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HomeMy WebLinkAboutApproved Documents - 3/1/2021City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Bldg Maintenance Department to expend $ 5,971.22 plus est. shipping costs of $ to pay for or purchase This purchase or expenditure is being made because: Replacement of VFD (variable frequency drive) for Air Handler #3 (mechanical room) at the 5 Sullivan Brothers Convention Center. Vendor selected for this purchase: K & W Electric Inc. �■ Bids or written quotes were taken on this purchase, as follows: K & W Electric - $ 5,971.22 Black Hawk Electrical - $ 17,270 IT Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: ▪ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 420-22-6860-2152 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is and the current available balance is Respectfully submitted, $ 1,730,000.00 $ 203,973.98 Greg Ahlhelm 2/15/2021 Michelle Weider 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Convention Center $ 34,525.65 plus est. shipping costs of $ Incl Major Cooking Appliances for new Lobby Grill Kitchen AND Department to expend to pay for or purchase Work Tables and Bar workstation for new Lobby Grill This purchase or expenditure is being made because: Renovation is greatly expanding kitchen and need to properly equip kitchen for expected demand and capacity needs. This is a Reauthorization due to slightly higher actual shipping costs Vendor selected for this purchase: Martin Brothers n Bids or written quotes were taken on this purchase, as follows: Martin Brothers $34,535.65 US Foods $35,724.62 Wilson Restaurant: $39,375.00 IT Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): 11/16/2020 for $30,163.57 and $4,290.49= $$34,454.06 Please check the following box(es) as appropriate to describe the funding for this expense: ▪ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 420-22-6860 2110 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is and the current available balance is Respectfully submitted, Brendon Wagner, GM $ 165,000.00 $ 146,813.13 2/18/21 M/c/e//e 1Neta er 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Leisure Services Department to expend $ 7,495.00 plus est. shipping costs of $ 0 to pay for or purchase Purchase of 12 x 11 commercial insulated rolling steel overhead door for Young Arena. This purchase or expenditure is being made because: current door is 26 years old and has failed beyond repair and needs replaced. Supports the City's Strategic Plan, 4.5-"Maintain City facilities that support quality of place". Vendor selected for this purchase: Christie Door Company, Cedar Falls Iowa �■ Bids or written quotes were taken on this purchase, as follows: Christie Door Company $7,495.00 Overhead Door Company $7,679.00 n Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: ▪ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 420-37-4500-2152 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is and the current available balance is Respectfully submitted, $ 40,289.00 $ 7,495.00 Paul Huting 2/17/2021 M/c/e/le VVedter 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the MIS Department to expend $ 3,170.74 plus est. shipping costs of $ to pay for or purchase Backup and Recovery storage licensing This purchase or expenditure is being made because: This is licensing for our storage array which holds backups of our network servers. Vendor selected for this purchase: n Bids or written quotes were taken on this purchase, as follows: n Bids or quotes were not taken on this purchase because: Dell/EMC is the vendor that we purchased this through originally so licensing is through them (Dell) Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: ❑ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 420-01-8225-2106 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is $ 260,000.00 and the current available balance is $ 165,837.47 Respectfully submitted, Chris Youngblut 2/17/2021 !Michelle IIVela er 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Planning Department to expend $ 3,000.00 plus est. shipping costs of $ 0.00 to pay for or purchase Asbestos Survey Services for 742 Grant Ave, 325 W. 13th Street 321 W. 6th Street and 1027 Sycamore Street. This purchase or expenditure is being made because: In preparation of demolition Vendor selected for this purchase: Hawkeye Environmental n Bids or written quotes were taken on this purchase, as follows: New Horizons LLC - $12,340 Terracon - $5,980 B2 Environmental - $3,780 and Hawkeye Environmental - $3,000 n Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: ❑ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 419 08 5150 1396 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is and the current available balance is Respectfully submitted, Noel Anderson $ 350,000.00 $ 338,710.00 Michelle lil/eta er 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Police Department to expend $ 4,000.00 plus est. shipping costs of $ 00 to pay for or purchase I-CrimeFighter software for the police department records management. This purchase or expenditure is being made because: This is a new annual software and support agreement used by the Police department for records management Vendor selected for this purchase: At Scene LLC. n Bids or written quotes were taken on this purchase, as follows: IT Bids or quotes were not taken on this purchase because: This software, I-CrimeFighter is proprietary to At Scene LLC Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: General Fund IT Road Use Tax IT Sewer n Sanitation ElBonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 010-1100-1105-1520 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is $ 110,355.00 and the current available balance is $ 77,010.10 Respectfully submitted, Dave Mohlis, Police Captain 2/16/2021 N//che//e /1/eza er 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) PUBLIC WORKS SANITATION DEPARTMENT REFUND REQUEST GARBAGE/YARD WASTE j"-Os M Name: Date: 2'1 f r c9'1 Address: 13 (a anilie,iAnd, City/State/Zip: Vkt,-i- foo , 5-1/1 0 I Phone: Service Address: (31 D. alCiletAhrla **Documentation Included: te7Yes No Refund Amount Requested: $ /4-O . to-0 ** All request for refunds required proof of payment before refunds are processed. Comments: Previ o1k - e 4&.lat b\JA- � rern.ove- \i/dwlreti attirr toil I �"OSIe. Ned c.1 f a1 4 to [ . (41 Signature/Sanitation Department Date Confirmed Refund Amount: $ ! i 1 ' (4 ° Confirmed w/Water Works: -Yes No Michelle Weidner 3/1/2021 Finance Signature Date Refund Amount Paid: $ 149.60 �131uz.,1 ve(5\N et. cric,Ny.a cbc. cKycx (:\ us,fr ko b qv.) leb\Ls2 *1)--cArSig aS Vetok iLOn City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Street Department to expend $ 14,886.00 plus est. shipping costs of $ to pay for or purchase 1 - HiWay E2020 10 ft. SS V-Box with Dual Auger This purchase or expenditure is being made because: This is a demo unit to be added to a snow truck. Vendor selected for this purchase: TriState Truck Equipment n Bids or written quotes were taken on this purchase, as follows: TriState Truck Equipment Dubuque, IL $14,886.00 n Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: ❑ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 420-19-7100-2117 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is $ 195,000.00 and the current available balance is Respectfully submitted, $ 184,484.70 Sandie Greco 2/18/2020 Michelle 1Nezdyzer 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) • City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Street Department to expend $ 18,576.00 plus est. shipping costs of $ to pay for or purchase 2 - 11 ft. Reversible Snow Plows with Parking Jack installed on plow This purchase or expenditure is being made because: To replace worn out plows. (Only vendor locally to replace with identical plows) Vendor selected for this purchase: Henderson Products, Inc. n Bids or written quotes were taken on this purchase, as follows: Henderson Products, Inc. (thru Sourcewell) Manchester, IA $18,576.00 n Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: IT Road Use Tax IT n Sanitation ❑ Federal/other grants ❑ General Fund Bonds This expenditure is to be coded to the following 419-19-7100-2117 & 420-19-7100-2117 Sewer Other (specify) budget line -item: (Fund - Department - Activity - Account Number) in which the budgeted amount is and the current available balance is Respectfully submitted, Sandie Greco 2/18/2020 (Project Code) $ 570,000.00 195,000.00 $ 8,060.70 195,000.00 Michelle IA/ ediier (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) 3/1/2021 Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) City Clerk Use Only Finance Committee Approval Date 3/1/2021 City of Waterloo Expenditure Pre -Authorization Request Form The Finance Committee of the City Council is hereby requested to authorize the following purchase or expenditure submitted by the Traffic Operations Department to expend $ 3,250.00 plus est. shipping costs of $ to pay for or purchase 1 - "Prepare To Stop" Overhead 48" X 24" LED Blank Out Sign This purchase or expenditure is being made because: To replace malfunctioning overhead sign eastbound on University Ave. on the curve before Ansborough Ave. intersection (replacing with same model) Vendor selected for this purchase: Traffic Control Corporation n Bids or written quotes were taken on this purchase, as follows: Traffic Control Corporation Ankeny, IA $3,250.00 n Bids or quotes were not taken on this purchase because: Prior Committee Actions (Dates): Please check the following box(es) as appropriate to describe the funding for this expense: ❑ General Fund IT Road Use Tax IT Sewer n Sanitation . Bonds ❑ Federal/other grants ❑ Other (specify) This expenditure is to be coded to the following budget line -item: 419-17-7120-2125 (Fund - Department - Activity - Account Number) (Project Code) in which the budgeted amount is and the current available balance is Respectfully submitted, Sandie Greco $ 21,511.20 $ 8,774.05 2/17/2021 Michelle 1Ne/dner 3/1/2021 (Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010) PROJECT BUDGET WORKSHEET - ALL PROJECTS PAGE ONE Project Name City Contract No. Project Manager Project Budget Total FY20 Bureau of Justice Assistance (JAG) 2020-DJ-BX-0325 Captain Dave Mohlis $ 44,769.00 1. How will this project be funded? To be assigned by the Finance Dept. Project No. 11 GRT Subproject No. JAG20 A. Federal Grant Yes x No CFDA # 16.738 % Paid by federal grant 100.00% Grant Name FY20 Bureau of Justice Assistance (JAG) Grant Agreement Number 2020-DJ-BX-0325 B. State Grant Yes 1 1 No 1 % Paid by state grant Grant Name Grant Agreement Number C. City Match Source of Funding % Paid by City D. Other Entities Yes No x % Paid by other entity Name 2. Attach copies of any grant agreements that will fund the project (REQUIRED) 3. Does the project include the purchase of right of way or other real property? If yes, will real property purchases be reimbursable under the grant? If yes, have you attached authorization to purchase real property to this document? 4. Will this project include any non -participating expenses, such as: A. Stormwater permit fees B. Publication, or printing costs C. Others, list 5. Does this project cover any regular full-time salaries or benefits? If yes, employee/position to be covered. Done None ❑X ❑ Yes No ❑ ❑X ❑ 0 ❑ ❑X ❑ ❑X ❑ ❑X ❑ 0 ❑X ❑ 6. Include a brief description of the project in the space below: (REQUIRED) Funds allocated by the 2020 Justice Assistance Grant will be used in a joint effort by the City of Waterloo, City of Cedar Falls and Black Hawk County for law enforcement personnel costs for officers assigned to the Tri-County Drug Enforcement Task Force which is a multi -jurisdictional task force responsible for investigation of drug related crime. The funds will be used to supplement salary/benefits & overtime not funded through the Byrne Justice Assistance Grant. Page 2 must be attached and signed. K:\shared goodies\forms\JAG_20_FY20_Project_Budget_Worksheet.xls\Page 1 All Projects (Mar 2010) PROJECT BUDGET WORKSHEET- NON -CONSTRUCTION PAGE TWO City Clerk Use Only Finance Committee Approval Date 3/1/2021 Project Name (from page one) FY20 Bureau of Justice Assistance (JAG) 2020-DJ-BX-0325 Department No. project will be budgeted under 11 Activity No. project will be budgeted under 010 11 1150 REVENUES: 3000 Cash on Hand 3350 Federal Grant 3352 Federal HUD Grant 3354 Shared Program - Local 3357 Shared Program - County 3358 Shared Program - City 3360 Shared Program - State 3361 State Grant 3720 Donations - Restricted 3750 Sale of Bonds EXPENDITURES: 010 11 1160 To be assigned by the Finance Dept. Project No. 11GRT Subproject No. JAG20 (Each column should only include amounts by fund) Fund: 1150 26,861.40 Fund: 1160 Fund: Fund: Total 17,907.60 44,769.00 TOTALS $ 26,861.40 $ 17,907.60 $ $ $ 44,769.00 1111 Salaries - Regular 1112 Salaries - Part Time 1315 Education & Training 1345 Travel - Official City 1346 Travel - Prof Training 1390 Contractual Services 1302 Outside Agencies 26,861.40 $ 26,861.40 17,907.60 17,907.60 TOTALS $ 26,861.40 $ 17,907.60 $ $ $ 44,769.00 Michelle 1Neia'yter 3/1/2021 (Signature Dept. Head) Date (Signature Finance Dept. Review) Date K:\shared goodies\forms\JAG_20_FY20_Project_Budget_Worksheet.xls\Page 2 (Donat or NON-constr) (Mar 2010) WATEREaCt WaORKS 325 "ycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES ACCOUNT SUMMARY Phone: (319) 232-6280 www.waterloowater.org PaEe 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 12/02/2016 12/27/2016 Waterloo Water Works Services Water $56.63 Water Service Excise Tax $3.97 Water Works Subtotal $60.60 City of Waterloo Services Sanitary Sewer $55.89 Storm Water Fee $5.13 Garbage $19.60 Yard Waste / Recycle Curbside $5.60 City of Waterloo Subtotal $86.22 CHARGE SUMMARY Credits/Payments Deposit Charged -$105.00 $105.00 Water Works Subtotal $60.60 City of Waterloo Subtotal $86.22 Total Current Service Charges $146.82 Total Amount Due $146.82 Amount Due After 12/27/2016 5152.98 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 10/04/2016 11/28/2016 64 Actual 93 Actual 29 6 4 2 0 2 4 6 SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: W AST p R KS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 146.82 Amount Due After : 152.98 Billing Due Date: 12/27/2016 Amount Enclosed: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 • Please check box if contact information requires updating and indicate the change(s) on reverse side WATERLOO WAT -WORKS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Paee 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE ACCOUNT SUMMARY Billing Frequency: Billing Date: Billing Due Date: Quarterly 03/02/2017 03/23/2017 Waterloo Water Works Services Water $240.17 Water Service Excise Tax $16.82 Late Penalty $6.16 Water Works Subtotal $263.15 City of Waterloo Services Sanitary Sewer $339.45 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $388.20 1 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward $146.82 -$152.98 -$6.16 Water Works Subtotal $263.15 City of Waterloo Subtotal $388.20 Total Current Service Charges $651.35 Total Amount Due $645.19 Amount Due After 03/23/2017 $676.61 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 11/28/2016 02/22/2017 93 Actual 231 Actual 138 SPECIAL MESSAGES ■ Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO W TE l O RKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Joste Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 645.19 Amount Due After : 676.61 Billing Due Date: 03/23/2017 Amount Enclosed: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO. IOWA 50704 Please check box if contact information requires updating and indicate the change(s) on reverse side WAIERTERWORKSlia2sagkV S 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Paee 1 of 1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 06/02/2017 06/23/2017 Waterloo Water Works Services Water $26.95 Water Service Excise Tax $1.89 Service Charge $28.00 Water Works Subtotal $56.84 City of Waterloo Services Sanitary Sewer $45.05 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $93.80 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward $645.19 -$673.19 -$28.00 Water Works Subtotal $56.84 City of Waterloo Subtotal $93.80 Total Current Service Charges $150.64 Total Amount Due $122.64 Amount Due After 06/23/2017 $128.68 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 02/22/2017 05/22/2017 231 Actual 241 Actual 10 • SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information -=-- -:0---tMhCI'CE-ttCbN. ,ECKS PAYABLE TO: WATERLOO WA WO, Rf<5 P.O. Box 27 Waterloo, Iowa 50704 Phone. (319) 232-6280 8113101(41 ' - Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Please check box if contact information requires updating and indicate the change(s) on reverse side Account Number: 113754-539198 Total Amount Due: 122.64 Amount Due After : 128.68 Billing Due Date: 06/23/2017 Amount Enclosed: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO. IOWA 50704 WATERLOO WATER WORKS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Page 