AUTHORIZATION TO INCUR TRAVEL EXPENSES

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1 Page 1 TRAVELER: STATUS (Check One) PEOPLE FIRST ID NO.: CONTACT PERSON: HEADQUARTERS: RESIDENCE(City): OFFICIAL TEMPORARY Officer/Employee OPS Non-Employee/Independent Contractor DEPARTMENT: Transportation MAIL STATION: COST CENTER: TELEPHONE: AUTHORIZATION TO INCUR TRAVEL EXPENSES EXPECTED DATE/TIME OF DEPARTURE FROM HEADQUARTERS: DATE: TIME: PURPOSE/REASON FOR TRAVEL BUSINESS LOCATION (City, State) DATE TIME BUSINESS COMMENCES BENEFITS TO STATE BUSINESS ENDS EXPECTED DATE/TIME OF RETURN TO HEADQUARTERS: DATE: TIME: SUBSISTENCE MODE OF TRANSPORTATION (Refer to DOO Handbook for guidance) INCIDENTAL EXPENSES ESTIMATED COST MEALS: $ PER DIEM: $ LODGING: $ AIRLINE: $ RENTAL CAR: $ OTHER: $ DOT VEHICLE STATE MOTOR POOL STATE AIRCRAFT COMPLIMENTARY (COMP) POV (Privately Owned Vehicles) $ Requires completion of Rental Car vs. POV worksheet. Lesser amount will be paid unless business reason provided supporting use of POV. I HEREBY CERTIFY THAT TRAVEL AS SHOWN ABOVE IS TO BE INCURRED IN CONNECTION WITH OFFICIAL BUSINESS OF THE STATE. $ $ OTHER PERSONNEL IN PARTY: Multiple travelers with similar itineraries should share/use the same mode of transportation. OTHER SIGNATURE REQUIREMENTS: Traveler Signature Date Immediate Supervisor Signature Date Authorized Official Signature Date Other Signature Date Refer to Section , F.S., Chapter 69I-42 F.A.C. and the Department of Financial Services Reference Guide and the Disbursement Handbook for Employees and Managers for complete instructions. CLASS A TRAVEL STATUS Continuous travel of 24 hours or more away from official headquarters. CLASS B TRAVEL STATUS Continuous travel of less than 24 hours requiring overnight absence from official headquarters. CLASS C TRAVEL STATUS Travel for short day trip not requiring overnight absence from official headquarters. MAXIMUM ALLOWANCES FOR MEALS AS FOLLOWS: BREAKFAST $6.00 When travel begins before 6 a.m. and extends beyond 8 a.m. LUNCH $11.00 When travel begins before 12 noon and extends beyond 2 p.m. DINNER $19.00 When travel begins before 6 p.m. and extends beyond 8 p.m., or when travel occurs during night-time hours due to special assignment. Lodging < 50 miles (Secretary Only See Instructions) Foreign Travel (Secretary Only) Out-of-State (Secretary) Out-of-State Materials Testing (District Secretary or State Highway Engineer) Out-of-State Routine Operational Requirements D2, D3 Only (District Secretary) Non-DOT (SMS or above) Event (Assistant Secretary/District Secretary) Any fraudulent claims of mileage, per diem, or any other travel expenses are subject to prosecution as a misdemeanor.

2 Page 2A TRAVELER: STATUS (Check One) PEOPLE FIRST ID NO.: CONTACT PERSON: HEADQUARTERS: RESIDENCE(City): OFFICIAL TEMPORARY REIMBURSEMENT OF TRAVEL EXPENSES DATE TRAVEL PERFORMED FROM POINT OF ORIGIN TO DESTINATION Officer/Employee OPS Non-Employee/Independent Contractor PURPOSE OR REASON FOR TRAVEL (NAME OF CONFERENCE OR CONVENTION) DEPARTMENT: Transportation MAIL STATION: HOUR OF DEPARTURE and RETURN COST CENTER: CLASS A & B MEAL ALLOWANCE PER DIEM/ ACTUAL LODGING TELEPHONE: MAP VICINITY INCIDENTAL EXPENSES AMOUNT TYPE SIGNATURES I hereby certify or affirm that the above expenses were actually incurred by me as necessary traveling expenses in the performance of my official duties; attendance at a conference or convention was directly related to my official duties of the agency; any meals or lodging included in a registration fee have been deducted from this travel claim; and that this claim is true and correct in every material matter and conforms in every respect with the requirements of Section , Florida Statutes, Chapter 69I-42 F.A.C., Department of Financial Services Reference Guide and the Disbursement Handbook for Employees and Managers. TRAVELER: DATE: WORKING TITLE: Pursuant to Section (3)(a), Florida Statutes, I hereby certify or affirm that to the best of my knowledge the above traveler was on official business for the State of Florida and the travel was performed for the purpose(s) stated above. AUTHORIZED OFFICIAL: DATE: TYPED OR PRINTED NAME: WORKING TITLE: 0 MILES $0.445 $0.00 SUMMARY LESS TRAVEL ADVANCE (Agency VO. NO. ) < > LESS NON-REIMBURSABLE PURCHASING CARD CHARGES <$0.00> NET AMOUNT DUE TRAVELER <STATE> $0.00 LN ORG CODE EO OBJECT CODE AMOUNT BEG TRAVEL END TRAVEL C B PROJECT ID WORK FCT JUSTIFICATION: USE ONLY TR-DATE CK-DATE ECAT DATE Total $0.00

3 Page 2B TRAVELER: HEADQUARTERS: RESIDENCE(City): OFFICIAL TEMPORARY REIMBURSEMENT OF TRAVEL EXPENSES DATE TRAVEL PERFORMED FROM POINT OF ORIGIN TO DESTINATION STATUS (Check One) Officer/Employee OPS Non-Employee/Independent Contractor PURPOSE OR REASON FOR TRAVEL (NAME OF CONFERENCE OR CONVENTION) PEOPLE FIRST ID NO.: DEPARTMENT: Transportation MAIL STATION: HOUR OF DEPARTURE and RETURN COST CENTER: CLASS A & B MEAL ALLOWANCE PER DIEM/ ACTUAL LODGING CONTACT PERSON: TELEPHONE: MAP VICINITY INCIDENTAL EXPENSES AMOUNT TYPE 0 MILES $0.445 $0.00 SUMMARY LN ORG CODE EO OBJECT CODE AMOUNT BEG TRAVEL END TRAVEL C B PROJECT ID WORK FCT JUSTIFICATION: USE ONLY TR-DATE CK-DATE Total $0.00 ECAT DATE

4 Page 2C TRAVELER S NAME: PEOPLE FIRST ID NO.: TRAVEL : - DIRECT BILLING THIS SECTION REQUIRED TO BE COMPLETED ONLY WHEN TRAVEL RELATED EXPENSES WERE PAID USING THE STATE OF FLORIDA PURCHASING CARD OR WERE PAID DIRECTLY TO ANOTHER STATE AGENCY DATE FROM TO DESCRIPTION OF ITEM ACQUIRED AMOUNT VENDOR/COMMON CARRIER/ STATE AGENCY TICKET NUMBER/ STATE VEHICLE NO. PURCHASING CARD NON-REIMBURSABLE CHARGES THIS SECTION REQUIRED TO BE COMPLETED ONLY WHEN NON-REIMBURSABLE ITEMS WERE PURCHASED USING THE STATE OF FLORIDA PURCHASING CARD DATE MERCHANT/VENDOR DESCRIPTION OF NON-REIMBURSABLE ITEM AMOUNT ADDITIONAL JUSTIFICATIONS, COMMENTS OR EXPLANATIONS $0.00

5 INSTRUCTIONS INSTRUCTIONS FOR COMPLETING THE TRAVEL INFORMATION: Data entered in this area will be transferred to page 2a automatically. TRAVELER: Name of the individual performing the travel. PEOPLE FIRST ID #: Traveler's People First identification number. HEADQUARTERS: Check appropriate box. City in which the traveler performs majority of his/her assigned duties. DEPARTMENT: The agency name "Transportation" or the name of another state agency. RESIDENCE (City): City in which traveler lives. MAIL STATION: Traveler's interoffice mailing address. STATUS: Check appropriate box for employment status. CONTACT PERSON: Person to notify for inquiries related to the travel voucher. TELEPHONE: The telephone number of the contact person. User ID. AUTHORIZATION TO INCUR TRAVEL EXPENSES EXPECTED TIME OF DEPARTURE FROM HEADQUARTERS: Departure date and time, (including A.M. or P.M.) from headquarters. BUSINESS LOCATION: The city and state where business is to be performed. BUSINESS COMMENCES: The date and time of when business will begin. BUSINESS ENDS: The date and time of when business will end. EXPECTED TIME OF RETURN TO HEADQUARTERS: Return date and time, (including A.M. or P.M.) to headquarters. PURPOSE / REASON FOR TRAVEL: Give nature of travel. Specify name of conference, convention, seminar, training, or meeting. No acronyms or abbreviations. BENEFITS TO THE STATE: A statement of benefits is required for conference or convention hosted by an organization other than DOT. SUBSISTENCE: Estimate the cost of meals, lodging, and/or per diem. MODES OF TRANSPORTATION: Check all appropriate boxes. Estimate the cost for airline, rental car, POV, and any other method of transportation used. POV requires completion of Rental Car vs. POV worksheet. The lesser of the calculated amounts will be paid unless a business reason is provided supporting the use of the POV. INCIDENTAL EXPENSES: Estimate the cost of any incidental expenses. ESTIMATED COST: Record the total dollar amount for subsistence, modes of transportation and incidental expenses. OTHER PERSONNEL IN PARTY: List the name(s) of any DOT employee(s) traveling with traveler. COST CENTER: Cost center number from which travel will be paid. (Optional) TRAVELER SIGNATURE: Individual who performed travel. Signature must be in ink, preferably not black. IMMEDIATE SUPERVISOR SIGNATURE: Traveler's Immediate Supervisor. According to (3)(a) F.S., the traveler's immediate supervisor must sign the Authorization to Incur Travel Expenses section. AUTHORIZED OFFICIAL SIGNATURE: Individual authorized to approve travel. Authorized official must have a completed Payment Document Authorization Form on file with District Financial Services or Disbursement Operations Office. Conference/Convention travel: The Secretary's designees for conference/convention travel are Authorized Officials. If the authorized official is also the immediate supervisor, either sign again or write "same". OTHER SIGNATURE REQUIREMENTS: Additional signature required for special circumstances as indicated. Check the appropriate box to indicate the required level of approval.

