HomeMy WebLinkAboutOfcr R. Michael - UofI Clinics - Duty related injury - 11/17/2019 FINANCE DEPT. STAFF ONLY
LINE ITEM USED 010-11-1100-134Q 6—
TRAVEL REQUEST FY_2020_ BUDGETED b--t)U
CITY OF WATERLOO EXPENDED YTD (�dG
THIS REQUEST g�
LEFT AFTER THIS
REQUEST
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Original-Clerk/Finance Co -Department
NAME(S) AND POSITION(S): DATE:
Officer Robert Michael November 17,2019
NAME OF CLASS/MEETING: DESTINATION: Iowa City, la.
Duty Related Injury
DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE: Return Date: DATE(S) OF MEETING:
11/17/19 11/17/19 November 17, 2019
PURPOSE OF TRAVEL:
Officer Michael was involved in a duty related injury on August 27, 2019. This injury requires trips back and forth
to Iowa City(University of Iowa Clinics)for treatment. This will include mileage/fuel and parking only.
WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL: x COST$ N/A
YES NO
METHOD OF TRAVEL:
XXXXXXXX CITY VEHICLE PRIVATE VEHICLE
AIRFARE DEPARTING FROM:
ESTIMATE OF COST: BUDGET LINE ITEM:
$0.00 LODGING TAXI X GRANT REIMBURSABLE
$0.00 MEALS iG a% PARKING YES NO
$0.00 t REGISTRATION AIRFARE X REQUIRED CERTIFICATION
$79.-76- L MISC/TOLLS YES NO
TOTAL FOR ALL: $ 7.9-78 RO �� TOTAL: $ 79-M &()s s 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
D AR MENT EAD MAYOR
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