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221621 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 357812 Page 1 of 1 4 � ONE CIVIC SQUARE WILLIAM MISER CHECK AMOUNT: $587.00 CARMEL, INDIANA 46032 5208 ROLAND DRIVE INDIANAPOLIS IN 46228 CHECK NUMBER: 221621 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 4343003 267 . 00 TRAVEL & LODGING 1192 4343004 150 . 00 TRAVEL PER DIEMS 1192 4355300 170 . 00 ORGANIZATION & MEMBER rQ, Rsyp CITY OF CARMEL Expense Report (required for all travel expenses) NOIANA DEPARTURE DATE: 4/15/2013 TIME: AM / PM RETURN DATE: 4/18/2013 TIME: AM / PM REASON FOR TRAVEL: Training DESTINATION CITY: Merrillville, IN Transportation Gas/Tolls/ Meals Date Parkin Lodging Misc. Total Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem 4/15/13 $89.00 $50.00 $139.00 4/16/13 $89.00 $50.00 $139.00 4/17/13 1 $89.00 $50.00 $139.00 $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 Total $0.00 $0.00 $0.00 $0.00 $267.00 $0.00 $0.00 $0.00 $0.00 $150.00 $0.00 DIRECTOR'S STATEMENT: I hereby affirm that a!!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 6/28/2013 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: �/Vi-Z 6— City of Carmel Form#ER06 Revision Date 6/3/2013 Page 2 d U►S!�h William Miser Room No. 4078 54208 Roland Dr Arrival 04-15-13 Indianapolis IN 46228 Departure 04-18-13 United States Page No. 1 of 1 Folio No. INFORMATION INVOICE Conf. No. 2274325 Membership No. GR 6015995035559833 Cashier No. 14 A/R Number Group Code 04131ASBUL Company Name 04-18-13 12:05:17 AM EST Date Text Charges Credits 04-15-13 Room 89.00 04-16-13 Room 89.00 04-17-13 Room 89.00 04-17-13 267.00 Total 267.00 267.00 Balance 0.00 Club Carlson: A faster way to a free night stay at over 1000 Carlson hotels worldwide. Enroll and learn more at the front desk or at clubcarlson.com Thank You For Staying With Us I agree that my liability for this bill is not waived and agree to be held personally responsible in the event that the indicated person,company or association fails to pay for any portion or the full amount of these charges. Guest Signature I Radisson Hotel At Star Plaza 800 East 81 st Avenue Merrillville,IN 46410 Phone 219-769-6311 Fax 219-769-1462 Email: RHI—MERR@radisson.com Bavommedeaud l ft"rds© Indiana University World MasterCard" �Bumni Association, Inc. LORI A MISER March 28-April 25. 2013 Account Information: www.bankofaraerica com w :- .` Y'U t sue-: _aln- . ,.:�'�—1 :.��. �w Mail billing Inquiries to: New Balance Total........................................................................$ Bank of America. P.O.Box 851001 _... - - --....__...... .... .........................................................._......._:..... New Balance Tiitat:;::::::: : ::::;:::::::$ Only the Total 2 years $ Minimum Payment If you would like information about credit counseling services.call 1-866-300-5238. b f n •��F%�': R.� .�°x,•y`�. .g; �� _ _� ��r,''�` t _ _ a5�ic4.�:�°�' +�ltds. `4'+�t- �� - --��.�.' -,.i' ��r 3� :� .3 '4T_��f 'vz�s• Ott`• �� nr..;� - �4 t ;4,: Transaction Posiing Reference Account Date Data Description Number Number Amount Total Payments and Other Credits 04/23 PMT FROM BILL PAYER SERVICE. 9839 – Purchases and Adjustments 04/19 04/20 RADISSON HTL AT STAR 5 MERRILLVILLE IN 0678 4501 267.00 ARRIVALDATE 4/15/13 22 BANK OF AMERICA Account Number P.O.BOX 851001 DALLAS,TX 75285-1001 New Balance Total ......................... $ 88 0429 N 733 928 12389 02990 #902 'AT 0.384 LORI A MISER Enter payment amount $ 5208 ROLAND DR INDIANAPOLIS IN 46228-2243 Check here for a change of mailing address or phone numbers. Please provide all corractlons on the reverse side. itttIIIIIItIIIII�IIIr�IIrIIIIIIrItIIIIiIIIIItIIIIIIIIII�IIIItItII Mail this coupon along with your check payable to:Bank of America �: 5 240 2 2 2 50II: L5540207796450Ill' i Indiana Association of Building Officials Member Registration Packet i . 2013 INDIANA Coa e Education. Conference & Annual Business Meeting April IS%- IS% Radisson Hotel at STAR Plaza Merrillville, IN ® �cJl!lccnfri10Vd,n- U{�a�Urrs"Unijiriie �` �'�t� o� �� fi � C TJ= S?*b,rj,t. iin=;rra�jr tr ijUn T 1 � UtlR #°Ow.4 ®! CrlGril Jt "l ily li am��nl [JIM ® ;-,��i`�L�l��jiil�tni Id7�.�,✓trjft7�, - � , IAB®, an International Code Council Chapter www.labo.com CITY OF CARMEL D.O.C.S. STAFF EDUCATION AND TRAINING REQUEST FORM Amended September, 2009 Please complete this form, attach any supporting documents or explanation regarding the training, and submit to supervisor for approval. Specify what type of training you are requesting (i.e. management, planning, customer service, etc.): Q L Lb I t—" C o e1 Q, Name of group or organization providing this training: tl 11Q':a.n SGG, o U i li��' n4 Q Explain what new skills or knowledge will be acquired through this training: Specify if this training fulfills a continuing education requirement for professional licenses and/or certification: Additional Comments: Location of Training: ��C�.,rr. ��', �f� lYl���.r►a . Dates of Training: fs 14, 17 r Is{ , 'ZGl JW; Llid zin 3 - I e'� Employee,.Sil, ' ature Printed.Name Date of.Request Supervisor Comments: Approved Date Registration Form I ndiana C ode E ducation C onference First Name Last Name GI-t� ©� Ca.tz.t�ta✓� ...Jurisdiction/..Organization[Company tDW :tv l _-_ S«ub•R.E Street Address City State Zip Code 31-7-571 -2 Z02 31 -1 -511- 2499 .Phone Fax C M ise,,rn GdGrIfte "IL-rV Email Address Check one: /IABO Member Attendees and guests must e g wear their name badges at IABO/FIAI Dual Member all times during the conference!! Required for education Non-Member classes and all meals. Please check if you are any of the following for IABO or FIAT: Board of Director. Committee Chairman Committee Member Past President Honorary Member To register fax or mail to: Indiana Association of Building Officials P.O. Box 50 Columbus, IN 47202-50 Ph (812)526-3738 Fax(812)378-1890 2 Edit- Centralized Order Entry Page 1 of 1 Home>MyICC Shopping Cart Receipt Thank you for your order. Your Gmfirmation Number Is VSJPA72A3344. You May Print This Page For Your Records. item quantity 1price Idiscount Itax Ishipping net-total Renew 1 Certification 1.00 $70.00 $0.00 50.00 50.00 $7000 Certification Reinstatement Fee 1:00 S10000 $0.00 Isom 1$000 $100 00 Billing/Shipping Information Customer Name: Miser William C Billing Name: Miser William C email: cmiser @carmel.in.gov Contact phone: (317)254-1055 Shipping Label: William C Miser Billing Label: William C Miser Inspector Inspector Hamilton County Plan Hamilton County Plan 5208 Roland Dr 5208 Roland Dr Indianapolis,IN 46228 Indianapolis,IN 46228 Payment Information Payment Amount. $170.00 Net-Total: $170.00 Payment Method: MasterCard Net-Applied $170.00 c Cardholder's Name Expiration Date: 2014/08 Authorization Code: 05565Z Referen:e Number: VSJPA72A3344 c Sustainable Attributes Verification and Evaluation Program One Resource—Multiple Green Rating Systems. https://ay.iccsafe.org/eweb/DynamicPage.aspx?WizardKey=d3ba3 l 67-edb3-4c4e-965e-62... 