210280 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 027850 Page 1 of 1
ONE CIVIC SQUARE JAMES BRAINARD
CARMEL, INDIANA 46032 CHECK AMOUNT: $2,501.42
CHECK NUMBER: 210280
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CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343001 613.40 TRAVEL FEES &EXPENSE
1160 4343003 895.52 TRAVEL LODGING
1160 4343004 292.50 TRAVEL PER DIEMS
1160 4357004 700.00 EXTERNAL INSTRUCT FEE
W CITY OF CARMEL Expense Report (required for all travel expenses)
EXHIBIT A
NDIANp�
EMPLOYEE NAME: Jim Brainard DEPARTURE DATE: 6 10 12 TIME: 6: 15 AM PM
DEPARTMENT: Mayor RETURN DATE: 6/16/12 TIME: 1: 15 AM M
REASON FORTRAVEL: U.S. Conference of Mayors DESTINATION CITY: Orlando Florida
Annual Meeting
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM X
Date Transportation Gas/Tolls/ Lodging Meals
Parkin Misc. Total
Air -fare Car Rental Other g g g Breakfast Lunch Dinner Snacks Per Diem
3/19/12 $700.00 $700.00
5/25/12 $285.60 $285.60
5/25/12 $327.80 $327.80
6/12/12 $65.00 $65.00
6/13/12 $65.00 $65.00
6/14/12 $65.00 $65.00
6/15/12 $65.00 $65.00
6/16/12 1 $32.50 $32.50
6/16/12 $895.52 $895.52
$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 1 $613.401 $0.001 $0.001 $0.001 $895.52 $0.00 $0.001 $0.00 $0.001 $292.50 $700.00
DIRECTOR'S STATEMEN hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: i Date:
f
City of Carmel Form ER06 Revision Date 6/28/2012 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:
I 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.
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:
City of Carmel Form ER06 Revision Date 6/28/2012 Page 2
UNITED STATES CONFERENCE OF MAYORS For USCM Use Only
1620 EYE STREET, N.W., WASHINGTON, D.C. 20006
REGISTRATION RECEIPT PLEASE PRESENT AT REGISTRATION) IDNo: 69
3/19/2012 Fee: $700.00
Date: Paid: Yes
Payment: CreditCard
RegType: Member City Mayor
Meeting: 80th Annual Meeting, Orlando, FL, June 13 -16, 2012
69
Jim Brainard
Mayor
City of Carmel
One Civic Square
Carmel, IN 46032
Arrival Date: 6/12/2012 Departure Date: 6/16/2012
Loews Royal Pacific Resort at Universal Orlando
Original
rags i ui
Kibbe, Sharon
From: Brainard, James C
Sent: Thursday, March 15, 2012 3:59 PM
To: Kibbe, Sharon
Subject: Fwd: Registration Receipt for Annual Meeting in Orlando, FL
For our file.
Begin forwarded message:
From: Amy Gorman a orman(o
Date: March 15, 2012 3:05:54 PM EDT
To: ibrainard(a)carmel.in. og_v
Subject: Registration Receipt for Annual Meeting in Orlando, FL
VIEW PROFILE
Print This Profile
69
JIM BRAINARD
Mayor
City of Carmel
One Civic Square
Carmel, IN 46032
Phone: 317 571 -2401
ibrainardOcarmel.in.aov
REGISTRATION INFORMATION
Confirmation Number: 12Annual68716
Registration Date/Time: 3/15/2012 12:11:52 PM
Registration Type: MayorMember
Badge Name: Jim
Newly Elected No
First Time No
Special Needs No
Payment Amount: $700
Payment Method: CreditCard
Paid Yes
HOTEL REQUEST INFORMATION
Loews Royal Pacific Resort at Universal Orlando
Room Type Price King Bed
Single $199 Yes
Arrival Date: 6/12/2012
Departure Date: 6/16/2012
Card Type: ft
Card Number: xxxxxxxxxxx 6
Expiration Date: 02/14
Check Number: xxxxxxxxxxx
3/15/2012
ra�c�ui�
Hotel Notes:
no changes
Amy Gorman
The U.S. Conference of Mayors
1620 1 street, NW
Washington, DC 20006
202/861 -6749
202/467 -4276 (fax)
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3/15/2012
Page 1 of 1
Transaction Date: 05252012 Fri
Transaction Description: EXPEDIA INC ATLANTA GA
AIRTRAN AIRWAYS, INC.
From: To Carrier Class:
INDIANAPOLIS ATLANTA HARTSFIELD FL M
ORLANDO INTERNATIO
FL M
N/A YY 00
N/A YY 00
Ticket Number 33270640337211 Date of Departure: 06 /10
Passenger Name: BRAINARD /JAMES CLAUD
Document Type: PASSENGER TICKET
Cardmember Name: JAMES C BRAINARD
Amount 285.60
Doing Business As: AIR TRAN AIRWAYS AGENCY
Merchant Address: 9955 AIRTRAN BLVD
ORLANDO
FL
32827 -5385
UNITED STATES
Reference Number: 320121470493162574
Category: Travel Amine
https: online. americanexpress. com /myca/estmt/us /print_doc.html 6/27/2012
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I I X Itinerary 146643929129
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Flight: Indianapolis Orlando $285.60 Confirmed
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Expedia itinerary number: 146643929129 Main contact: James Claude Brainard
Airline ticket numbegs): 3327064033721 Preferred phone: 1 3174317477 Ad oices
Customer Support AirTran Airways oonfirmation code: MBYZ4G
Itinerary EAOs
Use the itinerary Traveler and cost summary
assistance e-mail form James Brainard Adult Delta #9053879335 $245.58
Taxes Fees $40.02
Print a receipt Total $285.60
Seat assignments, meal preferences, and special requests must be confirmed with the airline; we
cannot guarantee that they will be honored. Free and special meals are not available on many flights.
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Sun 10- Jun -12
Indianapolis (IND) to Atlanta (ATL) 432 mi M.
Depart 6:15 am Arrive 7:44 am (695 km) GIr��Cran
Terminal NORTH Duration_ 1hr 29mn Flight: 1615
TERMINAL
Econom Class Seat assi upon check -in (_j7] More Information Boein 717. 90% on time
Atlanta (ATL) to Orlando (MCO) 404 mi
Depart 8:50 am Arrive 10:10 am (650 km) lfJ''6`Il
Terminal NORTW Duration: 7hr 20mn Flight: 1828
TERMINAL__
Econ omylCoach Class Seat assig_nmants uPon c heck -i n j More Information Boeing 737 700�90% o time
Total distance: 836 mi (1,345 km) Total duration: 2hr 49mn (3hr 55mn with connections)
Airline rules regulations
Tickets are nonrefundable. A fee of $75.00 per ticket will be charged for itinerary changes after the
tickets are issued, provided that the booking rules were followed. „r t4ZSf,CALI.,,„EVi,R,- c.'-,,r.
Page 1 of 1
Transaction Date: 05/252012 Fri
Transaction Description: SW AIR DALLAS TX
SOUTHWEST AIRLINES (MASTE
From: To. Carrier Class.
ORLANDO INTERNATIO INDIANAPOLIS WN B
N/A YY 00
N/A YY 00
N/A YY 00
Ticket Number. 5262443123770 Date of Departure- 06/16
Passenger Name: BRAINARD /JAMES
Document Type: PASSENGER TICKET
Cardmember Name: JAMES C BRAINARD
I Amount E: 327.80
Doing Business As: SOUTHWEST AIRLINES
Merchant Address: PO BOX 36611
DALLAS
TX
75235
UNITED STATES
Reference Number: 320121470493162575
Category: Travel Airline
https: online. americanexpress. com /myca/estmt/us /print_doc.html 6/27/2012
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DEPART 11:00 AM Orlando, FL (MCO) to Flight Saturday, 3une 16, 2012
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Page 1 of 1
Transaction Date: 06/16/2012 Sat
Transaction Description: LOEWS HOTELS ROYAL PORLANDO FL
17156604 888716 -9738
Cardmember Name: JAMES C BRAINARD
Amount 1,402.35
Doing Business As: ROYAL PACIFIC RESORT
Merchant Address: 6300 HOLLYWOOD WAY
ORLANDO
FL
3281 &7614
UNITED STATES
Reference Number: 320121720312813505
Category: Travel Lodging
https: online. americanexpress. com /myca/estmt/us /print_doc.html 6/27/2012
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1
Mayor and Mr. Jim Brainard Room Number: 3344
United States Arrival Date: 06 -10 -12
Departure Date: 06 -16 -12
INFORMATION INVOICE
06 -16 -12
Date Description Charges Credits
86 --12 m mm
tb oo ccoo anon 199.00
06 -I0-1� Occ. aT x1 1 1.94
06- 1.0-1-2 -State Tax -675x/ 12.94
06-- 1-I--- I- 2__._.. Roo in Accom modatirnr 199.00
06-1 -1 -12 Occ. Tax Eocal-6 1 1.94
06= 12 State`Sales Tax -6:5�. 12.94
06- h2�1-2— -StarSeftiee Room# 3344: CHECK# 5701
06 -12 -12 Room Accommodation 199.00
06 -12 -12 Occ. Tax Local 6% 11.94
06 -12 -12 State Sales Tax 6.5% 12.94
06 -13 -12 Room Accommodation 199.00
06 -13 -12 Occ. Tax Local 6% 11.94
06 -13 -12 State Sales Tax 6.5% 12.94
06 -14 -12 Room Accommodation 199.00
06 -14 -12 Occ. Tax Local 6% 11.94
06 -14 -12 State Sales Tax 6.5% 12.94
06 -15 -12 Room Accommodation 199.00
06 -15 -12 Occ. Tax Local 6% 11.94
06 -15 -12 State Sales Tax 6.5% 12.94
06 16 12 XXXXXXXXXXX XX /XX 1,402.35
Total 1,402.35 1,402.35
Balance 0.00
6300 Hollywood Way Orlando, FL 32819 T: (407) 503 -3000 F: (407) 503 -3010 Toll -Free: (888) 430 -4999
www.loewshotels.com www.universalorlanclo.com
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Mayor Jim Brainard
IN SUM OF
One Civic Square
Carmel, IN 46032
$2,501.42
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1160 Expense Report 43- 430.01 $613.40 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1160 Expense Report 43- 430.03 $895.52
materials or services itemized thereon for
1160 Expense Re ort 43- 570.04 $700.00 which charge is made were ordered and
1160 Expense Re ort 43- 430.04 $292.50 received except
Thu ,96day, June 28, 2012
r
Mayor
Title
Cost distribution ledger classification if
claim paid motor 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 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))
06/28/12 Expense Report $613.40
06/28/12 Expense Report $895.52
06/28/12 Expense Report $700.00
06/28/12 Expense Report $292.50
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