HomeMy WebLinkAboutPR 15092: MOU - TX FOREST SERVICE/REG. INCIDENT MGMT TEAM MEMBER & CITY OF PAinteroffice
MEMORANDUM
Tb: Mayor, City Council, and City Manager
From: Valecia R. Tizeno, First Assistant City Attorney
Date: February 4, 2009
Subject: P. R. No. 15092; Council Meeting February 10, 2009
Attached is P. R. No. 15092 authorizing a Memorandum of
Understanding between the Texas Forest. Service and Regional.
Incident. Management Team Member and the City of Port Arthur.
VRT:ts
Attachment
cc: Chief of
Fire Chip
Director
Director
Director
Director
Director
Po
'f
of
of
of
of
of
lice
Public Works
Planning
Utility Operations
Human Resources
Community Services
z.pr75092_memo
P. R. No. 15092.
02/03/09 to
RESOLUTION NO.
A RESOLUTION AUTHORIZING A MEMORANDUM OF
UNDERSTANDING BETWEEN THE TEXAS FOREST SERVICE
AND REGIONAL INCIDENT MANAGEMENT TEAM MEMBER
AND THE CITY OF PORT ARTHUR
WHEREAS, it is deemed in the public interest to authorize a
Memorandum of Understanding ("MOU") between The Texas Forest
Service ("TFS") and Regional Incident Management Team ("RIMY")
Member and the City of Port Arthur, as delineated in the Memorandum
of Understanding attached hereto as Exhibit "A"; and
WHEREAS, the purpose of the MOU is to delineate the
responsibilities and procedures for RIMY activities under the
authority of the State of Texas Emergency Management Plan; and
WHEREAS, the provisions of this MOU apply to RIMY activities
performed at the request of the State of Texas; and
WHEREAS, the scope of this MOU also includes training
activities mandated by the State of Texas and TFS to maintain RIMY
operational readiness; and
WHEREAS, this MOU shall begin as of the date of the last
signature and shall terminate August 31, 2009, unless terminated
earlier in accordance with Section IX.B.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF PORT ARTHUR:
Section 1. That the facts and opinions in the preamble.
Z.pi15 o92
are true and correct.
Section 2. That the City Manager is herein authorized to
sign, on behalf of the City of Port Arthur, a. Memorandum of
Understanding between The Texas Forest Service and Regional
Incident Management Team Member and The City of Port Arthur, as
delineated in the Agreement, attached hereto as Exhibit "A"
Section 3. That a copy of the caption of this Resolution.
be spread upon the Minutes of the City Council.
READ, ADOPTED AND APPROVED on this day of
A.D., 2009, at a Meeting of the City Council of
the City of Port Arthur, by the following vote: AYES:
Mayor
Councilmembers
NOES:
ATTEST:
MAYOR
TERRL HANKS, ACTING CITY SECRETARY
APPROVED AS TO FORM:
CITY ATTO Y ~~~ b~)
z.prisasz
APPROVED FOR ADMINISTRATION:
CITY MANAGER
z_pr15092
EXHIBIT "A"
'Memorandum of Understanding
Between
The Texas Forest Service
And
Regional Incident Management Team Member
And
The Participating Agency/Employer
This Memorandum of Understanding (MOU) is entered into this day of ,
2009 by and between the. Texas Forest Service, a member of The Texas A&M University
System, an agency of the state of Texas (TFS) and Regional Incident Management Team (RIMY)
Member (Member) and the Participating Agency/Employer
(Employer).
I. PURPOSE
To delineate responsibilities and procedures -for RIMY activities under the authority of
the State of Texas Emergency Management Plan.
II. SCOPE
The provisions of this MOU apply to RIMY activities performed at-the request of the
State of Texas. The scope. of this agreement also includes training activities mandated by
the State of Texas and TFS to maintain RIMY operational readiness.
III: PERIOD OF PERFORMANCE
This Contract shall begin as of the date of the last signature and shall terminate August
31, 2009, unless terminated eazlier in accordance with section IX.B.
IV. DEFINITIONS
A. Activation: The process of mobilizing RIMY Members to deploy to a designated.
incident or event site. When the RIMY responds to such a mobilization request; the
Member is required to arrive with all equipment and personal geaz to the designated
Point of Assembly (POA) within two hours of activation notice. The time at which
the RIMY Member receives a request for activation and' verbally accepts the
mission will be considered the time at which personnel costs to be chazged to RIMY
activities shall begin.
B. Alert: The process of informing RIMY Members that an event has occurred and
that RIMY may be activated at some point within the next 24-48 hours.
C. De-Activation: The process of de-mobilizing RIMY Members upon notification
from the State to stand down.
D. Director: The Director of TFS.
E. Member: An individual who has been formally accepted into an RIMT, meeting all
requirements for skills and knowledge, and is in good standing with regard to
compliance with necessary training and fitness.
F. Participatine A¢ency/Bmployer: The RIMT Member's employer who, 6y
execution of this MOU, has provided official support of the Member's involvement
in the RIMT..
G. State: For the purpose of this MOU, the State of Texas through the Governor's
Division of Emergency Management (GDEM).
H. RIMT; An integrated collection of personnel and equipment meeting standardized
capability criteria for addressing incident management needs during disasters.
I. TFS/State Sponsored RIMT Trainine and Exercises: Training and/or exercises
performed at the direction, control and funding of TFS and/or the State.
Local RIMT Sponsored Training. and Exercises: Training and/or exercises
performed at the direction, control and funding of a participating agency or RIMT
Member in order to develop and maintain the incident management capabilities of
the member and the RIMT. -RIMT sponsored training shall be coordinated with
TFS staff and receive prior written authorization to conduct such training.
V. RESPONSIBILITIES
A. TFS shall:
Recruit and organize the. RIMT, according to guidelines prescribed 6y TFS.
2. Provide .administrative, financial and personnel management related to the
RIMT and this agreement:
3. Provide training to RIMT Members. Training shall be consistent with the
objectives of developing, upgrading and maintaining. individual skills, as
identified in the position description requirements, necessary to maintain
operational readiness.
4. Develop, implement and exercise an internal notification and call-out system
for RIMT Members.
Provide all tools and equipment necessary to conduct safe and effective
incident management operations. as listed in the current approved RIMT cache
list.
6, Maintain all tools and equipment in the RIMT cache in a ready state.
7. Provide coordination between. the State, other relevant governmental and
private. entities, Employer and RIMT Member.
8. Maintain a primary contact, list forall RIMT,Members.
9. Maintain personnel files on all members of RIMT for the purpose of
documenting .training records, emergency notification and other
documentation as required by the State.
B. The Employer shall:
1. Maintain a roster of al] its personnel participating in RIMT activities.
2. Provide a primary point of contact to TFS for the purpose of notification of
RIMT activities.
3. Provide administrative support to employee members of RIMT, i.e. "time off'
when fiscally reasonable to do so for RIMT activities such as training,
meetings and actual deployments.
4. Submit reimbursement claims within thirty (30) days of official deactivation
or completion of TFS/State sponsored RIMT training of the RIMT Member.
C. Member shall:
1. Be physically capable of performing assigned duties required in the position
description (PD) requirements for the assigned position.
2. Maintain knowledge; skills and abilities necessary to operate safely and.
effectively in the assigned position.
3. Maintain suppoR of Employer for participation in RIMT activities.
4. Keep Employer advised of RIMT activities that may require time off from
work.
5. Advise RIMT point of contact of any change in notification process, i.e.
address or phone numbei changes.
6. Be available for immediate call-out during the period Member's assigned
RIMT is first on the rotation for call-out:
7. Respond immediately to a mobilization request with acceptance or refusal of
cun•ent mission request and arriving within 2 hours from time of mobilization
request to the assigned POA.
8. Maintain all equipment issued by RIMT in a ready state and advising TFS
Manager deployed with RIMT of any lost, stolen or damaged items assigned
to Member. '
9. Be prepared to operate in the disaster environment.
10. Follow the RIMT Code of Conduct in Attachment A.
3
VI. PROCEDURES
A. Activation
I. Upon request from the State for disaster assistance, and/or determination that
pre-positioning the RIMT is prudent, TFS shall request the activation of the
RIMT to respond to a designated POA.
2. TFS shall communicate an Alert and/or Activation notice to RIMT Members
through the internal .paging and call-out system according to the current
approved mobilization plan.
B. Mobilization, Deployment and Re-deployment
TFS will notify members of activation of RIMT.
2. Upon arrival at the POA, the State representative will provide initial briefings,
maps, food, housing and any other items essential to the initial set-up and
support of the RIMT.
3. When RIMT is activated; the RIMT, including all necessary equipment, will
move to the pre-designated point of departure (POD} for ground or air
transportation.
4. The RIMT shall be re-deployed to the original POA upon completion of the
RIMT mission.
C. Management
1. TFS will have overall management, command and. control of all RIMT
resources and operations.
2. Tactical deployment of RIMT will be under the direction of the local Incident
Commander and the RIMT Incident Commander assigned to the incident.
VII. TRAINING AND
A. Local RIMT Sponsored Training and Exercises
Periodically RIMT Members will be requested or required to attend local RIMT
sponsored training or exercises. Local RIMT sponsored training or exercises shall
be performed- at the direction, control and funding of the local RIMT in order to
develop the technical skills of RIMT Members. Costs associated with this training
or exercises will not be reimbursed by TFS or the State.
B. TFS/State Sponsored RIMT Training and Exercises
Periodically RIMT Members will be required and/or invited- to attend TFS/State
RIMT training and/or exercises: This training and exercises will be performed. at
4
the direction; control and funding of TFS, or the State in order to develop and
maintain the incident management capabilities of the RIMT. Allowable travel costs
associated with this training will be reimbursed by TFS.
C. Minimum Training Requirements
Member is required to attend a minimum of 50% of the available RIMT training
and exercise opportunities provided for-the assigned RIMT position. Failure to
attend a minimum of 50% of the training opportunities will result in dismissal from
the RIMT. Exceptions may be granted at the discretion of the RIMT Incident
Commander. '
VIII. ADMINISTRATIVE, FINANCIAL AND PERSONNEL MANAGEMENT
A. Reimbursement to Employer
TFS will reimburse Employer for all wages identified -and allowed in the
RIMT Standazd Pay Policy (Attachment B). TFS will reimburse all amounts
necessary to fund payroll associated costs of state and/or federal disaster
deployments..
2. TFS will reimburse Employer for the cost of backfilling while Member is
activated. This shall consist of expenses generated by the replacement of a
deployed Member on their normally scheduled duty periocUday.
TFS will reimburse Employer for salaries and backfill expenses ofany
deployed Member who would be required to return to regulazly scheduled.
duty during the personnel rehabilitation period described. in the demobilization
order. If the deployed Member's regularly scheduled shift begins or ends
within the. identified rehabilitation period, Employer may give the deployed
Member that time off with pay and backfill his/her position. If Member is not
normally~scheduled to work during the identified rehabilitation period,. then no
reimbursement will be made for Member.. TFS will determine the personnel
rehabilitation period that will apply to each deployment based on the
demobilization order for that deployment.
TFS will reimburse Employer fotreasonable Havel expenses associated with
Member's travel for RIMT training or deployment. All travel reimbursements
will be in accordance with the State of Texas Travel Allowance Guide;
published by the Comptroller of Public Accounts.
5. TFS will reimburse Employer for reasonable (as determined by TFS) personal
costs associated with Member's participation in a deployment.
6. TFS will reimburse Employer for emergency procurement of RIMT_materials,
equipment and suppliespurchased and consumed by Member in providing
requested assistarice on a replacement basis. Prior.approval 6y the TFS
manager deployed with the RIMT`must be obtained and original receipts for
such items must be submitted with reimbursement request to TFS.
7. Employer shall submit to TFS all reimbursement requests within 30 days of
Member de-activation or completion of TFS/State sponsored training event.
B. Reimbursemeut of RIMT Member as an Individual Resource
1. TFS will pay an individual resource Member for all wages specified in the
RIMT Standazd Pay Policy (Attachment B). Payment for these wages will be
determined based upon the Member's RIMT position in the RIMT Pay
Schedule by Position (Attachment C).
2. TFS will reimburse an individual resource Member for reasonable (as
determined by TFS) travel expenses associated with Member's travel for
RIMT training or deployment. All travel reimbursements will be in
accordance with the State of Texas Travel Allowance Guide, published by the
Comptroller of Public Accounts.
3. TF5 will reimburse an individual resource Member for reasonable (as
determined by TFS) personal costs associated with participation in a
deployment.
4. TFS will reimburse an individual resource Member for emergency
procurement of RIMT materials, equipment and supplies purchased and
consumed by Member in providing requested assistance. Prior approval by
the TFS manager deployed with the RIMT must be obtained and original
receipts for such items must be submitted with reimbursement request to TFS.
5. Individual resource Member must submit to TFS all reimbursement requests
within 30 days of Member de-activation or completion of TFS/State
sponsored training event.
C. Medical Care for Injury or Illness
I. If Member incurs an injury or illness during an RIMT training exercise or
deployment, TFS will pay for triage medical caze to ensure Member is
properly treated and medically evaluated. TFS will make a determination as
to whether the injury or illness was work related and will notify Employer for
proper processing of Workers Compensation claim. Employer will be
responsible for handling any additional medical care for work related. injuries
or illnesses under its Worker Compensation insurance. Member will be
responsible for handling any additional medical care for non-work related.
injuries or illnesses under his/her personal health insurance.
D. Liability
It is mutually agreed that TFS, Employer and Member shall each be
responsible for their own losses arising out of the performance of this MOU.
E. Reimbursement Process
6
All requests for reimbursement must be submitted using the most current
RIMT Travel and Personnel Reimbursement Form (Attachment D).
TFS will process payment to Employer or individual resource member for all
allowable expenses within 30 days of receipt of the. properly completed and
supported RIMT Travel and Personnel Reimbursement Form.
3. Neither Member nor Employer will be reimbursed for costs incurred by
.activations that are outside the scope of this agreement.
4. All financial commitments herein aze made subject to availability of funds
from the State.
IX. CONDITIONS, AMENDMENTS AND TERMINATION
A. This MOU may be modified or amended only by the written agreement of all
parties.
B. Any party, upon 30 day written notice, may terminate this MOU.
C. TFS complies with the provisions of Executive Order 11246 of Sept. 24, 1965, as
amended and with the rules, regulations and relevant orders of the Secretary of
Labor. To that end, TFS will not discriminate against-any employee or Member on
the grounds of race, color, religion, sex or national origin. In addition the use. of
state or federal facilities, services and supplies will be in compliance with
regulations prohibiting duplication of benefits and guaranteeing nondiscrimination.
Distribution of supplies, processing of applications, provisions of technical
assistance and other relief assistance activities shall be accomplished in an equitable
and impartial manner, without discrimination on the grounds of race, color, religion,
nationality sex, age or economic status.
D. This MOU is governed by the laws of the State of Texas. Venue for any suits
related to this agreement shall be in Brazos County, Texas.
X. POINTS OF CONTACT
TFS Emaloyer
Paul Hannemann
John B. Connally Building
301 Tarrow, Suite 304
College Station, TX 77840
Tel#: 979-458-7344
e-mail: phannemann(a~tfs tamu.edu
Member
XI. ENTIRE AGREEMENT
This MOU along with the following Attachments reflects the entire agreement between
the parties:
Attachment A, RIMT Code of Conduct
Attachment B, RIMT Standazd Pay Policy .
Attachment C, RIMT Pay Schedule by Position
Attachment D, RIMT Travel and Personnel Reimbursement Form (most current
revision)
Employer and Member hereby acknowledge that they have read. and understand this entire MOU.
All oral or written agreements between the parties hereto relating to the subject matter of this
MOU that were made prior to the execution of this MOU have been reduced to writing and aze
contained herein. Employer and Member agree to abide by all terms and conditions specified
herein and certify that the information provided to TFS is true and correct in all respects to the
best of their knowledge and belief.
This MOU is entered into by and between the following parties:
TEXAS FOREST SERVICE:
Signature:
Name: Tom G. Bogus
Title: Interim Director
Date:
PARTICIPATING AGENCY/EIVIPLOYER
Signature:
Name:
Title:
Date:
RIMT MEMBER:
Signature:
Name:
Date:
ATTACHMENT A
RIMT Code of Conduct
• No transportation/use of illegal drugs/alcohol.
• Firearms are authorized to be carried by only current TCLEOSE
certified commissioned officers.
• Normal radio protocol used/traffic kept to a minimum.
• Know your chain of command/who you report to.
• Limit procurement of equipment.
• Do not take things without authorization.
• Act professionally.
• Remain ready even when unassigned.
• Recreation limited to unassigned hours.
• Maintain/wear safety gear/clothing.
• Wear proper uniform.
• Remember your actions reflect your organization and RIMT.
9
ATTACHMENT B
RIMT Standard Pay Policy
I. Scope
The provisions of this policy apply to all members of an RIMT.
II. Purpose
The purpose of this document is to delineate the policy and procedures for payment
and/or reimbursement. of payroll expenses to include salazies/wages and associated fringe
benefits incurred during state activations of a RIMT member (Member).
III. Pay Rate
A. The Texas Forest Service (TFS) will reimburse Participating Agency/Employer
(Employer) for the participation of each Member who is employed by that Employer
at the hourly rate or salary identified on the most current payroll printout provided by
the Employer requesting salary reimbursement. TFS may also reimburse Employer
for the allocable portion of fringe benefits paid to or on behalf of the Member during
the period of activation. The actual benefits paid must also be shown on or attached
to the Employer payroll printout submitted to TFS.
B. As an individual resource, members without Employer will be paid. at a rate
identified with his/her RIMT position on the RIMT Pay Schedule by Position.(see
Attachment C). The individual resource's 40-hour workweek will begin upon
acceptance of the mission. The individual will be paid for the first 40 hours at the
standazd base rate of pay, and at one and one-half (1 %_) times for all other hours in
that same week. The workweek will consist of seven consecutive workdays to
include weekends and holidays.
IV. Work Shift
A. Every day is considered a workday during the Activation until the Activation is over,
and the RIMT returns to its original Point of Assembly. Therefore, Saturday, Sunday,
holidays and other scheduled days off are also considered workdays during the period
of activation.
B. Each Employer or individual resource is assured pay for base hours of work,
mobilization and demobilization, travel, or standby at the appropriate rate of pay for
each workday.
V. Ordered Standby
Compensable standby shall be limited to those times when an individual is held, by
direction or orders, in a specific location, fully outfitted and ready for assignment.
to
ATTACI~MENT C
RIMT PAY SCHEDULE BY POSITION
.s_~i~?--E~ T , y ~*~,~<~ . ~ ~ sPOSITION TITI;E -£ s ''
v s~~ `=""~?2-rt n ~..~- . E'r a`~`--,r r.?'9....-uT ~za. c Rz rt~i" . _ _i4.1_ . gA.I.~$
+. _ ___
COMMAND
ICT3 INCIDENT COMMANDER TYPE 3 24
IOF3 INFORMATION OFFICER TYPE 3 24
LOFR3 LIAISON OFFICER TYPE 3 24
PI03 PUBLIC INFORMATION OFFICER 3 24
SOF3 SAFETY OFFICER TYPE 3 24
OPERATIONS
DIVS DIVISION/GROUP SUPERVISOR 24
OSC 3 OPERATIONS SECTION CHIEF TYPE 3 24
STLO STRIKE TEAM LEADER (CREW, ENGINE, DOZER,. MILITARY, or
TRACTOR-PLOW) 21
TFLD TASK FORCE LEADER 2I
PLANNING
DMOB DEMOBILIZATION UNIT LEADER 24
PSC3 PLANNING SECTION CHIEF TYPE 3 24
RESL RESOURCE UNIT LEADER 24
SITL SITUATION UNIT LEADER 24
LOGISTICS
COML COMMUNICATIONS UNIT LEADER 24
FACL FACILITIES UNIT LEADER ~ 24
FDUL FOOD UNIT LEADER 24
GSUL GROUND SUPPORT UNIT LEADER 24
LSC3 LOGISTICS SECTION CHIEF TYPE 3 24
MEDL MEDICAL UNIT LEADER 24
SUBD SUPPORT BRANCH DIRECTOR 26
SPUL SUPPLY UNIT LEADER 24
SVBD SERVICE BRANCH DIRECTOR 26
FINANCE
COMP COMPENSATION/CLAIMS UNIT LEADER 24
COST COST UNIT LEADER 24
FSC3 FINANCE/ADMINISTRATION SECTION CHIEF TYPE 3 24
PROC PROCUREMENT UNTT LEADER 24
TIME TIME UNIT LEADER 24
ATTACHMENT D
MOST CURRENT REVISION OF THE
RIMT TRAVEL AND PERSONNEL REIMBURSEMENT FORM.
lz
T L* ~ ~ REGIONAL
~-~ INCIDENT MANAGEMENT TEAM
FOREST' ~ ~ .SERVICE TRAVEL AND PERSONNEL
me ryas nnm unn.c ~s~ry system REIMBURSEMENT FORM
INSTRUCTIONS FOR COMPLETING THE FORM
PART 1-PAYMENT INFORMATION.
1.) Please provide a current IRS Form W-9 Request Fbr Taxvaver Identification Number and Certification if this is yourfirst
reimbursement request or it has been at least five years since your last request. The Texas Forest Service needs this
information to establish a Vendor ID in its accounting system. Tlie Taxpayer Name and Number provided must.
successfully match the IRS database before the vendor ID can be established.
2.) Upon RIMT Member De-Activation, or completion of a TFS /State Sponsored RIMT Training event, please submit [he
reimbursement form and all supporting documentation within thirty (30) business days to:
Texas Forest5ervice
ATTN Catherine Roggenbuck
301 Tamow Ste 304
College Station TX 77840-7R96
Phone 8 (979) 458-7350
3.) Pleaseindicatewhether or not the reimbursement request is being made 6y an Aeencv / Emolover or an Individual RIMT
Member by checking the appropriate box at the top of the form.
4.) Fill in the Pavee Name along with the Address to be used formailing payment. Please provide the Texas Forest Service
with a contact name. ohone number. and email address in the event there are questions with the reimbursement
request.
S.) Provide the Name of the Incident or RIMT 7rainine Event along with the 6eeinnine and endive dates covered by the
reimbursement request. __
PART 2 -SALARY / BACKFILL /PAYROLL ASSOCIATED CO5T5
1.) Please complete the appropriate section of Part 2 based on the type of reimbursement request.
2.) Complete the Pavroll Calculation Worksheet located in this worksheet as a separate tab.
3.) Calculate payroll expenditures for RIMT members activatedseparate from Backfill employees.
4.) Provide copies of OF-288 Emereencv FireFiehter Time Reports to support [he payroll hours reimbursed.
S.) Individual RIMT Members will be reimbursed for personnel costs according to Attachment C of the MOU. _
6.) For Agency /Employer reimbursement requests, please provide copies of emolovee timesheets indicating the rate of pay
and associated payroll-related expenses.
7'.) See additional instructions provided on the Payroll Calculation Worksheet.
PART 3-TRAVEL/MILEAGE/SUPPLIES -
1.) Each RIMT Member will receive a packet during the activation process or on the first day of a sponsored training event.
Documents included in thgpacket are (a) DaiN Meal Loe. (b) Daily Mileaee Loe. and (c) Daily Suovly Loe. Theselogs are to
be filled out by hand each day. Upon De-Activation, the RIMT Member will total, sign, and submit each log to the contact
person listed on the reimbursement form. These individual logs, along with attached receipts, will support the amounts
requestedfor reimbursement Fbr TFS/State Sponsored Training Events, only the. Daily Meal LOg and the Daily Mileage
Log will need to be completed.
2.) Please list each RIMT Member alongwith his/her total Food, Mileage, and/or Supplies reimbursement. Remember [o
attach the individual logsandreceipts (if required) to support the amounts.
3.) Please be aware that receipts are required to be turned in with the reimbursement request if supplies were purchased or
if fuel cost reimbursementis requested in lieu ofmileage.
4.) Reimbursement rates for meals and mileage are subject to change. See this website:
httvs://fmx.cvastate.tx.us/fm/travel/travelrates.oho for thecurrent rates in effect.
S.) See each individual log for additional instructions.
PART 4 -CERTIFICATION
1.) Sienatures anddaies of all parties are required at the bottom of the reimbursement.form before the request will be
processed for payment:
2.) Your signature on this form certifies that thereimbursement request follows the guidelines established in the. -
Memorandum of Understandine between [he Texas Forest Service and [he Reeional Incident Mana¢ement Team Member
and the Particivatine Aeency /Emolover
T L ~(~1 L \ LJ INCIDENT MANIAGEMENT TEAM
FOREST / ', SERVICE TRAVEL AND PERSONNEL.
Tfi eTexas.A&M unlve rsTty System REIMBURSEMENT FORM
PART1-PAYMENT INFORMATION Check One: Participating Agenry/Employer Individual Member
PoKe Name vema. -s <xes~x ice. e r
-sE - td' ~~~a ~~G.-
eae::
SVeet Tvxn/Gry Stvte Zip
Gntocf
Nome Phone Number EmpilAddreu
mridenpErent aeg/Fnd Oates
PART 2 -SALARY / BACKFILL /PAYROLL ASSOCIATED COSTS
meaee anaM a mmdeteaPayrari rolamban wa.kheet q.:„PParbaP aar„mmmtian
AMOUNT
li) REIMBURSEMENT TO AGENCY/EMPLOYER
A Payroll Expenditures for RIMT members during activation
e Cost of 6ackfull while RIMT members are activated.
Subtotal $ -
/°/ REIMBURSEMENT TO INDIVIDUAL MEMBER Subtotal
PART 3 -TRAVEL / MILEAGE! SUPPLIES
L'si mrh FlMT Memher separately %mse lnrlude Me noilyMM LOq~ FOOD MILEAGE (or FUEL( SUPPUES
Doily MTevge[o9, ondnalMSUpdy Lag jot mrM1 indiWdual Attorll a0
inquired rmeiPtr mosepomte rheet glwxr andsubmlt wiM tln'sjdrm SubjeR to Malimum
No maip[s required Odometer readinas
orJuelllckets inquired Itemized re[eigts
required
i
Z
3
a
s
6
l
B
9
l0
Subtotal
AMOUNT
PART4-CERTIFICATION
I certify that the above services were rendered or goods received; that they correspond in every particular with the
con[ractunderwhich they were procured; that the invoice is true and unpaid; and that the claim was presented [o the.
State within the applicable limitations period.
TOTAL
Signa(urt ofEmployer or lndnitlwl Membn pvie iFSAttounff Papble Appoml note
T31MT Oe~rtmentalAUMmhopon Oob FAME Coding (SLSA~OBI Code)
NOTE: Sfgnoture ondsupporting documentation are required; inromplete reimbunementJorms will delay poyment.
Dated Ol/ZO/2009
T ~ X A S R[°I°N°L
~~ /~('~ INtlOENT MANAGEM
FOREST ~ S~n~/ ~~[~ NAME OF AGENCVIEMPLOYER OR INDIVIDUAL
PAYROLL CAICUUTIOX
Thf' l'e%9S Il YIM UOIVCf6 F5y System INCIDENT NAME
II.I RF MRVRSEMENi TO AGEN LY/EMPLOYER
A O iV 5 S
Imtrvatlnni'
l./ Ufe th/Sf[ttlvn ijpvr vr<an Fmp'vyer/Apen[Y v^dpvldlmplvye<a vxlwlyd durlnp pn RIMiM[Itlent.
[./Indlmte Nelntldent Nam[on (h[Ilne vt tll[mp of thbpvge. '
3 / LUf (he nvme+vf tM1e emplvyeea axivmedolong wile IGe tlvte range. Fw ev[hlndlHduvl, fill in M[omvuno- fn regulvr pvY. omtimepvV. and asao[ivtedpvyrelllenefiupvld [e Eheemplvyee wM1lle Metmplvyee wm an vnignmmt.
O/ Additlcnvl [WUmm vreWavided jarotllerpayrdl-relatedb[n[fitrro! apetlfkally I/tted. O^lylndude benefitmx[ amoNa[ed wllil[ (he employee wvs vxivited on vn RlMimaignmmt.
5.l %ovlde[vpi[f ofthe [mpl^Y[[ iOF}H8 Emngenry FiaFlpMn ilme Report tv rapport Ehe ho/n worked w vuignmmt Alm, q^vlde an Employe/ApenrYpvpell tlmahMjar Meperlad Indl[ated tp f/ppvx flegvlvr Poy vnd ReneQli.
8/[arry MCFO(vl of this EeRlpn to the RIMT lmvel vnd FelmbuxemmtFOrm pax }-(I,W.
RFGVUR P AY OVERTIME PAY PAYR°LLVISSOWTFD B FNFf ITS WNRE EMPLOYFE IP ACIIVpIFO
NAMF WTf MNGE NOURS AATE SAURY NoupS MiE SALARY iKA MEUIGL LIfE DFMAL
S 5 5 ~ S ~ S S- 5 S S
LDEL_VSDi:
1./ Vf¢tM1BSe[tion i)yvw ore vn Empbyn/Ageery^^din[unedbp[k(lll[ox+whlle avid employees wort vttiv^(ed during pn RlMTln[Ident
3/ Indlmte EheMdden[NOmeon lht Rne oTlhemp oftM1i, page.
%1 ux me names ^/rne employe., paid, aiwg wim me dme ra^Pe Forearn i^mwdaw, prim m^^maa^NI^rapwa.p^R /rtxime pae ^pd ae,ariged paraube^e0N pam(a th. empl^vee medp.mrx/In.
a.l addhionW rowmn+pregovidm/o.omepondl.dondbe^erts^ovpmPFaiN lNted. mN/de ou be^(rt rw riondwanbp[xPll wrola pn emwpyee wofpmvued on o^RIMTO,ng^me^t.
S./ Prondeon EmplDyldAgengpvYroll tlmeflleetforth[prriadindirmedro,oppoxthe RegvlorpoG, OVMIme Pog andAno[ivTed Ben (upammm<Rpn o^a<nwtedemplayee.
6.1 CpnV the total o/IMiie[tion fo Me RIMT imrel and flelmbwsement Form Port }-(IfB. '
XAMF DATE PGXGF RfGVUR PRY
XODRE M(F SALARY OVERTIME PAY
IIODRS MTE Sp1ARY PRYROlLAt50CIATfD BF
fIG MfDIUL LIFf NFFIR WHIIE
DEMAL EMPIOYEE IS A CTIVRifD
S S 5 5 S 5 S 5 5
RI.I EMRVRSEMENi TORN NOV OVILR ML MfMOEfl
iFILf /r~~ .
3 / Us[ (hilte[tlan ij yolvale pn Individuol RlMimember ottlmfed dlu/rig pn RIMTIn<Ident.
2f Intllm(e (heln[IdmTNomeon tbeline vt the top o)fM1i[pvge.
3/ In6[ate the dvluvnge ojae othe RlMTi^[lde^[ PrcNde yow POfitloa THle UutM1eho/dYratela/^dl^ANV[M1ment CO/the M°UOf themte vj [eimbw mt.
9/Pmulde mplua(yow OF}BBvFmerpenryilreflgM1Mr Nme RePax mmpi+vx lM1e M1a/n waked on as+lgnmene '
5f Co<rythetotvl of Niuenlonm Me fllMi POVel and Relmbunemm[Form POrt1-IIIf.
RFGUUR PRY
NAME DATf MHGf pOSrtIONTRLF NOURS MTF SAURY
RIMT RFIMB FORM
PART 3-111>
5
RIMT REIMRPoRM
PART31118
5
RIMTREIMS FORM
PRRTD pII
Dated OL30/09
TE AS
Four 1 : S~RV[CE
The Tezas A&M University System
NAME
INCIDENT
REGIONAL
INCIDENT MANAGEMENT TEAM
DAILY MEALLOG
InstruRions:
1.) Please enter [he date and the actual dollar amauntspent for breakfast lunch, and dinner. Ifprovided; mark N/A.
2./ The Agency is not allowed to reimburse alcoholic beverage purchases.
3.) The daily meal reimbursement mte is based an the curten[ Meals In-State rote se[ by the Texas CDmptro!!er's Office.
See this website: httns://fmx.cao.state. ix.us/hn/Navel/travelrates.aho for the currentra[e in effect.
4.J Mea/Receipts are no[required.
5.J This log should be completed by hand and included with the request for reimbursement.
6.J Upon De-Activation, or completion of a7FS/State sponsored Vaining event please TOtol, Signand Date the bottom of this lag.
DATE. BREAKFAST LUNCH DINNER TOTAL
z
3
0
5
6
2
8
9
ID
13
I]
13
39
IS
16
ll
38
39
20
TOTAL $
signature of RlMTMember Dote
Dated 01/20/09
T E A S
SOREST ; ,SERVICE
The Texas A2rM Unlve rslty System
NAME
INCIDENT
REGIONAL.
INCIDENT MANAGEMENT TEAM
DAILY MILEAGE.(or FUEL) LOG.
IOStNCflons:
1.) Please enter each new day'ssforting and ending odometer reading.
2.) Indicate the destination and purpose of the [ravel.
3.) If you prefer to be reimbursed for fuel costs only, put N/A Jor the odometer reading and list the fuel expense under the Miles Driven
rolumn. Attach fuel receiptstoaseporate piece of paper and submit them with this log for reimbursement.
4.) The reimbursement rate is based on the State of Texas standard mileage mte and is subjeR to change.
See this website: httos'//( pa tat t /f /[ a el/t a I [ - h for the rumen[ rote in effect.
5.) This log should be completedby hand and included with the request for reimbursement.
6./ Upon De-Activation, or completion of oTFS/State sponsoredcraining event please Total, Sign and Date the bottom of [his log.
STARTING ENDING MILES ,
DATE ODOMETER ODOMETER DRIVEN DESTINATION AND PURPOSE.OF TRAVEL
t
3
a
s
6
J
8
9
1a
]1
]2
13
tx
u
I6
1)
18
19
30
TOTAL - 5. /mi $
To calculate the ip[al mileage reimbursement: a.J Sum the Miles Drven by day andb.)
Multiply the total miles driven by the current State of Texas standard mileage rate in effect.
9ignoture of RlMT Member - aura
Dated 01/20/09
T L ~ t , V
FOREST , ;SERVICE
The Tezas A&ht Univcrs[ty System
NAME
REGIONAL
INCIDENT MANAGEMENT TEAM
DAILYSUPPLYtOG'
INCIDENT
Ins[rucYions: - ~ -
I.J Please enter the dote, dollaramaunt, description, ondjustifl'cation for any supplies or equipment purchased for the incident.
L/ 06tain proper approval before purchasing any supplies orcquipmen[.
3.) Supplies or equipment purchased without [he proper authority will not be reimbursed.
4.) Itemized Receipts ore required. Please attach receipts to a separate piece of paper and submit with this lag.
5.) This log shpuld be completed by hand and included with the request for reimbursement.
6.l Upon Oe-Activation, please Tolol, Sign and Date [he bottom of this log.
DATE DESCRIPTION OF ITEM PURCHASED AMOUNT JUSTIFICATION FOR.PURCHASE
1
3
5
6
l
8
9
]a
3]
]1 '
13
30
35
36
3J
I8
39
Ia
TOTAL ~ $
Signature of FIMT Member av[e
Dated 01/20/09