Course Approval Number: ra,a INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Dk7l_l) -5 36 701 oo Operator pA Technical Contact Hours Earned: pprentice 1 HOUR General Contact Hours Earned; 0 s?r�.� 2 .�_:,�..��.��.��,.r�:�_� ;ice ��.�•.m. I NST,RUGTIONS,.��:�:;�z�.� 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. a i ^ham GERTIFIEDSQPER�470R1APPREIVTI '011 ,ORIUI%1yT1.ON 1. NAME: 2 ADDRESS (number and street): 0 'EC> w g City: St te: ZIP code: Telephone number: Work: W 'v �(oa -�-1 Home/Cell: 3i7 S 7i oZ6 3 Check here if this is an address change E -mail Address: -w J& n�,.. U�� „�.-.rt..�?�o..:�� a€ COU, RS, E;; I. NFORMATIO. N�ra�ot, i,• .�""�,_�_.��''�h�.�;.r�r':'�s, *_'�.:t..r�.��t�. 3. NAME OF TRAINING COURSE: t 4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE: APPROVED ENVIRONMENT INC SAME 6. DATE(S) ATTP D7 o day, year 7. LOCATION ATTENDED: W WW.APPROVEDCE.COM 8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATORIAPPRENTICE AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE PROVIDER: Technical Contact Hours: General Contact Hours: 1 HOUR 0 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 result in the denial of continuing education credit for this course. 10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR: Ann Bersbach 12. S 13. P INTED NAME OF CERTIFIED OPERATORIAPPRENTICE: 14. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: k)Cv IE� d 5 Z/ o a0 Operator certification /apprentice number: Class: Expiration date: Huntington Online Banking Account Information Today's Beginning Balance Pending Transactions Account Balance Nickname Type Overdraft Protection (ODP) I i Interest Earned but Not Paid Previous Year Interest Year To Date Interest Pending Transactions Date Type Payee Debit Credit 05/03/2012 090=1 APPROVED ENVIROMENT IN 462418628 IN $25.00 XXXXXXXXX VOUCHER 117272 WARRANT ALLOWED T9981 IN SUM OF OLIVER, BRAD Wastewater Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 050712 01- 7042 -06 $25.00 Voucher Total $25.00 Cost distribution ledger classification if claim paid under vehicle highway fund 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee T9981 OLIVER, BRAD Purchase Order No. Wastewater Terms Due Date 5/4/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/4/2012 050712 $25.00 hereby certify that the attached invoice(s), or bill(s) is (are) true and :orrect and I have audited same in accordance with IC 5- 11- 10 -1.6 I Date Offi er