HomeMy WebLinkAboutOfcr S. Crozier - Duty Related Injury - 1/17/2019 FINANCE DEPT. STAFF ONLY
LINE ITEM USED 010-11-1100-134,6 br
TRAVEL REQUEST FY _2020_ BUDGETED /6-00 "e,
CITY OF WATERLOO EXPENDED YTD 7/f 2
THIS REQUEST [( i
LEFT AFTER THIS
REQUEST
DATE 7jJr✓ /J-�?'/y
Original-Clerk/Finance Co - Department
NAME(S) AND POSITION(S): DATE:
Officer Steve Crozier November 17,2019
NAME OF CLASS/MEETING: DESTINATION: Cedar Rapids, Ia.
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 Crozier was involved in a duty related injury on October 20, 2019. This injury requires trips back and forth
to Cedar Rapids (Physicians of Iowa)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 PARKING YES NO
$0.00 REGISTRATION AIRFARE X REQUIRED CERTIFICATION
$ff-481 MILEAGE/FUEL MISC/TOLLS YES NO
110
TOTAL FOR ALL: $ 192 48-// TOTAL: $ -1-f 48 444 PER PERSON
I BELIEVE THIS TRIP SERVES A PUBLIC PURPOSE I APPROVE THIS TRAVEL REQUEST
AND IS NECESSARY AND BEN EFIC LTO THE
CITY OF WATERLOO
DEPART NT HEAD MAYOR
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DATE DATE