HomeMy WebLinkAboutORANGE, COUNTY OF (22)i
INSURANCE NOT Ri WIAE€, N-2021-197
CDWORK MAY MGM
ee CLERK( Of COUNCY
N
0
MUTUAL AID AGREEMENT
forthe
COVID-19 Vaccination Effort
This Mutual Aid Agreement ("AGREEMENT") between the County of Orange, a political subdivision of
the State of California, ("COUNTY" or "LEAD AGENCY") and clan OF 40" AM ("MUTUAL AID
PARTNER" or "PROVIDING JURISDICTION") pertaining to mutual aid assistance provided under the
Orange County Operational Area Agreement ("OAA") is made and entered into as of _
2021. COUNTY and MUTUAL AID PARTNER are individually referred to as "PARTY" and collectively
referred to as "PARTIES."
NOTE. Use of such an agreement does not guarantee state or federal reimbursement.
WHEREAS, this event and associated conditions will collectively be referred to as the Novel Coronavirus
COVID-19 Vaccination Effort ("COVID-19 Vaccination Effort"); and
WHEREAS, COVID-19 is a world-wide pandemic resulting in significant health and economic impacts
across the globe;
WHEREAS, on February 26, 2020, the Orange County Health Officer declared a Health Emergency;
WHEREAS, on February 26, 2020, the Chair of the Emergency Management Council issued a
Proclamation of Local Emergency pursuantto the requirements of the California Emergency Services Act,
which was ratified by the Board of Supervisors on March 2, 2020;
WHEREAS, on March 4, 2020, the Governor of the State of California proclaimed a state of emergency
in response to the COVID-19 pandemic pursuant to the California Emergency Services Act;
WHEREAS, on March 13, 2020, the President of the United States issued a Major Disaster Declaration
for California (FEMA-4482-DR-CA) in response to the COVID-19 pandemic pursuant to section 501 (b) of
the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121-5207 (the "Stafford
Act"). This action made the State of California, local and Indian tribal governments and certain private
non-profit (PNP) organizations eligible to apply for reimbursement from the Federal Emergency
Management Agency (FEMA) Public Assistance (PA) Program'.
WHEREAS, the COUNTY has implemented a vaccination effort ("COVID-19 Vaccination Effort") intended
to vaccinate all eligible community members free -of -charge to curtail the impacts of COVID-19 on
residents throughout the County;
' See https:/Iwww.fema.gov/assistance/public/program-overview for more information.
1
of competent jurisdiction because of the concurrent active negligence of COUNTY or
COUNTY Indemnitees, MUTUAL AID PARTNER and COUNTY agree that liability will be
apportioned as determined by the court. Neither PARTY shall request a jury
apportionment.
ii. By COUNTY: COUNTY agrees to indemnify MUTUAL AID PARTNER, and hold MUTUAL AID
PARTNER, its elected and appointed officials, officers, employees, agents and those
special districts and agencies which COUNTY's Board of Supervisors acts as the governing
Board ("MUTUAL AID PARTNER Indemnitees") harmless from any claims, demands or
liability of any kind or nature, including but not limited to personal injury or property
damage, arising from or related to the services, products or other performance provided
by COUNTY pursuant to this Agreement. If judgment is entered against COUNTY and
MUTUAL AID PARTNER by a court of competent jurisdiction because of the concurrent
active negligence of MUTUAL AID PARTNER or MUTUAL AID PARTNER Indemnitees,
COUNTY and MUTUAL AID PARTNER agree that liability will be apportioned as determined
by the court. Neither PARTY shall request a jury apportionment.
2. Waiver of Claims
I. Each PARTY hereto agrees to waive all claims against all other PARTIES hereto for any loss,
damage, personal injury or death occurring in consequence of the performance of this
Mutual Aid Agreement; provided, however, that such claim is not a result of gross
negligence or willful misconduct by a PARTY hereto or its personnel.
ii. Each PARTY to this Agreement waives all claims against all other PARTIES to this
Agreement for compensation for any loss, damage, personal injury, or death occurring to
personnel and/or equipment as a consequence of the performance of this agreement.
