219302 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 356653 Page 1 of 1
ONE CIVIC SQUARE ALEXIA DONAHUE WOLD
CARMEL, INDIANA 46032 230 W 49TH ST CHECK AMOUNT: $1,859.20
INDIANAPOLIS IN 46208 CHECK NUMBER: 219302
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343001 1, 534 .20 TRAVEL FEES & EXPENSE
1192 4343004 325 . 00 TRAVEL PER DIEMS
na191NC'R.ci�
CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: Alexia Donahue Wold DEPARTURE DATE: 4/13/2013 TIME: 12:00 PM
DEPARTMENT: DOCS RETURN DATE: 4/17/2013 TIME: 5:00 PM
REASON FOR TRAVEL: American Planning Association Conference DESTINATION CITY: Chicago
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X TRAVEL PER DIEM X
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
4/13/13 $52.00 $330.55 $65.00 $447.55
4/14/13 $52.00 $330.55 $65.00 $447.55
4/15/13 $52.00 $330.55 1 $65.00 $447.55
4/16/13 $52.00 $330.55 $65.00 $447.55
4/17/13 $4.00 $65.00 $69.00
$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.
ii6iTotal $0.00 $0.00 $0.00 $212.00 $1,322.20 $0.00 $0.00 $0.00 $0.00 $325.00 $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 4/18/2013 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:
.,pCity of Carmel Form#ER06 Revision Date 4/18/2013 Page 2
Hyatt Regency Chicago
151 East Wacker Drive
Chicago, IL, USA 60601
Tel: 312-565-1234
H Y A T T Fax: 312-239-4414
REGENCY' chicagoregency.hyatt.com
INFORMATION INVOICE
Payee Alexia Donahue-Wold Room No. 0858
230 W 49th Street Arrival. 04/13/13 Sat
Indianapolis IN 46208 Departure 04/17/13 Wed
Page No. 1 of 1
Membership Folio Window
Bonus Code Folio 1
Confirmation No. 15354681-1 Invoice
Group Name
Date Description Charges Credits
04/13 Guest Room 284.00
04/13 Occupancy Tax 46.55
04/14 Guest Room 284.00
04/14 Occupancy Tax 46.55
04/15 Guest Room 284.00
04/15 Occupancy Tax 46.55
04/16 Guest Room 284.00
04/16 Occupancy Tax 46.55
04/17 Valet Parking 52.00
04/17 Valet Parking 52.00
04/17 Valet Parking 52.00
04/17 Valet Parking 52.00
04/17 -1530.20
Total 1,530.20 -1,530.20
Balance -0.00
Guest Signature
I agree that my liability for this bill is not waived and I agree to be held Please direct any billing inquiries/concerns 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 I presented
at the time of check-in.
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Page 1 of' 1
AM
Lz K
/
Order Confirmation
Order, #APA7236.CART
Order Surnrnary:
Product Quantity Price
2013 APA National Planning Conference 1 $695.00
Exhibitor Meet and Greet 1 $0.00
Expo Lunch ]. $0.00
PowerPoint Presentations i $0.00
$695.00 Total
Credit Card Payment! i
Type of Card
Name on Card Angelina Conn
Credit Card#
Expiration Date 2013-03
Billing Address Line 1 1340 N Dequincy St
Billing Address Line 2
City Indianapolis
State/Province IN
Country UnIted States
Zip/Postal Code 46201
Continue to hiy Account
https://www.ptannina.ora/cart/receipt/?OrderlD=7236 12/18/2012
_ 2 Hyatt Regency Chicago
:i 151 East Wacker Drive
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. 04113/13 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
r..
f.
D t De crt - ... �e its:
ae s o
04113 Group Room 219.00
04113 Occupancy Tax 35.89
04/14 Group Room 219.00
04/14 Occupancy Tax 35.89
04115 Group Room 219.00
04/15 Occupancy Tax 35.89
04/16 -764.67
Total 764.67 C-764--7
Balance 0.00
Guest Signature
I agree that my liability for this bill is not waived and I agree to be held Please direct any billing inquiries/concerns 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 I presented
at the time of check-in.
k-IMUS t-recia utras - ACCOUIlt Activity Page I o1'2
OPEN AN ACCOUNT CARD MEMBER AGREEMENT RATES I LOCATIONS CONTACT US HELP Search IGO SECURITY
My Citl Payments Financial Tools Benefits&Services Go to Cili.com Sign Off
�TTWelcome Last Login:April 18,2013,3:27 PM I My profile I Secure Messages
Account Activity
Use the menus below your card summary to sort your account activity or to search for a specific purchase or credit.
Cit!ThankYouO Preferred Card Do%ofoad your Statement
Current Balance Minimum Payment Due Payment Due May 14,2013
$ $0.00 NONE
Late Payment Warning
Statement Balance-04/16/13 $
ViewiEdrt Scheduled Payments
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Transaction Date De—scHpItion—, AmQun
:
04/1 312 01 3 jrCc`HYATT HOTELS CHICAGO CHII AZAL7
L,,—�-00 914.67
Select Time Period: Transaction Type
Since Last Statement All Transactions
Transaction Details as of 04/18/2013
Sale Date Description Amount
httV.)s://www.accountontine.com/cards/svc/AccoutitActivity.dv 4/18/2013
VOUCHER NO. WARRANT NO.
Alexia Donahue Wold ALLOWED 20
IN SUM OF $
c/o One Civic Square
Carmel, IN 46032
$1,859.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1192 43-430.01 $1,322.20 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1192 43-430.01 $212.00
materials or services itemized thereon for
1192 I I 43-430.04 I $325.00 which charge is made were ordered and
received except
Monday, April 22, 2013
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
04/17/13 Hotel Costs $1,322.20
04/17/13 Parking Fees $212.00
04/17/13 I I Attendance at APA I $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