Loading...
HomeMy WebLinkAbout215109 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 204048 Page 1 of 1 ONE CIVIC SQUARE ADAM C MILLER CHECK AMOUNT: $2,241.30 CARMEL, INDIANA 46032 CHECK NUMBER: 215109 CHECK DATE: 12/4/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 2 , 241 . 30 TRAINING SEMINARS 4`t OF CAq� - (� CITY OF CARMEL Expense Report (required for all travel expenses) ��NDIANpi EMPLOYEE NAME: Adam Miller DEPARTURE DATE: 11/4/2012 TIME: 800 AM /PM DEPARTMENT: Police Department RETURN DATE: 11/17/2012 TIME: 1700 AM/ PM REASON FOR TRAVEL: Training (Al Team) DESTINATION CITY: Birmingham, Alabama EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM XXXX Transportation Gas/Tolls/ Meals Date Lodging Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 11/4/12 $65.00 $65.00 11/5/12 $65.00 $65.00 11/6/12 $65.00 $65.00 11/7/12 $65.00 $65.00 11/8/12 $65.00 $65.00 11/9/12 $522.90 $65.00 $587.90 11/10/12 $65.00 $65.00 11/11/12 $65.00 $65.00 11/12/12 $65.00 -$65.00 11/13/12 $65.00 $65.00 11/14/12 $65.00 $65.00 11/15/12 $65.00 $65.00 11/16/12 $65.00 $65.00 11/17/12 $808.40 $65.00 $873.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0.00 Total 1 $0.00 $0.001 $0.001 $0.001 $1,331.30 $0.00 $0.001 $0.001 $0.00 $910.00 $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 11/21/2012 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 11/21/2012 Page 2 3400 Colonnade Parkway a Birmingham,AL 35243 U � � a Phone(205)967-0002 a Fax(205)969-0901 (W Official Sponsor If the debittcredit card you are using for check-in name 329/KXPL is attached to a bank or checking account,a hold Miller,Adam room number: will be placed on the account for the full anticipated address arrival date: 11/4/2012 2:06:OOPM 11/9/2012 dollar amount to be owed to the hotel,including departure date: estimated incidentals,through your date of check-out adultichild: 1/0 and such funds will not be released for 72 business room rate: $89.00 hours from the date of check-out or longer at the discretion of your financial institution. RATE PLAN L-GVS HH# 789409621 BLUE AL BONUS AL CAR Rates subject to applicable sales,occupancy,or other taxes.Please do not leave any money or items of'value unattended in Confirmation: 80878424 your room.A safety deposit box is available for you in the lobby.I agree that my liability for this bill is not waived and agree to be held personally liable in the event that the indicated person,company or association fails to pay for any part or the full amount of these charges.I have requested weekday delivery of USA TODAY.If refused,a credit of$0.75 will be applied to 11/9/2012 PAGE 1 my account In the event of an emergency,I,or someone in my party,require special evacuation due to a physical disability Please indicate yes by checking here: ❑ signature: �. .,.. s,•�,e7-r•'a'•uF'E w.-'°':rte;^°Rr. :•?.q^?e::`x'�" :. :L.:,.... `~?'�zi'�..e z -,�f c^=7:rs•�„"t::C.:'.- .ij:Y iz1 .::�r? ``^e., �:if':.°`„,Tl:t`='c'C,�",s�•`-'.”" ' '�`.,jlf'+.nF°,_�`,.? 2""a`.x..x.:w`w.s._ ''n +_•s: z:"r� •:.a= *....x wr °'y'.�22. #S 'fj+'f a.N +w„" t:'_ -a:... �` `,,;+F N� t `• '',.J a ,.; .,_• ^^ .a .• dy>'ts; � ^r.F ; ,r'sdescri+Lion t f,"'.z •tsti•:e.�'?,_..��• r•ss"a. Pn _ c •a*.: amount, w=• reference � ,h „+ � _ �r�. .::��iv^a-�N:r.r'fr"^__ -...w._', ;,.•�...w ,..�i<.,.« .r.... ;.$��..e t .sZ: :�. �._.a.-�...3".. _ _ _rn___ ...�:c:o_.�.0-^-x""- - --- - - - - 11/4/2012 1073008 GUEST ROOM $89.00 11/4/2012 1073008 STATE TAX $3.56 11/4/2012 1073008 COUNTY TAX $6.23 11/4/2012 1073008 CITY TAX $5.79 11/5/2012 1073196 GUEST ROOM $89.00 11/5/2012 1073196 STATE TAX $3.56 11/5/2012 1073196 COUNTY TAX $6.23 11/5/2012 1073196 CITY TAX $5.79 11/6/2012 1073404 GUEST ROOM $89.00 11/6/2012 1073404 STATE TAX $3.56 11/6/2012 1073404 COUNTY TAX $6.23 11/6/2012 1073404 CITY TAX $5.79 11/7/2012 1073634 GUEST ROOM $89.00 11/7/2012 1073634 STATE TAX $3.56 11/7/2012 1073634 COUNTY TAX $6.23 11/7/2012 1073634 CITY TAX $5.79 11/8/2012 1073908 GUEST ROOM $89.00 11/8/2012 1073908 STATE TAX $3.56 11/8/2012 1073908 COUNTY TAX $6.23 11/8/2012 1073908 CITY TAX WILL BE SETTLED TO + + (::$:5:22.90 EFFECTIVE BA) CE OF •"";'g_ .`` '°„""iv ,i '� r -�i:Frt!5.`.' .'-'.. °s '_Fsy" �ta:ter.., --orrA--'as.b''"t�”? W;' p... q '°: =' Y�'".:r,rr' �x• x - o a., t p`?.::. ., t... T :tr a r ..Y ., . r::•�than for.�eser�vatlonszca111.80Oehamptondor-visitMus°onllne,at�hampfon.cbm; , 1 �,,.A ,;,;. tit. _ �,:ri_ _ � _ .._�„ ,r , account no. date of charge T4,22602 lio/check no. A card member name authorization initial establishment no.and location establishment agrees to transmit to card holder for payment purchases&services taxes tips&mist. signature of card member total amount X 0.00 u C O N R A D m HOME© ° n. H H O N O R S Wa oRr Hilton DoePkeE Gand V..tio ntroa . , HILTON WORLDWIDE ^ ^ �PR|OQH|LL�U|TE� Gpn»QHioSu�eby Marriott 3goOCnbnnadepo�°oy J�xnn�t Birmingham aimvingoamx|uou4a V20e)8698098 , ` ' � � � .Date 09Nov12 Room Charge 06.00 09Nov12 State Occupancy Tax 3/4 09Nov12 City Tax 5.59 County 7a 6.02 / Room Charge 86.00 'IqNovl2 "`"`""°'"p='^, 'u^ 3�44 . 1No 2 Cih/Ta« 5.58 10 2 County Tax 0.02 2 Room Charge 86.00 _ 1 N01 2 State Occupancy Tax 3.44 2 City Tax 5.59 2 County Tax 6.02 N 8v 12 Room Charge 88.00 12N.ov12 "`"`" " 3.44 / o"/2 5.5O *�vvv12 � 6.02 omvv/� 88.00 /v ovvu 3.44 ' `anvv` 5.50 /omuv/ 8.02 /*m 86.00 / c 3.44 1 2� �.�� 5,50 ��, / �"" 6.02 15Nov12 R»»m 86.00 i5Nov12 uoaeuocu 3.44 15Nox12 City ) 5.58 15Nov12 County a ` �����' 6.02 10Nov12 Room CU z'����. 88.00 ~ ONnv12 3.44 >Nox12 uny-fa» 5.50 `1GNov12 0�02 17Nov12 Card#: Amount: 80840 Auth:568091 Signature on File -�-- This card was electronically swiped on00Nov/2 Balance: 0.00 As o Rewards Member, you could have earned points toward your free dream vacation today. Start naming points and olho utotux, plus enjoy oxo|uo/vo member offers. Enroll today at the front desk. 5. �� Al Institute of Pholice Technology and illwllanagemenU u'4 A 3 4G VT 1�/'• UNIVERSITY OF NORTH FLORIDA 5 This is to certify that fh e; 2 o` GYANDMP�P � A4fa?n y-41 r�9 completed • / hour training course Traffic Crash Reconstruction Conducted in Birmingham, Alabama November (qbRSE O. O. UNIVERSITYof :x x i4 NORTH FLORIDA. �,_.��;.;. r s:..,._,«_- ,...,�.� Y�.�..,..,,z, t •P �,z^_a.+ ,jam. �.,....� b...:;a- ,,y.�wv.-,.r..« kc -•x,€� �.,e�_ ��-:. ,... .,.�.�> .6i:Y�.ru=s>''1e3 a:'Ri.+�>�.�'R�f•.,,:a8 F...n x.:...a ,,.�..• ..p .._,. � .r.�+;�' ^,-+' e`�... ,..� �,.._?Y.F,�''P°." k p° �`'P" _. ;'S S.:i' a �s - VOUCHER NO. WARRANT NO. ALLOWED 20 Adam C. Miller IN SUM OF $ $2,241.30 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 210 -570.00 $2,241.30 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 Wednesday, November 28, 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)) 11/28/12 reimbursement $2,241.30 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