Grassroots Womxn Rising Statewide Assembly REIMBURSEMENT FORM

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1 Grassroots Womxn Rising Statewide Assembly REIMBURSEMENT FORM Please complete the following information and attach original receipts. Remember to include who we should make the check out to. This form is due by Tuesday, April 30, Name: Make Check Payable to: Address: City Traveling From: Expense Type Detail Amount (parking, rental car, gas for rental car, public transportation, shuttle, etc.) Mileage $0.58 per mile) Dinner while traveling on 3/15/19 and 3/17/19 (max $28 per meal) Childcare/Attendant (attach completed Proof of Payment form) Mail completed form, with receipts attached, to: Pam Flood Urban Habitat 2000 Franklin Street Oakland, CA Total:

2 TRAVEL REIMBURSEMENT POLICY Reimbursements will not be provided outside of these guidelines unless there is prior approval. You must attend the entire convening, which is the full day Saturday, March 16 th and half day Sunday, March 17 th, to receive reimbursement. We will reimburse you for your actual travel expenses, up to the maximum amount listed below for each TCE BHC site. All requests for reimbursement, except mileage, must be accompanied by a receipt. Participants from out of town will travel to Fresno on Friday, March 15, Del Norte: o Participants traveling from Del Norte will be reimbursed for the actual expense for round trip airfare to Oakland, and up to $300 for rental car and gas expenses. Secure your flight and make your rental car reservation early to get the lowest rate, and please carpool, if possible. o Participants will receive reimbursement for mileage for travel to/from the airport and for parking at the airport. Fresno: o Participants traveling from Fresno will receive reimbursement for mileage or public transportation for travel to/from the hotel. Please carpool, if possible. Salinas, Kern, Merced, and Sacramento: o Participants traveling from Salinas, Kern, Merced, and Sacramento will receive reimbursement for mileage for travel to/from the hotel, or for rental car and gas expenses (up to the maximum noted below). Make your rental car reservation early to get the lowest rate, and please carpool, if possible. Oakland, Richmond, Coachella, City Heights, Santa Ana, Long Beach, Boyle Heights, and South Los Angeles: o Transportation to/from the convening will be provided via charter bus from the following locations: Oakland/Richmond (Bus Route 1): Pick up/drop off in Oakland at TCE Center for Healthy Communities at 2000 Franklin Street. Overnight parking is available. A reservation is required. Los Angeles Area servicing Long Beach, Boyle Heights, and South Los Angeles (Bus Route 2): Pick up/drop off in Los Angeles at the TCE Center for Healthy Communities at 1000 North Alameda Street. Overnight parking is available. A reservation is required. Coachella (Bus Route 3): Pick up/drop off in Coachella. City Heights/Santa Ana (Bus Route 4): Pick up/drop off in City Heights and Santa Ana o Participants will receive reimbursement for mileage or public transportation for travel to/from the bus stop, and for parking at the bus stop, if needed. o We will NOT provide reimbursement for other travel expenses (for example airfare, rental cars, and mileage to/from hotel) from sites with charter buses.

3 o Please sign up for roundtrip charter bus transportation from your area on the application form, and you will receive additional details including pick up location and times, and parking. Meals: o Dinner will be provided for those taking a charter bus to the convening on Friday, March 15 th. For everyone else traveling from out of town we will reimburse you for your actual expense for dinner while traveling to the convening on Friday, March 15 th up to $28. o Breakfast, lunch, and dinner will be provided at the convening on Saturday, March 16 th. o Breakfast and lunch will be provided at the convening on Sunday, March 17 th. o Dinner will be provided for those taking a charter bus from the convening on Sunday, March 17 th. For everyone else traveling from out of town we will reimburse you for your actual expense for dinner while traveling home on Sunday, March 17 th up to $28. o There will be no reimbursement for other meals. o All requests for reimbursement for meals must be accompanied by a receipt. CHILDCARE/ATTENDANT REIMBURSEMENT POLICY Reimbursements will not be provided outside of these guidelines unless there is prior approval. You must attend the entire convening, which is all day on Saturday, March 16 th and half day Sunday, March 17 th, to receive reimbursement for your childcare/attendant expenses. The daily payment limit is $120. Reimbursements are only for care that has NOT been provided by a partner or spouse. The convening participant is responsible for paying the childcare or attendant care provider directly and in a timely and adequate manner. A completed and signed Proof of Payment Form is required to show that the provider was paid. Please print the Proof of Payment Form and have it signed by the provider, and attached it to this Reimbursement Form as proof of payment. Please indicate your need for reimbursement for childcare or attendant expenses on the application form.

4 MAXIMUM Reimbursement Amount TCE BHC Site to/from home, bus stop, or airport Air Lodging (arranged and pre paid) Parking (parking at the Doubletree Hotel is free) Meals Boyle Heights City Heights N/A Yes Actual cost at bus stop, if needed (more details soon) Coachella N/A Yes Actual cost at bus stop, if needed (more details soon) Del Norte Fresno to/from airport. Up to $300 for rental car Complementary airport shuttle provided by hotel 6:00 am 9:00 pm. Actual cost Yes Actual cost at airport N/A N/A N/A N/A

5 MAXIMUM Reimbursement Amount TCE BHC Site to/from home, bus stop, or airport Air Lodging (arranged and pre paid) Parking (parking at the Doubletree Hotel is free) Meals Kern N/A Yes N/A Long Beach Merced N/A Yes N/A Oakland Richmond Sacramento N/A Yes N/A

6 MAXIMUM Reimbursement Amount TCE BHC Site to/from home, bus stop, or airport Air Lodging (arranged and pre paid) Parking (parking at the Doubletree Hotel is free) Meals Salinas N/A Yes N/A Santa Ana N/A Yes Actual cost at bus stop, if needed (more details soon) South LA

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