HomeMy WebLinkAboutApproved Documents - 05.02.2022K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
FINANCE DEPT. ONLY
Finance Committee approval required?
YES _____ NO _____
If so, date approved: _______________
City of Waterloo
Line-Item Budget Amendment Request Form
The Finance Committee of the City Council and/or Finance Dept. is hereby requested to authorize the following line-item budget
amendment for FYE 22 submitted by the Department:
EXPENSES/REVENUE
DECREASE EXPENDITURES (INCREASE REVENUE) INCREASE EXPENDITURES (DECREASE REVENUE)
Fund Dept Activity Acct # Acct Name Proj Code Amount Fund Dept Activity Acct # Acct Name Proj Code Amount
525 15 5400 3625 Damage Refund 8,976.30 525 15 5400 1378 Other Equip Repairs 8,976.30
TOTAL $8,976.30 TOTAL $8,976.30
This amendment is being requested because:
Prior Committee Actions (Dates):
(Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date
Date Posted (Finance Dept.)
Completed forms should be routed directly to the Finance Dept.
Sanitation
Insurance reimbursement to pay for damages to garbage truck #152003
K:\users\shared goodies\forms\Waterloo.33063.1.2022-April-_Budget_Amendment_Request_-_Sanitation_-525-15-5400-3625_to_1378-_$8_976.30 (Apr 2003)
Under File, Select "Save As"
From the "Save In" drop down box, locate the directory you wish to save your file in.
You may rename the file in the "File name:" box at the bottom of the screen.
REMEMBER: the form itself is protected so you can only enter information in the yellow high-lighted cells.
At the top of the form, go to the first cell requiring information. This is Cell E11, directly after "FYE"
Once you've completed the fiscal year you can press the "tab" key to go to the next cell requiring information to be entered.
You may continue to press the "tab" key to move between the areas of the form that you must complete.
Or, you can simply use your mouse and click on the individual yellow cells you wish to move to.
The "TOTALS" will automatically be completed for you.
Once all information is entered, save your file and print the form.
Obtain the required signature and date and route the completed form to the Finance Department for their signature/approval.
Completed forms should be routed directly to the Finance Dept.
FINANCE DEPT. ONLY
Finance Committee approval required?
YES NO 5/2/2022
If so, date approved:
City of Waterloo
Line -Item Budget Amendment Request Form
The Finance Committee of the City Council and/or Finance Dept. is hereby requested to authorize the following line -item budget
amendment for FYE 6/30/2022 submitted by the Airport Department:
EXPENSES/REVENUE
DECREASE EXPENDITURES (INCREASE
REVENUE)
INCREASE EXPENDITURES (DECREASE REVENUE)
Fund Dept Activity Acct #
Acct Name
Proj Code
Amount
Fund Dept Activity Acct #
Acct Name
Proj Code
Amount
291 29 7750 3350
Federal Grant
406,000.00
291 29 7750 2169
Airport Improv
366,000.00
291 29 7750 2103
Eng & Consul
40,000.00
TOTAL
$406,000.00
TOTAL $406,000.00
This amendment is being requested because:
additional funds will be needed to pay project expenses through the end of the fiscal year. Fiscal year project revenues are already
over budget by this amount.
Prior
(Dates):
Head or Designee)
w
_^05/13/2022 10:01 AM
Eo EDT
Date (Signature Finance Dept. Review)
Date Posted (Finance Dept.)
Date
K:IusersVshared goodiesWormsW P Projects (Apr 2003)
PROJECT BUDGET WORKSHEET INSTRUCTIONS
The purpose of the project budget form is to set up a budget and project code that can be used to more specifically
account for certain construction or non-construction projects funded with state and federal grants, donations, or any
"restricted" type revenue sources. This form should be completed BEFORE any invoices are processed or payments
are made. It is also needed before any of the revenue is deposited. If you are not sure if a particular project needs
a project code, please contact the Finance Department. We are glad to help!
1.) Page 1 is REQUIRED for all projects. Complete the page 2 (constr proj) tab if you are requesting a budget for
a construction project. Complete page 2 (donat or NON-constr) if you are requesting a budget for any project,
other than one involving construction.
2.) You MUST provide the CFDA # for all federally-funded projects, including those that involve federal funds but
are passed on to the city from the State of Iowa. The grantor is required to provide that number to you.
Sometimes that number is provided in the grant application only, so that is a good place to look for it if you can't
find it in the grant award document.
3.) The revenue and expense account numbers provided on both page 2 tabs are commonly-used examples only.
You may change, add or edit those if there's a number you need that isn't listed. This form isn't meant to list all
possible account numbers, only those that are used the most often.
4.) Separate columns should be completed on the budget worksheet (page 2) if the project involves different
"funds" (e.g. GO bond fund and grant-fund/fund 290). Expenses and revenue for each fund should be separated
into columns and EACH column's revenue and expenses MUST EQUAL! You will get an "error" message
below the expense totals line if they don't. You need to make a correction if you get an error message.
5.) In general, the Finance Department will assign the project codes. However, if you have a request or
suggestion for the code you'd like to use, please discuss that with the Finance Department before submitting
your worksheets.
6. Please remember to forward the related grant award document to the Finance Department, along with the budget.
PROJECT BUDGET WORKSHEET - ALL PROJECTS
PAGE ONE
Project Name
City Contract No.
Project Manager Project No.
Project Budget Total $Subproject No.
1. How will this project be funded?
A. Federal Grant Yes X No CFDA # 20.106 % Paid by federal grant
Grant Name Grant Agreement Number
B. State Grant Yes No % Paid by state grant
Grant Name Grant Agreement Number
C. City Match Source of Funding % Paid by City
D. Other Entities Yes No % Paid by other entity
Name
Done None
2. Attach copies of any grant agreements that will fund the project (REQUIRED)X
Yes No
3. Does the project include the purchase of right of way or other real property? X
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 X
B. Publication, or printing costs X
C. Others, list X
5. Does this project cover any regular full-time salaries or benefits?X
If yes, employee/position to be covered.
6. Include a brief description of the project in the space below: (REQUIRED)
be approved and added to the operations budget. Other operational costs, utilities, janitorial and personnel costs
are planned uses for FY-23 - 25.
Page 2 must be attached and signed.
100.00%
CRRSA Act Airport Grant 3-19-0094-49-2021
CRRSA Act Airport Grant Phase 1
To be assigned by the Finance Dept.
29AIP
0049
Keith Kaspari
300,000.00
Current plans for these funds are to pay operational costs including paint and beads for airfield painting and tar for crack
sealing the airfield, as well as possible smaller uses yet to be identified. Therefore, for FY-22 we are requesting $300,000
This is a four year grant, issued March 19, 2021. Therefore, funds must be obligated or used no later than March 18, 2025.
Airport Sponsor may use these funds for costs related to: operations, personnel, cleaning, sanitization, janitiorial services.
K:\shared goodies\forms\Waterloo.33058.1.Project_Budget_Worksheet_CRRSA_Grant\Page 1 All Projects (Mar 2010)
CONSTRUCTION PROJECT BUDGET WORKSHEET
PAGE TWO
Finance Committee
Approval Date _______________________
Project Name (from page one)
Department No. project will be budgeted under
Activity No. project will be budgeted under Project No.
Subproject No.
(Each column should only include amounts by fund)
Fund: __010____
Fund:
__010____ Fund: ______ Fund: ______
Total
REVENUES:
3000 Cash on Hand -$
3112 Local Option Sales Tax -
3350 Federal Grant 300,000.00 300,000.00
3357 Shared Program - County -
3358 Shared Program - City -
3360 Shared Program - State -
3361 State Grant -
3365 State RISE Grant -
3368 EPA Grant -
3377 EDA Grant -
3720 Donations - Restricted -
3750 Sale of Bonds -
______________________-
______________________-
TOTALS 300,000.00$ -$ -$ -$ 300,000.00$
EXPENDITURES:
2103 Engineering & Consulting -$
2125 Traffic Control Equipment -
2140 Land Acquisition -
2144 Land Improvements -
2146 Demolitions -
2151 Building Construction
2156 Bikeway Construction -
2162 Storm Sewers -
2163 Sanitary Sewers -
2164 Sidewalks -
2165 Streets & Roadways -
2199 Non-participating Misc -
2169 Airport Improvements -
1371 Bldg & Grounds Maint. 300,000.00 300,000.00
TOTALS -$ 300,000.00$ -$ -$ 300,000.00$
- - -
(Signature Dept. Head) Date (Signature Finance Dept. Review) Date
Keith Kaspari 4/8/2022
City Clerk Use Only
To be assigned by the Finance Dept.
