Backup Documents 01/24/2012 Item #16K 3ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 X' 3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through 94 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exce tion of the Chairman's signature draw a line throw h routinia lines #I throuph 44, complete the checklist, and forward to Sue Filson line #5).
Route to Addressee(s)
(List in routing order)
Office
' ' u
Date
1.
(Initial )
Applicable)
2.
January 24, 2012
Agenda Item Number
16 -K -3
3.
Chairman, with the exception of most letters, must be reviewed and signed by the Office of the
S/
4. Colleen M. Greene, ACA
County Attorney
(/ --r _
01/24/12
5. Ian Mitchell, BCC Executive Manager
Board of County Commissioners
I Documents Attached
1 Z
(Z
6. Minutes and Records
Clerk of Court's Office
(2k)((2_
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created /prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item
Name of Primary Staff
Colleen M. Greene, ACA
Phone Number
252 -8400
Contact
(Initial )
Applicable)
Agenda Date Item was
January 24, 2012
Agenda Item Number
16 -K -3
Approved by the BCC
Chairman, with the exception of most letters, must be reviewed and signed by the Office of the
Type of Document
Retention Agreement — Henderson Franklin
Number of Original
`k
Attached
I
I Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
<<matter_ number» /«document_numberu
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is appropriate.
Yes
N/A (Not
(Initial )
Applicable)
1.
Original document has been signed /initialed for legal sufficiency. (All documents to be signed by the
CMG
Chairman, with the exception of most letters, must be reviewed and signed by the Office of the
County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the
County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully
executed by all parties except the BCC Chairman and Clerk to the Board and possibly State
Officials.
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's Office and
N/A
all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the document or
CMG
the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's signature and
CMG
initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip should be
N/A
provided to Ian Mitchell in the BCC office within 24 hours of BCC approval. Some documents are
time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions
are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 01/24/12 and all changes made during the meeting
CMG
have been incorporated in the attached document. The County Attorney's Office has reviewed
the changes, if applicable.
7
Please return an executed copy to Colleen M. Greene, ACA
CMG
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
<<matter_ number» /«document_numberu
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MEMORANDUM
Date: January 27, 2012
To: Colleen Greene
County Attorney's Office
From: Teresa L. Polaski, Deputy Clerk
Minutes & Records Department
Re: Retention Agreement with Henderson Franklin
Enclosed please find one (1) original referenced above (Agenda Item #16K3), which
was approved by the Board of County Commissioners on Tuesday, January 24, 2012.
The Minutes & Records Department has retained an original, which will be kept
as part of the Board's Official Records.
If you have any questions, please call me at 252 -8411.
Thank you
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RETENTION AGREEMENT WITH
HENDERSON FRANKLIN
This Retention Agreement is made by and between the Board of County Commissioners
of Collier County, Florida (the "County "), and the law firm of Henderson Franklin of Ft. Myers,
Florida ( "Henderson Franklin ").
Whereas, Henderson Franklin has special expertise and resources in a wide range of legal
matters, with particular expertise in civil trial litigation, including employment and labor
litigation; defense of school boards, cities, counties and other governmental entities; and civil
rights litigation in state and federal court; and
Whereas, the County requires legal services which are particularly within the expertise of
Henderson Franklin specifically in defending the County through and including trial in the
lawsuit captioned Don Edwards v. Collier County (Case No. 09- 6111 -CA). Discovery is in the
early stages with numerous depositions pending. Henderson Franklin will also provide complete
trial preparation, attendance at trial, post -trial motions and related matters.
Now, therefore, in consideration of the premises contained herein, the County hereby
hires and retains Henderson Franklin and Henderson Franklin hereby agrees to provide legal
services to County.
ARTICLE 1
COMPENSATION; METHOD OF PAYMENT
1.1 Compensation shall be paid to Henderson Franklin in accordance with the terms set forth
in Exhibit "A" attached hereto and made a part hereof. Requirements for reimbursable
expenses are set forth in Exhibit "B," attached hereto and made a part hereof. Expenses
other than automobile expenses must be documented by copies of paid receipts or other
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evidence of payment. The Certificate contained in Exhibit "C" must be included with
every invoice submitted for payment.
