michael r hoffman - the dakota beacon:_2008... · charles a. blunt 4716 amberglow drive bismarck,...

Charles A. Blunt 4716 Amberglow Drive Bismarck, ND 58503

Michael R Hoffman Lawyer

P.O. Box 1056 120 North 3rd Street, Suite 100

Bismarck, North Dakota 58502-1056 Tel: (701) 355-0900 Fax: (701) 255-7979

September 23 , 2008

Re State of North Dakota v. Charles Blunt Burleigh County Case No. 07 K 789

Misapplication of Entrusted Property (Counts I & II)

Dear Sandy:

Enclosed please find additional discovery sent by the Burleigh County State ' s Attorney' s Office in regard to your case referenced above. These copies are for your file.

Thank you.

Sincerely,

Paulette Thurn Assistant to Michael R. Hoffman

/pt

Enclosures

BURLEIGH COUNTY STATE'S ATTORNEY

RICHARD J. RIHA STATE'S ATTORNEY

September 19, 2008

MICHAEL HOFFMAN ATTORNEY AT LAW PO BOX 1056 BISMARCK ND 58502·1056

Dear Mike:

Enclosed you will find additional discovery copies.

STATE VS.: Charles Blunt CASE NO.: 08-07-K-0789 COPIES ($.20 per copy): 78 @ $.20 TOTAL AMOUNT DUE: $15.60

SEP 23 RfC'D

Please make payment payable to Burleigh County State's Attorney.

Sincerely,

4.u~ Kim Bless Legal Assistant II

AssISTANT STATE'S ATTORNEYS:

CYNTHIA M. FELAND

LLOYD C. SUHR

JUUE LAWVER

TYRONE J • TURNER

JUSTIN J. SCHWARZ

PAMELA A. NESVIG

JEFFREY R. UBBEN

BRYAN D. DENHAM

COURTHOUSE • 514 EAST THAYER AVENUE • BISMARCK. NORTH DAKOTA 58501 • TELEPHONE 701-222-6672 • RESTITUTION L.lNE: 701-222-7529' FAX: 701-221-6897

Discovery Checklist - Supplement

Defendant: ____ Charles "Sandy" Blunt'--__ _

Defense Counsel: __ Michael Hoffman, ____ _

Crim. #. _F 327-07-04 __

Our File #: _08-07-K-0789_

Payment s to Dave Spencer with supporting documents:

_4_ December 27, 2004 (Ck #50047240)

_10_ March 22,2005 (Ck #50154876)

_12_April12, 2005 (Ref #00101858)

_4_April20, 2005 (Ref #00107990)

_2_ May 17, 2005 (Ref #00115922)

_6_June 7, 2005 (Ref#00119567)

_4_ June 22, 2005 (Ref #00122247)

_5_ October 4, 2005 (Ref #00135590)

_5_ October 11,2005 (Ref #00137310)

_4_ December 6,2005 (Ref #00144199)

_9_ December 20,2005 (Ref #00146578)

_6_ April 26, 2006 (Ref #00240907)

_3_ June 27, 2006 (Ref #00254698)

_4_ September 7, 2006 (Ref #00265731)

Other ________________________________ __

Date Mailed 9-1 q -0 8 Date Faxed _____ _ By ,;{~J3. Date Hand Delivered ____ _ Date Picked Up ____ _ By ___ _

t- " . CHeck Date: Decemoer12712004 Vendor Number: 0000028256

11lvoice ~umber

DEe 04

~

~

Check Number

50047240

Invoice Date VoucherID

December/2212oo4 00000698

-

./'-. Date

December12712004

WORKFORCE SAFETY AND iNSURANCE

WORKFORCE SAFETY & INSURANCE BISMARCK, ND 58503-0649 -

.~. ..,. -:,';,

.~. "

Date

.. . , . , 0' •••••••••• ......... - .. -. -' .-. - Check No.. "-50047240 -

Gross Amounl Discount Taken Paid Amount - 698.40 0.00 698.40

-

Total Total Total Gross Amount Discounts Paid Amount

$698.40 $0.00 $698.40

':. ':: :~:/: .... ,',::

- BANK O:~"-NORTH DAKOTA 5004724.0 77-28/913

--_:Pay J\mount $698.40***

.....

Pay ****SIX HUNPREDNn-TETY -EIGHT AND 40 1100 DOLLAR **** .

To The Order or SPENCER,DAVE 51 £ 2 . ." PATASKALA, OK; 43062

, TRAVEL EXPENSE VQUCHER STATE d'F NORTH DAKOTA SFN--5i785 (10-2004)

Purpose of

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\ * ..• DUPLiCATE 45537284' /SA~ ANTONIO

SPENCt:R/DAV·E-------- - _ ...... ---.. _-._ ..

**NOT VALID FOn******RETAIN THIS AECEIPT*** ~*TRAN8P.ORTATlmHf**THROU(jHOUT YOUR JliUHNEv;t;

NONREFiOVALUAFTDPT/CHGFEE' CPKECL

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FP t:AltXXXXXXXXXX 13379/XXXY./06 1722

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CO! .UMBUS OH (ill c48S B 1 iOr.C BR'iBJ ZN

MPI.S/ST PAUL ';0 6803 f: l?DEG RR7ST7.N

B 1 SMAfICK. N. O. co 6802 9 1 !l1)F.:C SR?!? 1 ~N

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SAMIS ABSTRACT CLAIM FOR PAYMENT WORKFORCE SAFETY & INSURANCE FINANCE DEPARTMENT SFN 52557 (11/2004)

Gte 27 2QM

WSI HelpLine 1-800-777-5033

Quesllons? Call us. Repon Injuries Immediately.

ND Fraud and Safety Hotline 1-800-243-3331

Report Fraud and Unsare Wort< Conditions.

1600 EAST CENTURY AVENUE, SUITE 1 PO BOX 5585

BISMARCK NO 58506-5585 TELEPHONE NUMBER (701) 328-3800

TOLL FREE FAX NUMBER 1-888-786-8695 TDD NUMBER (for the hearing impaired only)

(701) 328-3786

Prepared By

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Check Date: Marchl2212005 Vendor Number: 7009143 Check No. 50154876

InVOIC~~~u~m~b~e~r ____________________ ~I~n~v~o~ic~e~D~a~te~ ___________ V~ou~ch~er~ED~ ______ ~G~ro~s~s~A~m~o~u~n~t ______ ~D~is~c~o~u~n~t~T~a~k~e~n~ ____________ .~P~a~id~A~rn~ou~n~t~

MOVlNG EXPENSES Marchl17/2005 00001388

Check Number Date

50154876 Marchl2212oo5

11- t:; n 1 t:; '- A ':J e. .. -

12.845.87

Total Gross AmouDt

$12,845.87

M _ ... , t""'\ _e .• ,.. ....

0.00

Total Discounts

$0.00

12.845.87

Total Paid Amount

$12,845.87

, TRAVEL EXPENSE VOUCHER ·STATE OF NORTH DAKOTA SFN 52785 (10-2004)

Year Department

House hunting trip.

Mise expense was for parking at the f . Imbus airport and also e.xpense for ~ing company to relocate my' . belongings and 30 days of storage.

or lravel expenSBa or a

~~~~~~~~~~~~~~~~~ ______ ~~~-+~ ____ ~TOTAL 0.00 L..------I

0 UJ ~ ...-W (\...1

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RcPt# 18022 " -'

02/21105 18:32· LH 1 AU 75 TxnH 17699 " 02118/05 17:08 In 02/21/05 18:32 Out Tktlt 864247

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: .. : ,)~ BLUE FEE 1 . $ 21.00 · :.: : Total Fee $ 21.00 · .. ; HASffi'CARD $ 21.00-

XXXXXXXXXXXX5233 · :", APProval No.: 077964

t', •

';,' ,',

. ': '

Reference No.: 394 Change Due $ 0.00

THANK YOU FOR PARKING WITH US . BUCKLE UP FOR SAFETY

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Bismarck, Mpls SI PaL!1

tslsmarck Mpls:SI. Paul Columbus OH

SPENCER/DAVE

FA E US TAX·

DOM SE 3MEtH FEE

OTHER TAX

TOTAL LJSD

~··.~3.26

2B.74 12.130

28.(10

45~.80

11:1FEB05 21FEB05 21FEB05

L14R1~m L14R1""R L14RINR

Form of Payrnent: Mastercard Card Nbl: XXXXXXXXXXXX3379

E-Ticket Nbr: E01211 I 761426B

PASSENGER RECEIPT .. --,- -.'- ~~-:---- ',' -- -, ",: '

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Name/Place of Issue: TRAVELOCITY)

Total Fare This Ticket: USD 452 8('

End,)( ;."mi!III!;;Re~" il,UuIlS:

NOI·I.REFUI'IDABLE;PENAL T'f FOR CHId IC-ES

Tral1.5IJOltatioll subje<:llo terms of caniage plin:ed inside j,,:;';el Jacket.

Page 1 of 1

. ,., .. :'r'

.. . ' .. ' .. ~', ... ', .. : -'-. --:....:.....-.~. ____ ::...:...---.:.... -' -' '-' ·.~.~2~..:-~· ___ ·...:...:.:.. _' __ :",_ :,,-,:,~_~,;,~_. _: .L.: •• ;... ___ ~-= __ :"':-'.:~_'..!.: __ ·:_ :.:. '.

J.O·BB.ERS MOVING & STORAGE • f '!. . AGENT FOR AWED VAN UNES

~~P~~-~--e~R~e-mA~To-:--~ 1200 InduStrlal Drive

Bismarck, NO 58501-3317 (701) 222-1111

4400 North 'Broadway Minot, NO 58703 (701) 839-2632

6109 53rt1 Ave. S.W. Fargo, NO 58104

(701) 356-8080

13304 392nd Avenue Aberdeen, SO 57401

(605) 225-4650

::>LDTO:

•

• David Spencer

• ~

Ie Shipped Salesperson Tenns Sh~Vla

due upon receipt -Quantity Description

Allied Van Lines move per freight bill

warehou~e kandling 14,500 lbs first month storage thru 4/13/05 storage valuation $aS,300 for 30 days

.'

001751· Invoice Dale Your Order No. Our Order No.

3/14/05 451095 4512-1

SHIPPED TO: (If olher than SOLD TO)

• .. move from Pataskala, OH

to Bismarck, ND

• F.O.B.

-. Unit Price Amount

~/11C:OD &'"3 UJ,17 $11 ,041.39

.<.Jl)t.M... a.1.A1 ~.8.~

~. 398.7S,

'fO'l~ ~ .,·,,362.~O ~:j

C .... 145,'60 '"

TOTAL $11 J 948.24

...

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'f..A"'~ r s 7 b. 11

d;'1Q81 t-i -.-' -.. -":""-' .

. -.~ ..

KELLY I N H BI SMA R C K 181313 NORTH 12TH STREET

ElJ:S~IARCK, .,NORTH DAKOTA 58501

02/21/.05 (1-1 :0B 0005 A)

Room: 347- 0000279549

SPENCEI~, DAVID

WSI

dates 'rooin cle'rk

0~8/05 ,. 34'7 . -Bgel- C

82/18/05 347 130131 C 132/19/05 347 131301 C 132/19/05 347. 130131 C 132/20/05 347 013133 C 02/213/135 347 90133 C

<7131> 223-8.0131 RESERVATlm4S: . j,-80B-6.35-3559

t'ransac-tiol"l

ROOM CHARGE TAX ROOM CHARGE TAX ROOM CHARGE TAX

desc'/"iption

CORI:'ORATE ROOM TAX CORPORATE ROO!'I TAX CORPORATE ROOM TA::<

balance

ROOM CHARGE TAX

165.1313 H .. 5B

• .. • ... 4 -

amoLlnt

55.130 5.513

55.130 5 .• 50

55.013' 5.59

..... - ... ~~ .. .-.. '---1 u---+ l \.. :r 860' re'nt~a-car.

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FOR I::=:f~~f JITIONAL CHARGE, OPTIONAL IFi JDUCTS, DAMAGE' WAIVER.IBEtlIEij6~ ~SONAL ACCIDENT INSURANCE J ~ "'~LEMENTAL .,LlABILlTY ~~~~~~~:Afj~;J.~~~~~s-~BiEEiijNTCEiEB~' x~~j~~--~"'-=---,--,:-="'--,-"~,-,-,-,,,-,:----:--)~N. BEFORE DECIDING ~vv-t1.~. • ".::

ETHER TO PURCHASE ANY OF

~\ci~~~~~~~E~~~~~~;~~~~~~~~~~~~~~~~t~,c~C~~~'P~'~;"'~Pn~~_1 ~1i~~~~~~~~~;':~~ JR PERSONAL INSURANCE OR li.i BENTER' X :DIT :,CARD PROVIDES YOU 11'AM~IYJ'IW, JERAGE DURING THE RENTAL ~~w UOD. THE PURCHASE OF ANY TRESE PRODUCTS IS NOT

lUlRED TO RENT VEHICLE

.REPLACEMENT VEHICLE

COLOR

MODEL

CONDITION AGREED TO ·x _. __ I'

18 B 0 RENTER ~

D~i UE3~ .i

GI .QNDITION SAME ON RETURN Ves No

T E 1/8 1/4 3/B 1/2 5/8 314 7/8 ~

i·:J·) GasoHn€, R,::fupr1:.=

"'::':!

R IS AN AFFIlIATE OF ENTERPRISE RENT-A.cAR COMPANY, WHICH OWNS AlL RIGHTS TO ENTERPRISE NAMES AND MARKS, ©

.",:; ....

.. : AMDUNT DUE_~

January 5,2005

Dave W. Spencer, C.S.P.

~062

Dear Dave:

On behalf of Workforce Safety & Insurance (WSI) I am pleased to offer you the position of Chief of Employer Services, with a starting salary of$98,000 annually. In addition to your salary, the following employer..,paid fringe benefits are included with your employment: health insurance, $1,300 oflife insurance, employee assistance·program, and an 8.12% retirement contribution (if you elect to go with the defined contribution plan). You will accrue sick leave at the rate of 12 days per year and annual leave, which is based on years of service and begins with 12 days per year.

\....-. WSI would also like to extend to you the following relocation concessions:

• Transportation expenses for one pre-move house-hunting trip, including rpund trip mileage (not to exceed 12 cents per mile) or airfare, actual meals, and actual lodging for the employee and spouse, for up to three consecutive days.

• Transportation of one vehicle (not to exceed 12 cents per mile) while en route to the employee's new duty station. .. .

• Actual meal ~d lodging expenses incurred by the employee and immediate family while en route to the employee's new duty station.

• Actual cost of rental truck or licensed moving company. • Any lodging expenses for the employee and iIrimediate family while. occupying temporary

quarters within the state not to exceed thirty days.

You must submit receipts to be reimbursed for these items and portions of the reimbursement may be taxable and reported on your federal W2. In the event of a voluntary resignation, you will be responsible to repay the relocation reimbursement according to the following schedule:

Resignation Before I Year Between 1 mid 2. Years After 2 Years

Responsible to Repay 100% 50% 0%

· I am looking forward to hearing from you. Feel free to contact me directly at (701) 328-6025 or [email protected] if you have any questions or need further infonnation.

Sincerely,

Amy Klein Human Resource Generalist

Office of Management and Budget

Travel

Policy 521 - Moving Expenses

August 1, 2003

Permanent Employees: Chapter NDCC 44-08-04.3 allows for payment of moving expenses. for "a permanent employee who has been employed in that department, institution or agency not less than one year" when the employee is transferred to another city for new duty assignment "of a permanent nature within that department, institution or agency."

Moving expenses are to be processed on a claim for payment in SAMIS as follows:

SAMIS Object Code 2166

Reimbursement for allowable moving expenses which are not taxable to the employee but are reportable to the Internal Revenue Service (IRS): 1. All actual costs of moving personal household goods and furnishings, not to exceed 11,000

lbs. (4,989 .60 kilograms). 2. Transportation, of one vehicle, (not to exceed 12¢ per mile for travel by car) and lodging

expenses incurred by the employee and immediate family while en route to the employee's new duty station. This does not include meals.


Reimbursement for taxable moving expenses reportable to the IRS. 1. Meal expense incurred by the employee and immediate family while en route to the new duty

station. 2. Transportation expenses are limited to one round trip, and actual meal and lodging costs for a

pre-move house-hunting trip, for the employee and spouse, for three days. 3. The expenses for the employee and immediate family while occupying temporary quarters

within the state not to exceed 30 days. 4. Reimbursement for mileage that exceeds 12¢ per mile for travel by car while enroute to the

employee's new duty station.

Limitation: reimbursement for the relocation of permanent employees is limited to $5,000 by statute. Verification for expenses will be a paid receipt from a licensed moving company, highway mileage between duty stations, meal, and lodging receipts;

(continued)

67

i /

Policy 521 (continued)


Travel

August 1, 2003

New Employees: payment of moving expenses for newly hired employees is not specifically addressed by statute. However, it is recognized that market conditions for some higher-level, professional positions involve competitive recruitment activity that often requires payment of moving expenses as a part of the employment agreement.

Agency administrators may include moving expense reimbursement as part of a job offer when it can be demonstrated that local employment market conditions and job requirements are such that recruitment outside of the immediate geographical area was necessary and where such reimbursement is necessary to attract the best candidate. .

Reimbursement is not limited to $5,000 for new employees.

68

, WORKFORCE SAFETY AND INSURANCE

WORKFORCE SAFETY & lNSURANCE BISMARCK, ND 58503-0649

SPENCER,DA VID W 1600 E Century Ave Bismarck. ND 58503

ELECTRONIC PAYMENT ADVICE

NON-NEGOTIABLE

Fold on this Nne for maKing

Payment Date: 04/12/2005 Reference: 00101858 Invoice Number Invoice Date VoucherID Gross Amount Discounts 'Taken ' Late Charges Paid Amount

MARCH/APRil.. MOVING 04/0812005 00001544 2,390.02 0.00 0.00 2,390.02

~

~.,:ndor Number Name 7009143 Spencer,David W

Reference Date Total Gross Amt Total Discounts Total Late Charges Total Paid Amt

00101858 04/1212005 $21390.02 SO.OO $0.00 $2,390.02

·"

TRAVEL EXPENSE VOUCHER STATE OF NORTH DAKOTA SFN 52785 (10-2004) Month Year Department Official Position

September 2005 Executive Chief of Employer Services Employee Name Employee 10 I Busine4SSSuSnit Fiscal Month Biennium

Spencer, Dave

26 Bismarck - Fargo 27 Fargo - Grand Forks

Purpose ofTravel and Explanation of Expenses:

Presentation at Compensation Clinics in Fargo. Dave Spencer and Sandy Blunt shared a room, however, the billing was ~II put on Dave's bill which is attached.

Line

7009143 ,~;'~9rnP;i':;::R:;:-';~Taxi&'~h;~ ~. _Mi'~~'~ '" Me~ls', ·~., .. :.·o~u~t~oISf ':.'

:""'.~:·.'·~'"··'~,·.·T!;~,.:,::.rf..·a··,:.I!I!'.·.s;:.::.:: •.. ·,~.:.~~.:.·.',,',:;,: •... :.e,·f·.'·.·. . .•. : •.• : .. • ... : .... , ... o:·.:,.·,T.,,~,·r •. 'ae~:,·.n{.·sA .• ,.,i~.,.r .•.. _.~_::.'.,.:,: ... i:·., ef· .. ,', '. . -. ,- '.' .. ,., _. . . ~ _ . ·::~::::::}~~~~~t~_· :~:~:State}~

Lodg. In State 521015

Lodg. out of State 521075

Meals in State 521020

Meals out of State 521060

IRS Meals -Taxable 521035

Miscellaneous Expense

Olher Transportation in Slate 521025

Other Transportation out of State 521085

Air Transportation In State 521010

Air Transportation out of State 521070

Vehicle Miles In State I 521030

Vehicle Miles out of State I xl 521090

Total Expenses (Ref. Doc. No. of Advance: . I Less Travel Advance

NET EXPENSES

I hereby certily lIlat the within i~"'d s~ment repre'W'ting a claim for payment or per diem, mileage 'or travel expenses ~r a comblnalion thereof, truthfully and accurately slalJ'"Jhef'ayyof ,OrvJ-9 an91'e mileage traveled. and lIle purpose thereof. J -1 TOTAL ~~--~--~~~~~~~¥---~------~~------------------~----~~~~----~ Ec,.,yee Slgna~ UP'"' --""-., Dale/I b l' /0 ,) Departmental Approval t~ Date if-2e~ D5

55.25

55.25

110.50

110.50

110.50

,. " . ,.

t. IJ

.. Mr David Spencer

Pataskala, OH 43062·9641 US

Room No.

Arrival

Departure

703

09-26-05

09-28-05

OF FARGO

Membership No.

NRNumber

Group Code

Foliollnvolce No.

Page No.

Cashier No.

User ID

PC 290612944

192114

1 of 1

JWILLIAMS

wwwJchotelsgroup.com

---I --._.-. ,----------l_Date L ___ ,_._ /09-26-05 [09-26-05' . )09~27"()5

')09-27-05

109-27..()5

'-' -27-05

jOS-28-05

I Room Rate'

IT8X ,*GallerY Restaurant

I"Gallery Restaurant

I Room Rate

Tax

)American ~press

Description

#703 : CHECK #00005536

#703 : CHECK #00005536

XXXXXXXXXXX1004

Thank you for staying at The Holiday Inn Fargo. Qualifying pOints will be credited to your account. We look forward to welcoming you back.

Guest Signature: ___________________ _

Total

Balance

Charges

119.95 I '12:59 .. r ..

3.00- \.

- ":3.00' "I 11'9.95 I

12.59 I I

265.08

0.00

Credits I I

-1 -- -I

I _ 2~_5.?B.I

265.08

I have received the goods and I or services In the amount shown heron. I agree that my liability lor this bills not waived end agree 10 be held personaUy fiable 1i1 !he evant that the indicated person, company. Dr associalion fails to pay lor any part or the lull amount of these charges. If a credit card charge, I further agree 10 perform the obligations set iorth in the cardholder's agreement .... ith the issuer.

Holiday Inn Fargo 3803 13th Ava South

Fargo, NO 58103 Telephone: (701} 282.2700 Fax: (1'01) 281-1240

WORp'ORCE SAFETY AND INSURANCE WORKFORCE SAFETY & lNSURANCE BISMARCK, ND 58503-0649

SPENCER,DA VID W

Bismarck, ND 58503

Electronic Payment (ACH/EFTlWire) deposited to your account

Fold on this line for mailing

Payment Date: 12120/2005

. , __ .. H.···· .... , ELECTRONIC PAYMENT ADVICE

Reference: 00146578 Invoice Number Invoice Date VoucberID Gross Amount Discounts Taken Late Cbarges . Paid Amount

NOVIDEC 05 DS Dec/16/2005 00003800 1,138.03 0.00 0.00 1,138.03 CSP CERIFICATION Dec/06/2005 00003801 115.00 0.00 0.00 115.00

~

~ndor Number Name (UU':I14.:1 tipencer,JJavICl W


00146578 Dec/20/2005 $1,253.03 $0.00 $0.00 $1,253.03

.LU US, It's personal.

Vendor # . 7{)O 143

Fiscal Month PO Number

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TRAVEL~XPENSEVOUCHER STATE OF NORTH DAKOTA

-SFN 52785(10-2004)

Mnn~ -- hf t-JI!~t.1L ;';:S EmP1)~~ t;P Iwe ;,~

Holll Day Polnls Covered By Trallef (Show AM or PM) - ......

PlIJIose ofTmvel end ExplanaUon 01 ExpBnlBl:

f.pA{lI) o~ C£tl.TlfJfl) SN6rj

"f,lJJfEsr/o/1lAl( .,.

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Uno Due Dale OepL Account Oper. 10 Unit

Oepartmenl

r.lnP/JJvt/L ~6tv/'U::.( c'#:i'P:nP1!/AW.:(t. SG/!VIf.£C EmP'181! !p 1 , ~ fausiness Unit F"oscal MonUl BIennium

~o IY Vetllde : Camm' R Taxi & = Misc. MBSls Maals R Lodging LO<Iging

/oJ. • OlhorAlr InSlale OU1of ~ InSlate OulO! M11uli r Trone. r Trans. r Exp. SIBle Blais

1/l:;'.1D

LOC\g.in Slall 621015

Lodg. aLA of Slate &Zton Moala In Stale miND

Meals out of Stale 521080 IRS MesJ& • tUltlll 15210.3.5

MisceDaneous ExpeN8 /1'5.1" OlharTransportDllon In Stale 121025

OlherTranspooallon out of Siale IQIIIII5

A1tTransp01talion in Slale 5UOIO

Air TransponaUon oul of SUilt: 1521070

Vehicle MlJes in Slate . 5210Xl

Vehlde Miles out of Stale • 1210;0

T DIal Expanses (Ref. Dot. No. of Advance: I Less. Tmvet Advance

NET EXPENSES 11/15. ~., .. CI8&8 Fund Prejed AdlYi1y RasDurc:e ResDU1CO Amount

10 .. 10 Type CalegDl)'

=~IIlJl.r.t~."'~·LI.W"· "PJ1"lIIII'IQ.ClalmklrP"'IIIINIorpaIOoanl.m"ICI8D1n-..l'~IIf.~IICIItIllelBal. TOTAL //~. II-

1ItII:I1hI1lIha;lnwt.a,lItICIlIWpvpctIIt""'ot I

EmPID~'~£..I. DS)~ .!tq jc) > I.J-III - I

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. CERTIFIED SAFETY PROFESSIONALS 20B Burwash Avenue tet: 2t7·359-92bJ Savoy. Illinois 618~ ra",; 217,359-0055

Invoice Number: 051206134832105 Payment Date: H-D6-200s Order Total: $ 115.00

Billing Informalion Name David W. Address ,ji .... City • State NO Zip 58503 Telephone Number 7014263531 Payment Date 12-06-2005 Credit Card American Express

XXXX-XXXX-XXXX-10D4

Candidate Information Name DAVID W SPENCER Address City Stale· Zip Email Addressdspencer@state_nd.us Personal1D7493262212

Description

Renewal of CSP Certification

Unit Quantity Price

1$ 115.00

Extended Price

$ 115.00

Amount Paid $ 115.00

Please print this page to serve as a receipt

---

https:llwwws.bcsp.orglboardofcertifiedsafetyprofe-70/mck-cgildirectpaycredit.cgi 12/6/2005

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.. North Dakota SAMIS ABSTRACT 'CLAIM FOR PAYMENT FINANCE DIVISION ••• W9rkforce S!ifety.

W S I & Insurance To us, it's personal;

SFN 52557 105120113)

Vendor. 7 ix5?ld'2.. vendor~WI ::::t""nlVJ'lIA

Fiscal MonUt PONwnbii In.oloo,':9:' (j;) , I DIscount Amounl & Data

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BISMARCK NO 58506-5585 "TELEPHONE NUMBER I1Dl) 32&-380D

TOLL FREE FAX NUMBER 1·88&-78_95 TOO NUMBER Ifor Ih8 he.ring impaired only)

1101)32&-3786 YIWN.Wo~fOfCBSafBty,com

IvendoC,\2fe C~~JrAhn 'nyoit~~oo Voucher III .2.Xl'lJ

invoice Amount ProJoct 1099 Type Number

Il"i",DD

l7 LY Jy Prepared 8y

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if /"

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TRAVEL EXPENSE VOUCHER STATE OF NORTH DAKOTA SFN 52785 (10-2004)

Month Year

N ovem berlDecember 2005 Employee Name

Spencer, Dave Hour

Day Points Covered By Travel (Show AM or PM)

Depart An1val

8 Bismarck"F argo 6:30 B.m.

28 Bismarck-Las Vegas 10:30 a.m. 12:30 p.m.

29 Las Vegas

30 Las Vegas -1 Las Vegas -

2 Las Vegas

3 Las Vegas - Bismarck 12:00 p.m.

Purpose of Travel and Explanation of Expenses:

November 8, 2005, Speaking engagement in Fargo to Safety Group.

Nov. 28 - Dec. 3, 2005 - Las Vegas "Jational Ergonomic Conference

F" Dec. 2, 2005 - Dave Spencer and Randy Wegge shared the room at the Monte Carlo. They had to move due to conference ending and their flight didn't leave until next a.m.

Line Due Date Dept. Account Oper. 10 . Unit

/i

Department Official Position

Executive Chief of Employer Services Employee 10 I Busin48~nit Fiscal Month Biennium

7009143

Vehicle R Comm'l R Taxi & R Meals R Lodging

Other Air Misc. Meals

Out of Lodging Miles e Air e e Exp. In Stale e hi State Out Of

f Trans. f Trans. f Stale f Stale

408 I tiro.". 30.00

",( \,o.v~o 0 l1B.81

,~~ 0 l1B.81 .•

I hA. ..45:00 0 118.81

~ .,.A-a:tJo 0 118.81

16.00 roJ...R.Oo 0 152.55

30.00 I l I,l) ...8:"So 0

Lodg. in State 521015

Lodg. out of Siale 521075 627.79 Meals in Siale 521020

Meals out of State 521080 3/¥)-~0

IRS Meals - Taxable 521035

Miscellaneous Expel"!se 2D.... -16:"0""0 Other Transportation in State 521025

Other Transportation out of State 521085 1&J.'OtJ Air Transportation in State 521010


Vehicle Miles in State I 408.00 x -r 0.280 521030 114.24 Vehicle Miles oul of Stale I x I . 521090

Total Expenses 1,033.03 (Ref. Doc. No. of Advance: ) T Less Travel Advance . ..-. NET EXPENSES /(])~3 Class Fund Project Activity Resource Resource Amount

10 10 Type Category

I hereby C:7a.th~~e within ilemize~1r~menl representing a claim lor paymenl ar per diem. mileage or lravel expenses ar.a·combinalion Ihereal lruthfully a acru lely ~es the day I saNice Bnd the. mileage traveled. and the purpose thereof. I TOTAL

Empl1t19YfLf~ Date iV;!il~~ ----'"

~partmental Approval I' t$ Dat12 _ l~ - O'S \\

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QUAN. CLASS DESCRIPTION PRICE IIMOUNT

DAVID W SPE"':H t.·. ""'-0 v" .->-= .. -Jf1c (/1 C,,~ ~ '-". ~ CJ.!

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DATE r ~)-1 AUTHORIZATION SUB ' I I I 2.."7 0) \ '1.1 t 1...2- TOTAL 1...\-1 1(.0

REFERENCE NO. R~ TAX ~ -

FOUO/CHECK NO. SERVER ~-ERK

~ ~ ~J' /3 1,,-0 I

- SALES SLIP Iltl"!11 06 \tl~

j) e-::::;;;Trv IMPORTANT: RETAIN ~HI§ COpy FOR YOUR RECORDS

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WHIITLESEA / HENDERSON T~~';--RECEIPT FOR TAXI FARE

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FROM: /JI6#!i! () ~2,O [kptll

TO: Alf(fotGT FARE: Jt . .o1:> TIP:

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l/./ll::l/(J~·I 11:49 Out.

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i\ppr-OVd I NIL: 57254[3

n;"~ enJI)(:t, Nu. D~)4:).

," (I ,;\1t:,P. DI.lP. $ IJ. on . ,:\ You Have A NiCe! Day

F r :' r,1QIJ i ry P I ease Cal I 7C 1 750-'6790 \ . ' ... ' ~ ..

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ql: CFDKGOLDBA 11/28/0.5 1 :4B RM

CO: VIDEO 12/02/0511:11 AM

Arrival Date: 11/28/05 Departure Date: 12/02/05

~

Name: DAVID SPENCER

Address: 1600 E CENTURY AVE

BISMARCK ND 58506

LAS VEGAS

3570 Las Vegas Blvd. South Las Vegas, NV 89109 FOR RESERVATIONS CALL 1-800-634-6661

702-731-7110

Group Code: SCERG5

Casino ID:

Room #: RT 581

ResvlD: 386500266366

Folio 10: 386833182017 Page: 1

.·:Dat~::;:::·'::,::;:::::;::B:~:r~r.~~:¢~::::::l::::::::i\::\::: ::::p.~~~fli·m()n:::::::::::{:::::::::{t:::::::;::::::i:;:::::::::::=:tU:::::::::m::::;:::::::::::::::::::.::?;::::~:::::i::t:::::::::Q6.@fij'~¥::::::::::::L:::::::::m::Qr~#h~\:f:m::::u::::::::::m:::::::::t:::HMI~h#~:::;:'H/

11/28/05 APPLIED DEPOSIT 140.6J 140.61

11/28/05

11/29/05 11/29/05

• 11/29/05

~30/05 11/30/05 ll/30/05

12/01/05 . 12/01/05 12/01/05

12/02/05

XXXXXXXXXXXXX1004 RT 581ROOM CHARGE RT 581

TAX 0592437~AFE LAGO COFFEE SHOP ..

~AFE LAGO COFFEE SHOP TIP RT 581ROOM CHARGE RT ·581

TAX 2453182AUGUSTUS CAFE

~UGUSTUS CAFE TIPS . RT 581ROOM CHARGE RT 581

TAX 0412408~AFE LAGO COFFEE

~AFE LAGO COFFEE RT 581ROOM CHARGE RT

TAX FRONT DESK AMEX

SHOP SHOP TIP 581

109.00 9.8J

15.05 2.00

109.00 9.8J

18.32 2.00

109.00 9.81

. 15 .05 l.91

109.00 9.8'

J

Thank You for Staying at Caesars Palace

389.04

21.80 6.71 4.71

114.10 132.42 134.42

253.23 268.32 270.23

389.04

.00

Reservations 1.800.311.8999 www.montecarlo.com

DAVID SPENCER

~n:ibC~ REsORT & CASINO

LAS VECAS

3770 Las Vegas Blvd. South. Las Vegas, Nevada 89109

Rate Name Address - Room 26310

Arrive 12/02/05 Depan 12/03/05 Persons 1

BISMARCK ND 585038297

Deposit Amount

Company Name

-Guest Information 1.702.730.7777

Group Code XPROGDS Travel Agent No.

Page _1 Resv No 386862612828

Thank you for staying at Monte Carlo DATE REFERENCE DESCRIPTION $ CHARGES CREDITS $ BJ>..LANCE

12/02/05 386879002542 ROOM CHARGE 26310 139.95 TAX 12.60 J.52.55

12/02/05 386874816704 APPLIED DEPOSIT 152.55 *************1004

12/02/05 386874825630 MONTE CARLO BREW PUB 5.50 26310SP' XP:MCA2091892

12/03/05 386884846793 AMERICAN EXPRESS PAYMENT 5.50

5.50

. -.. ~

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:-'_~':-,s.-_· .. ,'._!._~,-:·_:':~.UMMAR:._:-:;_' ••. ·.-,-'-'":,~",,~._.,_'.,.' •• -_.:,'.;:, •. , .. '~, •. ,_._~_' .• ,,Y,',,~.'.'_~~'.'.~.'.' •• O.·.f.:· •. ~,f ..... t .. :.;'.~.·: .. ' ... :.,._c •. _: ... : •.• HAR .• ,· ..••.. ·_.:.· ... '.~.·,:·."···_'.·· .. ',·.-·._·.B·RGT'-AX~E'VE-OS.·:·· .• ··RA·S/.".G: .... E"" .... _, .•.. " .:.,""::''':,,:\': '.'

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You agree that regardless of billing or master account arrangemenlS you are liable for any and·a11 charges posted to youTro(lm(~). You are further liable for all damages to the room(s) caused by you or your guestslinvitees during your stay and your signarure on thls card authorizes aJl persons in your room(s) to charge to your accounL You authorize us to place a hold against your credit or debit card to guarantee charges and, in the event that you do not senle your account at your departure time or if room charges incurred by you or your gueslSlinvitees, or damages to your mom(s), are posted to your account subsequent to your depanure, you hereby authorize us to charge your credit card or debit card or apply funds you have on deposit with us against what you owe. The extenl of any complimenraries received is based upon qualified casino play that is reviewed during Itnd after your stay. Please notify a Guest Services Representative immediately if there are any errors to your name, rate or length of stay. FIreproof safety deposit boxes are provided for gueslS to d.eposit their valuables. We have no liability for guest valuables not deposited. By providing your email address, you consent to receiving and request, infonnational and promotional email from MGM MIRAGE and ilS related andlor affiliated resort properties. For information on MOM MIRAGE's Privacy Policy, please visit the One Club Booth or mgrrunirage.com. PelS are prohibited. .

~.'

x-----------------------------------------I agree to VDcate the room by 11:00 a.m. on the Dbove mentioned date.

Debit cards accepted only upon check out. MTC·IITLOOa (8105)

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WORKFORCE SAFETY AND INSURANCE WORi~fORCE SAFETY & INSURANCE BISMARCK, ND 58503-0649

SPENCER,DA VID W

Bismarck, ND 58503

t. ....

Electronic Payment (ACHlEFTlWire) deposited to your account


Payment Date: 04/26/2006


Reference: 00240907 Invoice Number Invoice Date Voucher In Gross Amount Discounts Taken Late Charges Paid Amount

041306DaveSpencer April 3/2006 00004843 46] .21 0.00 0.00 461.2] 041306DSpencer April 3/2006 00004844 66.66 0.00 0.00 66.66

~

~ ~ Vendor Number Name

IUUYJ4j bpenCer,lJav]Q W

Reference Date Total Gross Amt Total Discounts Total Late Charges . Total Paid Amt

00240907 Apr/26/2006 $527.87. $0.00 $0.00 $527.87 .. - - .

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; . North Dakota Workforce Safety

& Insurance To us, it's personal.

BLOG

PEOPLESOFT CLAIM FOR PAYMENT FINANCE DIVISION SFN 52557 (1212005)

APR 2 4: 2006

KK

1600 EAST CENTURY AVENUE, SUITE 1 PO BOX·5585

BISMARCK ND 58506-5585 TELEPHONE NUMBER (701) 328-3800

TOLL FREE FAX NUMBER 1-888-786-8695 TOO NUMBER (for the hearing impa.ired only)

(701) 328-3786 com

.5D

" TRAVEL EXPENSE VOUCHER STATE OF NORTH DAKOTA SFN 52785 (10-2004)

i Month Official Position

4. April 1 Year I Department

2006 Executive Chief of Employer Services Fiscal Month 1 ~, ... '''''u, .. - Employee Name I ~mplOyee 10 I Business Unit

Spencer, Dave 7009143 485

2 I""""'''''''' - Duluth 1:30 p.m. 10:30 p.m. 520 I 0 24.50 1 0 75.71 J 3 IDuluth ·tllSmarCK 3:30p.m. 11:30 p.m. 52010 49.0010

1 Purpose of Travel and =1'",,,,,,,u,1 of =I'C""C'" Interviewing/Recruiting Loss Prevention Staff.

/" /\

OtherT

other I

Air' "'''''I'UII .. UUII in State'

'Air ,a""I'UliaIlUII out of State



Meals In State. 521020

~5210BO , iRS Meals. Taxable 521035

'VI' ....... II .. "COUS Expense

inState

out of State

521025

5210B5

521010

521070

Vehicle Miles in State 1 x 1 521030

Vehicle Miles out of State 1 1,040.00 x 1 0.300 521090

1 Total~-(Ref. Doc. No. of Advance: )' 1 Less Travel Advance

,

1-

75.71

73.50

312.00.J .461.21

,-"uest Name: David Spencer

'!!BIll USA

a~ INN ON LAKE SUPER.lOR ~

Arrive: 04111/06 Time: 09:29PM Depart: 04/)'2/06 Time: 08:35 AM

04/11106 04/11106 04112/06

ROOM CHARGE 343 ROOM TAX 343t PAY AMERICAN EXPRE Ck Out 08:35

.. , .

ROOM TAX *********** 1 004 568291

Guest Signature: ---------------------------------------

350 Canal Park Drive Duluth, MN 55802

Tel: 218-726-1111 Fax: 218-727-3976

I ~OlioB~lance:

Page No. J

Room#: 343 FoJio#: R05436 - 1 Group#:

Guests: 1

Clerk: BRADY

Stat: HIST

Charges

$67.00 $8.71

Credits· ,,: .. : ',". '" -~ "

($75.71)

WSI

CA

North Dakota Workforce Safety

& Insurance To. tlSJ it's personai.

BLDG

PEOPLESOFT CLAIM FOR PAYMENT FINANCE DIVISION SFN 52557 (12/2005)



TOLL FREE FAX NUMBER 1-888-786-8695 TOO NUMBER (for the hearing Impaired only)

(701) 328-3786 www.WorkforceSafetY.com

Number

6 t//3 0 (P D S~(!.II..J.-

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TRAVEL EXPENSE VOUCHER $JAT[-OF NORTH DAKOTA St=N 52785 (10-2004)

Purpose and of Expenses:

March 7, 2006 -/SIUlPremium Auditing Meeting.

Department

EtXpanSBo$: or B

TOTAL ~~ __ ~~L-~ __ ~~~~ ____ ~ __________________________ ~ ____ -+ __ +-____ ~

Lodging OLiIOf ,Stale

WORKFORCE SAFETY AND INSURANCE WOF..K'.:ORCE SAFETY & INSURANCE BISMARCK, ND 58503-0649

SPENCER,DA VID W

Bismarck, ND 58503



Payment Date: 06127/2006


Reference: 00254698 Invoice Number Invoice Date VoucherID Gross Amount Discounts Taken Late Cbarges Paid Amount

062306 D. Spencer Junl23/2006 00005364 252.50 0.00 0.00 252.50

'-'

l - Vendor Number Name

IUU~}43 ~pencer,uavld W Reference Date Total Gross Amt Total Discounts Total Late Charges Total Paid Amt

00254698 Junl27/2006 $252.50 $0.00 $0.00 $252.50

,

North Dakota VVorkforce'Safe~

'. & Insurance WS I To us, it's personal.

I {oo I :B

PEOPLESOFT CLAIM FOR PAYMENT

. FINANCE DIVISION SFN 52557 (1212005)

i ENTERED r

JUN 2 6 2006.

KK CA BLDG

J

1600 EA$T CENTURY AVENUE, SUITE 1 PO BOX 5585


TOLL FREE FAX NUMBER 1-888-786-8695 TDD NUMBER (for the hearing impaired only)

(701) 328-3786 . com

/L.~

j

TRAVEL EXPENSE VOUCHER STATE o'F NORTH DAKOTA

Purpose Travel and Explanation

Tuesday - June 20, 2006 - Meeting in Fargo, ND with manufacturing focus group.

Thursday - June 22, 2006 - Meeting in Fargo, ND with Paul Schmidt, Case IH

expenses or a

~~~~~~~~~~~~~~~~~~ __ ~ ____ ~~~L-~~ __ T~OTAL

WOIUq<'ORCE SAFETY AND INSURANCE WORKFORCE SAFETY & rnSURANCE BISMARCK, ND 58503-0649

I1!iiNCER.DAVJ?W ve

Bismarck, ND· 503

Electronic Payment (ACHIEFTIWire) deposited to your account


PaytDent Date: 09/07/2006 Invoice Number Invoice Date VoucherID Gross Amount

SAUG16-06 Augl16/2006 00005884 181.06

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~ndor Number Name "'UU9143 I::ipenCer,lJaV10 W

Reference Date Total Gross Amt

00265731 Sep/07/2006 $181.06


Reference: 00265731 Discounts Taken Late Charges Paid Amount

0.00 0.00 181.06

Total Discounts Total Late Charges Total Paid Amt

$0.00 $0.00 $181.06

North Dakota· Workforce Safety

W.I & Insurance To us, it's personal.

Vendor

CA BLDG

J

PEOPLESOFT CLAIM FOR PAYMENT FINANCE DIVISION SFN 5255? (1212005)

1600 EAST CENTURY AVENUE, SUITE 1 POBOX 5585


TOLL FREE FAX NUMBER 1-888-786-8695 TOO NUMBER (for the hearing impaired only)

(701) 328-3786 com

.00 I~·£O

I , r

. :

i

TRAVEL EXPENSE VOUCHER STATE OF NORTH DAKOTA

and

Interview 4 LPS candidates

TOTAL

David Spencer 1600 East Century Bismarck, ND 58506 US

Room No.

Arrival

Departure

273

08-16-06

08-17-06

19~.

*~ tdVU'\! OF FARGO

Membership No.

NR Number

Group Code

Foliollnvoice No.

Page No.

Cashier No.

User 10

PC 290612944

876279

1 of 1

24

APETERSON

www.ichotelsgroup.com

.IL ___ D_a~te __ ~ ________________________ ~D~e~s~c~r~ip~t~io~n~ ______________ ~ ______ ~~C~h~a~r~g~e~s __ -L __ C~re~d~it~s~-J 08-16-06 Spirits - Beverage r·· - ... -.. ... ... .-[----.. -.. -.- ...... - ---.. ---.-._-.

#273 : CHECK #00001626

08-16-06' ." Accommodation 1--··-- ... --. --1-------····----·--·---·--·---· -

I·· -..... -.. -..... ---.- -1--------·-------.--.----'--------------. r----·-··-·· 17:5°T-----·--····-,

.------.-- .--... -.- .. r -. ··-60.00["-------··--,

08-16-06 Tax -----·---·-----·-r··--·-· 6.00 -r------, Thank you for staying at The Holiday Inn Fargo. Qualifying points will be

-'dited to your account. We look forward to welcoming you back_ ~. .

GuestSignature: ________________________________________ _

Total 83.50 0.00

Balance 83.50

I have received the goods and I or services In the amount shown heron. I agree that my liability for this bill is not waived and agree 10 be held personally liable in the event that the indicated person, company, or association fails to pay for any part or the full amount of these charges. If a credn card charge, I further egree to periorm the obligations set forth in the cardholders agreement with the Issuer.

Holiday Inn Fargo 3803 13th Ave South

Fargo, NO 58103 Telephone: (701j 282-2700 Fax: (701) 281·1240

CA

WORKFORCE SAFETY & INSURANCE FINANCE DEPARTMENT SFN 52557 (11/2004)

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IjJ::iMAKCK NO 58506-5585 TELEPHONE NUMBER (701) 328-3800

TOLL FREE FAX NUMBER1-BBB-786-8695 TOD NUMBER (for the hearing impaired only)

. (701) 328-3786

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Month

of Travel and Explanation

To Fargo, meetings with Case IH, Merit Care Hospital and Dakotah Medical Foundation staff.

0.00

David Spencer 1600 East Century Bismarck NO 58506

. US

Room No.

Arrival -

Departure

." . . .

132

05-18-05

. 05-19-05

OF FARGO

Membership No.

NRNumber

Group Code

Folio/Invoice No.

Page No.

Cashier No.

User 10

PC 290612944

154435

1 of 1

34

SPETERSEN

www.lchotelsgroup.com

Date

105~18-05 I i05-18~05

Description

. '1 Room Rate'

ITax -

Thank you for staying at The Holiday Inn Fargo. Qualifying points will be credited to your account We look forward to welcoming you back.

\.."

Guest Signature: ___________________ _

Total

Balance

Charges I Credits ... 45':00 ---'1"'--' ._ ... _- ..

4.73 ..... . . .. --I' -" . - -- ---

49.73 0.00

49.73

I have received the goods and I or serviCes In the amount shown heron. I agree thai my liability for this bill Is not waived and agree to be held personally liable In the evant that tha Indicated person. company. or association falls to pay for any part or tha full amount of these charges. If a credit ca!d charge. I further agree to perform the obfigatlons set forth In the cardholder's egreement wllh the Issuer. .

Holiday Inn Fargo 3803 .13th Ave South

Fargo, NO 58103 Telephone: (701) 282·2700 Fax: (701) 281·1240

WORKFORCE SAFETY AND INSURANCE WORKFORCE SAFETY & INSURANCE BISMARCK, ND 58503-0649


SPENCER,DA VID W

Bismarck, ND 58503

NON-NEGOTIABLE


Fold on this line for maiDng

Payment Date: 06/22/2005 Reference: 00122247 Invoice Number Invoice Date VoucberID Gross Amount Discounts Taken Late Charges Paid Amount

JUNE 05 DS 06/]712005 00002205 652.81 0.00 0.00 652.81

~

~ndor Number Name 700914., Spencer,lJaVld W


00122247 06/22/2005 $652.81 $0.00 $0.00 $652.81

TRAVi:L EXPENSE VOUCHER STATE OF NORTH DAKOTA SFN 52785 (10-2004) Month Year

June 2005 Fmployee Name

Dave Spencer - Hour Day Points Covered By Travel (Show AM or PM)

Depart Arrival

12 Bismarck - New Orleans 10:00AM 5:00PM

13

14

15 New Orleans - Bismarck 6:15AM 4:30PM

-..


Annual AASCIF Meeting in New Orleans

~

Line Due Date Dept. Account Oper. 10 Unit

Department Official Position

Executive Chief of Employer Services Employee ID J BUSin48~nit Fiscal Month Biennium

7009143 R Comm'l R Taxi & R Meals R

Vehicle Misc. Meals Lodging Lodging

Miles e Air e Other Air e Exp. InState Out of e

in State Out Of f Trans. f Trans. f State f State

43.00 37.60 0 170.37

170.37

37.60 0 170.37

23.50 0


Lodg. out of State 521075 511.11 Meals in State 521020

Meals out of State 521080 98.70 IRS Meals - Taxable 521035

Miscellaneous Expense 43.00 Other Transportation in State 521025

Other Transportation out of State 521085 6;

Air Transportation in State 521010


Vehicle Miles in State I x I 521030

Vehicle Miles out of State I x I 521090

Total Expenses 652.81 (Ref. Doc. No. of Advance: ) I Less Travel Advance

NET EXPENSES 652.81

Class Fund Project Activity Resource Resource Amount 10 10 Type Category

. /\ ~~.rtil~: the y"'juhin itemized ~#nt representing a claim for payment or per diem, mileage or travel expenses or a combination thereof,

1 TOTAL tru .~ ,nd rately lat~ Jays rvice and the mileage traveled, and the purpose thereof. I

EmpIOY~L. Date t /11/0 f ~

Departmental Approval

~~ Date 6.- (1 - oS-

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A Grand Hotel in the French Quarter

I} Royal SonestaHotel New Orleans

Spencer, Mr. David 1600 East Century Ave. Bismarck, ND 58506

ACTIVITY DATE CHARGE CODE DESCRIPTION

06/12/05 R# 1 Room Rate 06/12/05 RT 1 Room Tax 06/12/05 BK 1 OCCUPANCY TAX 06/13/05 R# 1 Room Rate 06/13/05 RT 1 Room Tax 06/13/05 BK 1 OCCUPANCY TAX 06/14/05 R# 1 Room Rate 06/14/05 RT 1 Room Tax 06/14/05 BK 1 OCCUPANCY TAX 06/15/05 AX 1 371572225281004 0209 MA

Subtotals:

PAID IN FULL --- THANK YOU!

06/15/05

99H1SX Page 1

Room 3186 CHARGES

149 .. 00 > 19.37

2.00 149.00,>

19.37 I 2.00

149.00) 19.37

2.00

CREDITS

1ID,~'7

511.11

====;=============== 511.11 511.11

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

**PRE-CHECK-OUT FOLIO. TOTAL SUBJECT TO AMENDMENT.** THANK YOU FOR STAYING AT THE ROYAL SONESTA HOTEL.

Signature X -----------------------------------------

300 Bourbon Street New Orleans, Louisiana 70130-2213 Telephone (504) 586-0300 Fax (504) 586-0335 www.royalsonestano.com

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.. u rnlua and Safety Hotline 1-800 .. 243 .. 3331

Report Fraud and Unsale Work Condlllons.

..• _ ... ~ .... " \/V I} ~:lB-3800

TOLL FREE FAX NUMBER 1-888-786-8695 TOO NUMBER (for the heating Impaired oniy)

(701) 328-3786

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ToNY!s O.:CAB SERVICE

'Honesty and ResponSibility

PASSENGER'S RECEIPT, TAXICAB FARE

DATE: , ( f - .. 2005 . / 3g 6D

...... AMOUNT OF FARE.. $ _______ _

, 5 (JD OrnER CHARGES I' $ _____ _

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TOTAL '13. z;o .$ ____ _

DRIVERS NAME: JUAN A. ORTIZ

TAXI NUMBER JPI-28 • I',

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------~lr--~·~'~--------------------------------------------------------------------------__ ~ . WORKFORCE SAFETY AND INSUR.ANCE WORKFORCE SAFETY & INSURANCE BISMARCK, ND 58503-0649

SPENCER,DA VID W

Bismarck, ND 58503




Pavment Date: 10104/2005 Reference: 00135590 Invoice Number Invoice Date Voucher ID Gross Amount Discounts Taken Late Charges Paid Amount

SEPT 05 DS SeP!26/2005 00003076 308.38 0.00 0.00 308.38

Vendor Number Name 7009143 l:>pencer,DaVld W


00135590 OctJ04/2005 $30B,3B $0.00 $0.00 $308.38

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WSI HelpLine 1·-800-777-5033

Questlons7 can us. Report Injuries ImmedfBlely.


IUUU ~,.,_ ...... _ .•. _.

Report Fraud and Unsafe Wor1t Conditions.

PO BOX 5585 BISMARCK NO 58506-5585

TELEPHONE NUMBER (701) 32B-3800 TOLL FREE FAX NUMBER 1-888-7B6-8695

TOD NUMBER (for the hearing impaired only) (701) 32B-3786

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Year Department Official Position I Month

Sept 2005 Executive Chief of Employer Services Employee Name Employee ID Fiscal Month Biennium

Spencer. Dave ··,·:····'Hour ....

Day Points Covered By Travel . (Show AM or PM) ·Oap.art .' .. Anival

20 Bis-Dickinson-Williston 10:00 a.m.

21 Williston - Minot

22 Minot- Bismarck 4:00 p.m.


Presentation at Comp Clinics in Dickinson. Williston and Minot. ND.

7009143 Taxi & R Misc.

Other' Air e . Trans. f Exp.

521 I 20.00

25.00

12.50



Meals in Stale 521020


IRS Meals -Taxable 521035


Other Transportation in State 521025

Other Transportation out of State 521085

Air Transportation in State 521010

Air Transportation out of State 521070.

Vehicle Miles in State I 521.00 x I 0.280 521030

Vehicle Miles out of State I x I 521090

Total Expenses (Ref. Doc. No. of Advance: I Less Travel Advance

NET EXPENSES

Line Due Dale . Dept. 10

Account Oper. Class Fund Unit

. Activity' ID

Resource Resource _. Type Category

I hereby certify thayne wilhi'}'ilemi,q Slalemenl»l\>resenUng a cleim for paymenl or per diem. mileage or travel expenses or e combinaUon thereof. / I truthfully and aceyral~ly Sla)l'5 ~ao/s 31_.e~Brld Ihe mileage traveled. and Ihe purpose thereof. TOTAL ~~~~~~+-~~~~------~------~-------------------.~~--~~~------,

?loyeeSlgycitu¢' (/A L Date /0/3 laS ~ /~y~ /-7" J z 'l' ( Departmental Approva\,. ~~ ~~ Date ~ _ tc.. -0 S-

49.50

55.50

105.00

57.50

145.88

308.38

308.38

Amount 'i.:

09/21/0t? ,3:55'Arill

Folio # ] 2088

SPENCER, DA YJD

, J

Airport International Inn P. O. Box 1800

Williston, ND 58802 701-774-0241

"

Room: Arrival:

BISMARCK, ND 58506 Departure:

Company: ,.,

Trans # Date Description Charges Payments

57919 912012005 Rrn: 202 State for 912012005 ' $45.00 $0,00 57920 912012005 10% SALES TAX for 912012005 $4.50 $0.00

Balance:

Folio Summary

Previous Balance: Room Charges:

Other Charges/Credits: Phone Charges:

Method of Pay: Credit Card Tax: Less Payments:

Signature: ---------------------1 Total Amount Due:

Thank you for choosing to stay with us.

Please let us know if there 'is anything we can do to make your next stay more enjoyable.

NV 2.1 SP 2

202 9/20/2005

9/2112005

Balance

$45.00 $49.50 $49.50

$0.00 $45.00

$0.00 $0.00 $4.50 $0.00

$49;50

.'} "I • to

4401 21SEP 4402 21SEP 4616 21SEP 4617 21SEP 4618 21SEP 4877 22SEP

Interna"op~ .. MINOT .nn

0921170326A

21SEP05 05:59pm

22SEP05

1

326

1

12:13pm

AX xxxx-xxxxxx-x1004 58503

WORKFORCE SAFETY

LOUNGE 911 PAIDOUT-TIPS 911 ROOM ROOM 326 STATE TAX ROOM 326 LODGING TAX . ROOM 326 AMERICAN EXPRESS

Balance Due

1505 North Broadway • P.O. Box 777· Minot, North D.akota 58702-0777 (701) 852-3161 • Fax (701) 838-5538 • For Reservations Call1·aOO-735-4493

email: iinn @ ndak.net • www.internationalinn.com

15.00 3.00

50.00 3.50 2.00

.00

50.00

1 o

TA

02/09

73.50

. .. ..• ~.KFORCE SAFETY AND lNSURANCE

WORKFORCE SAFETY & INSURANCE BISMARCK. ND 58503-0649


SPENCER,DAVID W

3 L ""Bismarck. ND 58503


Fold on this One for mailing

Payment Date: 10/11/2005 Reference: 00}37310 Invoice Number Invoice Date Voucher ID Gross Amount Discounts Taken Late Cbarges Paid Amount

SEPT 05 DAVES Oct/03/200S 00003129 438.90 0.00 0.00 438.90

Vendor Number Name '/UU':I143 :::ipencer.uaVld. W

Total Paid Amt Reference Date Total Gross Amt Total Discounts Total Late Cbarges

00137310 Oct/111200S $438.90 $0.00 $0.00 $438.90

CA

,-.


. -::-.

1600 EAST CENTURY AVENUE, SUITE· POBOX558~

BISMARCK NO 58506-558~ TELEPHONE NUMBER (701) 328-380C

'ND Fraud and Safety Hotline I TOLL FREE FAX NUMBER 1-88B-786-B69~ 1-800-243-3331 TOO NUMBER (for the hearing impaired only;

Report Fraud and Unsafe War!< CondlUans, (701) 328-37 BE

WSI HelpLine 1-800-7n-5033

QuesUons7 c..J1 us. Report InJuri .. Immediately.

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Department Official Position , ,V'VIIIII

September I Year 2005. Executive Chief of Employer Services

Employee Namd Employee 10 Fiscal Month Biennium Spencer, Dave

Bis-Wahpeton-Fargo 9:00 a.m.

27 Fargo

28 Fargo-Grand Forks

29 Grand Forks-Bismarck 5:00 p.m.

Purpose ofTravel and Explanation of Expenses:

Presentation at Comp Clinics ~ Wahpeton, Fargo and Grand Forks, ND

Line Due Date Dept. 10 ..

Account Oper. UnIt

7009143

680 I

···\Taxl &;. R '::bilier Air"· e ",J~afl:s.. . f

Misc.· . {M~~ls'-: Exp. In Stale :

20.00 25.00

25.00

12.50

; Meais·'.> Out'of .: .State .. '



Meals in Slate 521020


IRS Meals - Taxable 521035


Other Transportation in State 521025

Other Transportation out of Stale 521065

Air Transportation in Siale

Air Transportation out of State Vehicle Miles in Slate I 680.00 Vehicle Miles out of State I Total Expenses (Ref. Doc. No. of Advance:

NET EXPENSES

Class Fund Project .' ... ID

521010

521070

xl 0.280 ;;21030

x I

Activity 10

521090

I Less Travel Advance

Resource Resource Type .' Category

I hereby~#e :~*,a;tth~~i:n ~mize41atement representing a daim for payment Dr per diem. mileage or \ravel expenses or a combination thereof. J / TOTAL INthfuny a rate ateythe d'flA of service and the mileage traveled. and /he purpose thereof. ~~~~~~~~--------~--~--~------------~-,~--__ ~r---~-. Emp'Jt:t..gn~tfry' f Dale 101<- /, <' ~ .nrY'L4/ll/ 1"/ SLq J

55.25

55.25

Lbdging' OutOt

:'-State' .'> ~ "', ".

55.50 V

166.00

82.50

190.40

438.90

438.90

Amount

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- ...... ....,!!I!~ ............

15 facility is operated under franchise agreement with Ramada Franchise System, Inc.

D a 'c e .() 9 / .~::") / 0::; ..... ~,,~ .. '""'- .. '''''''''-TI'lN . G F I<. .··~··~I i::;:;;i·~~···:"_:~·:'::::~:;O::-c::::::=:':-.=".,c TiMe 11:02 P.O. BOX 13757

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. . .XfJtiJ:·~~iiy. f{a~ada 1111'1

;se1';j~c~~~lIniessyou .call )!t; .. ",..i''';·'''n1. i~~ 'j;tLS5421-imO to opt out .

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F;:C.Ol'fi . Ty pl:' NIlD i 50.0

SE:~:; 28 ()~f j, L) : ~~~, ~) E~ 1=' ;::~,) O::i :1. 1 . ()~j .. I ... JI

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Mr David Spencer

Pataskala, OH 43062-9641 .. US

.Room No.

Arrival

Departure

Date , .-- --___ - . __ ._--......1..--

703

09-26-05

09-28-05

09-26-05 ! Room Rate -.~=-=.=o;_ .-

09-26-05 !Tax

OF FARGO

Membership No.

AJR Number

Group Code

Folibllnvoice No .

Page No.

Cashier No.

User ID

PC 290612944

192114

1 of 1

34

SPETERSEN

www.ichotelsgroup.com

--,-----_ .. _-, --------~

I I !

Charges I Credits : ~======~==~===-~--=~~----~

==============:!,==11=9.=95~4--+=2 ~'t~:

Description

Ii 12.59 . i i . I

~09:-2?:05=~r*Gall~~s~nt- #703 : CHECK #0-0-00-5536 I 3.00 I :=;:;~=27=-05-~=' ~~ry Restaurant #703 : CHECK #00005536 -3.00 i ~27-051 Room Rate ========11!===1-1=9=.9=5==11~===== ~=========- ,==~======================~================= . ;~~=~?-0~_ .. __ :2:~~_c. -=r Thank you for staying at The Holiday Inn Fargo., Qualifying points will be credited to your account. We look forward to welcoming you back.

GuestSignature: __________________ =--==-__ == __ ~ ____ _=== __

Total

Balance

12.59 , ----'-------, .

265.08 0.00

265.08

I have received the goods and I or services in the amount shown neron. I agree that my liability for this bill is not waived and agrp.E' \0 be held personally liable in 'the event that the Indicated person, company, or association falls to pay for any part or the full amount of these charges. If a credit card charge, I further agree to perform the obligations set forth In the cardholder's agreement with the issuer.

Telephone:

fu- Q)re~ (bk IAJC{(~~~)

d " 1'\ r-f ,,,.,J. tI$e. 1-. Holiday Inn Fargo I' 380313th Ave South 7 ! { j.

Fargo, NO 58103 """'Jl, -ft- , ~ (701) 282-2700 Fax: (701) 281-1240

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Travel

Policy 521 - Moving Expenses

August 1, 2003

Permanent Employees: Chapter NDCC 44-08-04.3 allows for payment of moving expenses for "a pennanent employee who has been employed in that department, institution or agency not less than one year" when the employee is transferred to another city for new duty assignment "of a permanent nature within that department, institution or agency."

Moving expenses are to be processed on a claim for payment in SAMIS as follows:


Reimbursement for allowable moving expenses which are not taxable to the employee but are reportable to the Internal Revenue Service (IRS): 1. All actual costs of moving personal household goods and furnishings, not to exceed 11,000

lbs. (4,989.60 kilograms). 2. Transportation, of one vehicle, (not to exceed 12¢ per mile for travel by car) and lodging

expenses incurred by the employee and immediate family while en route to the employee's ~ . new duty station. This does not include meals.


Reimbursement for taxable moving expenses reportable to the lRS. 1. Meal expense incurred by the employee and immediate family while en route to the new duty

station. 2. Transportation expenses are limited to one round trip, and actual meal and lodging costs for a

pre-move house-hunting trip, for the employee and spouse,fot three days. 3. The expenses for the employee and immediate family while occupying temporary quarters

within the state not to exceed 30 days. 4. Reimbursement for mileage that exceeds 12¢ per mile for travel by car while enroute to the

employee's new duty station.

Limitation: reimbursement for the relocation of permanent employees is limited to $5,000 by statute. Verification for expenses will be a paid receipt from a licensed moving company, highway mileage between duty stations, meal, and lodging receipts.

(continued)

67

-' . . .. , ~ .

K ELL ~ I N H D! S·rt ARC K 1&80 HORTH laTH STREET

etsMARCK, NORtH DAKOTA 58501

(701) 223-8001 RESEr<VATIONSI 1-800-6:35-355'3

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Policy 521 (continued)


Travel

August 1, 2003

New Employees: payment of moving expenses for newly hired employees is not specifically addressed by statute. However, it is recognized that market conditions for some higher-level, professional positions involve competitive recruitment activity that often requires payment of moving expenses as a part of the employment agreement. .

Agency administrators may include moving expense reimbursement as part of a job offer when it can be demonstrated that local employment market conditions and job requirements are such that recruitment outside of the immediate geographical area was necessary and where such reimbursement is necessary to attract the best candidate.

Reimbursement is not limited to $5,000 for new employees.

68

January 5,2005

.~C.S.P.

~062

Dear Dave:

On behalf of Workforce Safety & Insurance (WSI) I am pleased to offer you the position of Chief of Employer Services, with a starting salary of$98,000 annually. In addition to your salary, the following employer-paid fringe bimefits are included with your employment: health insurance, $1,300 ofllfe insurance, employee assistance program, and an 8,.12% retirement contribution (if you elect to go with the defined contribution plan). You will accrue sick leave at the rate of 12 days per year and annual leave, which is based on years of service and begins with 12 days per year.

WSI would also like to extend to you the following relocation concessions:

• Transportation expenses for one pre-move house-hunting trip, including round trip mileage . (not to exceed 12 cents per mile) or airfare, actual meals, and actual lodging for the employee and spouse, for up to three consecutive days.

• Transportation of one vehicle (not to exceed 12 cents per mile) while en route to the employee's new duty station.

• Actual meal and lodging expenses incurred by the employee and immediate family while en route to the employee's new duty station. .

• Actual cost of rental truck or licensed moving company. o Any lodging expenses for the employee and immediate family while occupying temporary

quarters withln the state not to exceed thirty days.

You must submit receipts to be reimbursed for these items and portions of the reimbursement may be taxable and reported on your federal W2. In the event of a voluntary resignation, you will be responsible to repay the relocation reimbursement according to the following schedule:

Resignation Before 1 Year Between 1 and 2 Years After 2 Years

. Responsible to Repay 100% 50% 0%

I am looking forward to hearing from you. Feel free to contact me directly at (701) 328-6025 or . [email protected] if you have any questions or need further infonnation.

Sincerely,

Amy Klein Human Resource Generalist

['.-':;-RKFOR~~ SAFETY AND INSURANCE WORKFORCE SAFETY & INSURANCE BISMARCK, ND 58503·0649

I !~ SPENCER,DA VID W

Bismarck, ND 58503


NON-NEGOTIABLE

. Fold on this line for mailing

Payment Date: 04/20/2005 Reference: 00107990 Invoice Number Invoice Date Voucher ID Gross Amount Discounts Taken Late Charges Paid Amount

APR OS DS 04/15/2005 00001613 169.46 0.00 0.00 169.46

~ndor Number Name 7009143 Spencer ,DaVld W


00107990 04/20/2005 $169.46 $0.00 $0.00 $169.46

TRAVELE~PENSE VOUCHER STATE OF NORTH DAKOTA SFN 52785 (10-2004)

Month

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Mr David Spencer . 'Ir

askala OH 43062 US

Room No.

Arrival

Departure

119

04-11-05

04-13-05

OF FARGO

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Date Description I Charges

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l Thank you for staying at The Holiday Inn Fargo. Qualifying points will be credited to your account. We look forward to welcoming you back.

Total 99.46 0.00

Balance 99.46

Guest Signature: ___________________ _

I have received the goods and I or services in the amount shown heron. I agree that my liability for this bill is not waived and agree to be held personally liable In the event that the indicated person, company, or association fails to pay for any part or the full amount of these charges. If a credit card charge, I further agree to perform the obligations set forth In the cardholder's agreement with the Issuer. ..

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SPENCER,DA VID W

41" F' Bismarck, ND 58503

NON-NEGOTIABLE

Electronic Payment (ACHlEFTfWire) deposited to your account 2552022374

Fold on this line for mal1ing

PaY1llent Date: 05117/2005 Reference: Iilvoice Number Invoice Date VoucherID Gross Amount Discounts Taken Late Charges

AY 05 DS 05/1112005 00001929 693.70 0.00 0.00

SMAY05 0511112005 00001930 884.69 0.00 0.00

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~ilorNumber Name 7009143 . Spencer ,David W

Reference Date Total Gross Amt Total Discounts Total Late Charges

00115922 05/17120' $1,578.39 '0 $0.00

00115922 Paid Amount

693.70

884.69

Total Paid Amt

$1,578.39

'.

Sandy, David

From: Blunt, Sandy A.

Sent: Monday, April ii, .2005 5:31 PM

To: Long, James D.; Sandy, David

Subject: FW: Moving Expenses

From: Bob Indvik [mailto:[email protected]] Sent: Monday, April 11,20055:09 PM To: Blunt, Sandy A. Subject: Moving Expenses

Dave Sandy.

Page 1 ofl

I have been made aware that Sandy Blunt's moving expenses were considered income to him and thus were subject to income tax.

Part of the offer accepted by Sandy to. become Executive Director/CEO of WSI was payment of all moving related expenses. Therefore I am authorizing WSI to reimburse Sandy for the amount of the tax liability. Ifs the board's intent to cover all moving related expenses.

I am also aware that part of Dave Spencer's compensatidn package also included payment of moving expenses. WSI is authorized to reimburse Dave for the amount of the tax liability.

Bob Indvik.

411212005

·j o.

. WORKFORCE SAFETY AND INSURANCE WORKFORCE SAFETY & INSURANCE BISMARCK, NO 58503-0649


SPENCER,DA VID W b

Bismarck, ND 58503

NON-NEGOTIABLE

Electronic Payment (ACHlEFTlWire) deposited to your accouII:t

Fold on this One for maiOng

Payment Date: 06/07/2005 Reference: Invoice Number Invoice Date Voucher ID Gross Amount Discounts Taken Late Charges

June 05 DS 06/0212005 00002087 77.30 0.00 0.00 May OS ds 06/01/2005 00002088 75.73 0.00 0.00

~

~endor Number Name IUU~143 ~pencer,UavlC1 W

Reference Date Total Gross Amt Total Discounts Total Late Charges

00119567 06/07/2005 $153.03 $0.00 ' $0.00

00119567 Paid Amount

77.30

75.73

Total Paid Amt

~153.03

CA

CLAIM FOR PAYMENT WORKFORCE SAFETY & INSURANCE FINANCE DEPARTMENT SFN 52557 (11/2004)

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"':'1 nl:flpL.lne 1-800-7n-5033

QuesIIons? Call us. Repon Injuries . ImmedlllloIr·

ND Fraud and Safety Holllne 1-800-243-3331

Report Fraud and Unsafe Work CondlUans.

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IOUU ~::'I L:cNTURY AVENUE, SUITE 1 PO BOX 5585


TOLL FREE FAX NUMBER 1-888-786-8695 TOO NUMBER (for the hearing Impaired only)

(701) 328-3786

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Purpose

Conduct Audits with Minot Field Staff

Department

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michael r hoffman - the dakota beacon:_2008... · charles a. blunt 4716 amberglow drive bismarck,...

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