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L'ivision of Controller MONTGOi\ilERY COUf\JTY PUBLIC SCHOOLS

Hockville, Maryiand 20850

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MOf\JTHLY STATEMENT OF MILEAGE FOR USE OF PRiV.l\TE VEH!CLE

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Division of Controller MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville, Maryland 20850

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MONTHLY STATEMENT OF MILEAGE FOR USE OF PRIVATE VEHICLE

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INSTRUCTIONS: This form should be submitted to your immediate supervisor by the third of the month for the preceding month. Supervisors will forward immediately to the appropriate account manager; the Division of Controller should receive forms by the sixth of the month. (For additional information, see MCPS Regulation DIE-RA: Local Trc.vel.) Lisi all official stops in date order.
Base School Location New: 0 Yes CZfNo

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(First)

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(Middle)

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Patricia
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22.0

Board Member
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ACCOUNT NUMBER

MCPS Form 220-2, Rev. 8/07

k,;.. Division of; Controller MONTGOMERY COUf\!TY PUBLIC SCHOOLS Rockville, Maryland 20850

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MONTHLY STATEMENT OF MiLEAGE FOR USE OF PRIVATE VEHICLE

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INSTRUCTIONS: This form should be submitted to your immediate supervisor by the third of the month for the preceding month. Supervisors wili forward immediately to the appropriate account manager; the Division of Controller should receive forms by the sixth of the month. (For additional information, see MCPS Regulation DIE-RA: Local Travel.) List all official stops in date order.

Employee 10 No.

f () I

I I I I
(First)

I
(Middle)
(Apt. No.)

Base School Location New: 0 Yes (Zf No

B oard of Education
No. Miles to and from Home and Base l.ocatioi

Name O'Neili
Address

(Last)

Patricia (Street No.)

(Street)

22.0
Job Tille Board Member

(City)

(State)

(ZIP Code)

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e._,r-mo'nfh' Item

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,

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?

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miles@

Other
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ACCOUNT NUMBER

MCPS Form 220-2, Rev. 8/07

PURCHASING CARD Card Member Transaction Log

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

MCPS Form 234-21 June 2009

Card member name Patricia O'Neill School/office name B~o~a1~-d~o~f~E~-~dt~1c~n~t~io:n~----------------------:-------------============= Work location CESC. Room J 23 For the period: From September 29, 2013 To October 28, 2013

USIE SEPARATE LOG FOR EACH ACCOUNT

Account (03, 05, etc.) 504091

Date Ordered I0/03/2013

Date Delivered J 0/04/2013

Total Amount
($)

Supplier Name

Supplies/Services (required) (Student or other-must be identified.) Lunch during MABE Annual Conf. O'Neill, Hixson, Madalena, Kaiser Lodging, MABE Annual Conference l 0/02/20 l3 -10/06/2013

Statement

Date

$54.36 Clarion Fontainbleau Hotel, Breakers Pub, O.C., tvlD

10/28/2013

l0/07/20 J 3

10/07/2013

$151.53

Clarion Fontainbleau Hotel, O.C., MD

l0/28/2013

504091

Total

$205.89

CERTUFICATION STATEMENT

of:}

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 in the Purchase Card Guide. I understand that any material misrepresenratiorj.oe-omqsion from this log maybe grounds for cancellation purchase card privilege and/or disciplinary action. .
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10/28/13

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Page 1 oi 5 Balance

StiriltementS ... :.-:=:.::

,ATRICIA O'NEILL MCPS MDTAX 3000123-5 ' ~

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New Charges$

Other Oeblts $

Payments $

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AclaYity
10/04/13

Dale reileolsei:ner transactionor postingdate Reierence Code Amount S

Card Numbe, CLABION RESORT FONTA OCEAN CITY 0 4105243535 ~~~~~~-REF# CLARION RESORT HOTEL OCEAN CITY 10/07/13 FOL# 684822 LODGING ARRIVAL DATE DEPARTURE DATE
10/02/13 10/06/13

MD
10/03/13

54._3_6_. 151.53

MD
10/07/13

00
$145.00 New Charqes/Other Debits Payments/Other Credits 205.89 0.00

ROOM RATE ROC NUMBER 684822 Total for PATRICIA O'NEILL

Do not staple or use paper clips

t-,...,...,.,...,,,1\/umber

Payment Coupon

Please enter account number on all correspondence.

