HomeMy WebLinkAboutOfcr R. Michael - UofI Clinics - Duty related Injury - 2/19 3/12, 2020 FINANCE DEPT. STAFF ONLY
f LINE ITEM USED 010-11-1100-1345
TRAVEL REQUEST FY _2020_ BUDGETED cf6
CITY OF WATERLOO EXPENDED YTD /—�a5'
(( THIS REQUEST
LEFT AFTER THIS
REQUEST ( J
DATE o
Original-Clerk/Finance Co -Departnient
NAME(S) AND POSITION(S): DATE:
Officer Robert Michael April 23, 2020
NAME OF CLASS I MEETING: DESTINATION: Iowa City, la.
Duty Related Injury
DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE: Return Date: DATE(S) OF MEETING:
February 19, 2020 March 10, 2020 February 19-March 12, 2020
PURPOSE OF TRAVEL:
Officer Michael was involved in a duty related incident on August 27, 2019. At that time he sustained a long term injury
that requires trips to and from the University of Iowa Clinics in Iowa City. This is for mileage, fuel, and parking for those
visits.
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:
$0.00 LODGING TAXI X GRANT REIMBURSABLE
$0.00 MEALS PARKING YES NO
$0.00 REGISTRATION AIRFARE X REQUIRED CERTIFICATION
$293.25 MILEAGEIFUEL MIISC/TOLLS YES NO
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01
TOTAL FOR ALL: $ 293.25 f-6-1 3114 TOTAL: $ 293.25 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
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DATE DATE