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Home My WebLink About209656 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 366288 Page 1 of 1 ONE CIVIC SQUARE NORMAN RILEY CARMEL, INDIANA 46032 6775 E 241 CHECK AMOUNT: $28.10 CICERO IN 46034 CHECK NUMBER: 209656 CHECK DATE: 6/5/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 28.10 OTHER EXPENSES L] CITY OF CARMEL Expense Report (required for all travel expenses) {NOIAN 2010 mileage reimbursement rate is 50 cents /mile EMPLOYEE NAME: Norman Dale Riley 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 In Meals Misc. Total Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 5/14/12 $12.00 $12.00 $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 $0.00 $0.00 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 a I 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 5/22/2012 Page 1 be— Approved Environment, Inc. Class: Activated Sludge Biological Process Control Date: May 14, 2012 Time: 9:00 AM to 4:00 PM Registration starts at 8:30 AM Location: Comfort Suites 515 S West Street Indianapolis, Indiana 46225 Hotel Phone: (317) 631 -9000 Directions: attached Parking: $5 /day Please park your car at the parking garage next to the front door of the hotel. Keep your ticket and pay while you are leaving. The machine accepts cash and credit cards. Overnight: Sleeping room rate is $84 /night hot breakfast and free internet. Parking will be added to your room bill. Lucas Oil Stadium Tour: Scheduled for May 14, 2012 during lunch hour. Tickets are $5.00 /person. Snacks and light lunch will be provided that day before and after the tour. If you have any questions, please contact customer services at 1- 877 241 -9859. Sincerely, Ann Bersbach Chief Executive Office Approved Environment Inc. 2346 S. Lynhurst Dr. Suite F201B Indianapolis, Indiana 46241 1.877.241.9858 a Submit by Email Print Form Prescribed by State Board of Accounts MILEAGE CLAIM General Form No. 101 (1955) UTILITIES TO DALE RILEY, 6775 E. 241ST STREET, CICERO, IN 46034 DR. (Governmental nit SEWER WWTP On Account of Appropriation No. for ice, Board, Department or Institution DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE 20 Point Point Start Finish TRAVELED PER MILE 5/14/12 WWTP 445 S. West St. City parking Garage �a Activated Sludge Biological process control class 1 1 8 05 5/14/12 445 S. West St. City parking Garage WWTP 14.5 29.0 Activated Sludge Biological process control class 14.5 8 05 Auto License No. TOTALS 0 0.00 16.10 SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid. Date r n c V, Approved Environment, Inc. Class: Activated Sludge Biological Process Control Date: May 14, 2012 Time: 9:00 AM to 4:00 PM Registration starts at 8:30 AM Location: Comfort Suites 515 S West Street Indianapolis, Indiana 46225 Hotel Phone: (317) 631 -9000 Directions: attached Parking: $5 /day Please park your car at the parking garage next to the front door of the hotel. Keep your ticket and pay while you are leaving. The machine accepts cash and credit cards. Overnight: Sleeping room rate is $84 /night hot breakfast and free internet. Parking will be added to your room bill. Lucas Oil Stadium Tour: Scheduled for May 14, 2012 during lunch hour. Tickets are $5.00 /person. Snacks and light lunch will be provided that day before and after the tour. If you have any questions, please contact customer services at 1- 877 241 -9859. Sincerely, Ann Bersbach Chief Executive Office Approved Environment Inc. 2346 S. Lynhurst Dr. Suite F201B Indianapolis, Indiana 46241 1.877.241.9858 E4n4rE,aR 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 WWT l 1- 5962- T06-G00 re�B 00perator ❑Apprentice Technical Contact Hours Earned: 6.0 General Contact Hours Earned: 0 LNSTRUGTION_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 attending the entire wastewater operator continuing education course. CERTIFIEDYOPERATOR/APPRENI ICE INFO,RMITION_f L 1. NAME: N N L(5: 2. ADDRESS (number and street): S r City: State: ZIP code: Telephone number: Iy f2 Ei 1 ivt 7 �f Work: Home /Cell: ig W 99y hs'Y Check here if this is an address change E -mail Address: 3. NAME OF TRAINING COURSE: Activated Sludge Biological Process Control 4. NAME OF TRAINING COURSE PROVIDER: S. NAME OF RGANIZATION SPONSORING COURSE: Approved Environment, Inc. �ame 6. DATE(S) ATTENDEDjrponth, dax,,yfjr): 7. LOCATIO1 T la napotis, Indiana 8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERA_TOR/AP AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE PROVIDER: Technical Contact Hours: General Contact Hours: 6.0 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. SIGNATURE OF CERTIFIED OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE: 14. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: U.J Ct l (3 i I I O 4 :3 G/ Operator certification /apprentice number: Class: Expiration date: VOUCHER 125025 WARRANT ALLOWED T9959 IN SUM OF RILEY, NORMAN WASTEWATER Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 051412.2 01- 7042 -06 $16.10 i i i Voucher Total 6.10 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 T9959 RILEY, NORMAN Purchase Order No. WASTEWATER Terms Due Date 5/23/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/23/2012 051412.2 $16.10 6 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. Date 720cer