1.2 The rates set forth in Exhibit "A" shall remain in effect without change for a minimum of
two (2) years from the effective date of this Agreement. In the subsequent years of the
Agreement, upon the request of Henderson Franklin, the County Attorney is authorized to
negotiate to increase the hourly rate up to a maximum of ten (10) percent without
approval by the Board of County Commissioners. In the negotiation process, Henderson
Franklin must substantiate the reason the request is being made (i.e. market conditions,
increase in CPI, etc.)
1.3 Multiple Attorney Assignments.
The County acknowledges that, from time to time, it may be advisable for Henderson
Franklin to assign more than one attorney to this case. Nevertheless, in order to ensure
that such multiple attorney assignments are efficient and cost - effective for the County,
Henderson Franklin agrees to the following procedures and billing limitations for
multiple attorney assignments.
1.3.1 A primary attorney will be identified for this case and that attorney will be the
contact attorney for the County except in the case of an emergency or the
County's written pre - approval. In practice, this means that generally only the
primary attorney will meet or communicate directly with County personnel or
attend meetings, court, arbitrations, mediations or other proceedings on behalf
of the County.
1.3.2 Attorneys assigned to a project or case other than the primary attorney will be
less senior attorneys with lower billing rates unless the additional attorney(s)
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has /have a demonstrated expertise that will demonstrably enhance the value
and efficiency of the legal services being provided to the County.
1.3.3 Henderson Franklin agrees that internal or in -house conferences among
multiple attorneys assigned to a project or case shall be kept to the minimum
reasonably necessary for the provision of the legal services in question. To the
extent internal or in -house conferences among multiple attorneys assigned to a
project or case are necessary, each such attorney may bill his or her customary
rate for up to thirty (30) minutes for any such conference. To the extent such a
conference exceeds thirty (30) minutes in length, Henderson Franklin agrees
that it will discount the total billings for all attorneys involved in the
conference by forty -five (45) percent.
1.4 Henderson Franklin may submit invoices for hourly work assignments pursuant to
Exhibit "A" only after the services for which the invoices are submitted have been
completed or expenses incurred. An original invoice plus one copy is due within fifteen
(15) days of the end of the month, except the final invoice which must be received no
later than sixty (60) days after the work is completed or the expiration of this Agreement.
1.5 To be deemed proper, all invoices must comply with the requirements set forth in this
Agreement and must be submitted on the form and pursuant to the instruction prescribed
by County. Payment may be withheld for failure of Henderson Franklin to comply with a
term, condition, or requirement of this Agreement.
1.6 Payment shall be made to Henderson Franklin at:
Henderson Franklin
1715 Monroe Street
Post Office Box 280
c
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Ft. Myers, FL 33902
ARTICLE 2
INSURANCE
2.1 In order to insure the indemnification obligation contained above, Henderson Franklin
shall as a minimum, provide, pay for, and maintain in force at all times during the term of
this Agreement, professional liability insurance in an amount not less than Three Million
Dollars ($3,000,000.00) Per Occurrence, Combined Single Limits. If any liability
insurance obtained by Henderson Franklin to comply with the insurance requirements
contained herein is issued on a "claims made" form as opposed to an "occurrence" form,
the retroactive date for coverage shall be no later than the commencement date of the
assigned work to which this Agreement applies, and such insurance shall provide, in the
event of cancellation or non - renewal, that the discovery period for insurance claims (tail
coverage) shall not be less than three years following the completion of the assigned work
and acceptance by the County.
2.2 Such policy or policies shall be issued by United States Treasury approved companies
authorized to do business in the State of Florida, and having agents upon whom service of
process may be made in Collier County, Florida.
2.3 Henderson Franklin shall furnish to the Risk Management Director Certificates of
Insurance or endorsements evidencing the insurance coverages specified by this Article
prior to beginning performance of work under this Agreement.
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ARTICLE 3
TERM AND TIME OF PERFORMANCE
The term of this Agreement shall be for a period of two (2) years to begin January 24,
2012 and to end on January 24, 2014, unless terminated earlier in accordance with the provisions
of this Agreement. Absent notice of intent to terminate, the Agreement may be renewed upon
mutual consent of the parties for three (3) additional terms of one (1) year each. In the event the
term of this Agreement extends beyond a single fiscal year of County, the continuation of this
Agreement beyond the end of any fiscal year shall be subject to the availability of funds from
County in accordance with Chapter 129, Florida Statutes.
3.1 Time shall be deemed to be of the essence in performing the duties, obligations and
responsibilities by this Agreement.
3.2 Any amendments, alterations, variations, modifications or waivers of provisions of this
Agreement shall only be valid when they have been reduced to writing, duly signed by
both parties hereto, and attached to the original of this Agreement.
ARTICLE 4
TERMINATION
4.1 This Agreement may be terminated by either party for cause upon ten (10) days' notice or
by either party for convenience upon no less than thirty (30) days' advance written notice
in accordance with the "NOTICES" section of this Agreement.
4.2 Termination of this Agreement for cause shall include, but not be limited to, failure to
suitably perform the work, failure to continuously perform the work in a manner
calculated to meet or accomplish the objectives of County as set forth in this Agreement,
or multiple breach of the provisions of this Agreement notwithstanding whether any such
breach was previously waived or cured.
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4.3 In the event this Agreement is terminated for convenience, Henderson Franklin shall be
paid for any services performed to the date the Agreement is terminated; however, upon
notice by either party to terminate, Henderson Franklin shall refrain from performing
further services or incurring additional expenses under the term of this Agreement.
Henderson Franklin acknowledges and agrees that Ten Dollars ($10) of the compensation
to be paid by County, the adequacy of which is hereby acknowledged by Henderson
Franklin, is given as specific consideration to Henderson Franklin for County's right to
terminate this Agreement for convenience. Henderson Franklin's obligations to the
County as provided for hereunder shall cease upon termination, except for participating in
an orderly and professional transfer of such responsibilities and files or copies of files to
the County or its designee.
ARTICLE S
RECORD AUDIT AND INSPECTION
5.1 County shall have the right to audit the books and records of Henderson Franklin
pertinent to the funding under this Agreement. Henderson Franklin shall preserve and
make available, at reasonable times for examination and audit by County, all financial
records, supporting documents, and other documents pertinent to this Agreement for a
period of three (3) years after termination of this Agreement or, if any audit has been
initiated and audit findings have not been resolved at the end of the three years, the books
and records shall be retained until resolution of the audit findings.
5.2 If the Florida Public Records Act (Chapter 119, Fla. Stat.) is determined by County to be
applicable to Henderson Franklin's records, Henderson Franklin shall comply with all
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requirements thereof, however, no confidentiality or non - disclosure requirement of either
federal or state law shall be violated by Henderson Franklin.
ARTICLE 6
CONFLICT OF INTEREST
6.1 Henderson Franklin states that it is familiar with and will comply with the terms and
conditions of Chapter 112, Part III, Florida Statutes (Code of Ethics).
6.2 It is important that Henderson Franklin be independent and impartial in order to properly
conduct its services to the County. Henderson Franklin shall not act as counsel in any
lawsuit or other adversary proceeding in which County is named as an adversary party or
in which Henderson Franklin takes an adverse position to the County.
6.3 Neither Henderson Franklin nor its employees shall have or hold any continuing or
frequently recurring employment or contractual relationship that is substantially
antagonistic or incompatible with Henderson Franklin's loyal and conscientious exercise
of judgment related to its performance under this Agreement.
6.4 In the event Henderson Franklin is permitted to utilize subcontractors, herein, to perform
any services required by this Agreement, Henderson Franklin agrees to prohibit such
subcontractors, by written contract, from having any conflicts as within the meaning of
this section.
6.5 If at any time Henderson Franklin' firm represents a client in matters having to do with
the Collier County government, be it before the Board of County Commissioners or any
other agency or division of Collier County government, Henderson Franklin will contact
the County Attorney's Office before undertaking such representation so that it can be
determined whether a conflict of interest exists.
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ARTICLE 7
INDEMNIFICATION
Henderson Franklin agrees, to the fullest extent permitted by law, to indemnify and hold
harmless the County against damages, liabilities and costs arising from the negligent acts of
Henderson Franklin in the performance of the professional services under this Agreement, to the
extent that Henderson Franklin is responsible for such damages, liabilities and costs. Henderson
Franklin shall not be obligated to indemnify the County for the County's own negligence or for
the negligence of others.
ARTICLE 8
OWNERSHIP OF DOCUMENTS
8.1 Any and all reports, photographs, surveys, and other data and documents provided or
created in connection with this Agreement are and shall remain the property of County.
In the event of termination of this Agreement, any reports, photographs, surveys, and
other data and documents prepared by Henderson Franklin, whether finished or
unfinished, shall become the property of County and shall be delivered by Henderson
Franklin to the County within seven (7) days of termination of this Agreement by either
party. Any compensation due to Henderson Franklin shall be withheld until all
documents are received as provided herein.
ARTICLE 9
INDEPENDENT CONTRACTOR
9.1 Henderson Franklin is an independent contractor under this Agreement. Services
provided by Henderson Franklin shall be subject to the supervision of Henderson
Franklin, and such services shall not be provided by Henderson Franklin as officers,
employees, or agents of the County. The parties expressly acknowledge that it is not their
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intent to create any rights or obligations in any third person or entity under this
Agreement.
ARTICLE 10
NONDISCRIMINATION, EQUAL OPPORTUNITY
AND AMERICANS WITH DISABILITIES ACT
10.1 Henderson Franklin shall not unlawfully discriminate against any person in its operations
and activities in its use or expenditure of the funds or any portion of the funds provided
by this Agreement and shall affirmatively comply with all applicable provisions of the
Americans with Disabilities Act (ADA) in the course of providing any services funded in
whole or in part by County, including Titles I and H of the ADA (regarding
nondiscrimination on the basis of disability), and all applicable regulations, guidelines,
and standards.
10.2 Henderson Franklin's decisions regarding the delivery of services under this Agreement
shall be made without regard to or consideration of race, age, religion, color, gender,
national origin, marital status, physical or mental disability, political affiliation, or any
other factor which cannot be lawfully or appropriately used as a basis for service delivery.
10.3 Henderson Franklin shall comply with Title I of the Americans with Disabilities Act
regarding nondiscrimination on the basis of disability in employment and further shall not
discriminate against any employee or applicant for employment because of race, age,
religion, color, gender, national origin, marital status, political affiliation, or physical or
mental disability. In addition, Henderson Franklin shall take affirmative steps to ensure
nondiscrimination in employment against disabled persons. Such actions shall include,
but not be limited to, the following: employment, upgrading, demotion, transfer,
recruitment or recruitment advertising, layoff, termination, rates of pay, other forms of
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compensation, terms and conditions of employment, training (including apprenticeship),
and accessibility.
10.4 Henderson Franklin shall take affirmative action to ensure that applicants are employed
and employees are treated without regard to race, age, religion, color, gender, national
origin, marital status, political affiliation, or physical or mental disability during
employment. Such actions shall include, but not be limited to, the following:
employment, upgrading, demotion, transfer, recruitment or recruitment advertising,
layoff, termination, rates of pay, other forms of compensation, terms and conditions of
employment, training (including apprenticeship), and accessibility.
10.5 Henderson Franklin shall not engage in or commit any discriminatory practice in
performing the Scope of Services or any part of Scope of Services of this Agreement.
ARTICLE 11
NOTICES
11.1 Whenever either party desires to give notice to the other, such notice must be in writing,
sent by registered or certified United States Mail, postage prepaid, return receipt
requested, or by hand- delivery, addressed to the party for whom it is intended at the place
last specified. The place for giving notice shall remain the same as set forth herein until
changed in writing in the manner provided in this section. For the present, the parties
designate the following:
FOR COLLIER COUNTY:
Jeffrey A. Klatzkow, County Attorney
Government Center
3299 Tamiami Trail East, Suite 800
Naples, Florida 34112
mi
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FOR HENDERSON FRANKLIN:
John Potanovic, Esq.
1715 Monroe Street
Post Office Box 280
Ft. Myers, FL 33902
ARTICLE 12
MISCELLANEOUS
12.1 WAIVER OF BREACH AND MATERIALITY
Failure by County to enforce any provision of this Agreement shall not be deemed a
waiver of the provision or modification of this Agreement. A waiver of any breach of a
provision of this Agreement shall not be deemed a waiver of any subsequent breach and
shall not be construed to be a modification of the terms of this Agreement.
12.2 COMPLIANCE WITH LAWS
Henderson Franklin shall comply with all federal, state, and local laws, codes, ordinances,
rules, and regulations in performing its duties, responsibilities, and obligations related to
this Agreement.
12.3 SEVERANCE
In the event a portion of this Agreement is found by a court of competent jurisdiction to
be invalid, the remaining provisions shall continue to be effective unless County and
Henderson Franklin elect to terminate this Agreement. The election to terminate this
Agreement based upon this provision shall be made within seven (7) days after the
finding by the court becomes final.
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12.4 APPLICABLE LAW AND VENUE
This Agreement shall be interpreted and construed in accordance with and governed by
the laws of the State of Florida. Venue for litigation concerning this Agreement shall be
in Collier County, Florida.
12.5 PRIOR AGREEMENTS
This document supercedes all prior negotiations, correspondence, conversations,
agreements, and understandings applicable to the matters contained herein and the parties
agree that there are no commitments, agreements or understandings concerning the
subject matter of this Agreement that are not contained in this document. Accordingly,
the parties agree that no deviation from the terms hereof shall be predicated upon any
prior representations or agreements, whether oral or written. It is further agreed that no
modification, amendment or alteration in the terms or conditions contained herein shall
be effective unless contained in a written document in accordance with Article 3 above.
12.6 INCORPORATION BY REFERENCE
The truth and accuracy of each "Whereas" clause set forth above is acknowledged by the
parties. The attached Exhibits "A," "B," and "C" are incorporated into and made a part of
this Agreement.
DATE:
DJ"T-E�-.', CK, C LERK
iroved a to form &legal sufficiency
Collee Greene,
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
B lua_ W. Y�
FRED W. COYLE, CHAIR&AN
12
Approved as to form and
legal sufficiency
Colleen M. Greene
Assistant County Attorney
HE SON FRAN
By:
John Potan vic, sq.
< AllIts: E •
16K3 11
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing Retention Agreement was acknowledged before me this day of
,
2012 by ✓0ii � !� /� Soj�e�iv.(�ef/
o � as /Z of Henderson
Franklin, He is personally known to me or produced
identification.
!Lt
Signature of Notary P lic
el
Name of Notary Public typed, printed or
My Commission Expires:
CLAUDIA KELLY
.. :.; Commission # DD 885037
` -t Expires July 6, 2013
'W „�...•' BadedThuTmyF rinMurariaa0P38�7018
13
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EXHIBIT A
For professional services rendered, Henderson Franklin's fee shall be based on the hourly rate as
follows:
John F. Potanovic, Partner $275.00 per hour
All other Partners $275.00 per hour
Suzanne M. Boy, Associate $190.00 per hour
All other associates $190.00 per hour
Paralegals $90.00 per hour
Henderson Franklin's fee shall not exceed $100,000.00 in the case of Don Edwards v. Collier
County (Case No. 09- 6111 -CA) without the approval of the Board of County Commissioners.
Any expenditure beyond the initial $100,000.00 approval by the Board of County Commissioners
must have Board approval prior to work being performed.
In the event that Henderson Franklin is required or requested to perform any additional or
extraordinary services not herein contemplated, Henderson Franklin shall be entitled to apply for
additional compensation, the amount of which shall be subject to the approval of County and no
such additional compensation in excess of the amount herein stated shall be paid unless
specifically authorized in advance by County in its sole discretion.
Henderson Franklin shall provide, at no cost to County, the annual response to County's auditors
regarding pending or threatened litigation. The auditors typically request information regarding
all litigation, claims and assessments considered to be material. The response should include the
nature of the litigation, the progress of the case to date, an estimate of the amount or range of
potential loss, and any other information considered necessary to explain the case. Henderson
Franklin shall provide said response within 30 days of receipt of the request.
NOTES:
Divisions, or departments within such divisions, shall be responsible and pay for legal
counsel services relating to litigation and outside counsel specifically for cases, matters or
issues relating to such division or department, as determined by the County Attorney in
coordination with the County Manager.
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EXHIBIT B
1. In addition to the charges for professional fees set forth in Exhibit "A," and the
Schedules attached hereto, County shall reimburse Henderson Franklin for out -of-
pocket expenses reasonably incurred in the course of rendering such legal services,
including costs of long distance calls, printing, costs of reproduction, and necessary
travel expenses incurred in accordance with the requirements of Chapter 112, F.S.
Henderson Franklin shall not charge for travel of attorneys between its offices so that
it can provide the best available and most appropriate lawyer in any of its office
locations for the issues involved.
2. Henderson Franklin shall submit invoices on a monthly basis for the payment of out -
of- pocket expenses. Each invoice shall include a signed certificate listing all costs,
expenses, vouchers, invoices and other documentary evidence that will describe in
reasonable detail the basis for expenditures for which reimbursement is sought as set
forth below.
3. REQUIREMENTS
The following represents Collier County's payment requirements for legal costs
➢ Your federal employee identification number must be on all invoices submitted.
➢ The applicable Purchase Order number must be on all invoices submitted.
➢ No service, interest, or other charge of like nature is to be imposed with regard to
any item, invoice, or request. All firms doing business with Collier County must
have a current W -9 "Request for Taxpayer Identification Number and
Certification" on file.
➢ Services rendered must be specifically and concisely identified.
➢ Names of persons performing services, hourly rates, and dates must be listed. The
County agrees to reimburse Henderson Franklin for retention and utilization of
sub - consultants.
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➢ Reimbursable expense must be verified by attached receipts or copies thereof.
➢ Claims for mileage and meals cannot exceed statutory allowance as provided for
under Chapter 112, F.S. Meals and mileage cannot be charged unless the
professional has traveled outside the county of the principal business location.
➢ Claims for lodging at single rate (actual cost) must be substantiated by paid bill or
charge, with a cap of no more than $150.00 per night.
➢ Car rentals required for travel should include compact or standard -size vehicles
only.
➢ Common carrier travel shall be reimbursable at tourist or coach class fares only.
➢ Accounting Division requires original receipts, or copies of receipts which have
been individually certified to be true copies of the originals. In addition the
Certificate contained in Exhibit C must accompany each invoice. The certifying
person must sign the Certification form and a description provided of the items,
which are certified.
➢ Faxes shall not be reimbursed
➢ Legal Research costs (Lexis- Nexis, Westlaw, etc.) shall not be reimbursed
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EXHIBIT C
CERTIFICATE
IT IS HEREBY CERTIFIED that:
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1, has been duly designated as special counsel to
render legal services or provider of services for or on behalf of Collier County;
2. Each of the documents hereinafter identified and attached is a true and correct copy of the
original record;
3. Expenditure(s) enumerated represent costs necessarily incurred during the course of
official business for which payment has not been received and for which documentation is
not available or reasonably retrievable;
4. Claims are in compliance with the applicable statutes and administrative orders, and with
the express provision that all other parties are barred from entitlement to any part of these
costs.
RE: Invoice No. , Dated _
Period Covered: , Amount
IN-HOUSE CHARGES:
Photocopies:
Mileage:
OTHER (Copies of invoices required):
Long Distance Calls
TOTAL:
04.0411/4740
Other:
copies @ $0.15 /each
miles @ /mile
FOR THE FIRM
Signed: —
Print Name:
Title:
Date:
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