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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
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purchase or expenditure submitted by theDepartment to expend
9-198/11
$plus est. shipping costs of$to pay for or purchase
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This purchase or expenditure is being made because:
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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:
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Prior Committee Actions (Dates):
Please check the following box(es) as appropriate to describe the funding for this expense:
General FundRoad Use TaxSewerSanitation
Bonds Federal/other grants Other (specify)
This expenditure is to be coded to the following budget line-item:
434.33.9911.3263
(Fund - Department - Activity - Account Number)(Project Code)
9-198/11
in which the budgeted amount is$
9-198/11
and the current available balance is$
Respectfully submitted,
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(Signature Dept. Head or Designee)Date(Signature Finance Dept. Review)Date
K:\\shared goodies\\forms\\Expenditure Pre-Authorization.xls (Mar 2010)