HomeMy WebLinkAboutPR 15419: MEMORANDUM OF UNDERSTANDING WITH TEXAS FOREST SERVICEPORT ARTHUR FIRE DEPARTMENT
MEMORANDUM
To: Steve Fitzgibbons, City Manager
From: Larry D. Richard, Fire Chief
Mark Blanton, Police Chief
Re: Proposed Resolution 15419
Date: August 3, 2009
COMMENT
RECOMMENDATION
The Fire Department and Police Department recommend that City Council approve Proposed
Resolution #15419.
BACKGROUND
The Governor's Division of Emergency Management has tasked the Texas Forest Service to
establish several Incident Management Teams (IMT) to respond to emergencies throughout the
State of Texas. The Fire Department has identified six personnel, and the Police Department has
identified two personnel, that have the required training and credentials to be part of the
Southeast Texas Incident Management Team. IMT team personnel are, Larry Richard, John
Avery, Mike Free, Mark Mulliner, Richard Bodin, Robert Havens, John Owens, and Ken
Carona. Personnel would be made available to respond to incidents throughout the State at the
discretion of the Fire Chief, Police Chief, and City Manager.
BUDGET/FISCAL EFFECT
Cost associated with deployment including travel, wages and backfill overtime are reimbursable
from the Texas Forest Service.
STAFFING/EMPLOYEE EFFECT
None
SUMMARY
The Fire Department and Police Department recommend that City Council approve Proposed
Resolution #15419.
"REMEMBER, WE ARE HERETO SERVE THE CITIZENS OF PORT ARTHUR"
P. R. 15419
08/03/2009 ldr
RESOLIITION N0.
A RSSOLIITION AIITHORIZING THS CITY MANAGER TO
ERSCIITE A MEMORANDIIM OF UNDERSTANDING WITH THE
TESAS FOREST SERVICE TO PROVIDE EMERGENCY
RESPONSE INCIDENT MANAGEMENT TEAM PERSONNEL TO
SIIPPORT THS STATE IN A PENDING OR ACTIIAL
DISASTER, OR AS NEEDED TO RESPOND TO OTHER
EVENTS.
WHEREAS, the Texas Forest Service has established
Incident Management Teams; and
WHEREAS, the Incident Management Teams will be
utilized by the State of Texas to assist in providing
incident management skills throughout the State of Texas in
an impending or actual disaster, at the request of the
Governor's Division of Emergency Management; and
WHEREAS, individuals who serve on the Incident
Management Teams must possess certain certifications,
credentials, and training; and
WHEREAS, the City of Port Arthur Fire Department and
Police Department currently employ eight individuals who
possesses all of the required certifications, credentials
and training required by the Texas Forest Service; and
WHEREAS, the training and certification possessed by
these individual provided invaluable service in
coordinating many elements of the evacuation and
repatriation of Port Arthur citizens during recent
hurricanes and other emergencies; and
WHEREAS, the City of Port Arthur wishes to continue to
receive updated training for these individuals related to
incident management and to offer the skills of these
individuals to other entities in the state; and
WHEREAS, the Texas Forest Service will reimburse the
City of Port Arthur for wages, and other costs related to
the emergency response of this individual, as well as
backfill overtime.
NOW THEREFORE, BS IT RESOLVED BY THE CITY COIINCIL OF
THE CITY OF PORT ARTHIIR:
Section 1. That the facts and opinions in the
preamble are true and correct.
Section 2. That the City Manager is hereby authorized
and directed to execute a Memorandum of Understanding in
substantially the same form as attached hereto as Exhibit
.. A,.
Section 3. That a copy of the caption of this
resolution shall be spread upon the Minutes of the City
Council.
READ, ADOPTED AND APPROVED on this day of ,
A.D., 2009, at a Regular Meeting of the City Council of the
City of Port Arthur, Texas, by the following vote:
AYES:
NOES:
Debris Prince, Mayor
ATTEST:
Terri Hanks, City Secretary
APPROVED AS TO FORM:
r,~ ~~~
Mark T. Sokolow, City Attorney
APPROVED FOR ADMINISTRATION:
Steve Fitzgibbons, City Manager
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, 2012, unless terminated earlier 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 amve with all equipment and personal gear 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 charged to RIMY
activities shall begin.
B. Alert: The process of informing RIMY Members that an event has occurred and
that RIMY maybe 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. Participating Agency/Emnloyer: The RIMT Member's employer who, by
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.
