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Home My WebLink About213577 10/09/2012 �M f CITY OF CARMEL, INDIANA VENDOR: 212690 Page 1 of 1 ONE CIVIC SQUARE SCOTT MOORE CARMEL, INDIANA 46032 CHECK NUMBER: 213577 CHECK DATE: 10/9/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 673 . 00 TRAINING SEMINARS CITY OF CARMEL Expense Report (required for all travel expenses) 1NDIAN?-"" EMPLOYEE NAME: Scott Moore DEPARTURE DATE: 9/23/2012 TIME: 1730 AM M DEPARTMENT: Police Department RETURN DATE: 9/28/2012 TIME: 1300 AM PM REASON FOR TRAVEL: NAPWDA K9 Re-Certification DESTINATION CITY: Elkhart, IN EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM Date Transportation Gas/Tolls/ Lodging Meals Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 9/23/12 $25.00 $25.00 9/24/12 $50.00 $50.00 9/25/12 $50.00 $50.00 9/26/12 $50.00 $50.00 9/27/12 $448.00 $50.00 $498.00 $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 $448.001 $0.00 $0.00 $0.00 $0.001 $225.00 $0A0 � 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 10/8/2012 Page 1 wyj ^r 1 p y 09-28-12 Scott Moore Folio No. 21922 Room No. 212 3 civic sq A/R Number Arrival 09-23-12 Carmel IN 46032 Group Code IND Departure 09-28-12 us Company Conf. No. 61082750 Membership No. Rate Code IYEXT Invoice No. Page No. : 1 of 1 Date I Description ( Charges I Credits 09-23-12 *Accommodation 80.00 09-23-12 State Tax-Room 5.60 09-23-12 Bed/Occupancy Room Tax 4.00 09-24-12 *Accommodation 80.00 09-24-12 State Tax- Room 5.60 09-24-12 Bed/Occupancy Room Tax 4.00 09-25-12 *Accommodation 80.00 09-25-12 State Tax-Room 5.60 09-25-12 Bed/Occupancy Room Tax 4.00 09-26-12 *Accommodation 80.00 09-26-12 State Tax-Room 5.60 09-26-12 Bed/Occupancy Room Tax 4.00 09-27-12 *Accommodation 80.00 09-27-12 State Tax-Room 5.60 09-27-12 Bed/Occupancy Room Tax 4.00 09-28-12 448.00 Total 448.00 448.00 Balance 0.00 Guest Signature: I have received the goods and/or services in the amount shown heron. I agree that my liablity for this bill is not waived and agree to be held personally liable in the event that the indicated person, company,or associate fails to pay for any part or the full amount of these charges. If a credit card charge,I further agree to perform the obligations set forth in the cardholder's agreement with the issuer. Staybridge Suites Elkhart 3252 Cassopolis Street Elkhart, IN 46514 Telephone: (574)970-8488 Fax: (574)970-8499 2012 INDIANA STATE WORKSHOP September 24th through September 28th, 2012 REGISTRA TION FORM PLEASE PRINT LEGIBLE Name: Ap Home Address: City: Stater, Zip Code: E Mail: SIYf1 'LQ ltir^rbt H j,[y1, Q�✓ Agency: P'5 f1cl-1p Agency Address: �`U�` '50 Gant City: 64nl?. State: -�j Zip Code: t/p6,? Work Phone: (YZJ S SQQ Home Phone: (� NAPWDA Workshop Waiver: The undersigned participant recognizes the possibility of injury occurring as a result of his/her participation in the K9 Workshop. I furthermore state that my canine and I are in a physical condition necessary to be able to participate in the events, as needed for training and certification purposes. I hereby waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA, the Elkhart County Sheriff Department and the County of Elkhart, their employee's, affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical, to myself or my canine. I also agree to abide by all rules and regulations as set forth by NAPWDA and the event organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any and all property, persons and to include the hotel accommodations and or any ra'nin venue. Date: 3 l ),I / 1�, Sign Name: Print Name: Current NAPWDA Member? Yes V- No K9 Breed: G L15 K9 Name: K9 Age: Type of K9 (check appropriate descriptions): Patrol t' Narcotic v Cadaver_ Dual Purpose K9'S Working Ability Beginner— Intermediate Advanced Handler's Ability: Beginner_ Intermediate Advanced Purpose(s) of Attending Workshop (check at least one): Training` Certification (New) Certification (Renewal) If certifying, which areas of certification you will be attempting: Air C0`�CS Registration Form Page .1 of 2 NOTE. Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. NAPWDA Membership Dues (must be a member to test for certification): Membership dues are $45.00 per year. Make NAPWDA Membership dues a separate check Payable to NAPWDA. Do not include this.money in the same check ds.t&, ivorkshbp registration fee. Civilian SAR Handlers;applying for Associate Membership must be sponsored by a current NAPWDA Regular me#iber and provide a current Criminal History Records Check at the time they initially join and upon renewing yearly. This record check must be obtained from a Law Enforcement Agency and cover that person for the entire United States or entire State that they live in (not just a city or county level). Associate Membership Info & Application may be printed out from the NAPWDA web site (Membership Information tab). View Certification Test Rules at www.napwda.com/about Workshop Fee: The cost of the workshop is $125.00 per K9 team. A K9 team is 1 handler with 1 dog. There is an additional workshop fee of$75.00 per additional dog for any K9 Handler wishing to train or test with an additional dog. Make workshop fee checks payable to Indiana Police Canine Workshop. Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams-Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Mail Registration to: Indiana Police Canine Workshop 52677 CR I 1 Elkhart, In 46514 Attention: Mike McHenry Mail checks and completed Registration Form in before September 1, 2012. No refunds at all after September 1, 2012. Cadaver Detection Teams - Please respond by September 1, 2012, so that we may make the necessary arrangements for this phase. Workshop Coordinator/ Contact: Sgt. Michael McHenry Cell: 574-320-7419 E-mail: mmchenrygelkhartcountysherif£com Registration Form Page 2 of 2 NOTE: Reminder: Registration Form is a two (2) page document, PLEASE RETURN BOTH PAGES OF REGISTRATION FORM. VOUCHER NO. WARRANT NO. ALLOWED 20 Scott L. Moore IN SUM OF $ $673.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 210 -570.00 $673.00 I hereby certify that the attached invoice(s), or I 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 Monday, October 08, 2012 Chief of Police 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)) 10/08/12 lodging/meals NAPWDA training $673.00 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