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Home My WebLink About216705 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 248970 Page 1 of 1 ONE CIVIC SQUARE ANN GALLAGHER CARMEL, INDIANA 46032 171 PARKVIEW COURT CHECK AMOUNT: $291.80 CARMEL IN 46032 CHECK NUMBER: 216705 CHECK DATE: 1/29/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 291 . 80 TRAINING SEMINARS Southwest Airlines - Purchase Confinnation Page 1 of 2 SOUnWu1111W. Thank you for your purchase! Indianapolis,IN-IND to Denver,CO-DEN New Purchases in Trip Air Confirmation#G5KQ5Y Indianapolis,IN-IND to Denver,CO j-DEN I Saturday,April 13,2013-Tuesday,April j 16,2013 J EarlyBird Check-In Purchased I i Air Total: $311.80 Amount Paid $311.80 Trip Total $311.80 APR 13 LSAT j 04/13/13 - Denver New purchases added to your trip. ......... AIR Indianapolis,IN-IND to Denver,CO-DEN 04/13/2013 - 04/16/2013 Confirmation#G5KQ5Y Adult Passenger(s) Rapid Rewards# ANN GALLAGHER 00000185598906 Subscribe to Flight Status Messaging i t DEPART 07:20AM Indianapolis, IN(IND)to I Flight Saturday,April 13,2013 APR 13 18:ISAM Denver, CO(DEN) ( #1581 Travel Time 2 h 55 m SAT l i i (Nonstop) RETURN i 02:20PM Denver, CO(DEN)to ' Flight APR 16 j 06:40PM Indianapolis, IN(IND) #2512 Tuesday,April 16,2013 Travel Time 2 h 20 m TUE ( (Nonstop) I PRICE:ADULT Trip Routing Fare Type I View Fare Rules Fare Details Quantity Total • No Change Fees Wanna Get Away (applicable fare difference applies) Depart IND-DEN � � • Reusable Funds 1 $145.90 (nontransferable-no name changes allowed) • Nonrefundable • No Change Fees Return DEN-IND Warma Value (nontransferable Away • Reusable Fun difference applies) 1 $145.90 (nontransferable-no name changes allowed) • Nonrefundable Earn at least 1619 Rapid Rewards Points per person when you take this Subtotal $291.80 trip. Fare Breakdown Carry-on Items:1 bag+1 small personal Item are free,see full details. Checked Items:First and second bags are free,size and weight limits apply. Bag Charge $0.00 https://www.southwest.com/reservations/confirm-reservations.html?disc=0%3A32D/o3A 13... 1/15/2013 Southwest Airlines - Purchase Confirmation Page 1 of 2 sourHwE,aT cotln° Thank you for your purchase! Indianapolis,IN-IND to Denver,CO-DEN New Purchases in Trip Air Confirmation#G5KQ5Y Indianapolis,IN-IND to Denver,CO -DEN Saturday,April 13,2013-Tuesday,April 16,2013 d EarlyBird Check-In Purchased Air Total: $311.80 Amount Paid $311.80 Trip Total $311.80 [APR 1s tT 04/13/13 - Denver New purchases added to your trip. AIR Indianapolis,IN-IND to Denver,CO-DEN 04/13/2013 - 04/16/2013 Confirmation#G5KQ5Y Adult Passenger(s) Rapid Rewards# ANN GALLAGHER 00000185598906 Subscribe to Flight Status Messaging DEPART 07:20AM Indianapolis, IN(IND)to Flight Saturday,April 13,2013 [;� l 08:15AM Denver, CO(DEN) #1581 Travel Time 2 h 55 m AT (Nonstop) RETURN 02:20PM Denver, CO(DEN)to Flight Tuesday,April 16,2013 APR 16 06:40PM Indianapolis, IN(IND) #2512 Travel Time 2 h 20 m TUE (Nonstop) PRICE:ADULT Trip Routing Fare Type I View Fare Rules Fare Details Quantity Total • No Change Fees Wanna Get Away (applicable fare difference applies) Depart IND-DEN • Reusable Funds 1 $145.90 EXceIlerd Value (nontransferable-no name changes allowed) • Nonrefundable • No Change Fees Wanna Get Away (applicable fare difference applies) Return DEN-IND • Reusable Funds 1 $145.90 EXOelIent Value, (nontransferable-no name changes allowed) • Nonrefundable Earn at least 1619 Rapid Rewards Points per person when you take this Subtotal $291.80 trip. Fare Breakdown Carry-on Items:1 bag+1 small personal item are free,see full details. Bag Charge $0.00 Checked Items:First and second bags are free,size and weight limits apply. https://www.southwest.com/reservations/confirm-reservations.html?disc=0%3A32%3A13... 1/15/2013 \1 NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES CONFERENCE REGISTRATION FORM t_IF'ESAlfERS 201-3 APRIL 14-16, 2013 Y COLORADO CONVENTION CENTER • DENVER PAGE 1 ATTENDEE INFORMATION J First name: 1-9 Last name: Preferred first name for badge: ri Privacy Disclaimer. C'�� // By registering for this conference Organization: c 1 you acknowledge that your contact Address: C ' `�' S /� �CA/ information will be included on the �� U attendee list made available to -e City: �� Statey�"J Zip: 1 �U?i L all meeting registrants,including _ exhibitors. Only exhibitors have Telephone: ( 311 1 �7� -a'S UU Cell: ( 1 the opportunity to purchase Pot updates on4•-will not be pained'n program nwlrlial the attendee list. Attendee Email: / /4 C, Chef r7i e f�� s G r,4 Initial here if you do not Email a copy of registration info to: / m want your contact information Entzralrernareemaaonly included in conference materials. Special Requests: Emergency Contact Name(required): Z G' Day Phone:( ) O 3 - Evening Phone: 13-bread and accepted the Liability and Photography Waiver on page 2 of this registration form. j/ Please check food functions you will be attending: - {J�0-ec, a I- we'I C�Ui2 _A s4) /�4 IK Sunday Box Lunch i�.Jylonday Continental Breakfast Tuesday Closing Breakfast Plenary 1n` I Sunday Opening Reception I%%'Monday NHTSA Awards Luncheon Will you be staying at the one of the Conference hotels? ides El No If not,where will you be staying? Is this your first Lifesavers Conference? ❑ Yes 7A(o What field do you work in? ❑Consultant/Researcher ❑Community Programs ❑Local Government ❑Advocacy/Consumer Group ❑Insurance Industry ❑EMS/Fire ❑State/Federal Govt. ❑Judge/Prosecutor ❑Child Passenger Safety ❑Public Health/Medical ❑Auto Industry ❑Law Enforcement ❑Child Restraint Manufacturer ❑Student *Mich workshop track(s)will you most likely be attending? •Adult Occupant Protection ❑Distracted Driving ❑Teen Traffic Safety ❑Impaired Driving •Roadway Safety 'Occupant Protection for Children ❑Other Highway Safety Priorities ❑Criminal Justice/Law Enforcement •Communications ❑Vulnerable Populations(Bicyclists/Motorcyclists/Pedestrians/Older Drivers) PRE-CONFERENCE WORKSHOPS I am registering for: 5�CPS Latest Technology Workshop Details on Pre/Post activities page of our website. REGISTRATION FEES (Checkone) Your registration fee includes an opening reception,two breakfasts,two lunches,refreshment breaks,exhibits,workshops,and program materials. 4—Early-Bird Special-Until January 11,2013 $350 • Regular Registration-After January 11,2013 until March 1,2013 $400 • Late/On-Site Registration-After March 1,2013 $500 • Moderator/Speaker $350 paying by credit card or • Moderator/Speaker(attending day of presentation only) Indicate day: $0 purchase order? • Poster Presenter $350 You can also securely • Approved Undergraduate/Graduate Student-Registration Code: $50 register online at Note:Additional exhibit personnel—please use the exhibit registration form. Total Amount Due $ www.lifesaversconference.org WWW.LIFESAVERSC0NFERENCE.0RG REGISTRATION FORM PAGE 2 PAYMENT METHOD �f Check one ❑Visa ❑MasterCard ❑Check L are�ase Order(see below) Total Amount$ 3_5,j2 ,06 ❑I agree to pay the above total amount according to card issuer agreement. Card Number: Expires: / CW2 Code: ID:C^r,ie r e 3Acn rC.R:.::Pi o'I)cna0.of pia,r%Snrz :no n PC Signature: Print name as it appears on card: Billing Address: City/State/Zip: Purchase order must be attached.Indicate bill-to address below if different from registration address. l Attention:� 14 /'rig Uerml—, Organization: Address:3cu L Sg(,ZrA1/r City/State/Zip: 0141-1-»-e / 1 y[o0`5 Z PAYMENT TERMS R Registration fees must be paid by check in U.S.dollars payable to Lifesavers Conference,Inc.,credit card(Visa or MasterCard-we do not accept American Express)or attached purchase order. GI Registrations received without payment or purchase order number will not be processed. 19 Registration must be mailed by April 4,2013.After that date wait and register on-site. Lifesavers Fed.ID#:52-1648356 Mail form with payment or purchase order to: Or Fax: Lifesavers Conference,Inc. (703)922-7780 Do not mail form after faxing. Conference Registration P0.Box 30045 Alexandria,VA 22310 NOTE:If you do not receive a confirmation via email or U.S.mail within 14 days,please contact us at(703)922-7944 or email us at lofgren @meetingsmgmt.com CONFERENCE LODGING 61 Headquarters:Hyatt Regency Denver at the Colorado Convention Center 1a Sheraton Denver Downtown Reserve your room online via a link on the Travel/Hotel page of our website. CANCELLATION POLICY Lifesavers does not accept cancellations by phone. Cancellations must be mailed to Lifesavers Conference, or emailed to Lofgren @meetingsmgmt.com. You will receive a confirmation of your cancellation.Requests received by March 29,2013 will be refunded less a$25 administration fee.Refunds will be issued after the conference.Requests made after March 29,2013 or"no-shows"are not eligible for a refund. LIABILITY/PHOTOGRAPHY WAIVER By registering for the Lifesavers 2013 Conference,you agree and acknowledge that you are participating in Lifesavers Conference events and activities on your own free and intentional will.You acknowledge this freely and knowingly and that you are,as a result,able to participate in Lifesavers Conference events and hereby assume responsibility for your own well-being.This acknowledgement includes your guest(s)participation in any tours and evening events. The Lifesavers Conference plans to take photographs during the 2013 conference and reproduce them in Lifesavers educational,news,or promotional mate- rial,whether in print,electronic or other media,including the Lifesavers website.By participating in the Lifesavers 2013 Conference,you grant Lifesavers to reserve the right to use your name and photograph for such purposes.All postings are property of Lifesavers,and may be displayed or used by Lifesavers for any purpose. WWW.LIFESAVERSCONFERENCE.0RG 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)) 01/24/13 air fare reimbursement $291.80 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 Ann Gallagher IN SUM OF $ 171 Parkview Court Carmel, IN 46032 $291.80 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 210 I -570.00 $291.80 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 Thursday, January 24, 2013 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund