Date:

(mm/dd/yr)
KILOMETERS CLAIM FORM
NAME: VANJA DIJAK

DIVISION: Coastview

FOR THE MONTH OF: Dec-19 BARGAINING UNIT:

KMS PER GOOGLE

Trip # DATE (mm/dd/yr) FROM TO TRIP PURPOSE MAPS CURRENT RATES PER KM
1 2-Feb CV- Head Office CV Bills 4.2 $ 4.00 HEU =
2 2.1 $ 4.00 HSA =
3 4.2 $ 4.00 NURSES =
4 $ - EXEMPT =
5 $ -
6 $ - INVOICE CODING
7 $ - Vendor No.
8 $ -
9 $ - Invoice No.
10 $ -
11 $ - Date Rec'd
12 $ -
13 $ - Dist:
14 $ - Acct/Dept:
15 $ - 6610-63
16 $ -
17 $ -
18 $ -

Total Voucher
TOTAL KILOMETERS: 10.5 $12 Approval to Pay

Employee Signature: _______________________________________(Must Sign or will be returned back for signature)

Total Reimbursement: @$ ___0.54___/km X__33.6_______ (km) = $ __________72___

Manager's Approval: _______________________________

Exception Variance (Appropriate signature required to be paid).

KM over Manager/Director Approval

Trip # Reason
Google Maps Name
 1-Mar-20

VANJA DIJAK

Coastview

CURRENT RATES PER KM:

0.54 Cents
0.52 Cents
0.50 Cents
0.50 Cents

INVOICE CODING
Date Due

Ref.

$0.00

$ -
Manager/Director Approval
Signature
 COAST FOUNDATION SOCIETY (1974) Date: __________________________
(mm/dd/yr)
KILOMETERS CLAIM FORM
NAME:_________________________________

DIVISION:______________________________

BARGINING UNIT:_HEU

FOR THE MONTH OF: ___October, 2016_______________________________________

DATE KMS PER

(mm/dd/yr) GOOGLE
Trip # FROM TO TRIP PURPOSE MAPS CURRENT RATES PER KM:
1 5/10/2016 Head Office Chester meeting with client 3.2 HEU = 0.53 Cents
2 5/10/2016 Chester Safeway (525 East 11th) Pick up client supplies 3 HSA = 0.52 Cents
3 5/10/2016 Safeway (525 East 11th) McLean Apt drop off client supplies 2 NURSES = 0.50 Cents
4 5/10/2016 McLean Apt Head Office return to office for paperwork 2.4 EXEMPT = 0.50 Cents
5/10/2016 Total 10.6
INVOICE CODING
5 7/10/2016 Head Office Client Address X client visit 1.5 Vendor No. Date Due
6 7/10/2016 Client Address X Head Office return trip 1.5
7/10/2016 Total - HEU Minimum $4.00 for day Invoice No. Ref.

Date Rec'd

Dist:
Acct/Dept: Amt:

Total Voucher

Approval to Pay
TOTAL KILOMETERS: 10.06 *

Employee Signature: _________________________

Total Reimbursement: @ _10.6___/km X___0.53______ (km) = $ ___$5.62 + $4.00 = $9.62__________

Manager's Approval: _________________________

Exception Variance

KM over
Manager / Director Approval
Trip # Google Maps Reason Name Signature
2 1.5 road was closed, detour necessary