HomeMy WebLinkAboutOut of State Travel Request - RenewGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerii, of the Board by 121-00pm on Thursday)
REQUESTING DEPARTHE NT:Brooke Decubber
REQUEST SUBMITTED By; Gists Pichardo
,,Dell Anderson
CONTACT PERSON ATTENDING ROUNDTABLE,
CONFIDENTIAL INFORMATION: .'.YES
DATE: 01/29/2026
PHONE: (509) 765-9239 ext 5353
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;TYPE S), OF DOCUMENTS
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SUBMITTED:
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(CHECK ALL
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THAT AP "L
DAgreernent Contract
0AP Vouchers
0—Appointrnent Reappointment
OIARPA Related
—.--Bids IRFPs I Quo,*es Award
-Bid Opening Scheduled
Boar s /tts
Commi d ee
r Budget
ui Related
—County Code
.... jErnergency Purchase
'Employoe Rel,
Facilities Related
Financial
EjFunds
DHearing
Purrd
Jinvoices I chase Oers
Grants — Fed!Stat4:�/County
7 Leases
EIMOA.'MOU
DMinutes
rdine
170ancs
'"Out of State Travell
Cash
ElPolicies
Pr orations
—Request for Purchase
e s o I u t i o n
C1 Recommendation
Professional Sere Consultant
Support Letter
Surplus Req.
-7Tax Levies
DThank You's
[]Tax Title Property
OWSLCB
Out of State Travel Request for Brooke Decubber. Traveling to Las Vegas,, NV
ff4@ 17r r
Mill 1-7*2 41111
Estimated cost: 3441.39
If necessary, was this document reviewed by accounting? YES
LEGAL REVIEW:
If this document requires lec all re fec to all for review pri
route q or
If necessary, was this document reviewed by legal? YES 0 NO
DATE OF ACPON: DEFERRED OR CONTINUED TO:
APPROVE:
I.
D2:
D3:
nPNitf:r) A QT A I IN,[
4/23/24
WITHDRAWN,
* N/A
RECEIVED
GRANT COUNTY COMMISSIONERS
Outov%f State Travel Request Applicatior
Traveler's Nr Brooke Dubr Department/Office: REND
Purpose ofTraveltratio
ri.
Larh Empower
Las Vegas, N
Dates of Travel'. r Agri[ 3 , 2 � Total Trip Cost Estimate: 1 31 �.E3
(This line will auto -sum the costs listed below)
Travel Type (Select One)
------------
taut of State Travet
Q Out CCINUS Travel (AK; HI or USTerritory)
[] Foreign Travel
Q Extradition
Fund Number/Department:
Explanation for Rate, Required if hotelcost is greater than per them orgovemment rate
No Government Rates Avaitabte
Rental Car equilr ? It Yes, Rental Car Cost-,
0 Yes
No
Air Carrier:
Alaska Airlines
r r is N rrie T t
Clerra Pichardo/ Accounting Technician
Cost of Flight:
is 324-401
Preapproved by EO>DH?
Q Yes
0 No
Conference Fee.
11699-00
Estimate of M E During Travel:
_ 451,08
Additional Exerg ;
A t#1 costs for extended stays, Might
upgrades, etc, at the expense of the traveler)
f Yes, EO/DH Name:
DellAnderson
0
0
* ren w
Gr-ont Solwwiaml tHeolth 6 UJW.lr*".
O VED
J N 21-av
RENEW
.e Must attach training information including agenda, start and end times and meat informationk
Forms missing any of the required information will be returned for comptetion.
Aftfields must be filled in compLeteLy.
0 In -State Training 0 Out -of -State Training El Webinar
(Must be received 30-days in advance) (Must be received 90-days in advance)
Employee Name:,
Training Name: -
4 q Dates of training.
Departing Date-.,
DepartingTime:
Registration Cost..,# .......
Q
Today,*s Date: 11210�24,0
Locatlow.. iV
Hotet: ),Yes 0 No
Are there any room blocks for this training at a specific hotel?
I----------- - ------ # -------
Transportationk4
Personal Car 0 Company Car
(if requestingto take personal car, direct supervisor signature is required betow)
Airfares Yes No
FLIght / airport preferences?
How will this training add value to the orani atien?
DY16641 MIA-k.4,00 i SAJV 6f i
Estimated Cost:—oj? -7q
Y-, Funding Source: . .. ...................
Training Approved: VNe s ONo
Direct Supervisor Signature.* ----------
L--^ -
Personal Car Approval: S ONo
Direct Supervisor Signature:
Executive Staff Approval: 0 No
Executive Staff Signature:
Date:-
I — 2--F
Date,.,—- ---_,-___
Clete:
L�-
- — - ---------- ------
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