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Home My WebLink About219386 04/24/2013 CITY OF CARMEL, INDIANA VENDOR 00362899 Page 1 of 1 ONE CIVIC SQUARE ADRIENNE KEELING ,� ..^ CARMEL, INDIANA 46032 cio Docs CHECK AMOUNT: $1,382.78 c 0 Docs CHECK NUMBER: 219386 CHECK DATE: 4/24/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 4231400 38 . 22 GASOLINE 1192 4343003 1, 019 . 56 TRAVEL & LODGING 1192 4343004 325 . 00 TRAVEL PER DIEMS amily Express ' 8885 W State Rd 114 enesselear IN 47.378 e9 UnleadedPUMP 18 olurne 10 . 739 ! _RICE /G $3 . 559 , fis TOTAL $38 . 22 � erch Tax $0 . 00 TOTAL $38 . 22 XXXXXXXXXXX5742 ' 04/17/2013 14 : 18 :43 I I agree to pay tF l? above Total Amouri+t according to Card I;yssuer Agreement .; , Save a Fortune On Fuel" feperks . corn g: H YATT REGENCY' Adrienne Keeling 1 Civic Square - Carmel IN 46032 Resv #: 4631246 You have Checked Out of Room 577 Date Description Amount Apr 13 Package Room $219.00 Apr- 13 Occupancy Tax $35.89 Apr 14 Package Room $219.00 Apr 14 Occupancy Tax $35.89 Apr 15 Package Room $219.00 Apr 15 occupancy Tax $35.89 Apr 16 Package Room $219.00 Apr 16 Occupancy Tax $35.89 Apr 17 $1,019.SGCR $0:00 Card: " ::-,.-: -..'. . Thank you for choosing Hyatt Regency Chicago. Our goal is to provide every guest with an exceptional stay and we are interested in hearing your feedback regarding your visit. A FEE OF 1 NIGHTS ROOM AND TAX WILL APPLY IF 24 HOURS NOTICE OF YOUR EARLY DEPARTURE IS NOT GIVEN. Please contact us at: qualitychirctahyatt.com or 312-565-1234 Billing: NA.Customerservice9hyatt.com or 383-472-2870 CITY OF CARMEL Expense Report (required for all travel expenses) '. xoinxa: / EMPLOYEE NAME: _Adrienne Keeling DEPARTURE DATE: 4/13/2013 TIME: 12:00 PM AM/ PM DEPARTMENT: DOCS RETURN DATE: 4/17/2013 TIME: 5:00 PM AM/ PM REASON FOR TRAVEL: _APA Conference/Continuing Ed DESTINATION CITY:Chicago, IL EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT_ TRAVEL PER DIEM _X_ Date Transportation Gas/Tolls/ Lodging Meals Misc. Total Air-fare jCarRental Other Parking -BreakfastT Lunch Dinner Snacks Per Diem 4/13/13 $254.89 $65.00 $319.89 4/14/13 $254.89 $65.00 $319.89 4/15/13 $254.89 $6500 $319.89 4/16/13 $254.89 $65.00 $319.89 4/17/13 $38.22 $65.00 $103.22 $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 $0.00 $0.00 $0.001 $38.22 $1,019.561 $0.001 $0.00 $0.00 $0.00 1 $325.00 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 If 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#ERO6 Revision Date 4/18/2013 Page 2 m l A iaW TJwl PAN gg-4 Cl of Virectors'"Y 4 arai intormation1w/ .Ko- , er,PresentattonsI22&�?:-- ;'� Saturda y.Rhiid6li�,- .1h bnday,Scheduli�59,; rr 50 je S AY Scheduie'8 114 0 )9., eclnesclay,bcheduf,� 1011.11� I M,K, rs' '.Nno09 ®1 �, A 4 and Comrnitt4e,� iv I Page 1 of 1 �X Pk Order Confirmation Older #APA7236.CART Order Summary: Pi oduct Quantity Pnce 2013 APA National Planning Con(erenoe 11 $(,9500 Exhibitor Meet and Grent 1 $0.00 Expo Lunch 1 $0.00 PowerPOmt Presentations 1 $0.00 _._ $695.00 Total I Credit Card Payment Type of Card MC Name on Card Angelina Conn Credit Card# ending in 5536 Expiration Date 2013-03 Billing Address Line 1 1340 N Dequincy St Billing Address Line 2 City Indmnapohs State/Province IN Country United States Zip/Postal Code 46201 Continue to My Account https://www.planning.org/cart/receipt/?OrcierlD=7236 12/13/2012 y Hyatt Regency Chicago 151 East Wacker Drive ?s Chicago, IL, USA 60601 Tel 312-565-1234 H YAT T Fax: 312-239-4414 REGENCY' chicagoregency.hyatt.com INFORMATION INVOICE Payee Angie Conn Room No. 3003 1 Civic Square Arrival, 04/13/13 Sat Carmel IN 46032 Departure 04/16/13 Tue Page No. 1 of 1 Membership Folio Window Bonus Code Folio 1 Confirmation No. 15359000-1 Invoice Group Name DAPA .Date Description({;.; . Charg ::r es';,;::' : Credits. 