3. Governmental Immunity:
To the fullest extent authorized by law, all activities performed under this agreement are
deemed to be governmental functions. Neither COUNTY or MUTUAL AID PARTNER, nor
their employees, except in cases of willful misconduct, gross negligence, or bad faith shall
be liable for the death of or injury to persons, or for damage to property when complying
or attempting to comply with this Agreement.
4. Insurance:
i. Each PAR'T'Y shall be responsible for providing insurance for its own employees and
representatives.
ii. Claims for injuries incurred while participating in the COVID-19 Vaccination Effort will be
submitted under the Workers Compensation policy of the injured PARTY's employer. (i.e.,
3
vi. Provide any additional documentation requested by COUNTY in support of the MUTUAL
AID PARTNER's Vaccination Effort Reimbursement Request.
vii. Maintain records for audit, as described within the FEMA Public Assistance Program and
Policy Guide (Exhibit 2). MUTUAL AID PARTNER shall make records available for inspection
upon request of the COUNTY.
viii. Remedy any audit finding related to Vaccination Effort Reimbursement Requests,
including any audit finding identified under the Improper Payments Elimination and
Recovery Improvement Act (IPERIA).
ix. MUTUAL AID PARTNER agrees to provide sufficient documentation, as defined by the
COUNTY, to ensure adequate validation of costs for reimbursement. As necessary during
this public health crisis, MUTUAL AID PARTNER will assist with the COVID-19 Vaccination
Effort and ensure that cost documentation is submitted to the COUNTY for review and
verification to ensure County has complete cost documentation to support County
reimbursement requests.
3. COUNTY Responsibilities
I. Conduct an initial review for completeness of MUTUAL AID PARTNER Vaccination Effort
Reimbursement Request and supporting documentation for consistency with
Reimbursement Rules (Section B.1 herein).
ii. Submit MUTUAL AID PARTNER Vaccination Effort Reimbursement Request to third party
reimbursement funding grantors within 30 days of receipt of complete request, including
backup documentation, from MUTUAL AID PARTNER.
III. Monitor the status of the MUTUAL AID PARTNER Vaccination Effort Reimbursement
Request and inform the MUTUAL AID PARTNER of progress.
iv. Work with MUTUAL AID PARTNER to resolve any issues with Vaccination Effort
Reimbursement Requests.
v. Reimburse MUTUAL AID PARTNER when the COUNTY has determined that sufficient
documentation has been received and reimbursement funds are available.
vi. In response to auditing or monitoring requests made by third party reimbursement
funding grantors, COUNTY will work with MUTUAL AID PARTNER to ensure adequate
documentation is gathered to effectively respond to requests for information.
E
N-2021-197
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
AISY GOMEZ
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
BJ#BO
TJOSIAN
Senior Assistant City Attorney
CITY OF SANTA ANA
STINERIDG
City Manager
RECOMMENDED FOR APPROVAL:
VALENTIN
Chief of Police
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deployed and must have a pre -executed MOU or Post -Event Agreement. All supporting
documentation must be provided. The expenses incurred may vary depending on the Type of
Mutual Aid provided.
Examples of Eligible Expenses:
Only labor and associated fringe benefits are being accepted for processing by the County at
FEDERAL EMERGENCY MANAGEMENT AGENCY
COST SUMMARY ROLL -UP
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
CATEGORY
CLAIM COST
COMMENTS
ELIGIBLE COSTS
LABOR REGULAR TIME
$ 585.44
Resources requested by the County and deployed at the
$ 585.44
(At -POD)
POD site and IMT
LABOR OVERTIME
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
LABOR REGULAR TIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
LABOR OVERTIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
OTHER COSTS
$
$
(If pre -approved)
TOTAL
$ 585.44
$ 585.44
1 certify that the above information was transcribed from timesheets, payroll records, equipment log, invoices, stock records or other
documents which are available for audit. This claim is for cost incurred within the approved Grant Performance Period.
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the term and conditions of the
Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Section 3729-3730 and 3801-3812).
The above resources were requested by the County of Orange for Vaccination Efforts and provided or deployed by Mutual Aid
Partner certifying this report.
CERTIFICATION AND COMMENTS:
Certified by:
Date:
Kristine Ridge, City Manager
Applicant's records have been reviewed and found correct with the exceptions and/or comments noted below:
Reviewed b IEM):
Date:
Enter Name, Title of lEM Compliance Reviewer
Reviewed b (Orange County):Date:
Enter Name, Title ofOC Compliance Reviewer
FEDERAL EMERGENCY MANAGEMENT AGENCY
APPLICANT'S BENEFITS CALCULATION WORKSHEET
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
ENTER TOTAL ANNUAL PAYROLL
$111,500,730.00
REGULAR TIME %
OVERTIME %
Holidays
12 4.62%
benefit is
d tothe
Vacation Leave
14.3 5.50%
Eaj,,e
mefringe
electtheper
Sick Leave
9.6 3.69%
box
* Social Security
N/A r
• Medicare
1.45% r
* Unemployment
* Worker's Comp
$ 5,838,487.74 5,24% r
** Retirement
$ 8,997,813,87 8.07%
Health Benefits
$ 10,489,526.82 9.41%
Life Insurance Benefits
Other (De nbe Beal
r
Total in %of annual salary)37.97%
(FIGURES IN BLUE AUTOMATICALLY -GO" TO THE FORCE ACCOUNT LABOR SHEETS)
COMMENTS:
Life Insurance Benefits are included in the Health Benefits category.
I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER
DOCUMENTS
WHICH ARE AVAILABLE FOR AUDIT.
CERTIFIED: Kristine Ridge, City Manager
DATE:
-Only categories for overtime fringe benefits.
"Only an overtime fringe benefit when supporter) by employee contract
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City of Santa Ana
Santa Ana Police Department
CLAIM NO.
60 Civic Center Plaza PO Has 1981
INVOICE NO.
Santa Ana, CA 92702
DATE
714-647-5315
RESOURCE TYPE
srhyner@santa-ana.org
TO
County of Orange
IMT MAP - Claims
601 N. Ross St., 4th Elam, Room 426
Santa Ana, CA 92701
714-834-4150
Disaster: COVID-19 PAYMENT TERMS
Vaccination PODS Due on receipt
DESCRIPTION QUANTITY TOTAL
Labor - Stralght Time -At PODSite or IMT
13.00
$686.44
Labor - Overtime -At POD Site or IMT
0.00
Labor -Straight Time -Outside POD Site or IMT
0.00
$0.00
Labor -Overtime - Outside POD Site or IMT
0.00
$0.00
OTHER COSTS
Make all checks payable to City of Santa Ana.
THANK YOU FOR YOUR BUSINESS!
INVOICE
Claim No. 1
PM127
8/31/2021
Emergency Management Mutual Aid
Page 11 of 11
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Eligibility For Reimbursement
A and must have a pre -executed MOU or Post -Event Agreement. All supporting
3ntation must be provided. The expenses incurred may vary depending on the Type of
Aid provided.
Examples of Eligible Expenses:
labor and associated fringe benefits are being accepted for processing by the County at th
FEDERAL EMERGENCY MANAGEMENT AGENCY
COST SUMMARY ROLL -UP
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
CATEGORY
CLAIM COST
COMMENTS
ELIGIBLE COSTS
LABOR REGULAR TIME
$ 4,928.06
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 4,928.06
LABOR OVERTIME
$ 2,201.75
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 2,201.75
LABOR REGULAR TIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
LABOR OVERTIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
OTHER COSTS
$
(If pre -approved)
$
TOTAL
$ 7,129.81
$ 7,129.81
I certify that the above information was transcribed from timesheets, payroll records, equipment log, invoices, stock records or other
documents which are available for audit. This claim is for cost incurred within the approved Grant Performance Period.
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the term and conditions of the
Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Section 3729-3730 and 3801-3812).
The above resources were requested by the County of Orange for Vaccination Efforts and provided or deployed by Mutual Aid
Partner certifying this report.
CERTIFICATION AND COMMENTS:
Certified by:
Date:
Kristine Ridge, City Manager
/
is Z/
Applicant's records have been reviewed and found correct with the exceptions and/or comments noted below:
Reviewed b IEM :
Date:
Enter Name, Title of IEM Compliance Reviewer
Reviewed b (Orange County):
Date:
Enter Name, Title of OC Compliance Reviewer
IHolidays
Vacation Leave
Sick Leave
* Social Security
* Medicare
* Unemployment
* Worker's Comp
** Retirement
Health Benefits
Life Insurance Benefits
APPLICANT'S BENEFITS CALCULATION WORKSHEET
12
14.3
9.6
ENTER TOTAL ANNUAL PAYROLL
$111,500,730.00
REGULAR TIME %
4.62%
5.50%
3.69%
N/A r
1.45% r
$ 5,838,487.74 5.24%
$ 8,997,813.87 8.07% (
$ 10,489,526.82 9.41%
Total in % of annual salary) 37.97%
OVERTIME %
7dh
is
egee
(FIGURES IN BLUE AUTOMATICALLY "GO" TO THE FORCE ACCOUNT LABOR SHEETS,
Life Insurance Benefits are included in the Health Benefits category.
I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER DOCUMENTS
WHICH ARE AVAILABLE FOR AUDIT.
CERTIFIED: Kristine Ridge City Manager DATE:
Only
Only categories for overtime fringe benefits.
"' Only an overtime fringe benefit when suppc
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City of Santa Ana
Santa Ana Police Department
CLAIM NO.
60 Civic Center Plaza PO Box 1981
INVOICE NO.
Santa Ana, CA 92702
DATE
714-647-5315
RESOURCE. TYPE
srhyner@santa-ana.org
TO
County of Orange
IMT MAP - Claims
601 N. Ross St., 4th Floor, Room 426
Santa Ana, CA 92701
714-834-4150
PODS
PAYMENTTERMS
Due on receipt
DESCRIPTION QUANTITY TOTAL
Labor -Straight Time -At POD Site or IMT
119.50
$4,928.06
Labor - Overtime - At POD Site or IMT
23.00
$2,201.75
Labor -Straight Time- Outside POD Site or IMT
0.00
$0.00
Labor -Overtime- Outside POD Site or IMT
0.00
$0.00
OTHER COSTS
Make all checks payable to City of Santa Ana.
THANK YOU FOR YOUR BUSINESS!
INVOICE
Claim No.2
PM128
8/31/2021
Emergency Management Mutual Aid
Page 11 of 11
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)d and must have a pre -executed MOU or Post -Event Agreement. All supporting
Bntation must be provided. The expenses incurred may vary depending on the Type of
Aid provided.
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labor and associated fringe benefits are being accepted for processing by the County at th
FEDERAL EMERGENCY MANAGEMENT AGENCY
COST SUMMARY ROLL -UP
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
CATEGORY
CLAIM COST
COMMENTS
ELIGIBLE COSTS
LABOR REGULAR TIME
$ 3,003.08
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 3,003.08
LABOR OVERTIME
$ 307.42
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 307.42
LABOR REGULAR TIME
$ _
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$ -
LABOR OVERTIME
$ _
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
OTHER COSTS
$
(If pre -approved)
$ -
TOTAL
$ 3,310.50
$ 3,310.50
1 certify that the above information was transcribed from timesheets, payroll records, equipment log, invoices, stock records or other
documents which are available for audit. This claim is for cost incurred within the approved Grant Performance Period.
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the term and conditions of the
Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Section 3729-3730 and 3801-3812).
