19-003 David Wellhouse & Associates, Inc. Claims for State Mandated Cost Reimbursement for FY 2018-2019_2-19-20David Wellhouse
...and Associates, Inc.
Ms. Kristen Squarcia
City Clerk
City of Cupertino
10300 Torre Avenue
Cupertino, California 95014
February 19, 2020
RE: COPIES OF FEBRUARY 2020 STATE MANDATED COST REIMBURSEMENT CLAIMS
Dear Ms. Squarcia:
Enclosed are the copies of the February 2020 state mandated cost reimbursement claims prepared on behalf
of the City of Cupertino by David Wellhouse & Associates, Inc..
I would like to especially thank you and the City staff for the support, experience, and professionalism
extended to me throughout this process. In this field, the optimization of the state mandated cost
reimbursement process is directly influenced by a good working relationship and the support extended by
City staff.
Thank you again for selecting David Wellhouse & Associates to fulfill your state mandated cost claiming
needs. As always, I have very much enjoyed working with you and hope to assist the City of Cupertino
for many years to come.
In the next few days, you should receive an invoice for our services for the preparation and filing of the
February 2020 state mandated cost reimbursement claims. Should you have any questions, please contact
me at (916) 797-4883.
Sincerely,
Renee M. Wellhouse
Enclosures
3609 Bradshaw Road, Suite H-382 • Sacramento, California 95827
(916)797-4883 • FAX (916) 797-4887
yyir David Wellhouse
...and Associates, Inc.
STATE MANDATED COST CLAIMS RECEIPT
FEBRUARY 2020 STATE MANDATED COST CLAIMS
AGENCY: CITY OF CUPERTINO
DATE: FEBRUARY 15, 2020
The State Controller's Office, Division of Accounting, Local Reimbursement Bureau hereby
acknowledges receipt of the following State Mandated Cost Claims (SB 90) prepared and
submitted on behalf of the above -noted agency by David Wellhouse & Associates, Inc.
CHAPTER
CLAIM PERIOD
AMOUNT
Chapter 256, Statutes of 1995
FY. 2018/2019
$5,711
Domestic Violence Arrest Standards
Chapter 698 & 702, Statutes of 1998
FY. 2018/2019
$3,966
Domestic Violence Arrest & Victim Assistance
Chapter 1460, Statutes of 1989
FY. 2018/2019
$2,923
Administrative License Suspension
Chapter465, Statutes of 1976
FY. 2018/2019
$1,693
Peace Officers Procedural Bill of Rights
Chapter 630, Statutes of 1978
FY. 2018/2019
Peace Officer's Personnel Records
Chapter 999, Statutes of 1991 FY. 2018/2019 $1,158
Rape Victim Counseling Center Notices
Chapter 483, Statutes of 2001 FY. 2018/2019
Crime Victims Domestic Violence Incident Reports II
Chapter 1120, Statutes of 1996 FY. 2018/2019
Health Benefits for Survivors of Police & Fire
Chapter 721, Statutes of 2015
U Visa 918 Form, Victims of Crime: FY. 2018/2019
Nonimmigrant Status
State of California
,.__.
iI VIIQI O VIIIVQ
PROGRAM DOMESTIC VIOLENCE ARREST
1 POLICIES AND STANDARDS
CLAIM FOR PAYMENT
m anuarea frost manual Tor Local
For State Controller Use Oniy
19) Program Number 00167 FORM
20) Date Filed F A M-27
21) LRS Input f1
9843231
( CITY FINANCE OFFICER
r CITY OF CUPERTINO
10300 TORRE AVENUE
CUPERTINO, CA 95014
Reimbursement
Claim Data
(22) FORM 1, (04)(a)
58
(23) FORM 1, (04)(b)
205
(24) FORM 1, (06)
5-711
(25) FORM 1, (07) A. (g)
(03)
(04)
(05)
Type of Claim
(09) Reimbursement ®
(10) Combined
(11)Amended ❑
1 (26) FORM 1, (07) B. (g)
(27) FORM 1, (07) C. (g)
(28) FORM 1, (09)
(29) FORM 1, (10)
Fiscal Year of Cost
(06)
(12) 2018 2019 1(30)
FORM 1, (12)
Total Claimed Amount
(07)
(13) $5, 711
(31) FORM 1, (13)
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) 5 711 1(34)
Due from State
(fl8)
1
(17)
(35)
Due to State
(18)
(36)
(37) CERTIFICATION OF CLAIM
In accordance with the provisions of Government Code sections 17560 and 17561, I certify that I am the officer authorized by the local
agency to file mandated cost claims with the State of California for this program, and certify under penalty of perjury that I have not
violated any of the provisions of Article 4, Chapter 1 of Division 4 of Title 1 of the Government Code.
I further certify that there was no application other than from the claimant, nor any grants) or payments) received for reimbursement of
costs claimed herein and claimed costs are for a new program or increased levei of services of an existing program. All offsetting
revenues and reimbursements set forth In the parameters and guidelines are Identified, and all costs claimed are supported by source
documentation currently maintained by the claimant.
The amount for this reimbursement is hereby claimed from the State for payment of amwal costs set- forth on the attached statements.
I certify under penalty of perjury under the taws of the State of California that the foregoing is true and correct.
Signature of Authorized Officer
c_
c k-r, -
Type or Print Name and Title of Authorized Sign tory
(38) Name of Agency Contact Person for Claim
Name of Consulting Firm / Claim Preparer
DAVID WELLHOUSE & ASSOCIATES (DWA)
Form FAM-27 (Revised 9/19)
Date Signed Z l 1 V ( Za
Telephone Number Lf 0
Email Address �G (I�S�Es1 S (� C� pe-rfi c one
Telephone Number
Email Address
Telephone Number (916) 797-4883
Email Address dwa_ �a_ e„PP(dS,trazyQ, nPt
PROGRAM
DOMESTIC VIOLENCE ARREST POLICIES
FORM
167
AND STANDARDS CLAIM SUMMARY
1
(01) Claimant
(02) Fiscal Year
City of Cupertino
2018/2019
(03) Department
(04) Claim Statistics
(a) Number of reported responses to incidents in the fiscal year of claim
58
(b) Average productive hourly rate including applicable indirect costs (Refer to claiming
instructions)
$205.13
(c) Standard time allowed — 29 minutes (0.48 of an hour)
0.48
Unit Cost Method — Reimbursable Activity D
(05) Ongoing Activity
D. Implementation of New Policies [Line (04)(a) x (04)(b) x (04)(c)]
$5,711
(06) Total Direct and Indirect Costs for Activity D [Carry forward from line (05)(D)]
$5,711
Direct Costs
Object Accounts
Actual Cost Method
(a)
(b)
(c) Materials
(d)
(e)
(f)
(g)
(07) One -Time Activities
Salaries
Benefits
and
Contract
Fixed
Travel
Total
Supplies
Services
Assets
and
Training
A. Development of Written Policies
0
0
0
0
0
0
0
B. Adoption of Written Policies
0
0
0
0
0
0
0
C. Training Officers on New Policies
0
0
0
0
0
0
0
(08) Total Direct Costs (A, B, C)
0
Indirect Costs
(09) Indirect Cost Rate [From ICRP or 10%]
(10) Total Indirect Costs [Refer to Claim Summary Instructions]
(11) Total Direct and Indirect Costs [Line (06) + line (08)(g) + line (10)]
$5,711
Cost Reduction
(12) Less: Offsetting Revenues
(13) Less: Other Reimbursements
(14) Total Claimed Amount [Line (11) - {line (12) + line (13)}]
$5,711
W
State of California
State Controller's Office
Mandated Cost Manual for Local Aaencles
PROGRAM
For State Controller Use Only
DOMESTIC VIOLENCE ARRESTS AND
FORM
VICTIM ASSISTANCE
(19) Program Number 00274
274
CLAIM FOR PAYMENT
(20) Date Filed
FAM-27
(21) LRS Input
9843231
Reimbursement Claim Data
(� CITY FINANCE OFFICER
(22) FORM 1, (04)A. 1. (r�
CITY OF CUPERTINO
(23) FORM 1, (04)A. 2. (f)
S, 10300 TORRE AVENUE
CUPERTINO, CA 95014
(24) FORM 1, (04)A. 3. (f)
(25) FORM 1, (04) B. 1. (f)
3,966
c
--�—
Type of Claire
1 (26) FORM 1, (06)
(03)
(09) Reimbursement NO
(27) FORM 1, (07)
(04)
(10) Combined ❑
(28) FORM 1, (09)
(05)
(11)Amended ❑
1(29) FORM 1, (10)
Fiscal Year of Cost
(fl6)
(12) 2018 20
(30)
Total Claimed Amount
(07)
(13) $3,966
(31)
Less: 10% Late Penalty (refer to attached Instructions)
(14) 1(J2)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) 3 66 1(34)
Due from State
(08)
(17) 3 966 1(35)
Due to State
(18) 1
(36)
(37) CERTIFICATION OF CLAIM
In accordance with the provisions of Government Code sections 17560 and 17561, i certify that I am the officer authorized by the local
agency to file mandated cost claims with the State of California for this program, and certify under penalty of perjury that I have not
violated any of the provisions of Article 4, Chapter 1 of Division 4 of Title 1 of the Government Code.