04/13 Group Room f 219.00' 04/13 Occupancy Tax 35.89 04/14 Group Room 219.00 04/14 Occupancy Tax 35.89 04/15 Group Room 219.00 04/15 Occupancy Tax 35.89 04/16 -764.67 Total 764.67 -764.67 Balance 0.00 Guest Signature 1 agree that my liability for this bills not waived and I agree to be held Please direct any billing inquiries/concems to: personally liable in the event that the indicated person,company or Email.na.customerservice @hyatt.com association fails to pay for any part or the full amount of these charges. Phone: 1-888-472-2870 If I do not check out in the Lounge with a host,I authorize the hotel to process all charges incurred during the stay to the credit card 1 presented at the time of check-in. UUw II-1,c011 Carus - Account Activity Patric 1 of 2 WEN AN ACCOUNT CngO IELI.IBER AGREEA1ENT FUMES I LOCATIONS CONTACT US HELP Soerch IGO SECURITY M9 Chl Payments Protector Tools Benefits A Services Go to Cib cam Sign Off ^Welcome BRYAN D CONN l Last Login April 18,2013,3 27 PM l My Piohle i Secure Messages m.._...r�.-a_... ._.~✓-. .�--y_—.gyp~- �Y��v Account Activity IN 5536-5536 Use the menus bolo W your card summary to sod your account activity or to search for a Specific purchase or credo. Cili ThankYouis Preferred Card Pow bad Yom Staten eni Current Balance'd' Minimum Payment Due Payment Due May/4,2013 5155.90 $0.00 Late P3Ymen1 Wammg I Statement Balance 04116/13 IFIS8276 Ayrdfdle RavoNmg Credit $23,845A2 ufw.�4'YOJ Neel Statement Closing Date May 17,2013 Line t Earned Points!I Activity Since Last Statement Total Revolving Credit Line S24,96000 1,787 PaymentalAdjustments/GaOas ($3,882]6) Last Payment Date Ad,17,2013 Sea Dennis Purchases $15590 Last Payment Amount $3,88276 Cash Advances $000 Past Due Amount $000 View your balance Total Payments In Pre,ress $0 fig " transfer Ofe east MM013 Via,,Edit Scneduiad Payments View your Paperless Letters 01)fine in the Document Center View All Account Activity Create a Reood 11 Download Your Statement Tent y Authorizations �i view au Temporary mmffior¢atwn ��t Your Temporary Authorizations are lemperary and subject to change Orgy Posted Transactions can be disputed. Transaction Date Dcscr pope Amours 04/13Yd013 HYATT HOTELS CHICAGO CHICAGO,IL 814.61 OW1 7.2013 IKEA BALTIMORE MID 31.00 04/170013 PURE EATERY INDIANAPOLIS IN _ 11.01 04/1612013 MARATHON PET R0134072 MUNSTER IN 1.00 04/1112013 PARKMOBILE 877J27-545]GA 1.00 Select Time Period, Transaction Type Slue Last Statement - Ail Transactors Transaction Details as of 04/1812013 Sale Data Description Amount 0411712013 CLICK-TO PAY PAYMENT,THANK YOU -53,882.76 0411 U2013 BOCKWINKEL'S CHICAGO IL $4.45 0411 U2013 INTELLIGENTSIA COFFEE CHICAGO IL $10.50 04/1612013 NOODLES COMPANY 9002 CARMEL IN $11.74 04116/2013 MARATHON PETRO13072 MUNSTER IN 525.05 j 04/1 W2013 THREE FLOYDS BREW PUB MUNSTER IN $48.68 041192013 CARIBOU COFFEE CO 475 CHICAGO IL S4.42 . https://www.accountonline.com/cards/svc/AccountActivi ty.do 4/18/2013 Prescribed by Stale 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)) 04/17113 APA Conference Hotel $1,019.56 04/17/13 $38.22 04/17/13 Attendance at APA Conference $325.00 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. Adrienne Keeling ALLOWED 20 IN SUM OF $ c/o One Civic Square Carmel, IN 46032 $1,382.78 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS PO#/Dept. INVOICE NO ACCT#MTLE AMOUNT Board Members 1192 43-430.03 $1,019.56 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1192 42-314.00 $38.22 materials or services itemized thereon for 1192 43-430.04 $325.00 which charge is made were ordered and received except Monday, April 22, 2013 Title Cost distribution ledger classification if claim paid motor vehicle highway fund