The above resources were requested by the County of Orange for Vaccination Efforts and provided or deployed by Mutual Aid
Partner certifying this report.
CERTIFICATION AND COMMENTS:
Certified by:
Date:
Kristine Ridge, City Manager
Applicanfs records have been reviewed and found correct with the exceptions and/or comments noted below:
Reviewed b IEM):
Date:
Enter Name, Title of lEM Compliance Reviewer
Reviewed b (Orange County):
Date:
Enter Name, Title of OC Compliance Reviewer
FEDERAL EMERGENCY MANAGEMENT AGENCY
APPLICANT'S BENEFITS CALCULATION WORKSHEET
APPLICANT
JURISDICTION
CATEGORY
DISASTER
Countyof Orange
Ci of Santa Ana
I B
4482-DR-CA
ENTER TOTAL ANNUAL PAYROLL
$111,500,730.00
REGULAR TIME %
OVERTIME %
Holidays
12 4 62%
If the benefit is
applied to the
Vacation Leave
14.3 5.50%
overtime fringe
rate, select the
Sick Leave
9.6 3.69%
proper box
* Social Security
N/A r
* Medicare
1 45% r
* Unemployment
r
* Worker's Comp
$ 5,838,487,74 5.24% r
** Retirement
$ 8,997,813.87 8.07% 1—
Health Benefits
$ 10,489,526.82 9.41/° °
Life Insurance Benefits
Otherloe:er.be nerel
Total in % of annual salary) 37.97%
(FIGURES IN BLUE AUTOMATICALLY 'GO" TO THE FORCE ACCOUNT LABOR SHEETS)
COMMENTS:
Life
Insurance Benefits are Included in the Health Benefits category.
I CERTIFY THAT THE INFORMATION ABOVE
WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER DOCUMENTS
WHICH ARE AVAILABLE FOR AUDIT.
CERTIFIED: Kristine Ridge City Manager
DATE: LL117 Z%
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INVOICE
City of Santa Ana
Santa Ana Police Department
CLAIM NO.
Claim No. 3
60 Civic Center Plaza PO Box 1981
INVOICE NO.
PM129
Santa Ana, CA 92702
DATE
8/31/2021
714-647-5315
RESOURCE TYPE
Emergency Management Mutual Aid
srhyner@santa-ana.org
TO
County of Orange
IMT MAP - Claims
601 N. Ross St., 4th Floor, Roam 426
Santa Ana, CA 92701
714-834-4150
Disaster: COVIO-19
PAVMENTTERMS
Vaccination PODS
Due on receipt
DESCRIPTION QUANTITY
TOTAL
Labor -Straight Time - At POD Site or IMT
62.00
$3,003.08
Labor - Overtime - At POD Site or IMT
6.50
$307.42
Labor -Straight Time- Outside POD Site or IMT
0.00
$0.00
Labor - Overtime - Outside POD Site or IMT
0.00
$0.00
OTHER COSTS
68.50
Make all checks payable to City cf Santa Aoo.
THANK YOU FOR YOUR BUSINESS!
Page 11 of 11
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deployed and must have a pre -executed MOU or Post -Event Agreement. All supporting
documentation must be provided. The expenses incurred may vary depending on the Type of
Mutual Aid provided.
Examples of Eligible Expenses:
Only labor and associated fringe benefits are being accepted for processing by the County at thi
' Equipment Examples of Ineligible Expenses:
• Mortal to Mortal Compensation
t,omaination or ivweage ana rues Tor the same venicie
All Uounty-requested labor costs are a igi e.
