214005 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 359018 Page 1 of 1
ONE CIVIC SQUARE KATHERINE MALLOY
CARMEL, INDIANA 46032
CHECK NUMBER: 214005
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 698 . 00 TRAINING SEMINARS
ASV oF CAR,y�
CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: Katherine Malloy DEPARTURE DATE: 9/23/2012 TIME: 10:00 AM/ PM
DEPARTMENT: Police Department RETURN DATE: 9/28/2012 TIME: 1:00 AM/ PM
REASON FOR TRAVEL: K-9 Training / Re-cert 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
9/24/12 $50.00 $50.00
9/25/12 $50.00 $50.00
9/26/12 1 1 $50.00 $50.00
9/27/12 $50.00 $50.00
9/28/12 $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 $0.001 $0.00 $0.00 $0.001 $448.001 $0.001 $0.00 $0.00 $0.00 1 $250.001 $0.00
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 10/18/2012 Page 1
09-28-12
Katherine Malloy Folio No. Room No. 317
3 civic sq A/R Number Arrival 09-23-12
Carmel IN 46032 Group Code IND Departure 09-28-12
us Company Conf. No. 61083514
Membership No. Rate Code IYEXT
Invoice No. Page No. 1 of 1
Date I Description I 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 ST'A'TE WORKSHOP
September 24th through September 28th, 2012
REGISTRATION FORM(PLEASE PRINT LEGIBLE)
Name:
Home Address:
City: State: _ Zip Code:
E Mail:
Agency: car wt l
Agency Address: 3
City: CCI,�1 State: Zip Code: 4&c)'3 Z
Work Phone: Irt 5-Ti-Z5cv Home Phone: 3iT
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 training venue.
Date: O'k / of / 2o�2 Sign Name: c arY
Print Name:
Current NAPWDA Member? Yes ✓ No
K9 Breed: SV,4 V K9 Name: Iclq se K9 Age:
Type of K9 (check appropriate descriptions) /
Patrol _ Narcotic Cadaver_ Dual Purpose ✓
K9'S Workiniz 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: Ncr c o� c S
Registration'Form:Page 1 of 2
**** NOTE: ****
Reminder: Registration Form is a two (2) page document,
PLEASE RETURN BOTH PAGES OF REGIST'RAT'ION FORM.
NAPWDA Membership Dues (must be a member to test for certification):
Membership dues are $45.00 per year. Make NAP.WDA'.1Glembership dues:a separate check
Payable to NAPWDA. Do riot include thas nione'y:in.the sariie.check as',ahe worksliob
registrdiion."fee.
Civilian SAR Handlers applying for Associate Membership must be sponsored by a current
NAPWDA Regular member 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 11
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: mmchenry(a)elkhartcountysheriff.com
Registration:Form-Page 2 of 2
**** NOTE: ****
Reminder: Registration Form is a two (2) page document,
PLEASE RETURN BOTH PAGES OF REGISTRATION FORM.
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))
10/18/12 meals/lodging- K9 training $698.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Katherine E. Malloy
IN SUM OF $
$698.00
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
210 -570.00 $698.00
I hereby certify that the attached invoice(s), or
I I 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
Thursday, October 18, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund