250449 10/07/15 CITY OF CARMEL, INDIANA VENDOR: 353824
® :I ONE CIVIC SQUARE U S FOODS CHECK AMOUNT: $*****1,320.34*
CARMEL, INDIANA 46032 PO BOX 78000 CHECK NUMBER: 250449
DEPT#78792 CHECK DATE: 10/07/15
DETROIT MI 48278-0792
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 199065 536.63 FOOD & BEVERAGES
1096 4239039 92419 783.71 GENERAL PROGRAM SUPPL
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO. DATE' NO. NUMBER - - - LOC.* REP. -ORDERED
90569922 0092419-- -09/15/15 90569575 __Sa96 - � - 1054 0062 O9/1 1/15
R0-ute: 2191 / 10ORDER NUMBER: 775191
Bill .__ - Sh-ip __ _ - R6mi
CARMEL CLAY PARKS&RECREAT - CARMEL- CLAY AY PARKS&RECREAT
To: 1411 E. 116TH ST - T6: 12 S_.-CENTRAL -PARK _DRIB --E- _ _. .. .--To:
-- __ _ - - - -- - - -
PO BOX- 78000 DEPT-'-#78792
CARMEL IN - C'ARMEL _-- =-- .. -___ � -- --TN---__.._-_-_.__ _._ ___-T f: EG"C;-`INSFaECT ION FEE--PD----
46032 - - - 46032 - - _ - - -- - ---DETROIT--' _.... .. MI
-843 873. . 48278=-0792..
Att: MICk4ELLE_ COMPTON------- - - DEPT-#._070 -__ ffal �t28-2118
_- _ -- --_ _- _. . -. . __ ._ _ __ -- ___-- -_ .___. ____ _ _-_._ -
�t z tF'r'rrt: 12301 CUi'113ERLAhiIG_RT� FISHERS u ._.' `It�l gpL�. ^_ __d9%-15/1`S- -` ._ ___. Page 01 :cif;0I
ler r S "c za1 _ENTER- OFF--OF--ri-i.TH_'STREET-i-i .i-__-_ _
r�',iffr rts: NET 30 -DAYS __ Ins ti :
rQty ___ .Sales Pr dura "" De criptan py(fP-Size - - Lath C-44Jeagii�t F'i^acxn Unit: ---Ezte pled!
Ordered Shipped Unit Number D Un itg _-P'ric6 Price
------
16-
---16- 16 CS 5497284 COOKIE, CHIP AHOY -CHOC 100 CAL72/:B1`-OZ- -CHIPS AHOY._.._. . ._.__ .-_--_-______---CSV -29:4500 X471. 20
3 3 CS 780i483- --CRACKER, CHS PNT BUTR SNDWH'-SO24/6/4 'EA AUSTIN -. _ __-_ -_.-__-_CS . -21.7600. _ _ - 6S.. 28
REFRIGERATED
2 2 CS 0878173 ORANGE, CA CHO FRESH REF 138 EA CROSS- VALY CS_ 34. 7600 69. 52
2 2 CS 3331469 APPLE, GLDN DLC 125 CT -UA. FCY125 -EA CROSS VALY CS" 3S. 3!;00 70. 70
4 4 CS 6006555 - BANANA, YLW FRESH REF 40 LB PACKER CS 25. 4400 101. 76
#
PRODUCT- CLASS RECAP
TOTAL 'DRY PIECES ORDERED: 19 PIECES SHIPPED:, 19 ITEMS SHIPPED: 2 536. 48
TOTAL REFRIGERATED PIECES ORDERED: 8 PIECES SHIPPED: 8 ITEMS SHIPPED: 3 241.98
�+ INVOICE SUMMARY #.
-FUEL SURCHARGE - - 5. 25
TOTAL. WGT SHIPPED: 399. 15 PIECES -ORDERED: 27- PIECES SHIPPED: 27 ITEMS SHIPPED: 5
PRODUCT TOTAL $ 778. 46
7SE
ED-
201 CHARGES S.25
TAXABLE AMOUNT $ .00
------- GEN SALES TAX . 00
This amount is an estimate at time of- shipping prior to any adjustments mad, at delivery: $ 783. 71
we
INVOICE
Page 1 of 2
ACCOUNT NUMBER INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER PURCHASE ORDER# SALES LOCATION SALES REP DATE ORDERED
90569922 199065 09/18/2015 90569575 39080 1054 62 09/17/2015
FREIGHT TERMS ORDER NUMBER PAYMENT TERMS ROUTE NUMBER SPECIAL INSTRUCTIONS
781586 NET 30 DAYS 5282 ENTER OFF OF 111TH STREET!!!
BILL TO SHIP TO REMIT TOr�-
CARMEL CLAY PARKS&RECREAT CARMEL CLAY PARKS&RECREAT US Foods,Inc.
1411 E. BOX 78000 DEPT#78792
CARMEL,N 6032 CARMEL6TH ST 1235 , N 4603TRAL 2RK DRIVE E IL GG INSPECTION FEE PD SEP 2 8 2015
ATTN:MICHELLE COMPTON Dept.:0 DETROIT,MI 48278-0792
(000)000-0000 (317)843-3873 (800)428-2118 BY:
SHIPPED FROM: 12301 CUMBERLAND RD,FISHERS, IN DRIVER NAME: Daniel Ireland ROUTE NUMBER: 5282
SHIPPED DATE: 09/18/2015 DRIVER ID: 3220930 STOP NUMBER: 3
INVOICE LINE DETAILS
QUANTITY SALES PRODUCT DESCRIPTION LABEL PACK SIZE CODE WEIGHT PRICING UNIT EXTENDED
ORD SHP I ADJ I UNIT NUMBER UNIT PRICE PRICE
DRY
1 1 0 EA 1183599 CANDY,M&M PLN 1.69 OZ M&M 48 EA B EA $52.5200 $52.52
1 1 0 CS 5585476 CHIP,PTATO BKD ORIG GLTN/FR BAKED LAYS 64/1.125 OZ CS $31.9900 $31.99
2 2 0 CS 5597604 CHIP,CHS CNCHY PLN SS BAG CHEE-TOS 64/2 OZ CS $33.7200 $67.44
1 1 0 CS 5597810 CHIP,TORTLA COOL RANCH TRGLE DORITOS 64/1.75 OZ CS $30.8200 $30.82
2 2 0 CS 5597851 CHIP,TORTLA NACHO CHS TRGLE DORITOS 64/1.75 OZ CS $31.5800 $63.16
2 2 0 CS 5597968 CHIP,CORN ORIG TFF SS BAG FRITOS 64/2 OZ CS $33.7600 $67.52
2 2 0 CS 5601679 CHIP,PTATO REG PLN SS BAG LAY'S 64/1.5 OZ CS $31.1200 $62.24
1 1 0 EA 6210777 CANDY,KIT KAT VNDG STD 1.5 Z KIT KAT 36 EA EA $30.5800 $30.58
1 1 0 EA 6717219 CANDY,BAR SNCKR SS DMSTC 1.86 SNICKERS 48/1.86 OZ EA $35.4300 $35.43
1 1 0 EA 8036576 CANDY,M&M PNT 1.74 OZ M&M 48 EA EA $34.1400 $34.14
2 2 0 EA 8053126 CANDY,RESES PNT BUTR CUP REESE'S 36 EA EA $27.7700 $55.54
PRODUCT CLASS RECAP
PRODUCTCLASS TOTAL PIECES TOTAL PIECES TOTAL PIECES TOTAL PIECES TOTAL ITEMS TOTAL WEIGHT TOTAL EXTENDED
ORDERED SHIPPED ADJUSTED DELIVERED SHIPPED SHIPPED PRICE
DRY 16 16 0 16 11 95.95 $531.38
DELIVERY SUMMARY TOTALS 16 16 0 16 11 95.95 $531.38
Page 1 of 2
U 1 INVOICE
� Page 2 of 2 "
ACCOUNT NUMBER INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER PURCHASE ORDER# SALES LOCATION SALES REP DATE ORDERED
90569922 199065 09/18/2015 90569575 39080 1054 62 09/17/2015
FREIGHT TERMS ORDER NUMBER PAYMENT TERMS ROUTE NUMBER SPECIAL INSTRUCTIONS
781586 NET 30 DAYS 5282 ENTER OFF OF 111TH STREETM
DELIVERY SUMMARY
AS SHIPPED DELIVERY AMOUNT $536.63
Product Total Adjustments $0.00
Total Charges Adjustment $0.00
Total Allowance Adjustment $0.00
Sales Tax Adj: Rate:VAR $0.00
TOTAL ADJUSTMENT 0.00
DELIVERED AMOUNT $536.63
INVOICE SUMMARY
Product Total $531.38
FUEL SURCHARGE $5.25
Sales Tax Rate: 0.00 $0.00
PLEASE REMIT THIS AMOUNT BY 10/18/2015 $536.63
CUSTOMER ACCEPTANCE
Interest shall accrue on all unpaid balances exceeding established credit terms at a rate equal to the lesser of(a)1-1/2%per month or(b)the maximum rate that the customer may lawfully contract to pay,and in
all events calculated in accordance with applicable law.
-1v7 C
CUSTOMER SIGNATURE: mark c
SIGNED AT: 09/18/2015 10:54 AM(UTC)
We appreciate your business.Please visit our website www.usfoods.com/order for a fast and easy way to order or contact customer service at:(800)253-0277
Page 2 of 2
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
353824 U S FoodService, Inc. Terms
Dept 78792
P.O. Box 78000
Detroit, MI 48278-0792
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
9/15/15 92419- Tour de Carmel Snacks 2015 39066 $ 783.71
9/18/15 199065 Concessions 39080 $ 536.63
Total $ 1,320.34
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No.
353824 U S FoodService, Inc. Allowed 20
Dept 78792
P.O. Box 78000
Detroit, MI 48278-0792 In Sum of$
$ 1,320.34
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or Board Members
Dept# INVOICE NO. CCT#/TITL AMOUNT
1096-60 92419 4239039 $ 783.71 1 hereby certify that the attached invoice(s), or
1095-1 199065 4239040 $ 536.63 bill(s) is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
October 1, 2015
Signature
$ 1,320.34 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund