HomeMy WebLinkAboutFire_Ambulance_(Patient_Care_Reporting_Software)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/Ambulance
17354.46
Ambulance patient care reporting software and data management services
0.00
Annual subscription fee for ambulance patient care reporting and data management services
ESO Solutions, Inc.
Annual database/records management subscription in which fire department currently utilizes
010-12-1410 1520
17,490.00
17,022.12
Jason Hernandez
9/21/2026
Docusign Envelope ID: 9AE04D1C-71CB-8FF3-80F2-97C7E76B2C98
10/05/2026
10/05/2026