CM-10-08-169ROUND ROCK, TEXAS
PURPOSE. PASSION. PROSPERITY.
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 $4.141.08
Item Caption: from Texas Forest Service for "TF Austin Exercise"
Approval Date: 20 August 2010
Department: Finance
Project Manager: Cheryl Delaney, Finance Director
Item Summary:
This item is a request to obtain reimbursement in the amount of $4.141.08 from the Texas Forest Service for
expenses related to four employees who were deployed for service related to Hurricane Alex.
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
TEXAS
FOREST jc SERVICE
The Texas A&M University System
PART 1- PAYMENT INFORMATION
REGIONAL
INCIDENT MANAGEMENT TEAM
TRAVEL AND PERSONNEL
REIMBURSEMENT FORM
Check One: E Participating Agency / Employer
TFS Voucher leo.
Individual Member
Payee Name
City of Round Rock Police Department
TRANSPORTATION
AVM Vendor
Subject to State of
Texas Maximums
Address
221 E. Main Street
Round Rock TX 78664
City of Round Rock Police Department
Contact
Street
Christi McAllister
Town/City State
512-218-5433 cmcallister@round-rock.tx.us
Zip
Name
Phone Number Email Address
Incident/Event Hurricane Alex
PART 2 - SALARY / BACKFILL / PAYROLL ASSOCIATED COSTS
Please attach a completed Payroll Calculation Worksheet as supporting documentation.
Beg/End Dates
06/29/10
07/01/10
(1)
REIMBURSEMENT TO AGENCY / EMPLOYER
A
Payroll Expenditures for RIMT members during activation
8
Cost of backfull while RIMT members are activated
Subtotal
REIMBURSEMENT TO INDIVIDUAL MEMBER
Subtotal
PART 3 - TRAVEL / MILEAGE / SUPPLIES
List each RIMT Member separately. Please include the Daily 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 Police Department
$ -
$ -
$ -
2
3
4
5
6
7
8
9
10
Subtotal
PART 4 - CERTIFICATION
1 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 applicable limitations period.
Si ' ..e of Employer or Individual Member
Date TFS Accounts Payable Approval Date
TFS IMT Departmental Authorization
Date
FAMIS Coding (SL -SA -OBJ Code)
NOTE: Signature and supporting documentation are required; incomplete reimbursement forms will delay payment.
Q610-03-11,1
AMOUNT
4,141.08
4,141.08 I
AMOUNT
$ -
$
$ -
$
$
$ -
$ -
$ -
$ -
$ -
$ -
TOTAL
$ 4,141.08
Revised 01/27/09