HomeMy WebLinkAboutPre-Authorization_Form__(1)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)
Fire
2,860.00
Radon mitigation at WFR Station 5
0.00
Station 5's radon levels have tested high which is a health hazard for the firefighters
living at the station
Bergen Plumbing, Health and Cooling
This is used/refurbished equipment allowing us to purchase at a lower cost.
010-12-1400 1533
60,000.00
27,083.49
Bill Beck 04/23/2025
Docusign Envelope ID: 7D7EBCA0-A6A7-4D22-9B9C-D5F92B0F6811
May 5, 2025
May 5, 2025