HomeMy WebLinkAboutInv# PC - 6204 - PUBLIX SUPER MARKETS, INC - 08/10/2022 (6)City of Dania Beach
P-Card Monthly Sign-Off Sheet
Invoice Batch #:
Last 4 digits of credit card number: xxxx-xxxx-xxxx- Statement Month:
P-Card Monthly Sign-Off Sheet (this page)
Bank of America statement
Electronic scans of original receipts – (must be in order as they appear on the Bank of America statement)
Host Account Summary form for food expenditures (if applicable)
By signing below, I certify that I have reviewed and approve all charges as in compliance with the rules
and regulations set forth in the “P-Card Policy”and “P-Card Acknowledge Form”.
Cardholder (print)Signature Date
Reconciler (print)Signature Date
Department Head (print)Signature Date
Purchasing Reviewer Signature (print name) Signature Date
After review, sign and forward your packet via email to tstevens@daniabeachfl.gov
Complete your monthly P-Card Reconciliation Packet in this Order
Signatures: Cardholder, Reconciler, and Department Head signatures are required. The cardholder signs as
the cardholder. If Dept. Head is also the cardholder you must sign in both places. The reconciler will sign as
the approving party of transactions listed on the BOA statement. The cardholder and reconciler cannot be
the same person. If Dept. Head is also the reconciler you must sign in both places as the approving party of
transactions listed on the BOA statement.
TO BE COMPLETED BY FINANCE