6 INSTRUCTIONS INSTRUCTIONS FOR COMPLETING THE TRAVELER'S INFORMATION: Data transferred from page 1. REIMBURSEMENT OF TRAVEL EXPENSES DATE: (MM/DD/YY) Date(s) of actual travel. TRAVEL PERFORMED FROM POINT OF ORIGIN TO DESTINATION: Departing location to the city or town of where business will commence. List each location separately and NO ABBREVIATIONS. PURPOSE OR REASON FOR TRAVEL: Give reason for travel. Specify name of conference, convention, seminar, training, meeting, etc... NO ACRONYMS or ABBREVIATIONS. HOUR OF DEPARTURE / HOUR OF RETURN: Actual time of departure and return. (Including A.M. or P.M.) CLASS A & B MEAL ALLOWANCE: Itemize daily using the appropriate meal allowance $6, $11, and $19 per F.S Deduct any meals included in a registration fee paid by DOT. PER DIEM / ACTUAL LODGING: Itemize daily. For per diem use the standard rate of $80 per day prorated on a quarterly basis. For actual lodging, use single occupancy rate including taxes. MAP : Point to point mileage calculated from the Official Department of Transportation map, or actual mileage (odometer or internet mapping program such as MapQuest). VICINITY : Mileage other than map mileage incurred within headquarters or destination. INCIDENTAL EXPENSES: List the amount and type of charge being claimed. (Do not itemize daily). : Total cost for Class A & B meal allowance. : Total cost for Per Diem / Actual Lodging. MILES: Total of map and vicinity mileage x $0.445/mi. Calculate to the third decimal point and round down to the nearest cent. : Total cost for Transportation / Incident Expenses. SUMMARY : Add all column totals for total cost of reimbursement. LESS TRAVEL ADVANCE: If applicable. Only one travel advance to a voucher. Subtract amount from Summary Total. LESS UNALLOWABLE PURCHASING CARD CHARGES: If applicable. Subtract the dollar amount from Summary Total. NET AMOUNT DUE TRAVELER <STATE>: Total due <owed> after subtracting amounts for Class C meals, travel advances (if applicable), and non-reimbursable purchasing card charges. TRAVELER SIGNATURE: Individual who performed travel. WORKING TITLE / DATE: Working title of traveler and date Travel Form was prepared. AUTHORIZED OFFICIAL SIGNATURE: Individual authorized to approve travel. Authorized person must have completed Payment Document Authorization Form on file with District Financial Services or Disbursement Operations Office. TYPED OR PRINTED NAME: Name of Approver authorizing travel. (PRINT CLEARLY) WORKING TITLE / DATE: Working title of Approver and date of signature. LINE NUMBER: District Financial Services/Disbursement Operation use only. ORGANIZATION CODE: The nine digit FLAIR Organization code which will represent the cost center to be charged. Multiple organization codes may be used. EO: Numbers or letters used to access pre-established files to expand accounting data. OBJECT CODE: The six digit FLAIR Organization code identifying the type of expenditure. Multiple codes may be used. Double click on OBJECT CODE in order to access the travel object code listing. AMOUNT: Dollar amount for each cost distribution line. : Dollar amount should match Net Amount Due. TRAVEL : Record the actual beginning and ending dates of travel. (MM/DD/YY) CB: "0" to identify a federal aid participating project or "1" to identify a non-participating project. PROJECT IDENTIFICATION: The eleven digit Financial Project number. WORK FCT: The three digit work activity function code. JUSTIFICATION: To explain any unusual claims for reimbursement. FOR USE ONLY: District Financial Services/Disbursement Operations use only.

7 INSTRUCTIONS INSTRUCTIONS FOR COMPLETING THE WHEN THE STATE OF FLORIDA PURCHASING CARD IS USED FOR TRAVEL, RECORD THE CHARGES ON PAGE 2C AND SUBMIT WITH PAGE 2A. Record the traveler's information including the beginning and ending dates of travel. DIRECT BILLING: This section required to be completed only when travel related expenses were paid using the State of Florida Purchasing Card or expenses were paid directly to another State Agency. DATE: Date of purchase. VENDOR/COMMON CARRIER/STATE AGENCY: Name of merchant, airline, rental car company or State Agency. TICKET NUMBER/STATE VEHICLE NO.: If charge is for an airline ticket enter the ticket number. If the charge is for the rental of another state agency vehicle or aircraft enter the vehicle/aircraft number. FROM: Record the point of origin. (Only required for transportation charges.) TO: Record the point of destination. (Only required for transportation charges.) DESCRIPTION OF ITEM ACQUIRED: Describe the item(s) purchased. AMOUNT: Dollar amount of airline ticket, rental car, and item purchased. PURCHASING CARD NON-REIMBURSABLE CHARGES: To be completed when charges are made using the State of Florida Purchasing Card for items that are not reimbursable from state funds. Non-reimbursable items such as upgrade on rental car, non-mandatory parking, personal calls on hotel bills, movies, etc... ADDITIONAL COMMENTS, JUSTIFICATIONS AND EXPLANATIONS.

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