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coEpooas PROCUREMENT CARD TRANSACTION SUMMARY (LOG) IZ70/2010 856AM <br />Cardholder. Tintle,Robert AccountNbr: 0277 <br />FM IM <br />1/23/2010 SHOPKO 00400986 Return - Empoyee Recognition Event -$7485 65117 011 8910 87 <br />2/0112010 HONEYBAKED HAM CO AND Employee Recognition Event $6200 65117 011 8910 87 <br />Total Statement Summary: 12.85 <br />I, the undersigned card holder, do hereby certify under penalty of pequry, 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 I stah ue, and that payment for <br />these charges has not been requested or made from petty rash, department order or other method. <br />Statement Date: 12/17/2010 <br />CarjO a1deeSIgnttm Date <br />For IosVstolen cards, call. Reviewed and Approved by, <br />Bank of America: (800) 305-7735 <br />Treasury Office* 682-5027 <br />Supe sons Signature Data <br />A-p p,Mj 410 <br />gR5 <br />