COEP0033 <br />PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />01202011 12 45PM <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knowledge, the materials furnished, services rendered, expense incurred, or <br />other item of indebtedness as 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 <br />these charges has not been requested or made from petty cash, department order or other method 1 <br />Statement Date: 01/1712011 ~J xott,404L r 4) 1 <br />C oldees Signa re Date <br />For lost/stolen cards, call. Reviewed and Appr by <br />Bank of America, (800) 305-7735 ~1 ~7 / <br />Treasury Office 682-5027 0 r V v" /Z / f o 11 <br />upervisoes Signat*e Date <br />cti <br />Cardholder, Walsh,Tracy Account Nbr: 8601 <br />