further certify that there was no application other than from the claimant, nor any grant(s) or payment(s) received for reimbursement of
costs claimed herein and claimed costs are for a new program or increased level of services of an existing program. All offsetting
revenues and reimbursements set forth in the parameters and guidelines are ident"fled, and all costs claimed are supported by source
documentation currently maintained by the claimant.
The amount for this reimbursement is hereby claimed from the State for payment of actual costs set forth on the attached statements.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Signature of Authorized Officer
+
Date Signed 2 I ! ! 2-
Telephone Number L{ O is' - 34'-1--3-22�
V ! P-S TE+-i -:ygVA LGI A i C-A -N Email Address \ I S%✓lSC-t, C=v
Type or Print Name and Title of Authorized Signatory ✓
(38) Name of Agency Contact Person for Claim
Telephone !Number
Email Address
Name of Consulting Firm / Claim Preparer
Telephone Number _1916) 797-4883
DAVID WELLHOUSE & ASSOCTATES (DWA) Email Address [lwa r�ays�p�(dcaarPc pct mad
Form FAM-27 (Revised 9/19)
(01) Claimant II (02) Type of Claim Fiscal Year
CITY OF CUPERTINO
2018/2019
3) Department
ct Costs Object Accounts
Reimbursable Components (a) (b) (c) D(d) (e) (t)Salaries Benefits MaterialsTotal
and Assets
One -Time Activities
1. Printing Victims Cards
2. Adding Two New Crimes to Response Policy
3. Adding Information to Response Policy
1B. Ongoing Activity
Indirect Costs
(06) Indirect Cost Rate ( From ICRP }
Total Indirect Costs
Total Direct and Indirect Costs:
Cost Reduction
(09) Less: Offsetting Savings
(10) Less: Other Reimbursements
(1 1) Total Claimed Amount
- {Line (09) + Line ( I
Mate Cnnrrnllnr•'a nm�..
Mandated Cost Manual
MANDATED COSTS
FORM
DOMESTIC VIOLENCE ARRESTS AND VICTIMS ASSISTANCE
2
ACTIVITY COST DETAIL
(01) Claimant
(02) Fiscal Year 201812019
CITY OF CUPERTINO
(03) Reimbursable Components: Check only one box per form to Identify the component being claimed.
One -Time Activities
Ongoing Activity
Ej Printing Victim Cards
Providing Victims Cards
0 Adding Two New Crimes to Response Policy
0 Adding Information to Response Policy
04 Description of Expenses
Ob ect Accounts
(a)
Employee Names, job Classifications ,
Functions Performed and Description
(b)
Hourly
Rate or
Benefit
%
(c)
Hours
Worked or
(d)
Salaries
(e)
Benefits
(n
Materials
and
(g)
Contract
Services
(h)
Fixed
Assets
Total
Sal. & Ben.
of Expenses
Unit Cost
Rate
Ouantltv
Su lies
Police Officer
$205.13
19.3
$3,965.85
$3,966
Time spent providing victims cards to victims,
expiaing what the card is and how the victim can
use the card, addressing all question about the card
and shelters and providing an Interpreter, if necessary.
Police Officers spent 20 minutes per case.
There were 58 cases during the fiscal year.
OS Total Subtotal Page: of
3 966
3 966
EXHIBIT A
PROPOSED COSTS
FISCAL YEAR 2018-2019
LOS ALTOS UNINCORP.