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PATRICIA O'NEILL MCPS MDTAX 3000123~5 850 HUNGERFORD RM123 ROCKVILLE MD

20850-1718
11 I 1 1 1111

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Chee!{ here if address, telephone number, or e-mail address has changed. Note changes on reverse side .

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. Clarion Fontainebleau Hotel 10100 Coastal Highway Ocean City, MD 21842 United States Tel: 410-524-3535 Fax: 410-524-3834 Patricia O'Neill Montgomery County Bd Of Ed 850 Hungerford Drive Rockville, MD 20850 United States Email: becky_gibson@mcpsmd.org BE0930 - Mabe Page Number : Guest Number: Folio ID : No. Of Guest: Room Number : Room Rate : Club Account:
.L

,
Arrive Date: 10-02-13 09:29 Depart Date: 10-06-13 08:12

684822 A
l

1211 145.00

Copy Invoice

Fontainebleau Date 10-02-13 10-02-13 10-02-13 10-03-13 10-03-13 10-06-13

Hotel

l0-06-i3

08:14

VALERIEH Charges Credits -151.53 145. 00 6.53 145.00 6.53 -151.53 303.06 -0,00 -303.06

Reference DEPOSIT RT1211 RT1211 RT1211 RT1211

AX

Description Deposit Applied Room 4.5% Occupancy Tax Room 4.5% Occupancy Tax American Express

** Total *** Balance

EXPENSE STJlVJMARY REPORT Date 10-02-13 10-03-13 10-06-13 Total Room&Tax 151.53 151.53 0.00 Telephone 0.00 0.00 0.00 Food&Bev 0.00 0.00 0.00 Other -151.53 0.00 0.00 Total 0.00 151. 53 0.00
----------

Payment 0.00 0.00 -151.53

--~------303.06

---------0.00

---------0.00

----------151.53

----------151.53

151.53

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Division of Controller MONTGOMERY COUNTY PUBUC SCHOOLS

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MONTHLY STATEMENT OF MILEAGE FOR USE OF PRIVATE VEHICLE

11

INSTRUCTIONS: This form. should be submitted to your immediate supervisor by th? third of the month for the preceding month. Supervisors will forward immediately to the appropriate account manager; the Diviston of Controller should receive forms by the sixth of the month. (For additional information, see MCPS Regulation DIE-RA: Local Travel.) List all official stops in date order. Base School Location New: D Yes CZf No

Employee ID No.
Ne.me

I
(First)

l
(Middle)
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Board of Education
No. Miles to and from Home and Base l.ocatior 22.0 Job Title

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O'Neill
Address (Street No.) (Street)

Patricia

Board Member
(City} (Staie) (ZIP Code) Submittedfor Month of:

'fJ \)
Item

Maryland
Date Destination

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Parking, Tolls, Public Transportation Amount

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MCPS Form 220-2, Rev. 8/07

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INSTRUCTIONS: This form should be submitted to your immediate supervisor by the third of the month for the preceding month .. Supervisors will forward immediately to the appropriate account manager; the Division of Controller should receive forms by the sixth of the month. (For additional information, see MCPS Regulation DIE-RA: Local Travel.) Lisi all official stops in date order. Base School Location New: 0 Yes v.f No Employee ID No. Name O'Neill Address (Street No.) (Street)
--- -

I
(Middle)

Board of Education No. Miles to and irom Home and Base l.ocatiot

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I

(Last)

(First) Patricia

22.0
(Apt. No.) Job Title Board Member (State) (ZIP Code) Submitted for Month

6716 Landon Lane

(City) Bethesda Date Destination

Maryland
Purpose of Trip

20817
No. of Miles Reimbursable

oi:oe:r- ,
Item

Use one form for each month Parking, Tolls, Public Transportation Amount

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Division of Controller MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville, Maryland 20850

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MONTHLY STATEMENT OF MILEAGE

FOR USE OF PRIVATE
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INSTRUCTIONS: This form should be submitted to your immediate supervisor by the third of the month for the preceding month. Supervisors will forward immediately to the appropriate account manager; the Division of Controller should receive forms by the sixth of the month. (For addition a.Iiniormation, see MCPS Regulation DIE-RA: Local Travel.) List all official stops in date order. Base School Location New: 0 Yes 0 No

'
Name

,.. 0
Employee ID No. . (Last)

I
(First)

I
(Middle} (Apt. No.)

Board of Education
No. Miles to and from Home and Base Locatiot

O'Neill
Adcress
I

Patricia
(Street No.) (Streei) Job Title Board (City) (Staie} (ZIP Code)

22.0 Member

Submitted for Month oi:

Maryland
Date
I

Use one form for each mont No. of Miles Reimbursable

~r
-/ . Item

Parking, Tolls, Public Transportation" Amount

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ACCOUNT NUMBER _ MCPS Form 220-2, Rev. 8/07

PURCHASING CARD Card Member Transaction Log

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

MCPSForm 234-21 June 2009

Card member name Patricia O'Neill School/office name B~o;ar;d~o~f~ E~-d~L~lc~a~t~io;n=------------------------=~~------================== Work location CESC, Room 123 For the period: From June 29, 2013 To July 28, 2013

.USE SEPARATE LOG FOR EACH ACCOUNT

Supplies/Services (required) (Student or other-must be identified.) Lunch meeting with Smondrowski re: BCC Cluster and Policy CNE Account .(03, 05, etc.) 504091

Date Ordered 07/08/2013

Date Delivered 07/10/2013

Total Amount ($)

Supplier Name

Statement

Date

$38.18 Dupars Hamburger Hamlet, Bethesda

07/28/2013

07117/2013

07/19/2013

$38.93 Du pars Hamburger Ham let, Bethesda

Breakfast meeting with Zuckerman re: Transition

07/28/2013

504091

Total

$77.11

CERTIFICATION

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 in the Purchase Card Guide. I understand that any material misrepresentation or omission from this log maybe grounds for cancellation
of

mj9~!2J2l~t:er.
Signature,Cara Member

action

21__l_b_l3
Date

1[0-1
~Date

Signature,Apprw;~/Official

iJ53

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.ared For

Corporate Purchasing Cardmember Report

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Closing Date

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ATR!CIA O'NEILL JICPS MDTAX 3000123-5

07/28/13

Page 1 of 2

Balance
./

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PreviousBalance S

New Charges $

Other Deb~s $

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Other Credrts$

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DUPARS HAMLET 542929 BETHESDA REF# 000253179 3018975350 D.LJPARSHAMLET. 542929 BETHESDA REF# 000262004 3018975350

MD
07/08/13

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38.18 .. 38.93 77.11 0.00

MD
07/17/13

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PATRICIA O'NEILL .MCPS MDrAX 3000123-5 850 HUNGERFORD RM123 ROCKVILLE MD

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EmployeeID No. Name

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PURCHASING CARD Card Member Transaction Log

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

MCPS Form 234-21

June 2009

Card member name Patricia O'Neill School/office name ~B~o~a~rd~o~f~Eid~uc~a;t~io~n~===-============:-;:::::~~~~~~~=~~~~~~~~~~~~~~~~~~~= For the period: Fro~ February 28, 2013 Work location CESC, Room 123 To March 30, 2013

USE SEPARATE LOG FOR EACH ACCOUNT

Supplies/Services (required) (Student or other=-rnust be identified.) Dinner meeting prior to cluster meeting w! O'Neill, Brandman, Smondrowski Account (03, 05, etc.) 504091
/.

Date Ordered 0311912013

Date Delivered 03/19/2013

Total Amount.
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Supplier Name .

Statement

Date

$56.04 Hard Times Cafe, Rockville

03/30/2013

'

Total

$56.04

CERTIFICATION 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 in the Purchase Card Guide. I understand that any material misrepresentation o omission from this log maybe grounds for cancellation of my purchase card privilege and/or disciplinary action.

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03119/13

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HARD TIMES CAFE ROCK ROCKVILLE REF# 82 301-294-9720

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03/19/13

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MONTHLY STATEMENT OF M!LEAGE FOR USE OF PRIVATE VEHJCLE

INSTRUCTIONS: This form should be submitted to your immediate supervisor by the third of the month for the preceding month. Supervisors will forward immediately to the appropriate account manager; the Division of Controller should receive forms by the sixth of the month. (For additional information, see MCPS Regulation DIE-RA: Local Travel.) List all official stops in date order. Base School Location New: 0 Yes i;zi No Employee ID No. Name O'Neill Address (Street No.) (Street)

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Division of Controller MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville, Maryland 20850 ... ~. .,.... . .. , - __,, - ..,
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MONTHLY STATEMENT OF MILEAGE FOR USE OF PRIVATE VEHICLE

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INSTRUCTIONS: This torrn should be submitted to your immediate supervisor by the third of the month tor the preceding month. Supervisors will forward immediately to the appropriate account manager; the Division of Controller should receive forms by the sixth of the month. (For additional information, see MCPS Regulation DIE-RA: Local Travel.) List all official stops in date order. Base School Location New: 0 Y~s\2l No EmployeeID No. Name O'Neill Address (Street No.} (Street)

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(First) Patricia

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Board of Education No. Miles to and from Horne and Base Locatior 22.0 Job Title Board Member

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PURCHASING CARD Card Member Transaction Log

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

MCPS Form 234-21 June 2009

Card member name Patricia O'NeiJI School/officename iB~o:a~rd~~of~E~d~u~ca~t~io~n~-------------------------------------============ Work location CESC. Room 123 For the period: From December 29, 2012 To January 28, 20 l3

USE SEPARATE LOG FOR EACH ACCOUNT

Supplies/Services (required) (Student or other-must be identified.) Lunch meeting with Board member Rebecca Smondrowski Account
(03, 05, etc.)

Date Ordered 01/23/2013

Date Delivered 01/24/2013

Total Amount ($)

Supplier Name

Statement Date 01/28/2012

$52.20 Clydes Tower Oaks, Rockville

504091

Total

$52.20

CERTIFICATION STATEMENT I certifythat; to the best of my knowledge, the transactions recorded for the month indicated on this purchasing card log are correct and complete. Allpurchases were made in support of school programs as outlined in the Purchase Card Guide. I understand that any material misrepresent omissionfrom this log maybe grounds for cancellation of L-~ard privilege0d/or disciplinaryaction. ~ .

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01/28/13

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Activity
01/24/13 - Total-for

Date reflects either transaction or posting dale

Card Numbe CLYDES TOWER OAKS LG ROCKVILLE REF# 156 301-294-0200 PATRCIA-07NEILl:--MD 01/23/13

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Coupon

Please enter account number on all correspondence.

PATRICIA O'NEILL MCPS MDTAX 3000123-5 850 HUNGERFORD RM123 ROCKVILLE MD

20850-1718
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Server: VICTORIA Y 01/23/13 14:00, ~ ,._, YOES TOWER OAKS l 11.1:JE ..PkES~RVE PARKWAY ROCKVILLE, MD 20859
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WWW.CLYDES.COM d156 Table345 #Party2

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2 WATER 1 CLUB SODA 1 ICED TEA 1 BACON CHZBURGER, mediLITT 1 JUMBO CRAB S~ND 1 HOT TEA 1 DECAF COFFEE
Sub Total:

0.00 2.85 3,00 11 .95 16.95. 3.50 3.50

75

ACCOUNT NUMBER EXPRES Name: PO NEILL ""TRANSACTION APPROVED 1DRIZATION #: 504317 ~rence: 0123010000156 IS TYPE: Credit Card SALE
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Office of the Chief Operating Officer Department of Materials Management MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville, Maryland 20850

MCPS Form 234-ll June 2009

Card member name Patricia O'Neill

School/office name !B~o~a~rd~off~E~d~u~c,~1t~.io~ For the period: From September 29, 2012

11~--------~--------------==-=---=------------===============
Work location CESC Room 123 To October 28, 2012

USE SEPARATE LOG FOR EACH ACCOUNT

Supplies/Services (required) (Student or other=-rnust be identified.) Breakfast while attending MABE Annual Conference - PO, NK
Account

Date Ordered 10/04/2012

Date Delivered l 0/05/2012

Total Amount ($)

Supplier Name

Statement

Date

(03, 05, etc.) 504091

$23.02 Clarion Fontainbleau Hotel

l 0/28/2012

10/03/2012

I0/08/2012

$I5t.53

Clarion Fontainbleau Hotel '

Lodging, MABE Annual Conference I0/03/2012 -10/07 /20 12

l 0/28/2012

504091

Total

$17f55

CERTIFICATION 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 in the Purchase Card Guide. I understand that any material misrepresentation or omission from this log maybe grounds for cancellation of my urchase card privilege d/or disciplinary action. .. .

