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EMC® <br /> .n�%AGfMeh <br /> Emergency Management Assistance Compact <br /> Emergency Management Assistance Compact (EMAC) <br /> Intrastate Reimbursement Form (R-2) <br /> Event: Oregon,OR 2021 Fire No.2 <br /> Requesting State/Province: Oregon Date Submitted: 1/6/22 <br /> Resource Provider: City of Everett Fire Department <br /> Resource Provider/Vendor Number: U18-090 <br /> State Mission Number: 21-2454 EMAC Mission Number: 2114-RR-10543 <br /> Copies of all receipt and payment vouchers for all expenses are attached(please select): Yes <br /> Personnel Costs <br /> Total Regular Hours $ 5,912.67 Total Regular Fringe $ 1,422.99 <br /> Total Overtime Hours $ 51,197.51 Total Overtime Fringe $ 5,272.64 <br /> Total Backfill Hours $ 18,072.73 Total Backfill Fringe $ 1,229.39 <br /> Total Holiday Pay Hours $ - Total Holiday Pay Fringe $ - <br /> Total Compensatory Hours $ - Total Compensatory Fringe $ - <br /> Total Personnel Costs $ 83,107.93 <br /> Travel Costs <br /> Meals:Per Diem $ 240.00 Meals:Receipt $ - <br /> Air Travel $ - Airfare Baggage and Fees $ - <br /> Lodging $ - Parking/Tolls $ - <br /> POV/GOV/Rental $ - Laundry $ - <br /> Total Travel Costs $ 240.00 <br /> Equipment Costs <br /> Equipment by Rate $ 27,930.00 Equipment by Quantity $ - <br /> Total Equipment Costs $ 27,930.00 <br /> Commodity Costs <br /> Total Commodity $ - <br /> Total Commodity Costs $ - <br /> Other Costs <br /> Other by Rate $ - Other by Quantity $ - <br /> Total Other Costs $ <br /> Total Reimbursement $ 111,277.93 <br /> Total Donated $ - <br /> Comments <br /> Place Comments here <br /> REIMBURSEMENT PACKAGE CERTIFICATION <br /> The authorized official of the Resource Provider certifies that the totals for each category/claim are exact costs expended by the Resource Provider to perform the <br /> services as requested in the RSA.All supporting documentation for the claim are included and are certified as accurate.All documentation not included with this <br /> claim will be maintained by the Resource Provider or Assisting State for a period of ten(10)years following the above date of submission and maybe obtained for <br /> audit purposes by notifying the Assisting State EMAC Coordinator or State Director. <br /> Certified and Authorized By: <br /> gF City Clerk 1/6/2022 <br /> Prme Title Date <br /> S na re <br /> v -,gr--Suvk--- <br /> v 4/12/21 <br />