RATES CUPERTINO HILLS SARATOGA CITIES
GENERAL LAW ENFORCEMENT
Proposed Hours - Activity
Proposed Hours - Patrol
Total Hours
Capped Rates/CostsFY 2018-2019 @ $205.1.3
TRAFFIC ENFORCEMENT - DAYS:
Proposed Hours
Capped Rates/Costs FY 2018-2019 @ $200.93
Motor @ $199.89
TRAFFIC ENFORCEMENT - NIGHTS:
Proposed Hours
Capped Rates/Costs FY 2018-2019 @ $207.31
Motor @ $206.27
INVESTIGATIVE HOURS:
38,248.0
5,421.0
20,060.0
14,696.0
$7,845,709
$1,111,995
$4,114,854
$3,014,551
9,015.0
1,859.5
4,195.4
0.0
$8,640
$842,960
$0
$1,801,977
$363,094
0.0
0.0
0.0
0.0
$0
$0
$0
$0
Proposed Hours 7,200.0 600.0 2,400.0 0.0
Capped Rates/Costs FY 2018-2019 @ $202.48 $1,457,856 $121,488 $485,952 $0
FY19 Contract Cities —Proposed Costs add 2 FTE 08-15-2018 A - 36 DSA=3%
State of California
State Controller's Office
Mandated Cost Manual for Local Anencias
PROGRAM
For State Controller Use Only
ADMINISTRATIVE LICENSE
FORM
�/
SUSPENSION —PER SE
(19) Program Number 00246
L,�,
Z �
CLAIM FOR PAYMENT
(20) Date Filed
FAM-27
(21) LRS Input
(�
9843231
Reimbursement
Claim Data
(22) FORM 1, (04) A. 1. (h)
(� CITY FINANCE OFFICER
G CITY OF CUPERTINO
I(23) FORM 1, (04)A. 2. (h)
s] 10300 TORRE AVENUE
_(24)
CUPERTINO, CA 95014
FORM 1, (04) B. 1. (h)
2,923
1(25) FORM 1, (06)
C
(26) FORM 1, (07)
2,923
Type of Claim
1(27) FORM 1, (09)
(03) (09) Reimbursement
(04) (10)Combined L j
j(28) FORM 1, (10)
(05) (11)Amended 01(29)
Fiscal Year of Cost
(06)
(12) 2018/2019
1(30)
Total Claimed Amount
(07)
(13) 2 923
1(14)
! (31)
Less: 10% Late Penalty (refer to attached Instructions)
I (32)
Less: Prior Claim Payment Received
(15) (33)
Net Claimed Amount
(16) (34)
Due from State
(08)
(17) (35)
Due to State
(37) CERTIFICATION OF CLAIM
In accordance with the provisions of Government Code sections 17560 and 17561, < certify that I am the officer authorized by the local
agency to file mandated cost claims with. the State of California for this program, and certify under penalty of perjury that I have not
violated any of the provisions of Article 4, Chapter 1 of Division 4 of Title 1 of the Government Code.
further certify that there was no application other than from the claimant, nor any grant(s) or payment(s) received for reimbursement of
costs claimed herein and claimed costs are for a new program or increased level of services of an existing program. All offsetting
revenues and reimbursements set forth in the parameters and guidelines are identified, and all costs claimed are supported by source
documentation currently maintained by the claimant.
The amount for this reimbursement is hereby claimed from the State for payment of actual costs set forth on the attached statements.
certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Signature of Authorized Officer
i
t i 2-c
Date Signed
Telephone Number 0 • 3 zZ S
�5ra_ 1 21 �-c-c 't Email Address
Type or Print Name and Title of Authorized Signatory
(38) Name of Agency Contact Person for Claim
Telephone Number
Email Address
Name of Consulting Firm / Claim Preparer
Telephone Number (916) 797-4883
DAVID WEM OUSE & ASSOCIATES (DWA) Email Address
Form FAM-27 (Revised 9/19)
State Controller's Office
Local Mandated Cost Manual
PROGRAM Administrative License Suspension- Per Se
FORM
246
CLAIM SUMMARY
(01) Claimant:
(02) Fiscal Year: 2018/2019
CITY OF CUPERTINO
(03) Department
Direct Costs
Object Accounts
(04) Reimbursable Activities
(a)
Number
of cases
(b)
Uniform
Time
Allowance
(c)
Salary
Hourly
Rate
(d) (e)
Benefit Subtotal
Rate Salaries
(fl
Subtotal
Benefits
(d) x (e)
(g)
Materials &
Supplies
(h)
Total
(e) +(f)+(g)
(a) x(b) x(c)
A. Minors Detained But Not Arrested
1. Admonishing Drivers/Screening Tests on
Minors (IV.A1. & 2.)
