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Home My WebLink About331518 10/25/18 r CITY OF CARMEL, INDIANA VENDOR: 365677 ® ONE CIVIC SQUARE GORDON FOOD SERVICE, INC CHECK AMOUNT: $********95.11* CARMEL, INDIANA 46032 PO BOX 88029 CHECK NUMBER: 331518 MiroN�. CHICAGO IL 60680-1029 CHECK DATE: 10/25/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 926114025 95.11 FOOD & BEVERAGES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 365677 GORDON FOOD SERVICE, INC IN SUM OF$ CITY OF CARMEL PO BOX 88029 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. CHICAGO, IL 60680-1029 Payee $95.11 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 926114025 42-390.40 $95.11 1 hereby certify that the attached invoice(s),or 10/19/18 926114025 Food $95.11 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 Friday,October 19,2018 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 Page:1 of 1 Gordon P•O.Box 1787 INVOICE FOOD SERVICE STORE Grangfscdm MI 49501-1787 INVOICE# DATE 1-800-968-7500 926114025 10/19/2018 TAL ROUTING# STOP# CUSTOMER# PURCHASE ORDER SALES# REPRESENTATIVE MP# MP LOCATION TERMS N 100133245 4040 73406 1905 Fishers Net 30 Days Kristoffer Miller#73406 SHIP TO: Brookshire Golf Club 12120 Brookshire Pkwy Carmel,IN 46033 ITEM CODE CITY DESCRIPTION CAT COST GUIDE SPECS UNITPRICE TAX AMOUNT 8146401 1 EACH CHIP VARIETY PACK LSS 2-30CT FRITOL 1 12.99 12.99 4335231 1 EACH CREAMER ORIG FLVR NDAR CUP 4-50 COFFM 6 4.99 4.99 2163210 2 CASE 1-8CT MINI SUB BUNS MARKETPLACE 1 2.69 2.69 5.38 6058910 2 CASE 1-16CT HOT DOG BUNS MARKETPLACE 1 2.50 2.50 5.00 4351940 1 CASE DRINK ASST PK WM 24-20FLZ GATOR 9 0.58 13.99 13.99 1408231 1 EACH Hershey's Milk Choc W/Almond Candy Bars 1 19.99 19.99 6058630 1 CASE 1-16CT HAMBURGER BUNS MARKETPLACE 1 2.50 2.50 2.50 6806561 1 EACH GFS DELISLCD BKD VIRGINIA HAM 3 8.29 8.29 6806131 1 EACH GFS DELISLCD CKD TKY&RST 3 7.99 7,99 6171510 1 CASE DRINKASST FIERCE WM 24-20FLZGATOR 9 0.58 13.99 13.99 PRODUCT CATEGORY SUMMARY NUMBER OF PIECES SUBTOTAL 95,11 1-GROCERY 2-FROZEN 3-MEAT 4-SEAFOOD 45,86 16.28 FREEZER COOLER WAREHOUSE I MISC. TOTAL TAX 54POULTRY 6-DAIRY 7431SPOSABLES &SANITATION Customers signature evidences receipt of all items listed and its promise to pay INVOICE TOTAL 95.11 4.99 the amount due to GFS.Customer agrees that If a check draft and/or order of 9-0ISP.BEVG 10-PRODUCE 11-TABLETOP payment('Transaction')Issued for payment of this Invoice Is dishonored,GFS may re-present the Transaction and issue a draft against the account upon which the Transaction Is drawn for a fee up to the maximum permitted by law. PAID 0.00 27.98 TOTALS BY TAX CATEGORY Received By: SALE NBR 24 %RATE TAX %RATE TAX LANE NBR 02 The perishable agricultural commodities shown this invoice are sold subject to the V7" V USER ID 49803 statutory trust authored by section 5(c)of the Perishable Agricultural Commodities Act,1930(7 U.S.0 499e(c)).The seller of these commodities retains a trust claim over DATE 10/19/2018 Nese commodities,all inventories of food or other products derived from these commodities and any receivable or proceeds from the sale of these commodities until TIME(GMT) 12:40:00 full payment Is received.Eggs delivered in the state of Illinois include an Illinois Egg Signature: Inspection Fee in the price.Maryland MDA Inspection Fees at a rate of$.08 per dozen *Acceptance constitutes agreement to a timearice differential of 1 1/2%er month on the unpaid balance after the due date ____________ PLEASE CUT ALONG THE DOTTED LINElh�w y� PLEASE CUT ALONG THE DOTTED LINE THEN RETURN BOTTOM PORTION. �{' THANK YOU FOR YOUR ORDER. THEN RETURN BOTTOM PORTION. v PLEASE ENCLOSE THIS STUB WITH PAYMENT. Gordon Food Service,Inc. P.O.BOX 88029 Chicago,IL 60680-1029 UNT PAY THIS AMO CUSTOMER# INVOICE# DATE 95.11 100133245 926114025 10/19/2018 IIIIIIIIIIIIIIIIIIIIIIIIII;IIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIILIIIII IIIIIIII 100133245910926114025000009511700000951170