29AIP
0049
29
7710/7700
CRRSA Act Airport Grant Phase 1
K:\shared goodies\forms\Waterloo.33058.1.Project_Budget_Worksheet_CRRSA_Grant\Page 2 (Constr Proj) (Mar 2010)
PROJECT BUDGET WORKSHEET- NON-CONSTRUCTION
PAGE TWO
Finance Committee
Approval Date _______________________
Project Name (from page one)
Department No. project will be budgeted under
Activity No. project will be budgeted under Project No.
Subproject No.
(Each column should only include amounts by fund)
Fund: ______ Fund: ______ Fund: ______ Fund: ______
Total
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 -
______________________-
______________________-
______________________-
TOTALS -$ -$ -$ -$ -$
EXPENDITURES:
1111 Salaries - Regular -$
1112 Salaries - Part Time -
1315 Education & Training -
1345 Travel - Official City -
1346 Travel - Prof Training -
1390 Contractual Services -
______________________-
______________________-
______________________-
______________________-
______________________-
______________________-
TOTALS -$ -$ -$ -$ -$
- - - - -
(Signature Dept. Head) Date (Signature Finance Dept. Review) Date
City Clerk Use Only
To be assigned by the Finance Dept.
K:\shared goodies\forms\Waterloo.33058.1.Project_Budget_Worksheet_CRRSA_Grant\Page 2 (Donat or NON-constr) (Mar 2010)
Completed forms should be routed directly to the Finance Dept.
FINANCE KEPT. ONLY
Finance Committee approval required?
YES _ No 5/2/2022
If so, date approved:
City of Waterloo
Line -Item Budget Amendment Request Form
The Finance Committee of the City Council and/or Finance Dept. is hereby requested to authorize the following line -item budget
amendment for FYE 6/30/2022 submitted by the _ Housing Authority Department:
EXPENSES/REVENUE
DECREASE EXPENDITURES (INCREASE REVENUE)
INCREASE EXPENDITURES (DECREASE REVENUE)
Fund Dept Activity Acct #
Acct Name
Proj Code
Amount
Fund Dept Activity Acct #
Acct Name
Proj Code
Amount
283 13 5450 3352
Fed HUD Grant
30,000.00
283 13 5450 1400
Utility Service
30,000.00
TOTAL
$30,000.00
TOTAL
$30,000.00
This amendment is being requested because:
As Ridgeway Towers pays all utilities for its residents, we have had very unusual expenses this year due to overall increases in utility
costs.We also were panted almost double our previous operating subsidy by HUD during this past year.Therefore, we would like to use
most of this additional operating subsidy to pay for the shortfall in utilities.
Prior Committee Actions (Dates):
Head or Designee)
an, we fi,
Date (Signature Finance Dept. Review)
Date Posted (Finance Dept.)
5/2/2022
Date
K:lusem\shared goodieMformslBudget Amend RT Increase Revenue FYE $-30-22.xis (Apr 2003)
PROJECT BUDGET WORKSHEET INSTRUCTIONS
The purpose of the project budget form is to set up a budget and project code that can be used to more specifically
account for certain construction or non-construction projects funded with state and federal grants, donations, or any
"restricted" type revenue sources. This form should be completed BEFORE any invoices are processed or payments
are made. It is also needed before any of the revenue is deposited. If you are not sure if a particular project needs
a project code, please contact the Finance Department. We are glad to help!
1.) Page 1 is REQUIRED for all projects. Complete the page 2 (constr proj) tab if you are requesting a budget for
a construction project. Complete page 2 (donat or NON-constr) if you are requesting a budget for any project,
other than one involving construction.
2.) You MUST provide the CFDA # for all federally-funded projects, including those that involve federal funds but
are passed on to the city from the State of Iowa. The grantor is required to provide that number to you.
Sometimes that number is provided in the grant application only, so that is a good place to look for it if you can't
find it in the grant award document.
3.) The revenue and expense account numbers provided on both page 2 tabs are commonly-used examples only.
You may change, add or edit those if there's a number you need that isn't listed. This form isn't meant to list all
possible account numbers, only those that are used the most often.
4.) Separate columns should be completed on the budget worksheet (page 2) if the project involves different
"funds" (e.g. GO bond fund and grant-fund/fund 290). Expenses and revenue for each fund should be separated
into columns and EACH column's revenue and expenses MUST EQUAL! You will get an "error" message
below the expense totals line if they don't. You need to make a correction if you get an error message.
5.) In general, the Finance Department will assign the project codes. However, if you have a request or
suggestion for the code you'd like to use, please discuss that with the Finance Department before subm itting
your worksheets.
6. Please remember to forward the related grant award document to the Finance Department, along with the budget.
PROJECT BUDGET WORKSHEET - ALL PROJECTS
PAGE ONE
Project Name
City Contract No.
Project Manager Project No.
Project Budget Total $Subproject No.
1. How will this project be funded?
A. Federal Grant Yes No CFDA # % Paid by federal grant
Grant Name Grant Agreement Number
B. State Grant Yes No % Paid by state grant
Grant Name Grant Agreement Number
C. City Match Source of Funding % Paid by City
D. Other Entities Yes X No % Paid by other entity
Name
Done None
2. Attach copies of any grant agreements that will fund the project (REQUIRED)X
Yes No
3. Does the project include the purchase of right of way or other real property? X
If yes, will real property purchases be reimbursable under the grant? X
If yes, have you attached authorization to purchase real property to this document? X
4. Will this project include any non-participating expenses, such as:
A. Stormwater permit fees X
B. Publication, or printing costs X
C. Others, list X
5. Does this project cover any regular full-time salaries or benefits?X
If yes, employee/position to be covered.
6. Include a brief description of the project in the space below: (REQUIRED)
Page 2 must be attached and signed.
100.00%
United States Marshals Service
MOU with United States Marshals Service allowing for the repayment of overtime funds & safety equipment
Memorandum of Understanding- United States Marshals Service- Gang Enforcement & Operations
To be assigned by the Finance Dept.
11PRO
USWO
Chief Fitzgerald
12,475.00
purchased for use during investigations & apprehensions of violent fugitives.
K:\shared goodies\forms\Waterloo.33107.1.Operation_WO_JLEO22-US_Marshals_Project_Budget_Worksheet_4-18-22\Page 1 All Projects (Mar
2010)
PROJECT BUDGET WORKSHEET- NON-CONSTRUCTION
PAGE TWO
Finance Committee
Approval Date _______________________
Project Name (from page one)
Department No. project will be budgeted under
Activity No. project will be budgeted under Project No.
Subproject No.
(Each column should only include amounts by fund)
Fund: 1160 Fund: ______ Fund: ______ Fund: ______
Total
REVENUES:
3000 Cash on Hand -$
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 -
3873 Reimburse for Services 12,475.00 12,475.00
______________________-
______________________-
TOTALS 12,475.00$ -$ -$ -$ 12,475.00$
EXPENDITURES:
1111 Salaries - Regular -$
1112 Salaries - Part Time -
1315 Education & Training -
1345 Travel - Official City -
1346 Travel - Prof Training -
1390 Contractual Services -
1114 Overtime 7,000.00 7,000.00
1573 Safety & Protective Equipment 5,475.00 5,475.00
______________________-
______________________-
______________________-
______________________-
TOTALS 12,475.00$ -$ -$ -$ 12,475.00$
- - - - -
(Signature Dept. Head) Date (Signature Finance Dept. Review) Date
Memorandum of Understanding- United States Marshals Service- Gang Enforcement & Operations
City Clerk Use Only
Capt. Aaron McClelland 4/26/2022
11
010 11 1160
To be assigned by the Finance Dept.
11PRO
USWO
K:\shared goodies\forms\Waterloo.33107.1.Operation_WO_JLEO22-US_Marshals_Project_Budget_Worksheet_4-18-22\Page 2 (Donat or
NON-constr) (Mar 2010)
FINANCE DEPT. ONLY
Finance Committee approval required?
