252405 1 2/08/1 5 1�.,�.G�gMf(
�;; CITY OF CARMEL, INDIANA VENDOR: 359366
d ti; ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: S'"""`375.71"`
x, _� CARMEL, INDIANA 46032 PO BOX 7137 CHECK NUMBER: 252405
+.y,-_„�• INDIANAPOLIS IN 46206-7137 CHECK DATE: 12/08/15
< <TON
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 512031515 375.71 FOOD & BEVERAGES
Good things
CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
come from "''Dgt;,,v; DATE I' ':.CUSTOMER 5. .
BROOKSHI RE GOLF CLUB... �����®�
12120 BROOKSHIRE PKWY TflCKsOP412940 512031515 4 1
SYSCO INDIANAPOLIS, LLC
CARMEL IN 46033 4000 W 62ND ST
INDIANAPOLIS, IN 46268 R ARP
317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER
h,)A4ub NORMAL DELIVERY
CITY OF CARMELME I
1 CIVIC SQUARE DRIVER: THOMAS
,AR I IN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60-14, 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE.
QTY �'PAC SIZE, ITEM DESCRIPTION ITEM uNfr EXTENDED
r. CODE :PRICE PRC£
A':
IlTy
FFECTIVE , 7/01/15 SYSCO INDIANAPOLIS WILL NO LONGE ACCEP CASH AS A.„FORM OF AYMENT.,
SK YOUR MA FOR D TAILS: ... „
FROZEN
** .
F . :::::: ,'S 1:441 :2 OZ EADIBK DOUGH COOKIE BENFIT HOLI.DY THM 742'25' 314327:8' '44:60 4'4;60
F>.
5 OZ KRSCLS DOUGH K ;:::: :.
U COOKIE .
`. ,:.. 90.6;71 628623:- 69..'20 69:20 >':;>:>::;::»;:
GROUP .TOTAL**** 113.80 .........
- *:* PAPER & DISPOSABLE
S 1' 500 CT ORKADV 'NAP.K'I'N;' DI:SP;.XPRES:SNAP.;:.WHT DX9.00. 33;0.68::7::;:>:'S9 '2'6:' 59.25
D :: . S 375 CT YS CLS NAPKIN DNR 15X16:2:5.2PLY 1/8F NP3110A—SYS 5331:92:7:: . 5.3..99. 53.99
D ..: :::: NL 1000CT YSCO . STIRRER PLAS STRIPED WHT 5.25":: YSTS52SSYS8 10!066`'7' 2.9';9 2.99
D NL 50OCT YSTRNZ STRAW PLAS' :WRPD: JMBO STRP 7.75YSTWJ77SSER24 '0191516 3.99 7.98
D.: ... S :1` 150OCT EORG P TISSUE :TOI::LET :CORELESS .2PLY WH' 19.3:7'8:>6092605 "61..21 .. 61;,21
D S 800 FT EORG 'P TOWEL ROLL ENMOTION LRCS 4AUTO 89460 9627761 71.4 8” 71:48
T TAL
**
GROUP 0 2 1
56.9
MI' ..' RG S HGS`:<FOR:;FUEL SURCHARGE:;;;;" »>::»:: _: 5.0 0
ORD S RY 39895
P.O. BOX 7137
= 3 9 11.1 140 INDIANAPOLIS IN SUB
a IMPORTANT: PERISHABLE PRODSUCTS ARE NOT ELIGIBLE FOR RETURNggAFTE 4206-7137 TOTAL 375.71
3 9 11.1 14 O EA.OR VANV SHORTAGE AFTER YI SUI HVAOVIE ESIGNEO WILL
ECEOST RECEIVED MUSTE TAX
IF
DRIVER'S No. PCS CUST. O NO. PCS TOTAL
DELVD.
� SIEGNE CC pp p p SIGN E pp$ CCgg EgC3 UU CC�� ggEE 7)) EREggC.LLL pp INVOICE
oPUTHORRZzIED ggggY ggqqEE TIIONLTSIC LA OTHMEOPEIRIESHAI,gILETEA RICULTUSRALVOCOMEMApDIAL DETNTORIE�I OF'SFOOD90RFC THER PRObEUCTS TOTAL 375.71
=THESE COMMODITIES RETAIN�A TRUST CLAIM OVER EHESE COMMODITIES, PAYABLE ON OR BEFORE
I'DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL 1/01/16 LAST PAGE
o FULL PAYMENT IS RECEIVED
Prescribed by State Board of Accounts City Form No.201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/03/15 512031515 Food $375.71
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
120-
Clerk-Treasurer
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Sysco Indianapolis LLC
IN SUM OF $
PO Box 7137
Indianapolis, IN 46206-7137
$375.71
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1207 I 512031515 I 42-390.40 I $375.71 I hereby certify that the attached invoice(s), or
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
Thursday, December 03, 2015
r
Director, Brookshirlyolf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund