Consultant's Invoice and Travel Expense Worksheet
      To:        Triad National Security, LLC                         Send to:  invoices@lanl.gov
                 Los Alamos National Laboratory
                 Accounting Department, MS P240
                 P.O. Box 1663
                 Los Alamos, NM 87545-1663
      From:
          Name:                                                                      Date:
        Address:                                                             Billing Period:
          Phone:                                                                Agrmt No.:
          Email:                                                               Invoice No.:
      Labor Expended: (Do not include travel time)                                      Hourly Rate:
        LANL Requesting       Specific details of services rendered (i.e., nature and scope)         Hours per 
          Organization          in relation to service required by Consultant Agreement.    Date(s)     day       Subtotals
                                                                                                                        $0.00
      Travel Expenses:   Attach copies of receipts for all travel expenses claimed.
                                 Departure                                   Arrival 
           Travel Details:       City, State      Date of Departure        City, State        Date of Arrival
                    Airfare:       Airline          Date              From - To                Ticket Price
    Form 6371.00.0001 (Rev. 1.1, 8/1/19)                                                                             Page 1 of 2
                          Consultant's Invoice and Travel Expense Worksheet
                                                                                                                                   $0.00
                 Rental Car:                                                                          # of    $ Rate per 
                                    Company               City & State            Size of Car        Days         Day
                                                                                                                                   $0.00
           Gasoline or Local     Date     $ Amount
             Transportation:
                                                                                                                                   $0.00
                     Parking:                                                                                                      $0.00
                Private Auto:# of Miles $ per mile
                                                                                                                                   $0.00
                    Lodging:                                                No. of      Max lodging rate 
                                  Name of Hotel           City & State      Nights      (excluding taxes)     Taxes
                                                                                                                                   $0.00
                                                                                                                                   $0.00
                                                                                                                                   $0.00
                                                                                                                                   $0.00
                              Meals and                                    Daily M&IE rate for work location:
                   Incidental Expenses             Day of Departure and Return @ 75% of daily M&IE rate:           $0.00           $0.00
                                 (M&IE):                   Number of Days at 100% of allowable M&IE rate:                          $0.00
                       Other:Provide details of any other expenses claimed below.                             $ Amount
                                                                                                                                   $0.00
                                                                                     TOTAL AMOUNT OF INVOICE:                      $0.00
       CONSULTANT'S CERTIFICATION: The undersigned certifies that the information set forth herein is true 
       and correct and may be used as a basis for payment by Triad for services performed and/or 
       reimbursement of travel costs requested.
     Form 6371.00.0001 (Rev. 1.1, 8/1/19)                                                                                       Page 2 of 2