Non -labor resources provided by the county and requested through WebEOC may not
be eligible for reimbursement under public assistance unless specifically approved by
FEDERAL EMERGENCY MANAGEMENT AGENCY
COST SUMMARY ROLL -UP
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
CATEGORY
CLAIM COST
COMMENTS
ELIGIBLE COSTS
LABOR REGULAR TIME
$ 4,485.46
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 4,485.46
LABOR OVERTIME
$ 5,722.59
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 5,722.59
LABOR REGULAR TIME
$ _
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$ -
LABOR OVERTIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
OTHER COSTS
$
(If pre -approved)
$ -
TOTAL
$ 10,208.05
$ 10,208.05
I certify that the above information was transcribed from timesheets, payroll records, equipment log, invoices, stock records or other
documents which are available for audit. This claim is for cost incurred within the approved Grant Performance Period.
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the term and conditions of the
Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Section 3729-3730 and 3801-3812).
The above resources were requested by the County of Orange for Vaccination Efforts and provided or deployed by Mutual Aid
Partner certifying this report.
CERTIFICATION AND COMMENTS:
Certified by:
Date:
Kristine Ridge, City Manager
l6�%
Applicant's records have been reviewed and found correct with the exceptions and/or comments noted below:
Reviewed b IEM :
Date:
Enter Name, Title of IEM Compliance Reviewer
Reviewed b (Orange County):
Date:
Enter Name, Title of OC Compliance Reviewer
FEDERAL EMERGENCY MANAGEMENT AGENCY
APPLICANT'S BENEFITS CALCULATION WORKSHEET
APPLICANT
JURISDICTION
CATEGORY
DISASTER
Countyof Oran a
Ci of Santa Ana
B
4482-DR-CA
ENTER TOTAL ANNUAL PAYROLL
$111,500,730.00
REGULAR TIME %
OVERTIME %
Holidays 12 4,62%
If the benefit is
applied to the
Vacation Leave 14.3 5.50%
overtime fringe
rate, select the
Sick Leave 9.6 3,69%
proper box
* Social Security N/A F-
* Medicare 1 45% r
* Unemployment f
• Worker's Comp $ 5,838,487.74 5,24% F-
** Retirement $ 8,997,813.87 8.07% r
Health Benefits $ 10,489,526.82 9A1%
Life Insurance Benefits
Other we,=rme °Mel .
Total in % of annual salary)37.97%
(FIGURES IN BLUE AUTOMATICALLY "GO" TO THE FORCE ACCOUNT LABOR SHEETS)
COMMENTS:
Life Insurance Benefits are included in the Health Benehts category.
I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER DOCUMENTS
WHICH ARE AVAILABLE FOR AUDIT.
CERTIFIED: Kristine Ridge City Mana er L--
DATE: /() ( %Z�/
` Only categories for overtime fringe benefits.
Only an overtime fringe benefit when supported by employee contract
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City of Santa Ana
Santa Ana Police Department
CLAIM NO.
60 Civic Center Plaza PO Box 1981
INVOICE NO.
Santa Ana, CA 92702
DATE
714-647-5315
RESOURCE TYPE
srhyner@santa-ana.org
TO
County of Orange
IMT MAP - Claims
601 N. Ross St., 4th Floor, Room 426
Santa Ana, CA 92701
714-834-4150
Disaster: COVID-19 PAYMENTTERMS
Vaccination PODS Due on receipt
Labor -Straight Time-. At POD Site or IMT 101.50 $4,485.46
Labor - Overtime - At POD Site or l MT 86.00 $5,722.59
Labor -Straight Time- Outside POD Site or l MT 0.00 $0.00
Labor -Overtime- Outside POD Site or l MT 0.00 $0.00
OTHER COSTS
Make all checks payable to City of Santa Ana.
THANK YOU FOR YOUR BUSINESS!
187.50
INVOICE
Claim No.4
PM130
8/31/2021
Emergency Management Mutual Aid
Page 11 of 11
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deployed and must have a pre -executed MOU or Post -Event Agreement. All supporting
documentation must be provided. The expenses incurred may vary depending on the Type of
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Examples of Eligible Expenses:
Only labor and associated fringe benefits are being accepted for processing by the County at th
FEDERAL EMERGENCY MANAGEMENT AGENCY
COST SUMMARY ROLL -UP
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
CATEGORY
CLAIM COST
COMMENTS
ELIGIBLE COSTS
LABOR REGULAR TIME
$ 837.55
Resources requested by the County and deployed at the
(At -POD)
POD site and IMT
$ 837.55
LABOR OVERTIME
$ 684Resources
requested by the County and deployed at the
(At -POD)
.15
POD site and IMT
$ 684.15
LABOR REGULAR TIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$ -
LABOR OVERTIME
$
Resources requested by the County and deployed outside
(Outside -POD)
the POD site and IMT
$
OTHER COSTS
$
(If pre -approved)
$ -
TOTAL
$ 1,521.70
$ 1,521.70
1 certify that the above information was transcribed from timesheets, payroll records, equipment log, invoices, stock records or other
documents which are available for audit. This claim is for cost incurred within the approved Grant Performance Period.
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the term and conditions of the
Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Section 3729-3730 and 3801-3812).
The above resources were requested by the County of Orange for Vaccination Efforts and provided or deployed by Mutual Aid
Partner certifying this report.
CERTIFICATION AND COMMENTS:
Certified by:
Date:
Kristine Ridge, City Manager
Applicant's records have been reviewed and found correct with the exceptions and/or comments noted below:
Reviewed b IEM :
Date:
Enter Name, Title of IEM Compliance Reviewer
Reviewed b (Orange County):
Date:
Enter Name, Title of OC Compliance Reviewer
FEDERAL EMERGENCY MANAGEMENT AGENCY
APPLICANT'S BENEFITS CALCULATION WORKSHEET
APPLICANT
JURISDICTION
CATEGORY
DISASTER
County of Orange
City of Santa Ana
B
4482-DR-CA
ENTER TOTAL ANNUAL PAYROLL
$111,500,730.00
REGULAR TIME %
OVERTIME %
Holidays
12 4.62%
If the benefit is
applied to the
Vacation Leave
14.3 5.50%
overtime fringe
rate, select the
Sick Leave
9.6 3.69%
proper box
* Social Security
N/A r
' Medicare
1,45%
• Unemployment
` Worker's Comp
$ 5,838,487.74 5.24% r
*' Retirement
$ 8,997,813.87 8.07% r
Health Benefits
$ 10,489,526.82 9,41%
Life Insurance Benefits
Other ,Describe here,
r
Total in % of annual salary) 37.97
(FIGURES IN BLUE AUTOMATICALLY "GO- TO THE FORCE ACCOUNT LABOR SHEETS)
COMMENTS:
Life Insurance Benefits are included in the Health Benefits category.
I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER
DOCUMENTS
WHICH ARE AVAILABLE FOR AUDIT.
CERTIFIED: Kristine Ridge City Manager
DATE:
' Only categories for overtime fringe benefits.
" Only an overtime fringe benefit when supporter, by employee contract
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INVOICE
City of Santa Ana
Santa Ana Police Department
CLAIM NO.
Claim No. 5
60 Civic Center Plaza, PO Box 1981
INVOICE NO.
PM131
Santa Ana, CA 92702
DATE
8/31/2021
714-647-5315
RESOURCE TYPE
Emergency Management Mutual Aid
srhyner@santa-ana.Org
TO
County of Orange
IMT MAP - Claims
601 N. Ross St, 4th Floor, Room 426
Santa Ana, CA 92701
714-834-4150
Disaster: COVID-19
PAYMENT TERMS
Vaccination PODS
Due on receipt
TOTAL
Labor -Straight Time -At POD Site or IMT
19.00
$837.55
Labor - Overtime - At POD Site or IMT
8.00
$684.15
Labor -Straight Time- Outside POD Site or INC
0.00
$0.00
Labor - Overtime - Outside POD Site or IMT 0.00 $0.00
OTHER COSTS
(If pre -approved) $0.00
27.01D $1,521.70
Make all checks payable to City Of Santa Ana.
THANK YOU FOR YOUR BUSINESS!
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