319883 12/21/2017 0h.. - CITY OF CARMEL, INDIANA VENDOR: 359366
6 1 ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $*******914.63*
?� CARMEL-, INDIANA 46032 PO BOX 7137 CHECK NUMBER: 319883
M- i �O` INDIANAPOLIS IN 46206-7137 CHECK DATE: 12/21/11
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 138367333 894.95 FOOD & BEVERAGES
1207 - 4239040 138367334 19.68 FOOD & BEVERAGES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 359366 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
SYSCO FOOD SERVICES IN SUM OF$ CITY OF CARMEL
PO BOX 7137 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.
INDIANAPOLIS, IN 46206-7137
Payee
$914.63
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
138367334 42-390.40 $19.68 1 hereby certify that the attached invoice(s),or 12/7/17 138367333 Food $894.95
1207 101 1207 101
I
bill(s)is(are)true and correct and that the 138367333 I 42-390.40 I $894.95 12/7/17 138367334 Grill Cleaner $19.68
1207 101 materials or services itemized thereon for 1207 101
which charge is made were ordered and
received except
Friday, December 08,2017
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII CUSTOMERV� CUSTOMER.
S ORIGINAL INVOICE CONFIDENTIAL EPROPERTYE OF SYSCO
Good ings 12/07/17
BROOKSHIRE GOLF CLUB+++ come from rRvcK STOP 412940 138367333 0 1
12120 BROOKSHIRE PKWY /007
CARMEL IN 46033 �iSCQ�SYSCO INDIANAPOLIS, LLC RovTE PURCHASE ORDER
4000 W 62ND ST 4452 TERMS _PAST DUE:BALANCES ARE SUBJECR.TO SERVICE CHARGE
317-846-7431 INDIANAPOLIS, IN 46268 [
DUE FRIDAY 4 WEEKS AFTER ORDER
BROOKSHIRE GOLF SHELLFISH SHIPPER ID: IN007RS MANIFEST# 606154 NORMAL DELIVERY b
12120 BROOKSHIRE PKWY MA: SN139 GARY LEVERENZ
CARMEL IN 46033
O- QTX a PpiCK SIZE. .,. ,'ITEM N
UIT vHxr :. T p INVOICE ADJUSTMENTS y
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xTErs'DESCRIPTION "r • CODS PRICE: E DD "XI
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SK YOUR MA ABOUT SYSCOACCOUNTCENTER.COM & HOW YOU EARN CREDI ON YOUR ACCOUNT!
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*** DAIRY ***
C S 112#AV OTHKAS CHEESE KIT WISC ASSORTMENT 21415 3973724 11.870 153.12
12 900 T/WT-" 12! 900
5
GROUP
TOTAL** 153.12
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F S 115 T,B; SASOT� APTZR,;EGGROLL SANTA FE ,CHKN 4121',0420 ,2957;1%81 ,.;95.25;,, ..
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FSYS.'IMP. APTZR. QUICHE ASST MINI 698',5683 6985683 81. •93' 81.93 N
F.,';.. . S ,216 5 .O..,Z KRSCLS 'DOUGH;COOKIE..SUGAR_ .. RDB9:0675 1,62.8;637 62,. 2: 62.. 72
jr -S '240 .3302 TSPKMY .DOUGH COOKIE,WIiTCHOC',MAG 58807, 209449$ 97.89: 97.$9
GROUP TOTAL**** 337.79
***...PAPER;' & DISPOSABLE, * *
.
S 10 00 G: SYS :CLS-•GLOVE POLY CAST• DZSP.,MED ;3033&3112 8348245 :"4,9. 74 49, 74, ,
0
51000 T SYS„,CLS, KNZFE,...,PLA5 ',BLK 'MEDHVY>MDLNG YMWKESYS ,7963;467 .,.74 65 74'.65,
0
.