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PATRICIA O'NEILL MCPS MDTAX 3000123-5

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56.78ll

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CLARION RESORT FONTA OCEAN CITY -REF# 041Q!'i24353-5 CLARION RESORT HOTEL OCEAN CITY FOL# 649888 LODGING ARRIVAL DATE DEPARTURE DATE t0/03/12 10/07/12 00 ROOM RATE $145.00 ROG NUMBER 649888

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PATRICIA O'NEILL MCPS MDTAX 3000123-5 HUNGERFORD RM123 . 850 ROCKVILLE MD

20850-1718
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OCT04'12

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0.85
1 .00 7.00

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MABE's Annual Conference Fontainebleau Hotel 10100 Coastal Highway Ocean City, MD 21842 United States 410-524-3535 Fax: 410-524-3834 Patricia O'Neill Montgomery Co Board Of Ed 850 Hungerford Drive Room 123 Rockville, MD 20850 United States BElOOl - Mabe Page Number : 1 Guest Number: 649888 Folio ID A No. Of Guest: 1 Room Number : 1211 Club Account: .lill. Account

Arrive Date: 10-03-12 Depart Date: 10-07-12

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Fontainebleau Hotel Date 10-03-12 10-03-12 10-03-12 10-04-12 10-04-12 10-07-12 Reference DEPOSIT RT1211 RT1211 RT1211 RT1211 AX ***For

10-07-12

09:01

GERRIH Charges Credits -151.53 145.00 6.53 145.00 6.53 -151.53

Description

Deposit Applied Room Exch Rate: 0 4.5~ Occupancy Tax Room Exch Rate: 0 4.5~ Occupancy Tax American Express Authorization Purpose Only*** Code 560338 Authorized 602.47

Date 10-03-12

** Total *** Balance

303.06 -0.00

-303.06

Signature~~~~~~~~~~~~~~~~~~~~~I agree to remain personally liable for the payment of this account if the corporation or other third party billed fails to pay part or all of these charges.

PURCHASING CARD Card Member Transaction Log

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

MCPS Form 234-21

June 2009

Card member name Patricia O'Neill School/office name ~B~o:a~rd~of~ ~E:d:u~c.a~t~io:n~-------~-----------------------------============ Work location CESC, Room 123 For the period: From August 29, 2012 To September 28, 2012

USE SEPARATE LOG FOR EACH ACCOUNT

Supplies/Services (required) (Student or other-must be identified.) Lunch mtg. to discuss legislation with Delegate Barkley, O'Neill and Docca
I

Date Ordered
/
I/

Date Delivered 09/28/2012

Total Amount ($)

Supplier Name

Statement Date 09/28/2012

Account (03, 05, etc.) 504091

09/27/20120

$56.78 Mama Lucia, Rockville

'

- -

Total

$56.78

CERTIFICATION 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. Allpurchases were made in support of school programs as outlined in the Purchase Card Guide. I understand that any material misrepresent~mission from this log maybe grounds for cancellation of pc;,;i~ and/or disciplinary action . ~ . . .

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09/28/i 2

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PATRICIA O~NEILL MCPS MDTAX 3000123-5 ~\ll 850 HUNGERFORD RM123 ~ ROCKVILLE MD

20850-1718
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PURCHASING CARD Card Member Transaction Log

~ Office of the Chief Operating Officer Department of Materials Management MONTGOMERYCOUNTY PUBLICSCHOOLS Rockville, Maryland 20850

MCPS Form 234-21 June 2009

Card member name Patricia O'Neill School/office name is~o~a~rd~o~f~E~d~u~c~a~ti~o~n------------------------:--------------=============== Work location CESC, Room 123 For the period: From August I, 2012 To August 28, 2012

USE SEPARATE LOG FOR EACH ACCOUNT

Supplies/Services (required) (Student or other-must be identified.) Lunch mtg. w/Councilmernber Ervin Account (03, 05, etc.) 504091

Date Ordered
/

Date Delivered 08/03/2012

Total Amount ($)

Supplier Name

Statement

Date

08/02/2012

$42.99 Gordon Biersch, Rockville

08/28/2012

'

Total

$42.99

CERTIFICATION

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 in the Purchase Card Guide. I understand that any material misrepresentation or omission from this log maybe grounds for cancellation of mv purchase card privil.ege and/or disciplinary action.

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GB-ROCKVILLE 513 005 ROCKVILLE REF# 146 423-424-2000 - - - - - - - - .EOOD/ BEVERAGE I ROC NUMBER 146

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08/02/12

14600000000

42.99

Total for PATRICIA O'NEILL

New Charges/OtherDebits Payments/OtherCredits

42.99 0.00

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PATRICIA O'NEILL MCPS MDTAX 3000123-5 850 HUNGERFORD RM123 ROCKVILLE MD

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0810212012 - O'Neill lunch meeting with Councilmember Valerie Ervin

0146

Server: CLARA H 08/02/12 13:49, Swiped GORDON BIERSCH-ROCKVILLE 200 E. MIDDLE LN

UNIT A

Rec: 60 T: 55 Term: 7

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