Safety Training First Aid

Location:

Indianapolis, IN

Posted:

September 04, 2023

Contact this candidate

Resume:

Itemized Reimbursement Sheet Total Reimbursement Verified Reimbursement

[INTERNAL USE ONLY] Document

Checklist Yes/No

DIRECTIONS - Please Read $5,000.00) $0.00) All supporting receipts Please fill in the yellow boxes to list all reimbursable expenses you plan to claim as part of the RESTART grant, up to $5,000 total. This is the amount you can

request for reimbursement,

capped at $5,000.

Internal use only

Front/back of ID

Please use a separate line for EACH individual item that appears on a receipt. Do not combine items into one entry. Tax and shipping charges cannot be claimed, so please DO NOT include these. Proof of in business 2/15/20 Please reference the next sheet/tab on this document titled "Example Sheet" for an example of how to fill out this sheet using sample receipts. Your total will be shown in the blue box to the right of this text. Please use this number on your application. Proof of Marion County address Tip: If your spending exceeds $5,000 it is easiest to list the largest purchases first to reduce the number of items needed to hit the $5,000 limit. For assistance or questions about the spreadsheet, please email ************@***********.***. Date of Transaction

Vendor/Store as Appears on

Receipt Quantity Amount each

Product name as appears

on receipt Explanation of PPE usage Total

[Internal Use Only]

Verified Value

[Internal use only]

Verification Notes

PLEASE SEE THE NEXT SHEET/TAB TITLED "EXAMPLE SHEET" FOR AN EXAMPLE OF HOW TO FILL OUT THIS SHEET WITH SAMPLE RECEIPTS. 5/15/2020 [EXAMPLE] FACEMASKS LLC 2 $121.20) Disposable Masks Masks for employees $242.40) This column is for internal use

only.

This column is for internal use

only.

5/12/2020 National Independent Dispatch

Network of America

5.00 $799.99 COVID-19 Safety Training

Workshop

COVID-19 Safety Training & Supplies: $3,999.95

Packaging $0.00

Hanndling $0.00

Shipping $0.00

Receiving $0.00

Social Distancing $0.00

Sanitation $0.00

Enviromental Controls $0.00

Antibacterial Face Mask $0.00

Antibacterial Gloves $0.00

Sanitizers $0.00

Safety & Cleaning Manuels $0.00

Safety Posters & Signs $0.00

$0.00

7/29/2020 Amazon 1.00 $749.00

Epson SureColor T2170 24 Inch

Desktop Wide Format Wireless

Ink Jet Printer COVID-19 Safety Signs, Posters, & Labels $749.00 1.00 $14.99

Glow in the Dark Pigment

Powder-Epowy Resin Color

Pigment Dyes... Luminous Skin

safe Long Lasdting Self

Glowing Said $14.99

1.00 $3.93 Dynarex Medicine Cup CODVID-19 First Aid $3.93

$0.00

7/30/2020 Amazon 1.00 $261.84

Canon Pixma MG6320 Black

Wireless Color Photo Printer

with Scanner & Copier COVID-19 Safety Signs, Posters, & Labels $261.84

$0.00

7/30/2020 Lamination Depot 2.00 $40.73

PRO 3 Mil Matte 18in.

x250ftx1in. Core Roll

Laminating Film COVID-19 Safety Signs, Posters, & Labels $81.46

$0.00

8/5/2020 RPL Supplies 30.00 $2.99 Sublimation Face Mask-Audult COVID-19 Employee/Customer/Visitor

Safety $89.70

$0.00

8/5/2020 PRO WORLD 20.00 $2.99

Sublimation Face Mask With

Filter

COVID-19 Employee/Customer/Visitor

Safety $59.80

$0.00

6/19/2020 FM Expression 24.00 $13.66

Full Color Fashion for Darks12.

75x19 Gang Sheet

COVID-19 Employee Safety Work Shirts w/

Safety Rules Printed on Shirt $327.84

$0.00

5/29/2020 Best Buy 1.00 $319.92

HP Laser Jet Pro M 454dn

Color Lasre Printer COVID-19 Safety Signs, Posters, & Labels $319.92

$0.00

7/7/2020 Go Daddy 1.00 $120.06

Delux Linux Hosting w/ Panel

&.COM Domain Registration;

Office 365 Sarter

COVID-19 Website For Customer,

Empoyee, & Visitor Safety Training &

Awareness Content $120.06

$0.00

6/27/2020 Ink X Pro 1.00 $87.90

INKXPRO 400ml sublimation

ink cartridge refillable kit for

Epson Workforce WF COVID-19 Safety Signs, Posters, & Labels $87.90

$0.00

Total $6,116.39) EXAMPLE RECEIPTS AND COMPLETED REIMBURSEMENT SHEET This sheet shows an example of how to reference your reciepts and enter the items from the receipts into the spreadsheet on the first tab. Note how the PPE items on the receipts have been highlighted or circled to help speed up the process for the Indy Chamber's review team. Please scroll down to view how the information on the receipts has been reported on the reimbursement spreadsheet. Each individual item that appears on a receipt will use a separate line - items are not to be combined into one entry. Tax and shipping charges are NOT eligible to be reimbursed. EXAMPLE RECEIPT 1 EXAMPLE RECEIPT 2 EXAMPLE RECEIPT 3 EXAMPLE RECEIPT 4 EXAMPLE RECEIPT 5 Date of Transaction

Vendor/Store as

Appears on

Receipt Quantity Amount each

Product name as

appears on receipt

Explanation of PPE

usage Total

[Internal

Use Only]

Verified

Value

[Internal

use only]

Verificatio

n Notes

Total

Reimbursement

5/15/2020 [EXAMPLE] FACEMASKS LLC 2 $121.20 Disposable Masks Masks for employees $242.40) This column

is for internal

use only.

This column

is for internal

use only. $202.11)

5/20/2020 Silver in the City 1 $10.80

Locally Made Fabric Face

Mask Face mask for employee $10.80

5/13/2020 Amazon 3 $26.98

Vinyl Gloves, Disposable

Gloves Gloves for employees $80.94

5/7/2020 Lowes 3 $23.43 Common 2x10x8 Lumber

This is wood that will be

used to construct sneeze

guards around our cash

registers $70.29

5/7/2020 Lowes 1 $12.33 Common 4x4x8 lumber

This is wood for building a

barrier around our new

outdoor seating $12.33

5/6/2020 Safety Glasses USA 1 $5.79 Encon Veratti Safety glasses for employees $5.79 6/23/2020 Home Depot 2 $10.98 Weatherstrip 84"

Weatherstrip for new

exterior door that leads to

new outdoor seating $21.96

$0.00

Total $202.11)

Contact this candidate