219320 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 248970 Page 1 of 1
ONE CIVIC SQUARE ANN GALLAGHER
CHECK AMOUNT: $305.60
171 PARKVIEW COURT
CARMEL, INDIANA 46032 CARMEL IN 46032
CHECK NUMBER: 219320
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 305 . 60 TRAINING SEMINARS
C'P VF.NSgp��
CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: Ann Gallagher DEPARTURE DATE: 4/13/2013 TIME: 7:20AM AM / PM
DEPARTMENT: Police RETURN DATE: 4/16/2013 TIME: 6:40PM AM / PM
REASON FOR TRAVEL: Lifesavers Conference DESTINATION CITY: Denver, CO
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
4/13/13 $22.80 $65.00 $87.80
4/14/13 $65.00 $65.00
4/15/13 $65.00 $65.00
4/16/13 $22.80 $65.00 $87.80
$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
$0.00
Total $0.001 $0.001 20.001 $45.601 $0.00 $0.00 $0.00 $0.001 $0.001 $260.00 $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 4/19/2013 Page 1
Southwest Airlines - Purchase Confirmation Page 1 ol'2
sourrtwwcor
Thank you for your purchase!
Indianapolis,IN-IND to Denver,CO-DEN
New Purchases in Trip
_ Air
Confirmation#GSK05Y
Indianapolis,IN-IND to Denver,CO:
(-DEN
Saturday,Apn1 13,2013"Tuesday,April
16,2013
✓ Farz;E.�;}CttECl-(tt�urCha•;EC '
i
$ Air Total:$311.80
t
Amount Paid
$311.80
Trip Total
$311.80
� APR 33
SAT } 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$$GSKQ5Y
Adult Passenger(s) Rapid Rewards 1
ANN GALLAGHER 00000185598906
Subscribe to FOgnt Status Messaging
DEPART 07:20AM Indianapolis, 1N(iND)to { Firght i Saturday,April 13,2013
qvR 13� 08:15 AM Denver, CO(DEN) j 4ISS >
;.._..._......_.... 1 ;ravel Time 2 h 55 m
SAT ` ' ? 1 (Nonstop)
RETURN ? 02:20PM Denver, CO(DEN)to Right
r--•-----, i Tuesday,April 16,2013
l qPR t6 06:40PM Indianapolis, IN(IND) I 12512 Travel Time 2 t;20 in
TUE (Nonstop)
--.........._..................._.._._.... L _____—._�.. _.._...
PRICE:ADULT
Trip Routing Fare Type I mew Fare Rules Fare Details Quantity Total
• ba,Cba0 Fttn
;aapl,.ablo 13:P<f CIM.=• m'_!
Depart IND-DEN Wanna Get Away • Re-1.1 FUnot 1 5145.90
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• �CM N„9 Fm,h
WannaGet Away
Return DEN-IND • ��_,�=-�"�n+: i 5145,90
Ea#i4 VaAn: a�w«er
Earn at least 1619 Rapid Rewards Points per person woen YOU take this Subtotal $291.80
inp•
Fart
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Car,y,ya:ttm:1 bag• 1311 perwnnl Ren+are Ilea,5 y.h11 01-4,
0, t d i:n=rn.I,'I and srcond bags arr trn.;,sut a-weight 111111t,eltply. Bay Charge 50.0{5
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NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES
CONFERENCE REGISTRATION FORM
,_fFESAVERS 2O 13 APRIL 14-16, 2013 • COLORADO CONVENTION CENTER • DENVER
PAGE 1
ATTENDEE INFORMATION
First name: 14 -1— Last name:
Preferred first name for badge: N
Privacy Disclaimer.
By registering for this conference
Organization: ��/��� �C)�/CG P� you acknowledge that your contact
��i{ information will be included on the
Address: vQ attendee list made available to
State:T� Zip: L(470-3 2- all meeting registrants,including
City.
exhibitors. Only exhibitors have
Telephone: ( 31 ! -�S V y Cell: i ) the opportunity to purchase
the attendee list.
Attendee Email:_ ! / cro116(hc✓' (.2C'�tr>7�C/ .�,��f t� _
'/�� G Initial here if you do not
Email a copy of registration info to: s t�1�(f}t{' �� ' want your contact information
ri:r,v eErn+;T,e,v; included in conference materials.
Special Requests:
Emergency Contact Name(required):
Day Phone:( ) C 3 - Evening Phone:
E..l l ave read and accepted the Liability and Photography Waiver on page 2 of this registration form.
�lease check food functions you will be attending: - �O Qtr 4 Weal UZL key0/�_!
Sunday Box Lunch !*onday Continental Breakfast E ..Tuesday Closing Breakfast Plenary
Sunday Opening Reception i%%�wonday NHTSA Awards Luncheon '
Will you be staying at the one of the Conference hotels? [mss ❑No
If not,where will you be staying?
Is this your first Lifesavers Conference? ❑ Yes P6-No
What field do you work in?
El 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 0 Student
Which workshop track(s)will you most likely be attending?
Cl Adult Occupant Protection ❑Distracted Driving I-]Teen Traffic Safety ❑Impaired Driving
❑Roadway Safety 90ccupant Protection for Children ❑Other Highway Safety Priorities ❑Criminal Justice/Law Enforcement
LJ Communications [:]Vulnerable Populations(Bicyclists/Motorcyclists/Pedestrians/Older Drivers)
PRE-CONFERENCE WORKSHOPS
7! 1 am registering for: [54 CPS Latest Technology Workshop Details on Pre/Post activities page of our website. t
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 5400
• 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?
LJ 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
WW W.LIFESAVERSC0NFERENCE.0RG
REGISTRATION FORM
PAGE 2
PAYMENT METHOD
Check one ❑Visa E]MasterCard O Check ase Order(see below) Total Amount S
❑l agree to pay the above total amount according to card issuer agreement.
Card Number: Expires: / CW2 Code:
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. f
Organization:
Address:'3 C U, C ��(,t-,I:r City/State/Zip:. ��r P i --f—�" V(00 S Z
PAYMENT TERMS
V 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.
Registrations received without payment or purchase order number will not be processed.
Registration must be marled 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 taxing.
Conference Registration
P.O.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 Iofgren4meetingsmgmt.com
CONFERENCE LODGING
tt: Headquarters:Hyatt Regency Denver at the Colorado Convention Center
E 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®meetingsmgrni.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.ORG
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))
04/18/13 travel reimbursement $305.60
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
$305.60
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
210 I I -570.00 I $305.60 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
Friday, April 19, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund