Loading...
HomeMy WebLinkAbout325089 05/09/18 oi� CITY OF CARMEL, INDIANA VENDOR: 359366ONE CIVIC SQUARE SYSCO FOOD SERVICESCHECK AMOUNT: S*****1,70$.78* CARMEL, INDIANA 46032 PO Box 7137 CHECK NUMBER: 325089 IINDIANAPOLIS IN 46206-7137 CHECK DATE: 05/09/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 138501981 162.25 FOOD & BEVERAGES 1207 4239040 138504194 879.64 FOOD & BEVERAGES 1207 4239040 138513413 666.89 FOOD & BEVERAGES :1 VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) Vendor# 359366 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER SYSCO FOOD SERVICES IN SUM OF$ 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 $666.89 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 138513413 42-390.40 $666.89 1 hereby certify that the attached invoice(s),or 5/3/18 138513413 Food $666.89 1207 101 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 03,2018 A(--W t� 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 '3SOdSIa HOM MM`JNIA'IOANI MILISN ]IN MI H NI'SSNIINIMIo 30 SsRZO Y 30 Hzsm B sY 3ZYdIOIaw OZ Ho'AirwaRo 3AISBSN353Hd mi aAdasZIN 33HOY no2L u3NSH03 a3AI3o3H SI ZNMVd TMa 'IIISNO S3ISIa0wwoo zs3HI,djaozH 30 'vs zHi imaOSa330o3d HE)Nisnmao Sau fmao3H SMO3SdS z' H9�ra NO •ZNOo �sauia0ww0O 3SMI ROM a H3a SZaaaoHa)uno HO a003 3o s3IHoSN3ANI TI1f s3ISIaowwoo 3s3HS o King ISM Y SNIVS allO�Has 210 TIO 3'IENXVCI asn*dl aovoinie so3FIin01 03MS 33HY 30IOANIRiv a5IBI NOyGUSI'II sa33iaiaoNwooawaum iusY H'I�sInaa SHI :HOlSIAOna VOW 3viaoaw � z�rsoa HOIOANI •03H fl ME) 11 •QAZBa N9IS WWI SJd 'ON 'n+zo ss�e�aina.r�:onxx asev�xs•SSI Sad ON S.H3AIHa XV11 .V,O, L£TL-90Z9b EMS Ni 'SI'IOavNviaN2 80£ Z•£T 61 T 81 L£TL XOH 0 d OZ SIFI3II LQd 00 Z =HSOZkmo L 0 0=t T=NSdO SN ssoHo 3eno soa so axzMAD va 61: 'LZT 6T•LZT Sb09tZZ 90ZZ90099Z OO ONOO ZHa aInaIZ `HHa30o SLTHOZo3 'ISZ'Iz S T 3 zaasNacisia H .anoH9 L6 8 L6 8 b6b'6£OT OHWnr HSaH3 aSH NOINO HSHAdXl 8Z ....T SO T O Hona OHa � o ST 9£ ST 9£ 09Z999L 6b00019 LlSH NVW HV8 SSV70 SNMHSIRa NOSSXaM ZO S OOT Sc T a " 86'6£ 86'6£ tTO8S90 Z£90OT9 H rIHO dL xOH HSH9Ha iiHNVazO NOISXam Zo9O£ ScT 9 b 66 'ISLO.Z anoH9 9b'66 9b'66 b0£85£L SX009THX Z30S Z09_E S%iYits SIa thio ZHu sas so 08ZZ SO T d� :KIaVSOCISla I Hadva' zL £oz. _ *qvsos anoHo 0 96 £Z 66 S Lb8801:8 Z8L£LZZ1: aalaIHnd ldHIVM aai'IHna Hs'IS bZ Scb a A\ N 1111 91 6£ 9T 6£ Lt f, 6£bbb SSZ SHM HFIQQHHO isHOodoa a3stIs to T69 SZ T 7 L£ T9 L£ 19 091LL6L OOOZ£Z881 Fid 9fW IZS ONH4ffV7vv `HHadaa 6svaqac ZO 90I6 S z T ad` o £L OS 16 9T 896b 6 HS11 HaI'Ixala azomav vai xmiu(i vNoziuv ZO £z z S £ OS 8Z OS'8Z Sb65;S0b 8bLt£ ZO 69 T NIVIa kO14 XCL.MV0 Dd'9 MO 9E X.7NCST O w 0 XHa 3 aHNK%M W zz'tot rmxos anoH� 06 LS 96 8Z 9£LL£TT Z6L90998bL NI 9 Tx5 SVaK 'I'ii ,XNVHff SUOriuEls fiZ G Z S 0 Z a N' U H Z£ £v 0989TTZ 899TT. tXsajVr4I ' noz£ £ ssHnMsVua arTASNHf sz 9 Z Sa T 3 ti a .;SIVaK ossos anoHO os'sb Os 56 Ob6Z£LT 00-6L8s8-SZ09b s IYN aHIHa XI 99H IIlad FIdZOSL IbbT S'c T a ]CHIFIa .. �a ixNao x.v HnoX No a iaauo NHK'.3 nOX M H 9 NOD HHSNHOSNn00oy0osaS I&EV V HnOX xs x�a aaoa x X a�Iua uuiowv aozxa aoo a; rFi SSN�ISS(lCari 30IOANI d y' a3aN3X3 axNny slNa: W3si' MOISdIZiaSSQ YT3SI 3ZIS •':)IOftd X�� o: ££096 MI ZaKHF[O o ZNEHZASZ XHK9 6£TNS :VK XMXd ZHIHSXOOHS OZTZT o XHHAI'I3a 'I`KHON LSILI9 #SSHJIKVN SHLOOMI aI H3ddIHS HSIa'I'I3HS a9105 HHIHSXOOHfi F- 'd:gCrdO H3Sav smsam b xvaIHa aria T£bL-968-LTE 39H � a�InHas os sosrens RW s�KTJVs NIIa ssVd- SW2i3s T66b 89Z9b NI 'SI'IOa`dNviami IS aMZ9 M OOOb T 3oH3a0 3SYHJHNd oZZ 'SIZOarNdIQMI OOSXS IIIIIIIIIIIIIIIIIIII IIIIIIIIII IIIIIIIIIIII£III£III0III9IIIPIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIII'IaIIIKIIIkI IIIVO 600/ mO� XMd HHIHSXOOHS OZTZT £ £T6£T98£T Ob6ZTb i5'.�s +++gnZO aI09 SHIHSX00Hfi o l eIIIv s e e o 11v 11 s IIIzIIIIIIrIIIN iSiiz/£0/5 o OOSAS 3O X11iUdOxaIVLLNZQI3dOo aZ)IOA17XID2o sHKossnJ IIII PROPER CUSTOR'S ORIGINAL INVOICE CONFIDENT IIIIIIIIIIIIIIIIIIIIIII 4 IIIIIIIIIIIIIIIIII IIIIIIIIIII IIIIIIIIIII IIIIIII IIIIIIIIIII CONFIDEOICE NUMBER NTIAL PROPERTY OF SYSCO IIIIIII IIII I III VIII VIIIA 3 O DELV.'DATE '. CUSTOMER BROOKSHIRE GOLF CLUB... Goocthmgs 5/03/18 12120 BROOKSHIRE PKWY �� m�r�o� TRIIcx sl11 oe 412990 138513913 3 2 SYSCO INDIANAPOLIS LLC /009 CARMEL IN 96033 / 4000 W 62ND ST ROUTE PURCHASE ORDER b 317-846-7431 INDIANAPOLIS, IN 46268 4491 TERMS -PAST DUE BALANCES ARE SUBJECT TO SERVICE CHARGE DUE FRIDAY 4 WEEKS AFTER ORDER SHELLFISH SHIPPER ID: IN007RS MANIFEST# 617157 NORMAL DELIVERY 10 BROOKSHIRE GOLF 0 12120 BROOKSHIRE PKWY MA: SN139 GARY LEVERENZ y CARMEL IN 46033 9z ITEM UNIT ' vNiT EXTENDED T p INVOICE ADJUSTMENTS y o "QTX ,PACK: SIZE ITEM DESCRIPTION TAx c CODE: PRICE ANouNT PRICE ! x I CODE 4TY t K GROUP TOTAL**** 127.19 MIS GE HUS.', FOR. FUEI,SURCHARGE 4.70 ORDER SU14MARY 42373b H O z 7 N N M ... .. .. a f+ 0 a 0 a i A .. z 0 0 H d z w { CASES SPLIT OT.PCS CUBE GROSS WT. OPEN:11:00 AM CLOSE: 2:00 PMREMIT TO. z P.O. BOX 7137 INDIANAPOLIS, IN SUB 46206-7137 TOTAL 666.89 18 1 19 13.2 308 TAX DRIVER'S NO. PCS COST.s—x—evx°se°ss°F we xxexs NO. PCS TOTAL SIGN DELVD. SIGN v REC. A INVOICE TOTAL 666.89 �\ 1PRESENTATIVE ORTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SUBJECT TO THE STATUTORY TRUST PAYABLE ON OR BEFORE flORIZED BY SECTION 5 C) OF THE PERISHABLE AGRICULTURAL COMMODITIES ACT 1930 V.S.C. 499EN THE SELLER OF THIS COMMODZAINS A TRUST CLAIM OVER THESE COMMODITIES ALL INVENTORIES OF FOOD OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES ANY RECEIVABLES OR PROCEEDS FROM THE SAL OF THESE COMMODITIES ITIL FULL PAYMENT IS RECEIVED.FURTHER YOU AGREE WITH 6/01/18 LAST PAGE PECT TO ANY DISPUTE ARISING OUT OF YOUR RECEIPT OF THESE PRODUCTS/SERVICES: YOU ARE GIVING UP YOUR RIGHT TO SERVE IN ANY CAPACITY.OR TO PARTICIPATE AS A MEMBER OF A CLASS OF CLAIMANTS,IN ANY LAWSUIT INVOLVING ANY SUCH DISPUTE. VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ALLOWED zo Vendor# 359366 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 $162.25 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 138501981 42-390.40 $162.25 1 hereby certify that the attached invoice(s),or 4/24/18 138501981 Plastic Bowls $162.25 1207 101 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 Monday,April 30,2018 I� C 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 IIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIN DELIVERY COPY EE. CUSTOMER CONFIDENTIAL E PROPERTY OF SYSC. I N 4 1 2 9 4 0 1 3 8 5 0 1 9 8 1 0 0 1 F 4/24/18 BROOKSHIRE GOLF CLUB+++ Good�things come from TRUCx STOP, 412940 138501981 3 1 12120 BROOKSHIRE PKWY a% come /000 CARMEL IN 46033 SYSCO INDIANAPOLIS, LLC ROUTE PURCHASE ORDER 4000 W 62ND ST M INDIANAPOLIS, IN 46268 TERMSPAST nUE sALpNCEs ARE 'SUBJECT To SERVICE CHARGE [ 317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER � BROOKSHIRE GOLF SHELLFISH SHIPPER ID: IN007RS MANIFEST# DROP-SHIP m 12120 BROOKSHIRE PKWY MA: SN139 GARY LEVERENZ 0 CARMEL IN 46033 DRIVER: I O S2TY d PACK ,SIZE ITEM DESCRIPTION _ !9.. INVOICE ADJUSTMErrrs % CODE g CE E PRENDED X i CODE': QTY K SK YOUR MA ABOUT SYSCOACCOUNTCENTER.COM & H W YOU CAN EARNCREDI ON YOUR ACCOUNT! . .., . ., . P.O. 10386910 SHIPPER 9 INVOICE #,. 142856098 1. ". *** PAPER & DISPOSABLE *** ,9. A IL . H 1 S 8100 C OMET BOWL PLAS FINESSE 1202 BLK VB12BK 0763874 162.2591. 162.25 b ...' ROP-SHIP,; . . ::. y . ... .' '. GROUP TOTAL**** . .. '. .... .. 0 . : 162.25. Y 2 :ORD7622 . . 1. . M .. . ' i:. , M t .. ^?7 .. ._... ..:' ... ......— .... M % n .. ..... _.. ._.. ..._ .....__.. ....._ 0 .. .. .. .. ,, : .. ,., 9. 0 . .. , -. . .. .., .... >. __ ,,. . ._ L. % % 1.., a .1 I .. .,.. .. 1 ti• :. „, .. .. .... ; 919 I . a , •.::. , .. i • ,.. . y % 1. . .. .. .. ... .. H ,: ...:: .. .. .. Z ... ...i ...::: O ... ,. M .. , .- _ .,, - M. ..:. : ..... .. :: :, , , ,. .. ..., ...:. . axK CASES SPLIT OT.PCS CUBE GROSS WT. OPEN:1100 AM CLOSE: 2:00 PM •_,REMIT•To .. I P.O. BOX 7137 M 1 1 .7 31 INDIANAPOLIS, IN SUB 46206-7137 TOTAL 162.25 1 1 .71 31 TAX DRIVER'S NO. PCS I CUST. ....—..sv —E.oz—as NO. PCS TOTAL SIGN DELVD. SIGN v REC. X INVOICE TOTAL 162.25 MPORTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SUBJECT TO THE STATUTORY TRUST PAYABLE ON OR BEFORE UTRORIZED BY SECTION 5 (C) OF THE PERISHABLE AGRICULTURAL COMM0DITIES ACT 1930 (U.S.C. 499E(C11. THE SELLER OF THIS COMMODI TAINS A TRUST CLAIM OVER THESE COMMODITIES ALL INVENTORIES OF MOD OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES, SPECT TOCANY D SPUTE ARISINGIVABLES OR SOUT OFOM THE SiU YOUR RECEIPT OFETHESEODITIES PRODUCTS%SERVTIL ICES:LL PAYMENT YOU AREIGIVINGIUPDYOUR RIGATYOU TO SERVE INANY 5/25/18 LAST PAGE PRESENTATIVE CAPACITY,OR TO PARTICIPATE AS A MEMBER OF A CLASS OF CLAIMANTS,IN ANY LAWSUIT INVOLVING ANY SUCH DISPUTE. 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 $879.64 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 138504194 42-390.40 $879.64 1 hereby certify that the attached invoice(s),or 4/26/18 138504194 Food $879.64 1207 101 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,April 26,2018 did/ 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 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1111111111111111111 CUSTMER'S ORIG INAL olOMERCONFIDENTIAL PROPERTY OF SYSCO:CINVOICE NIIIIIIIIIIIIIIGI4/26/18 O0441ngs BROOKHIRE 12120 BROOKSHIRE GOLF CLUB... ��come �from �O�4 W TRucx sTOP 412940 138504194 0 1 M 12120 BROOKSHIRE PKWY / /008 CARMEL IN 46033 SYSCO INDIANAPOLIS, LLC ROUTE PURCHASE ORDER 000 62ND ST 4455 TERMS -PAST DUE BALANCES ARE SUBJECT TO SERVICE CHARGE:-' 0 317-846-7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 WEEKS AFTER ORDER BROOKSHIRE GOLF SHELLFISH SHIPPER ID: IN007RS MANIFEST# 616534 NORMAL DELIVERY °% 12120 BROOKSHIRE PKWY MA: SN139 GARY LEVERENZ z CARMEL IN "46033 DRIVE ITEM, UNIT _ `• EXTENDED T p INVOICE ADJUSTMENTS " ° PACK; SIZE ITEMiDESCRIPTION TAx o S`TY CODE PRICE nNouNx PRICE X,I coDE'i• QTY: SK YOUR MA ABOUT SYSCOACCOUNTCENTER COM & HOW YOU EARN CREDI ON YOUR OUNT! 7. .: *** MEATS *** . .. F 1 S 605.3 OZ NT BEEF PATTY GRD SEA HS FRZ 7703003 6964597 73.80 73.80 . y F 1 S 25 LB JHNSVLE BRATWURST CKD ULTIMATE 5X1 101558 2116860 43.32 43.32 b \1 F 2 S 2 LB BRLCLS E'RANK ALL-MEAT 5X1 6 IN 7486506792 1137736 28.95 57.90 °z GROUP TOTAL**** 175.02 n *** CANNED & DRY *** C 1S ONLY36CT MARS CANDY BAR MILKY WAY 255386 1771785 26.81 26.81 N M �J C 1S ONLY 4 CT HERSHEY CANDY BAR PAYDAY 80723 7030414 18.75 18.75 �I C 1S NL 8 CT SNICKER CANDY BAR SNICKER 1.86 OZ 256479 1793837 36.50 36.50 0 % V C 1S ONLY48 CT M&M CANDY M&M PEANUT 1.74 OZ 4380788 34.70 34.70 ~ C 1S ONLY36 CT REESES CANDY PEANUT BUTTER CUP 44000 5197769 27.38 27.38 0 N 1 S 641.502 SUNCHIP CHIP MULTIGRAIN GRDN SALSA LSS 44428 6799136 36.25 36.25 1 CS 230 CT LAYS CHIP VARIETY BKD 92268 4830455 27.51 27.51 1 cS 160 CT. LAYS CHIP VARIETY SYSCO/FRITO LAY 3.1831. 6586721 27.51 27.51 1 S 483..750ZPLANTER PEANUT SALTED 10029000077086 3259928 27.56 27.56 GROUP, TOTAL****:' 262.97 *** PAPER, &_DISyPOSABLE *** „ 1 S 1 50CT SYS CLS BAG PLAS RECLOSE GAL XX HE 304985530 7863634 49.95 49.95 7tl 1 S1000 T YS CLS FORK PLAS BLK MEDHVY MDLNGT YMWFESYS 8003370 62.86 62.86 0 "GROUP" TQTAL 12.81.:1: *** SUPPLY &. EQUIPMENT *** v D 1 CSI 24 HR SYSCO FUEL CANNED. CHAFING WICK 4HR 10324 4783678 66.99. 66.99 m ROUP :TOTAL „ ., , CASES SPLIT OT.PCS CUBE GROSS WT. OPEN:11•00 AM CLOSE: 2:00 PM REMIT To P.O. BOX 7137 M 11 5 16 11.9 138 INDIANAPOLIS, IN SUB 46206-7137 TOTAL TAX DRIVER'S NO. PCS COST.sxcseo 0. PCS TOTAL SIGN DELVD. SIGN v REC. INVOICE A TOTAL IPRESENTA ORTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SUBJECT TO THE STATUTORY TRUST PAYABLE ON OR BEFORE HORIZED BY SECTION 5 (CI OF THE PERISHABLE AGRICULTURAL COMMODITIES ACT 1930 V.S.C. 499EN,. THE SELLER OF THIS COMMODIAINS A TAUST CLAIM OVER THESE COMMODITIES ALL INVENTORIES OF FOOD OR OTER RODUCTS DERIVED FROM TESE COMMODITIES,PECT TOCANY DISPUTE ARISINGS OR SFROM OUT OFTHE SM OF YOUR RECEIPT OFETHESEODITIES PRODUCTS%SERVIL IC S:LL PAYMENT YOU AREIGIVING UPOYOUR RIGATYOU TO ERVE INTANYCONT. ON PAGE 2 TIVE CAPACITY,OR TO PARTICIPATE AS A MEMBER OF A CLASS OF CLAIMANTS,IN ANY LAWSUIT INVOLVING ANY SUCH DISPUTE. �' llIII llllllll111111l 1111 Ill IIIIIIIIIII11111111111111111Ill 111111111111111111111111111111111111Ill CUSTOMER LS ORIGINAL UNVMERCE CONFIDE TE NU�tffiEPROPI.•'RAAGEE : SYSCO • I N 4 1 2 9 4 0 1 3 S 5 0 4 1 9 40 0 2 C 4/26/18 Good ingS BROOKSHIRE GOLF CLUB+++ come from T"C STOP 412940 138504194 0 2 12120 BROOKSHIRE PKWY S��sco� /008 CARMEL IN 46033 SYSCO INDIANAPOLIS, LLC ROUTE PURCHASE ORDER M 9000 W 62ND ST 4455 TERMS---PAST DUE BALANCES ARE•SUBJECT TO SERVICE CHARGE .: p 317-846-7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 WEEKS AFTER ORDER BROOKSHIRE GOLF SHELLFISH SHIPPER ID: IN007RS MANIFEST# 616534 NORMAL DELIVERY ro 12120 BROOKSHIRE PKWY MA: SN139 GARY LEVERENZ CARMEL IN 46033 n VER: QTY n PACK SSZE LTEMDESCRIPTION ITEM UNIT SIT ; EXTENDED A p INVOICE ADJUSTMENTS x CORE PRICE AMovNx; PRxCE x I QTY•: *** PRODUCE *** -N (C 1 CS 25 LB BBRLIMP SALAD CHICKEN 51071 2510717 47.77 47.77 C 1 CS 25 LB BBRLIMP SALAD TUNA ALBACORE 51194 2511947 49.60 49.60 GROUP TOTAL**** 97.37 ! *** DISPENSER *** n H 1 S 1 GAL OCACOL SYRUP COKE CLASSIC 5X1 BIB 04250010 4090593 79.89 79.89 °z 1 S 15 GAL COCACOL SYRUP COKE DIET 5X1 BIB 04240010 4273546 79.89 79.89 c . *10k* y GROUP TOTAL: ..::: „ `i y MISC GE HGS FOR FUEL SURCHARGE 4.70 * O ORDE SUMMAY 35797 35816 0 a . , N O yza m i yya n .. .. .. y d :. ...f, ..^....... ...... ........ ... .. ... z z K CASES I SPLIT k OT.PCs CUBE GROSS WT. OPEN•11•00 AM CLOSE 2:00 PM REMIT TO z P.O. BOX 7137 4 4 2.5 120 INDIANAPOLIS, IN SUB 46206-7137 TOTAL 879.64 15 5 20 14.4 258 TAX DRIVER'S NO. PCS CUST.sxceaso xervoxce evxnsxces oe n..,.xm�s NO. PCS TOTAL SIGN DELVD. SIGN X REC. INVOICE TOTAL 879.64 UTAINS:A:TRUST :- THORIZED VISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SUBJECT TO THE STATUTORY TRUST PAYABLE ON OR BEFORE ION 5 (C) OF THE PERISHABLE AGRICULTURAL COMMODITIES ACT 1930 (U.S.C. 499EN,. THE SELLER OF THIS COMMODIAIM OVER THESE COMMODITIES ALL INVENTORIES OF FOOD OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES5/25/18 LAST PAGE S OR PROCEEDS.FROM THE SAL OF THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED.FURTHER YOU AGREE WIT�3PUTE ARISING OUT OF YOUR RECEIPT OF THESE PRODUCTS/SERVICES: YOU ARE GIVING UP YOUR RIGHT TO SERVE IN ANY ACITY,OR TO PARTICIPATE AS A MEMBER OF A CLASS OF CLAIMANTS,IN ANY LAWSUIT INVOLVING ANY SUCH DISPUTE.