TFS/State Sponsored RIMT Training 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:
1. Recruit and organize the RIMT, according to guidelines prescribed by 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.
Maintain a primary contact list for all 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 all 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 ofTFS/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 support 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, r.e.
address or phone number 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
current 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 prepazed 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
1. 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.
VIL TRAINING AND EXERCISES
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
a
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
1. 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 period/day.
3. TFS will reimburse Employer for salaries and backfill expenses of any
deployed Member who would be required to return to regularly 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.
4. TFS will reimburse Employer for reasonable 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.
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 supplies purchased and consumed by Member in providing
requested assistance on a replacement basis. 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.
7. Employer shall submit to TFS all reimbursement requests within 30 days of
Member de-activation or completion ofTFS/State sponsored training event.
B. Reimbursement of RIMT Member as an Individual Resource
1. TFS will pay an individual resource Member for all wages specified in the
RIMT Standard Pay Policy (Attachment B). Payment for these wages will be
determined based upon the Member's RIMT position in the most current
revision of 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. TFS 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
1. If Member incurs an injury or illness during an RIMT training exercise or
deployment, TFS will pay for triage medical care 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
1. 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
I . All requests for reimbursement must be submitted using the most current
RIMT Travel and Personnel Reimbursement Form (Attachment D).
2. 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 are 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 Employer
Paul Hannemann
John B. Connally Building
301 Tarrow, Suite 304
College Station, TX 77840
Tel#: 979-458-7344
e-mail: phanneminn~~tfs.tamu.edu
Member
7
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 Standard Pay Policy
Attachment C, RIMT Pay Schedule by Position (most current revision)
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 are
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. Boeeus
Title: Interim Director
Date:
PARTICIPATING AGENCY/EMPLOYER
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 salaries/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
standard base rate of pay, and at one and one-half (1'h) 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.
t0
ATTACHMENT C
RIMT PAY SCHEDULE BY POSITION
ICS
;:ID ' ~ s `, ~ ~" , ~ ~ ,-POSITION TITLE ~ ~ `-=$," ~ -t~~ ~ z
rte ~-;,, ;: .~:.~ g n,r.-,;;- - '~-,,s ~;"`~- . -~~ HO~URLY~c
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
DNS 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 21
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
FALL 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 UNIT LEADER 24
TIME TIME UNIT LEADER 24
Dated 5/8/09
11
ATTACHMENT D
MOST CURRENT REVISION OF THE
RIMT TRAVEL AND PERSONNEL REIMBURSEMENT FORM
iz
T E X A ~ REGIONAL
INCIDENT MANAGEMENT TEAM
FOREST.SERVICE TRAVEL AND PERSONNEL
me ryas ,. ev n,t u.,rvarn r,v sv.rr..., REIMBURSEMENT FORM
INSTRUCTIONS FOR COMPLETING THE FORM
PART 1 -PAYMENT INFORMATION.
1.) Please provide a current IRS Form W-9 Request Fo Taxpayer Identification Number and Cert'rfication if this is yourfirst
reimbursement request or R 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. The Taxpayer Name and Number provided must
successfully match the IRS database before the Vendor ID can be established.
2.) Upon RIMT Memher De-AQivation, or completion of a TFS /State Sponsored RIMT Training event, please submit the
reimbursement farm and all supporting documentation within thirty (30) business days to:
Texas Forest Service
ATTN Catherine Roggenbuck
301 Tartow Ste 304
College Station T% 77840-7896
Phone p (979) 458-7350
3.) Please indicate whether or not the reimbursement request is being made by an Agency / EmDloyer or an Individual RIMT
Member by checking t he appropriate bps at the top of the form.
4.) Fill in the Payee Name along with [he Address to be used for mailing payment. Please provide the Texas Forest Service
with a contact name phone number and email address in [he event there are questions whh the reimbursement
request.
5.) Provide the Name of the Incident or RIMT Training Even[ along with the beginning and endin dates covered by the
reimbursement request.
PART 2 -SALARY / BACKFILL /PAYROLL ASSOCIATED COSTS
1.) Please complete the appropriate section of Part 2 based on the type of reimbursement request.
2.) Complete [he Payroll Calculation Worksheet located in [his worksheet as a separate tab.
3.) Calculate payroll expenditures far RIMT members activated separate from eackfill employees.
4.) Provide copies of OF-288 Emergency FireFighter Time Reports to support the payroll hours reimbursed.
5.) Individual RIMT Members will be reimbursed for personnel costs according to Attachment C of the MOU.
6.) Far Agency /Employer reimbursement requests, please provide copies of employee timesheets indicating the rate of pay
and associated payroll-related expenses.
7.) See additional instmctions provided on the Payroll Calculation Worksheet.
PART 3 -TRAVEL /MILEAGE /SUPPLIES
1.) Each RIMT Member wilt receive a packet during the activation process or on the first day of a sponsored training event.
Documents included in the packet are (a) Daily Meals & Lodging Log (b) Daily Transportation/Mileage Log, and (c) Daily
Supply Log. These logs are to be filled out by hand each day. Upon DrACtivation, the RIMT Member will total, sign, and
su6m¢ each log to the contact person listed on [he reimbursement form. These individual logs, along with attached
receipts, will supportthe amounts requested for reimbu rsement. For TFS/State Sponsored Training Events, only the
Daily Meals & Lodging Log and the Daily Transportation log will need to be completed.
2.) Please list each RIMT Memher along with his/her total Meals & Lodging, Transportation, and/or Supplies
reimbursement. Remember to attach the individual logs and receipts (if required) to support the amounts.
3.) Please be aware that receipts are required to be turned in with the reimbursement request rf supplies were purchased or
if fuel cost reimbursement is requested in lieu of mileage.
4.) Reimbursement rates for meals, lodging, and mileage are subjeR [o change. See this website:
httpr//fmz wa state tz us/fm/travel/travelrates ohpfor the current rates in effect.
5.) See each individual log for additional instructions.
PART 4 -CERTIFICATION
1.) Signatures and dates of all parties are required at the bottom of the reimbursement form before the request will be
processed for payment.
2.) Vour signature on this form certifies that the reimbursement request follows the guidelines established in [he
Memorandum of Understa ding between the Tex s Forest Serv'ce and the Rea oval Inc dent Management Team
Member and the Par[ c paF ng Agency /Employer.
TEXAS REGIONAL
INCIDENT MANAGEMENT TEAM
FORESTSERVICE TRAVELANDPERSONNEL
REIMBURSEMENT FORM
The Texas A&M University System
PAR71-PAYMENT INFORMATION [heck One: Participating Agenty/Employer Individual Member
Puyte Npm¢ rt~w
"
'}s _
R
Aetlresr
StrtR T •+/GY Srom Lp
Cw b6
Noma Pnpw NUmbw fmoilAddre+a
Incidenl/FVerrt &q/EM Mr¢t
PART 2 -SALARY / BACKFILL /PAYROLL ASSOCIATED COSTS
AMOUNT
In REIMBURSEMEM TO AGENCY/EMPLOYER
" Payroll Expenditures for RIMT members during activation
s Cost of back(ull while RIMT members are activated
Subtotal $ -
(In REIMBURSEMENT TO INDIVIDUAL MEMBER Subtotal ~~
oeora-roeuvl /eeu eere/nmol ¢e
AMOUNT
urtwm alMrM.mnerseppmtery awoseind~ee the wip Mea¢og, MEAlS LODGING TRANSPORTATION SUPPLIES
Wif/Mkngelry,oMCOdy EUppM by Nreprh lMNiAral Attach all
cewved receipts rooseporafe meet o)poper osM subme wdh rMS)prm. Sub/eR ro Smte pJ
Texaz Maximums Air/ore. Careentol, pr
Fuel rerelpts requree ttemliedrereryrs
required
t 5 -
1 s -
5
a 5 -
5 5 -
6 5
l S
8 5
9 5
l0 5
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 [rue and unpaid; and that the claim was presented to the
State within [he applicable limitations period.
TOTAL
Sgmmre aj Employer orfMrvidwl MemM naM1 iFSA®unh POyoDNAppmvof INfe
1f51MTCepprM1nmNIAU[Mr¢pion Nh fPMn CWirp (SL~L-09/CWef
NOTE: Signature ondsupporting documentation ore required; incomplete reimbursementJorms will debypoyment.
Revised 01/27/09
T E x A s REGIDNAI
INCIOFM MANAGfMFN[ iFAM
- PAY0.0ll fAlCUWiroN WDRYSHEET
FOREST„'"° ',',SERVICE NAME OF AGENCVI EMPLOYER ORIN[RVIDUAL
The TCxaa Abe M1 U(fivCf Si.[y SyStCm INtl DENT NAME
11.1 •••.~. a SusflWfp
A rR enaN
dl~orv~,Misn i/ youron an fmplvyer/Aemw o^d pas empwaar aeNwm eunnp on RIMn^ne.nt.
