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HomeMy WebLinkAboutInv# PC - 22093 - PUBLIX SUPER MARKETS, INC - 11/08/2024DANIA BEACH SEA IT. LIVE IT. LOVE IT. Lost/Missing Receipt Form for P-Card The City of Dania Beach expects your best efforts to obtain original receipts. In the rare event that a receipt cannot be obtained, or is lost, this form may be used to document your purchase. Excessive use of this form could result in suspension of purchasing privileges. Supervisor approval is required. Card Holder Information Vendor Information Name: Deborah Sabino Last 4 of CC: 2316 Name: Publix Department: Community Development Phone #: 954-924-6805 x3643 Purchase Date: November 8, 2024 Purchase Information Please provide details as to why the original receipt is not available and how the problem will be avoided in the future. Ice Tea, Lemonade and ice for CD Team Building Event. © I certify this purchase is a valid City expense ® I certify this purchase will not be submitted on any other form for reimbursement Line Item Detail: Please provide the item description, quantity, and total for each item on the receipt. Quantity Item description Individual amount Total 1 Publix 29.13 29.13 Signature Department Head or Direct Supervisors Signature Updated June 2019 Date Date Shipping: Invoice Total: 29.13 If more items were purchased, please continue on separate page.