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Exhibit C <br />City of Eugene / Public Works <br />Parks & Open Space Division <br />1820 Roosevelt Blvd., Eugene OR 97402 <br />(541) 682 -4800; (541) 682 -4882 FAX <br />2012 Neighborhood Matching Grant Program <br />Request for Reimbursement City of Eugene Contract #: 2012 -05331 <br />Grantee: Jefferson Westside Neighbors <br />Grant Project: Tree Inventory and Assessment � , Person making reimbursement request: �'� ��"' I f <br />Send payment to: S'I1K-��+ P -I <br />9 Ack N ST <br />ISOC' 09 x'402. <br />Itemized Request: <br />Receipt Date <br />Supplier / Vendor <br />Supply / Service <br />Amount $$ <br />Le 2 <br />i nr s bk <br />$ ©c lc�� M�6.� S (Z <br />$ I Z'L 3 . q q <br />$ / /Lail <br />1(�fSi�i't <br />2-��. /}c���2� (L � <br />$ 5.�Y <br />Vtb /Za)Z <br />fN5 /FL;ID eA <br />1 -P IrA6 <br />$ Z.) <br />TOTAL <br />$ ) 3 10 . <br />Approved by Pr ect1C rdinator Approve 4Y NMG o !` <br />Z3 1 /! /v <br />9 <br />Signature Date submitted Brian Iliott, PWM/ Cindy Clarke, NSP <br />City Account Code: 011 - 0735 - 62900 - 644015 <br />