DEPOSIT SLIP

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Division of Controller Office
850 Hungerford Drive, Room 154
Rockville, Maryland, 20850
Billing@mcpsmd.org

~

Requestor:
Department:

I

Print Form ]

Cash

D Check D

D

Credit Card

Reset Form

Money Order

Board of Education
Request Date:

June 2013

School:
Contact Name:

Becky Gibson

E-Mail:

Becky_Gibson@mcpsmd.org

Phone:

301-279-3617

Fax:

301-279-3860

Address:

CESC,Room 123

I

Chris BarclayReimbursement to AMEX

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Customer Signature

·----

·--- ..··--·-·---

-·-·-···

-··- - -·--- ·---- .. _..J

Ch<i' Boccl'y Reirnbursernent

·---------1

Cash

~2148 I

Chris BarclayReimburse~-;~~~~----J---

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to AMEX

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$318.21

Receipts Confirmation for Customer Only

'.f(_~~-~e_a_m_o_u_n_t
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$318.21

Received By(

'----·--------

Received Date

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(0

PURCHASING CARD
Card Member Transaction Log

.I
I

MCPS form 234-21

June 2009

Office of the Chief Operating Officer
Department of Materials Management
MONTGOMERY COUNTY PUBLIC SCHOOLS • Rockville, Maryland 20850

~

Card member name Christopher Barclay
School/office name Board of Education

Work location CESC, Room L23
To July 18, 2013

For the period: From June 29, 2013

Total Amount
($)

USE SEPARATE LOG FOR EACH ACCOUNT
Supplies/Services (required)
(Student or·other-must
be identified.)

Account
(03, 05, etc.)

Date Ordered

Date Delivered

07/24/2013

07/24/2013

$31.00 Buffalo Wild Wings, College Park

Dinner meeting

07/28/2013

504091

07/20/2013

07/2J/2013

$53.99 Chandler's Crabhouse, Seattle, WA

Dinner mtg. during CUBE Conference

07/28/2013

50<1002

07/08/2013

07/l0/2013

$13. !O Du lies Gourmet, Dulles, VA

Lunch during CUBE Conference

07/28/2013

504002

07/04/2013

07/05/2013

$336.70 1-Iotwire Sales, Online Travel

Mistakenly used, will be reimbursed

~I\

07/28/2013

504091

07/08/2013

07/09.12013

$211.00 Hotwire Sales, Online Travel

Mistakenly used, will be reimbursed

\)~

07/28/2013

504091

Airport parking during CUBE Conf

07/28/20 IJ

504002

Parking

07/28/2013

504002

Supplier Name

Statement

o,

Date

'

~

07/21/2013

07122/2013

07/08/2013

07/09/2013

Total

CERTIFICATION

$50.00 lAD Dulles Economy
$5.00 !AD DuJles Pay and Go

v

//

$700.79

STATEMENT

I certify that, to the best of my knowledge, the transactions recorded for the month indicated on this purchasing card log are correct and complete. All purchases were made in
support of school pro~
as outlined in the Purchase Card Guide. I understand that any materi9).f11isrepresentatiolJ. or orpission from this log maybe grounds for cancellation
of my purchase card privVe~n<l/or
disciplinary action.

_, '._fJ,~~or~

~I~~

Date

bff~~~£~

SianLJ7e. oorovtna Official

_/_/_

Date

~

,-------------------------------------~

PURCHASING CARD
Card Member Transaction Log

MCPS Form 234-211
[une 2009

Office of the Chief Operating Officer
Department of Materials Management
MONTGOMERY COUNTY PUBLIC SCHOOLS• Rockville, Maryland 20850

~

Card member name Christopher Barclay
School/office name Board of Education

Work location CESC, Room I23
To .July 28, 2013

For the period: From June 29, 2013

Total Amount
($)

USE SEPARATE LOG FOR EACH ACCOUNT
Supplies/Services (required)
(Student or other-must
be identified.)

Account
(03, 05, etc.)

Date Ordered

Date Delivered

07/1112013

07/12/20 l3

$26.00 Nando's Peri-Peri, Silver Spring

Lunch meeting with Marcus Moore

07/28/2013

504091

07/16/2013

07/17/2013

$13.20 New Fortune Restaurant, Gaithersburg

Dinner meeting regarding construction

07/28/2013

504091

/

07/ 18/2013

0712012013

$18.06 Peso's Kitchen & Lounge, Seattle, WA

Lunch while attending CUBE conf

07/28/2013

504002

·-·

07/2212013

07/23/2013

$27.00 Ruby Tuesday's, Linthicum,

Meeting with constituent regarding

07/28/2013

504091

,.,/··

Supplier Name

Statement

Date

I.·

/

-:

state construction money
07/18/2013

07/18/2013

$52.44 Seattle Yellow Cab, Seattle, WA

Ground transp. while attending CUBE

07/28/2013

504002 ,__...

07/25/2013

07/26/2013

$28.00 Woodside Deli, Silver Spring

Breakfast meeting

07/28/2013

504091

07/17/2013

07/l 8/2013

$25.00 United Airlines, Washington D.C.

Baggage fee, flight to CUBE conf

07/28/2013

504002

07/20/2013

07/2112013

$1 l.58 United Airlines, Washington D.C.

In-flight meal, flight from CUBE conf

07/28/2013

504002

//

,_,.

(No receipt given)
Tota!

CERTIFICATION

$201.28

STATEMENT

I certify that, to the best of my knowledge, the transactions recorded for the month indicated on this purchasing card log are correct and complete. All purchases were made in
support of school prog.r: is as outlined in the Purchase Card Guide. l understand that any material misrepresentation or om~sion from this log maybe grounds for cancellation
of my purchase carc!"Iri
e and/or disciplinary action.
/l
·
-t--'~~

~-

re, Card Member

_1?__/~-4
Dote~

L/F'0A~d')

f:_) /czt;14~J0r'~
Zionofure.Aoorovino Officia?

_/_/~

Date

\2)

r--~~~~~~~--~~~~~~~~~~~--~~~~~~~~~~~~~~~~~~~~~~--~~--,

PURCHASING CARD
Card Member Transaction Log

~

.

MCPS form 234-21
June 2009

Office of the Chief Operating Officer
Department of Materials Management
MONTGOMERY COUNTY PUBLIC SCHOOLS • Rockville, Maryland 20850

~

Card member name Christopher Barclay
School/office name Board of Education
For the period: From June 29, 2013

Date Ordered

Date Delivered

07/21/2013

07/2:2/2013

07/21/2013

07/22/2013

om 712013

07/18/2013

07/22/2013

07/22/2013

Work location CESC, Room 123
To .luly 28, 2013

Total Amount
($)

USE SEPARATE LOG FOR EACH ACCOUNT
Supplies/Services (required)
(Student or other-must
be identified.)

Supplier Name

$25.00 United Airlines, Washington D.C.
$8.35 Wendy's, Linthicum, MD
$25.19 Westin Seattle Dining, Seattle, WA
$1, 160.25 Westin Seattle, Seattle, WA

Statement

Account
(03, 05, etc.)

Date

Baggage fee, return flight from CUBE

07/28/2013

504002

:,_

Meal while attending CUBE conference

07/28/20 l3

504002

'v-

Meal while attending CUBE conference

07/28/2013

504002

\..--

Lodging while attending CUBE conf

07/28/2013

504002

!,....

(July 17 through July 21, 2013)

07/28/2013

504091
504002

t-:

504002

"""'

.•..

/

;

07/18/2013

07/19/2013

$12.00 Yellow Cab Services, Seattle, WA

Ground transp. while attending CUBE

07/28/2013

07/18/2013

07/20/2013

$10.00 Ye! low Cab Services, Seattle, WA

Ground transp, while attending CUBE

07/28/2013
<

07/20/2013

07/21/2013

$11.00 Yellow Cab Services, Seattle, WA

Ground transp. while attending CUBE

504002

07/28/2013

07/20.2013

07/22/2013

$9.00 Yellow Cab Services, Seattle, WA

Ground transp. while attending CUBE

07/28/2013

504002

07/21/2013

07/22/2013

$47.00 Yellow Cab Services, Seattle, WA

Ground transp. while attending CUBE

07/28/2013

504002

Total

'
:-''

$1,307.79

CERTIFICATION STATEMENT

' · - .••.•..
~µ-~'76-l.&l~

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--·~~

__

/__
Date /__

(,

'~;~~~l~i~!

Corporate Purchasirng
Cardmember Repoll't

=·;:·?/ ·=·::;.-:):~<~\:;:.:·':r:~=;\;=;::i;:_

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,io.........,..,,.-• ••,.,_ •.. __

Preoared For

CHRISTOPHER BARCLAY
MCPS MDTAX 3000i23-5

Previous Balaoce $

I

New

II

590.61

Closing Date

07/28/i3

Charges $

Other Debi!s $

2,209.8611

Paymenls S

0.0011.-=: .:

. :···

. ·. .-

Page

Balance
Due$ Do Not Pay

Olher Credns$

59~-~1.11-:.
::r-::r:··:::?

1of4

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.

-

!"ii.I

For important information
regarding your account
refer to page 2.

iii
llil

For your records only - do not pay.
For assistance or questions about your account, contact us at www.americanexpress.com/checkyourbill
call Customer Service at 1-800-492-4920.

Activity. Oare reilecls

either transaction

0< posting dale

07/21/13

J7/10/13

J7/05/13
J7/09/13
)7/22/13
)7/09/13
)7/12/13

Amount$

Reference Cede

Card Numbe1
07/24/13

or

BUFFALO WI LO WINGS 0 COLLEGE PARK
MD
_REF.#
__QQ0835.a3 _ 30j_-.4.86c0333
__..
__.07/2-4./.1.3
FOOD/BEVERAGE
.
ROG NUMBER 00083583
CHANDLERS CRABHOUSE SEATTLE
WA
REF# 342
206-223-2722
07/20/13
FOOD/BEVERAGE
ROG NUMBER 342
DULLES GOURMET MARKE DULLES
VA
REF# 47361
800-742-5030
07/08/13
FAST FOOD RESTAURAN
ROC NUMBER 47361
HOTWIRE-SALES FINAL 866-468-9473
CA
REF# 8206513793~ TRAVEL
. 07/04/13
HOTWIRE-SALES FINAL 866-468-9473
CA
REF# B2065258181 TRAVEL
07/08/13
!AD DULLES ECONOMY 8 DULLES
VA
REF# 011785786
703-572-4584
07/21/13
!AD DULLES PAY AND G DULLES
VA
REF# 012898832
703-572-4584
07/08/13
NANDOS PERI PERI 650 SILVER SPRING
MD
REF# 10156320130 3015887280
07/11/13

31.00J

00083583000

.

34200000000

53.99/

47361()(](]()(](]

13.10

336.70
211.00

-:/

01178578600

01289383200

5.00

10156320130

26.00

v

Continued on Page 3
................................
Please enter account
number on all
correspondence.

Do iii:it'sfap1e·i'ir use·paf:ier dips

Payment Coupon

CHRISTOPHER BARCLAY
MCPS MDTAX 3000123-5
850 HUNGERFORD RM123
~OCKVILLE
MD

20850
Check here if address,
telephone number, or
e-mail address has
.
changed. Note changes on
reverse side.

D

Prepared For

Account Number

CHRISTOPHER BARCLAY
MCPS MDTAX 3000123-5
Activity
07/17/13

07/20/13
07/23/13

07/18/13
07/26/13

07/18/13

.

07/21/13

07/22/13

07/22/13

07/18/13

Continued
NEW FORTUNE RESTAURA GAITHERSBURG
MD
REF# 0000000026 301-926-8828
07/16/13
FOOD/BEVERAGE
ROG NUMBER 0000000026
PESOS 02810012825300 SEATTLE
WA
REF# 652000489
2062839353
07/18/13
RUBY TUESDAY #4726 0 LINTHICUM
MD
REF# 29586660
8003250755
07/22/13
RESTAURANT CHARGES
ROG NUMBER 29586660
Seattle Yellwo Cab 1 Seattle
WA
REF# BZZ2CX
8774174551
07/18/13
THE WOODSIDE DELI
SILVER SPRING
MD
851016532
USFC20910 07/25/13
ROG NUMBER 8510165320798000
UNITED AIRLINES
WASHINGTON
DC
TKT# 01626029425300 AIRLINE/AIR C 07/17/13
SPECIAL SERVICE TICKET
BARCLAY
/FIRST CHECKED UNITED AIRLINES
UNITED AIRLINES
WASHINGTON
DC
FROM
D_U_l,,1.,,1;$_
A_RP.lQC
TO
CARRIER CLASS
SEATTLE WA
UA
DO
TO
UNAVAILABLE
YY
00
TO
yy
UNAVAILABLE
00
TO
yy
UNAVAILABLE
OD
UNITED AIRLINES
HOUSTON
TX
TKT# 01629205097730 AIRLINE/AIR C 07/.20/13
SPECIAL SERVICE TICKET
BARCLAY
/INFLIGHT A LA UNITED AIRLINES
UNITED AIRLINES
HOUSTON
TX
FROM
DULLES ARPT DC
TO
CARRIER CLASS
yy
SEATTLE WA
DO
TO
yy
UNAVAILABLE
00
TO
yy
UNAVAILABLE
00
TO
yy
UNAVAILABLE
DO
UNITED AIRLINES
SEATTLE
WA
TKT# 01626031605962 AIRLINE/AIR C 07/21/13
SPECIAL SERVICE TICKET
BARCLAY
/FIRST CHECKED UNITED AIRLINES
UNITED AIRLINES
SEATTLE
WA
FROM
SEATTLE WA
TO
CARRIER CLASS
DULLES ARPT DC
UA
DO
TO
UNAVAILABLE
00
YY
TO
UNAVAILABLE
DO
YY
TO
yy
UNAVAILABLE
DO
WENDYS #0153 0000001 LINTHICUM
MD
REF# 23793224
4107213770
07/21/13
RESTAURANT CHARGES
ROC NUMBER 23793224
WESTIN SEATTLE DININ SEATTLE
WA
REF# 164259191
206-728-1000
07/17/13

Closing Date

Page 3 of 4

07/28/i 3

Reference Cede

Amount$

00000000260

6520004a900

18.06/

29586660000

27.00./

52.44'/
85101653207

28.00,i

19980450000

25.00 ,/

20288999000

11.58

20381251000

25.00/

23793224000

8.35./

tli'-25919100

2S.1?.
1/

07/24/2013 - Buffalo Wild Wings, College Park ··· ·
Dinner meeting

buT~alo

Wild

07/20/2013 - Chandlers Crabhouse, Seattle, WADinner meeting during CUBE conference

Wings

Cir i11 f, Bar
10~~~ Baltimore Ave
Co:-1~; .::: :J.1rk, MD :2074(;

CHANDLElrS

(301. ~86-0333
11

~r~

CllABHOUSE

ists: 3 Srvr: Kevin
7:51pm 3373.2479.00399

-23-2013

1 Water
1 12 \'lings

Established 1.988

0.00
f .20

Honey BBQ
Si'1eet Bbq

Guest#

H:l:

i

Sub-Total:

7.63

1 Water

0.00

1 12 Wings

7.20

Table 41 #Party 0
BLAINE N SvrCk: 34 19:59 07/20/13
Separate checks: 3-of-8

0342a

Honey BBQ
Thai Curry
Guest# 2 Sub-Total:

~st

1
1

Water
12 Wings

12.00
30.00

1 CALI ROLL
1 GRILLED SCALLOPS

:.63

~11h

0.00
7.2S

07 /20

Parmesan Garlic
He: ,~y BBQ

Tnhl.

21 :;;.(

42.00
3.99
- '19

1 Basket Fries

Guss' :'3 Sub-Tot
0342

uffalo

Wild Wings
Grill & Bar
10240 Balt imore :~ve
Coll2ge Park, MG Z0740
(301) 486-0333

Emp:

~:evinAt-1EX
Tbl# 112

07-23 7:51pm
-

-

-

-

81583
-

. - - - - - - ·~- ... - - ·- - -· - - ·- - - - - - - ·- - - •..

SALE

:f.H*********** 1008
"'"' / ** B.~RCLAY/C

-·~[;er:

AMOUNT:
·r1P:

TOTAL:

'77 . 12

Server: BLAINE N (#131)
07/20/13 22:10, Swiped T:

41

Rec:241
Term: 8

CHANDLER'S CRABHOUSE
901 FAIRVIEW AVE NORTH
SEATTLE, WA 98109
(206)223-2722
MERCHANT #: 000040280308
CARD TYPE
ACCOUNT NUMBER
AMERICAN EXPRES xxxx· .
Name: C BARCLAY
00 TRANSACTION APPROVED
AUTHORIZATION #: 520959
Reference: 07200~0000342
TRANS TYPE: Credit Card SALE
CHECK:
TIP:
TOTAL:

45.99

07/11/2013 - Nando's Peri-Peri, Silver Spring Lunch meeting with Marcus Moore

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07/21/2013 - Washington-DullesInternational Airport Airport parking during CUBE conference

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Host: Julia

METROPOLITAN WASHINGTON AIRPORTS AUTHORITY
THANKS YOU FOR PARKING
AT
WASHINGTON-DULLES INTERNATIONAL AIRPORT

07/11/2013 ,,

T14

1 :QB PM

20C52
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N:= ...

Drink (2 d? 15!
t ·'1ic :. "!! Vlr a.1~
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sctrrHLAND PRlllTING
sH:t EVE:PORT, LA.
(

PARKING RECEIPT
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07116/2013 - New Fortune Restaurant, Gaithersburg ... · Dinner meeting regardng construction

16515 S FREDERICK AVt
t~AiTHERSBURG, MD 20877
07il6i2013
20:53:.\3
r·leith3[1t IO:
Oi279.
T e.1rr1111al ID·

07/18/2013 - Peso's Kitchen & Lounge, Seattle, WA-

Lunch wh..ileattending CUBE Conference

Cocktnil
Check Tab Cov Sarvar I iee
Date
777584 B 1
3f1 11:05:50 PH 7/18/2013

1i01ll2997
CREDIT CARD

HH Tilll Tacos

4.00
0.50
0.50
5.00

ShriaP
Shr·ililP

AMEX SALE
l!U26

0002&1
0001
5+-1618
Svi~ed
Onlnic

SERVER
ft{lproval Cede:

EntJy Method:
Mode:

HH trsb

Spring Ralls

Food Sub-Total

HI.DO

Cranbr:rry Juice

3.75
-----3.75

,

·'·1b-Total

pp~JiD}\1,j.

n

Ilther Sub-Total

O.fJO

SUB TOTAL

07/22/2013 - Ruby Tuesday's, Linthicum Dinner meeting with constituent regarding
state construction money

I

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1l

d.75
1.31

TOT1ll

15.06
THAHKYOU

TUFL
Vf 472l1
n.. ML ;)C(ii)
.:-jf"l.J Vot.11 11<:!'

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f\1111 I (,. ;,...

~',~'.}.:JIJi)

Ct"18Li<

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Sal1is Tax

PESO'S
Date: 7/18/21l13

Card Jype:
Card Number:
Expiration Date:
Server ID:
Server Name:
Cha ck ~lumber:

Time: 11:05:52 PM

311
Si rbr ina

777!i84

BARCLAY/C

~I

: , f'.i.LAY

IP
OfAL
-· ffl•,•' 1.'·'

!lpproval: 586854

IOMIER

& LOUNGE

American Express
XXXXXX
XX/XX/XXXX

Tab Number:

hme;:

r

KITCHEN

COPV

Page 1 of 1

Receipt from Seattle Yellwo Cab 182

07/1712013 - Seattle Yellow Cab - Ground transportation
while attending CUBE conference

. I . .:.: • ;

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f=J~:!

Custom Amount
Tip

Total

$43.70
$8.74

$52.44

R/1Q/701 <.

r,.ood£idgJ;J@ii,_5ilverSpring
reakfast Meetink-

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07/17/2013 - United Airlines, Washington D..C.
Baggage fee, flight to CUBE conference

Baggage

~NiTEDrJj<

Receipt

Issu~ a~te: 17 JUL 2013 IAO ATO

Dascript..icn

O.i:.~
~:mcrican E~press lOOOO:;

First Bag Fee

r '!I'illw Ider Name
1; l!!lRCLAV

Total Fees

USO $25.00

Conf i rmat i o:i:

84 3KSQ

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07/21/2013 - United Airlines, Washington D.C.
Baggage fee, flight from CUBE conference
:)

PASSENGER RECEIPT

EXCESS BAGGAGE

1 OF 1

21JUL13
EV/081294
/SEATTLE
BARCLAY/CHR!STOPHERSTON
**NOT VALID FOR**
**TRANSPORTATION*
PSGR TICKET

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TICKET
C ~ ~J)}.~';EIPT
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BARCLA'r'/CHRI
03 77291 320 7, Rte LOC-B43KSQ

SEA UA IAD

·OF

PRNTR-B5DD95

~ON

B43KS

J7~ ,T AND·1

SERIE~

1 FIRST CHECKED BAG 25.00

2!JUL13!1JD1A>.

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UA 401 649091

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25.00

lflll /Ill fll/11111/llff l//ll/f !,(RA VE

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016 2603160596

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25.00

07/17/2013 - Westin Seattle Dining, Seattle, WAMeal while attending CUBE conference

07/21/2013 - Wendy's, Linthicum Meal while attending CUBE conference

:.::.-~- .

Ke11sn ~urger ~1stro

~

Wendys

Site

1900 5TH AVENUE
SEATTLE, WA 98101
206-256-7600

100007656
1339911

. 410.,.850-0694

Comments

VielGOIH8

888-624-~8140
_.Jul21'13

e:·
d Type:
t #:

.

H

07/17/13

10:42 PM

Type:

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Guests

20

1

11:39PM

.Am ex

CHICKEN BURGER

12. 00

)WEET POT FRIES
1ERRIER

4.00
7.00

XXXXXXXXl

d Entry :· S-~JIP E0

ns

Table

~LLIAN

PURCHASE
5441~·1:.,.
192J
26 Mai

SubTotal

23.00

Taxes...

2.19

\ARCLAY, CH

Tota 1 25. 19

8 . ·-p;:

25 .19

---------------------------------------•••.•••

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176440

25. 19

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Total.

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1900 Fifth Avenue
Seattle,

WA 98101

THE WESTIN

206-728-1000

SEATTLE

http://www.westin.com/seattle
0711712013 - 07/2112013 - Westin Seattle. Seattle,
Lodging while attending CUBE conference
Barclay,
7108

Christopher

14TH AVE

TAKOM..~PARK, MD 209127065

Page Number

1

Guest Number

1488945

Arrive

Date

07-17-2013

A

Depart

Date

07-21-2013

Folio

ID

No. Of Guest

1

Room Number

1937

Time

07-21-2013

13:00

Invoice
Charges

Date

Reference

07-17-2013

RT1937

Description
Room Charge

07-17-2013

RT1937

State Tax

07-17-2013

RT1937

Seattle Tourism Assessment

07-17-2013

RT1937

Occupancy Tax

$15.75

07-18-2013

92407990

In Room Dining

$24.30

07-18-2013

RT1937

Room Charge

07-18-2013

RT1937

State Tax

07-18-2013

RT1937

Seattle Tourism Assessment

07-18-2013

RT1937

Occupancy Tax

$15.75

07-18-2013

50401983

Relish

$21.00

07-19-2013

RT1937

Room Charge

07-19-2013

RT1937

State Tax

07-19-2013

RT1937

Seattle Tourism Assessment

07-19-2013

RTl937

Occupancy Tax

$l5.75

07-19-2013

93416670

In Room Dining

$64.36

07-20-2013

RT1937

Room Charge

07-20-2013

RT1937

State Tax

07-20-2013

RT1937

Seattle Tourism Assessment

07-20-2013

RT1937

Occupancy Tax

07-21-2013

l.0:15:20

l.8558470036 0:07

$2.00

07-21-2013

10:15:20

Telephone Tax State

$0.19

07-21-201.3

AX

American Express

** Total
** Balance
Tell us about your stay. www.westin.com/reviews

Credits

$225.00
$19.35
$2. 00

$225.00
$19.35
$2.00

$225.00
$19.35
$2.00

$225.00
$19.35
$2.00
$15.75

$-1,160.25
$1,160.25
$0.00

$-1,160.25

WA -

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Page 1of2

Notification Details

;,~;.,~.~·lFinancial
..~·:~;~,./
:;Hyfanage1nent

~:r..
,:J.:_« .;:;~Si.."('t. 11·1
fli.. "sl·-.·~..J\...J,_l \...-.
0

Expense Reports Mrqise

instructions

ContactUs Home Logout Preferences !::!.filQ

.

Expenses: Exoenses Home > Expenses Home >

.ill Information
'

.

,.

This notiflcation has been closed, with the result: Approve

~~_penseIEXP288771 for Barclay, Christopher (305.68 USO)
Barclay,
Expense Report for
Individual's Cost Center
Christopher
Expense Report Total
To Gibson, Rebecca
Attachments
Sent 08/05/2013 13:50:38
Closed 08/05/2013 15:20:39
ID 14187851
Responder Gibson, Rebecca
From

Barclay, Christopher
71101
305.68 USO

Instructions
.. ....•.•.
.
Please approve or reject this expense report. Please provide a Note if you reject

Ca_s~.a~tj 9t~'?E_E~penses:Business Expenses

Line Date

Expense
Typ·e

07/05/2013 Mileage
2

07/08/2013 Mileage

Reimbursable
Amount (USO) Justification
· Computer update and
18.08 document signing - Carver
Education ·committee meeting
18.08 _COB
·-

3

07/09/2013 Mileage

4

07/11/2013 Mileage

5

07/14/2013 Mileage

6

07/15/2013 Mileage

7

07/15/2013 Mileage

8

Expense
Accounts
Updated

·
· Attachments

Yes
Yes

-·· ......

Linkages to Learning
11.30 Celebration - Imagination
Stage
_
Lunch w/ Marcus Moore 3.96 DTSS
Ramadan lftar Celebration 27.69 Islamic Center of Maryland
Drive for Supplies - Richard
16.95 Montgomery HS

Yes

Yes
Yes

Yes

07117/2013 Mileage

18.08 Oral Argument - Carver
Dulles Airport - Flight to
18.36 Seattle

Yes

9

07/21/2013 Mileage

Dulles Airport - Flight to
18.36 Seattle

Yes

10

07/22/2013 Mileage

Back to School Filming 9.04 Glenallen ES

Yes

11

07/22/2013 Mileage

Meeting w/ constituent 18.08 Carver

Yes

12

07/22/2013 Mileage

Meeting on School
31.08 Construction - Baltimore

Yes

13

07/23/2013 Mileage

14

07/24/2013 Mileage

18.08 Boardfiocs Training - Carver
Fiscal Management Mtg 18.08 Carver

Yes
Yes

httn-//rP.srP.ntrlhl Rl m~m:mrl.nn:r:ROlS/OA HTMT./OA i.sn?OAF1mc=FND WFNTF DF.T...

4/lS/2014

.

Page 2of2

Notification Details

15

07/25/2013 Mileage

16

07/25/2013 Mileage

17

07/26/2013 Mileage

18

07/30/2013 Mileage

6.22 Meeting w/ Constituent
18.08 Ed Matters Taping - Carver
Office visit to sign Leasing.
18.08 documents - Carver
Meeting w/ MCCPTA
18.08 Leadership - Carver

Total

V Previously

Submitted Expenses

:Expense
· :Type

Yes
Yes
Yes

305.68

.

.
:Datev

Yes

-·---- -·-·~.~

Reimbursable: Payment
. AmountMethod
6.72 USO Mileage
6.72 USO Mileage

Merchant
Name

02/27/2014 Mileage
02/26/2014 Mileage
02/26/2014 Mileage

5.60 USO Mileage

02/22/2014 Mileage

6.16 USO Mileage

02/2112014_Mileage
02/20/2014 Mileage

4.48 USO Mileage
6.72 USO Mileage

02/20/2014 Mileage

3.36 USO Mileage

0.2/20/2014 Mileage
02/20/2014 Mileage

1.68 USO Mileage
6.72 USD Mileage

.02/19/2014 Mileage

8.96 USD Mileage

1Justification
Strategic Planning - Carver
Meeting w/ Superintendent Carver
Meeting w/ Councilmember
Branson
State of Black Montgomery Civic Center
Meeting w/ Chief of Staff
Meeting w/ MCPS Staff Carver
Walter Johnson Cluster
Meeting - Tilden MS
Edison HS Open House
Meeting w/ MCPS Staff Carver
A&S Meeting - Universities
at Shady Grove

~pprova~s History

Se-Ci~bate · .. ·
1
2

Sta!us · ··Performer

.

. Approval Group

_

Comments

08/05/2013 15:20:40 Approved Gibson, Rebecca MCPS_IEXPENSE_APPROVER_GROUPS
08/13/2013 11:15:15 Approved lkheloa, lkhide
MCPS_IEXPENSE_APPROVER_GROUPS

Related Applications

@)

Expense Report Details

Response
Note
Return to Work!ist

D Display

next notification after my response

Copyr,\Jlit (c) 2006, Oracle. Ali rights reserved.

Privacv Slatement

PURCHASING

CARD

Card Member Transaction

Log

MCPS Form 234-21

June 2009

Office of the Chief Operating Officer
Department of Materials Management
MONTGOMERY COUNTY PUBLICSCHOOLS " Rockville, Maryland 20850

~

Card member name Christopher Barclay
School/office name Board of Education

Work location CESC, Room 123
To August 28, 2013

For the period: From July Z9, 2013

Total Amount
($)

USE SEPARATE lOG !FOR EACIHACCOUNT
Supplies/Services (required)
(Student or other-must be identified.)

Account
(03, OS, etc.)

Date Ordered

Date Delivered

08/06/2013

08/09/2013

$19.67 Baja Fresh, Silver Spring

Dinner Meeting

08/28/2013

504091

07130/2013

07/31/2013

$63.90 Bombay Indian Restaurant, Silver Spr.

Dinner Meeting with Northeast

08/28/2013

504091

Supplier Name

Statement

Date

Consortium (missing receipt)
OS/08/20l 3

08/08/2013

$49.20 Eggspectation, Silver Spring

Breakfast Meeting with MCCPTA

08/28/2013

504091

03/ 15/2013

08/I 6/2013

$20.00 Eggspectation, Silver Spring

Meeting (missing receipt)

08/28/2013

504091

08/08/20 lJ

08/09/2013

Parking while attending Breakfast

08/28/2013

504001

$5.00 MCG DOT, Silver Spring

mtg with MCCPTA (missing receipt)
,

Oo/07/20 L3

08/08/2013

$16.75 Potbelly Sandwich, Silver Spring

Dinner meeting

08/28/2013

504091

C3/27/2013

08/~8/2013

$36.36 Ted's 355 Diner, Rockville

Lunch meeting with Srnondrowski

08/28/2013

504091

(missing receipt)
Total

$210.88

CERTIFICATION STATEMENT
I certify that, to the best of my knowledge, the transactions recorded for the month indicated on this purchasing card lqg are correct and complete. All purchases were made in
support of school programs as otiitlined in the Purchase Card Guide. I understand that any material misrepresentation or omission from this log maybe grounds for cancellation
-01-=F

m,,..Lx,.'l!.~:..!..<'.~as&.eZ!_c~a~[!Lk:pr::'::iv~H~geL:~~isciplin
action.
Sig1 ture, Card Member

_1L;_l_;_L3_
Date

·

\JJ p~
Siqn~rovinq

_jj_;_L;
Official

Date

-!!5-

Corporate ~lUlrcQ'iia.isiffiig
Cardmemlbletr fmepm't
Prepared For

Closing Dale

CHRISTOPHER BARCLAY
MCPS MDTAX 3000123-5

08/28/13

IA'lifj
Page 1of2

Balance

Due$ Do Not Pay
For importantinformation
regardingyour account
refer to page 2.

For your records only - do not pay.
For assistance or questions about your account, contact us at www.americanexpress.comicheckyourbiii
call Customer Service at 1-800-492-4920.

Activity

or

Dale reflectseithertransactionor postingdale
Reference Code

Card Numbs

Amount S

::;p§t1t.lt§'?trnm~RP:§AT§#!'f§M]T~A~9~~¥§%J:r
.. :08Iia~~ :·:~::-.: ·.'.'.::.. .::•.:.:::·:·:=.-::.T·:.:::..::: .' .,:<..·':::..:·::n== 3~~2Q~rns,<~
08/09/13 BAJA FRESH 84 330654 SILVER SPRING
MD
REF# 0000009978· (30·1)587•65"42·· 08f06/13
-01-/3_1_/1-3--B-OM_B_A_Y-IN-DIAN
RESTAU SILVER SPRING
MD
REF# 356000018
3015937222
07/30/13
MD
08/09/13 EGGSPECTATION RESTAU SILVER SPRING
REF# 18
301-585-1700
08/08/13
FOOD/BEVERAGE
ROG NUMBER 18
08/16/13 EGGSPECTATION RESTAU SILVER SPRING
MD
REF# 7
301-585-1700
08/15/13
FOOD/BEVERAGE
ROG NUMBER 7
MD
08/09/13 MCG DOT 82751 PRKNG SILVER SPRING
REF# 054806272
240-777-6000
08/08/13
MD
08/08/13 POTBELLY 036 5429298 SILVER SPRING
REF# 000607265
3015629696
08/07/13
MD
08/28/13 TED'S 355 DINER 5429 ROCKVILLE
REF# 000841768
3013400088
08/27/13

19.67/

00000099780

·-·-- ····· ·· -- ------ -····
35600001800

63.90

18000000000

49,207

70000000000

20.00

05480627200

5.00

!
iI
.1

00060726500

I

36.36 !

00084176800

New Charges/Other Debits
Payments/OtherCredits

Total for CHRISTOPHER BARCLAY

Do not staple or use paper clips

210.88
-2,209.86

Please enter account
number on all
correspondence.

Payment Coupon

CHRISTOPHER BARCLAY
MCPS MDTAX 3000123-5
R50 HUNGERFORD RM123
ROCKVILLE

MD

20850
Check here if address,
telephone number,or
e-mail addresshas
changed. Notechangeson
reverse side.

D

Potbelly Sandwich Works
www.potbelly.com
911 ELLSWORTH DR C-8
(301) 562-9696

Host: Roxi
Ordel'156

QBIU7

=)

g

Nantucket Nect.
c;; ,...,., Sa 1ad

"i 11ed

Chicken

licken Salad

1
6
5
15
0

1e in

Total

xxxxxxxxxx
.-co1:502119

Try the "OMG" BLT!
Order the NEW Toasty
Turkey BLT sandwich
with Nueske's bacon!

--- Check Closed ---

16 -75

16.75

'

**n'.ESTAURANT**

BAJA

FRESH

SILVER

SPRING

084

CJ5 1 5 F E N T 0 tl S TR E ET
SILVER

GM:
PHONE:
[1 a t e

:

Card Type:
Acct lf:
Exp Date:
Auth Code:
Check:
Server:

SPRING,

~AMAL

MD 20910

MOHAMMAD

301-587-6542
A u g CJEi ' 1 3 O 5 : 5 2 P H

AMEX

~-~
~;}~ls p e c t a t i o 1 •

xxxxxxxx
XX/XX
506015

9 9-r s
100 MUHAMMAD
C BARCLAY
19 . 6 7

Subtotal:

001 8

EVA L
S I GN :

-'- ___ _______ _ _ ___ _ ___ _ _ _ _ __.. _

I AGREE TO PAY THE ABOVE TOTAL
ACCORDING
TO MY CARD ISSUER
AGREEMENl.
CUSTOMER
COPY
THANK YOU ..... COME

AGAIN

TABLE 3 i!Partv2
SvrCk: 4 9:51a OB/00/13

DI NI NIC-l
1 COFFEE

2.79

LARGE GF
1 Ill EGGSUBERANT
1 LOBSTER OMELETTE

1

SOON

4.59

13.49
17.99
Sub Total:

STATE TAX
08/08 10:4.=iaTOT . !\ L :

:

38.86

2.34

4 ~

0018

Server: EV,~ L
08/08/13 11 :17, Swiped

Rec:
T:

18

3 Term: 2

EGGSPECTAT fON
-"~ ~LLSWORTH DRIVE
:R SPRING, MD 20910
... )585-1100

HANT#:
1

TYPE

ncAN

uM

ACCOUNT NUMBER

xxxx~:xxxxx.

E.~PRES
3: C BAl~CLAY
TRANSACTION APPROVED

AUTHORIZATION #: 561855

Reference: 0808010000018
TRANS TYPE: Credit Card SALE
CHECK:
TIP:
TOTAL

41 .20
-·-·--------~--- ---·

Gibson, Becky
From:

Workflow Mailer from PFMS <mcps_fms@mcpsmd.org>
Wednesday, September 18, 2013 9:06 PM
Gibson, Becky
Action Required: Expense IEXP294314 for Barclay, Christopher (232.24 USD)
ATTOOOOl.gif;ATT00002.gif; Notification Detail.html

Sent:
To:
Subject:
Attachments:

From
To
Sent
Due

Barclay, Christopher
Gibson, Rebecca
09/18/2013 19:05:41
09/23/2013 19:05:41
ID 14253086

Expense Report for Barclay, Christopher
Individual's Cost Center 33201
Expense Report Total 232.24 USO
Attachments

Instructions
Please approve or reject this expense report. Please provide a Note if you reject.

Cash and Other Expenses:
Line Date

1
2
3
4
5
6
7
8

9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

08/02/2013
08/06/2013
08/06/2013
08/08/2013
08/08/2013
08/09/2013
08/09/2013
08/12/2013
08/i 6/2013
08/20/2013
08/20/2013
08/20/2013
08/2112013
08/22/2013
08/22/2013
08/22/2013
08/24/2013
08/26/2013
08/26/2013
08/26/2013
08/27/2013
08/27/2013
08/28/2013
08/28/2013
08/28/2013
08/28/2013
08/29/2013
08/30/2013
08/30/2013
08/30/2013

Expense Type

Business

Reimbursable

Expenses
Amount

(USO) Justification

6.78 Meeting w/ constituent - Carver
6.78 Meeting w/ Carol Croll - Carver
6.78 Meeting w/ Dr Zuckerman
6.78 Meeting w/ Constituent - Silver Spring
6.78 Document signing - Carver
6.78 Meeting at Carver
7.91 Dinner w/ Herman Taylor - Chevy Chase
6.78 Meeting at Carver
6 ..78 Meeting on Construction - Carver
5.65 Meeting w/ Constituent Silver Spring
6.78 Meeting w/ Rep Delaney's Rep - Carver
9.04 Dinner w/ constituent - Bethesda
6.78 Most Hopeful Teacher Event - Carver
7.91 Meeting w/ Unions
6.78 Items meeting w/ Dr Starr
6. 78 Agenda Setting - Carver
6.78 Back to School Fair - Carver
3.96 School Visit Weller Road ES
4.52 School Visit Nothwood HS
4.52 School Visit Sligo.MS
3.96 School Visit Rockville HS
5.65 Lunch w/ Ms Smondroski - Rockville
6.22 School Visit Bethesda - CC HS
6. 78 School Visit Bethesda ES
7.35 School Visit Rosemary Hills ES
6.22 School Visit Hoover MS
6.78 Items w/ Dr Starr - Carver
24.86 School Visit Damascus HS
22.60 School Visit Baker MS
10.17 Tour of Gaithersburg HS

Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Mileage
Total

232.24
1

Attachments

Previously Submitted Expenses
Date

Expense Type Merchant Name

07/30/2013 Mileage
07/26/2013 Mileage
07/25/2013 Mileage
07/25/2013 Mileage
07/24/2013 Mileage
07/23/2013 Mileage
07/22/2013 Mileage
07/22/2013 Mileage
07/22/2013 Mileage
07/21/2013 Mileage

Approvals

Reimbursable Amount Payment Method Justification
Meeting w/ MCCFTA
18.08 USO Mileage
Leadership - Carver
Office visit to sign Leasing
18.08 USO Mileage
documents - Carver
6.22 USO Mileage
Meeting w/ Constituent
18.08 USO Mileage
Ed Matters Taping - Carver
Fiscal Management Mtg 18.08 USO Mileage
Carver
18.08 USO Mileage
BoardDocs Training - Carver
Back to School Filming 9.04 USO Mileage
Glenallen ES
Meeting on School
31.08 USO Mileage
Construction - Baltimore
Meeting w/ constituent 18.08 USO Mileage
Carver
Dulles Airport - Flight to
18.36 USO Mileage
Seattle

History

Seq. Date
1
09/18/2013 19:05:40

Status Performer
Notified Gibson, Rebecca

Approval Group
MCPS_IEXPENSE_APPROVER_GROUPS

Related Applications
@l Expense Report Details
Copyright (c) 2006, Oracle. All rights reserved.

Please click here to Respond

2

Comments

~

MONTGOMERY COUNTY BOARD OF EDUCATION
Rockville, Maryland
May 22, 2013

MEMOR.A.NDUM
To:

Mrs. Susan Chen, Controller
Division of Controller

From:

Ikhide Roland Ikheloa, Chief of Staff~

Subject:

Check Request Payable to Christopher Barclay, ID

Qw>
-

Please issue a check in the amount of $32.50 in reimbursement of the attached receipts
for transportation and meals while attending meetings and deposit check.
Please charge the account numbers indicated.
Mr. Christopher Barclay
$14.00 - BOE Expense
$18.50 - Out of State
Thank you.
IRJ:rlg
Attachment

.
.

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091'.W13 - Montgomerv Countv Council Bui Iding. Cafeteria Lunch meeting with Council Member Valerie Ervin

04/ 16/2013 - Santiago's Cab - NSBA Conference Ground Transportation to Airport from Hotel

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THAN!< YOU
'09/2013 '12:18PM
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1jo:J000#0119
CLERKOl

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$2. 00

$14. 00

DRIVER

DATE_!±_I

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Thank. You - Call UsAgain

619-420-9589
. from Mexico

or

619-690-5870

Tel: 664-630-12-43

$0. ii~

l fEMS

CASf 1
04/13/2013 - NSBAConferenceSnack while attending conference

'iOUR RECEIPT
THANK YOU
1J4/13/2013
3; 30PM O 1
-100000#5091
CLERkO1
.PECIAL COQl{lf
~PECIAL COOKIE

i2.5U
$2.50

~TPIS
CAS':

''.>.

00

PURCHASING

CARD

Card Member Transaction Log

MCPS Form 234-211
June 2009

Office of the Chief Operating Officer
Department of Materials Management
MONTGOMERY COUNTY PUBLICSCHOOLS • Rockville, Maryland 20850

~

Card member name Christopher Barclay
School/office name Board of Education

Work location CESC, Room l 73
To September 28, 2013

For the period: From August 29, 2013

Total Amount

USESEPARATElOG FOR EACH ACCOUNT
Supplies/Services (required)
(Student or other-must be ideritified.)

Date Delivered

09/25/2013

0912612013

$7.00 Colonial Parking, Rockville

Parking, Board Retreat

09/28/2013

504091
_,

09/19/2013

0912012013

$4.45 DC Parking, Washington

Parking, Congressional Black Caucus

09/28/2013

504001

Lunch meeting with R. Smondrowski

09/28/2013

504091

Garage Parking, Montgomery Moving

09/28/201 J

504001

Supplier Name

($)

Statement

Date

Account
(03, 05, etc.)

Date Ordered

Annual Leg. Mtg. (missing receipt)
09/12/2013

09113/2013

09/12/20 l3

0911212013

$34.99 La Madeleine, Rockville,
$3.00 MCG DOT, Silver Spring

Forward Event
09/ 17/2013

0911.8/20 l 3

$31.79 Staples, Rockville

Supplies for iPad, Stylus

09128120 l3

503030

09106120 l3

09/07/2013

$32.00 The Wine Harvest, Potomac

Lunch meeting with R. Srnondrowski

09/28/2013

'504091

09119/20 l 3

0912012013

$14.00 The Woodside Deli, Silver Spring

Meeting (missing receipt)

09/28/20 l3

50409!

Total

CERTlflCATION

$127.23

STATEMENT

I certify that, to the best of my knowledge, the transactions recorded for the month indicated on this purchasing card log are correct and complete. All purchases were made in
support of school programs as outlined ir;))le Purchase Card Guide. I understand that any material misrepres
tion or omission from this log maybe grounds for·cancellation
of my/p'V"c~e cardfrivil~
and./~~. ~Ii nary action.
.
.
-rr

UU4/~A/L,-,; A.c;L,&:h

.

JL;_I_; 1'3
Date

lL1LtL
Date

'Corporate Purchaisirng
~ardmember Repo~t

_i\;.ww. arnericanexpress.com/checkyourbitI
- .- . -

---

- - .- - --

- - - - - - - - - - - - - - ~~
- - - - . - - - . - --.-.-·.

09/28/13

CHRISTOPHER BARCLAY
MCPS MDTAX 3000123-5

PreviousBal.)flCe $

I

.-

..

tisirg-Ueuo:::

P1ep:>Jed For

21o.88ll

New

Charges$

OtherDebris$

127.23ll

Payments$

o.ooll:= . · ·=·

~~=o.~~ll·r

OtherCr..:Jrts
$

Page 1of2

Balance
Due$ Do Not Pay

o:oo.1

For important information
regardingyour account
refer to page 2.

For your records only - do not pay.
For assistance or questions about your account, contact us at www.americanexpress.com/checkyourbill
call Customer Service at 1-800-492-4920.

or

I\ .'f'"lo.foR..,I!!.;~,~ Dalereflectseitheruensactonor poslirrJ date
J.,O...C.~:lol'\-=ll"-:1

Amount S

ReferenceCo:fe

Card Number

": -210.88: .

OS/05/13 ·.·CORPORATEREMITTANCERECEIVED

.09/05:'

09/26/13

MD
Q9/25/13

18890008000

7

09/20/13

DC PARKING 0000
WASHINGTON
DC
REF# 18178676
202-671-2020
09(19/13
FINES
ROC NUMBER18178676

18178676000

4.45

09/13/13

LA MADELEINE 20
ROCKVILLE
MD
REF# 0294003
FAST FOODRESTAU 09(12/13
MCG DOT 82751 PRKNG SILVER SPRING
MD
REF# 031495269
240-777-6000
09I12/13

02940030000

34.99 ~

03149526900

3.00.

MD
09/17(13

00063086600

31.79.

MD
09/06/13
THE WOODSIDEDELI
SILVER SPRING
MD
851016532
USFC20910 09/19/13
ROC NUMBER851016532639BOOO

32490249817

32.00

85101653263

14.00

·~~~~~~~~~~~~~~~~~~~

COLONIAL PARKING #77 ROCKVILLE
REF# 18890008
202- 295- 816~- PARKING FEES
ROC NUMBER18890008

---··---------·-·----------

-·09/12/13

------

09/18/13

STAPLES 00912
REF# 000630866

09/07/13

THE WINE HARVESTPRK POTOMAC
REF# 32490249817 240-314-0177

09/20/13

ROCKVILLE
(800)333-3330

New Charges/Other Debits
Payments/OtherCredits

Total for CHRISTOPHER BARCLAY

Do not staple or use paper clips

127.23
,210.88

Please enter account
number on all
correspondence.

Payment Coupon

CHRISTOPHER
BARCLAY
MDT AX 300 0 12 3 -5
~ 850 HUNGERFORD
RM123
~ ROCK~ILLE
MD

oo.

·::i;~::M C P S

~08tiG
Check here if address,
telephonenumber, or
e-mail addresshas
changed. Note changes on ;
reverse side.

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P~rLh.·~ 13/G9/25 14:19:24

600l/81/s

la Madeleine
11858 Rockville Pike
1~.11kvi lle, MD 20852
\JU 1) 984-2270

C0mments or Suggestions?
1-866-328-3736

Date:
Sep12'13 01:39PM
Card Type: AMEX
·Acct~:
XXXXXXXX
Card l..try: SWIPED
·rans l.pe: PURCHASE
·rans Key: DID001402514119
uth Code:

heck:

:heck ID:
'erver:

MONTGOMERY
COUNTY
WAYNE AVE GARAGE
RECCIPT
K20

528723
6706

X 1
10263 Karla.

r.01\JfRY TIME:
)9/12/L1

34.99

ota 1

::or

agree to pay the above amount

)9;12/13
JARK-DU!i.:

in accordance with my card

issuer agreement
*****No Signature Required*****
CUSTOMER COPY

07: 5.

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10:3b
HRS:Mirl
0:02:41
$ 3.00

Kii1;(; i)F PA···tv11-r
A~,11:;.' l C:1~,; EXP"·
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xxxxx 101
AJfH. CODE 582284

Side

No
No

Side
Lemonade
Potato Cup
Tk 51"•2
Ulll·S

NO BREADON TOP
SPFCIAL PREP

Mush room Cup
Perrier

·<xxxxxxx,

2.39
3.99
9.49
0.uU

3.99
2.29

AMEX

34.99

suotor .'
Tax

33.14

Pay111e1 il

34.99

1 .85

--------------4 Check Closed-----------·
--------·-----Sep12' 13 01 :39PM-----.--------

Join our Cafe eClub
www.lamadeleine.com/eclub

rHANK

Y8o11

FOR \OUR

09![!6{2013 - The Wine Harvest, Gaithersburg

Lunch meeting with R. Smondrowski

T~e Wine Harvest
www.thewinehar~est.com
240-314-0177

that was easy.
Low prices. Every item. Every day.
1531 Rockville Pike
Rockville, MO 20852

lABLfl 10 Invl 83~09.1

Closed to Credit Cara -·

Amt·:

:can txpress

(30 l) 881-6390
1631507 6 006 31·
0912 09/17/13 o~ ···.

OAlE/T!ME: 3/6/2013 2:45:17 PM
SERVER: Stephanie Adams

STATION: 01

:~·.t******+*********"
Item Count: 13

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REWARDS NUMBER 2230585800
ACOM Bii.MBOOSTYl.U

$8.50

Soup 2
1 CHI CKEN

•**********i c-, •

-)KU

=========================================

2 CUP SOUP~

~F;

1

SALAD SAMO#

':

$7.50

29'
29
1
$31

·5::-;': 8991829

Toast
Ch ips

·TAL

Pickles

;tandard Tax 6.00%

ND BREAD
1 lURKEY CRAN SANDI
Purnp.srnickel
Chips/Grapes

$7.50

. I' ·IL.

1

$2.00

· ·· i can Express
No. : XXXX ./XX
.,, ··. No. : 502353

FOUNTAHJ :soDAtt

=============~===~==================·======

$25.50
$1 .53
$27.03

Subtotal
Tax 2
Total before tip:

TOTAL

T ip amount:

.••..
-'-·
;::.
}':;

3
[SJ

ITEMS

1

L11·eindtotal:

CREDIT CARD PURCHASE
...:a;·d Type.:

.~m"«i•'iill

Save with Staples Brand products,
most trusted brand in ,/ f ice product

$27.03
Express

XX/XX

HH>-Ht:~

fHANK YOU FOR SHOPPING AT STAPLES

Transaction 1yµ~: PRE-AUTH
Ref Nurn: 327501745
.uth Code: 547664
1

Ca1d Entry Methnrl
Opened: 9/5/201

Swiped
~1:12 PM

Shop online at www.staples.com
,:rom 1aptops and tablets

to snacks,
furniture and paper, as a Staples
Rewards member, you w i 11 get 5% back
on it all, no ~atter how you shop in store or online.

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