YES _____ NO _____
If so, date approved: _______________
City of Waterloo
Line-Item Budget Amendment Request Form
The Finance Committee of the City Council and/or Finance Dept. is hereby requested to authorize the following line-item budget
amendment for FYE 2022 submitted by the Department:
EXPENSES/REVENUE
DECREASE EXPENDITURES (INCREASE REVENUE) INCREASE EXPENDITURES (DECREASE REVENUE)
Fund Dept Activity Acct # Acct Name Proj Code Amount Fund Dept Activity Acct # Acct Name Proj Code Amount
010 11 1150 3373 Federal Pass Thru11GRT.HOTS21 4,800.00 010 11 1150 1114 Overtime 11GRT.HOTS21 4,800.00
010 11 1160 3373 Federal Pass Thru11GRT.HOTS21 3,200.00 010 11 1160 1114 Overtime 11GRT.HOTS21 3,200.00
TOTAL $8,000.00 TOTAL $8,000.00
This amendment is being requested because:
Prior Committee Actions (Dates):
(Signature Dept. Head or Designee) Date (Signature Finance Dept. Review) Date
Date Posted (Finance Dept.)
Completed forms should be routed directly to the Finance Dept.
Police Department
Aaron McClelland, Police Capt 4/22/2022
This is to conform with the City's budget line item control policy. See attached paper work- $8,000 in additional funding for Meth HotSpots
CFDA #16.710 Grant #19-CAMP-16 to be used by 6/30/2022.
K:\users\shared goodies\forms\Waterloo.33079.1.Budget_Amendment_Meth_HOTS21_4-22-2022 (Apr 2003)
Under File, Select "Save As"
From the "Save In" drop down box, locate the directory you wish to save your file in.
You may rename the file in the "File name:" box at the bottom of the screen.
REMEMBER: the form itself is protected so you can only enter information in the yellow high-lighted cells.
At the top of the form, go to the first cell requiring information. This is Cell E11, directly after "FYE"
Once you've completed the fiscal year you can press the "tab" key to go to the next cell requiring information to be entered.
You may continue to press the "tab" key to move between the areas of the form that you must complete.
Or, you can simply use your mouse and click on the individual yellow cells you wish to move to.
The "TOTALS" will automatically be completed for you.
Once all information is entered, save your file and print the form.
Obtain the required signature and date and route the completed form to the Finance Department for their signature/approval.
FINANCE DEPT. ONLY
Finance Committee approval required?
YES _____ NO _____
If so, date approved: _______________
The Finance Committee of the City Council and/or Finance Dept. is hereby requested to authorize the following line-item budget
amendment for FYE 2022 submitted by the Department:
DECREASE EXPENDITURES (INCREASE REVENUE)INCREASE EXPENDITURES (DECREASE REVENUE)
Acct Name Proj Code Amount Acct Name Proj Code Amount
Cash On
Hand 12GRT.OUTREACH 700.00
Educational
Services 12GRT.OUTREACH 700.00
TOTAL $700.00 TOTAL $700.00
This amendment is being requested because:
Prior Committee Actions (Dates):
4/11/2022
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Date Posted (Finance Dept.)
Completed forms should be routed directly to the Finance Dept.
City of Waterloo
Line-Item Budget Amendment Request Form
EXPENSES/REVENUE
Fire
Fund Dept Activity Acct #Fund Dept Activity Acct #
Pat Treloar
010-12-1412 3000 010-12-1412 1315
To carryforward the cash balance in the community outreach project to purchase food and promotional items for a city department educational
luncheon and a community open house in observance of National EMS Week, May 15-21, 2022.
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)
K:\shared goodies\forms\Expenditure Pre-Authorization.xls (Mar 2010)
City Clerk Use Only
Finance Committee
Approval Date ________________
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 Department to expend
$plus est. shipping costs of $to pay for or purchase
This purchase or expenditure is being made because:
Vendor selected for this purchase:
Bids or written quotes were taken on this purchase, as follows:
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 Road Use Tax Sewer Sanitation
Bonds Federal/other grants
This expenditure is to be coded to the following budget line-item:
in which the budgeted amount is $
and the current available balance is $
Respectfully submitted,
(Signature Dept. Head or Designee)Date (Signature Finance Dept. Review)Date
Other (specify)
(Project Code)(Fund - Department - Activity - Account Number)