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OOEP 3 <br />PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />104MIC)12:OOPM <br />I, 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 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. - I .'N <br />- <br />Statement Date: 10/152010 <br />For lost/stolen cards, call: <br />Bank of America' (800) 305-7735 <br />Treasury Office: 682-5027 <br />Cardholder's Signature Date <br />Rewewed and Approved <br />Supervisor's Slg re Date <br />''Np'N'p,,,,~v~v,,UUUAID <br />XYP <br />Cardholder. MAST STROUD,KIM Account Nbr. 6657 <br />