6800 F EORG P '1!OWEL ..ROLL„ENMOTON.LRG, 4AUT0 $'.9460 9627:761 75.53'; 75.53„ <. .
GROUP TOTAL**** 199.92
**%* DISPENSER *** �+
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.... ....25L OLGERS, COFFEE;; LIQUID `FRZ .GONG CO,...255006220.6.:. ,2Z,16..Q45 1.26 92 726...92
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S •1 GRI,'. OCACOT. SYRUP COKE.,CLASSIC 5X7 828 0425'0010 4090:593 .77.20 77.20,
GROUP ,TOTAL**** 204.12 N
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CASES SPLIT OT.PCS CUBE GROSS
WT. OPEN: 7:00 AM CLOSE: 2:00 PM . REMIT Td
P.O. BOX 7137
10 10 7.2 184 INDIANAPOLIS, IN SUB
46206-7137 TOTAL 894.95
10 10 7.2 184 TAX
DRIVER'S - NO. PCS COST.sxcnso xervoxce avro��ces az Acc xr�s NO. PCS TOTAL
SIGN DELVD. SIGN X REG.
INVOICE
TOTAL 894.95
rHE
RTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SUBJECT TO PAYABLE ON OR BEFORE
STATUTORY TRUST AUTHORIZED BY SECTION 5 (C) OF THE PERISHABLE AGRICULTURAL COMMODITIES ACT 1930 (U.S.C.
(C)). THE SELLER OF THIS COMMODITY RETAINS A TRUST CLAIM OVER THESE COMMODITIES, ALL INVENTORIES OF 1/05/18 LAST PAGE
OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OFE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED.
IIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 111111111111111111 CUSTOMER LS ORIGINALNvMERcE CONFIDENTE EPROPERT E OF SYSCO
s3 3 GoodthQmg0 1 M 12/07/17
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BROOKSHIRE GOLF CLUB+++ come from TRncx ssoP 412940 138367334 8 1
BROOKSHIRE PKWY
CARMEL
��,��®� /007
CARMEL IN 46033 SYSCO INDIANAPOLIS, LLC
4000 W 62ND ST R°vss PURCHASE ORDER
317-846-7431 INDIANAPOLIS, IN 46268
4452 TERMS —PAST DUE BALANCES ARE SUBJECT TO SERVICE CHARGE: O
DUE FRIDAY 4 WEEKS AFTER ORDER
BROOKSHIRE GOLF SHELLFISH SHIPPER ID: IN007RS MANIFEST# 606154 NORMAL DELIVERY ro
12120 BROOKSHIRE PKWY MA: SN139 GARY LEVERENZ
CARMEL IN 46033
D QTY,,, s. HACK: SIZE:; ! ITEM UNIT CiNxT E T p INVOICE ADJUSTMENTS y
CODE ;PRICE utoUHi EPR CE D. '
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SK YOUR MA ABOUT SYSCOACCOUNTCENTER COM & H W YOU CAI EARN A CREDir ON YOUR OUNT!
1111 of Alk Allow
*** PAPER & DISPOSABLE ***
S 10 X5IN ECOLAB PAD GRIDDLE POLISHING 60225-07-00 0065324 14 68 14.68 N
GROUP TOT "
MISC CHARGES CHGS FOR FUEL SURCHARGE 5.00 * b
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CASES SPLIT MT.PCS CUBE GROSS NT. OPEN: 7:00 AM CLOSE 2:00 PM REMIT TQ
P.O. BOX 7137 M
1 1 .2 1 INDIANAPOLIS, IN SUB
46206-7137 TOTAL 19.68
1 1 .2 1 TAX
DRIVER'S NO. PCS COST...——Im av:nENcss of ncc xmss NO. PCS TOTAL
SIGN DELVD. SIGN X REC.
INVOICE
TOTAL 19.68
IMPORTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SUBJECT TO PAYABLE ON OR BEFORE
HE STATUTORY TRUST AUTHORIZED BY SECTION 5 (C) OF THE PERISHABLE AGRICULTURAL COMMODITIES ACT 1930 (U.S.C.
jug499E(C)). THE SELLER OF THIS COMMODITY RETAINS A TRUST CLAIM OVER THESE COMMODITIES, ALL INVENTORIES OF 1/05/18 LAST PAGE
(OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF
HESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED._