HomeMy WebLinkAboutOfcr R. Michael - UofI Clinics - Duty related injury - 6/11/20 (2) FINANCE DEPT. STAFF ONLY
n LINE ITEM USED 010-11-1100-1345
v TRAVEL REQUEST FY zozo BUDGETED
CITY OF WATERLOO EXPENDED YTD
THIS REQUEST
'A LEFT AFTER THIS
REQUEST
DATE
Original-Clerk/Finance Copy-Department
NAME(S) AND POSITION(S): DATE:
Officer Robert Michael 6/11/20
NAME OF CLASS/MEETING: DESTINATION:
Iowa City, Iowa
Duty Related Injury DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE: RETURN DATE: DATE(S) OF MEETING:
4/28/20 4/28/20 4/28/20
PURPOSE OF TRAVEL/TRAINING:
Officer Micheal was Involved in a duty related Incident on August 27,2019.At that time Officer Michael sustained a long tens injury that requires treatment at the University of Iowa Clinlea.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 MohlisQ0----—
DEPARTMENT HEAD ¢ LM
�
MAYOR
6/11/20
DATE
DATE
K:\Shared Goodies\Forms\Travel Request Form January 2010