EXHIBIT C.pdf
PDF 196 KB Posted
- Attached to
- North Florida Mobile Irrigation Lab Services
- Solicitation number
- RFP-15924
- Issued by
- Leon County, Florida
About this file
This document is an In-State Travel Expenses Voucher for Reimbursement issued by the Florida Department of Agriculture and Consumer Services, Bureau of Finance and Accounting, under the direction of Commissioner Wilton Simpson. The form serves as the official reimbursement instrument for state employees and non-employees/independent contractors who incur travel expenses while performing official duties, attending conferences, or participating in training activities. The voucher accommodates itemized daily expenses including common carrier costs, hotel accommodations, per diem and meal expenses, mileage reimbursement at the established rate of $0.445 per mile, and miscellaneous incidental expenses. Travelers are required to certify that all expenses were necessarily incurred in the performance of official duties and that any meals or lodging included in conference registration fees have been deducted from the claim. The form designates specific object codes (OBJ-261400, OBJ-261100, OBJ-261200, OBJ-261300, OBJ-261030, OBJ-261040, and OBJ-261500) for budget allocation purposes.
The voucher requires certification by both the traveler and district supervisor, with final authorization by the contract manager, ensuring proper oversight and accountability of state travel expenditures. Reimbursement amounts are calculated by subtracting any travel advance provided for the relevant month from the total documented expenses, with the net amount due reflected as total compensation owed. The form mandates disclosure of the traveler's Social Security Number for payroll, travel, and benefits administration purposes in compliance with 26 U.S.C. Section 6109, with the department maintaining confidentiality except as required by law or for authorized benefit purposes. All claims must conform to Section 112.061 of the Florida Statutes governing official travel reimbursement policies.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| EXHIBIT D.pdf | ||
| Appendix V.pdf | ||
| APPENDIX II.pdf | ||
| EXHIBIT A.pdf | ||
| APPENDIX III.pdf | ||
| RFP DOA 25 26 80.pdf | ||
| EXHIBIT F.pdf | ||
| APPENDIX IV.pdf | ||
| EXHIBIT E.pdf | ||
| EXHIBIT B.pdf |
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Text version
EXHIBIT C
WILTON SIMPSON
COMMISSIONER
Florida Department of Agriculture and Consumer Services Bureau of Finance and Accounting
TRAVELER (Please type or print)
ADDRESS
CITY OF RESIDENCE
FEID / SOCIAL SECURITY NO.1
Check One: State Employee
Non-employee/Independent RECIPIENT
CITY OF HEADQUARTERS
DIVISION OF OWAP
IN-STATE TRAVEL
EXPENSES VOUCHER FOR REIMBURSEMENT STATE ZIP CODE
DATE
Travel Performed
From Point of Origin to Destination
Purpose or Reason (Name of Conference)
IF PURPOSE OF TRAVEL IS TRAINING,
PLEASE HIGHLIGHT
Hour of Departure and Hour of Return
IN-STATE ITEMIZED DAILY EXPENSES Common Carrier Paid by Traveler
Hotel Per Diem Standard
Meals Meals (A&B)
Mileage Incidental Expenses
Map Vicinity Amount Type
I hereby certify or affirm that above expenses were actually incurred by me as necessary traveling expenses in the performance of my official duties; attendance at a conference or convention was directly related to the official duties of the agency; any meals or lodging included in the conference or convention registration fee have been deducted from this travel claim; and that this claim is true and correct in every material matter and same conforms in every respect with the requirements of Section 112.061, Florida Statues.
1 Mandatory Disclosure of Social Security Number – 26 U.S.C. 6109 requires the Florida Department of Agriculture and Consumer Services to obtain Social Security Numbers (SSN) from every employee to whom compensation is paid.
Employee SSNs are maintained and used by the department for payroll, travel and benefits purposes, and are reported to federal and state agencies on forms required by law or for benefits purposes. The department will not disclose an employee’s SSN without the consent of the employee to anyone outside the department except as mandated by law or as required for benefit purposes. Failure to provide a SSN will result in denial of benefits or compensation.
TRAVELER’S SIGNATURE: DATE: @ .445
TRAVELER’S TITLE: $ $ $ $ 0.00 $ 0.00 $ 0.00
Section 112.061(3)(a), Florida Statutes, I hereby certify or affirm that to the best of my knowledge the above travel was on official business of the state of Florida and was performed for the purpose(s) stated above: OBJ-261400 OBJ-261100 OBJ-261200 OBJ-261300 OBJ-261030
OBJ-
261040 261500
DISTRICT SUPERVISOR’S
SIGNATURE: DATE:
COMPLETE THE REVERSE SIDE IF TRAVEL WAS PERFORMED BY
COMMON CARRIER, STATE VEHICLE OR STATE PLANE AND CHARGED TO
THE STATE.
SUPERVISOR’S TITLE
(RECIPIENT):
Reimbursement Total: $0.00 Less Travel Advance for Month of : $<0.00>
EXECUTE REVERSE SIDE IF TRAVEL WAS PERFORMED BY COMMON CARRIER, STATE VEHICLE
OR STATE PLANE AND CHARGED TO THE STATE.
Net Amount Due: $0.00 Travel Advance for Month of : $0.00 Total Due: $0.00
CONTRACT
MANAGER ’S
SIGNATURE: DATE:
File details come from the government source that posted it. Updated .