HomeMy WebLinkAbout16-003 David Wellhouse & Associates, Inc._Claim Reimbursement sheets for FY 2014-2015'David Wellhouse
...and Associates, Inc.
March 29, 2016
Ms. Grace Schmidt
City Clerk
City of Cupertino
10300 Torre Avenue
Cupertino, California 95014
RE: COPIES OF FEBRUARY 2016 STATE MANDATED COST REIMBURSEMENT CLAIMS
Dear Ms. Schmidt:
Enclosed are the copies of the February 2016 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 2016 state mandated cost reimbursement claims. Should you have any questions, please contact
me at (916) 797-4883.
Sincerely,
Renee Wellhouse
Enclosures
3609 Bradshaw Road, Suite H-382 • Sacramento, California 95827
(916) 797-4883 • FAX (916) 797-4887
U
State Controller's Office
For State Controller Use Only
PROGRAM
(19) Program Number 00167
DOMESTIC VIOLENCE ARREST POLICIES
AND STANDARDS
CLAIM FOR PAYMENT
(20) Date Filed
uy
(21) LRS Input
9843231
Reimbursement Claim Data
CITY FINANCE OFFICER
_'
CITY OF CUPERTINO
(22) FORM 1. (04)(a)
1
10300 TORRE AVENUE
(23) FORM1, (04)(b)155
(24) FORM1 (06)
6,806
CUPERTINO, CA 95014
(25) F0RM1, (07)A. (g)
Type of Claim
(26) FORM 1. (07) B. (9)
(27) FORM 1. (07) C. (g)
(03)
(09) Reimbursement
(28) FORM 1, (09)
10
(04)
(10) Combined ❑
(29) FORM 1. (10)
681
(05)
(11) Amended ❑
Fiscal Year of Cost
(06)
(12) 2014/2015
(30) FORM i, (12)
Total Claimed Amount
(07)
(13) $7487
(31) FORM 1, (13)
Less: 10% Late Penalty (refer to attached instuctons)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) $7,487
(34)
Due from State
(08)
(17) 7 487
(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 th a 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 Government Code.
I further certify that there was no application other than from the claimant, nor any grants or payments received for reimburse ment 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
documentation currently maintained by the claimant.
and guidelines are Identified, and all costs claimed are supported by $ ource
The amount for this reimbursement is hereby claimed from
the State for payment of actual costs set forth on the attached statem ants.
I certify under penalty of perjury under the laws of the Stale of California that the foregoing is true and correct,
Signature of Authorized Officer
rr
f
l•. r... t .
Date Signed t— 1Gf'I C'
Telephone Number
f
( Lt C t 11 (h44 Email Address C
Type or Print Name and 11110 orAuthorize Signato�i
(38) Name orAgency Contact Person for Claim
Telephone Number
Email Address
Name ofConsulting Firm /Claim Preparer
Telephone Number (9_1 6) 797-4883
DAVID WELLHOIISE & ASSOCIATES (DWA) Email Address dire 1~enee@streWest.net
Local Mandated Cost Manual
Form FAM-27 (Revised 07/15)
PROGRAM DOMESTIC VIOLENCE ARREST POLICIES
AND STANDARDS CLAIM SUMMARY
167
(01) Claimant (02)
CITY OF CUPERTINO
(03) Department
FORM
Fiscal Year
2014/2015
(04) Claim Statistics
(a) Number of reported responses to incidents in the fiscal year of claim 91
(b) Average productive hourly rate including applicable indirect costs (Refer to claiming 155.82
instructions)
(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)] $ 6,806
(06) Total Direct and Indirect Costs for Activity D [Carry forward from line (05)(D)] $ 6,806
Direct Costs Object Accounts
Actual Cost Method (a) Salaries (b) Benefits (c) Materials (d) Contract (e) Fixed (f) Travel (g) Total
and Services Assets and
(07) One -Time Activities Supplies Training
A. Development of Written Policies O
B. Adoption of Written Policies 0
C. Training Officers on New Policies 0
(08) Total Direct Costs (A, t3, C)
Indirect Costs
(09) Indirect Cost Rate
(10) Total Indirect Costs
(11) Total Direct and Indirect Costs
Cost Reduction
(12) Less: Offsetting Revenues
(13) Less: Other Reimbursements
(14) Total Claimed Amount
0 0
0
10 10
0 0
0
0 0
010
0
0 0
[From ICRP or 10%]
[Refer to Claim Summary Instructions]
[Line (06) + line (08)(g) + line (10)]
[Line (11) - {line (12) + line (13))]
0
0
�0
l0
10.00°
$ 681
$ 7,487
$ 7,487
CJ
State Controller's Office
t..ocai ivianaatea
cost Manual
For State Controller Use Only
PROGRAM
DOMESTIC VIOLENCE ARREST AND VICTIM ASSISTANCE
CLAIM FOR PAYMENT
(19) Program Number 00274
(20) Date Filed
7
(21) LRS Input
9843231
CITY FINANCE OFFICER
Reimbursement Claim Data
(22) FORM 1.(04)A.1.(f)
CITY OF CUPERTINO
(23) FORM 1, (C4)A. 2. (f)
10300 TORRE AVENUE
CUPERTINO, CA 95014
(24) FORM 1, (04) A. 3. (f)
(25) FORM 1, (04) B. 1. (f)
3,545
Type of Claim
(26) FORM 1, (06)
10
(03)
(09) Reimbursement
(27) FORM 1, (07)
354
(04)
(10) Combined
,(28) FORM 1, (09)
(05)
(11)Amended
(29) FORM 1, (10)
Fiscal Year of Cost
(06)"
(12) 2014/2015
(30)
Total Claimed Amount
(07)
(13) $3,899 1(31)
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) $3,899 1(34)
Due from State
(08)
(17) 3 899
(35)
Due to State
(18)
(36)
(37) CERTIFICATION OF CLAIM
In accordance with the provisions of Government Code Sections 17560 and 17561, I certify that i am the officer authorized by the local
agency to file mandated cost claims with the State of California for this program, and certify under penalty of perjury that I have not
violated any of the provisions of Article 4, Chapter 1 of Division 4 of Title I Government Code,
I further certify that there was no application other than from the claimant, nor any grants or payments received for reimbursement of
costs claimed herein and claimed costs are for a new program or increased level of services of an existing program. All offsetting
revenues and reimbursements set forth in the parameters and guidelines are identified, and all costs claimed are supported by source
documentation currently maintained by the claimant.
The amount for this reimbursement Is hereby claimed from the State for payment of actual costs set forth on the attached statements.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Signature of Authorized Officer
Date Signed It rr
��{'/i
I i' Telephone Number` rf
r,/ r . ( 11 ,t 1 R, l i., Email Address , � : kI! 71(
Type or Print Name and Title of Authorized Signatory
(38) Name of Agency Contact Person for Claim
Telephone Number
Email Address
Name of Consulting Flrm / Claim Preparer
Telephone Number (91 6) 797-4883
DAVID WELL$OUSE & ASSOCIATES (DWA) Email Address dvza—retaee@surewest.uet
Form FAM-27 (Revised 07/15)
Mandated Cost Manual
MANDATED COSTS
FORM
DOMESTIC VIOLENCE ARRESTS AND VICTIMS ASSISTANCE
2
ACTIVITY COST DETAIL
(01) Claimant
(02) Fiscal Year 2014/201 5
CITY OF CUPERTINO
(03) Reimbursable Components: Check only one box per form to identify the component being claimed.
One -Time Activities
Ongoing Activity
Printing Victim Cards
Providing Victims Cards
Adding Two New Crimes to Response Policy
jAdding Information to Response Policy
04 Description of Expenses
Object Accounts
(a)
Employee Names, Job Classifications ,
(b)
Hourly
l Benefit
(c)
Hours
(d)
(e)
(f)
Materials
(g)
Contract
(h)
Fixed
Total
Functions Performed and Description
Rate or
%
Worked or
Salaries
Benefits
and
Services
Assets
Sal. & Ben.
of Expenses
Unit Cost
Rate
QgjySupplies
Police Officer
$155.82
I
22.8
$3,544.91
,
$3,545
Time spent providing victims cards to victims,
explaing 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.
I
Police Officers spent 15 minutes per case.
!
There were 91 cases during the fiscal year.
I
I
I
I
I �
!
II
I
I
(05) Total Subtotal
Pager of
53.545
53,545
C,
States (`nntrniier'. (lffl..-.
i..vcar ivianaaiea
Uost Manual
For State Controller Use Onl
PROGRAM
(19) Program Number 00246
ADMINISTRATIVE LICENSE SUSPENSION — PER SE
CLAIM FOR PAYMENT
(20) Date Filed
246
(21) LRS Input
9843231
CITY FINANCE OFFICER
Reimbursement Claim Data
(22) FORM 1, (04)A. 1. (h)
CITY OF CUPERTINO
10300 TORRE AVENUE
(23) FORM 1, (04)A. 2. (h)
305
CUPERTINO, CA 95014
(24) FORM 1, (04) t3.1. (h)
6 62i_
(25) FORM 1, (06)
Type of Claim
(26) FORM 1, (07)
6,928
(03)
(09) Reimbursement ®
(27) FORM 1, (09)
I 10
(28) FORM 1, (10)
693
(04)
(10) Combined
(29)
(05)
(11)Amended
Fiscal Year of Cost
(06)
(12) 2014 2015
(30)
Total Claimed Amount
(07)
(13)
(31)
Less: 10% Late Penalty (refer to attached instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) $7. 621
(34)
Due from State
(08)
(17) $7,621
(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 Division
of 4 of Title 1 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 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
i < Date Signed 1 i '. �!
f •/
(
Telephone Number )—. 7
i
( 'if
_ (`. � ..) ( :_-Lfl tr1 , ! (.>, l,s ( k 'i) ,- Email Address _C________/___
,' ;( .i
Type or Print Name and Title of Authorized Signatory J
(38) Name of Agency Contact Person for Claim
Telephone Number
Email Address
Name of Consulting Firm / Claim Preparer
Telephone Number (916) 797-4883
DAVID WELLUOUSE & ASSOCIATES (DWA) Email Address dwa—renee@surewest net
___-
s Cate •.00vroner s Vnlce
MANDATED COSTS
,h
ADMINISTRATIVE LIC
ENSE SUSPENSION
CLAIM SUMMARY
(01) Claimant (02) Type of Claim
CITY OF CUPERTINO Reimbursement f]
Estimated
Claim Statistics
(03) Leave Blank
Direct Costs
(04) Reimbursable Activities
A. Minors Detained But Not Arrested
I. Admonishing Drivers/Screening Tests on
Minor (IV.A.I & 2)
2. Seizing Licenses & Serving Notices/
Completing Sworn Reports/Submitting
Reports to DMV (IV.A.3. to A.S.)
B. Arrested Drivers for Violation of DUI Statute
I. Seizing Licenses & Serving Notices/
Completing Sworn Reports/Submitting
Reports to DMV (IV.B.I. to B.3.)
C. Arrested Drivers for
Controlled Substances
Reimbursable for FY's 1997-98 to 1998-99 only
Informing Arrested Drivers of Sanctions
05) Total Direct Costs
Indirect Costs
(06) Indirect Cost Rate
(07) Total Indirect Costs
(08) Total Direct and Indirect Costs:
Cost Reduction
(09) Less: Offsetting Savings
(10) Less: Other Reimbursements
( II) Total Claimed Amount
FORM
ALS• I
Fiscal
Year
2014/2015
Object Accounts
0.2667 $152.74
8 0.25 $152.74 $305 4t"xnS
a
(b)
c
d
(e)
h
Number
Uniform
Salary
Benefit
Subtotal
Subtotal
Materials
Total
of
Time
Hourly
Rate
Salaries
Benefit
and
Cases
Allowance
Rate
(a) x (b) x (c)
(d) x (e)
Supplies
(e) + (f) + (g)
L9j 0.25 $155.82 L $6,622 $6,622
tt
cti-acswith
.P,
LL [ 1 _____
0.0083 ,
�•i
6 928 � $6,928
{ From ICRP }
fl tll1O/
Fixed Rate , 0.00
i6) x line (05)(e)] $693
05)(h) t line (07)] $7.621
+ line (10)}] $7,621
C/
19
re
PEACE OFFICERS PROCEDURAL BILL OF RIGHTS
CLAIM FOR PAYMENT
9843231
CITY FINANCE OFFICER
CITY OF CUPERTINO
10300 TORRE AVENUE
CUPERTINO, CA 95014
(03)
(05)
Fiscal Year of Cost
(06)
Total Claimed Amount
Less: 10% Late Penalty
(refer to attached Instructions)
Less: Prior Claim Payment Received
Net Claimed Amount
Due from State
(08)
D t State
ue o
(37) CERTIFICATION OF CLAIM
in accordance with the provisions of Government Code Sections 17560 end 17561, 1 certify that I am the officer authorized by the local
agency to file o f i of the provisions cost
claims
ims e with
the h State
oof f Califo ni4a of for
thisitlel program,
Gogram, anand
t certify under penalty of penury that I have not pterviolateArti4. foof
I further certify that there was no application other than from the claimant, nor any grants or payments received prode
ogram.
