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259197 05/31/16
�1`! 4� CITY OF CARMEL, INDIANA VENDOR: 359366 �. ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $*****3,074.32* =a; CARMEL, INDIANA 46032 PO BOX 7137 CHECK NUMBER: 259197 �'��ron�°' INDIANAPOLIS IN 46206-7137 CHECK DATE: 05/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 0945065 —33.55 FOOD & BEVERAGES 1207 4239040 605121546 2,110.05 FOOD & BEVERAGES 1207 4239040 605191591 997.82 FOOD & BEVERAGES VOUCHER NO. WARRANT NO. ALLOWED 20 SYSCO FOOD SERVICES PO BOX 7137 IN SUM OF$ INDIANAPOLIS, IN 46206-7137 $2,110.05 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Course PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 605121546 I 42-390.40 I $2,110.05 1 hereby certify that the attached invoice(s), or 1207 101 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, May 12, 2016 I Cost distribution ledger classification if claim paid motor vehicle highway fund 'rescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL kn invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by ✓hom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due nvoice Date invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 05/12/16 I 605121546 I Food I $2,110.05 1207 101 I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120 Clerk-Treasurer GoodtNngs CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO come from ::>: ;::<ie>::r.:. :::::::::.::.::::::::::•:••:•:.::.: ::...:..:...:...::::::::::::.::.:::...::::::::::::::::.::::::::::::::::::::.:::. BROOKSHIRE GOLF CLUB... 12120 BROOKSHIRE PKWY /SCO rt..ere;:<s.: :'.?.>: 412940 605121546 2 3 SYSCO INDIANAPOLIS, LLC CARMEL IN 46033 4000 W 62ND ST690��?: m INDIANAPOLIS, 2 0 S IN 4 6 68 317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER SHELLFISH SHIPPER ID: IN007RS IMANIFTITI J64841 CITY OF CARMEL IMA: SN139 GARY LEVERENZ 1 CIVIC SQUARE DRIVER: THOMAS CARMET. 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PIECES RECEIV 0 M T FOR ANY S HO E AFTER Y U r I TAX Ar v I I I 'R ." PIF:r In � I 00. PCs ICUST.X 0 IS TOTAL . DRIVER'S N ELVD. SIGN 7REC.'C INVOICE � SIGN . I T Pkltj.Aff,4 %T!r CS140 _ A�,0%1% %O I I fI.�tr�QLpg geVj � 6 I A '0,�A PAYABLE ON OR BEFORE TOTAL 2 P.1 F? J�A �VVT �W7k -4 �10211rft�j( ': -T 8�%RC?I ,I,- ' , I fi T S A 0 , DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL ON PAGE 3 1.FULL PAYMENT IS RECEIVED. I � 1 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) SYSCO FOOD SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 7137 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service INDIANAPOLIS, IN 46206-7137 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $964.27 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Brookshire Golf Course Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s).or bill(s)) AMOUNT 0945065 42-390.40 ($33.55) 1 hereby certify that the attached invoice(s),or 5/19/16 0945065 Return Food ($33.55) 1207 101 1207 101 605191591 42-390.40 $997.82 bill(s)is(are)true and correct and that the 5/19/16 605191591 Food $997.82 1207 1 1 101 materials or services itemized thereon for 1207 101 which charge is made were ordered and received except Thursday, May 19,2016 �G 1 I 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— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Good things CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO comefr .:::Al~ty:;:bA7�:>::::>::>::>:<CLSFd3�kFii:;:::>::ii:<zz<:t>:<::<:»::>:::':.:.,.;..'; . . ;:.;:.;:.;;;:• :.:: :<:i:<::<cssis:?:<isi: >::>::::>r.:»:::<:>:<:;<::<:::: BROOKSHIRE GOLF CLUB... • :: E.,......S:,;!?P:;:;.. 12120 BROOKSHIRE PKWY 1/SCO ...:....... .:�::. 412940 REQ NBR: 0945065 1 SYSCO INDIANAPOLIS, LLC CARMEL IN 46033 4000 W 62ND ST _'• R�'�:�`•`».><'.... .. ... ... INDIANAPOLIS, IN 46268 .::.:. »>'»:... . ....;.,..:.::....:......;; .�:::.........:::.:. .. ......... 317-846-7431 .:. SHELLFISH SHIPPER ID: IN007RS 1 CIVIC SQUARE IMA* GARY LEVERENZ * * PICK—UP ONLY * * DRIVER: DWAYNE THOMAS CARMEL TN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60-1.4 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE. �::i::::::.s:::i:::::::y:::: :.•;:.::•::::•;:.::::>::i::::.s:.>:.>:.::::::::S::i::i:::::::::::i::i::::::::::::i::;:::::::::i::i:::;:::::i::i:::;:::::::R:::i::;;;:s:.::.:::>:i:::::::>:.:i;is;:i�:::::::>:::i:::::i::i<:�<iii::i::i:::::::::<:;::::::::::::::;:::,•';Y::::::::S;::i:::i::i::::::::::::::i::i:::i::i.:.:...;..i::•i:•ii:.:.:::.:.:...:...:::::;:::�.::>:: .. ..:....>:.:..:...>� ::: :.... ::::: .ISE..:::::::.:::::::.:�::::::::.;•:.;.:::<.�.;:.;:.;:.;:.;:;::::::::.�:...... .�.. :: .. .:::::•::::.: ........... .. ...............G................................................:.:.......:....................I NE... . 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