0.2667
2. Seizing Licenses & Serving
Notices/Completing Sworn Reports/
Submitting Reports to DMV (IV. A. 3. to A.
5.)
0.2500
$0.00
B. Arrested Drivers for Violation of DUI
Statute
1. Seizing Licenses & Serving Notices/
Completing Sworn Reports/ Submitting
Reports to DMV (IV. B.1 to B. 3.)
57
0.2500
$205.13
$2,923
$2,923
(05) Total Direct Costs
$2,923
$2,923
Indirect Costs
(06) Indirect Cost Rate
[From ICRP or 10%]
(07) Total Indirect Costs
[Line (06) x line (05)(e)]
$0
(08) Total Direct and Indirect Costs
[Line (05)(g)+line(07)
$2,923
Cost Reduction
(09) Less: Offsetting Revenues
(10) Less: Other Reimbursements
(11) Total Claimed Amount
[Line (08)-{line (09) +line (10)}]
$2,923
RATES
GENERAL LAW ENFORCEMENT
Proposed Hours - Activity
Proposed Hours - Patrol
Total Hours
Capped Rates/Costs FY 2018-2019 @ $205.13
TRAFFIC ENFORCEMENT- DAYS:
Proposed Hours
Capped Rates/Costs FY 2018-2019 @ $200.93
Motor @ $199 89
TRAFFIC ENFORCEMENT - NIGHTS:
Proposed Hours
Capped Rates/Costs FY 2018-2019 @ $207.31
Motor @ $206.27
EXHIBIT A
PROPOSED COSTS
FISCAL YEAR 2018-2019
LOS ALTOS UNINCORP.
CUPERTINO HILLS SARATOGA CITIES
38,248.0
5,421.0
20,060.0
14,696.0
$7,845,709
$1,111,995
$4,114,854
$3,014,551
9,015.0
1,859.5
4,195.4
0.0
$8,640
$842,960
$0
$1,801,977
$363,094
0.0
0.0
0.0
0.0
$0
$0
$0
$0
INVESTIGATIVE HOURS:
Proposed Hours 7,200.0 600.0 2,400.0 0.0
Capped Rates/Costs FY 2018-2019 @ $202.48 $1,457,856 $121,488 $485,952 $0
FY19 Contract Cities —Proposed Costs add 2 FTE 08-15-2018 A - 36 DSA=3%
State of California
..k.—W.4-W„U, 11 manciaTecl cost manual Tor LOCaI Agencies
PROGRAM For State Controller Use Only
PEACE OFFICERS PROCEDURAL BILL OF RIGHTS (19) Program Number 00187 FORM
187 CLAIM FOR PAYMENT (20) Date Filed FAM-27
(21) LRS Input
9843231
(° CITY FINANCE OFFICER
co, CITY OF CUPERTINO
sa, 10300 TORRE AVENUE
CUPERTINO, CA 95014
Cit
(03)
Fiscal Year of Cost
Claimed Amount
Less: 10% Late Penalty (refer to attached Instructions)
Less: Prior Claim Payment Received
Net Claimed Amount
Due from State (D8)
IDue to State
1(37) CERTIFICATION OF CLAIM
Reimbursement Claim Data
I(22) FORM 1, (04)
(23) FORM 1, (05)
(24) FORM 1, (06)(A)(g)
(25) FORM 1, (06)(13)(g)
Type of Claim
(09) Reimbursement
(10) Combined
(11) Amended
(26) FORM 1, (06)(C)(9)
�(2=8) FORM 1, (08)
,(29) FORM 1, (09)
(12) 2018/2019
(30) FORM 1, (11)
(13) $1,693
(31) FORM 1, (12)
(14) 1(32)
(15)
(33)
(16) $ 1, 693
(3-1) "—
(17) $1,69,(35)
(18)
l`36)
4
In accordance with the provisions of Government Code sections 17560 and 17361, 1 certify that I am the officer authorized by the local
agency to file mandated cost claims with the State of California for this program, &-ad certify under penalty of perjury that I have not
violated any of the provisions of Article 4, Chapter 1 of Division 4 of Title 1 of the Government Code.
1 further certify that there was no application other than from the claimant, nor any grant(s) or payment(s) received for reimbursement of
costs claimed herein and claimed costs are for a new program or increased level of services of an existing program. All offsetting
revenues and reimbursements set forth in the parameters and guidelines are identified, and all costs claimed are supported by source
documentation currently maintained by the claimant.
The amount for this reimbursement is hereby claimed from the State for payment of actual costs set forth on the attached statements.
1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Signature of Authorized Officer
Type or Print Name and Title of Authorized Signatory
(38) Name of Agency Contact Person for Claim
Name of Consulting Finn / Claim Preparer
DAVID WELLHOUSE & ASSOCIATES [DWA)
Form FAM-27 (Revised 9/19)
Date Signed 2
Telephone Number Lf d — — 3 22S
Email Address f-S+ue_', S.A. C,ae�t h b, o�
Telephone Number
Email Address
Telephone Number (916) 797-4883
Email Address dya—XeUee@R'iirPT Psit nvt
PROGRAM
187
PEACE OFFICERS PROCEDURAL BILL OF RIGHTS
CLAIM SUMMARY
FORM
1
(01) Claimant
CITY OF CUPERTINO
(03) Department
(2)
Fiscal Year
2018/2019
Claim Statistics
(04) Number of full-time sworn peace officers employed by the agency during this fiscal year
34
Flat Rate Method
(05) Total Cost [Line (04) X $49.78 for 2018-19 FY] [Skip (06) to (09) and carry forward total to line (10)]
$1,693
Actual Cost Method
Direct Costs
Object Accounts
(06) Reimbursable Activities
(a)
Salaries
(b)
Benefits
(c)
Materials
And
Supplies
(d)
Contract
Services
(e)
Fixed Assets
(f)
Travel
And
Training
(g)
Total
A. Administrative Activities
B. Administrative Appeal
C. Interrogations
D. Adverse Comment
(07) Total Direct Costs
$0
Indirect Costs
(08) Indirect Cost Rate
[From ICRP or 10%]
(09) Total Indirect Costs
[Refer to Claim Summary Instructions]
(10) Total Direct and Indirect Costs
[Refer to Claim Summary Instructions]
Cost Reduction
(11) Less: Offsetting Revenues
(12) Less: Other Reimbursements
(13) Total Claimed Amount
[Line (10) - (line (11) + line (12))]
$1,693
N
State of California
State Controller's Office
Mandatad Cnst Manual fnr Lneai onanrias
PROGRAM
For State Controller Use Onl
(19) Program Number 00127
(20) Date Filed
(21) LRS Input
RAPE VICTIMS COUNSELING CENTER NOTICE
1271 CLAIM FOR PAYMENT
FORM
FAM-27
Reimbursement Claim Data
9843231
CITY FINANCE OFFICER
(22) FORM 1, (03)
34
CITY OF CUPERTINO
10300 TORRE AVENUE
(23) FORM 1, (04)1. a. (e)
CUPERTINO, CA 95014
(24) FORM 1, (04)1. b. (e)
(25) FORM 1, (04) 2. a. (e)
Type of Claim
(26) FORM 1, (04) 2. b. (e)
1,158
(27) FORM 1, (06)
(03)
(09) Reimbursement ®
(04)
(10)Combined ❑
(28) FORM 1, (07)
(05)
(11) Amended ❑
(29) FORM 1, (09)
Fiscal Year of Cost
(06)
(12) 201$ 2019
(30) FORM 1, (10)
Total Claimed Amount
07)
(13) 1 158
(31)
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16> 1 158
(34)
Due from State
(08)
(17) $1,158
(35)
Due to State
(18)
(38)
(37) CERTIFICATION OF CLAIM
In accordance with the provisions of Government Code sections 17560 and 17561, 1 certify that I am the officer authorized by the local
agency to file mandated cost claims with the State of California for this program, and certify under penalty of perjury that I have not
violated any of the provisions of Article 4, Chapter 1 of Division 4 of Title 1 of the Government Code.
I further certify that there was no application other than from the claimant, nor any grant(s) or payment(s) received for reimbursement of
costs claimed herein and claimed costs are for a new program or Increased level of services of an existing program. All offsetting
revenues and reimbursements set forth in the parameters and guidelines are Identified, and all costs claimed are supported by source
documentation currently maintained by the claimant.
The amount for this reimbursement Is hereby claimed from the State for payment of actual costs set forth on the attached statements.
I certify under penalty of perjury under the laws of the State of California that the foregoing Is true and correct.
Signature of Authorized Officer
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(38) Name of Agency Contact Person for Claim
Telephone Number
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Form FAM-27 (Revised 9/19)
RAPE VICTIMS COUNSELING CENTER NOTICE
CLAIM SUMMARY
FORM
1
PROGRAM
127
(01) Claimant
CITY OF CUPERTINO
(02)
Fiscal Year
2018/2019
Claim Statistics
(03) Number of rape victims involved in at least one alleged violation of Penal Code sections 261,
261.5, 262, 288a, or 289 for the fiscal year of claim.
34
Direct Costs
Object Accounts
(04) Reimbursable Activities
(a)
Salaries
(b)
Benefits
(c)
Materials
and
Supplies
(d)
Contract
Services
(e)
Total
1. One -Time Costs
a. Update policies and procedures
b. Modify existing record -keeping systems
2. Ongoing Costs
a. Reprint Victims of Domestic Violence (VDV) Cards
b. Law Enforcement Officer's and Support Cost
(From Form 2.1)
$1,158
$0
$1,158
(05) Total Direct Costs
$1,158
$0
$1,158
Indirect Costs
(06) Indirect Cost Rate
[From ICRP or 10%]
(07) Total Indirect Costs
[Refer to Claim Summary Instructions]
(08) Total Direct and Indirect Costs
[Line (05)(e) + line (07)]
$1,158
Cost Reduction
(09) Less: Offsetting Revenues
(10) Less: Other Reimbursements
(11) Total Claimed Amount
[Line (08) - (line (09) + line (10))]
$1,158
TPRRAMRAPE VICTIMS COUNSELING CENTER NOTICE FOR7 ACTIVITY COST DETAIL
2.1
(01) Claimant
(02) Fiscal Year
CITY OF CUPERTINO
2018/2019
(03) Reimbursable Activity: Ongoing Costs: Rape victims involved in at least one alleged violation of
Penal Code sections 261, 261.5, 262, 288a, or 289 for the fiscal year of claim.
(04) Description of Expenses: Complete columns (a) through (f). Object
Accounts
(a)
Standard Time
(Hour/Victim)
(b)
Number
of Victims
(c)
Total Time
(Hours)
(a x b)
(d)
Hourly
Rate
(e)
Salaries
(c x d)
(f)
Fringe
Benefits
Road Officers (10 min/victim) .166 Hours
List Job Classification(s)
1. Police Officer
34
5.64 $205.13 $1,158
2.
3.
* Total Cases
Clericals (4 min/victim) 0.066 Hours
List job classification(s)
1.
2.
3.
* Total Cases
Dispatchers (2 min/victim) 0.033 Hours
List job classification(s)
1. Dispatcher
2.
3.
* Total Cases
* Total Victims not to Exceed Form-1, line (03)
$1,158
$0
(05) Total Subtotal Page: of
EXHIBIT A
PROPOSED COSTS
FISCAL YEAR 2018-2019
LOS ALTOS
RATES CUPERTINO HILLS
GENERAL LAW ENFORCEMENT
Proposed Hours - Activity
Proposed Hours - Patrol
Total Hours
Capped Rates/Costs FY 2018-2019 @ $205.13
TRAFFIC ENFORCEMENT - DAYS:
Proposed Hours
UNINCORP.
SARATOGA CITIES
38,248.0 5,421.0 20,060.0 14,696.0
$7,845,709 $1,111,995 $4,114,854 $3,014,551
9,015.0 1,859.5 4,195.4 0.0
Capped Rates/Costs FY 2018-2019 @ $200.93 $8,640 $842,960 $0
Motor @ $199.89 $1,801,977 $363,094
TRAFFIC ENFORCEMENT - NIGHTS:
Proposed Hours 0.0 0.0 0.0 0.0
Capped Rates/Costs FY 2018-2019 @ $207.31 $0 $0 $0
Motor @ $206.27 $0
INVESTIGATIVE HOURS:
Proposed Hours
7,200.0 600.0 2,400.0 0.0
Capped Rates/Costs FY 2018-2019 @ $202.48 $1,457,856 $121,488 $485,952 $0
FY19 Contract Cities —Proposed Costs add 2 FTE 08-15-2018 A - 36 DSA=3%