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O 4 \ \ . PFM Financial Services LLC <br /> G Airport Corporate Center <br /> One Corporate Drive, ive, Suite 101 <br /> Bohemia, NY 11716 <br /> � Pnone 631 -580 -6258 <br /> MI Free 800 -356 -5148 <br /> Fax 888- 356 -3188 <br /> Application to Participate www.powercardpfm com <br /> To participate in the PCard program, the following information must be completed and signed by an <br /> authorized representative. <br /> Legal Name of Entity <br /> City of Centerville <br /> Mailing Address 1880 Main Street <br /> Centerville, MN 55038 <br /> Federal Tax ID Number 41- 1267014 <br /> Name arid Title of Authorized Representative Dallas Larson, City Administrator <br /> Central Bank <br /> Bank Account to be debited for the charges (or) Account # <br /> Fund Account to be debited for the charges <br /> Name and Title of Person Who Will Administer Dallas Larson, City Administrator <br /> PCard Program <br /> Mailing Address of the Administrator - Telephone ( ) <br /> Fax ( ) <br /> Email <br /> Current Annual Budget $2,054,700 <br /> Population 4000 <br /> Highest Month End Spend Amount $200,000 <br /> (Excluding Payroll) <br /> Yr>ur purchdsinq raid cmdr( 11/11• wdi hr mvi, v d dunuiIfy June <br /> Harris Barik rog000s a copy of your cryauirallnn s audm'd <br /> norm/ al stdtemrnls wirhin !lorry 1101 rlays ul curnplv0orr rack <br /> yr_al <br /> Please indicate the month of the year your audit <br /> is generally completed & available: <br /> Are your a udited financials available online? Yes <br /> (YIN) <br /> 32 <br />