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Home My WebLink About209556 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 358789 Page 1 of 1 0 ONE CIVIC SQUARE RALPH GRUWELL CHECK AMOUNT: $100.00 CARMEL, INDIANA 46032 9035 MT SHASTA SOUTH W. GLENN VILLAGE CHECK NUMBER: 209556 INDIANAPOLIS IN 46234 CHECK DATE: 6/512012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 051512 100.00 OTHER EXPENSES 44-4 i CITY OF CARMEL Expense Report (required for all travel expenses) NDIA j 2010 mileage reimbursement rate is 50 cents /mile EMPLOYEE NAME: Ralph Gruwell 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 I Dinner I Snacks Per Diem 5/15/12 Primary Treatment $25.00 $25.00 5/15/12 Activated Sludge II $25.00 $25.00 5/23/12 UV Disinfection $25.00 $25.00 5/23/12 Removing Metals from WW $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 Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $100.00 DIRECTOR'S STATEMENT: I here y 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 5/25/2012 Page 1 WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the EDUCATION CREDIT REPORT wastewater approval number MUST be provided. State Form 51139 (R3 4 -08) Training Course Approval Number: INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT W k 7 v\iS 1- Operator ❑Apprentice Technical Contact Hours Earned: 1 HOUR General Contact Hours Earned: 'a% t upMyr 0 ;IIVSTRUGTIONS 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 CERTIIEDQFERiATOR /APPRN „TICEINFORMATI,UN��' 1. NAME• n 67 2. ADDRESS (number and street): City: State: ZIP code: Telephone number: T IZJ d P'S 5 rJ 14 lo Z 3 4 work: Check here if this is an address change 13 E -mail Address: Home /Cell: pi 317 86 7 3. NAME OF T COURSE: C'h' rv► A Q T,P�.4 fir e�rf 4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE: APPROVED ENVIRONMENT INC SAME 6. DATE(S) ATTENDED (month, day, year): r 7. LOCATION ATTENDED: eJ .1S VWVW.APPROVEDCE.COM 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: 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. SI ATU OF C RTI D OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED 0PERATOR/APPRENTICE: 14. CONTINUING EDU ATION CREDIT HOURS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: W W 01 1 -3D- Z Operator certification /apprentice number: Class: Expiration date: Certificate of Completion Approved Environment, Inc. Page 1 of 1 Approved Environment, Inc. P.O. Box 42744 Indianapolis, IN 46242 877 241 -9858 Email: Support(, Certificate of Completion Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South Carolina, North Carolina, Mary land. Kentucky and Ontario anada. Name: Ralph E. Gruwell Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234 Course Title: Primary Treatment Course Value: 1 Contact Hour Approval Number: IN WWT11 -5905 TO1 -G00, PWSTI 1 -4186, OH OEPA- S296785- OM, NC CEO] 140414, MD 3464- 05 -06, KY 10305 Date: 5/15/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WWO18036 Operator Class Level: 1 License Expiration Date: 06/30/2012 Operator Signature: wee Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002, Approved Environment, Ine., Indianapolis, Indiana http:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/15/2012 TTr WASTEWATER OPERATOR /APPRENTICE CONTINUING p roper credit, the To ensure EDUCATION CREDIT REPORT N,� wastewater approval number �•j MUST be provided. State Form 51139 (R3 4 -08) INDIANA DEPARTMENT OF E Training Course Approval Number: ENVIRONMENTAL MANAGEMENT i F leis D �lL? Operator []Apprentice Technical Contact Hours Earned: 1 HOUR General Contact Hours Earned: 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 o /a rentice attendin the entire wastewater o erator continuin education course. pm CERT�IFIEDOPERATOR /APPRENTICEINFORMAfTION�� r 3 1. NAME: ►QA UweLL 2. ADDRESS (number and st 'q_5fw et): 03S, f. S City: f State: ZIP code: Telephone number: Work: 317 Home /Cell: R) kj `7 (e l0 7 7 Check here if this is an address change E-mail Address: RG r UW e L L CA r►tne 1 IN Go V 3. NAME OF TRAINING COURSE: �I e 4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE: APPROVED ENVIRONMENT INC SAME 6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED: l�_ Z VWWV.APPROVEDCE.COM 8.T AL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR /APPRENTICE 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. SI ATURE OF CERTIF ED OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR /APPRENTICE: a I Pti GtQ to e L_L, 14. CONTINUING EDU ATION CREDIT HOURS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: Operator ceification /app tice number: r I Class: Expiration date: Certificate of Completion Approved Environment, Inc. Page 1 of 1 Approved. Environment, Inc. P.O. Box =42744 Indianapolis, IN 46242 1- 877 -241 -9858 Email: Supportriapprovedce.com Certificate of Completion Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South Carolina. North Carolina Nlar }land, Kentucky and Ontario, Canada. Name: Ralph E. Gruwell Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234 Course Title: Activated Sludge II Course Value: 1 Contact Hour Approval Number: IN WWT11 -5908 TO]-GOO,, OH OEPA- 5296730 -OM, NC CE01130404, MD 3467- 05 -06, KY 10297 Date: 5/15/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WWO18036 Operator Class Level: 1 License Expiration Date: 6/30/2012 Operator Signature: Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyri Approved Environment, Inc,, Indianapolis, Indiana http: /www.approvedce. con/ onlineCEUs /ceuCertificateOfCompletion.asp 5/15/2012 WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the wastewater approval number EDUCATION CREDIT REPORT MUST be provided. State Form 51139 (R3 4 -08) Training Course Approval Number: INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT IA16� v l )(Operator ❑Apprentice Technical 1oHOUR ours Earned: General Contact Hours Earned: 0 r_."� ��STRlJCTI®IdS� emu, s 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 wastewa ope rator continuing education course. C.t,RTIF,tE,D�PR% ACTOR /PPR 1. NAME: 2. ADDRESS (number and street): 10.5 M� :Sh9S�� cfiP� S City: State: ZIP code: Telephone number: rod P I! S 2 3 Work: C3 Home /Cell: X17 ?6 y b /077 Check here if this is an address change E -mail Address: GO`t)RS I'IVFORtNIie�TI,ON�a -,fir 3. NAME OF TRAINING COURSE: e6fla,� 4. NAME OF TRAINING COURSE PROVIDER: S. NAME OF ORGANIZATION SPONSORING COURSE: APPROVED ENVIRONMENT INC SAME 6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED: 231 Z VWVW.APPROVEDCE.COM 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: 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. SI NATU OF CE IFIED OPERATORIAPPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE: 7 ',2 LP E, GR u we L L 14. CONTINUING ED CATION CREDIT HOURS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: 'I'IIA E, (0-3o-12- Operator certification /apprentice number: Class: Expiration date: Certificate of Completion Approved Environment, Inc. Page 1 of 1 Approved. Environment, Inc. P.O. Box 42744 Indianapolis, IN 46242 1- 877 241 -98.58 Email: Support(a)approvedcexom Certificate of Completion Courses are approved in the following states: Indiana, Illinois Ohio, Alabama Delaware, South Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada. Name: Ralph E. Gruwell Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234 Course Title: UV Disinfection Course Value: 1 Contact Hour Approval Number: IN WWT11 -5936 TO1 -G00, PWST07 -3193, OH OEPA- B443661- OM, NC CEO 1230701, MD 3928- 07 -03, KY 8328 Date: 5/23/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WWO18036 Operator Class Level: 1 License Expiration Date: 06/30/2012 Operator Signature: Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/23/2012 SSE "c, WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the EDUCATION CREDIT REPORT wastewater approval number MUST be provided. State Form 51139 (R3 4 -08) Training Course Approval Number: '•a` INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT t �B16 l SLY Technical Contact Hours Earned: 15pperator ❑Apprentice 1 HOUR General Contact Hours Earned: 0 3.... 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/app rentice attending the entire wastewater operator continuing education course. CERTIFIER !QP,E,_RATO,R /AP,P,R,E „NTICE 010 NO G X .r >11 �31 1. NAME: rr �h Go- I t toe LL 2. ADDRESS (number and street): p 35' SGT AJfA d R S City: State: ZIP code: Telephone number: .1 Work: W t �/t> �S S q Z 2 3# Home /Cell: 3 17 B�g/O(v?? Check here if this is an address change E -mail Address: y ON 11 }CO .t�..,;3 3. NAME OF TRAINING COURSE: rn o v r e fR �S o wt �'1 _f �'e r 4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE: APPROVED ENVIRONMENT INC SAME 6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED: �J -23— WWW.APPROVEDCE.COM 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: 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. SI�iG�1TU OF TIF D OPERATORIAPPRENTICE: 13. R TED NAME OF CERTIFIED C TOR/AP PRENTICE: 14. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO: G L Operator certification /apprentice number: Class: Expiration date: A) LIV 016036 _T� �•3o- lZ Operator certification /apprentice number: Class: Expiration date: Certificate of Completion Approved Environment, Inc. Page 1 of 1 Approved Environment, Inc. P.O. Box 42744 Indianapolis, IN 46242 1 -877- 241 -9858 Email: Support(a),approvedee.com Certificate of Completion Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South Carolina., North Carolina, Maryland, Kentucky and Ontario, Canada. Name: Ralph E. Gruwell Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234 Course Title: Removing Metals from Wastewater Course Value: 1 Contact Hour Approval Number: IN WWT11 -5926 TO1 -G00, OH OEPA- S396249 -OM, NC CE01030503, MD 3485- 05 -06, KY 10307 Date: 5/23/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WWO18036 Operator Class Level: 1 License Expiration Date: 06/30/2012 Operator Signature: Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002. approved Environment, Inc,, Indianapolis. Indiana https:// www. approvedee. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/23/2012 h Approved Environment Inc. 2346 S Lynhurst Dr Ste F201 B M Inc. INDIANAPOLIS, IN 46241 (317) 241 -9858 Approved Environment, Inc. US Description: Online Course: Primary Treatment Order Number: P.O. Number: Customer ID: Invoice Number: 770C Billing Information Shipping Information Ralph E. Gruwell 9035 Mt. Shasta Dr. South Indianapolis, IN 46234 Shipping: 0.00 Tax: 0.00 Total: USD 25.00 Date /Time: 15- May -2012 17.30:16 Transaction ID: 4354330930 Transaction Status: Captured /Pending Settlement Authorization Code: 026669 Payment Method: Approved Environment Inc. JEInc. 2346 S Lynhurst Dr Ste F201 B Approved Environment, Inc. INDIANAPOLIS, IN 46241 (317) 241 -9858 PP US Description: Online Course: Activated Sludge II Order Number: P.O. Number: Customer ID: Invoice Number: 771 C Billing Information Shipping Information Ralph E. Gruwell 9035 Mt. Shasta Dr. South Indianapolis, IN 46234 Shipping: 0.00 Tax: 0.00 Total: USD 25.00 Date/Time: 16- May -2012 16:30:16 Transaction ID: 4354330934 Transaction Status: Captured /Pending Settlement Authorization Code: 842833 Payment Method: q Approved Environment Inc. Inc. 2346 S Lynhurst Dr Ste F201 B INDIANAPOLIS, IN 46241 (317) 241 -9858 Approved Environment, Inc. US Description: Online Courses: UV Disinfection Removing Metals Order Number: P.O. Number: Customer ID: Invoice Number: 821C Billing Information Shipping Information Ralph E. Gruwell 9035 Mt. Shasta Dr. South Indianapolis, IN 46234 Shipping: 0.00 Tax: 0.00 R q Total: USD 50.00 Date/Time: 18- May -2012 17:30:16 Transaction ID: 4354330950 Transaction Status: Captured /Pending Settlement Authorization Code: 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 T1025 GRUWELL, RALPH Purchase Order No. WWTP Terms Due Date 6/4/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/4/2012 051512 $100.00 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 Date O cer R VOUCHER 125038 WARRANT ALLOWED T1025 IN SUM OF GRUWELL, RALPH WWTP Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 051512 01- 7042 -06 $100.00 Voucher Total $100.00 Cost distribution ledger classification if claim paid under vehicle highway fund