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HomeMy WebLinkAboutSupplemental Attachments-12/19/2016 Io In O co v 00 .— N- O CO OO CT) f- N CO 00 0) 0) 0 N e- 0) 0) Cr) 0 ti V) 0) LU F co- co- 0 N- 00 I. — 00 I. CS) .— r co M) T CO N i4 CO CT O Q CD O fY V Q > a�.+ y ' . . i--i 0 = 1 a F" F� i x U W W - Q o x • vl as 1.) a ? O c ° � � 0 •E b o ; < _ E r, Ts VE .•I •. N 0 a, O'ti ' O 0 a b oaxx , N yOv LL z N▪ tu � d � A " co 00A ., ,* b v C 0 :p cop ▪ a� c ° ° - V ... ct y C cd cz$ e; a FINANCE DEPT. STAFF ONLY LINE ITEM USED ;?,66,07. 7$36,•/346 TRAVEL REQUEST FY2Di7 BUDGETED 3�v o " CITY OF WATERLOO EXPENDED YTD /6—e/ ./..1 THIS REQUEST /3 0 — LEFT AFTER THIS r-4"REQUEST /?G l DATE ;m ) Original-Clerk/Finance Copy- Department NAME(S) AND POSITION(S): DATE: Wayne Castle December 14, 2016 Associate Engineer NAME OF CLASS/ MEETING: DESTINATION: Ames, IA Society of Land Surveyors Workshop DEPARTURE POINT IF NOT WATERLOO: DEPARTURE DATE: RETURN DATE: DATE(S) OF MEETING: January 13, 2017 January 13, 2017 January 13, 2017 PURPOSE OF TRAVEL/TRAINING: Society of Land Surveyors Workshop—Laws Impacting Surveying in Iowa WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL: X COST $ YES NO METHOD OF TRAVEL: X CITY VEHICLE PRIVATE VEHICLE AIRFARE DEPARTING FROM: ESTIMATE OF COST: BUDGET LINE ITEM: 266-07-7830-1346 LODGING TAXI X GRANT REIMBURSABLE MEALS PARKING YES NO 130.00 REGISTRATION AIRFARE X REQUIRED CERTIFICATION MILEAGE/FUEL MISC/TOLLS YES NO TOTAL FOR ALL: $ 130.00 TOTAL: $ 130.00 PER PERSON I BELIEVE THIS TRIP SERVES A PUBLIC PURPOSE I APPROVE THIS TRAVEL REQUEST AND IS NECESSARY AND BENEFICIAL TO THE CITY OF WATERLOO DEPARTMENT HEAD MAYOR December 14, 2016 / K:\Shared DATE ared Goodies\Forms\Travel Request Form January 2010 .,. _ .11.,.. _,....: „ , ;.,, , ,,,,,T..,,,,,d 1..,.11..j.cr,,,,„..,"c• 7g t'l .11 r. 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PRSRT STD •9., Society of Land Surveyors of Iowa U.S.POSTAGE I%) 100 Court Avenue, Suite 203 PA I D Des Moines, IA 50309 DES MOINES,IA PERMIT NO.4976 AI WAYNE CASTLE CITY OF WATERLOO ENGINEERING DEPT 715 MULBERRY ST WATERLOO IA 50703-5714 . . . ... . .. . ... .. . !:....:;-.I.::'::.;:.':-.•:1_:.F.::::";:.:1:3:::.:i cocr::; i•-•' ;;;:if;1:5;;;;. f5..:di! - .iii .,;!: :..4,.............. z lift, t ,f3 * - Q Ilift. N.) ... . _. •-. = a - z• -. ;,, 3 In SOCiEry gf% (/) e ,-, o_ 3 a .7 'Z. - * = T • s::;"• <, rn c0 .., .7< Ar • 1. 3.. 2,', 2',, g a, - - - ,'''' 71.. .1: , . • p- ••• m- M".. et . CD 7 07 co S 1;3 ....-1 , ...0 to — ,,, ''.--- ' C t.P = = <It - ... = O. - ,... , , zt IIIIIII4 lilt F.:1 Cel . — 2 7.1 ,...m• = a •-• 3' ' " . 1 23. ;1.7 a 15,' ;„ L.., a `2,' III IV ..... C = -. 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CO .. al O N CO 7 p 7 O ,,.�♦ ��.. \ C O — N Q . o6 2JJ ❑ WQUfn2Jcnco0u) ,I- { O E °--g- ,...}.//, Z N — ��1•`' V cd 0) O U J ,--� G -0 cd 0 0 tie N cd > O> -O O m F` il r 2 o ci . _ Ni, p M C L CD t (/ rilio 67 ' p 12" Ft i > �/i 1 to o aa) c ai C ' V E o Etea–' Q � '7 Er a m -i m a °' - Ca� Cna CC �.. cd a� A Q � � � r4 b E o c > a) c ._ c0) — cd N d W E E co r •. 1� � o -0 U ca ca o E �' i o � � i m � O M O 0 co N o o �� m .