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[]
["Form 110-58",null,null,null,"COUNTY OF ALAMEDA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Business Unit:",null,null,null,null,null,"protection password: \"aud2016\""]
["Revised 1/2019",null,null,null,"AUDITOR-CONTROLLER AGENCY",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"effective date"]
[null,null,null,null,"2019 DAILY TRAVEL EXPENSE REIMBURSEMENT CLAIM",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Voucher #:",null,null,null,null,null,"New mileage rate",null,"2020-01-01"]
[null,null,null,null,"(Do not use for Training or Conference related Travel)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Current mileage rate",0.57999999999999996,"2019-01-01"]
[null,null,null,null,null,null,null,null,null,"FOR THE MONTH OF",null,null,null,null,",",null,null,null,null,null,null,null,null,null,null,null,null,"Prior mileage rate ",0.54500000000000004,"2018-01-01"]
["Only expenses incurred in current calendar year (January 1 - December 31) may be submitted on this form."]
["(April 15th is the deadline for submitting any expenses incurred in previous calendar year.)"]
["  Type or Print"]
[]
[]
[null,"First Name",null,null,null,null,null,"Last Name",null,null,null,null,null,null,null,"ALCOLINK Supplier ID",null,null,null,null,null,"Employee ID"]
[]
[]
[null,"Department Name",null,null,null,null,null,"Department Liaison",null,null,null,null,null,null,null,"Liaison Phone #",null,null,null,null,null,"QIC"]
[]
[null,"Worksite Address",null,null,null,null,null,null,null,null,null,null,null,null,null,"Home Address"]
[]
[null,"EXPENSE SUMMARY"]
["Non-shaded areas in this section, excluding registration fees, are populated as data is entered in the \"Travel Expense Detail\" on page 2.  See instructions."]
[]
[null,"MILEAGE ALLOWANCE",null,null,null,{"$f":"SUMIFS(M77:M104,A77:A104,\">=\" & Curr_Mile_Eff_Date,A77:A104,\"<\"&AD4)","v":0},"Net miles at 58.0 cents per mile effective January 1, 2019",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(Vehicle_use_8_days=TRUE,$AD$23=TRUE),0,+F22*Curr_mileage_rate)","v":0},null,null,null,{"$f":"IF(SUM(F22:F22)-M105<>0,\"Total mileage not equal to total on Travel Detail Expense page\",\"\")","v":""}]
[null,"MINIMUM ALLOWANCE",null,null,null,"If vehicle was used at least 8 days in the month and the computed mileage is less than $10.00, check the checkbox for the minimum allowance of $10.00 in lieu of mileage.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(Vehicle_use_12_days=TRUE,0,IF(AND(W22<10,Vehicle_use_8_days=TRUE),10,0))","v":0},null,null,null,null,"Vehicle use for 8 days?",false,{"$f":"IF(Vehicle_use_12_days=TRUE,\"FALSE\",Vehicle_use_8_days)","v":false}]
[null,"PREMIUM ALLOWANCE",null,null,null,"If vehicle was used at least 10 days in the month and 20 lbs or more of County records, manuals, and supplies necessary to do the job were carried therein, check the checkbox for $12.00 allowance.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(Vehicle_use_12_days=TRUE,12,0)","v":0},null,null,null,null,"Vehicle use for 12 days?",false]
[null,"MONTHLY PARKING FEES",null,null,null,"Only specific employees in the Assessor's Office and Public Heath Departments who are required to regularly drive their vehicles for work assignments as a condition of employment and who are on the list of eligible employees filed with the Auditor's Office may enter the monthly parking fee.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,"Final invoice?",false]
[null,"PARKING, BRIDGE TOLLS, GAS, & PUBLIC TRANSIT",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"+P105","v":0}]
[null,"MEALS  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"+Q105","v":0}]
[null,"LODGING ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"+S105","v":0}]
[null,"CAR RENTAL AND OTHER TRAVEL RELATED EXPENSES",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"+T105","v":0}]
[null,"OTHER EXPENSES",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"+X105","v":0}]
[null,"TOTAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(W22:W30)","v":0}]
[]
[null,"CLAIMANT'S CERTIFICATION",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(W31<30, W31<>0, Final_invoice=FALSE),\"Total claim is less than $30. Claim will be denied unless it is the last claim for the fiscal year.\",\"\")","v":""},"Out of state travel?",false]
[null,"I certify that I incurred the local travel expenses detailed herein in accordance with Chapter 3.36 of the Alameda County Administrative Code and, if applicable, Board Resolution 174227, and that this information is true and correct to the best of my knowledge."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(Out_of_state_travel?=TRUE,\"Attach Form 110-25 Out of State Travel (OOST) Authorization Request\",\"\")","v":""}]
[]
[]
[null,"CLAIMANT'S SIGNATURE",null,null,null,null,null,null,null,null,"PRINTED NAME",null,null,null,null,null,null,null,null,null,"Date"]
[]
[]
[]
[]
["ACCOUNTING INFORMATION"]
["Business Unit",null,null,"Account",null,"Fund","Department",null,null,"Program",null,"Sub-Class",null,null,null,null,"Budget Yr",null,"Project",null,null,null,"Amount"]
[null,null,null,610191,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(W23:X26)","v":0},null,null,null,null,null,"Invoice Type"]
[null,null,null,610193,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(W22)","v":0},null,null,null,null,null,"MILE"]
[null,null,null,610201,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(W27:X29)","v":0},null,null,null,null,null,"MIMI"]
[null,null,null,610461,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"+W30","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total",null,{"$f":"SUM(W45:X48)","v":0}]
[]
[null,null,null,"Invoice #:",null,null,null,null,null,null,null,null,null,"Invoice Type:",null,null,null,null,null,null,"Payment Handling:",null,null,"DP"]
[]
[null,"Payment Comments:"]
[]
[]
["AUTHORIZED APPROVER CERTIFICATION"]
[null,"I certify that the expenses claimed herein were required in accordance with Chapter 3.36 of the Alameda County Administrative Code and, if applicable, Board Resolution 174227."]
[]
[]
[]
[null,"SUPERVISOR/FINANCE DEPARTMENT SIGNATURE",null,null,null,null,null,null,null,null,"PRINTED NAME",null,null,null,null,null,null,null,null,null,"Date"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"AUTHORIZED APPROVER SIGNATURE",null,null,null,null,null,null,null,null,"PRINTED NAME",null,null,null,null,null,null,null,null,null,"Date",null,null,null,null,null,null,null,"N"]
[]
[]
["Form 110-58"]
["It is essential to complete the “First/Last Contact?” column.  If the trip originated or ended at your place of residence, indicate “Y.” If \"Y,\" record the gross trip miles (actual driving distance) and regular commute miles (the driving distance between your home and your regularly assigned worksite). The County only reimburses mileage in excess of the regular commute. If the gross mileage is greater than the regular commute mileage, compute the difference as the net allowable miles. If the gross trip mileage to the first or last point of business contact of the day is less than the regular commute mileage, you may not claim mileage reimbursement for that trip. If the trip included both the first and last point of business contact in the day, the round-trip commute miles must be used to determine the net allowable miles. Please consider using a County Motor Pool Vehicle and/or Clipper Card to avoid incurring future transit-related expenses and having to file reimbursement claims.  For Motor Pool information visit http://alcoweb.acgov.org/gsa/mv/reserve.htm;  for Clipper Card go to http://alcoweb.acgov.org/gsa/bta. "]
[]
[]
[]
[]
[]
["TRAVEL EXPENSE DETAIL"]
[null,"DATE","PURPOSE OF TRIP \nORIGIN/DESTINATION (home/client visit must include case number)",null,null,null,null,"FIRST/LAST CONTACT? \n(Y/N)","GROSS TRIP MILES",null,"LESS REGULAR COMMUTE MILES",null,"NET ALLOW MILES",null,null,"PARKING, BRIDGE, GAS, & PUBLIC TRANSIT","MEAL COSTS",null,"LODGING EXPENSES","CAR RENTAL & OTHER TRAVEL RELATED EXPENSES",null,"OTHER EXPENSES "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ITEM",null,"COST"]
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[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I80=\"\",\"\",IF(I80-K80<0,0,I80-K80))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H80=\"Y\",K80=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H80<>\"Y\",K80<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I83=\"\",\"\",IF(I83-K83<0,0,I83-K83))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H83=\"Y\",K83=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H83<>\"Y\",K83<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I86=\"\",\"\",IF(I86-K86<0,0,I86-K86))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H86=\"Y\",K86=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H86<>\"Y\",K86<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I89=\"\",\"\",IF(I89-K89<0,0,I89-K89))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H89=\"Y\",K89=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H89<>\"Y\",K89<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I92=\"\",\"\",IF(I92-K92<0,0,I92-K92))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H92=\"Y\",K92=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H92<>\"Y\",K92<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I95=\"\",\"\",IF(I95-K95<0,0,I95-K95))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H95=\"Y\",K95=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H95<>\"Y\",K95<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I98=\"\",\"\",IF(I98-K98<0,0,I98-K98))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H98=\"Y\",K98=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H98<>\"Y\",K98<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(I101=\"\",\"\",IF(+I101-K101<0,0,I101-K101))","v":""},null,null,null,"B",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(H101=\"Y\",K101=\"\"),\"This trip originated or ended at your place of residence, please enter commute miles.\",IF(AND(H101<>\"Y\",K101<>\"\"),\"This trip did not originate or end at your place of residence, no need to enter commute miles\",\" \"))","v":" "}]
[null,null,"FROM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"L"]
[null,null,"TO:",null,null,null,null,null,null,null,null,null,null,null,null,null,"D"]
[]
["                                                                                                                                                                                                               ",null,null,null,null,null,null,null,null,null,"TOTALS:",null,{"$f":"SUM(M77:M104)","v":0},null,null,{"$f":"SUM(P77:P104)","v":0},{"$f":"SUM(R77:R104)","v":0},null,{"$f":"SUM(S77:S104)","v":0},{"$f":"SUM(T77:U104)","v":0},null,null,null,{"$f":"SUM(X77:X104)","v":0}]
["           "]

{"sheet":"Instructions","index":1,"n_rows":10,"n_cols":1,"rows_kept":10,"cut":false,"hidden":false,"merged":[[9,0,9,1],[3,0,3,1],[7,0,7,1],[1,0,1,1],[2,0,2,1],[4,0,4,1],[5,0,5,1],[6,0,6,1],[8,0,8,1]]}
[]
["DISCLAIMERS: If you are completing the PDF version of this form, please note that the Net Allowable Miles from Page 2 does not carry over to the Mileage Allowance on Page 1.  Please enter the total Net Allowable Miles in the Mileage Allowance Box, multiply by the applicable mileage rate and enter total amount for mileage rate."]
["Who May Use This Form\n- County employees who do not receive a vehicle allowance and who incur travel expenses (including mileage, parking, bridge charges, public transit fares, meals, and other incidentals) while performing official business not associated with a conference or training expense.                                                                                                                                                                                                                                    - County employees who receive a monthly vehicle allowance MAY NOT claim mileage for travel within Alameda, San Francisco, Contra Costa, Santa Clara, and San Mateo counties.\n- County employees with conference/training-related travel expenses, must use Form 110-30 (Personal Expense Claim).  \n- Non-County employees must use Form 110-64 (Non-County Employee Expense Claim)."]
["Prohibited Uses of This Form: Non-reimburseable expenses include but are not limited to: internet fees due to telecommuting;  prepayment and upgrades from standard room rates; office and cleaning supplies and other sundry items; meals in conjunction with a half-day training, County Managers Affiliation, social, retirement, political events, or included in registration or airline fares; and food/beverages for staff performing their normal functions or County meetings. For additional information concerning reimbursement for meals, please see the Disbursement Manual of Accounting Policies and Procedures (MAPP) or contact your department liaison. "]
["Monthly Parking Fees: If an employee participates in the County’s pre-tax parking program, the employee should only have the amount not claimed for reimbursement on the 110-58 deducted on their paycheck.  For example, if monthly parking cost is $100 and the employee is reimbursed $70.00, only $30.00 may be deducted from his or her paycheck. For more information regarding the county’s pretax parking program, contact the Employee Benefits Center.\n"]
["Purpose of Trip Origin/Destination: For client visits (e.g., home or hospital visits), enter the case number in the \"purpose\" cell.  The use of the welfare case number is not a violation of the HIPAA Privacy Act Rule because the welfare case number is not protected health information (45 CFR section 160.103) and, alternatively, (2) it falls within the HIPAA Payment Exception (45 CFR section 164.506(c)(1)). If the expense was for BART, bus passes, FasTrak toll charges, single-metered parking, bridge tolls, multi space pay-and-display metered parking, unmetered parking, or another form of transportation, designate it on the form by writing the expense type, e.g., BART."]
["Mileage: Use the mileage rate in effect at the time of travel (not when the claim is submitted).  If the reimbursement includes mileage, the employee must complete the First/Last Contact column.  If the trip started or ended at the employee's place of residence, the answer is \"yes\" and the employee must enter commute mileage, i.e., the driving distance between home and the regularly assigned worksite, in the \"less commute miles\" column.  The Net Allowable Miles is equal to the gross trip miles minus the commute miles.  The County only reimburses employees for mileage in excess of their regular commute.  If the gross mileage is greater than the regular commute mileage, compute the difference as the net allowable miles.  If the gross mileage is less than or equal to the regular commute miles, the employee may not claim reimbursement for mileage for that trip."]
["See examples on the next tab for more information.  Please consider using a County Motor Pool Vehicle and/or Clipper Card to avoid incurring future transit-related expenses and having to file reimbursement claims.  For Motor Pool information visit http://alcoweb.acgov.org/gsa/mv/reserve.htm;  for Clipper Card information go to http://alcoweb.acgov.org/gsa/bta.\n"]
["Travel Expense Detail and Supporting Documents: Original receipts are required for gas, unmetered parking, lodging and other forms of transportation.   Original, detailed receipts showing items purchased and tip, if applicable, are required for meal reimbursement.  Photocopies or faxed copies of receipts are not accepted.  All receipts must be legible and on or attached to an 8 1/2 x 11 sheet of paper.  Lodging and transportation charges should be supported by the original itemized hotel bill and any other applicable documentation.  Please list the travel expense detail and associated receipts in chronological order. The Auditor's Office may require additional documents to support the claim."]
["Claim Submittal: Claims must be submitted in the calendar year they are incurred, no later than April 15th of the following calendar year. Do not submit a claim for less than $30 unless it is the last claim of the year. Do not submit multiple claims for expenses incurred in the same month. If claims for multiple months are submitted, use a separate form for each month, submit them together, and attach a calculator tape showing the total reimbursable amount.  All claims require the employee identification number and the last five digits of the employee's Social Security Number.  Do not use red ink except to designate the business unit. Use only yellow highlighters. Information must be legible and in chronological order. Submit the completed and signed form, with supporting documents, to the department finance unit who will complete the accounting information section and create an ALCOLINK voucher.  After the claim is reviewed for accruacy and MAPP compliance, approved and signed by the departmental approver, the department forwards the claim and supporting documents to the Auditor's Office, QIC 20111, Attention: Expense Claims."]

{"sheet":"Examples","index":2,"n_rows":35,"n_cols":1,"rows_kept":35,"cut":false,"hidden":false,"merged":[]}
["   Form 110-58 Examples"]
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["The following examples use the following assumptions:"]
["     -  Jane, a County employee, lives in Berkeley"]
["     -  She drives 10 miles to her office in Oakland"]
[]
["Example A"]
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["On January 2, 2015, Jane drove 60 miles from her home in Berkeley to Sacramento to meet with a client.  Because her regular commute is 10 miles, she is eligible to receive reimbursement for 50 miles each way."]
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["The trip would be calculated on Form 110-58 as follows:"]
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["Example B"]
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["On January 5, 2015, Jane visited several clients.  The last client she visited was only two miles away from her home, eight miles short of her regular commute.  The form is programmed to calculate zero net allowable miles rather than eight negative miles.  In this way, reimbursement for the other trips will not be impacted."]

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