reimbursement
All offsetting
costs claimed herein and claimed costs are for a new program or increased level of services of an existing p g
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.
Local Mandated Cost Manual
r State Controller Use Onl PROGRAM
(19) Program Number 00187
(20) Date Filed 1 87
(21) LRS Input
Reimbursement Claim Data
(22) FORM 1, (04)
1, (05)
M 1, (06)(A)(g)
M 1, (06)(B)(g)Type
of ClaimM
MR05))
1, (06)(C)(g)(09)
Reimbursement
M 1, (06)(D)(g)(10)
Combined
M 1, (08)(11)
Amended
M 1. (09) r
(12) 2014 2015
(30) FORM 1, (11)
(13) 1 337
(31) FORM
(15)
(33)
(18)
(36)
Signature of Authorized Officer
Type or Print Name and Title of Authorized Signatory
(38) Name of Agency Contact Person for Claim
Name of Consulting Firm I Claim Preparer
VID WELLH0USE & ASSOCIATES (DWA)
Form FAM-27 (Revised 07/15)
Date Signed
Telephone Number
Email
Telephone Number
Email Address
Telephone Number (916) 797-4883
Email Address dw2.—ranae@surewe-t.�et
PROGRAM
187
PEACE OFFICERS PROCEDURAL BILL OF RIGHTS
CLAIM SUMMARY
FORM
1
(01) Claimant
CITY OF CUTPERTIN0
(02) Fiscal Year
201.4120.j5
(03) Department
Claim Statistics
(04) Number of full-time sworn peace officers employed by the agency during this fiscal year
30
Flat Rate Method
(05) Total Cost [Line (04) X $44.57 for 2014-15 FY] (Skip (06) to (09) and carry forward total to line (10)]
$1,337
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
Indirect Costs
(08) Indirect Cost Rate [From ICRP or 10%]
%
(09) Total Indirect Costs
(10) Total Direct and Indirect Costs
Cost Reduction
(11) Less: Offsetting Revenues
(12) Less: Other Reimbursements
(13) Total Claimed Amount
Revised 07/15
[Refer to Claim Summary Instructions]
[Refer to Claim Summary Instructions]
[Line (10) - (line (11) + line (12))] I $1,337
4r` David Wellhouse
...and Associates, Inc.
STATE MANDATED COST CLAIMS RECEIPT
FEBRUARY 2016 STATE MANDATED COST CLAIMS
AGENCY: CITY OF CUPERTINO
DATE: FEBRUARY 15, 2016
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, 2014/2015 Actual
$7,487
Domestic Violence Arrest Standards
Chapter 698 & 702, Statutes of 1998
FY. 2014/2015 Actual
$3,899
Domestic Violence Arrest & Victim Assistance
Chapter 1460, Statutes of 1989
FY. 2014/2015 Actual
$7,621
Administrative License Suspension
Chapter 465, Statutes of 1976
FY. 2014/2015 Actual
$1,337
Peace Officers Procedural Bill of Rights
Chapter 630, Statutes of 1978
FY. 2014/2015 Actual
Peace Officer's Personnel Records
Chapter 999, Statutes of 1991 FY. 2014/2015 Actual
Rape Victim Counseling Center Notices
Chapter 901, Statutes of 2000 FY. 2014/2015 Actual
Local Government Employee Relations
Chapter 1120, Statutes of 1996 FY. 2014/2015 Actual
Health Benefits for Survivors of Police & Fire
till FEB 162016
STATE CONTROLLER'S OFFICE
DIV. OF ACCOUNTING & REPORTING
Received By: 'Steve Purser
State Controller's Office
Division of Accounting & Reporting
Local Reimbursement Bureau