HomeMy WebLinkAboutFire_(Ventilator_Screen_Repair)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
4650.00
5YR PM, 30K Service and Screen Repair of VOCSN Transport Ventilator
100.00
This ventilator was sent into the manufacturer with a broken screen for repair and was found to
need routine service and parts replacements before it can be returned for clinical use.
3B Medical dba React Health, LLC
React Health is the manufacturer.
Emergency approval from Finance Chair and Director (4/29/26)
010-12-1410-1571 Machinery & Equipment Replacement
21,150.00
21150.00
Jason Hernandez 5/1/2026
Docusign Envelope ID: 18E865A8-8BEC-8278-831D-8796D0B6988E
5/18/2026