HomeMy WebLinkAbout19-193 David Wellhouse & Associates, Inc._Claim Reimburseent sheets for FY 2017-2018*/David Wellhouse
.and Associates, Inc.
February 26, 2019
Ms. Grace Schmidt
City Clerk
City of Cupertino
10300 Torre Avenue
Cupertino, California 95014
RE: COPIES OF FEBRUARY 2019 STATE MANDATED COST REIMBURSEMENT CLAIMS
Dear Ms. Schmidt:
Enclosed are the copies of the February 2019 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 2019 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
iir David Welffiouse
...and Associates, Inc.
STATE MANDATED COST CLAIMS RECEIPT
FEBRUARY 2019 STATE MANDATED COST CLAIMS
AGENCY: CITY OF CUPERTINO
DATE: FEBRUARY 15, 2019
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. 2017/2018 $5,430
Domestic Violence Arrest Standards
Chapter 698 & 702, Statutes of 1998 FY. 2017/2018 $3,771
Domestic Violence Arrest & Victim Assistance
Chapter 1460, Statutes of 1989 FY. 2017/2018 $2,100
Administrative License Suspension
Chapter 465, Statutes of 1976 FY. 2017/2018 $1,524
Peace Officers Procedural Bill of Rights
Chapter 630, Statutes of 1978 FY. 2017/2018
Peace Officer's Personnel Records
Chapter 999, Statutes of 1991 FY. 2017/2018 $2,113
Rape Victim Counseling Center Notices
Chapter 901, Statutes of 2000 FY. 2017/2018
Local Government Employee Relations
Chapter 1120, Statutes of 1996 FY. 2017/2018
Health Benefits for Survivors of Police & Fire
L4 FEB3 15 2019
I'a C C51;) 1 R0,rLL4;R S
Received By:
Steve Purser
State Controller's Office
Division of Accounting & Reporting
Local Reimbursement Bureau
State Controller's Office
PROGRAM DOMESTIC VIOLENCE ARREST
�y POLICIES AND STANDARDS
CLAIM FOR PAYMENT
For State Controller Use Only
FORM
FAM-27
(19) Program Number 001$7
(20) Date Filed
(21) LRS Input
(01
9843231
Reimbursement Claim Data
(02 CITY FINANCE OFFICER
(22) FORM 1,(04)(a)
66
Ce° CITY OF CUPERTINO
SVe 10300 TORRE AVENUE
c CUPERTINO, CA 95014
(23) FORM 1, (04)(b)
156
(24) FORM 1, (06)
(25) FORM 1, (07) A. (g)
(26) FORM 1, (07) 6. (g)
Type of Claim
(03) (09) Reimbursement
(27) FORM 1, (07) C. (g)
(04) (10) Combined ❑
(28) FORM 1, (09)
10
(29) FORM 1, (10)
494
(05) (11)Amended ❑
Fiscal Year of Cost
(06) 3;
(12) 2017/2018
(30) FORM 1, (12)
Total Claimed Amount
(0Z)
(13) $5,430
(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)
(34)
Due from State
(OS)
(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 I 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, Ali 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 -(
Telephone Number `( �i i
Ci C _ c tL t' 1,1 (L_ f ' H Email Address
Type or Print Name and Title of Autho zed Signatory
(38) Name of Agency Contact Person for Claim Telephone Number (916) 797-4883
DAVID WELLH017SE & ASSOCIATES (DWA) Email Address dwa-renee(asurewest.net
Name of Consulting Firm / Claim Preparer Telephone Number
Email Address
Mnnrin4oA (nc+ M-,;,& fnv I A..---7....
Form FAM-27 (Revised 9/18)
PROGRAM
DOMESTIC VIOLENCE ARREST POLICIES
FORM
1 67
AND STANDARDS CLAIM SUMMARY
1
(01) Claimant
(02) Fiscal Year
City of Cupertino
2017/2018
(03) Department
(04) Claim Statistics
(a) Number of reported responses to incidents in the fiscal year of claim
66
(b) Average productive hourly rate including applicable indirect costs (Refer to claiming
instructions)
$155.82
(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)]
$4,936
(06) Total Direct and Indirect Costs for Activity D [Carry forward from line (05)(D)]
$4,936
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%]
10.00%
(10) Total Indirect Costs [Refer to Claim Summary Instructions]
$494
(11) Total Direct and Indirect Costs [Line (06) + line (08)(g) + line (10)]
$5,430
Cost Reduction
(12) Less: Offsetting Revenues
(13) Less: Other Reimbursements
(14) Total Claimed Amount [Line (11) - (line (12) + line (13)}]
$5,430
N
Manriatarl C nat Manual for Local Agencies
state t;ontrouers 'iii
;For State Controller Use Only
PROGRAM DOMESTIC VIOLENCE ARRESTS AND
(19)
FORI111
Program Number 00274
VICTIM ASSISTANCE
274 4 CLAIM FOR PAYMENT (20)
Date
FAM�27
(21)
nput
LRS Input
(C
Reimbursement Claim Data
984323 I
(( CITY FINANCE OFFICER
(22) FORM 1, (04)A. 1. (f)
(23) FORM 1,(04)A. A. 2. (f)
0. CITY OF CUPERTINO
5i 10300 TORRE AVENUE
(24) FORM 1, (04) A. 3. (f)
CUPERTINO, CA 95014
c
(25) FORM 1, (04) B. 1. (f)
3,428
(26) FORM 1, (06)
10
1 Type of Claim
(27) FORM 1, (07)
1p3) (09) Reimbursement ®
(28) FORM 1, (09)
(04) (10) Combined ❑
(29) FORM 1, (10)
(05) (11) Amended ❑
Fiscal Year of Cost
Doti)„-
(12) 2017 2018
(30)
Total Claimed Amount
(07)
(13 $3,771
(31)
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) $3,771
(34)
Due from State
(OB)
(17) $3,771
(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
California for this and certify under penalty of perjury that I have not
agency to file mandated cost claims with the State of program,
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
increased level of services of an existing program. All offsetting
costs claimed herein and claimed costs are for a new program or
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 I - d i l
Telephone Number `i, 7
\%UUC,. (_fhi (7L Email Address f; (1 iitf (1 f7r� 1'f,
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 WELLUOUSE & ASSOCIATES (DWA) Email Address dwa—renee@aurewest.net
Form FAM-27 (Revised 9/18)
X
State Controller's Office
PROGRAM
246
ADMINISTRATIVE LICENSE
SUSPENSION - PER SE
CLAIM FOR PAYMENT
( 9843231
( CITY FINANCE OFFICER
Mandated Cost Manual for Local Agencies
For State Controller Use Onl
(19) Program Number 00246 FORM
(20) Date Filed FAM-27
(21) LRS Input
Reimbursement Claim Data
CITY OF CUPERTINO
10300 TORRE AVENUE
CUPERTINO, CA 95014
(03)
(04)
(05):
Type of Claim
(09) Reimbursement
(10) Combined
(11) Amended
®
(22) FORM 1, (04)A. 1. (h)
(23) FORM 1, (04)A, 2. (h)
(24) FORM 1, (04) S. 1. (h)
(25) FORM 1, (06)
1,909
(26) FORM 1, (07)
(27) FORM 1, (09)
(28) FORM 1, (10)
1 1
(29)
Fiscal Year of Cost
(00)
(12) 2O17/2O18
(30)
Total Claimed Amount
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) 2 100
(34)
(35)
Due from State
(08)
(17)
Due to State
(18)
(36)
(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
Type or Print Name and Title of Authorized Stignatory
(38) Name of Agency Contact Person for Claim
Name of Consulting Firm / Claim Preparer
DAVID WELLHOUSE & ASSOCIATES (DWA)
Form FAM-27 (Revised 9/18)
Date Signed
Telephone Number 'Of / %
Email Address ("i�1� (' fit] t ,
Telephone Number
Email Address
Telephone Number (916) 797-4883
Email Address dwa—*'enee@s urewP + n
et
State Controller's Office
PROGRAM Administrative License Suspension- Per Se
IVIdl,uW
p pFORM
246
CLAIM SUMMARY
I
(01) Claimant:
(02) Fiscal Year: 2017/2018
CITY OF CUPERTINO
(03) Department
Direct Costs
Object Accounts
(a)
(b)
(c)
(d) (e)
(f)
(9)
(h)
(04) Reimbursable Activities
Number
of cases
Uniform
Time
Allowance
Salary
Hourly
Rate
Benefit Subtotal
Rate Salaries
Subtotal
Benefits
(d) x (e)
Materials &
Supplies
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
$155.82
$0.00
$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.)
49
0.2500
$155.82
$1,909
$1,909
(05) Total Direct Costs
$1,909
$1,909
Indirect Costs
(06) Indirect Cost Rate
[From ICRP or 10%]
10.00%
(07) Total Indirect Costs
[Line (06) x line (05)(e)]
$191
(08) Total Direct and Indirect Costs
[Line (05)(g)+line(07)
$2,100
Cost Reduction
(09) Less: Offsetting Revenues
(10) Less: Other Reimbursements
(11) Total Claimed Amount
[Line (08) -{line (09) +line (10)}]
$2,100
fate Cnntrnllpr'a Office
Mandated Cost Manual for Local Agencies
PROGRAM
187
PEACE OFFICERS PROCEDURAL BILL OF RIGHTS
CLAIM FOR PAYMENT
For State Controller Use Only
FORM
FAM-27
(19) Program Number 00187
(20) Date Filed
(21) LRS Input
(C
Reimbursement
Claim Data
9843231
CITY FINANCE OFFICER
(22) FORM 1, (04)
32
(23) FORM 1, (05)
54
0 CITY OF CUPERTINO
s, 10300 TORRE AVENUE
(24) FORM 1, (06)(A)(g)
CUPERTINO, CA 95014
(25) FORM 1, (06)(9)(9)
(26) FORM 1, (06)(C)(g)
Type of Claim
(27) FORM 1, (06)(D)(g)
(03) -.. , (09) Reimbursement ®
(28) FORM 1, (08)
(04) (10) Combined ❑
(29) FORM 1, (09)
(05) _ ~ (11) Amended ❑
Fiscal Year of Cost
(06)
(12) 2017 2018
(30) FORM 1, (11)
Total Claimed Amount
(07)
(13) $1,524
(31) FORM 1, (12)
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) $1,524
(34)
Due from State
(08)
(17) 1 524
(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 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. Ail 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
(.' _//
9 Date Signed _
1
{ ' C 4�(, (- ( ((_X Telephone Number `G) o r 7 > -z
( _ -k-- r //L,'. Lt i t� I i Ct K� (�61'- Email Address L- i I V '4( (j r f' 's��l hi t)�
Type or Print Name and Tide of Authorized Signatory7)
(38) Name of Agency Contact Person for Claim Telephone Number
Email Address
Name of Consulting Firm / Claim Preparer Telephone Number (91 F) 797-4883
DAVID WELLHOUSE & ASSOCIATES (DWA) Email Address dwa—renee@surewest.net
Form FAM-27 (Revised 9/18)
PROGRAM
PEACE OFFICERS PROCEDURAL BILL OF RIGHTS
FORM
187
CLAIM SUMMARY
1
(01) Claimant
(2) Fiscal Year
CITY OF CUPERTINO
2017/2018
(03) Department
Claim Statistics
(04) Number of full-time sworn peace officers employed by the agency during this fiscal year
32
Flat Rate Method
(05) Total Cost [Line (04) X $47.61 for 2017-18 FY] (Skip (06) to (09) and carry forward total to line (10)]
$1,524
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))]
$1,524
V
State Controller's Office
n uualG1.1 UVJI IVid11UGI 101 Local
Agencies
PROGRAM
-ForState Controller Use Only
RAPE VICTIMS COUNSELING CENTER NOTICE
1 27 CLAIM FOR PAYMENT
FORM
(19)Program Number00127
(20) Date Flied
PAM 27
(21) LRS Input
(01) 984323 I
Reimbursement Claim Data
(02) CITY FINANCE OFFICER
CITY OF CUPERTINO
(�) FORM 1, (03)
Count'
10300 TORRE AVENUE
(23) FORM 1, (04) 1. a. (e)
saes` CUPERTINO, CA 95014
(24) FORM 1, (04) 1. b. (e)
city
--....—
(25) FORM 1, (04)2. a. (e)
Type of Claim
(26) FORM 1, (04) 2. b. (e)
1,921
(27) FORM 1, (06)
(03) a
(09) Reimbursement
10
(28) FORM 1, (07)
192
(04)
(10) Combined ❑_
(29) FORM 1, (09)
(05}
(11) Amended
Fiscal Year of Cost
(06)
(12) 2O17/2O18
(30) FORM 1, (10)
Total Claimed Amount
107
(13) $2 113
(31)
Less: 10% Late Penalty (refer to attached Instructions)
(14)
(32)
Less: Prior Claim Payment Received
(15)
(33)
Net Claimed Amount
(16) $2. 113
(34)
Due from State
(08)
(17) $2, 113
(35)
Due to State
(18)
(36)
(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 I 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 art 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 j j 5 —/�
X�� Gp Lac
,� (" Telephone Number
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 I Claim Preparer
Telephone Number (916) 797-4883
DAVID WELLHOUSE & ASSOCIATES (DWA) Email Address dwa—renee@surewestnet
Form FAM-27 (Revised 9118)
PROGRAM RAPE VICTIMS COUNSELING CENTER NOTICE
127 CLAIM SUMMARY
(01) )Claimant (02)
CITY OF CUPERTINO
FORM
1
Fiscal Year
Claim Statistics
2017/2018
(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.
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)
$1,138
$783
$1,921
(05) Total Direct Costs
$1,138
$783
$1,921
Indirect Costs
(06) Indirect Cost Rate
[From ICRP or 10%]
10.00%
(07) Total Indirect Costs
[Refer to Claim Summary Instructions]
$192
(08) Total Direct and Indirect Costs
[Line (05)(e) + line (07)]
$2 113
Cost Reduction
(09) Less: Offsetting Revenues
(10) Less: Other Reimbursements
(11) Total Claimed Amount
[Line (08) - {line (09) + line (10))]
$2,113
PROGRAM
RAPE VICTIMS COUNSELING CENTER NOTICE
FORM
127
ACTIVITY COST DETAIL
2.1
(01) Claimant
(02) Fiscal Year
CITY OF CUPERTINO
2017/2018
(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)
(b)
(c)
(d)
(e)
(f)
Number
Total Time
Hourly
Salaries
Fringe
Standard Time
of Victims
(Hours)
Rate
(c x d)
Benefits
(Hour/Victim)
(a x b)
Road Officers (10 min/victim) .166 Hours
List Job Classification(s)
1. Police Officer
44
7.30
$155.82
$1,138.11
$783.02
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)
$1,138
$783
(05) Total Subtotal Page: of