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? Li 2Y /3/. 3/ . <br /> • <br /> • <br /> TRAVLER'S NAME Matt Rodrigues s • <br /> BUSINESS PURPOSE FOR <br /> TRAVEL(REQUIRED) Presenter at the Colorado Sustainability Symposium representing C4S APWA TRAVEL POLICY APPLIES TO THE REIMBURSEMENT <br /> OF ALL EXPENSES REPORTED 014 THIS FORM.PLEASE <br /> CONTACT YOUR STAFF LIAISON IF YOU DID NOT RECEIVE <br /> TRAVEL THE TRAVEL POLICY DOCUMENT WITH THIS FORM. <br /> STAFF LIAISON'S NAME Anne Jackson AUTHORIZATION* 4723 FURTHER.ANY EXPENSES WHICH OO NOT CONFORM TO <br /> IRS ACCOUNTABLE PLAN RULES WILL NOT BE REIMBURSED <br /> BY APWA. PLEASE REMIT YOUR REQUEST FOR <br /> REIMBURSEMENT WITHIN 80 DAYS OF WHEN THE EXPENSE <br /> IS INCURRED. PLEASE ENSURE ALL EXPENSES ARE <br /> MAKE CHECK PAYABLE TO: City of Eugene APPROPRIATELY DOCUMENTED AND SUPPORTED BY AN <br /> ORIGINAL,ITEMIZED RECEIPT,IF OVER$5.00 USD. <br /> MAILING ADDRESS: 1820 Roosevelt Blvd. <br /> Eugene OR <br /> CITY 97402 <br /> STATE/PROVINCE ZIP IP COCE <br /> Account Code Date Mileage Bus/Taxi Room Meals <br /> Phone Tolls/Park Other Comments <br /> (Miles) (Including Tips) (Including Tips) (Misc./lips) <br /> 555-120-125-010 11/02/17 $191.58 Breakfast <br /> through Lunch $228.00 Per Anne agreed to 1/3 airfare for trip <br /> 11/03/17 since I was retuning from Chicago. <br /> Dinner Airfare+bag Total fair 5609/3=5203+$25 baggage check <br /> 0 $0.00 $191.58 $0.00 Total $0.00 $0.00 $228.00 <br /> See other See Breakfast Meals and Lyft rides on second expense <br /> request Other Lunch <br /> Dinner request <br /> 0 $0.00 $0.00 $0.00 Total $0.00 $0.00 $0.00 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> 0 SO.00 $0.00 SO.00 Total 50.00 $0.00 $0.00 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> 01 $0.00 50.00 $0.00 Total $0.00 $0.00 S0.00 <br /> Breakfast <br /> Lunch <br /> Dinner <br /> 0 $0.00 $0.00 $0.00 Total $0.00 $0.00 50.00 <br /> TOTAL MILES 0 <br /> X IRS RATE for 2017 0.535 TOTAL <br /> I EXPENSES <br /> TOTAL $0.00 $0.00 $191.58 $0.00 <br /> 1 $0.00 SO.00 $226.00 g419.58 <br /> REIMBURSABLE AIRFARE <br /> TRAVELER'S SIGNATURE/DATE (PAID DIRECTLY BY TRAVELER) <br /> LESS ADVANCE(APWA staff only) <br /> APPROVAL OF PROGRAM MANAGER OR DIRECTOR/DATE BALANCE DUE TO(FROM)TRAVELER111.11.1.11.1111111- <br /> If the balance is due to APWA please attach your personal check to the expense report a d <br /> DIRECTOR OF FINANCE OR INTERIM EXECUTIVE DIRECTOR'S APPROVAL/DATE record your check!!in this blank <br /> PLEASE SUBMIT YOUR COMPLETED EXPENSE REIMBURSEMENT FORM WITH SUPPORTING DOCUMENTATION TO THE MAIL ADDRESS BELOW WITHIN.•.AYS OF WHEN YOU INCUR <br /> THE EXPENSE. ORIGINAL.ITEMIZED RECEIPTS MUST BE PRESENTED TO APWA FOR ALL EXPENSES OVER$5 USD. IF EMAIL OPTION IS CH• •,PLEASE REMIT A PDF FILE W/A <br /> SCANNED COPY OR PHOTO OF THE ORIGINAL, ITEMIZED RECEIPTS. PHOTOCOPIES OF THE EXPENSE FORM AND/OR RECEIPTS WILL N• PROCESSED FOR REIMBURSEMENT. <br /> MAIUNG INSTRUCTIONS: <br /> AMERICAN PUBLIC WORKS ASSOCIATION <br /> ATTN: Stall Liaison/Program Manager <br /> 1200 MAIN ST.,STE 1400 KANSAS CITY,MO 64105-2100 QUESTIONS S.z. D BE DIRECTED TO THE APWA STAFF LIAISON <br /> /2RJL4 s - d L ,v it-G7 /u <br />