HomeMy WebLinkAboutOfcr R. Michael - Duty Related Injury - 8/31-10/11/2019 FINANCE DEPT. STAFF ONLY
LINE ITEM USED 010-11-1100-1345
\ TRAVEL REQUEST FY _2020_ BUDGETED /5Jv ��
CITY OF WATERLOO EXPENDED YTD
THIS REQUEST
LEFT AFTER THIS
REQUEST SU7
DATE
Original-Clerk/Finance Co -Department
NAME(S) AND POSITION(S): DATE:
Officers Robert Michael October 11th, 2019 rx.n
NAME OF CLASS I MEETING: DESTINATION: Iowa City, Iowa
Duty Related Injury
DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE: Return Date: DATE(S) OF MEETING:
8/31/19 10/11/19 August 31- October 11th, 2019
PURPOSE OF TRAVEL:
Officer Michael was involved in a serious on duty injury on August 27, 2019. The injury requires trips back and forth to
Iowa City(University of Iowa Clinics) for treatment. This will include mileage/fuel and parking only. T,e eons
WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL: x COST$ N/A
YES NO
METHOD OF TRAVEL:
)O=XXXX CITY VEHICLE PRIVATE VEHICLE
AIRFARE DEPARTING FROM:
ESTIMATE OF COST: BUDGET LINE ITEM:
$0.00 LODGING TAXI X GRANT REIMBURSABLE
$.00 MEALS PARKING YES NO
$0.00 REGISTRATION AIRFARE X REQUIRED CERTIFICATION
$580.23 MILEAGE/FUEL MISCITOLLS YES NO
TOTAL FOR ALL: $ 580.23 TOTAL: $ 580.23 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
�/ QLt ' L L
DEPART T MAYOR
L
DATE DATE
EMPLOYEE EXPENSE RECORD*
AND REIMBURSEMENT FORM
City of Waterloo, Iowa
Name: Robert Michael Title: Police Officer
Destination: Iowa City From: 8131/2019 To: 10/4/2019
Conference/Meeting Name:
City Council Approval Date:
N/A(less than$100)
Date of Travel Gas/Mileage Lodging** Meals Other Expenses Total
Miles x 0.375
8/27/2019 170 $ 62.90 $ - $ $ $ 62.90
8/28/2019 170 62.90 - $ 62.90
8/29/2019 170 62.90 $ 62.90
8/31/2019 170 13.90 Gas 49.00 $ 62.90
9/3/2019 170 62.90 Parking $3.00 $ 65.90
9/11/2019 170 62.90 $ 62.90
9/13/2019 170 62.90 Parking 4.20 $ 67.10
9/14/2019 170 34.84 Parkin 1.80 $ 36.64
- Gas 28.06 $ 28.06
9/18/2019 9 (23.20) Gas 26.53 $ 3.33
9/20/2019 170 62.90 Parking 1.80 $ 64.70
Total 1539 $ 465.84 - 114.39 $ 580.23
*All requests must be accompanied by travel request form.
**Receipt required
Total Paid to: Rob Michael $
Total Charged to: Visa#4 $
(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 travel so indicated.
Si tune of Employee
��nA Q k- Ay_iz:�
Depa ment Head or Designee
l0 -lb - 19
Date
3010 Knoke Pl,Cedar Falls,IA 50613-4734 to University of Iowa... https://www.mapquest.com/directions/lisUl/us/iowa/cedar-falla/50...
YOUR TRIP TO: Gp
University of Iowa Hospitals and Clinics
1 F#R 25 MIN 1 84.8 MI
Est. fuel cost. $5.74
Trip time based on traffic conditions as of 11:08 AM on October 9, Print a full health report of your car with HUM
2619.Current Traffic:Light vehicle diagnostics(800)906-2501
_.._ _. . . -_ ... _ - -------------- . ..... ......... ._. .. .....
1. Start out going east on Knoke PI toward Parrish St.
Then 0.04 miles -..._.___.....- - -..................._..... 0.04 total miles
I
2. Turn right onto Parrish 81.
- Then 0.17 miles ------ --- - - 0.20 total miles
i
i
3. Tum left onto Rainbow Dr.
Then 0.82 miles __. .. .. . -. _.. .- .. .- 1.02 total miles
i
i
4. Turn left onto Greenhill Rd.
i
If you reach Lefsch Rd you've gone a little too far. I
Then•0.11 miles .: . _ ... -._. . . -- -:-... .:- - ------ - .. _ -- .-- - --- -- -_ 1.13 total miles
TAT
S. Merge onto US-218 S.
Then 5.77 miles - ----- ........... .._ _.. -.._.. ... . . ....... .. ...-._ ._.. . ....__ _ .._ _. 6.90 total miles
TAT 6. Merge onto 1-380 S/US-20 EIIA-27 S via EXIT 71 toward Dubuque/Cedar
i Rapids.
Then 6,54 miles -- -- ._.__..... .___ _.__... ..... . -._ -.---_ .. ....... . . ... .. ..... . ........ 13,45 total miles
T�T 7. Merge onto IA-27 S toward Cedar Rapids.
Then 68.27 miles .... ........._-. ....._.... ...-.... ..._.._....._._,.. .._..._ ....._.. - _ .- 81.72 total miles
sXIr B. Take the Melrose Ave exit, EXIT 93,toward County Hwy-F46/University Hts.
Then 0.32 miles _ - ..... ._.. .___ - _ _.-.. .. ---..._ ._.__. _ ._ ..__._._ 82.03 total miles
9. Turn left onto Melrose Ave.
Then 2.63 miles ._ ....:.. ._. _ - ....... _.- _ -.-..-._.. . . .. . .... . .. .. 84.66 total miles
` 10. Turn left onto Hawkins Dr.
I Hawkins Dr Is lust past.Trlangle P1.
If you reach Melrose PI you've gone a little too far.
Then 0.18 miles - - - 84.84 total miles
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