Exhibit_D1_-_DERS_Monthly_Activity_Detail.xlsx
XLSX spreadsheet 62 KB Posted
- Attached to
- Master Agreement AZ|CTR072894
- Contract number
- CTR072894
- Issued by
- Arizona
About this file
The document is a User Guide for a Monthly Activity Detail (DERS) transportation invoice spreadsheet, designed to provide detailed instructions for completing service logs for transportation services. While the specific state, agency, or jurisdiction is not explicitly named in the provided document, it appears to be a standardized template for tracking transportation service trips, potentially for a state or local government transportation program.
The guide outlines comprehensive requirements for documenting transportation services, including capturing details such as service date, number of passengers, driver information, reason for transport, pickup and drop-off locations, and billing specifics. The invoice template supports multiple transportation service types, including local and distant ambulatory and non-ambulatory transportation, with provisions for tracking additional services like attendant support, wait time, and no-show fees. The document provides specific instructions for recording mileage, calculating charges, and ensuring each trip entry includes unique identifiers like authorization numbers and driver identifications. The spreadsheet is designed to calculate total charges based on service rates and units provided, enabling precise billing and service documentation.
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Text version
Instructions This User Guide is intended to provide some helpful tips for completing the Monthly Activity Detail. Please note the bottom of this Excel document contains multiple worksheet tabs.
| Service Log Tab |
| Service Date: Enter the date that service was provided for each individual service line |
| Number of passengers: Enter the total number of passengers included in the trip |
| Authorization/PO Number: System of Record authorization number or PO number |
| Driver Name / Number: Complete the Driver Name / Number (Driver Numbers must be unique to each driver, the format required is John Doe / 12345) Each driver for the duration of the contract shall have a unique driver number and that number must not be reassigned to another driver in the event the driver is separated from the provider (this number could be an employee number) |
| Reason for Transport: Type in the reason for transport from the Transportation Request Form (Exhibit A1) |
| Pick up and drop off information: Fill in the addresses and times of both pickup and drop off for the client |
| Flag Drop: Flag Drop is (1) for each flag drop (per location as stated in the contract) |
| Service: Select the transportation service provided to client |
| Rate: The rate for the transportation service as submitted in Attachement A |
| # of Unit(s): Units can include Mileage, No Show, Minutes and Hours. See following two rows below for additional information. |
| Mileage and No Show: Mileage as the actual mileage driven to at least one decimal point. Total mileage for any complete trip is required to be entered on a single line corresponding to the first pickup, the total miles must be for the entire trip to the final destination of the last passenger in the vehicle taken from an odometer reading, in vehicle GPS reading or, taximeter (internet map searches will not be accepted). No Show is a flat rate per occurence as defined in the contract. |
| Wait Time and Attendant: Enter the actual amount of time in minutes only. All times will begin after the required wait time per the contract. |
TRANSPORTATION INVOICE USER GUIDE REV. 09/09/2019
Service Log
| DERS Monthly Activity Detail | |
| Contractor Name: | Division/Program Name: |
| Service Month: | Client/Passenger Name: |
| SERVICE DATE | # OF PASSENGERS | AUTHORIZATION/PO NUMBER | DRIVER NAME / NUMBER | REASON FOR TRANSPORT | PICK UP ADDRESS | PICK UP TIME | DROP OFF ADDRESS | DROP OFF TIME | FLAG DROP (s) | SERVICE | RATE | # of UNIT(S) | CHARGE | |||
| (Units x Rate) | SERVICE | RATE | # of UNIT(S) | CHARGE | ||||||||||||
| (Units x Rate) | TOTAL | |||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
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| $0.00 | $0.00 | $0.00 | ||||||||||||||
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| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 | ||||||||||||||
| $0.00 | $0.00 | $0.00 |
TRANSPORTATION TRIP LOG
Page &P of
Descriptions
| Ambulatory Transportation - Local |
| Ambulatory (Passenger Van 8+ Passengers) Transportation - Local |
| Non-Ambulatory (Wheelchair Van) Transportation - Local |
| Attendant - Local |
| Wait Time - Local |
| No Show Fee - Local |
| Ambulatory Transportation - Distant |
| Ambulatory (Passenger Van 8+ Passengers) Transportation - Distant |
| Non-Ambulatory (Wheelchair Van) Transportation - Distant |
| Attendant - Distant |
| Wait Time - Distant |
| No Show Fee - Distant |
File details come from the government source that posted it. Updated .