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COEPM33 <br />Cardholder. Tintle,RObert <br />1 I NEW DAWN BAKERY OPS <br />1 1 FULL CITY COFFEE ROOPS <br />PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />SRRP Committee Meeting 01105/11 <br />SRRP Committee Meetmg 01105111 <br />Total Statement Summary: <br />Account Nbr. 0277 <br />$24 00 ) 62200 1 131 ) 8910 ) 54 <br />$16.00 1 62200 131 ) 8910 1 54 <br />01/18/2011 12 50PM <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knowledge, the matenals 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 rash, department order or other method. <br />Statement Data. 01/17/2011 <br />CjQ olden's Signature Date fff <br />For Iostfstolen cards, call. Reviewed and Approved by <br />Bank of America (800) 305-7735 „ram l <br />Treasury Office. 682-5027 N IJ~L <br />Date D <br />Supef isors Signature <br />