212143 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 359016 Page 1 of 1
`.` ONE CIVIC SQUARE KAREN BREEDLOVE
CARMEL, INDIANA 46032 17330 BIGLEAF MAPLE BLVD#133 CHECK AMOUNT: $36.90
WESTFIELD IN 46074 CHECK NUMBER: 212143
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 TRAINING CLA 36 . 90 OTHER EXPENSES
4
CITY OF CARMEL Expense Report (required for all travel expenses)
,NDIANP EXHIBIT A
EMPLOYEE NAME: �(�(\Le\1p(���Q_ C� r'¢ Q_�,\�1I� DEPARTURE DATE: — TIME 0Q)
DEPARTMENT: ��0.�9J1\ (J� RETURN DATE: L(� TIME: OO AM a
REASON FOR TRAVEL.- \C.SS , �t G��y1��C, DESTINATION CITY: }- j t QV1C!
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Parkin Lodging Misc. Total
Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
a r\a,=Ck 3L,rra
$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 $0.001 $0.001 $0.00 $0.00 $0.00 -1to.001 $0.001 $0.00
DIRECTOR'S STATEM T: 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: o
City of Carmel Form#ER06 Revision Date 1/11/2008 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 $60 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 $30 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 $30 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 $60 for out-of-state travel
EMPLOYEE ACKNOWLEDGEMENT OF MEAL ADVANCE AND OBLIGATION TO DOCUMENT EXPENDITURES:
I hereby acknowledge receipt of$ , 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: 4z___ Date: '260
61
City of Carmel Form#ER06 Revision Date 1/11/2008 Page 2
Indiana Section American Water Works Association
in conjunction with
Indiana Rural Water Association ,
® and
'INQIANA
sECtoN Indiana American Backflow Prevention Association
r '
AWWA SMALL SYSTEMS BACKFLOW PREVENTION and
COMMITTEE CROSS CONNECTION CONTROL
Odetta Cadwell,Committee Chair
Indiana Rural Water Association
317-402-7349
Neal McKee,Committee Co-Chair FEES, TIME and LOCATION:
IN-American Water-West Lafayette
765-743-7973—Office Registration fees: $30 for AWWA, IRWA, or InABPA members; $60 for non-members
Gale Gerber
Nappanee Water Utility
574-773-4623-Office Time: Registration: 8:00am (local time)—Workshop: 8:30am-12:30pm
Brian Reed Locations: August 7, 2012—Indiana-American Water Co.
E.J Prescott,Inc.
866-993-2100-Office Southern Indiana Operations & Treatment Center
Liz Melvin 2423 Middle Road; Jeffersonville, IN 47130
IDEM Drinking Water Branch
317-234-7418-Office August 21, 2012— Riley Park Shelter House
Jeff Morris Apple Street& Main Street (US 40) Greenfield, IN 46140
M.E.Simpson Company
800-255-1521-Office September 13, 2012—Plumbers & Steamfitters Local #166 JATC
Michael Ward 2930 West Ludwig Road, Fort Wayne, IN 46818
I ndian a-American-Kokmo
765-457-5563-Office Presenters: James Probst; Test Gauge & Backflow Supply and InABPA
John Crider Indiana Dept of Environmental Mgmt Representative(tentative)
Town of Berne
260-589-2811-Office Representatives from Utilities Utilizing Backflow Programs
Bryan Forkner
City of Westfield QQ _
317-896-5452-Office dT-... ...... .................. ...... ...... ... ...............
Chris Johnsen
IN-American Water REGISTRATION
765-743-7973-Office
Ryan Smith BACKFLOW PREVENTION/CROSS CONNECTION CONTROL
Indiana-American-Kokomo
317-457-5563-Office Date: Location Attending:
Pat Powell
E.J.Prescott,Inc.
574-210-5845 System/Company Name
Kraig Cummings
Citizens Water Representative Position
317-263-6452 (Please send in one registration form for each person attending.)
John Shettle Address
Orestes Town Board
765-754-8893-Office
City/St/Zip County
Tel ( ) Fax ( )
FAX REGISTRATION TO: E-mail Fee Due $
855-215-5966 Member of? ❑ AWWA ❑ IRWA ❑ InABPA ❑ Neither
or ❑ Check Enclosed ❑ Pay on Site ❑ Bill Us (PO# ) ❑ Credit Card
MAIL REGISTRATION TO:
Indiana Section AWWA CREDIT CARD: Visa MC Discover American Express
PO.Box 534
Nashville,IN 47448 # Exp.:
NAME ON CARD: Security Code:
SIGNATURE
~ 812211� 34mw13uxst, arm el,IN 46074 ms Main u&Apple St,Greenfield,IN 46140 Goon maps
u�� OirauUonstoEK8ainSi�[ /�pp|eS� <�noenfia|d, |N4G14O
(_3�~�0��1�� %G.S mi —about 49 mins
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3458 VV 131 at St. Carmel, IN 48074
� ..........
1 Head west onVV 131st St go 0.1 mi
total 0.1 mi
SL 2� At �na traffic ciro|o. takethe 4th exit and stay` unVV 131st St go 1.0 mi
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0�^ 3. At the traffic oirn|e, continue straight hnstay onVV 131st St go 1.0 mi
n About mins total 2.2 mi
4. At the traffic circ|e, continue straight � stay-on W 131�� � �2 mi
8 ' ' total 2.4 mi
'
0�� 5. Ad the traffic ciro|o, continue abaighttostay on VV 131st St go 0.8 mi
w About mins total 32 mi
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m
total 3.3 mi
7. At the traffic nim|o, continue straight to stay on VV 131st St go 0.3 mi
w
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8. Turn hghtonb� N Meridian St go 3.3 mi
Q ^ ` `
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Q. Merge onto 1465 EIUS-31 S �Aothe ramp to US-31 S go 14.9 mi
About 16 mins total 21.8mi
10 Take'exit Washington to Bt �toward U���O � O4 i
� �x r o nQron zoyya Qu � m
total 22.2 mi
11. Turn left onto E Washington St go4.2mi
w About mins total 28.4 mi
12. Continue onto UG-40 E go 10.5 mi
[*w>
--'
About 1Jmins total 36.Ami
13. Turn left onto Morristown Pike go33ft
«
total 3G.Qmi
E Main St & Apple St. Greenfield. IN 46140
-_-------- _
These directions are for planning purposes only.You may find that construction projects, traffic,weather, or other events may cause
conditions to differ from the map results, and you should plan your route accordingly. You must obey all signs or notices regarding your route.
Wp data @2012Gougle
Directions weren't right? Flease find your route on maps.google.com and click"Report a problerrV at the bottom left.
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VOUCHER # 121967 WARRANT # ALLOWED
T5962 IN SUM OF $
BREEDLOVE, MICHELLE
CARMEL WATER DISTRIBUTION
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
082112 01-6040-06 $36.90
Voucher Total $36.90
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
T5962
BREEDLOVE, MICHELLE Purchase Order No.
CARMEL WATER DISTRIBUTION Terms
Due Date 8/27/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/27/2012 082112 $36.90
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 Offi r