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<br />PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Cardholder: _________________________________ <br />General Ledger Account String <br />Trans Vendor Description (specify item Transaction <br />Work Resource <br />DateNamepurchased/business purpose)Amount <br />CategoryAccountFundProgramProjectActivity <br />UnitType <br />Total Statement Summary: $ <br /> <br />I, the undersigned card holder, do hereby certify under penalty, that, to the best of my knowledge, the materials furnished, services rendered, expense incurred, or other item of indebtness <br /> as <br />charged in the foregoing bill is a true and correct charge against the City of Eugene; that the claim is just and due; and that payment for these charges has not been requested or made <br /> from <br />petty cash, department order or other method. <br />__________________________________________________ <br />Statement Date: ______________________ <br />Cardholder’s Signature Date <br />__________________________________________________ <br />Supervisor’s Signature Date <br />__________________________________________________ <br />Proxy Signature Date <br /> <br />