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cori'mm PROCUREMENT CARD TRANSACTION SUMMARY (LOG) 11/19/2010 3 29PM <br />Cardholder. Corey,Kurt <br />Account Nbr: 8582 <br />F <br />0 <br />- <br />0115)2010 <br />HAMPTON INN <br />HAMPTON INN lodging at APWA Fall Conference 10/13-1;/. $155.60 <br />61711 011 8910 <br />87 <br />Total Statement Summary: $155.60 <br />1, 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 1s just and due, and that payment for <br />these charges has not been requested or made from petty cash, department order or other method <br />Statement Date: 11117/2010 <br />For lost/stolen cards, call <br />Bank of America. (800) 3057735 <br />Treasury Office, 682-5027 <br />Cardhol~fs Signature Date <br />Reviewed and Approved by <br />V II Z X00 <br />Supervisor's Signature ate <br />V <br />