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10/09/14


1 10/16/13 9572 103,119.71 3-1201 2013001239 2 103,119.71
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103,119.71 103,119.71

Rina Hernandez, Administrative Services Manager, DPB

Release Line
October invoice, Coliseum
Devan Reiff
x3550
1944 Embarcadero
ORIGINAL INVOICE(S) MUST BE ATTACHED
10/11/13

BATCH NUMBER
BATCH DATE
2013-2014
TOTAL INVOICE
AMOUNT

Lamphier-Gregory


$103,119.71
Oakland, CA 94606



64428
INPUT/AUDITED BY
x





Amount

L
i
n
e

#

DPB
Invoice Date
MM/DD/YY
PO # Invoice Amount Invoice Number
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
DETAILED DESCRIPTION
AGENCY/DEPARTMENT DATE AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Invoice Total
Total
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12
-
Rina Hernandez, Administrative Services Manager, DPB

CA BOE
Sales Tax
ORIGINAL INVOICE(S) MUST BE ATTACHED
$103,119.71






FMA 03/28/12