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ACCOUNT NUMBER <br /> (XXX-XXX-XXX-XXX) 555-120-125-010 <br /> �� <br /> TRAVLER'S NAME Matt Rodrigues <br /> BUSINESS PURPOSE FOR APWA TRAVEL POLICY APPLIES TO THE REIMBURSEMENT <br /> TRAVEL(REQUIRED) C4S Winter Meeting in LA OF ALL EXPENSES REPORTED ON THIS FORM.PLEASE <br /> CONTACT YOUR STAFF LIAISON IF YOU DID NOT RECEIVE <br /> THE TRAVEL POLICY DOCUMENT WITH THIS FORM. <br /> TRAVEL <br /> STAFF LIAISON'S NAME Anne Jackson AUTHORIZATION# 3476 FURTHER,ANY EXPENSES WHICH DO NOT CONFORM TO IRS <br /> ACCOUNTABLE PLAN RULES WILL NOT BE REIMBURSED BY <br /> APWA. PLEASE REMIT YOUR REQUEST FOR <br /> REIMBURSEMENT WITHIN 60 DAYS OF WHEN THE EXPENSE <br /> IS INCURRED. PLEASE ENSURE ALL EXPENSES ARE <br /> APPROPRIATELY DOCUMENTED AND SUPPORTED BY AN <br /> MAKE CHECK PAYABLE TO: City of Eugene ORIGINAL,ITEMIZED RECEIPT,IF OVER$5.00 USD. <br /> MAILING ADDRESS: 1820 Roosevelt Blvd. <br /> -12/0111'"-.47 <br /> Y/ ,�� ,//[ 97402 <br /> CITY Oregon <br /> 0n ROVINCE ZIP CODE <br /> I Account Code Date ., Mileage Bus/Taxi Room Meals Phone Tolls/Park Other Comments <br /> (Miles) (Including Tips) (Including Tips) (Misc./Tips) <br />• 12/1 6 Breakfast <br /> 555-120-125-010 Lunch $254.20 Airfare for C4S Winter Meeting <br /> Dinner <br /> O $0.00 $0.00 $0.00 Total $0.00 $0.00 $254.20 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> O $0.00 $0.00 50.00 Total $0.00 $0.00 $0.00 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> O $0.00, $0.00 $0.00 Total $0.00 $0.00 $0.00 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> O $0.00 $0.00 $0.00 Total $0.00, $0.00 $0.00 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> O $0.00 $0.00 $0.0Q Total $0.00 $0.00 $0.00 <br /> TOTAL MILES TOTAL <br /> X IRS RATE for 2016 0.540 EXPENSES <br /> TOTAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $254.20 $254.20 <br /> REIMBURSABLE AIRFARE <br /> (PAID DIRECTLY BY TRAVELER) <br /> TRAVELERS SIGNATURE/DATE <br /> LESS ADVANCE(APWA staff only) <br /> BALANCE DUE TO(FROM)TRAVELER S 254.20 <br /> APPROVAL OF PROGRAM MANAGER OR DIRECTOR/DATE <br /> If the balance is due to APWA please attach your personal check to the expense report and <br /> record your check#In this blank <br /> DIRECTOR OF FINANCE OR INTERIM EXECUTIVE DIRECTOR'S APPROVAL/DATE <br /> PLEASE SUBMIT YOUR COMPLETED EXPENSE REIMBURSEMENT FORM WITH SUPPORTING DOCUMENTATION TO THE MAIL ADDRESS BELOW WITHIN 60 DAYS OF WHEN YOU <br /> INCUR THE EXPENSE. ORIGINAL RECEIPTS MUST BE PRESENTED TO APWA FOR ALL EXPENSES OVER$5 USD. <br /> MAILING INSTRUCTIONS: <br /> AMERICAN PUBLIC WORKS ASSOCIATION <br /> ATTN:ANNE JACKSON,STAFF LIAISON <br /> 1275 K Street,NW,Suite 750,Washington.DC 20005 QUESTIONS SHOULD BE DIRECTED TO THE APWA STAFF LIAISON <br /> 3 k q 2 y x'2-4-1(o <br />