IA01 Technical Exhibit 7 Travel Request Form W9124D20R0016.pdf

Contract # and TO #:

Traveler:

Request Date: Origin:

Destination:

Travel Purpose:

Start Date: End Date:

Total TDY Days: Travel Days:

Estimated Expenses:

Air Fare: Ticket: Taxes: Total: $0.00

Baggage: (round Trip) # of Bags: 1st Bag 2nd Bag Total: $0.00

Lodging: Days: Cost: Taxes: Total: $0.00

Per Diem Rate: Whole Days: 0 Travel Days: 0 Total: $0.001

Rental Car: # of Days: Daily Rate: Fees & Taxes Total: $0.00

Fuel:

Parking: Taxi/Shuttle: Tolls: Total: $0.00

POV Mileage: Miles: Total: $0.00

Total: $0.00 55 Cost Taxes

Total: $0.00

Total: $0.00

Total: $0.00

Total: $0.00

Total: $0.00

Total: $0.00

Trip/Expenses explanation:

$0.00 Receipts are required for air travel, auto rental, hotel and other non-subsistence items. Travel Expense Report and receipts must be turned in to support a claim for reimbursement within 5 working days of completion of travel to the Government for approval.

Signatures:

Traveler Signature/Date: Supervisor Signature/Date

Admin Signature/Date Government/COR Signature/Date

Travel Fee:

Miscellaneous Expenses:

Item

(Will be either 1 or 2 days)

Designated Driver: (Supervisor use only)

CONTRACTOR OFFICIAL TRAVEL AUTHORIZATION REQUEST

In and around mileage:

Total Estimated Travel:

MR#:

Effective Date 15 February

Approved Disapproved

Technical Exhibit 7 http://www.gsa.gov/portal/content/104877�

Cost

MILES

Cost

Miles Est. MPG Gas Cost (per

GAL)

Travel fee

TOTAL COST

ADDRESS TO

Rental Car

TOTAL COST

*Note: Policy change states that the traveler will not get reimbursed for tolls if the cost to take POV exceeds commercial transportation

COST COMPARISON OF DRIVING POV "OR" USING COMMERCIAL TRANSPORT TO TRAVEL LOCATION

SECTION I

ORIGIN TO DESTINATION

VS.OR

POV TRAVEL TO/FROM MISSION

ADDRESS FROM

Airfare

TOTAL COST

AIRPORT/RENTAL CAR LOCATION PARKING COST

ORIGIN TO AIRPORT/RENTAL CAR DESTINATION

ADDRESS TO

ADDRESS FROM

COST COMPARISON OF DRIVING POV "OR" USING COMMERCIAL TRANSPORT TO AIRPORT / RENTAL CAR LOCATION

(Roundtrip)

Total miles

TOTAL POV COST

MILES

(Roundtrip)

TOTAL MILES

Airport/Rental Car Location Parking (Daily Rate)

Number of Days

POV TRAVEL TO/FROM AIRPORT or RENTAL CAR LOCATION

TYPE OF CONVEYANCE

(Compare all) one way roundtrip

Taxi

Shuttle/Bus

TOTAL COST (ROUNDTRIP)

COMMERCIAL TRANSPORT TO/FROM AIRPORT or RENTAL CAR

LOCATION

Check which transportation you are comparing

NOTE: If you elect to use POV for Travel to Airport / Rental Car Location and it is more expensive than using Commercial Transport, total reimbursment (airport parking included) is limited to the cost of

Commercial Transport.

Remarks to Justify / Explain Request to Use POV vs. Commercial Transport If POV Cost is More (e.g., undue delay, rental facility operating hours, etc):

ADDENDUM 1 to Contractor Travel Request Authorization Form Instructions:

Complete White Blocks

Traveler Name

Travel Origin

Travel Destination

Begin Travel (Date) End Travel (Date)

Rental Car Gas

SECTION II

Remarks to Justify / Explain Request to Use POV vs. Commercial Transport If POV Cost is More (e.g., undue delay, rental facility operating hours, etc):

POV MILAGE COST

Request date:

Origin:

Destination:

Travel Purpose:

Start Date:

End Date:

Total TDY Days:

Travel Days:

Air Fare:

Ticket:

Taxes:

Baggage: (roundtrip) # of Bags:

1st Bag:

2nd Bag:

Lodging:

Days:

Cost:

Taxes:

Per Diem Rate:

Whole Days:

Travel Days:

# of Days:

Daily Rate:

Fees &Taxes:

Fuel:

Parking:

Taxi/Shuttle:

Tolls:

POV Mileage:

Miles:

In and around mileage:

Travel Fee:

Miscellaneous Expenses:

Cost:

Taxes:

Traveler Signature/Date:

Supervisor Signature/Date:

SERCO Admin Signature/Date:

Government/ACOR Signature/Date:

Travel Request Instructions

The taxes for the hotel room per night

Traveler's first and last name Date travel is submitted for approval (ex: 6Jan16) Location that traveler will start their travel from City and State where traveler's mission will be take place The reason for the mission The day traveler will begin their travel (ex: 6Jan16) The day traveler returns back to their original location Total number of days the traveler will be on the mission Drop down menu, choose one or two based on the mission duration. If the mission is more than 12 hours choose two.

Base price of the plane ticket without the taxes Taxes for the plane ticket

Automatically generates Automatically generates

Automatically generates The Government rate for lodging

Drop down menu, select one if the trip is 13 days or less. If your trip is 14 days or more than you will select two.

The Government rate for per diem Automatically generates Automatically generates Total numbers of days the traveler will be charged Daily rate that is on the e-invoice Total cost of fees for the entire rental car Estimated amount of fuel for the mission Total cost of parking Total cost it will be for a taxi or shuttle Total cost of tolls

Total POV miles the traveler will drive for the mission Total in and around mileage the traveler will drive

Traveler electronically signs this area Supervisor electronically signs this area SFL-TAP Travel POC appointee electronically signs The Government/COR electronically signs this area approving the traveler's travel.

Does not apply to Inverness Travel

Other expenses not listed on the request Base cost for the expense, not including the taxes Total cost of taxes for the expense

Travel Expense Report and receipts must be turned in to support a claim for reimbursement within 5 working days of completion of travel to the Government for approval.

Origin:

Destination:

Begin Travel (Date):

End Tavel (Date):

Air Fare:

Travel Fee:

Rental Car:

Rental Car Gas:

POV Mileage:

Address From:

Address To:

Miles:

Taxi:

Shuttle/Bus:

POV Mileage:

Address From:

Address To:

Miles:

Airport/Rental Car Location Parking Number of Days: The number of days the traveler's vehicle will be parked at the airport or rental car facility

Price of the plane ticket with the taxes

Addendum Instructions Automatically generates Automatically generates Automatically generates

Total POV miles the traveler will drive based on the addresses listed above

Automatically generates Automatically generates

Fee for the traveler to book their ticket

Address of the destination

Section I:

The traveler will need to fill out Section I if they are requesting to use their POV. The travler will need to compare taking Commercial transportaion vs. driving their POV. If you are requesting to use your POV and it exceeds the cost of commercial transportation, then you will only be reimbursed up to what it would cost to take commercial transportation.

Cost of the rental car including taxes

The daily rate for parking

Cost to take a Shuttle/Bus one way. The roundtrip will automatically generate

Address of starting location Address of the airport or rental car facility Total POV miles the traveler will drive based on the addresses listed above

Below the miles cell the traveler will estimate the total miles they will drive. Below the Gas Cost the traveler will be responsible for putting the current gas price, and with this information the total gas price will automatically generate to the left.

Address of the travel origin

Section II:

The Traveler will need to fill out Section II if they are requesting to take their POV to/from the rental car facility or the airport. If you are requesting to use your POV and it exceeds the cost of commercial transportation, then you will only be reimbursed up to what it would cost to take commercial transportation.

Cost to take a taxi one way. The roundtrip will automatically generate

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