CERTIFICATION OF SERVICES (Use this if an invoice is not supplied by the contractor) Date: Vendor’s Name: V-Number: Address: ____________________
_________________________________ ______________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________
Description of Service:
Date of Service
Please describe any issues or problems with performance of services: _____________________________________________________________ _____________________________________________________________
_____________________________________________________________
Please process payment prior to event and send check to _____________ _____________at Mail Code ________ I certify that the payment will be distributed by the Budget Manager after the performance/service has been completed satisfactorily. Budget Manager Signature (required) ______________________________ Amount Due: _$_________________
Purchase Order No. ____________________ REQUIRED Partial ___________ or Final ____________ Date Service Completed ________________ I certify that a Contract Agreement has been completed and amount due is approved for payment. Signature _________________________ Date ___________