220870 06/13/2013 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY
CHECK AMOUNT: $352.92
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033-9501 CHECK NUMBER: 220870
CHECK DATE: 6/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 352 . 92 OTHER EXPENSES
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CITY OF CARMEL Expense Report (required for all travel expenses)
%NOIAN.p EXHIBIT A
EMPLOYEE NAME: �Y) DEPARTURE DATE: o 0 TIME:
DEPARTMENT: t �'^► lC�'�0 RETURN DATE: G' ( . TIME: � AM
t' M
REASON FOR TRAVEL: Q-n I k DESTINATION CITY: �• �/�,l l' i
EXPENSES ARE FOR (check all that apply): TRA ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation . Gas/Tolls/ Meals
Date Parkin Lodging Misc. Total
Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
t ? $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
$0.00
$0.00
$0.00
$0.00
101 IN 1 0.00
Total $0.00 $0.00 $0.00 $0.00 00 $0.00 $0.00 $0.00 $0.00 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.
j
Director Signature: Date:
City of Carmel Form#ER06 Revision Date 6/13/2013 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 $32.50 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 $32.50 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 6/13/2013 Page 2
HILTON FORT WAYNE AT THE GRAND WAYNE CONVENTION CENTER
Hilton LOn 1020 South Calhoun Street I Fort Wayne,IN 46802
T: 260 420 1100 1 F: 260 424 7775
FORT WAYNE AT THE GRAND WAYNE
CONVENTION CENTER W:hilton.com
NAME AND ADDRESS:
CORDRAY, DIANA Room: 9251K1
11843 STONEY BAY CIR Arrival Date: 6/10/2013 2:57:OOPM
Departure Date: 6/12/2013
CARMEL, IN 46033
US Adult/Child: 1/0
Room Rate: $89.00
RATE PLAN L-G1
HH# 348692524 SILVER
AL US #999L7R4
BONUS AL CAR
Confirmation: 3512614388
6/12/2013 • PAGE 1
DATE REFERENCE DESCRIPTION AMOUNT HILTON
HHONORS
6/10/2013 2029116 GUEST ROOM $89.00
6/10/2013 2029116 OCCUPANCY TAX $6.23
6/10/2013 2029116 STATE TAX $6.23
6/11/2013 2029902 GUEST ROOM $89.00
6/11/2013 2029902 OCCUPANCY TAX $6.23
6/11/2013 2029902 STATE TAX $6.23
WILL BE SETTLED TG __ ..__ $202.92
ti EFFECTIVE BALANCE OF $0.00
COhRAD
Hilton
ESTIMATED CURRENCY TOTAL
You have earned approximately 4047 Hilton HHonors points and approximately 178 Miles with US Airways for this stay.Hilton HHonors(R)
stays are posted within 72 hours of checkout. To check your earnings or book your next stay at more than 3,900 hotels and
Thank you for choosing Hilton!Book your next stay at hilton.corn and take advantage of our internet-only Advance Purchase Rates and
limited-time special offers!
>"G�ei>�rc�I+fvi
DATE OF CHARGE FOLIO NO./CHECK NO.
Zip-Out Check—Outer 454013 A #+prr
Good Morning ! We hope you enjoyed your stay. With Zip-Out Check-Out® AUTHORIZATION INITIAL
there is no need to stop at the Front Desk to check out.
• Please review this statement. It is a record of your charges as of late last PURCHASES&SERVICES
evening. HO ?cl.-pC)17
• For any charges after your account was prepared,you may:
TAKES
•pay at the time of purchase.
•charge purchases to your account,then stop by the Front Desk for an
updated statement. TIPS&Mlsc.
•or request an updated statement be mailed to you within two business days. s j
If the statement meets with your approval, simply press the Zip-Out Check-Out TOTALAMOUNT
button on your guest room telephone.Your account will be automatically checked 0.00
out and you may use this statement as your receipt.Feel free to leave your key(s) PAYMENT DUE UPON RECEIPT
in the room. Please call the Front Desk if you wish to extend your stay or if you
have any questions about your account. 0 vilt,a
r
AGENDA
STATE BOARD OF ACCOUNTS SCHOOL
GRAND WAYNE CENTER
FORT WAYNE, INDIANA
WEDNESDAY, JUNE 12, 2013
Registration — Each day in the Anthony Wayne Ballroom Lobby
ANTHONY WAYNE BALLROOM
9:00 AM Public Employees Retirement Fund (PERF) Update
Mr. Jim Neddeff, Field Services Counselor
Indiana Public Retirement System (INPRS)
10:00 AM BREAK
10:30 AM Budget Preparation Guidelines
Mr. Dan Jones, Assistant Budget Director (DLGF)
11:30 AM LUNCH
1:00 PM Indiana Department of Revenue (DOR) Regulations
Mr. Nick Fetchina, Tax Auditor (DOR)
2:00 PM BREAK
2:15 PM Question and Answer Session/Wrap-up*
Mr. Todd A. Austin, CPA (SBOA)
Mr. Charles W. Pride, Sr., CPA (SBOA)
Mr. Dan Jones (DLGF)
Mr. Nick Fetchina (DOR)
3:30 PM ADJOURN
*A question box will be provided on both days of the School for deposit of your written
questions.
AGENDA
STATE BOARD OF ACCOUNTS SCHOOL
GRAND WAYNE CENTER
FORT WAYNE, INDIANA
TUESDAY, JUNE 11, 2013
Registration — Each day in the Anthony Wayne Ballroom Lobby
ANTHONY WAYNE BALLROOM
9:00 AM Welcome
Mr. Michael H. Bozymski, CPA, Deputy State Examiner
Mr. Paul D. Joyce, CPA, Deputy State Examiner
State Board of Accounts (SBOA)
Mr. Micah Vincent, Commissioner
Department of Local Government Finance (DLGF)
9:30 AM New Legislation/Uniform Compliance Guidelines
Mr. Charles W. Pride, Sr., CPA (SBOA)
10:15 AM BREAK
10:30 AM Child Labor Laws/Common Construction Wage Requirements
Mr. Kenneth Boucher, Director
Bureau of Child Labor
Indiana Department of Labor
11:30 AM Termination of Utility Service Requirements
Mr. Todd A. Austin, CPA (SBOA)
42:00 Noon LUNCH
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev 1995)
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
i Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
'�i� o3��,�• l r�
S
Total
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.
ALLOWED 20
IN SUM OF
$ � 'C�
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# l 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund