CM-11-05-109ROUND ROCK, TEXAS
PURPOSE, PASSION. PROSPERITY.
Agenda Item No.
City Council Agenda Summary Sheet
Consider executing invoice packet ("Regional Incident Management Team Travel and
Personal Reimbursement Form") to obtain reimbursement in the amount of $11,507.04
Agenda Caption: from Texas Forest Service for the Possum Kingdom Complex Fire.
Meeting Date: 27 -May -2011
Department: Finance
Staff Person making presentation: Cheryl Delaney
Finance Director
Item Summary:
This item is a request to obtain reimbursement in the amount of $11,507.04 from the Texas Forest Service for
expenses related to personnel and equipment deployed for service related to the Possum Kingdom Complex Fire.
Strategic Plan Relevance:
8.0 — Maintain and enhance public confidence, satisfaction and trust in City Government
Cost: $11,507.04
Source of Funds: General Funds
Date of Public Hearing (if required):
Recommended Action:
REV. 6/10/10
TEAS
FOREST SERVICE
The Texas A&M University System
PART 1- PAYMENT INFORMATION
REGIONAL
INCIDENT MANAGEMENT TEAM
TRAVEL AND PERSONNEL
REIMBURSEMENT FORM
Check One: ❑X Participating Agency / Employer
Payee Name City of Round Rock Police Department
Address
221 E Main Street
LiIndividual Member
Round Rock
TX 78664
Contact
Street
Christi McAllister
Town/City
State
512-218-5433 cmcallister@round-rock.tx.us
Name
Phone Number
Zip
Email Address
Incident/Event Possum Kingdom Complex Fire TX-TXS-011(
PART 2 - SALARY / BACKFILL / PAYROLL ASSOCIATED COSTS
Please attach a completed Payroll Calculation Worksheet as supporting documentation.
Beg/End Dates
04/15/11
/
04/20/11
(I)
REIMBURSEMENT TO AGENCY / EMPLOYER
TRANSPORTATION
A
Payroll Expenditures for RIMT members during activation
Airfare, Car Rental, or
Fuel receipts required
8
Cost of backfull while RIMT members are activated
City of Round Rock Police Department
$ -
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
requ'red receipts to a separate sheet of paper and submit with this form.
MEALS/LODG ING
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
Subtota I
PART 4 - CERTIFICATION
I certify that the above services were rendered or goods received; that they correspond in every particular with the contract
under w h hey were procured; that the invoice is true and unpaid; and that the claim was presented to the State within
the a •J. • e Iimita ions period.
ignature •f Employer or ividual Member Date
TFS IMT Departmental Authorization
Date
TFS Accounts Payable Approval Date
FAMIS Coding (SL -SA -OBJ Code)
NOTE: Signature and supporting documentation are required; incomplete reimbursement forms will delay payment.
CA4-. t -o5 t ooi
AMOUNT
$ 10,854.73
652.31
11,507.04
AMOUNT
$
$
$
$
$
$
$
$
TOTAL
$ 11,507.04
Revised 01/27/09
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