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COEP0033 PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Cardholder: Jones,Enc R Account Nbr: 4732 <br />512010 I OXFORD SUITES I OR APWA Conference lodging I $256.29 161711 1011 I 8920 I 87 <br />1/01/2010 ACT-GOPRSA PRSA November meeting 1 $20.00 ) 61711 ) 011 ) 8920 ) 87 <br />Total Statement Summary: <br />11118,7010 10 32AM <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knowledge, the materials furnished, series 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 lust and d ,and that payment for <br />these charges has not been requested or made from petty cash, department order or other method. <br />~ - It /I g ~d~U <br />Statement Date: 11/17/2010 e- <br />Cardholder's Sign m Date <br />For lost/stolen cards, call, Reviewed and yApproved by <br />116, <br />Bank of Amenca* (800) 305-7735 <br />Treasury Office 682-5027 I~ <br />SliipfifvI4oes Signature Date <br />~y <br />p <br />l) I <br />