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Home My WebLink About219287 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 355677 Page 1 of 1 ` ONE CIVIC SQUARE ANGELINA CONN ! CHECK AMOUNT: $1,234.46 CARMEL, INDIANA 46032 CHECK NUMBER: 219287 CHECK DATE: 4/24/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 4343003 764 . 67 TRAVEL & LODGING 1192 4343004 469 . 79 TRAVEL PER DIEMS Kt+�'s'�� ° .�rt`�°„4yi '° p' ��'Y3}I '� L�ro��' �r� �7� , �'�.,�3/�rT�'��i e �j'a4:.,.✓ , F - xt � K °� 9� + � ist}�'�i� tT � ` vi Eta i 4.ff-wag x v N'i { •+r -ti{. 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Wonors� 709� � ��.�-` �'�6Y�3n.0^+,,+ pia�.- } G vm�'V x `f°' �r r �'mf, r'�r+ !'+,•� $' s.. �,,g• '�'yid, S '"c "�� ni, ?t �°r f ti'�� .�� gyp-v 5-2'tfi �f�+1�9 ..fir�,�r h'�. �L"Deal H st Sponsorsr`L tt q.1.Y a t4'�r and Committee m 5 , 'my�A�•�� 1 ..�u�" �F ' � .� y�n r1t� •Y �$ - 5 .�( ,} ♦c Q9{. F 44t fJ 'f`o- rt sF n 41 . tk �,, �b y� �•'�0 4 «yn n}..,.„�� '� .�m y�J 'r'�C" ..Y`i � „C' 1'`4 '�e�"• � y' � a ti• � a� L t C� � +�, Aa tax, a-, i��'• i�e o- ��`�,��.g� '}'�'gl�.y�,�r'.�` �#��+�t� r .y �h .* ti','6it" t5q" ��db`$�"j.� �•�,�{ a 1pi�VF3�Q`�'. y' '� �, > .TM 2 G \i 4 }."'" �. i tl .[RSL✓2+. �^X i.� tTle.I`Y�vt�S.. 1 '+ �Y. i 0 Ly A L' Pff dt T' .r 1fGfN, Q,p�• S ^' ' 1 Page I ol: I (z: Order Confirmation Order #APA7236.CART Order Surrunary: Product Quantity Price 2013 APA National Planning Conference 1 $695.00 Exhibitor Meet and Greet 1 $0.00 Expo Lunch $0.00 PowerPoint Presentations 1 $0.00 $695.00 Total Credit Card Payment: Type of Card 1,1C Name on Card Angelina Conn Credit Card# ending in 5536 Expiration Date 2013-03 Billing Address Line 1 1340 1`4 Dequincy St Billing Address Line 2 City Indianapolis State/Province IN Country United States Zip Postal Code 46201 Continue to r•ty Account https://www.plaiiiiing.or.g/cart/receipt/?OrderlD=7236 12/18/2012 PRESCRIBED BY STA"1'E BOARD OF ACCOUNTS GENERAL_FORM NO. 101 (1955) MILEAGE CLAIM T0: Angelina Conn, (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATED NO. FOR APA National Conference,Chicano (OFFICE,BOARD,DEPARMTNE OR INSTITUTION) DATE FROM TO ODOMETER MILEAGE READING+ NATURE OF BUSINESS AUTO MILES @ $0.555 POINT POINT START FINISH TRAVELED PER MILE April 13 My house APA Conference 81,503 Drive to APA National Conference, Chicago, IL, 189 mi. $104.895 April 1.6 APA Conference My house 81,881 Drive home from APA National Conference, Chicago, IL 189 mi. $104.895 AUTO LICENSE NO. TOTALS $209.79 +ODOMETER READING colunvms are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Pursuant to the provisions and penalties of Chapter 155,Acts 1953: I hereby certify that the foregoing account is just and correct: that the amount claimed is legally due,after allowing all Just.credits.and that no part of the same has been paid. Date April 17,2013 Claim No. Warrant No. I have examined the within claim and IN FAVOR OF hereby certify as follows: That it is in proper form. i / That it is duly authenticated as required by law. That it is based upon statutory authority. That it is apparently{correct} {incorrect} On Account of Appropriation No. Disbursing Officer For I CERTIFY