223388 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367170 Page 1 of 1
ONE CIVIC SQUARE SCOTT AVERY
CARMEL, INDIANA 46032 287 TYNDALE DR CHECK AMOUNT: $132.09
OTALLON MO 63366
CHECK NUMBER: 223388
CHECK DATE: 8127/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4359000 132 . 09 SPECIAL PROJECTS
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CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: DEPARTURE DATE: - TIME: AM
DEPARTMENT: RETURN DATE: TIME: AM PM
REASON FOR TRAVEL: ���` `�� DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT ►/ TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
$0.00
$0.00
8/14/13 1 $2.31 $5.54 1 $21.26 $29.11
8/15/13 $2.53 $16.50 1 $83.95 $102.98
$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 1 $0.00 $0.00 $4.84 $0.00 $0.00 $22.04 $0.00 $105.21 $0.00 $0.00 $0.00 e
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: AUG 262013
City of Carmel Form#ER06 Revision Date 8/22/2013 Page 1
CPSE TRAVEL EXPENSE REPORT
Name: Scott Avery Reporting Month: ( August
Address: 1287 Tyndale Dr O'Fallon, MO 63366
Phone: 1636-262-4202 iPurpose of Travel: Carmel Accreditation Presentation
Expense Report Instructions: Please complete the form electronically rather than
handwritten if at all possible. Remember, "Excellence Begins With Us!" It is Meal Per Diem Chart-Full Daily Rate is$60.00
preferred that meals be claimed at actual expense, but you may also claim the Partial Rate
Per Diem Rate. Submit receipts with actual expenses. Use the Meal Per Diem On site rior to 0600 Hrs Breakfast $12.00
Chart at right for Per Diem rates. Submit receipts for all transportation,Lodging, Prior to 1300 Hrs Lunch $15.00
and"Other"claims. Use"Explanation of Expenses"table to detail all expenses Prior to 1700 Hrs Dinner $33.00
claimed in "Other" and "Incidentals" lines. Incidental Expenses may be Do not claim meals included in registration or provided
reimbursed up to$10/day(line#16). by host agency.
Enter Date MM/DD/YY 8/11/13 8/12/13 8113/13 8/14/13 8/15/13 8/16/13 8/17/13
Sun Mon Tues Wed Thurs Fri Sat Total
Meal Ex ense
1 Actual Breakfast 5.54 16.50 22.04
2 Actual Lunch
3 Actual Dinner 21.26 83.95 105.21
4 0.00 0.00 0.00 26.80 100.45 0.00 0.00 127.25
5 Per Diem
Subtotal,Meals 127.25
Transportation
6 Airfare
7 Baqclaqe Handling.
8 Rental
91 Fuel Rental Auto
Miles
10 'COL Rate: 0.5101
Amount
11 Parkin /Fer /Tolls
121 Cab/Bus
13 Other Transportation
Subtotal,Transportation
Lodging
14 Hotel/Motel
15 Other Lod in
Incidentals Subtotal,Lodging
16 Not Covered Above 2.31 2.53 1 4.84
Subtotal,Incidentals 4.84
Total Expenses Reported 132.09
Amount of CPSE Travel Advance-Enter 0 If No Advance Was Paid
CPSE Direct Billed/Prepaid Expenses(Hotel,Airline,Etc.)-Enter 0 If No Expenses Were Direct Billed to CPSE
Total Due Employee(Due to CPSE if a negative number) 132.09
'Give a detailed description in the table provided.
Explanation of"Other"Expenses
Line# Date Description Amount
Approved by:
08/20/13
Date (signature) Date si nature
Please Note: Receipts must be attached to receive reimbursement. Effective Date:Jan 1,2011
Houlihans
111 E Wacker Drive
Server: Ana 08/15/2013
Table 62/1 9:49 AM
Houlihans Guests: 1 90015
111 E Wacker Drive
Diet Coke 2.75
Server: Ana
09:50 AM DOB: 08/15/2013 Adult Breakfast Buffet 9.99
Table 6211 08/15/2013
9/90015 2 Items
Card #X,XXXX,XXXXXXX6948 8388614 Subtotal 12.74
Magnetic, card present: yes Tax 1.37
Approval: 418008 Total 14.11
Amount: $ 14.11 B a l a n c e DUB 14 . 1 1
+ Tip: � Thank you! Join us again soon!!
� Like us on Facebook! Houlihans Chicago
= Total:
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ITEMS ORDERED
AMOUNT
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1 CUP TOMATO BISO y 48.90 Tax
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Harry Caray's Catering & EbEnts brings 1
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HMSHOST 1401 S. Michigan Ave.
BURGER KING Chicago, IL
LAMBERT INTERNATIONAL AIRPORT ,]
Server: John 08/15/2013
247667 Jacquel i Table 101/1
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Guests: 2 7;50 PM
CHK 2106 GST 1 10029
AUG 14 13 6 :0 7 A M JACK DANIELS
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1 SAND EC HAM 2 . 8 9 Ry AGED RIBEYE 0.00
1 LG SODA FTN L 2 . 29 4!H—; p D 50.0
CASH " 20 . 00 AC & CHEESE 8.00
SUBTOTAL 5 . 18 Subtotal
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TAX 0 . 36 Tax .0 ,��
AMOUNT PAID 5 . 5 4 14.13
CHANGE 14 . 46 Total
--247667 Closed AUG14 06 : 0'• AM--- 149.18
1HANK YOU FOR YOUR BUSINESS! Balance Due 149 . 18
TELL US ABOUT YOUR EXPERIENCE Sign up for Mainstay Loyalty
Rewards. . .ask yo6r server.
GREG BOOTH Join us for Brunch
Saturday & Sunday 9:30 an.
