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HomeMy WebLinkAboutOfc R. Michael - UofI Clinics - Duty related injury - 8/24/2020 and 8/26/2020 FINANCE DEPT. STAFF ONLY LINE ITEM USED 010-11-1100-1345 TRAVEL REQUEST FY 21 BUDGETED 2366.91+1000 CITY OF WATERLOO EXPENDED YTD 2366.91 THIS REQUEST 184.00 LEFT AFTER THIS REQUEST 816.00 DATE 944A2Q� 4�5 arJ J Original-Clerk/Finance Copy-Department NAME(S) AND POSITION(S): DATE: Officer Robert Michael 9/14/2020 NAME OF CLASS/MEETING: DESTINATION: Iowa City, Iowa Duty Related Injury DEPARTURE POINT IF NOT WATERLOO: DEPARTURE DATE: RETURN DATE: DATE(S)OF MEETING: 8/24/2020 8/24/2020 August 24th, 2020 &August 26th 2020 PURPOSE OF TRAVEL/TRAINING: Officer Michael was involved in a duty related incident on August 27, 2019. At that time Officer Michael sustained a long term injury that requires treatment at the University of Iowa Clinics. This is for mileage only. WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL: X COST$ YES NO METHOD OF TRAVEL: CITY VEHICLE X PRIVATE VEHICLE AIRFARE DEPARTING FROM: ESTIMATE OF COST: BUDGET LINE ITEM: LODGING TAXI GRANT REIMBURSABLE MEALS PARKING YES NO REGISTRATION AIRFARE REQUIRED CERTIFICATION 184.00 MILEAGEIFUEL MISC/TOLLS YES NO TOTAL FOR ALL: $ 184.00 TOTAL: $ 184.00 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 m DEPAKTMENT HEAD MAYOR 6 - /6/- --') 0 SAL, DATE DATE K\Shared Goodies\Forms\Travel Request Form January 2010 EMPLOYEE EXPENSE RECORD* AND REIMBURSEMENT FORM City of Waterloo, Iowa Name: Robert Michael Title: Police Officer Destination: University of Iowa Hospitals From: 8/24/2020 To: 8/26/2020 Conference/Meeting Name: Purpose Duty related injury- medical appointment City Council Approval Date: N/A(less than$100) Paid by Date of Travel Mileage/Gas Lodging`* Meals Other Expenses Total City Card Miles x 0.575 8/24/2020 160 $ 92.00 $ 92.00 8/26/2020 160 $ 92.00 $ 92.00 Total 160 $ 184.00 $ 184.00 *All requests must be accompanied by travel request form. **Receipt required Total Paid to: Robert Michael $ $ 184.00 Total Charged to: $ (Check, if applicable) I hereby acknowledge that I was accompanied to this meeting/conference by my spouse, but that no additional costs were incurred on spouse's behalf. I believe the above to be a true and correct statement of facts related to the expenses listed above. The purpose of these expenses serves a public purpose as defined in Iowa state law. G1 Signature of Employee Nigk t Departmen�d or Designee ©9 - iy -- Zy Date YOUR TRIP TO: University Of Iowa Hospital 1 HR 20 MIN 1 80.0 MI f�i Est. fuel cost: $4.56 Print a full health report of your car with HUM Trip time based on traffic conditions as of 12:27 PM on June 16, 2020.Current Traffic:Light vehicle diagnostics(800)go6-2501 1. Start out going southeast on Mulberry St toward E 6th St. V- Then 0.04 miles _ _- __ _ _. .- 0.04 total miles 2. Take the 1st left onto E 6th St. I If you reach E 7th St you've gone a little too far. Then 0.07 miles - __....,...- -------- __. --------------- 0.11 total miles 3. Take the 1st right onto Franklin St. If you reach Walnut St you've gone a little too far. Then 1.72 miles _. ---- _..._____ __ -_ _ -.----___ _ __ _ 1.83 total miles ,r 4. Franklin St becomes Dubuque Rd. _ Then 4.62 miles __ - .-_--_---- - _ _ __ 6.44 total miles r+ 5. Turn right onto S 3rd St/County Hwy-V49. Continue to follow County Hwy-V49. If you reach Lafayette Rd you've gone about 0.4 miles too far. Then 1.13 miles _ _ _ _ _ __ 7.58 total miles 6. Merge onto 1-380 S/US-20 E/IA-27 S via the ramp on the left. rT If you reach Indian Creek Rd you've gone about 0.3 miles too far. Then 1.01 miles - __ _ _._. _.-___ . 8.59 total miles 7. Merge onto IA-27 S toward Cedar Rapids. TAT Then 68.27 miles _. __ _ _ 76.86 total miles EXIT 8. Take the Melrose Ave exit, EXIT 93, toward County Hwy-F46/University Hts. Then 0.32 miles - - - - 77.18 total miles 9. Turn left onto Melrose Ave. I Then 2.63 miles 79.81 total miles L 10, Turn left onto Hawkins Dr. ` I Hawkins Dr is just past Triangle Pl. If you reach Melrose Pi you've gone a little too far. Then 0.17 miles _ _ _ _ _.._ 79.96 total miles i. 11. University Of Iowa Hospital, 200 Hawkins Dr, IA, 52242, 200 HAWKINS DR. Your destination is just past S Hospital Dr. If you reach Elliott Rd you've gone about 0.3 miles too far. la Save to My Maps Use of directions and maps is subject to our Terms of Use.We don't guarantee accuracy,route conditions or usability.You assume all risk of use.