x

10/09/14


1 11/15/13 9593 73,483.74 3-1201 2013001239 2 73,483.74
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73,483.74 73,483.74

DPB
Invoice Date
MM/DD/YY
PO # Invoice Amount Invoice Number





Amount

L
i
n
e

#

$73,483.74
Oakland, CA 94606



64428
INPUT/AUDITED BY
x

BATCH NUMBER
BATCH DATE
2013-2014
TOTAL INVOICE
AMOUNT

Lamphier-Gregory


1944 Embarcadero
ORIGINAL INVOICE(S) MUST BE ATTACHED
10/23/13
Rina Hernandez, Administrative Services Manager, DPB

Release Line
October invoice, Coliseum
Devan Reiff
x3550
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
-






$73,483.74
ORIGINAL INVOICE(S) MUST BE ATTACHED
Rina Hernandez, Administrative Services Manager, DPB

CA BOE
Sales Tax
FMA 03/28/12