1) lndimta (Mlrcidanf Noma on fM lim at fM rop aj[hR papa.
3.1 llft (M mmo e/ Nvvmp'oyro vicervolN alenp wRll fM d^Urorpa. Por w[h individuo(fllln thv omountl jwrepubrpo8 avvrtima peg and anodvevd poyrall Mnvjb poN m fha employe whi4 thv amplwea Iw+on ofrpnmenG
d.l Adddienol ceWmnr on prwide!)orptbarpayrol4nlotM banv(Ib netrpz~mlly ItrfN. Only in[Wdv banafR rort+mfocored wMb tM empby(e wm oaNRN on on RIMI oulprvnaM.
5.) ProvNe[opef of (M vmpbYee) OfQ89 fmvrgmry linfi011M/ Omv Report to fuppert (hvlloum woM1M e^ snip^me^[ Alro, pmida an Empbya /Apenw NYrolllimmhM/or thvpariod IMI[otW to rapport flaqubr POY and &nvfh+.
.Idrnk ree(m m the flIMI novel and flam Wnement Porm Part S-(I)A.
NPME 11M[AANGF P[4USpp pAy
IbUR% Mif $AIAPV WfpRMF pAY
HOURS NAIL $PIpPY pAMIX4
iICA MEUICPL A550DARDRf
IIfF NL11R WNllF
Of Nipl (MIIOI((IS A CRVARD
y $ 5 $ $ $ S S S
B~ M'RSARF pCI1VAlFb
InnrD[tiow:
[.~ wr rnrrnem^pYam ore en rmploYer/Aqa^wa^dbmrnd sedyrr[wn wlol.pos emplw(•+wPre anNar.da.riry a^Rlmrlnadem.
11 IMlmn m.Irciemt Nama on rM p^. pr tM mp p/rha paq..
J.I fi+r IM mmar v)[b emplvywf poid, vbrp with tMdofa ronpa. fw w[II IndNiduv( fll in rM ampunn Jorrpvlar pw, wartime pvY, end wrocia[M mYloll Mnefrtr paid to thv employee wad/vrbocgrll.
dl Addiriv^vlcvlumnr araprv+Md/vroMerpaymll-rtlahl be^efrtt ^or (pec~mlly liIIW In[Wde vlllenafrt rof4 auo[bfad with bvrllfll while an emplvyav war a6Nlfad on vn RlMrufipnmvfR.
5.f Providaan Emp'wn/Apenry mYmil rlmahMfortM priW indimmd (o fupport the Rpubr PaY. OVVrtlme PaG and AUO[laMd Benvfrtf poN (v ba[ATIII on v[tirolW emploYVe.
exnnn to Me RIMT rmvel prM flaimbursaman(Porm Port S-(IIB.
R[4DIAR [ pY OV[0.nMf p AY
SPNRV
iICA pAYROII~
MfDICAL ASSDOARD pf
DiF NIfIR WMIIf
UFXIAI IMPIORFIf P CTVARO
rypMF DMEPANGf HUUPS MlF SPIpPV HOUP$ RPII
5 5 f B f
f y [ S
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S.) Wv thiueRbn i) your on an IndNldvpl fllMrmembaroRNafvd during pn PIMIin[bant.
3.f IndlmMrM1V lrtldmt NOme on (M lim attM Np of thin papa.
3.) IMimM tM dote range o/tervi[e to the RlMrin[Wen[ pmvke your POr)tlon rltk W(the IrourlV /aM jourd in PrtocM1ment C of the M0U a+Ne raN o)nimbwnment.
d.) PmvNe leper o/ yvwOf988 fineryenry flmfipbMr Tima Report (o fuDpolt the hours wrkW on p++ynmanL
SJ Carry IN (Mal o/ tM1irv([Ilon to (he FIMI iraval and flrlmburzement form Part I ~ (llf.
u4uva Per
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A[rlled DI/l]/0R
TEXAS
FOREST''SERVICE
The Texas .a&A7 Unlycrslty Sv5lern
NAME
INCIDENT
REGIONAL
INCIDENT MANAGEMENT TEAM
DAILY MEATS & LODGING LOG
Instructions:
1.1 Meese enter the date andtAe actual dollar amount spent/or breal~ost, Ivnch, and dinner. Ifprovlded, mark N/A
2.) Please enter any lodging expense incurred dwing a TFS/Sm to sponsored training evene Lodging will beproNded during incidents
3.J The daffy reimbursement cote Jar meals and lodging is subject to a maximum rote set Dy the Texas Comptroller's ice.
See lhu website: httosJ/finxcoastare.tx.us//m/Irovel/havelra[e:oho jar the current rates rn eJJeet.
d.J Please atroch on itemized hotel remiptfar any Lodging expense to be reimbursed. MealFeceipts are mtrequired
S.f TheAgenry is rotallowed to reimburse akoholic beverage purchases.
6.f Th is bg shook becompleted by hand andixluded with the request/or reimbursement
]J Upon pe-ACtivatbn, or completion oJe TF$/Stare sponsored training event please Total, S'gn and Dare the bottom of this bg
DATE BREAKFAST LUNCH DINNER LODGING TOTAL
2
3
0
5
6
H
9
lv
v
u
l3
16
IS
16
1>
18
]9
2(1
21
II
13
za
>5
TOTAL ~S
SigreNrtof fllM lh4niEar (bte
Revised 01/27/09
T E X A S
FORESTSERViCE
The Te zas ALY Al llnivvrsity System
NAME
INCIDENT
REGIONAL
INCIDENT MANAGEM ENT TEAM
TRANSPORTATION (or FUEL( LOG
f~snucawm:
1.j Please enrerfhemst of pirfpreaM/pr mrrentpl expenses incunedtp aftendp TF$/R?.e sppmpred tminirp event Ane-ticketaM/vrmrrerrtvl recerytivequired
1J Please enter each crew daY'sstartinp and<rMinp pdameto «vdisp fv be r¢imbwsetl7grmAeape. This does not vppNfvr mr remae
3.1 frNicvte Pe desrinabpn ondpur-pse of the travel beirp reimbursep
<.) IJ you Order fa 6e reimbursrd far fuel m4s any, put N/Ajar the odometer reading vM bsl fM1ejuelexpeme erMer the Miks Driven talvnn
Attach fuel rettipts to a tepgrpte-iete gJpaper ant submd Them with this bOfar reimbursement.
$.l The reimbursement rote is based pn the Stpfe pf Texas standard mikgge rate ant is subjeG ro charge.
See the wehsi(e: M1Nps//Imr ma stole tr us//m/trareVtravelmtes.phv for the mvenr rote in effect.
6 J ]he Ivpshadd be rompktetl by M1andand ixlud<d with th<rewMSt for menbursemem.
).1 Upon De-ARiwtivn, p Completion o/a TF$/$fafe sppruared habiip event pkose Total, Sipn vrM Dale the bottom of this bp.
STARTING ENDING MILES
DATE AIRFARE CAR RENTAL ODOMETER ODOMETER DRIVEN DESTINATION AND PURPOSE OF TRAVEL
3
a
s
s
r
e
9
tp
11
t}
13
le
ss
ie
19
ip
11
3}
Z3
l0
]5
SUB-TOTAL $ $ SU&TOTAL $. /„i $
To cakulare Ne fatal mileage reimbmsemenb a.l>um me roues vnven py vvy anp u./
Multiply the total miles dri venb the current Stateo Texas standard miles emte ine ert.
TOTAL $
ma
Revised 01/27/09
T E _~ A S REGIONAL
INCIDENT MANAGEMENT TEAM
DAILY SUPPLY LOG
FOREST ~~SERVICE
The Trzas A&M University Syslem
NAME
INCIDENT
lnstrucfions:
1.J Pleoze enter the date, Bogor amount, description, ordjustiJication Jor any suAPlies orequipment purchased Jar the incident
2.f Obmin proper oppmvol before purchosirg onysupplies or equipment.
3.) Supplies orequipment purchased without [he proper outhoriry will not be reimbursed
4.) Itemized Receipts ore required. Please attach receipts to a sepam[e piece aJpoper and submit with this log.
5.) This log should be completed by how oM induded with the request Jar r¢imbursement
6. j Upon De-Activation, please total, Sign and Date the bottom of th8 lag.
DATE DESCRIPTION OF ITEM PURCHASED AMOUNT JUSTIFICATION FOR PURCHASE
s
a
s
6
8
9
]0
II
11
]3
Id
IS
]6
U
18
19
20
TOTAL ~ $
Sipnamre o)FIM1 Member Dafe
Revised 01/27/09
