Rev. May 2015
VALENCIA COLLEGE
CERTIFICATION OF SERVICES
USE THIS FORM ONLY IF:
☐ Vendor/Contractor DOES NOT provide invoices. (Complete Sections A, B, C, & D)
OR
☐
Check is needed PRIOR to an event so that it can be hand delivered. (Complete Sections A, B, & C)
(NOTE: Section D should be completed AFTER the services are provided, please send to Accounts Payable, DO-330)
A. VENDOR INFORMATION (MUST be a Valencia Vendor)
Date: _______________
Vendor’s Name: ___________________________________
V-Number: ___________________________________
Address: ____________________________________________________________
____________________________________________________________
Description of Service: ________________________________________________________
________________________________________________________
Date of Service: ____________________________________
B. PRIOR PAYMENT
Amount Due $______________________
☐ Please process payment prior to event and send check to:
_____________________________ at Mail Code ___________
REQUIRED: I certify that the payment will be distributed after the performance and/or service has
been completed satisfactorily.
________________________________________ ________________________________________ __________________
Budget Manager Signature Budget Manager Printed Name Date
C. PURCHASE ORDER INFORMATION
Purchase Order Number (Required) _____________________________________________
☐ PARTIAL PAYMENT (PO will remain open) OR ☐ FINAL PAYMENT (PO will be closed)
D. SERVICE COMPLETED (Complete this section AFTER services are provided)
Date Service Completed ______________________________
I certify that (1) Contract Agreement has been completed, (2) Services have been performed and
amount due is approved for payment, and (3) If purchased with grant funds, used for grant
approved activities prior to the last date of the grant(s).
________________________________________ ________________________________________ __________________
Signature Printed Name Date