4/29/2013 BankAmedcar Rewards- Indiana University Alumni Association, Onc. World MasterCard" _ LORI A MISER Account Number: April 26-May 24, 2013 Account Information: - _ - `�.Sy - 'ov:= .,,-•: 6'.br .�_ {i., >-�'- "^r-:asst :.1?+-% ;.n�_( 9:.,`,3. k%nv.bankofamericac m Mail billing inquiries to: New Balance Total........................................................................$ Bankof America . . .............._............................................................. ........_. _-..... ............ — P.O.Box 851.001 Late Payment Warning:If we do not receive your Total Minimum Payment by New Balance Total...........................$ NYC-y Only the Total 13 months $ Minimum Payment If you would like information about credit counseling services,call 1-866-300-5238. ..d �w +. r$:te.f..:'-,�-1„ �,�i �•�•xro :.� Sw^ -K`,e'" 9'�[_.'.' '��yy��=A�'' ',5.'O�:E_, �r�';:£'��3:... ..=i''^S- i. ��' •°{4�.x.'- a'.: v;�2'`: 4p a,,z..•~"�'.'.. "..- .�.. ,. v' ?:.'ts 311 1w''..rst `9�' .':,{t', .rr,'.,.. t.:srb. ... '.. =� 4s:;=:,.a'L,?p`�••" s.'!�e'n;�kdy, .w�,.°{..iq;. .y.. .e,� ..�s�^Y:*' n. :l.r� ;.:'s}_°a+ "fb�: �1:*` 'i--`�C�-?`�;w-:^vf:-&:. c::; :w•t•�°r-.. R•.-'k:f�-.e+:.c `t'i�zi-�:. t.,•'Zy*'trn_ ��.p<. ��_. transaction Posting Reference Account Date Date Description Number Number Amount rota/ Payments and Other Credits 05/22 PMT FROM BILL PAYER SERVICE 8189 — Purchases and Adjustments 04/30 04/30 INT'L CODE COUNCIL INC 888.422-7233 IL 7376 4501 170.00 $170.00 _Interest Charged 05/24 05/24 Inte rest Charged on Purchases contlnued on next page:.. 22 BANK OF AMERICA Account Number: P.O.BOX 851001 DALLAS,TX 75285-1001 New Balance Total .............................................................$170.00 "'I'III"II'II'll'IIIIIIttiillllll'III'IrII��illiillllli�Ilillll Total Minimum Payment Due...................................................15.00 Payment Due Date ...................................................06/23/13 BB 0529 N 909 216 1245 19909 #001 AT 0.384 LORI A MISER Enter payment amount $> 5208 ROLAND DR INDIANAPOLIS IN 46228-2243 s# Check here far a change of mailing address or phone numbers. Please pmvlde all correctlons on the reverse side. ' III"IIIIttIIIIItItIiIIItIIIIIII"IIII'III'IIIIIIIIIIIIIIIIIIIIir Mall this coupon along with-yoUrcheck.payable to:Bank of America 0: 521,0222500: b55Lo020796Le50Ilie 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)) 06/03/13 $170.00 06/03/13 3 days per diem IABO $150.00 06/03/13 I I Hotel IABO I $267.00 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. William Miser ALLOWED 20 IN SUM OF $ c/o One Civic Square Carmel, IN 46032 $587.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS PO#/Dept. INVOICE NO. I ACCT#lrITLE AMOUNT Board Members 1192 43-553.00 $170.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1192 43-430.04 $150.00 materials or services itemized thereon for 1192 I I 43-430.03 I $267.00 which charge is made were ordered and received except a Friday, June 28, 2013 0 Title Cost distribution ledger classification if claim paid motor vehicle highway fund