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE ACCOUNT SUMMARY Billing Frequency: Quarterly Billing Date: 08/30/2017 Billing Due Date: 09/21/2017 Waterloo Water Works Services Water $26.95 Water Service Excise Tax $1.89 Service Charge $28.00 Late Penalty $6.04 Water Works Subtotal $62.88 City of Waterloo Services Sanitary Sewer $45.05 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9,00 City of Waterloo Subtotal $93.80 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward $122.64 -$156.68 -$34.04 Water Works Subtotal $62.88 City of Waterloo Subtotal $93.80 Total Current Service Charges $156.68 Total Amount Due $122.64 Amount Due After 09/21/2017 $128.68 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 05/22/2017 08/22/2017 241 Actual 251 Actual 10 140 ,120 0100 U_ 80 • 60 co • 40 • 20 0 0 0 N ryONS. ryN�, ryNy. �NC3 ryN93 �^�, ryO�6, �O^�. �A, • 1 SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO WA T .WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone. (319) 232-6280 Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Please check box if contact information requires updating and indicate the change(s) on reverse side Account Number: 113754-539198 Total Amount Due: 122.64 Amount Due After : 128.68 Billing Due Date: 09/21/2017 Amount Enclosed: REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 W, TERLc c w _ r�voRKS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Page 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE ACCOUNT SUMMARY Billing Frequency: Billing Date: Billing Due Date: Quarterly 11/30/2017 12/21/2017 Waterloo Water Works Services Water $25.20 Water Service Excise Tax $1.77 Late Penalty $21.80 Water Works Subtotal $48.77 City of Waterloo Services Sanitary Sewer $42.75 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $91.50 Previous Balance Credits/Payments Balance Forward Water Works Subtotal City of Waterloo Subtotal Total Current Service Charges Total Amount Due $122.64 -$467.36 -$344.72 $48.77 $91.50 $140.27 -$204.45 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 08/22/2017 11/22/2017 251 Auto Estimate 255 Auto Estimate 4 IL SPECIAL MESSAGES LOGAN AVENUE HY-VEE IS NOW ABLE TO TAKE PAYMENTS CURRENT BILLS Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO WA WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone. (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: -204.45 Amount Due After :-204.45 Billing Due Date: 12/21/2017 Amount Enclosed: REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 • Please check box if contact information requires updating and indicate the change(s) on reverse side WA►YERLO WAS WORT<S 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Pane 1 of 1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 03/01/2018 03/22/2018 Waterloo Water Works Services Water $27.70 Water Service Excise Tax $1.94 Water Works Subtotal $29.64 City of Waterloo Services Sanitary Sewer $42.75 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $91.50 CHARG(SUMMARY - Previous Balance Balance Forward - $204.45 - $204.45 Water Works Subtotal $29.64 City of Waterloo Subtotal $91.50 Total Current Service Charges $121.14 Total Amount Due -$83.31 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 11/22/2017 02/22/2018 255 Actual 264 Actual 9 SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: -11 WATERLOO WA R..,WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: -83.31 Amount Due After : -83.31 Billing Due Date: 03/22/2018 Amount Enclosed: EMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 • Please check box if contact information requires updating and indicate the change(s) on reverse side WATERLOO WATER WORT S . 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Page 1 of 1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 06/04/2018 06/25/2018 Waterloo Water Works Services Water Water Service Excise Tax Water Works Subtotal City of Waterloo Services Sanitary Sewer Storm Water Fee Garbage Yard Waste / Recycle Curbside City of Waterloo Subtotal $31.56 $2.21 $33.77 $42.75 $8.25 $31.50 $9.00 $91.50 CHARGE SUMMARY Previous Balance Balance Forward -$83.31 -$83.31 Water Works Subtotal $33.77 City of Waterloo Subtotal $91.50 Total Current Service Charges $125.27 Total Amount Due $41.96 Amount Due After 06/25/2018 $43.95 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 02/22/2018 05/23/2018 264 Actual 275 Actual 11 40 20 00 80 60 40 2011 rte 00 00 SPECIAL MESSAGES ■ Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO WATER WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account rte 00 00 SPECIAL MESSAGES ■ Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO WATER WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 41.96 Amount Due After : 43.95 Billing Due Date: 06/25/2018 Amount Enclosed: REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 Please check box if contact information requires updating and indicate the change(s) on reverse side VVTEI�E� YY� YY0R1<5 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Pate 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 08/30/2018 09/21/2018 Waterloo Water Works Services Water $64.37 Water Service Excise Tax $3,87 Water Works Subtotal $68.24 City of Waterloo Services Sanitary Sewer $42.75 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $91.50 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward Water Works Subtotal City of Waterloo Subtotal Total Current Service Charges Total Amount Due Amount Due After 09/21/2018 $41.96 -$45.00 -$3.04 $68.24 $91.50 $159.74 $156.70 $164,35 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 05/23/2018 08/21/2018 275 Actual 303 Actual 28 140 r.120 V 100 U 80 y 60 R 40 a 20 0 043 q, Prr ale SPECIAL MESSAGES • Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO WA WO RIBS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: 1.11.1 Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 156.70 Amount Due After : 164.35 Billing Due Date: 09/21/2018 Amount Enclosed: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO. IOWA 50704 Please check box if contact information requires updating and indicate the change(s) on reverse side WATERLOO VVA ER WORT<5 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Page 1 of 1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 11/30/2018 12/21/2018 Waterloo Water Works Services Water $74.02 Water Service Excise Tax $4.45 Water Works Subtotal $78.47 City of Waterloo Services Sanitary Sewer $42.75 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $91.50 CHARGE SUMMARY Previous Balance Credits/Payments $156.70 -$156.70 Water Works Subtotal $78.47 City of Waterloo Subtotal $91.50 Total Current Service Charges $169.97 Total Amount Due $169.97 Amount Due After 12/21/2018 $178.25 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 08/21/2018 11/21/2018 303 Actual 336 Actual 33 SPECIAL MESSAGES ■ Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOa A DZ WOR S P.O. Box 27 Waterloo, Iowa 50704 Phone. (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Please check box if contact information requires updating and indicate the change(s) on reverse side Account Number: 113754-539198 Total Amount Due; 169.97 Amount Due After : 178.25 Billing Due Date: 12/21/2018 Amount Enclosed: REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 WATERLOO WORKS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Paee 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE ACCOUNT SUMMARY Billing Frequency: Billing Date: Billing Due Date: Quarterly 03/04/2019 03/25/2019 Waterloo Water Works Services Water Water Service Excise Tax Late Penalty Water Works Subtotal City of Waterloo Services Sanitary Sewer Storm Water Fee Garbage Yard Waste / Recycle Curbside City of Waterloo Subtotal $29.10 $1.87 $8.28 $39.25 $47.40 $8.25 $31.50 $9.00 $96.15 Previous Balance Credits/Payments Balance Forward $169.97 -$178.25 -$8.28 Water Works Subtotal $39.25 City of Waterloo Subtotal $96.15 Total Current Service Charges $135.40 Total Amount Due $127.12 Amount Due After 03/25/2019 $133.49 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 11/21/2018 02/21/2019 336 Actual 346 Actual 10 • SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information WATERLOOWRI<5 P.O. Box 27 Waterloo, Iowa 50704 Phone: (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 127.12 Amount Due After : 133.49 Billing Due Date: 03/25/2019 Amount Enclosed: EMI _ .EMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 Please check box if contact information requires updating and indicate the change(s) on reverse side WATERLOO WATER . WORKS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Page 1of1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Qua rterly 05/31/2019 06/21/2019 Waterloo Water Works Services Water $29.10 Water Service Excise Tax $1.99 Late Penalty $6.37 Water Works Subtotal $37.46 City of Waterloo Services Sanitary Sewer $47.40 Storm Water Fee $8.25 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $96.15 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward Water Works Subtotal City of Waterloo Subtotal Total Current Service Charges Total Amount Due Amount Due After 06/21/2019 $129.15 -$135.52 -$6.37 $37.46 $96.15 $133.61 $127.24 $133.71 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 02/21/2019 05/20/2019 346 Actual 357 Actual 11 140 ,.-.120 0100 C) 80 60 1:1 40 In 20 0 M 1• SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS -PAYABLE TO: WATERLOO \A.,, ORKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 127.24 Amount Due After : 133.71 Billing Due Date: 06/21/2019 Amount Enclosed: • REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO. IOWA 50704 ■ Please check box if contact information requires updating and indicate the change(s) on reverse side WATEaVVOR KS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 Customer Name: Josie Moore Account Number: 113754-539198 Service Address: 1312 ENGLEWOOD AVE STATEMENT OF SERVICES 'ACCOUNT SUMMARY Billing Frequency: Quarterly Billing Date: 08/29/2019 Billing Due Date: 09/20/2019 Phone: (319) 232-6280 www.waterloowater.org Page 1 of 1 Waterloo Water Works Services Water Water Service Excise Tax Service Charge Late Penalty Water Works Subtotal City of Waterloo Services Sanitary Sewer Storm Water Fee Garbage Yard Waste / Recycle Curbside City of Waterloo Subtotal $29.10 $1.75 $28.00 $6.47 $65.32 $47.25 $12.00 $31.50 $9.00 $99.75 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward $131.30 -$165.77 -$34.47 Water Works Subtotal $65.32 City of Waterloo Subtotal $99.75 Total Current Service Charges $165.07 Total Amount Due $130.60 Amount Due After 09/20/2019 $137.05 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 05/20/2019 08/21/2019 357 Actual 365 Actual 8 • Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO wn,ToRi<s P.O. Box 27 Waterloo, Iowa 50704 Phone. (319) 232-6280 R ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 130.60 Amount Due After : 137.05 Billing Due Date: 09/20/2019 Amount Enclosed: REM[TTO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 Please check box if contact information requires updating and indicate the change(s) on reverse side WATERLOO$ T J 'NC RIDS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Paee 1 of 1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Qua rterly 11/27/2019 12/20/2019 Waterloo Water Works Services Water $29.10 Water Service Excise Tax $1.75 Late Penalty $2.63 Water Works Subtotal $33.48 City of Waterloo Services Sanitary Sewer $47.25 Storm Water Fee $12.00 Garbage $31.50 Yard Waste / Recycle Curbside $9.00 City of Waterloo Subtotal $99.75 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward Water Works Subtotal City of Waterloo Subtotal Total Current Service Charges Total Amount Due Amount Due After 12/20/2019 $130.60 -$133.23 -$2.63 $33.48 $99.75 $133.23 $130.60 $137.05 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 08/21/2019 11/21/2019 365 Actual 373 Actual 8 35 30 V 25 U 20 m 15 O 10 O 5 0 • Oti o`' rO^0. 9, 99 �0•&, NI ") SPECIAL MESSAGES Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLOO 1NAT WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Account Number: 113754-539198 Total Amount Due: 130.60 Amount Due After : 137.05 Billing Due Date: 12/20/2019 Amount Enclosed: REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 ■ Please check box if contact information requires updating and indicate the change(s) on reverse side WATERL04 WATFR WORE<S • 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Paee 1 of 1 ACCOUNT SUMMARY Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 02/28/2020 03/20/2020 Waterloo Water Works Services Water $29.68 Water Service Excise Tax $1.79 Water Works Subtotal $31.47 City of Waterloo Services Sanitary Sewer $47.25 Storm Water Fee $12.00 Garbage $35.25 Yard Waste / Recycle Curbside $12.00 Yard Waste / Recycle Site Maintenance Fee $9.50 City of Waterloo Subtotal $116.00 CHARGE SUMMARY Previous Balance Credits/Payments $130.60 -$130.60 Water Works Subtotal $31.47 City of Waterloo Subtotal $116.00 Total Current Service Charges $147.47 Total Amount Due $147.47 Amount Due After 03/20/2020 $154.27 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type. Usage (CCF) 11/21/2019 02/25/2020 373 Actual 378 Actual 5 OD 30 , U 25 U 20 d 15 VI CO SPECIAL MESSAGES Yard Waste/Recycling rate increased $3/mo to $4/mo **Mandatory Yard Waste/Recycling Site Maint Fee $5/ mo prorated effective 1/1/20 on this bill** Questions -call Garbage- Sanitation @291-4455 ■ Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: WATERLtd 1!1/AT� , WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Please check box if contact information requires updating and indicate the change(s) on reverse side Account Number: 113754-539198 Total Amount Due: 147.47 Amount Due After : 154.27 Billing Due Date: 03/20/2020 Amount Enclosed: REMIT TO: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 1/ ATERLO WORKS 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Pate 1 of 1 Customer Name. Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE Billing Frequency: Billing Date: Billing Due Date: Quarterly 05/28/2020 06/18/2020 Waterloo Water Works Services Water $29.68 Water Service Excise Tax $1.79 Late Penalty $6.80 Water Works Subtotal $38.27 City of Waterloo Services Sanitary Sewer $47.25 Storm Water Fee $12.00 Garbage $35.25 Yard Waste / Recycle Curbside $12.00 Yard Waste / Recycle Site Maintenance Fee $15.00 City of Waterloo Subtotal $121,50 1 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward $147.47 -$154.27 -$6.80 Water Works Subtotal $38.27 City of Waterloo Subtotal $121.50 Total Current Service Charges $159.77 Total Amount Due $152.97 Amount Due After 06/18/2020 $159.77 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 02/25/2020 05/21/2020 378 Actual 383 Actual 5 • SPECIAL MESSAGES PLEASE CONTACT CITY SANITATION (319) 291-4455 WITH QUESTIONS IN REGARDS TO THE YARD WASTE/RECYCLE SITE MAINTENANCE FEE Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYABLE TO: ita WATEr Sao e�rAT r WO 1<5 P.O. Box 27 Waterloo, Iowa 50704 Phone: (319) 232-6280 Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Please check box if contact information requires updating and indicate the change(s) on reverse side Account Number: 113754-539198 Total Amount Due: 152.97 Amount Due After : 159.77 Billing Due Date: 06/18/2020 Amount Enclosed: :allil)is"iif;: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704 W�,�rERL wORK 325 Sycamore Street P.O. Box 27 Waterloo, Iowa 50704 STATEMENT OF SERVICES Phone: (319) 232-6280 www.waterloowater.org Page 1 of 1 Customer Name: Account Number: Service Address: Josie Moore 113754-539198 1312 ENGLEWOOD AVE ACCOUNT SUMMARY Billing Frequency: Billing Date: Billing Due Date: Quarterly 08/28/2020 09/21/2020 Waterloo Water Works Services Water Water Service Excise Tax Late Penalty Water Works Subtotal City of Waterloo Services Sanitary Sewer Storm Water Fee Garbage Yard Waste / Recycle Curbside Yard Waste / Recycle Site Maintenance Fee City of Waterloo Subtotal $29.68 $1.79 $7,55 $39.02 $50.25 $12.75 $35.25 $12.00 $15.00 $125.25 CHARGE SUMMARY Previous Balance Credits/Payments Balance Forward $152.97 -$160.52 -$7.55 Water Works Subtotal $39.02 City of Waterloo Subtotal $125.25 Total Current Service Charges $164.27 Total Amount Due $156.72 Amount Due After 09/21/2020 $163.71 Previous Read Date Current Read Date Previous Read Previous Read Type Current Read Current Read Type Usage (CCF) 05/21/2020 08/19/2020 383 Actual 387 Actual 4 • IF YOU HAVE NOT COMPLETED YOUR CENSUS FORM - PLEASE VISIT 2020CENSUS.GOV AS SOON AS POSSIBLE Please detach and return the bottom portion with your payment. See reverse side for additional information MAKE CHECKS PAYLE TO: WATERLOO WATER WORKS P.O. Box 27 Waterloo, Iowa 50704 Phone: (319) 232-6280 ADDRESSEE: Josie Moore 1312 Englewood Ave Waterloo, IA 50701 Please check box if contact information requires updating and indicate the change(s) on reverse side Account Number: 113754-539198 Total Amount Due: 156.72 Amount Due After : 163.71 Billing Due Date: 09/21/2020 Amount Enclosed: WATERLOO WATER WORKS P.O. BOX 27 WATERLOO, IOWA 50704