HomeMy WebLinkAboutTR_Hernandez_Ward Docusign Envelope ID:C6B12465-6266-4883-8847-8598ADF50C4D FINANCE DEPT. STAFF ONLY
LINE ITEM USED 010-12-1410 1346
TRAVEL REQUEST FY 26 BUDGETED $6,000.00
CITY OF WATERLOO EXPENDED YTD $0.00
THIS REQUEST $1,011.36
LEFT AFTER THIS
REQUEST $4,988.64
DATE 07.14.25
Original-Clerk/Finance Copy-Department
NAME(S) AND POSITION(S): DATE:
07/08/2025
Dawn Ward, EMS Administrative Assistant
Jason Hernandez, Medical Supervisor
NAME OF CLASS/ MEETING: DESTINATION: Hilton Garden Inn, West Des Moines, Iowa
IEMSA Regional EMS Billing and Documentation DEPARTURE POINT
Conference IF NOT WATERLOO:
DEPARTURE DATE: RETURN DATE: DATE(S) OF MEETING:
08/12/2025 08/13/2025 8/12/2025-08/13/2025
PURPOSE OF TRAVEL/TRAINING:
Attend regional EMS conference to keep updated on billing and documentation standards for
compliance in EMS operations for reimbursement.
WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL: X COST $
YES NO
METHOD OF TRAVEL:
X CITY VEHICLE PRIVATE VEHICLE
AIRFARE DEPARTING FROM:
ESTIMATE OF COST: BUDGET LINE ITEM: 010-12-14101346
311.36 LODGING TAXI X GRANT REIMBURSABLE
150.00 MEALS PARKING YES NO
550.00 REGISTRATION AIRFARE X REQUIRED CERTIFICATION
MILEAGE/FUEL MISC/TOLLS YES NO
TOTAL FOR ALL: $ 1,011.36 TOTAL: $ 505.68 PER PERSON
I BELIEVE THIS TRIP SERVES A PUBLIC PURPOSE Date Approved by Finance Committee:
AND IS NECESSARY AND BENEFICIAL TO THE
CITY OF WATERLOO
Jason Hernandez 7/21/2025
DEPARTMENT HEAD DATE
Signed by:
07/08/2025
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DATE
K:AShared Goodies\Forms\Travel Request Form