314-429-3400 X105 Ask about our ;Private Dining
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323 EAST WACKER DRIVE, Page# 1 of 1
CHICAGO, IL 60601
Tel:312 565 0565 Fax:312 565 0540 Group Name Center for Public Safety Excellence/IAFC
www.swissotelchicago.com
International Association of Fire Chiefs
Scott Avery Arrival 08-14-13
287 Tyndale Drive Departure 08-16-13
O Fallon MO 63366
United States
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08-14-13 Deposit Transferred at C/I 440.00
08-14-13 Room Charge 189.00
08-14-13 State Room Tax 11.9% 22.49
08-14-13 City Room Tax 4.5% 8.51
08-15-13 Room Charge 189.00
08-15-13 State Room Tax 11.9% 22.49
08-15-13 City Room Tax 4.5% 8.51
Total 440.00 440.00
Balance Due 0.00
TAX Summary
Room 62.00
F&B 0.00
Other 0.00
Total 62.00
Guest Signature X
I agree that my liability for this bill is not waived and agree to be held personally
liable in the event that the indicated person,asociation,or company fails to pay
for any part or the full amount of these charges.
Snyder, Denise W
From: Scott Avery [seavery@ofallonfire.org]
Sent: Thursday, August 22, 2013 1:10 PM
To: Snyder, Denise W
Subject: FW: Purchased AVERY/SCOTT EDWARD 08-14-2013 Chicago/Midway IL WN
Attachments: L7H7D2.pdf; L7H7D2.txt
Here it is.
Thanks,
Scott E. Avery PhD(c), EFO, EMT-P
Chief Administrative Officer
O'Fallon Fire Protection District
Cell 636-262-4202
From: reservations(a)atcmeetings.com [ma i Ito:reservations('Oatcmeetings.com]
Sent: Wednesday, June 05, 2013 8:55 AM
To: seaveU(a)ofallonfire.org
Subject: Purchased AVERY/SCOTT EDWARD 08-14-2013 Chicago/Midway IL WN
Created 6/5/2013 1:55 PM GMT
[01 N__
For a single calendar entry click here
Travel Itinerary
Agency Booking Confirmation Number: L7H7D2
Passenger Names
VERY/SCOTT EDWARD
Please review your itinerary and fare for accuracy. Airline fares are dynamic and can change without
notice, even at time of ticketing. If you do not contact us within 24 hours, we will assume that the
itinerary and fare are correct. After 24 hours, changes are subject to any difference in fare plus an
airline-imposed fee.
Save a copy of your invoice now for proof of purchase.
Airlines may change schedules and flight numbers at any time. Confirm your flights 24 hours prior to
departure.
SOUTHWEST AIRLINES - Flight Number 4483 Confirmation: ARWBWY
Departure:Wed, 8/14/2013 6:50 AM Arrival:Wed, 8/14/2013 7:50 AM Equipment: 73W
Departure City: St Louis, MO (STL) Arrival City: Chicago/Midway, IL M�DW) Meal:
Departing Terminal: 2 Arrival Terminal: Travel Time: 1 hour(s)00 minute(s)
Status: Confirmed Class of Service: S- Economy Add flight to Calendar
Baaaaae Info
x
Miles: 251
Seat Assignments:
EAT ASSIGNMENT IS LIMITED TO AIRPORT CHECK IN
1
[AIRLINE CONFIRMATION NUMBER ARWBWY
SOUTHWEST AIRLINES - Flight Number 238 Confirmation: ARWBWY
Departure: Sun, 8/18/2013 6:05 PM Arrival: Sun, 8/18/2013 7:05 PM Equipment: 73C
Departure City: Chicago/Midway, Arrival City: St Louis, MO(STL) Meal:
IL MD
Departing Terminal: Arrival Terminal: 2 Travel Time: 1 hour(s)00 minute(s)
Status: Confirmed Class of Service: M- Economy Add flight to Calendar
Baaaaae Info
Miles: 251
eat Assignments:
EAT ASSIGNMENT IS LIMITED TO AIRPORT CHECK IN
IRLINE CONFIRMATION NUMBER ARWBWY
Invoice Detail
Name:AVERY/SCOTT EDWARD
Invoice Number: 000834922 Issue Date: 6/5/2013
Service Fee: 8900599805044 Issue Date: 6/5/2013 Amount: $19.00
Name:AVERY/SCOTT EDWARD
Southwest Issue Date: 6/5/2013
Airlines Ticket: 5262134678468 Amount: $259.80
Invoice Number: 000834922
Total Fare:$278.80
Your total has been charged to American Express ending in 1011
Approximate cost per air mile 0.52
Frequent Flyer Info
General Remarks
ATC hours M-F 8:30AM-7:OOPM ET 1-703-253-6004
24 Hour Emergency Service 1-800-568-1651
25.00 Fee per call plus ticket fee if applicable
International toll-free number 1-682-233-0914
International callers provide VIT code-HS2CT4
Tell us about your booking experience at www.atcmeetings.com/feedback
2
CITY OF CARMEL
FIRE DEPARTMENT
DATE: August 22, 2013
TO: Cindy Sheeks
FROM: Matthew Hoffman, Fire Chief
Attached you will find a reimbursement for expenses incurred while attending the Accreditation Hearings in
Chicago, IL August 13, 2013 through August 16, 2013. This particular claim is for the Peer Team Leader
which the department is responsible for by contract to pay his expenses for the hearings.
Please process this claim. If you have any questions, please feel free to contact me.
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))
$132.09
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Scott Avery
IN SUM OF$
$132.09
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
.`sx-} '.:_-' PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
.
I 43-590.00 1120 I $132.09
I 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
AUG 2 6 2013
,. Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
a.