county of alameda - acgov.org | alameda county government€¦ · sr. victim-witness consultant. 2....
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Completed only by thel rk 0 the Board's Office Agenda Date: I z" CBS Sign Off
COUNTY OF ALAMEDA OUT-OF-STATE TRAVEL AUTHORIZATION REQUEST
~ TO:
FROM: SUBJECT: DATE:
AUTHORIZATION NUMBER
Su.san S. Muranishi,. County Administrator Agency / Department Head - Print Nancy E. O'Malley OUT-OF-STATE TRAVEL (OOST) AUTHORIZATION REQUEST
I am requesting your approval ofthe following OOST request prior to the event taking place.
PLEASE TYPE I PRINT LEGIBLY District Attorney Victim Assistaace OiviSQS
AGENCY / DEPARTMENT DIVISION / UNIT TRAVElER'S NAME· JOB TITLE / CLASSIFICATION or VENDOR #PLEASE TYPE I PRINT LEGIBLY
1. Sr. Victim-Witness Consultant_. - 2.
3,
*NOTE: The only eligIble personal servIces contractors are those who are reImbursed traveVevents as stated 10
hislher contractual agreement with the County, Must specify Vendor # above. "
DETAILS OF TRAVEL
. DATES (DURATION): From: 4/161W2 / To: 4/20/20lL
POINT OF ORlGIN (City/State): Oakland, CA I DESTINATION (City/State): New Orleans, LA
PURPOSE OF TRIP: _X_CONFERENCE - MEETING - SEMINAR - TRAINING _OTHER
NAME OR TITLE OF EVENT (no acronyms please): 12th AJinuar Family Justice Center Conference
1. AUDITOR'S MAXlMUM REIMBURSEMENT (per person): $ COST PER TRANS TICKET: $: to(O~V
ITEMS COVERED: x: Transportation _It Food & Lodging .. ,Event Fees -------------------- TOTAL COST (Max Reimb/person )( no. of travelers): $ \btD~O 0 COUNTY TIME-OFF ONLY
ACCOUNTING INFORMATION / FUNDING SOURCE
BUSINESS ACCOUNT FUND . ORGANIZATION PROGRAM PROJECT/GRANT No. UNIT No. No. .No. No.
))A,..~r (" /"'4/.. J 106M :::l,7;/; ~ ~/l Aft\.A~cJ
2. NAME OF FUNDING SOURCE (please Specify):
3. AMOUNT OF FlJNDING 4. COUNTY COST AMOUNT (Noted on the Board Agenda) Ito toO. Lf.D
(PRINT NA.'A.E) PHONE NUMBER: 5101267·8872
REQUESTED BY: Kelti Sage
CAO:
3~-/L . (DATE)
'fJ ~ I(V (PRINTNAM ..._ -.. IGNATURE I ATE
Note: Travel agency should FAX the completed form to Au ontroller Agency to the attention of Travel Approver. FAX # (510) 272-6502. The Auditor-Controller's Office will notify the travel agency of the Authorization Number by phone or FAX
RETURN TO: Towanda Lee'"'" QIC 20702I..
110-25 (0411 0) Completed only by the <t k of ~he Board's Office Agenda Date: n n CBS Sign Off \ rAJ
V'
COUNTY OF ALAMEDA OUT-OF-STATE TRAVEL AUTHORIZATION REQUEST
Ihl=A=U=TH=O=RI=Z=A=T=I=O=N=NUM==BE=R==================================lJ11
TO: Susan S. Muranishi, County Administrator FROM: Agency / Department Head - Print Nancy E. O'Malley Si&natu,elbtfU1SUBJECT: OUT-OF-STATE TRAVEL (OOST) AUTHORlZATION REQUEST DATE:
I am requesting your approval of the following OOST request prior to the event taking place.
* NOTE: The only ehglble personal services contractors are those who are reIIDbursed travel/events as stated m
PLEASE TYPE I PRINT LEGIBLY
District Attorney AGENCY/DEPARTMENT OIVlSION / UNIT
TRAVELER'S NAME • JOB TITLE / CLASSIFICATION or VENDOR #PLEASE TYPE I PRINT LEGIBLY
~ . FUM Oev elWYY'i'd aw;\.JpecA&1\ 0-9 C2~ Ur'1.
2. ~
3. ..
hislher contractual agreement with the County. Must specify Vendor # above. '.
DETAILS OF TRAVEL
DATES (DURAnON): From: ~ /l(p /20\1. To: C8 /20.L..2ol 1
POINT OF ORlGIN (City/State): Oa.k..lC\vtd I (~ I DESTINATION (City/State): NM or .Q.Qa.V1S L-A
PURPOSE OF TRlP: / CONFERENCE - MEETING - SEMINAR - TRAINING OTHER
NAME OR TITLE OF EVENT (no acronyms please):~Clm~l1 ju..5~(J2... 0evrkr CAJ'A.fe 1'e Y'\.(L
1. AUDITOR'S MAXIMUM REIMBURSEMENT (per person): $ COST PER TRANS TICKET: $: (DO~D
/ F
ITEMS COVERED: I Transportation .:L. Food & Lodging __ Event Fees ------- --TOTAL COST (Max Reimb/person x no. of travelers): $lObD~ D COUNTY TIME-OFF ONLY
ACCOUNTING INFORMATION / FUNDING SOURCE BUSINESS ACCOUNT FUND ORGANIZATION PROGRAM PROJECT/GRANT No.
UNIT No. No. No. No. /''J A." r'c (", //'1 j..}/.. / It)/)~/') ;;) :2\/1 ':} A l'\ /"I AAAr~
2, NAME OF FUNDING SOURCE (please Specify):.. \ 0(00. 4-D3. AMOUNT OF FUNDING 4. COUNTY COST AMOUNT (Noted on the Board Agenda) _
~ 2l\S-j~IL (pRi1\iT NAME) (QIC) (SNritfRE) (DATE)
PHONE NUMBER:trll) Z1t1-~~ TIE LINE: _ FAX NUMBER($10J 'UJ71-81'0't
SIGNATURE)
0,2,1 -/2....~~~~vErl2\&w 0'MAu.£Uf- _ (DATE)I (pRINT NAME)!
CAO: It\~ rWt--- >l2." I \'2/ ~
Note: Travel agency should FAX the completed fonn to itor-Controller Agency to the attention of Travel Approver. FAX # (510) 272-6502. The Auditor-Controller's Office will notify the travel agency of the Authorization Number by phone,or FAX
I, RETURN TO: Towanda Lee - QIC 20702
- - - -
-------------------------
Completed only by the. Agenda Date: CBS Sign Off
II
110-25 (04/10)
COUNTY OF ALAMEDA OUT-OF-STATE TRAVEL AUTHORIZATION REQUEST
II AUTHORIZATION NUMBER
TO: Susan S. Muranishi, County Administrator FROM: Agency / Department Head - Print Nancy E. O'Malley SUBJECT: OUT-OF-STATE TRAVEL (OOST) AUTHORIZATION REQUEST DATE:
I am requesting your approval of the following OOST request prior to the event taking place.
PLEASE TYPE 1PRINT LEGIBLY ra.yY'\; \'1 0\\50 -\-\ ce. Ce.llkrz.District Attorney
AGENCY 1DEPARTMENT DIVISION 1UNIT TRAVELER'S NAME' JOB TITLE 1CLASSIFICATION or VENDOR #
PLEASE TYPE I PRINT LEGIBLY
l. NtA1I1 Ci (N\[712.. U'~-(vd"~1 ~((t{fh 5p?{I·~isrI I-- ...... V
2.
3. ..* NOTE: The only ehglble personal services contractors are those who are relIDbursed travel/events as stated ill
I . h h C M 'fy # bhis/her contractua agreement Wit t e ourtty. ust speci Vendor a ove. "
DETAll.S OF TRAVEL
DATES (DURATION): From: .1- @ / '2.012 To: .~_i..f).D/ '201
POINT OF ORIGIN (City/State): OCL\c:\i\t\d I CA I DESTINATION (City/StateYNesv OpJe.ans I LA
PURPOSE OF TRIP: VCONFERENCE MEETING SEMINAR TRAINING OTHER
NA!v1E OR TITLE OF EVENT (no acronyms please): \l:'M ~o. \ \'(\\\':~C'o.\\ O'"u.\ ~CI~.\,/ j\l>..~lr' lJI C.-e y\,~)}-
1. AUDITOR'S MAXIMUM REIMBURSEMENT (per person): $ foOD~1)/ COST PER TRANS TICKET: $:
ITEMS COVERED: \/Transportation \/Food & Lodging' Event Fees
0 COUNTY TIME-OFF ONLYTOTAL COST (Max Reimb/person xno. of travelers): $ \Cbb;)'D
ACCOUNTING INFORMATION I FUNDING SOURCE
BUSINESS ACCOUNT FUND ORGANIZATION PROGRAM PROJECT/GRANT No. UNIT No. No. No. - No.
l7\..d A ;:-r 1("",/1') 41:-. / 1/ a I') III /) IQ~..... Q .....,/\, /'IA /'C\~rJ
2. NAME OF FUNDING SOURCE (Please Specify):
3. AMOUNT OF FUNDING 4. COUNTY COST AMOUNT (Noted on the Board Agenda) \b~O.40
(QIC) '1-.S0D \
TIE LINE: RINTNAME)
PHONE NUMBER: ZIP"1- -'Ol(l1-~
RINTNAME) CAO:
APPRO DEPT.
(GNA) 2\ / $" \ 20\ "2.
.-y 0 (;,.,-VA (DATE) _ FAX NUMBER: Z- &7 ·t - U VV-'
Note: Travel agency shoUTd FAX the completed form to A tor-Controller Agency to the attention of Travel Approver. FAX # (510) 272-6502. The Auditor-Controller's Office will notify the travel agency of the Authorization Number by phone or FAX
RETURN TO: Towanda Lee - QIC 20702