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217957 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 365288 Page 1 of 1 �`i. ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $15.00 .? CARMEL, INDIANA 46032 15468 FOLLOW DRIVE NOBLESVILLE IN 46060 CHECK NUMBER: 217957 CHECK DATE: 3/1312013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4357004 REIMB 15 . 00 EXTERNAL INSTRUCT FEE Carmel arks&Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense 1/2s/13 SewSte, t oa 1 43S-1oo4 E-X - Ir`s�: F� 15.e—° Food N6vjle►. P,4.4 All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: Employee Name(print) 116 .5 ,Q*r4jkA,e =BY: Address JsOg3O ��; ��,ir;tl �� Check payable to: City, St, Zip ,r Signature: Approved by. Date: -�Z5113 Date: Z�Z121U Business Services Division, Revised 7-7-08 FILE: Shared\Forms\Business Services\Employee Exp Reimb Request Order Status littps://NvNvw.sei-vsafe.com/ss/catalog/order_status.aspx?ID=1832935... View Order History(order history.aspx) Take Online Course(/ss/courses/coursemanagement/courses aspx) ORDER PLACED SUCCESSFULLY Your purchase is now completed.You may click Take Online Course(/ss/courses/coursemanagement/courses aspx)to complete your course. NRAEF ORDER STATUS 175 West Jackson Boulevard, Customer Number:8618817 Suite 1500 Order Number 1832935 Chicago,Illinois 60604-2702 Status:Shipped Phone:(800)765-2122 Date Shipped 2/25/2013 12:5959 PM In Chicagoland:(312)715-1010 SHIP TO BILL TO Kurtis Baumgartner Kurtis Baumgartner 1235 Central Park Dr.East 1235 Central Park Dr.East Carmel,IN 46032 Carmel,IN 46032 (317)607-0815 Payment Method Visa####-####- -1676 Shipment Method:Unknown Invoices are sent via email and are delivered to the email address contained in the customer's user profile.To ensure that you receive these e-mails,you may • Orders ship out within 48 hours.Click here to view UPS Ground Transit need to add the domain address @restaurant.org to your safe list or address times(http'//www.ups.cortVmaps/results?zip=601741 book • We cannot ship orders to P.O.boxes. • APO/FPO and AE/AP addresses:we ship via USPS Priority Mail,a non-traceable means. QUANTITY PRODUCT DESCRIPTION PRICE TOTAL 1 SSEC 5(PRODUCTDETAIL.ASPX?ID=i71o) $15.00 $15.00 SSECT5 PRODUCT(S)SUB-TOTAL: $15.00_ SHIPPING&HANDLING: $0.00 SALES TAX: $0.00 ORDERTOTAL: $15.00 -SECURITY&PRIVACY-J Every transaction on ServSafe.com is secure.Any personal information you give us will be handled according to our Privacy Policy(#) RETURNS 1 of 2 2/25/2013 2:02 PM Kurtis Baumgartner From: ServSafe - National Restaurant Association [ServiceCenter @restaurant.org] Sent: Monday, February 25, 2013 2:00 PM To: Kurtis Baumgartner Subject: National Restaurant Association Order Confirmation Number 1832935 Dear Kurtis Baumgartner, Thank you for your order,we greatly appreciate your business.Your confirmation number 1832935. Please reference this number when making inquiries. Description e SSECT5 ServSafe Food Handler Online Course and Assessment BUNDLE 1 $15.00 $15.00 Sub Total $15.00 Shipping/Handling $0.00 _ Sales Tax $0.00 Grand Total $15.00 Payment method: Credit Card Bill to: Kurtis Baumgartner 1235 Central Park Dr. East Carmel, IN 46032 UNITED STATES Shipping Method: Unknown Ship to: Kurtis Baumgartner 1235 Central Park Dr. East Carmel, IN 46032 UNITED STATES You will receive an email notification to inform you when your order ships. If you need any assistance or have any questions,visit Customer Assistance on ServSafe.com. Please see below for the National Restaurant Association contact information and business hours. Service Center National Restaurant Association 175 West Jackson Boulevard, Suite 1500 Chicago, Illinois 60604-2814 Business hours: 8:00 a.m. to 6:30 p.m. CST Phone: (800) 765-2122 ext. 6703 In Chicagoland (312)715-1010 ext. 6703 Email:ServiceCenter(d)restaurant.org 1 ipcert.aspx https://www.servsafe.com/ss/Exams/certificates/ipcert.aspx?C[D=P.. Servft C fficate of 'Am chlevement rUll I Wong This s awarded to Kurtis .Baumigartner lo.'ngratuiat on.s' Yb,� have ca ServSafe-- Food Handler ANSI A(XREDITED PROGRAM CEIMMATE ISSUER 90655 Employee Food Safety Online Course and Exam NATIONA L RESTAURANT 0424-1-9 ASSOCIATION, )0- ) �12 1 of 1 2/25/2013 4:01 PM ipcert.aspx https://www.servsafe.com/ss/Exams/certificates/ipcert.aspx?CID=P... rvft e - � - * �- This certificate is awarded to ......... ________. ___Ku r_tl s_B.a u m.g.a r_tn e r_ .___. 1- - - - - - Congratulation_':You have completed - --- - ---- --- ANSI ACCREDITED PROGRAM a ry a e,u. Food Handier CERTIFICATE ISSUER #0655 Employee Food Safety Online Course and Exam NATIONAL < RESTAURANT ASSOCIATION® ­5 VV 1,1c son BA,Ste 1500, Chicago it.60604­2814 WvAV restaurant.org I Ww"v Servsaie r p n 1 of] ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 365288 Baumgartner, Kurtis Terms 15468 Follow Drive Noblesville, IN 46060 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 2/25/13 Reimb ServSafe for Food Handler Certification $ 15.00 Total $ 15.00 I 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. 365288 Baumgartner, Kurtis Allowed 20 15468 Follow Drive Noblesville, IN 46060 In Sum of$ $ 15.00 ON ACCOUNT OF APPROPRIATION FOR 109 - Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 Reimb 4357004 $ 15.00 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 7-Mar 2013 Signature $ 15.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund