CM-09-07-126Governor's Division of Emergency Management
IN STATE MUTUAL AID REIMBURSEMENT INVOICE
DISASTER / EVENT: Hurricane Ike
RESPONSE TYPE: PWRT
DATES DEPLOYED: FROM: 09/19/2008 TO: 11/25/2008
DATE SUBMITTED: 04/30/2009
FROM: CITY: Round Rock COUNTY: Williamson DEPARTMENT:
Finance
REMIT PAYMENT TO: City Of Round Rock, 221 E. Main St., Round Rock, TX 78664
(Make Check Payable to
and mailing address info)
COPIES OF RECEIPTS AND PAYMENT VOUCHERS FOR EACH CLAIM
ARE ATTACHED: 151 YES
■ NO
Force Account Labor Cost
Travel Cost
Time Cost
Benefit Cost
Meals
Lodging
Regular Time
Overtime
Sub Total
Labor Cost Total =
Mileage (Personal Vehicles)
Other
Travel Cost Total =
Force Account Equipment Cost Total =
Materials Cost Total =
Contract Work Cost Total =
Rented Equipment Cost Total =
Other Costs =
GRAND TOTAL =
DESCRIPTION OF SERVICES PROVIDED:
$ 10,142.30
$ 10,142.30
In response to request for deployment to Port Arthur, Tx in support of Hurricane Ike response & recovery operations.
Deployment of resources and self-sufficient personnel.
CERTIFIED AND APPROVED BY:
SIGNATURE:
PRINTED NAME: s R. Nuse, PE
EMAIL ADDRESS: cmcallister( round-rock.tx.us
TITLE: City Manager
DATE: 7/10/2009
PHONE NUMBER: 512-218-5433
The Authroized official of the assisting Agency certifies that the totals for each category'/claim are exact costs expended by the Assisting
Agency to perform the services requested. All additional supporting documentation not included with this claim will be maintained by the
Assisting Agency for a period of three (3) years following the above date of submission and may be obtained for audit purposes by notifying
the Assisting Agency authorized official named herein, or other appropriate persons.
7/8/2009 10:10 AM
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DISASTER / EVENT 1
Hurricane Ike
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PERIOD COVERING I
09/19/08 TO 11/25/08
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I CERTIFY THE ABOVE INFORMATION TO BE ACCURATE AND THAT THESE COSTS ARE ELIGIBLE FOR REIMBURSEMENT ACCORDING TO STATE POLICY.
City Manager 7/10/2009
AUTHORIZED SIGNAItJf TITLE DATE
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Governor's Division of Emergency Management
MATERIALS SUMMARY RECORD
1DESCRIPTION OF WORK PERFORMED
In response to request for deployment of resources and self-sufficient personnel to Port Arthur, Texas in support of Hurricane Ike response and r
TOTAL PRICE
$ 80.00
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$ 7,550.50
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$ 606.78
$ 604.59
$ 55.67
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$ 10,142.30
APPLICANT
(City of Round Rock, Texas
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Port Arthur
UNIT
PRICE
$ 80.00
$ 980.00
$ 7,550.50
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$ 604.59
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DESCRIPTION OF PURCHASE
MATERIALS / GOODS / SERVICES
Provide justification for purchase who/where/why
Program Radios and Charges
4 @ 20.00 each
Program Radios and Charges
24 @ 20.00 each, 20 @ 25.00 each
Vaccinations against Hepatitis A and B for
protection of staff deployed to disaster area.
Field supplies - food, consumables, etc.
Field supplies - food, consumables, etc.
Field supplies - food, consumables, etc.
Field supplies - food, consumables, etc.
Field supplies - food, consumables, etc.
VENDOR
RZ Communications, Inc.
Inv. #35747
RZ Communications, Inc.
Inv. #35291
Concentra / Occupational Health
Centers of Southwest, PA
Inv.#309918709 and #309915558
Wal-Mart
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Academy Sports & Outdoors
Wal-Mart
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7/8/2009 10:26 AM
CITY OF ROUND ROCK, TEXAS - HURRICANE IKE REIMBURSEMENT
Hep A Hep B
1 Abbott, Jack 73.00 117.50
2 Ackerman, Michael 73.00 60.00
3 Ainsworth, Norman 73.00117.50
.-..__.._....._
4 Allen, Jeffrey 73.00 117.50
5 Avila, William 73.00 117.50
6 Babin, Alain - 117.50
7 Briones, Raymundo 73.00 117.50
8 Cargill, Craig - 117.50
9 Carmichael, Justin 73.00 117.50
10 Carmichael, Patricia 73.00 117.50
11 Claypool, Joseph 73.00 117.50
12 Dixon, William - 117.50
13 Eckard, Jesse 73.00 117.50
14 Evans, Troy 130.50 -
15 Gray, Marc 130.50 60.00
16 Grubbs, Melissa 73.00 57.50
17 Hall, Bennett 73.00 117.50
18 Hallford, Jerry 73.00 117.50
19 Hau, Thomas 73.00 117.50
20 Herrera, Raymond 73.00 117.50
21 Huf, Jason 73.00 117.50
22 Hunter, James 130.50 -
23 Johnson, Jack 130.50 60.00
24 Kincaid, Michael 73.00 117.50
25 Mcbreen, Kevin 190.00 60.00
26 McKinney, Andy 73.00
27 Mitchell, Aaron 73.00 60.00
28 Morales, Raul 73.00 117.50
29 Myers, Charles - 90.50
30 Richards, James 130.50 60.00
31 Rodriguez, Ray 73.00 117.50
32 Ryle, Jacqueline 73.00 117.50
33 Ryle, Tim 73.00 117.50
34 Saffel, Shannon 73.00 60.00
35 Saldana, Roy 73.00 60.00
36 Saldivar, Abel 73.00 117.50
37 Saucedo, Robert 73.00 117.50
38 Stowe, Riley 73.00 60.00
39 Strong, John 73.00 60.00
40 Syma, Lonnie 130.50 -
41 Thach, Deborah 130.50 60.00
42 Uhrig, Jeffrey 73.00 117.50
43 Vela, Santos 130.50 -
44 Wenzel, Chris 73.00 117.50
45 Wise, Gary 73.00 117.50
3,570.00 + 3,980.50 = 7,550.50
DATE:
SUBJECT:
ITEM:
Department:
Staff Person:
Justification:
Funding:
July 8, 2009
Hurricane Ike Deployment Reimbursement Request
Authorize the City Manager to sign the reimbursement request to the
Governor's Division of Emergency Management for additional expenditures
related to the Port Arthur deployment from Sept. 2008.
Finance
Cheryl Delaney, Finance Director
This reimbursement is for items previously submitted under the
sheltering reimbursement that were identified by the State as needing to
be re -submitted under the deployment to Port Arthur.
N/A
Outside Resources: Port Arthur $10,142.30
Background:
The City of Round Rock deployed Police and Street department
personnel to the cities of Port Arthur and Galveston following
Hurricane Ike to assist in the cleanup.
5/17/2009
Request for City Council/City Manager Action
City Council j.' City Manager
Submit completed form for all City Manager and City Council approvals.
Department Name: Finance
Contact Person: Cheryl Delaney/Misty Gray
Project Mgr/Resource: Elaine S. Wilson
Project Coordinator: Elaine S. Wilson
Assigned Attorney: J. Kay Gayle
City Council or City Manager Approval Date:
Agenda Wording
For pil5lelstatitdttE ONLY
July
p
Received: dii+Y i9 8 11
Tag#: C -VI-
original Documents Received: `i
Project Name: Hurricane Ike Deployment Reimb Request
ContractorNendor: Governors Division of Emergency Mgmt
Funding Source: General Fund
Additional funding Source:
Amount: $10,142.30
Account Number: 4615 -loo -00000
7/10/2009
Authorize the City Manager to sign the reimbursement request to the Governor's Division of Emergency Management for additional expendtures related to the Pon Arthur deployment from Sept. 2
Finance Information
Is Funding Required?
Initial Construction Contract
Construction Contract Amendment
Change Order
❑Change in Quantity
Initial Professional Services Agreement
Supplemental Professional Service Agreement
Q Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
Yes Ea No
nUnforeseen Circumstances
Other (Please clearly identify action on lines below)
Amount
)08
Required for Submission of ALL City Council and Citv Manager Items
Project Mgr. Signature: Elaine S. Wilson fj
Dept. Director Signature:
*City Attorney Signatu
City Manager Signature:
Date:
Date:
Date:
Date:
7/8/2009
;City Attorney signature is required for all items.
REVISED 7/8/2009