COePOOM PROCUREMENT CARD TRANSACTION SUMMARY (LOG) 01121/2011 11 44AM <br />Cardholder: Eva,Kathy <br />Account Nbr: 4652 <br />1/06/2011 <br />FRANKLINCOVEYPRODUCTS <br />calendar $26.95 <br />62300 535 8921 41 <br />Total Statement Summary $26.95 <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knowledge, the materials tuinshed, services rendered, expense Incurred, or <br />other hem of Indebtedness as charged In the foregoing bill is a true and correct charge against the City of Eugene, that the claim is lust and due; and that payment for <br />these charges has not been requested or made from pettv cash, department order or other method. <br />Statement Date. 01/1712011 <br />For losVstolen cards, call <br />Bank of America (800) 30•-7735 <br />Treasury Olfice* 682-5027 <br />Cardhoi ses Signat Date <br />Reviewed and , y- <br />Supervisor's signature Date <br />