HomeMy WebLinkAboutTR_HernandezDocusign Envelope ID: DC93182E-EFC3-468E-9821-2C5F19E6OADB
TRAVEL REQUEST
CITY OF WATERLOO
FINANCE DEPT.
LINE ITEM USED
FY 26 BUDGETED
EXPENDED YTD
THIS REQUEST
LEFT AFTER THIS
REQUEST
DATE
Original - Clerk/Finance
STAFF ONLY
010-12-1410 1346
6,000.00
451.23
889.00
4,659.77
10/3/25
Copy - Department
NAME(S) AND POSITION(S):
Jason Hernandez, Medical Supervisor
DATE: September 24, 2025
NAME OF CLASS / MEETING:
Iowa EMS Association Conference/Trade Show
DESTINATION:
Des Moines, Iowa
DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE:
November 13, 2025
RETURN DATE:
November 15, 2025
DATE(S) OF MEETING:
Nov 13 - 15, 2025
PURPOSE OF TRAVEL/TRAINING:
The IEMSA Conference and Trade Show is the largest EMS event in Iowa and will provide numerous
updates on topics related to ambulance service regulation, clinical and treatment best practice as well
as the opportunity to network with other service directors and product vendors.
WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL:
X COST $
YES NO
METHOD OF TRAVEL:
X CITY VEHICLE
AIRFARE
DEPARTING FROM:
PRIVATE VEHICLE
ESTIMATE OF COST:
375.00
50.00
404.00
LODGING
MEALS
REGISTRATION
MILEAGE/FUEL
60.00
TOTAL FOR ALL: $ 889.00
TAXI
PARKING
AIRFARE
M ISC/TOLLS
BUDGET LINE ITEM: 010-12-1410 1346
X GRANT REIMBURSABLE
YES NO
X REQUIRED CERTIFICATION
YES NO
TOTAL: $ 889.00
PER PERSON
I BELIEVE THIS TRIP SERVES A PUBLIC PURPOSE
AND IS NECESSARY AND BENEFICIAL TO THE
CITY OF WATERLOO
Date Approved by Finance Committee:
Jason Hernandez, Medical Supervisor 10/6/2025
DEPARTMENT HEAD
September 24, 2025
DATE
K: \Shared Goodies\Forms\Travel Request Form
DATE
Signed by:
73-frapar Woo el
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