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181666 01/20/2010 CITY OF CARMEL, INDIANA VENDOR: 362632 Page 1 of 1 ONE CIVIC SQUARE TREAT AMERICA FOOD SERVICES a 8500 SHAWNEE MISSION PA RKWAY CHECK AMOUNT: $209.30 CARMEL, INDIANA 46032 MERRIAM KS 66202 CHECK NUMBER: 181666 UN CHECK DATE: 1/20/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4355100 641373 209.30 PROMOTIONAL FUNDS INVOICE #641373 ROUTE 604 604 DRIVER 239 FIELD, WILLIAM 01/08/2010 12:57pm Treat America 9702 East 30th Street Indianapolis, IN 46229 CUSTOMER 372602 CARMEL POLICE DEPT. 3 Civic Square Carmel, IN 46032 TERMS: CHARGE DELIVERED [PIN] ITEM CC PRICE QTY AMOUNT [0354] MAXWELL HOUSE MASTER BLEND 42/1.1 86635 42 26.50 5 132.50 [0657] AD CREAMER NON -DAIRY 120Z SHAKER 1 1.75 7 12.25 [0722] MAXWELL HOUSE DECAF 42/1.10Z 39039 42 27.50 2 55.00 [0186] AD SUGAR CANISTER (24/200Z) 1 1.91 5 9.55 TOTAL DELIVERED 19 209.30 TAX EXEMPT TOTAL DEPOSIT .00 INVOICE TOTAL 209.30 NO PAYMENT RECORDED "Thank you for your business" CUSTOMER SIGNATURE: Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 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. Payee Treat America Purchase Order No. 9702 East 30th Street Terms Indianapolis, IN 46229 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1/8/10 641373 payment for coffee 209.30 Total 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 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Treat America IN SUM OF 9702 East 30th Street Indianapolis, IN 46229 209.30 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT hereby certify invoice( s), DEPT. I hereb certi that the attached invoices or 1110 641373 551 209.30 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 January 13 20 1'0 Signature Chief of P01irP Title Cost distribution ledger classification if claim paid motor vehicle highway fund