HomeMy WebLinkAbout225966 11/05/2013 CITY OF CARMEL, INDIANA VENDOR: 00351270 Page 1 of 1
ONE CIVIC SQUARE BRIAN E SCHMIDT
! CARMEL, INDIANA 46032
CHECK NUMBER: 225966
CHECK DATE: 11/5/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 275 . 00 TRAINING SEMINARS
CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: Brian Schmidt DEPARTURE DATE: 9/15/2013 TIME: 1800 AM / PM
DEPARTMENT: Carmel Police Dept. RETURN DATE: 9/20/2013 TIME: 1300 AM / PM
REASON FOR TRAVEL: K-9 Recertification DESTINATION CITY: Valparaiso, Indiana
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
9/15/13 , l
9/16/13 $50.00 $50.00
9/17/13 $50.00 $50.00
9/18/13 $50.00 $50.00
9/19/13 $50.00 $50.00
9/20/13 $50.00 $50.00
$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
_K00
Total 1 $0.001 $0.001 $0.001 $0.001 $0.00 $0.001 $0.00 $0.00 $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 10/31/2013 Page 1
2013 NAPWDA Indiana Fall State Workshop
September 16th- 20th 2013
REGISTRATION FORM (PLEASE .PRINT LEGIBLE)
Name: 'Gi .A-1 E S"
Home Address:
City: State: .;--a Zip Code: fit. ,; Home Phone: (
EMai1: S c. .0 —(—D C +rte . hty
Agency: �a e � ��:�« P—
Agency Address: 3 C,v' t c-
City: State: rj Zip Code: Work Phone: j_,.rt
NAPWDA Workshop Waiver:
The undersigned participant recognizes the possibility of injury occurring as a result of his/her
participation in the K9 Workshop. I furthermore state that my canine and .1 are in a physical condition
necessary to be able to participate in the events, as needed for training and certification purposes. I hereby
waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA,
the Valparaiso Police Department and the County of Porter, City of Valparaiso, their employee's,
affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical, to myself or my
canine. I also agree to abide by all rules and regulations as set forth by NAPWDA and the event
organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any
and all property,persons and to include the hotel accommodations and or any training venue.
Date: ,3' / _/ -2p Sign Name: 1-z— f
Print Name: S.,—, ,
Current NAPWDA Member? Yes No
K9 Breed: L.k 6 M;),- K9 Name: L4 o K9 Age:
Type K9 (check all appropriate descriptions)Patrol _ Narcotic ✓ Explosive— Cadaver_ SAR
KTS Working Ability: Beginner_ Intermediate \/ Advanced _
Handler's Ability: Beginner_ Intermediate V Advanced —
Purpose of Attending Workshop (check at least one):
Training Certification (New) Certification (Renewal)
If certifying, LIST ALL areas of certification you will be attempting: Pd Z, �
Workshop Fee:
The cost of the workshop is S 125.00 per K9 team. A K9 team is I handler with I dog. There is
an additional workshop fee of x'75.00 per additional dog for any K9 Handler wishing to train
or test with an additional dog.
Make workshop fee checks payable to Valparaiso Fraternal Order of Police Lodge#76.
Mail checks and completed Registration Form in before September 1, 2013. Alo refunds at
all after September 1, 2013.
Mail Registration to:
Valparaiso Police Department
355 Washington St
Valparaiso, IN., 46383
Attention: Todd Kobitz
Mail checks and completed Registration Form in before September 1, 2013. No refund.#at
VOUCHER NO. WARRANT NO.
ALLOWED 20
Brian E. Schmidt
IN SUM OF $
$275.00
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
210 -570.00 $275.00
I hereby certify that the attached invoice(s), or
I
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
Thursday, October 31, 2013
Chief of Police
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))
10/31/13 K9 recertification $275.00
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