(, v > cd co co r T M 1(y 0 2 D Q) a) Z �---"N PETER-3 OP ID: COZA AC4R©• DATE(MAA/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: LSB Insurance PHONE FAX 242 Tower Park _INC,No.Ed): (NC,No): Waterloo,IA 50701 E-MAIL Kevin Boyle ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Hartford Fire Insuranc Co 19662 INSURED Peterson Contractors, Inc. INSURER B:Trumbull Insurance Co 27120 _ Reinbeck Motor Inc. INSURER c:Berkshire Hathaway Ins Co 22276 PO Box A/104 Blackhawk St Reinbeck, IA 50669 INSURER D:Zurich American Ins Co 16535 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBRR POUCY EFF POUCY EXP OMITS LTR1 INSR,WVD I POUCY NUMBER (MMIDDIYYYY) IMM/DO/YYYY). GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X I COMMERCIAL GENERAL LIABILITY X 41CSEQU2151 07/01/2016 07/01/2017 PREMISES fEaEocou encs) $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X Blnkt Contractual PERSONAL&ADV INJURY $ 1,000,000 X XCU Coverage GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS•COMP/OP AGG $ 2,000,000 POLICY', X I PRS LOC $ AUTOMOBILE LIABILITY (COMBINED SINGLE LIMIT 2,000,000 A I X ANY AUTO 141UENQU2152 07/01/2016 07/01/2017 BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED 1 BODILY INJURY(Per accident) $ AUTOS AUTOS I X HIRED AUTOS I X AUTOS ED PIPERPACG DAMAGETY $ Is UMBRELLA LIAB 1 XI OCCUR EACH OCCURRENCE $ 4,000,000 C X ' EXCESS LIAB I CLAIMS-MADE 47-XSF-100514.01 07/0112016 07/01/2017 AGGREGATE $ 4,000,000 DED 1 RETENTION$ $ WORKERS COMPENSATION IWC STATU• I '0TH- AND EMPLOYERS'LIABILITY Y/N X :TORY LIMITS' ER B €ANY PROPRIETOR/PARTNER/EXECUTIVE I41 WNQU2150 07/01/2016 07/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000 D Cargo CPP9267064-06 j 07/01/2016 07/01/2017 Cargo 1,000,000 D Rent/Lease Equip CPP9267064-06 ' 07/01/2016 07/01/2017 RenULeas 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space is required) RE: J5915 / F.Y. 2017 Wagner Road Sanitary Sewer Extension and Grading, Contact No. 899. The City of Waterloo, Iowa is named as an additional insured per contract requirements. Notice of cancellation per attached. CERTIFICATE HOLDER CANCELLATION WATER-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Waterloo ACCORDANCE WITH THE POLICY PROVISIONS. 715 Mulberry St. Waterloo, IA 5D7D1 AUTHORIZED REPRESENTATIVE /41 CetwiNak 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/051 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 91 CSE QU2151 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: APPLIES WHERE CG2010 1001 IS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT (If nc entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement,) A. Section II - Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the B. With respect to the insurance afforded to these additional insured(s) at the site of the additional insureds, the following exclusion is covered operations has been completed; added to Paragraph 2., Exclusions of Section I or - Coverage A - Bodily Injury And Property (2) That portion of "your work" out of which Damage Liability the injury or damage arises hes been put 2. Exclusions to its intended use by any person or organization other than another contractor This insurance does not apply to "bodily injury"or''property damage"occurring after, or rnr subcontractor engagedipalin performingartof operations for a principal as a part of the same project Form GH 20 32 01 13 Page 1 of 1 © 2013. The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission ) POLICY NUMBER: 41 CS^ QU2151 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: APPLIES WHERE CG2037 1001 IS REQUIRED BY 'WRITTEN CONTRACT OR AGREEMENT Location And Description of Completed Operations: ALL (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the"products-completed operations hazard". Form GH 20 33 01 13 Page 1 of 1 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: 4 1 CSE W2151 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NONRENEWAL TO DESIGNATED CERTIFICATE HOLDER SCHEDULE Number of Days Notice: Name of Certificate Holder: Part A: 30 BLANKET WHEN REQUIRED BY CONTRACT Part B: 10 Mailing Address: Part C: 30 Part D: 30 This policy is subject to the following additional D. If this policy is nonrenewed by the Company, Conditions when a number of days are shown in the notice of such nonrenewal will be provided to the Schedule for any of the above Parts. certificate holder in the Schedule, al least the A. If this policy is cancelled by the Company, other number of days in advance of the nonrenewal than for nonpayment of premium, notice of such effective date, as shown in Part D. cancellation will be provided to the certificate If notice is mailed, proof of mailing notice to the holder in the Schedule, at least the number of certificate holder's mailing address as shown in days in advance of the cancellation effective date, the Schedule will be sufficient proof of notice, If as shown in Part A. the number of days notice in the Schedule for any B. If this policy is cancelled by the Company for Part is left blank or is shown as zero, no notice will nonpayment of premium, notice of such be provided to the Scheduled certificate holder cancellation will be provided to the certificate under that Part. holder in the Schedule within the number of days Any notification rights provided by this notice of the cancellation effective date, as shown endorsement apply only to active certificate in Part B. holder(s) who were issued a certificate of C, If this policy is cancelled by the insured, notice of insurance applicable to this policy's term. such cancellation will be provided to the certificate holder in the Schedule, within the number of days notice of the cancellation effective date, as shown in Part C. Form IH 03 09 06 11 Page 1 of 1 ©2011, The Hartford PURCHASE OF ONE (1) NEW FORD F350 W/FLATBED Bid Opening: December 15, 2016 Estimate: $43,000.00 NO Bid Security Required Bidder Bid Security Bid Amount Stivers Ford Lincoln n/a $34,381.00 Waukee, IA Bill Colwell n/a $33,500.00 Hudson, IA Don's Truck Sales n/a $37,046.00 Fairbanks, IA PURCHASE OF ONE (1) NEW 1/2 TON PICK UP TRUCK Bid Opening: December 15, 2016 Estimate: $38,000.00 NO Bid Security Required Bidder Bid Security Bid Amount Community Motors Co., Inc. n/a $29,498.89 Cedar Falls, IA Jerry Roling Motors, Inc. n/a $28,389.00 Waverly, IA Rydell Chevrolet n/a $30,661.00 Waterloo, IA My intent is to understand these Goals more clearly. Goal 1 is, " ,upport the creation o; rlcvd, ,;vault sage jobs through a balanced economic development approact: of assisting existing businesses,fostering start-ups,attracting new employers, and cultivating ldequate workforce." This is expanded with "? Rnn nn* new jobs added by 2022 '. This seems to be far more job growth than in the last ten years. How is the goal of 2,500 new livable wage jobs arrived at? Do they reflect the current available work force in and around Waterloo? Or do they represent available workers not currently residing in Waterloo? What types of businesses are being targeted? or, is any type of business acceptable? These livable wages will have an impact on the internal community consumer spending,through the multiplier effect. These living wages projections should be therefore expanded to include what the Waterloo Community multiplier effect rate is and its impact on the community,what is that multiplier rate for Waterloo? Goal 2 draft is, " plement Community Policing Strategy that creates a safe environment in Waterlo " Included with this are the two following sub goals: A. Overall crime rates reduced to a point below the national average by 2022. B. Violent and property crimes are below the state average by 2022. It helps to have the sub goals defined so that what is being done is within 'known'goals. So,to assist this summary,the specific figures of the current 'overall crime rate' in Waterloo and the current national average overall crime rate should be defined and recorded and monthly or quarterly progress(or lack thereof) should be published. It would also be of help to define such figures by type of crime and location within the city and progress should be printed in the local newspaper. This same approach should be used for the Violent and property crimes. This can then become an element in Goal 4. Goal 3 is,"iteduce the City's property tax levies through a responsible balai L of cost reduction in the City operations and increases in taxable property valuations to ensure that Waterloo is a competitive, affnrrinhin rite Success Indicators: Property tax levy rate decreased to$16.50 per$1,000 by July, 2022. City's taxable property valuations increased by$250 million by 2022. Residential property valuations increased by 20%by 2022. How was the property tax levy rate of$16.50 arrived at? Is not the tax levy rate connected (in part) to property valuations? How does a property tax valuation increase of 20%come to be arrived at? Goal 4 is, ":_nhance the image of Water'!r,n -nd the City to residents and businesses inside and outside of the community" A sustained, positive media presence by 2022. How is such a goal defined? Which are the targeted media outlets? How is this supported by the first three goals? Randy Herod; 111 Highland Blvd. Waterloo, IA 50703: 235-9660: rherod@mchsi.com Nancy Higby From: KELLEY FELCHLE Sent: Monday, December 19, 2016 10:51 AM To: Nancy Higby Subject: FW:Tonight's Public Hearing #4 Attachments: mapjpg Hi Nancy, Could you please print the email and attached image and add it to the council folder? Thank you! Kelley Kelley Felchle City Clerk City of Waterloo 715 Mulberry Street Waterloo, Iowa 50703 (319)291-4323 %rlt-o to From: Jerry Grier [mailto:jbgrier@mchsi.com] Sent: Monday, December 19, 2016 10:49 AM To: MICHELLE WESTPHAL; KELLEY FELCHLE; Tom Powers; Bruce Jacobs; TOM LIND; PAT MORRISSEY; STEVE SCHMITT; amosward4(agmail.com Subject: Tonight's Public Hearing #4 My name is Jerry Grier and I live at 23 Lafayette. I intend to speak tonight at the public hearing regarding the proposed apartment building project. I am sending this email because I believe the attached map of what I am concerned with is easier to visualize. As an aside, Ron Welper does not have an email link on the city website where I got your emails, so could someone please forward this to him. As a person who lives in and owns property in what I like to call the parallel zone (the section of Waterloo that was built parallel to the river and not the compass) I whole heartedly support any and all efforts to beautify and improve the heart of the city.This is one of those projects. What I wish to speak against is the location. I personally believe there is a better location for all parties involved and it is only%2 block away from the proposed site and is city property. I say move the location to the other side of the Single Speed Brewery project on Commercial Street. The benefit to the City: 1 1. The proposed location would restrict future possibilities to the city assets of WCA and the Amphitheater. The alternative location would not. 2. The current location could become a hassle as to who is responsible and liable for what with all the activities of public and private uses.The alternative would not. The benefit to the developer: 1. The proposed location would also restrict future possibilities of expansion or repurposing since it would be basically land-locked around city property. 2. My suggested location would put the development more into the "main stream"of activities being surrounded by opportunities and not butted up against the river on half of its radius. It would be basically equidistant to the Sports Complex,the Library, the WCA and equally near Young Arena. 3. It would be on a bus route. 4. The retail part of the plan would be more visual on Commercial and not be secluded on a side street. I love the idea but hate the location! I encourage you to consider what I see as a better alternative. Thank you, Jerry Grier 2 a �_ p = w rs y .. -, s -x "€ r ri .0 ig , 4, ,,y ^ . � '4'� . f ." . ,-''',-,4,11!",.7%-'--," �. T '.,,,..c.., °.. 444-7 ' ,'" Y yt't FY 1 a}i Vim`« .„0";--#0,e, - 4`4 '` ,ccS'.Ilsfc e t s x:' ir- x .r''''''e- t F } k : z* z t+` y € �y i 4 a G 4 , i4y d r:. , - 1p, s �'' !'• . lein -go y Ai ! E ,. '...,,,,,:t.,,,,,,, 41111.-1 1 C km A i ,49 ciV bcc— Ce Or. HJT 4�' *�. -. -. `x" ,.1„....*:,...- y ,* ° d ,,# ! f, r i.e„ r -x e �x i `;=; `� q q �t € ' -�" ta 4 . IgE i _ ` N s ( 'L,?,''' '' - 4. . . ',1., 44'-'-'-' ' ' '' ' ;. le 4* i1471 „At 4t I V.,,.." :'-ii / '''..- ' - ''' - '.4#Z'',.....''', -t '4 $ . '' ' - ,, / -#7-.'-'4'---,..', - h '' . 1.- %,....,, ° ;. r" ` " `` • qlho VI ,� =i. - ,., } XF' S+.aF fin.,a b4 -'. _ ; t ec 'C c li] eo4 60to j Ig0 r - 0 ce � ` := ;: �� CITY OF WATERLOO , IOWA 1�4. ,,,,,r-...A. ....11;1��,� Nutt CITY HALL • 715 MULBERRY STREET 50703 °Ier100 ‘° Today's Date: 12/14/2016 Effective Date: 12/9/2016 Employment Date: 10/17/2005 To: City Council Members Re: Notice of Severance Department Library Job Title/Classification Information Literacy Coordinator This is to report that the employment of Kimberly W. Van Deest, with the City of Waterloo has been severed by reason of: 0 Retired Disability Related 0 No 0 Yes El Resigned 0 Termination 0 Other In accordance with City Policy,it is requested to allow payment which consists of the following: Benefits Total Hours (x)Hourly Rate Total Payout Vacation-Accrued 23.65 $ 27.09 $640.68 Vacation-Current 156 $ 27.09 $4,226.04 Usable Sick Leave** -9 $ 27.09 ($243.81) Frozen Sick Leave Personal Hours 0.2 $ 27.09 $ 5.42 Comp Time Pay 21.82 $ 27.09 $ 591.10 Unscheduled Leave $ - Plus Time 3.5 $ 27.09 $ 94.82 Total Payment $ 5,314.25 Comments: **Current year sick leave was over-used. Approved by 1. . - ,,, Date /y//S-JImo, Human Resources Date 12/14/2016 Routing: Original to Human Resources by Department Human Resources will forward original to City Clerk(Copy in Personnel File) Clerk's Office will forward copy/ of approved form to Department and Human Resources Updated 6/28/11 Council Agenda Date: �!i�6, 1 6 0 Accruals ❑Status 0-9 //,,,,,,\ ��y CITY OF WATERLOO , IOWA /1i;1�•,• r"(ri„ CITY HALL • 715 MULBERRY STREET 50703 ,151011 , %,...100 \° Today's Date: 12/8/2016 Effective Date: 12/7/2016 Employment Date: 8/26/2002 To: City Council Members Re: Notice of Severance Department Finance Job Title/Classification Financial Analyst This is to report that the employment of Joyce Schroeder with the City of Waterloo has been severed by reason of: ❑ Retired Disability Related ❑ No ❑ Yes 0 Resigned ❑ Termination ❑ Other In accordance with City Policy, it is requested to allow payment which consists of the following: Benefits Total Hours (x)Hourly Rate Total Payout Vacation-Accrued 150 $ 32.54 $4,881.00 Vacation-Current 101 $ 32.54 $3,286.54 Usable Sick Leave 32.5 $ 32.54 25% $264.39 Frozen Sick Leave Personal Hours 32 $ 32.54 $ 1,041.28 Comp Time Pay Unscheduled Leave Other Pay $ 9,473.21 Comments: Approved by /7 �4k- '{'-'441/11--"-- �� Pp �'.- � L� Date 0 -/� /� . Human Resourc _�--e- J ) V ` Date 12/9/2016 Routing: Original to Human Resources by Department Human Resources will forward original to City Clerk(Copy in Personnel File) Clerk's Office will forward copy of approved form to Department and Human Resources Updated 6/28/11 Council Agenda Date: /A t/ I 0 Accruals ❑Status 0-9