Attachment B
CalOES Reimbursement Invoice
_______________________________
Date
_______________________________
Title
_______________________________
Signature
:Local Agency, Return Invoice to
Governor’s Office of Emergency Services
Fire and Rescue Division
Reimbursement Processing
:Remit Payment to
Victorville Fire Department
14343 Civic Drive,
Victorville, CA, 92392
California Fire Assistance Agreement
Reimbursement Invoice
Cal OES-CAL FIRE-USFS-BLM-NPS-FWS-BIA
Cal OES F-142
: 95-2235918Federal Tax ID Number
: SB1RGMJ5U1M7UEI Number
: 0000007293FI$Cal Supplier ID
: 4FI$Cal Address ID
Invoice Number: U-20240464-VCV
: 08/16/2024Invoice Date
: CA-BTU-012090 Incident Order Number
: THOMPSON Incident Name
: VCVMACS Designator
SUMMARY INFORMATION
Resource Req. No. Strike Team Depart
Date/Time
Return
Date/Time
Personnel
Total
Equipment
Total
Support
Vehicle
Expense
Total
Admin
Surchg
E-6315 E-103.3 OES-6828-C 07/03/2024
0600
07/06/2024
1200 $16,415.1 $0.00 $0.00 $0.00 $1,641.51
$16,415.1 $0.00 $0.00 $0.00 $1,641.51
CLAIM TOTAL: $18,056.61
CAL FIRE (100.00%): $18,056.61
Mileage for Privately Owned Vehicle(POV)
only and is figured at a of 0.655 per actual
mile.
Engine Hours are based on a 16 hour portal to
portal day for each 24 hour period.
Agency Salary Survey on file: 07/01/2024
Support Vehicle Rates are: Apparatus Rates are: Personnel Rates are:
Sedan = $226.000 per day
Pick-Up (1/2 Ton) = $166.000 per day
Van = $309.000 per day
SUV = $279.000 per day
Other (3/4 Ton & Above) = $265.000 per day
Type I = $173.470 per hour
Type II = $163.550 per hour
Type III = $156.740 per hour
Type IV - VII = $150.470 per hour
Water Tender Tactical I = $148.070 per hour
Water Tender Tactical II = $127.210 per hour
Chief = $83.11
Deputy Chief = $80.94
Division Chief = $81.31
Assistant Chief = $34.59
Battalion Chief = $53.75
Co. Officer/Capt./Lt. = $42.20
App. Officer/Eng = $35.83
Firefighter/FF-PMedic = $31.13
Administrative Rate: 0.10000
The Invoice amounts are computed on the California Fire Assistance Agreement currently in place between Cal OES, CAL FIRE, USFS, BLM, NPS, FWS and BIA. Local agencies that have wages that exceed the minimum base rate shall be reimbursed using the Salary Rate otherwise the established base rate shall be used for reimbursement.
: Salary Rate: [[(S x H x 1.5) + M +E] x A] or Established Base Rate: [[(B x H x 1.5) + M + E] x A] Formulas Where S = Salary Rate; H = Total hours on Incident; A = Administrative Rate (%); B = Established Hourly Base Rate; E = Engine Reimbursement, where applicable; M= Claimed Miles
: As per the California Fire Assistance Agreement, there will be a delay in payment for invoices not returned to Cal OES by the local agency within 30 days ofReminder receipt.
I Certify that to the best of my knowledge and belief, and under penalty of perjury that the data above it correct. : CA-BTU-012090Incident Order Number
: THOMPSONIncident Name
: VCVMACS Designator
: OES-6828-CStrike Team
: E-103.3Request Number
Emergency Activity Calculation Record
Fire and Rescue
:Dispatch Information
: FMAGIncident Type : E-6315Unit Number :ICS/Other Title : : 07/03/2024Departed Date : 0600Time
: : 07/06/2024Returned Date : 1200Time : 78.00Total Hours :Apparatus Type : 1611837License Number ? YesOES Vehicle :Strike Team/Task Force Leader, Assistant Strike Team Leader, or a Overhead Personnel Vehicle Ownership Vehicle Type License Number Beginning Odometer Ending Odometer Total Miles Strike Team Expenses
Personnel Type Hourly Rate Paid Rate Hours on this F42 Total for this F42 Co. Officer/Capt./Lt. $42.20 $63.30 78.00 $4,937.4
App. Officer/Eng $35.83 $53.75 78.00 $4,192.5
Firefighter/FF-PMedic $31.13 $46.70 156.00 $7,285.2
Total Personnel $16,415.1
Equipment Rate Hours
Apparatus Hours $0.00 54.00 Apparatus Total $0.00
FEMA Equip Total $0.00
Special Equip Total $0.00
Equipment Subtotal $0.00
Rate Days/Miles
Vehicle Sub Total $0.00
Total Expense Claim $0.00
Admin Surcharge $1641.51
Total for this F-42 $18,056.61
(OES F-42) Less 0 engine hours overlap, Less support vehicle days overlap Less 0 FEMA Code hours overlap, Less 0 Special Equipment hours overlap EMERGENCY ACTIVITY RECORD (OES F-42)
1. AGENCY DESIGNATOR
CA-VCV
2. RESOURCE TYPE
OES-6828-C
3. INCIDENT ORDER NUMBER
CA-BTU-012090
4. INCIDENT REQUEST NUMBER
E-103.3
5. DISPATCH INFORMATION
: THOMPSONIncident Name : ICPReporting Location
: : 07/03/2024Committed To Incident Date : 0600Time
: :Return From Incident Date :Time
: : 07/06/2024Redispatched Date : 1200Time
6. DISPATCH FROM
:Incident Name :End Date
:Old Incident Order Number :Old Incident Request Number
7. REDISPATCHED INFORMATION -(START NEW F-42 IF REDISPATCHED) : LAKEIncident Name : 07/06/2024End Date
: CA-LPF-001542New Incident Order Number : E-44New Incident Request Number
8. OVERHEAD INFORMATION - ST(TF) LEADER / ST(TF) LEADER(TRINEE)/OVERHEAD :Overhead Type
:(ICS Title) :(Other ICS Title)
9. SUPPORT VEHICLE INFORMATION 10. PRIVATELY OWNED VEHICLE Vehicle Ownership License Number Vehicle Type Beginning Odometer Ending Odometer Total Miles
11. EQUIPMENT RESOURCE INFORMATION
: ENGINEApparatus :Resource Type
: E-6315Unit : 1611837License Number
: YesCDF/OES Vehicle
:Special Equipment :FEMA
Equipment Name License Number Description Code/Name License Number Description
12. PERSONNEL INFORMATION
: 4Number Of Personnel Assigned
Approved Personnel Rotation
Incoming
Crew No
Outgoing
Crew No
Incoming Crew Start
Date/Time
Outgoing
Crew End
Date/Time
Vehicle
Ownership
License
Number Vehicle Type Beginning
Odometer
Ending
Odometer Total Miles
PERSONNEL INFORMATION
Crew No. Name (Last, First) MACS ID Rank/Job Title Start End CAL FIRE Base Rate 1 DEROIAN, JOHN VCV Co. Officer/Capt./Lt. 07/03/2024:
0600 07/06/2024: 1200 No No
1 DEROSE, GRANT VCV App. Officer/Eng 07/03/2024:
0600 07/06/2024: 1200 No No
1 ARAMBURO, JESSE VCV Firefighter/FF-PMedic 07/03/2024:
0600 07/06/2024: 1200 No No
1 MEZA, CARLOS VCV Firefighter/FF-PMedic 07/03/2024:
0600 07/06/2024: 1200 No No
13. PERSONNEL INFORMATION - ACTUAL HOURS
Date Crew No. Start End Hours
14. Comments (Equipment Breakdowns, Personnel Change, Loss/Damage, etc.) Date Time Comment
07/03/2024 0600 ASSIGNED
07/06/2024 1100 DEMOB
07/06/2024 1200 REASSIGNED TO LAKE FIRE E44
15. COMPENSATION CLAIMS 16. SUPPLY NUMBER
: NoComp. Claims :S#
17. RESPONDING AGENCY INFORMATION
: Victorville Fire DepartmentAgency/Department Name : NoDocumentation Only
:Signature
: FIRE CAPTAINTitle
: John DeroianPrint Name : (760) 447-3427Your Phone Number
18. INCIDENT INFORMATION
: CAL FIREPaying Agency
:Signature of Authorized Incident Personnel
: FINANCE SECTION CHIEFICS Position/Title
: BILL STIRTONPrinted Name : 07/09/2024Date
: JEFF DAPPERCal OES Representative (if assigned) : 07/06/2024Date F42s Audit Logs
Date Field Original Value New Value
07/29/2024 10:16:49 Status CALOES REVIEW APPROVED
Personnel Audit Logs
Date Field Original Value New Value
07/29/2024 10:16:01 Rank / Job Title Co. Officer/Capt./Lt. App. Officer/Eng Actual Hours Audit Logs
Date Field Original Value New Value