252819 12/15/15 CSF.
CITY OF CARMEL, INDIANA VENDOR: 353824
® it ONE CIVIC SQUARE U S FOODS CHECK AMOUNT: $"'""*637.47*
CARMEL, INDIANA 46032 PO SOX 78000 CHECK NUMBER: 252819
x DEPT#78792
CHECK DATE: 12/15/15
DETROIT MI 48278-0792
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 2888234 637.47 FOOD & BEVERAGES
ACCOUNT INVOICE INVOICE CUSTOMER
NO� NODATE NO. NUMBER LOC . REP . ORDERED
90569922 2888234 12/11/15 90S69S75 39302 1054 0062 12/08/15
Route: S282 3 ORDER NUMBER: 867350
8ill Ship Remit
CARMEL CLAY PARKS&RECREA''l' CARMEL CLAY PARKS&RECREAT US Foods; Inc .
To: 1411 E. 116TH ST To: 123S CENTRAL PARK DRIVE E To:
#,o, ,2
CARMEL I N1 CARMEL IN EGG !NSPECTION ~EE ru
- Al-60-12 46032 -DETROIT
'517 843 3873 49272-0792
n�
Att:-
5hipFrm. 12301 CUMBERLAND RD FISHERS IN Ship17. 12/11 /15 Page 01 of 01
FrtTrms. Spcza2 ENTER OFF OF 111TH STREET / ! !
p t7rms. NET 30 DAYS Instr.
5ty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
]rdered Shipped Unit Number D - Unit Price Price
--- -
PAd
DRY
1 1 CS 0791616 CUP, FM 32 Z UHT 2S/20 EA MONOGRAM CS 36. 4800 $ 36. 48
1 CS 081423L CUP, FM 16 Z WHT 20/2S EA MONOGRAM- CS i9. 9100 19. 91
i CS 0814541 CUP, FM 20 Z WHT 2S/20 t-'.:A MONOGRAM CS 22. 9200 22. 92
I CS 32S6104 LID, CUP 12-24 Z BBL PLST 1000 EA WINCUP CS 18. 6100 18. 61
.,1 4 CS- 4260238 SAUCE, CHS NACHO SHLF STABL 4/107 OZ ORTEGA CS S4. 1100 216. 44
1 CS ES97604 CHIP, CHS CNCQY PLN SS BAG 64/2 07 CHEE-TOS CS 33. 7200 33. 72
I CS 55978SI CHIP, TORTLA OACHO CHS TROLE 64/1. 7S OZ DORITOS CS 31.000 31. S8
I CS SS97968 CHIP, CORN- ORIG TFF SS BAG 64/2 OZ FRITOS CS 33, 7600 33. 76
CS 32. S500 32. SS
F CS 5605472 CHIP, MULTGRNICHEDR SS BAG 64/1. S OZ SUN CHIPS
2 CS 9463638 CHIP, TORTLA CORN YLW RND 6/2 LB DELPASDO CS 21,9300 43. 86
FROZEN
PRODUCT CLISS RECAP
TOTAL DRY PIECES ORDERED: 14 PIECES SHIPPED: - 14 ITEMS SHIPPED: 10 489. 03
TOTAL FROZEN PIECES QRDERED: 4 PIECES SHIPPED:_ 4 ITEMS SHIPPED: 1 147-64
1NVOICE SUMMARY
TOTAL W'GT SHIPPED: 20. 8S PIECES ORDERED: is PIECES SHIPPEW 10 1TEMS SHIPPED: 11
PRODUCT TOTAL $ 63747
DEC 10 2015
TA XABLE AMOUNT $ 00
[By: GEN SALES TAX . 00
This amount is an estimate at -time of shipping prior to any adjustments made at delivery: 637. 47
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
12/11/15 2888234 Concessions 39302 $ 637.47
Total $ 637.47
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
Dept 78792 20
P.O. Box 78000
Detroit, MI 48278-0792 In Sum of$
$ 637.47
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or
Dept# INVOICE NO. CCT#/TITL AMOUNT Board Members
1095-1 2888234 4239040 $ 637.47 1 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
December 14, 2015
Signature
$ 637.47 Accounts Payable Coordinator
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund