File within 7-calendar days
of the last day of the event.
See Page 3 for Instructions
ARIZONA DEPARTMENT OF EMERGENCY AND MILITARY AFFAIRS (DEMA)
Division of Emergency Management
VENDOR TRAVEL CLAIM
DEMA Form TNG-03
Last Revised
March 2019
Section 1 - Vendor Information
Section 2 - Event Information
Travel Dates: Event Dates:
Name: Event Number:
Phone: Email: Event Name:
Street Address: Event Location:
City: State: Zip:
All travel claims must be properly completed and submitted for payment
within 7-calendar days of the last day of the event. Late travel claims are
subject to being denied by the State of Arizona in accordance with Arizona
Revised Statues and administrative rules promulgated there under.
Transportation:
POV
Carpool
GOV
*Contact the DEMA Grant Administration Office.
Driver
Passenger
Section 3 - Travel Expenses, Vendor Comments & Signature
DEMA Use Only
Date
MM/DD
Departure Address
Departure
Time
Arrival Address
Arrival
Time
Include Map
Mileage
Include Original Itemized
Receipts
Meals Lodging Other Miles Meals Lodging Other
Vendor Comments:
SAAM Rates
Lodging
Single Day
Ext. Day
Vendor Signature: Date:
Grant Admin Comments:
75%
100%
75%
Training Branch Manager Comments:
Authorized Reimbursement
Miles: x $.445 =
Training Branch Manager Signature: Date: Meals:
Lodging:
Other:
Pg 1
Optional Travel Claim Continuation Form
Date
MM/DD
Departure Address
Departure
Time
Arrival Address
Arrival
Time
Include Map
Mileage
Include Original Itemized
Receipts
DEMA Use Only
Meals Lodging Other Miles Meals Lodging Other
Pg 2
Vendor Travel Claim Instructions
PLEASE TYPE, PRINT, SIGN AND DATE. Handwritten claims can be difficult to read and may result in lengthy processing delays.
Section 1 - Vendor Information
Vendor Travel Dates - Enter the dates you traveled for this event in MM/DD/YY - MM/DD/YY format.
Vendor Name - Enter your legal name as submitted on your form W9 and your Arizona Procurement Portal vendor account.
Vendor Phone & Email - Enter your current phone number and email address so that we can contact with you with any questions regarding this travel claim.
Vendor Street Address - Enter your full street address to include city and zip code.
Vehicle Type - Select POV for personal vehicle or GOV for government vehicle. DEMA cannot reimburse instructors directly for use of government vehicles. Contact our
Grants Administration Office for details.
Carpool - Indicate if you carpooled to this event and if so, whether you were the driver or passenger. Mileage is only reimbursed to the driver.
Section 2 - Event Information
Event Dates - Actual dates of the event.
Event Number - Event number listed in the DEMA Learning Management System (Acadis).
Event Name - Enter the name of the event you attended.
Event Location - Enter the city the event was held in.
Section 3 - Travel Expenses, Vendor Comments & Signature
You must travel over 50 miles one-way to be eligible for mileage, meal and lodging expenses. Mileage, meal and lodging expenses will be reimbursed up to the published State
of Arizona travel reimbursement rates which can be found on-line at
https://gao.az.gov/publications/saam. It is the vendor’s responsibility to verify travel reimbursement rates
prior to the event.
Mileage - A printed map showing the most direct route from your home base to the event location is required. Mileage will not be reimbursed for travel to and from
meals.
Meals - All receipts must be itemized; credit card receipts are not accepted without individual items listed on the receipt (these can be hand written).
Lodging - A hotel folio must be itemized and show a zero balance.
Other - Other charges must be approved in advance by the DEMA Training Branch. Itemized receipts are required.
Vendor Comments - Enter any explanations that will assist us in processing your claim.
Vendor Signature & Date - Claims not signed & dated will be returned to the instructor.
Return Completed Travel Claim and Back-up Documentation To:
Arizona Department of Emergency and Military Affairs
Division of Emergency Management
Grant Project Specialist
5636 E McDowell Road, Phoenix, AZ 85008
Ph: 602-464-6348 | Email:
grants@azdema.gov