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.`v' <br />COEP0033 <br />Cardholder: Flowers,Jeffrey Jane <br />1/04=10 1 BI-MART <br />1/15/2010 1 ALBERTSONS#572 <br />PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Account Nbr: 2739 <br />SPLASH activity supplies K-6 <br />SPLASH activity supplies K-6 <br />$229 70 1 62900 1 535 1 8921 1 41 <br />$19 05 1 62900 1 535 1 8921 1 41 <br />1inar2mo 1026AM <br />1, the undersigned card holder, do hereby cerbfy under penalty of perjury, that, to the best of my knowledge, the materials furnished, services rendered, expense incurred, or <br />other dem 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 <br />Statement Date: 11/17/2010 <br />For lost/stolen cards, call <br />Bank of America: (800) 305-7735 <br />Treasury Office 682-5027 <br />rd s 5 g5- re Date <br />Reviewed and Approved <br />14110 <br />Supervisor's Signature Date <br />fO'~ <br />II)~ <br />l <br />