that the within bill is true and correct. that the mileage therein itemized and for which �o� charge is made was ordered by me and was Allowed necessary to the public business; and that the rate per mile is in accordance with statutes or governing In the sum of$1; ordinances..except (Board or Conunission) FILED Signature 2013 Date flic de) j BOYCE FORMS—SYSTEMS 1-800-382-8702 01136 GTPhRThyiklj�p� •` C s CITY OF CARMEL Expense Report (required for all travel expenses) `./NDIANA..• EMPLOYEE NAME: _Angelina Conn DEPARTURE DATE: 13-Apr TIME: 9:00 AM DEPARTMENT: DOCS- PZ RETURN DATE: 16-Apr TIME: 5:30 PM REASON FOR TRAVEL: National Planning Conference DESTINATION CITY: Chicago, IL EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM_X_ Transportation Gas/Tolls/ Meals Date Lodging Misc. Total Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem 4/13/13 $254.89 $65.00 $319.89 $0.00 4/14/13 1 $254.89 $65.00 $319.89 $0.00 $0.00 4/15/13 $254.89 $65.00 $319.89 $0.00 $0.00 4/16/13 $65.00 $65.00 $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 $764.67. $0.00 $0.00 $0.00 $0.001 $260.001 $0.00 0 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 4/18/2013 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 $30 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$30 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 4/18/2013 Page 2 ulk Hyatt Regency Chicago 151 East Wacker Drive Chicago, IL, USA 0O0O1 Tel: 312-~85 1234 HYATT Fax: 312-239-4414 REGENCY' hyatt.cmn INFORMATION INVOICE Payee Angie Conn Room No. 3003 1 Civic Square Arrival. 04/13/13 Sat Carmel |N40032 Departure 04110113Tue Membership Page No. 1 of | Folio Window | Bonus VV / Folio 1 Confirmation No, 1535900O 1 � - Invoice Group Name DAPA � 04/13 Group Room ^ 04/13 Occupancy Tax 219.00 04/14 Group Room 35.89 04/14 Occupancy Tax 219.00 04/15 Group Room 35.89 04/15 Occupancy Tax 219.00 35.89 04/16 Total 764.67 11" 764.67 � | | � Balance 0.00 Guest Signature |agree that my liability for this bill is not waived and|agree m»oheld Please direct any billing mvuinos/concemxto: personally liable m the event that the indicated person,company m sman:naxummemommo@hya«vom association fails to pay for any part o,the full amount u,these charges. Phone: 1-888-472-2870 xiun not check out mme Lovnovvwmaoo�.|aumonzvmoon�|m - process all charges incurred during the stay m the credit Gard|presented at the time,xuhoown. — | / �i r k Tk�^. wr i " X� Um' Y Kw yr t n+ 5 "..�_.ywym~t➢ _ �q 'xFT"+eb r IOWA r �PreSldent�4 "��Lq� rS AAy r t3oardofDt eCtOrS'�3xn '� .t k, t .- _ i ar t`c ,�. `}• r '� , u�' i ri y,�!` y t "&' t f t'S�r"'� p'"`gL.32s.. �u$ri�iSgis�`��N�^ -XIT nTx� .,r'' -C�,�,a •! R ?� *'� `'a r �s ' Y NAPA Companerrts � lFI p, t z` T ix � kGeneral'Infarmat�on 7 :iOYU I rr s l'jt Ma Nw-wow .t K a.. k i�,.j{ L$,� yr �. �.:,�+ �,,F, �[�`,E�idd4�v �n -�nFf y�hiy,s rr r-�au� 1�+ ,y<, adu h� fl,�c*' r�S�it � f PastersPresentatfonsg22; � s ' AlwommN ;✓+'r . Saturday Scheduie2S� Sy�undayh�edule37� a it t�k "v� ti -ts�, ea � f ti'; IVlanday Sqt;�hTedule,59 xr `< g- � �Tuesdayp5�hedute lU IWO FIT 1 T onorsn I fu"°�wx � K : and Committ' pia a•� :' - � �,: .�..-, ��'�f i� �. '�� `�'�CP�t �'.. �� OEM"