HomeMy WebLinkAboutOfcr R. Michael - UofI Clinics - Duty related injury - 6/11/20 FINANCE DEPT. STAFF ONLY
n LINE ITEM USED 010-11-1100-1345
U TRAVEL REQUEST Fy 2021 BUDGETED — /S
CITY OF WATERLOO EXPENDED YTD
{�( THIS REQUEST
LEFT AFTER THIS l
REQUEST
DATE - jri &-K02f)
Original-Clerk/Finance Copy- Department
NAME(S) AND POSITION(S): DATE:
Officer Robert Michael 6/11/20
NAME OF CLASS if MEETING: DESTINATION:
Iowa City, Iowa
Duty Related Injury DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE: RETURN DATE: DATES)OF MEETING:
4/28/20 4/28/20 4/28/20
PURPOSE OF TRAVEL/TRAINING:
Office'Micha sl was involved in a duty related incident on August 27,2019.At that time Officer Michael sustained along tend injury that requires treatment at the University of Iowa Clinics. This is for mileage/fuel and parking 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
92.00 MILEAGE/FUEL MISC/TOLLS YES NO
TOTAL FOR ALL: $ 92.00 TOTAL: $ 92.00 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
Capt. Dave Mohlis � — — ;
DEPARTMENT HEAD MAYOR
6/11/20
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: 4/28/2020 To: 4/28/2020
Conference/Meeting Name:
Purpose Duty related injury- medical appointment
City Council Approval Date:
N/A(less than$100)
Paid Date of Travel Mileage/Gas Lodging" Meals Other Expenses Total City Card
Miles x 0.575
4/28/2020 160 $92.00 $ 92.00
Total 160 $ 92.00 $
$ 92.00
"All requests must be accompanied by travel request form.
"Receipt required
Total Paid to: Robert Michael $ $ 92.00
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.
Signature of Employee
—L,,,6 c"Z,
Departm nt Head or Designee
41, - / 7 ^ ZU
Date
YOUR TRIP TO:
University Of Iowa Hospital
7 HR 20 MIN 1 80.0 MI
Est. fuel cost: $4.56
Trip time based on traffic conditions as of 12:27 PM on June 16, Print a full health report of your car with HUM
2026.Current Traffic:Light vehicle diagnostics(800)906-2501
( } 1. Start out going southeast on Mulberry St toward E 6th St.
Then 0.04 miles 0.04 total miles
2. Take the 1st left onto E 6th St.
If you reach E 7th St you've gone a little too far.
Then 0.07 miles 0.11 total miles
r+ 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
TI_ 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.
TAT
If you reach Indian Creek Rd you've gone about 0.3 miles too far.
Then 1.01 miles 8.59 total miles
TAT
7. Merge onto IA-27 S toward Cedar Rapids.
Then 68.27 miles
76.86 total miles
EXIT 8. Take the Melrose Ave exit, EXIT 93, toward County Hwy-F46/University His.
.71
Then 0.32 miles
77.18 total miles
9. Turn left onto Melrose Ave.
Then 2.63 miles
79.81 total miles
` 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 79.98 total miles
( } 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.
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