CM-10-06-120'ROUND ROCK. TEXAS
PURPOSE. PASSION. PROSPERITY
CITY OF ROUND ROCK
221 E. MAIN STREET
ROUND ROCK, TX 78664
PHONE 512-218-5400
Invoice #: TFS1
Invoice Date: 5/29/2010
Customer ID: TFS
Bill To:
Texas Forest Service
Catherine Roggenbuck
301 Tarrow #304
College Station, TX 77840
Ship To:
Invoice
Quantity
Item
Description
Unit Price
Total
TF Austin Exercise
May 3—May 7, 2010
Ann Treffer & Ken Evans salaries
$4,166.34
meals
$ 178.00
transportation
$ 88.61
Subtotal
$4,432.95
Tax
Shipping
Miscellaneous
Balance Due
$4,432.95
REMIT TO:
City of Round Rock
Attn: Elaine Wilson
221 E. Main Street
Round Rock, TX 78664
'� -1 D-Olp .120
TEXAS
FOREST SERVICE
The Texas A&M University System
PART 1- PAYMENT INFORMATION
PayeeName City of Round Rock
Address 221 E Main St
Contact
REGIONAL
INCIDENT MANAGEMENT TEAM
TRAVEL AND PERSONNEL
REIMBURSEMENT FORM
Check One: VParticipating Agency / Employer
Individual Member
Street
Christi McAllister
Round Rock
Town/City
Incident/Event TF Austin Exercise
PART 2 - SALARY / BACKFILL / PAYROLL ASSOCIATED COSTS
Please attach a completed Payroll Calculation Worksheet as supporting documentation.
TX 78664
State Zip
512-218-5433 cmcallister@round-rock.tx.us
Phone Number Email Address
Beg/End Dates
05/03/10
/
05/07/10
(1)
REIMBURSEMENT TO AGENCY / EMPLOYER
A
Payroll Expenditures for RIMT members during activation
B
Cost of backfull while RIMT members are activated
Subtotal
pU
REIMBURSEMENT TO INDIVIDUAL MEMBER
Subtotal
PART 3 - TRAVEL / MILEAGE / SUPPLIES
List each RlMTMember separately. 'Please incldde'the Dnilk Meal Log,
Daily Mileage Log, and Daily Supply Log for each individual. Attach all
required receipts to a separate sheet of paper and submit with this form.
MEALS/LODGING
TRANSPORTATION
SUPPLIES
Subject to State of
Texas Maximums
Airfare, Car Rental, or
Fuel receipts required
Itemized receipts
required
1
City of Round Rock
$ 178.00
$ -
$ 88.61
2
-
$
-
$
3
$
-
$
266.61
4
5
6
7
8
9
10
Subtotal
PART 4 - CERTIFICATION
I certify that the above services were rendered or goods received; that they correspond in every particular with the contract
under which they were procured; that the invoice is true and unpaid; and that the claim was presented to the State within
the applicably imitations period.
Signature of •toyer ndividual M- ber
Date
TFS IMT Departmental Authorization
Date
TFS Accounts Payable Approval Date
FAMIS Coding (SL -SA -08J Code)
NOTE: Signature and supporting documentation are required; incomplete reimbursement forms will delay payment.
AMOUNT
$
4,166.34
4,166.34
AMOUNT
$
266.61
$
-
$
-
$
$
-
$
-
$
-
$
-
$
-
$
-
$
266.61
TOTAL
$ 4,432.95
Revised 01/27/09
k
(
(
41.
B
;
(
k
\
§
41.
§
0
§
AVd 3WI1B3AO
(
\
)
PAYROLL -ASSOCIATED BENEFITS WHILE EMPLOYEE IS ACTIVATED
B. COST OF BACKFILL WHILE RIMT MEMBERS ARE ACTIVATED
k
\
\
)
8
8
0
;
k
\
■
)
5
F,
8
§
(
k
}
41.
a
;
!
41.
PAYROLL -ASSOCIATED BENEFITS WHILE EMPLOYEE 15 ACTIVATED
(
NOIIVAIDV 9
31fIVN 1N3UIONI
asmax3 u);snd31
133HSN OM NOLLV1fY1VD TIOSIAVd
Km
• z
• ®
10.,9.09
Request for City Council/City Manager Action
IID City Councils 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:
Assigned Attomey:JK Gayle
City Council or City Manager Approval Date:
Agenda Wording
For Adin nis}ration tT e ONLY41'
J_PC9?))
Received:��yy�
Tag #: L'T Jl, 1 GL
Original Documents Received: 2
Project Name: Texas Forest Service Reimbursement
ContractorNendor: Texas Forest Service
Funding Source: General Fund
Additional funding Source:
Amount
6/11/2010
4432.95
Account Number: 4615-100-00000
Consider executing invoice packet ("Regional Incident Management Team Travel and Personal Reimbursement Form") to obtain reinbursement in the amount of $4,432.95 from Texas Forest
Service for "TF Austin Exercise"
Finance Information
Is Funding Required?
Initial Construction Contract
Construction Contract Amendment
Change Order
Change in Quantity
Initial Professional Services Agreement
Supplemental Professional Service Agreement
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
Yes No El
Unforeseen Circumstances
Other (Please clearly identify action below)
Amount
Required for Submission of ALL City Council and City Manager Items
Project Mgr. Signature:
Dept. Director Signature:
*City Attorney Signature:
City Manager Signature:
Date:
Date:
Date:
Date:
ct, 1 oti (
'City Attorney signature is required for all items.
REVISED 6/9/2010
ROUND ROCK, TEXAS
PURPOSE. PASSION. PROSPERITY.
Item Caption:
City Manager Approval Summary Sheet
Consider executing invoice packet ("Regional Incident Management Team Travel and
Personal Reimbursement Form") to obtain reimbursement in the amount of $4,432.95
from Texas Forest Service for "TF Austin Exercise"
Approval Date: 11 June 2010
Department: Finance
Project Manager: Cheryl Delaney, Finance Director
Item Summary:
This item is a request to obtain reimbursement in the amount of $4,432.95 from the Texas Forest Service for
expenses related to two employees who were sent to Galveston Texas for the Texas Forest Austin Exercise.
Strategic Plan Relevance:
8.0 — Maintain and enhance public confidence, satisfaction and trust in City Government
Cost: Please put cost for this item ONLY
Source of Funds: Please use same source as on RFA
REV. 3/8/10