185282 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 362576 Page 1 of 1
j. ONE CIVIC SQUARE HCO COFFEE TEA INC CHECK AMOUNT: $91.90
CARMEL, INDIANA 46032 1114 E 52ND ST
INDIANAPOLIS IN 46205 CHECK NUMBER: 185282
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4355100 4355100 91.90 COFFEE
Invoice
Invoice Number:
HCO Coffee Tea 800781
1114 E. 52nd Street
Indianapolis, IN 46205 Invoice Date:
Apr 16, 2010
Page:
1
Sold To: Ship To:
CARMEL REDEVELOPMENT COMMISSION
30 W. Main Street Suite 220
Carmel, IN 46032
Customer ID Customer PO Payment Terms
CRD Net 30 Da
Safes Rep ID Sh ipping Metho Ship Date Due Date
WILB 1 Hand Deliver 4/16/10 5/16110
Quantity Item Description Unit Price Extension
1.00 CUSTOMIZED PAR -LEVEL INVOICE
1.00 3102270 FIRENZE BLEND 18/2.5oz 43.90 43.90
1.00 895900 FUEL CHARGE 3.50 3.50
1.00 5070270 FIRENZE DECAF 18/2.5oz 44.50 44.50
I
Subtotal 91.90
Sales Tax
ORDER ACCEPTED AS COMPLETE; CUSTOMER Shpg Hndlg
AUTHORIZED SIGNATURE DATE REC'D
Total Invoice Amount 91.90
Payment Received 0.00
Check No: TOTAL 91.90
Y Prescribed by Stale Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
F1
C O Ca f 4 Q e (1 h d 1 c4 Purchase Order No.
E. 52 nd SJ, Terms
q0_65 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1� -l0 8001$1 o -C�e QI, i
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
N c o (of-Fee Cj d led IN SUM OF$
I
14 C... 52
ytJrdhdPoJis, A
9).g6
ON ACCOUNT OF APPROPRIATION FOR
X02 �3s5�o
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
43 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
-27 20/0
Si azure
Director of Redevelopme
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund