212276 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 358709 Page 1 of 1
0 ONE CIVIC SQUARE TERRY KILLEN
CARMEL, INDIANA 46032 333 S.UNION STREET CHECK AMOUNT: $307.90
WESTFIELD IN 46074 CHECK NUMBER: 212276
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4343002 307 . 90 EXTERNAL TRAINING TRA
\�d of CRAM
CITY OF CARMEL Expense Report (required for all travel expenses)
NO�ANa EXHIBIT A
EMPLOYEE NAME: ✓�/ l�l �(� DEPARTURE DATE: I �/ TIME: N;,5 �' AM PM
DEPARTMENT. RETURN DATE: ��/�o� TIME: AM M
REASON FOR TRAVEL: -��C�} ��4���XU�C DESTINATION CITY: t Ebt:L
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
8/14/12 $103.95 $25.00 $128.95
8/15/12 $103.95 $50.00 $153.95
8/16/12 $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
Totall $0.00 $0.00 $0.00 $0.001 $207.901 $0.00 $0.00 $0.00 $0.001 $100.001 $0.0omilm
DIRECTOR'S STATEM : I hereby affirm t at II xpenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date: b I o j
City of Carmel Form#ER06 Revision Date 8/22/2012 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 followinq 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 expen res) being deduc d from t first paycheck issued more than 30 days after the date of my return.
Employee Signature: Date:
City of Carmel Form#ERO6 Revision Date 8/21/2012 Page 2
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IANA�STREET�COMIVIISSASSOCIATION
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2012 Annual Street Commissioners Convention
Registration Form:
August 14th 15th 16th
Name of Registrant �PwiA �,u4man �nq KI (� �n
Address: 13400 U) , 13 (
0Arm.--� ,
Phone: 1.311
Spouse's Name (if attending):
E-Mail Address: h ck4ml n bqrmt L. ,in Od �l K l lt(i 6) 6aCrILI, !.1
REGISTRATION FEE MUST BE ENCLOSED WITH FORM
Current ISCA Member $120.00 (Convention Package)
I Asst. Commissioner/Forman $120.00 (Convention Package)
Other Additional Registrant $120.00 (Includes Meals)
Vendor Registration $300.00 (Includes Meals & Vendor Cookout)
Booth Space (Includes 6-ft table and two chairs) $200.00
(Limited booth area — no more then 30 booth areas)
Note(s): Vendors must purchase a registration for each additional person in their
Group at the cost of $120.00:
All hotel accommodations must be made with a credit card at: FOUR POINTS by SHERATON
WEST LAFAYETTE
1600 Cumberland Avenue
West Lafayette, Indiana 47906
(T) 765-463-5511 (F) 765-497-3850
* When making hotel reservations, let the hotel know you are with the Indiana Street
Commissioners Association. I.S.C.A.
*The room rate's are $99.00 dollars for I.S.C.A. members they will be guaranteed until July 16th
After July 16th rooms will be released to the public. Cancellation must be made four days prior to
Arrival for full refund of deposit. Check-in time is at 3:00 p.m. Check-out is at 11:00
* Vendors who want (hospitality rooms) must contact; John Welborn at 765-420-1520 or E-mail
iwelborn @hicclaf.com
* Please complete and return registration form with payment by July 16th 2012:
MAIL: CONVENTION REGISTRATION WITH PAYMENT TO
LARRY LEE SECRETARY/TREASURER
LEBANON STREET DEPARTMENT
1301 LAFAYETTE AVE
LEBANON, INDIANA 46052
Four Points by Sheraton West Lafayette
1600 Cumberland Avenue C
West Lafayette, IN 47906 (�
765-463-5511 / 765-497-3850 PO I TS
https://www.fourpointswestlafayette.com
BY SHERATON
Killen, Terry Page Number 1 Invoice Nbr 1000005985
Guest Number 59889 Arrive Date 08-14-2012
Folio ID A Depart Date 08-16-2012
No. Of Guest 1
Room Number 204
Club Account SPG - A42896480353
Time 08-16-2012 09:10
Invoice
ME ..,
Date ..,a.,,,w Ref renceDescr ti4n `` „ ,.., '
asp...._ ...a.�._,,. ,.,__, ..�._ P.. ., ,_ ,._... .,..:...._.,�� _. i � M.u�..:..._.... ,� ,. ._.
08-14-2012 RT204 Room Charge $99.00
08-14-2012 RT204 Sales Tax $6.93
08-14-2012 RT204 Occupancy $4.95
08-15-2012 RT204 Room Charge $99.00
08-15-2012 RT204 Sales Tax $6.93
08-15-2012 RT204 Occupancy $4.95
08-16-2012 $-221.76
** Total $0.00
** Balance $0.00
As a Starwood Preferred Guest you have earned at least 396
Starpoints for this visit A42896480353.
Thank you for choosing Starwood Hotels. We look forward to welcoming
you back soon!
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))
08/20/12 $307.90
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Terry Killen
c/o Street Department IN SUM OF $
3400 W. 131st St.
Carmel, IN 46074
$307.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I I 43-430.021 $307.90 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
T sda -gust 23, 2012
jo� �. . . .
Street Commissioner
Street Con,,rT;}le7 c,;)er
Cost distribution ledger classification if
claim paid motor vehicle highway fund