226864 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 00350947 Page 1 of 1
ONE CIVIC SQUARE W EDWARD WOLFE
CARMEL, INDIANA 46032 22934 ANTHONY ROAD CHECK AMOUNT: $153.31
CICERO IN 46034
CHECK NUMBER: 226864
CHECK DATE: 12/3/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 153 . 31 OTHER EXPENSES
`�. OF CAN"
CITY OF CARMEL Expense Report (required for all travel expenses)
1NUFNAw EXHIBIT A
EMPLOYEE NAME: _WILLIAM WOLFE DEPARTURE DATE: j2��2�; TIME: AM/ PM
DEPARTMENT: _UTILITIES RETURN DATE: 2 O� TIME: AM/PM
REASON FOR TRAVEL: IWEA CONFERENCE DESTINATION CITY:NDIANAPOLIS
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBL jC
Date Transportation Gas/Toils/ Lodging Meals Misc. Total-
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
11/20/13 $24.00 $24.00
11/21/13 $24.00 $76.31 $100.31
11/22/13 $28.00 $28.00
$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 $0.001 $76.00 $0.00 $0.00 $76.31 $0.001 $0.00 $0.001 $0.0010111111KIN,
DIRECTOR'S STATEMENT: I ereby 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 11/25/2013 Page 1
e n4rQ 'VIr
�;�•-••---•-••�, ASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit,the
ov wastewater approval number
EDUCATION CREDIT REPORT Must be provided.
State Form 51139(R3/4-08) " Training Course Approval Number:
�'•:..... _-,-f` INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
WWT13-2371
13,6perator ❑Apprentice Technical Contact Hours Earned:
32
General Contact Hours Earned:
�4a`ti
,. s- .v rx k- 1NS'TR .�- � yS ti4
� 'OCOS
In accordance with 327 IAC 5-22-17(c), the training provider must submit this form within ninety(90) days of the
conclusion of the wastewater treatment continuing education course. Mail the completed.form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave- Mail Code 65-42
Indianapolis, IN 46204-2251
- Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
- Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
- The training provider must retain,a copy of this form for their records for a three (3)year period following the
presentation of each wastewater treatment continuing education course.
- Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator/apprentice attending the entire wastewater operator continuing education course
,CERTIIED�O,PERA�TUR/APPRENTI,CEIN;F 1'0111
1.NAME
2.ADDRESS(number and street):
City: State: ZIP code: Telephone number:
f t j t Work: Qf(3 f 711 77 1 '
lHome/Cell:, [I Check here if this is an address change❑ E-mail Address: ,=
3.NAME OF TRAINING COURSE:
77th Annual IWEA Conference
4.NAME OF TRAINING COURSE PROVIDER: 5.NAME OF ORGANIZATION SPONSORING COURSE:
Indiana Water Environment Association Indiana Water Environment Association
6.DATE(S)ATTENDED(month,day,year): 7.LOCATION ATTENDED:
November 20-22, 2013 Westin Hotel, Downtown Indianapolis
8.TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
9.CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON-LINE COURSES.
I,the undersigned,certify under penalty of law that this document(and any attachments)were prepared under my direction or supervision and that the
information submitted is,to the best of my knowledge and belief,true,accurate,and correct. I also understand that any omissions or misrepresentation
may result in the dental of continuing education credit for this course.
10.SIGNATURE OF.INSTRUCTO - 11.PRINTED NAME OF INSTRUCTOR:
I} (j
12.SIGNArTy URE OF CERTIF D_0_P� ATOR/APPRENTICE: 13.PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
14,CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification/apprentice number: Class: Expiration date:
Operator certification/apprentice number: Class:r-^"' Expiration date:!
VOUCHER # 136892 WARRANT # ALLOWED
T1032 IN SUM OF $
Wolfe, Edward
WWTP
i
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
WOLFE 01-7042-05 $152.31
1
1
C
Voucher Total $152.31
Cost distribution ledger classification if
claim paid under vehicle highway fund i
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1032
Wolfe, Edward Purchase Order No.
WWTP Terms
Due Date 11/25/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/25/201: WOLFE $152.31
1 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 t ta/w
Date Offic r