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05- 15- 12;12:56PM;EWEB <br />Exhibit C. <br />;541- 689 -0967 # 1/ 3 <br />City of Eugene / Public Works <br />Parks & Open Space Division <br />1820 Roosevelt Blvd., Eugene OR 97402 <br />(549) 682 -4800; (541) 682-4882 FAX <br />2012 Neighborhood Matching Grant Program <br />Request for Reimbursement <br />Grantee: Mohawk Grange and Harlow Neighbors Association <br />Grant Project: Willakentie Grange Site Impr vements <br />Person making reimbursement request: <br />Send payment to: <br />t <br />Itam170e1 Pont lact- <br />City of Eugene Contract #: 2012 -05335 <br />— Receipt Date <br />Supplier / Vendor <br />Su pl / Service <br />Amount $$ <br />$ <br />$ <br />$ <br />TOTAL <br />Approved by Project Coordinator <br />Approved by City NMG Coordinator <br />Signature Date submitted <br />Brian Elliott, PWM/POS or Cindy Clarke, NSP <br />City Account Code: 011- 0735 -62900 - 644015 <br />