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					                                                  Request for Payment of Fuel
                                                           Management Resources


 This form is to be used when requesting payments and/or reimbursements from the fleet account for purchases of fuel
 when the fuel card is not used.

   In order to be processed, all information must be completed.
   This form must be attached to the original receipt, which is submitted for payment.
 This form, signed as appropriate, MUST be attached to your Request for Employee Business Expense Reimbursement
 form, the Cardholder Purchasing Log form, or vendor invoice. The Business Office making payment will
 forward the form to Management Resources.

 Employee Name: _________________________ ID #: _______________ Region: __________
 Work Phone #: _______________ Work Location: ________________ Discipline: _____________
 Vehicle Asset #: _______________ Vehicle Type:  Road  Off-Road  Boat
 Fuel Purchase Information:                                                        Why fleet card was not used?
                                                                                     Station equipment not working
 Gallons (Qty in gallons): __________ Cost Per Gallon: $_________                    Driver PIN# problem
                                                                                     Bulk Fuel (attach reconciled tank log)
 Total Fuel Purchase: $__________
                                                                                     Wouldn’t accept fleet card; nearest
 Fuel Type:  Gas  E85  Diesel                Other: ________________            Voyager station is _____ miles
 Odometer: __________ Date: ____________                                             Other
                                                                                   ____________________________________
 Vendor Name: __________________________________________                           ____________________________________
 Vendor Location (town): __________________________________                        ____________________________________


 I certify that the fuel listed has been rendered to a DNR fleet vehicle.

 Employee Signature __________________________________________________ Date _____________

 Supervisor __________________________________________________________ Date ______________

 (After Payment completed, return to):
 Regional MR Supervisor _______________________________________________ Date ______________

 DNR FUEL ACQUISITION POLICY                                                     BUSINESS OFFICE USE ONLY: Check account
 All DNR fuel acquisitions are for DNR equipment only. DNR provides a
 “fuel card” with each fleet vehicle. The fuel card enables DNR to efficiently   FUND _201_ ORG _H721_ APPR _800_ (Fuel Only) 
 comply with fuel consumption reporting requirements of both the state and
                                                                                 AMOUNT TO BE REIMBURSED $ __________
 federal governments. It also enables DNR to obtain discounts on fuel and
                                                                                  Vendor Invoice
 refunds of federal taxes paid.
                                                                                  Employee Business Expense Form
 There are times when a station’s credit card equipment is not working, an
                                                                                   Purchasing Card Log
 ID# is forgotten, or bulk fuel is acquired. This form should be utilized in
                                                                                   Other __________________________
 those circumstances.
                                                                                 Processed by RGN & Name: __________________

                                                                                 DATE PROCESSED: _______________________




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BACKGROUND :
During FY 2005, Governor Pawlenty signed two Executive Orders that affect our fleet program, therefore, DNR needs
to implement changes to how we track and pay for fuel to comply with these directives:
         -Executive Order 04-08 requiring state agencies to take measures to improve air quality;
         -Executive Order 04-10 requiring state agencies to reduce petroleum consumption.
If you are interested in reading these Executive Orders in full, they and others can be found on the Governors website
at http://www.governor.state.mn.us/tpaw_other_page.asp?catid=13 .

ACTION REQUIRED :
Effective immediately for buying motor equipment fuel at retail stations:

         1. Use the Fleet Card (Voyager).
         2. Buy the lowest cost fuel (but always buy E85 for Flexible Fuel vehicles when it is available).
         3. Correctly enter the actual odometer reading during the credit card transaction for all road vehicles,
             as this information has taken on new importance.
         4. Ensure that the fuel put into the tank of that vehicle is accurately recorded onto the vehicle MUR.
         5. Separate transactions are required when buying fuel for off road equipment :
             If fueling hauled/trailered equipment (such as: boat motor, ATV, snowmobile, etc.) or filling
             portable bulk tanks & gas cans, do a separate transaction from the truck fuel and enter 9999
             when asked for the odometer reading. This will allow distinguishing road fuel from off-road fuel.
         6. If unplanned circumstances dictate that an employee acquired fuel, but didn’t use the fleet card (personally paid,
             used DNR Purchasing Card, or a store charge). This form must be completed and processed as follows:


Employee completes form “Request For Payment of Fuel”, Employee & Supervisor signs, appropriate
forms with original invoice is submitted to Business Office for payment, Business Office completes
payment, and removes this form and submits to Regional MR Supervisor for review, Regional MR
Supervisor forwards form to St Paul.

Possible payment requests could include:
Employee expense reimbursement through Business Office
DNR Purchasing log through Business Office
If no payment was made to vendor, submit original invoice and completed form to Business Office for payment

For any payment to be made from the Fleet account, the Business Office will verify that a “Request for Payment of Fuel” form is
completed and original invoice is attached to any payment request. The “Request for Payment of Fuel” form will be forwarded to
the Regional Management Resources office by the Business Office. Regional Management Resources will review all requests for
any action needed regionally, and then the form will be forwarded to St Paul for final audit. If an expense is determined to not be
the responsibility of Fleet, a reversing entry will be made to charge the Division.

On site bulk tanks will continue to require tank logs for recording of fills and disbursements.
         Bulk Fuel Utilize M-contract and use the fleet card to pay.
                  M-Contract not available in area? Signed quote is necessary for purchase over $500. One bid is required under
                  $2,500, two bids must be taken between $2,500 and $10,000. Do not exceed your ALP authority.



The DNR Fleet Card (currently Voyager) is assigned to vehicles, with individuals authorized to use any fleet card with an assigned PIN #.
This card enables efficient tracking and capability of auditing expenses by vehicle. It also enables the DNR to recoup federal gas taxes through
Voyager, who is authorized by IRS rules, as purchase quantity and product types are captured on the transaction. The card may be used for other
purchases associated with the asset (i.e. oil changes, car washes, fluids, tires & repairs, and other repairs & maintenance) contingent upon the
vendor accepting the card and DNR purchasing requirements are met.




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