HomeMy WebLinkAboutExhibit 2AIR Card Accountable Official Nomination Form
FAX TO: DESC-RRF- (210) 925-0555
Attention all AIR Card Cardholders —
(Military, Federal Civilian Agencies and State and Local Law Enforcement Agencies)
You are required to nominate an Accountable Official
wlere and return theAccan confirm the �ountable Official Cards currently +n use Nominatyour tian Furor ASAdPnsYou may
information embossed on the card is valid.P
attach a separate listing of all aircraft information attached with this nomination form. To cancel or deactivate any AIR Cards,
notify DESC-RRF in writing of the cancellation. NOTE. An Accountable Official must be a U.S. Government official, employee,
or military member, not contractor personnel.
Please verify the information, make any necessary revisions, sign and return this form to the facsimile number 210-925-
0555. NOTE: Failure to return this form will result in the deactivation of your AIR Cards.
DoDAAC Signal Code/Fund Code: APC/ORG/TEC: Unit/Wing/Squadron: Card/Account #
A/XP
Activity Name: CITY OF MIAMI POLICE DEPARTMENT
Address: 400 NW 2 Ave.
City: r•iami
State: _E1, Zip Code: - 1128
Date Sent: E-mail Address:
Country: USA
Phone:
Fax:
List of Vehicles #: Attach separate list if necessary:
Make: Model: VIN #:
Card #: 1406 EC 120
Eurocapter -
1 hereby establish myself as the Accountable Official for the AIR Card account identified above. In this context, I agree to assume
responsibility for AIR Cards associated with this account and their use in accordance with DoD Financial Management Regulation,
Volume 5, Chapter 33. Specifically, I agree to:
a. Receive the cards associated with this account, activate them, and control their distribution to users.
b. Oversee the use of all cards, to include review of associated transactions and exception reporting as prescribed in DESC's
procedures for card use.
c. Promptly report any misuse, loss or theft of any card in accordance with DESC procedures.
d, Maintain accuracy of the billing and contact data in the AIR Card database.
I understand that the DESC Certifying Official and Program Manager will be relying on my performance of the above duties to
administer the AIR Card program, including payment of the AIR Card invoice(s). I further understand that it is
slthepolicy
in ofthhvent
e
Department of Defense to hold accountable officials, in addition to certifying and disbursingi officers, pecuniarilyliable
of erroneous payments resulting from negligent performance of duties.
Authorized Signature:
Printed Name and Title:
THIS FORM MUST BE COMPLETED AND RETURNED TO DESC-RRF IMMEDIATELY FOR ACTIVATION
PURPOSES.
PLEASE FAX YOUR COMPLETED FORM UPON RECEIPT, DSN 945-0555
Date:
Organization of Accountable Official
MEMORANDUM FOR
ACKNOWLEGEMENT
DISC -RR
Bldg 1621-K
2261 Hughes Ave, Ste 128
Lackland AFB, TX 78236-9828
SUBJ: Appointment as Accountable Official
In accordance with your memorandum of (insert date), I hereby execute the following statement:
"By signature hereon, I acknowledge my appointment as an Accountable Official. I have read
and understand my responsibilities and pecuniary liability as descried in Chapter 33, Volume 5, of the
DoD Financial Management Regulation. I understand that I have the right to request relief of liability for
any certification I supported that is determined to be an illegal, improper, or incorrect payment. I further
understand that this appointment will remain in effect until revoked in writing by you (or your successor)
or until I am transferred, separated for any reason, or retire from service."
(Signature of Accountable Official) Date
Print Name of Accountable Official
Account ll: DODAAC: