Attachment 3(C) - CSO Form 010.pdf

CSO FORM 010 (EST. 09/05)

Section J - Attachment 3(C)

COURT SECURITY OFFICER (CSO) TRAVEL AUTHORIZATION

1. VOUCHER

VOUCHER DATE

VOUCHER TYPE

� Original

� Reclaim

CONTRACTOR�S NAME

2. TRAVELER

3. ITINARY

4. ESTIMATED COST

NAME: ___________________________________________________________________

FIRST M LAST

ADDRESS: _______________________________________________________________

CITY: ___________________________ STATE: ___________ ZIP CODE: ___________

SSN: __________________________ DISTRICT LOCATION: ______________________

TRIP BEGINS ON:

(MM/DD/YY):

TRIP ENDS ON:

(MM/DD/YY)

Lodging and M&IE $____________________

Transportation $____________________

Other $____________________

TOTAL $____________________

5. PURPOSE OF TRAVEL

��� CSO ORIENTATION (PHASE II) ���TEMPORARY POST ASSIGNMENT ���SPECIAL SECURITY ASSIGNMENT ���OTHER* TRAVEL A UTHORIZATION: _____________________________________________________________________________________________________________________________

* A written detailed justification is required.

TRAVEL CONDITIONS OR LIMITATIONS

7. MODE OF SUBSISTENCE

AUTHORIZED

8. PLANNED ITINERARY

MODE OF TRANSPORTATION AUTHORIZED:

� Use of common carrier transportation � Use of a rental car � Use of a Government furnished vehicle � Use of a privately owned vehicle. Mileage rate authorized: $________

Other (Use of any type of transportation method (i.e., train, bus) that does not exceed the cost of common carrier.)

NOTE: PER DIEM WILL

BE BASED ON LODGING

PLUS M&IE NOT TO

EXCEED GSA

LOCATION RATES.

(MM/DD/YY)

FROM: _______________________

TO: ___________________________

TO: ___________________________

TO: ___________________________

TO: ___________________________

YOU ARE AUTHORIZED TO TRAVEL AT GOVERNMENT EXPENSE IN ACCORDANCE WITH DEPARTMENT OF JUSTICE REGULATIONS UNDER THE CONDITIONS OUTLINED IN THIS AUTHORIZATION AS NECESSARY FOR THE CONDUCT OF BUSINESS RELATIVE TO THE APPLICABLE UNITED STATES MARSHALS SERVICE COURT SECURITY SERVICE CONTRACT.

9. CONTRACTOR�S REVIEWING AND APPROVING OFFICIAL

10. CONTRACTING OFFICER�S TECHNICAL REPRESENTATIVE�S APPROVAL

NAME (Print) APPROVAL DATE

SIGNATURE TITLE

NAME (Print) APPROVAL DATE

SIGNATURE TITLE

CSO FORM 010 (EST. 09/05)

Section J - Attachment 3(C)