HomeMy WebLinkAbout106.054 - FD-48, Request for Mileage Reimbursement FormEffective Date: October 2017 Section 104.016
Current Revision Date: 3/21/2022 ADA
Next Revision (2) Date: 3/21/2024 Page 1 of 2
100 Administrative Manual
SECTION 106.054 REQUEST FOR MILEAGE REIMBURSEMENT
FORM (FD-48)
INFORMATION SHEET
Form Number: FD-48
Title: REQUEST FOR MILEAGE REIMBURSEMENT
(Monthly City Business Vehicle Usage Record)
Contents: Report of mileage traveled on City business by any
Department member and payment authorization for
reimbursement of such mileage.
ONLY FIREFIGHTING MEMBERS will complete the
section concerning authorization for vehicle use,
confirmation of mileage and insurance, and battalion
chief’s signature.
ALL OTHER Department members will complete the form
after complying with the requirements of the City of Fresno
Administrative Order 2-2, which regulates mileage
reimbursement.
Submission Date: Firefighters, within ten calendar days of travel. All others,
first day of month following completion of travel.
Responsibility: Individual member concerned. Members shall provide a
current mailing address where indicated on the form and
verify all information submitted is correct.
Channels Through: Battalion chief or supervisor to the Business and Fiscal
Services Unit.
Cross Reference: City of Fresno Administrative Order 2-2
Administrative Manual, Section 108.2
Fresno City Fire Department
FD-48
FRESNO CITY FIRE DEPARTMENT
REQUEST FOR MILEAGE REIMBURSEMENT
Current Revision Date: 4/1/2022
Member Name Member ID Number Division
Number
Current Mailing Address:
Date
Reason for Trip and Destination
(Detailed From - To)
Beginning
Odometer,
or Station to
Station
Matrix
Ending
Odometer, or
Station to
Station Matrix
Total
Miles
(Reference: Administrative Manual, Section 108.2, Mileage Reimbursement)
FIREFIGHTERS ONLY (Complete this Section) INSURANCE COVERAGE:
VEHICLE USE AUTHORIZED:
Yes No MILEAGE CONFIRMED: Yes No
Policyholder Insurance Company Policy Number Expiration Date
I hereby certify that the foregoing is a correct statement of mileage I incurred, while utilizing my personal
vehicle on the date indicated. I further certify that such travel was necessary in connection with the
performance of authorized Fresno Fire Department business.
Signature Battalion Chief Signature
Date
PAYMENT INFORMATION Total Miles
Category 3 miles x .49/mile . . .
$
Category 4 miles x .56/mile . . .
$
Employee Signature (Non-firefighting) Date Authorized Signature Date