187109 06/24/2010 CITY OF CARMEL, INDIANA VENDOR: 361108 Page 1 of 1
ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTCp
CARMEL, INDIANA 46032 PO Box 5219
CHECK AMOUNT: $484.99
CAROL STREAM IL 60197 -5219
CHECK NUMBER: 187109
CHECK DATE: 6/24/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 PARKS 126.97 7003 -7311- 0007 -2984
1082 4239039 PARKS 126.97 7003- 7311 -0007 -2984
1095 4239040 PARKS 231.05 7003 7311 -0007 -2984
Please Direct Inquiries To: 1- 800 220 -8594
cbs COSTCO
WHOLESALE
Account Number New Balance Payment Due Amount Past Due Due Date
7003- 7311 0007 -2984 $502.77 $.00 $.00 06/20/2010
Billing Date Credit Line Available Credit
05/26/2010 $5,000 $4,497.23
This communication serves as official notice that all calls to /from our offices may be monitored and /or recorded for quality
assurance purposes.
TDD /Hearing Impaired: 800 365 -0186
STATEMENT OF YOUR ACCOUNT
FINANCE CHARGE SUMMARY
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
Reg 00014 $24.46 0.00000% 00.00% $.00 00.00% $502.77 $.00 06/26/2010
ACCOUNT DETAIL
Transaction Transaction Invoice User P.O. Transaction
Date Description Number ID Number Amount
05/20/2010 COSTCO ON LINE 847 187996620211 00001 $135.86
05/25/2010 COSTCO ON LINE 847 116337820211 00001 $135.86
00001 SUBTOTAL: $271.72
05/19/2010 COSTCO WHOLESALE -346 021444 00013 $231.05
00013 SUBTOTAL: $231.05
05/14/2010 PAYMENT THANK YOU 00001 $797.40
Online Account Access lets you take control of your Account anytime, anywhere. Registration is easy, secure and waiting for you at
www.hrscommercial.com. �r��q ¢yQpyy �q
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T J UN 0 7 2010
Return the below portion with payment. For billing errors or questions please refer to the back of the statement. Page 1 of 2
I
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
cos COSTCO
N/HOLESALE
ACCOUNT SUMMARY BALANCE SUMMARY
Outstanding
CURRENT 1 -29 DAYS PAST DUE 30 -59 DAYS PAST DUE Transaction $797.40
+New
$.00 $.00 $.00 Purchase(s)/Debit(s) $502.77
60 -89 DAYS PAST DUE 90 -119 DAYS PAST DUE 120 -149 DAYS PAST DUE +New Fees $.00
Finance Charges $.00
$.00 $.00 $.00
Payment(s) $797.40
150 -179 DAYS PAST DUE 180+ DAYS PAST DUE Credit(s) $.00
$.00 $.00 New Balance $502.77
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#346 CASTLETON, IN
6110 EAST 86TH STREET
CASTLETON, IN 46250
MEMBER #111787920129 `Xi
RESALE ON
E 1101 MIL...' WAY 16.85
E 1101 MILWAY 16.6,55
E 1160 SKIT1 ES 17.49
E 1160 SKIT ES 17.
E 919157 FRUIT(SNACKS 10.79
E 919157 FRUIT SNACKS 10.(9
E 503494 FIZZLD� \SKITL 12.59
E.. 503494 FIZZLDNKITL 12.59
E 1103 3 MUSKETEERS 16.85
E 1103 3 MUSKE EERS 16.66
E 1103 3 MUSKOTEERS 16..85
E 503494 FIZZLDkSKITL 12.59
E 1151 STARBU:ST '17.4
E 1151 STARBUR.S: 17.
E 1151 STARBURST 17.49
I
NON RESALE TOTAL 251 .00
TOTAL 11WAROA
VF Costco Wholesale 231.05
XXXXXXXXXXXX2984 SWIPED
05/19/10 11:50
Se9 000045 APP 021444
COStCO Wholesale ResP: AA
Tran ID 013930135000
Merchant ID 99034611
APPROVED PURCHASE
AMOUNT: $231.05
0346 009 0000000076 0070
CHANGE G0
TOTAL NUMBER OF ITEMS SOLD 15
CASHIER: Zee A RE&h .i
SAAVIA oi [t; 11 :50 0346 09 0070 76
THANK YOU!
PLEASE COME AGAIN!
Costco receipt Page I of I
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What's New Appliances Auto Baby Beauty Bed Bath Books1CDs/DVDs Computers Decor Electronics Floral Food Furniture
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Your Receipt
Thank you for shopping costco.com. Your order is in process.
Your order number is: 202669978
Order Date: 5/20/2010
Please print this page for your records.
Billing Address Pal nent Method
0908719,7)l W guos
Carmel Clay Parks Recreation Member Numbe 1 T )'�_lr 7 8 t
co Credit Card: "2984
1411 E. 116TH ST tl
CARMEL, IN 46032 MAY 4 1 20
Shipping
Tiffany Buckingham
Monon Center
1235 CENTRAL PARK DR E
CARMEL, IN 46032-4421
Your Order
Qty Description Ship Method Price Item Total
1 TRINITY 6-tier Chrome Shelving Standard $99-99 $99-99
Item 341584
Subtotal: $99-99
Shipping Handling: $26.98
Tax: $8.89
Order Total: $135.86
Please print this page for your records. j Em=0
An e-mail confirmation will be sent for your order. If you have any questions, please go to customer service.
Shop Confidently
Membership: We will refund your membership fee in full at any time if you are dissatisfied.
Merchandise: We guarantee your satisfaction on every product we sell with a full refund.
Exceptions: Televisions, projectors, computers, cameras, camcorders, iPod/MP3 players and cellular phones must be
returned within 90 days of purchase for a refund.
How to Return: Simply return your purchase to any one of our Costco warehouses worldwide for a refund (including
shipping and handling). If you are unable to return your order at one of our warehouses, please contact customer service or
Call our customer service center at 1-800-955-2292 for assistance. To expedite the processing of your return, please
reference your order number.
CUSTOMER SERVICE I ORDER STATUS I REBATES I CREDIT CARDS I COSTCO CONNECTION MAGAZINE
P,iv Stom —or d r ms and R av F LIT 'c<;
https 512012010
Costco Fund 109 Fund 108
ee a Genera
Food program program
Beverage supplies supplies
V# 361108 Invoice 4239040 4239039 4239039
1095 -1 1082 -7 1081 -6
05/19/10 21444 231.05
05/20/10 202669978 126.97 .com
05/25/10 202873361 126.97 .com
231.05 126.97 126.97 484.99
Costco 'Fund 109 Fund 108 TOTAL
General General
Food program program
Beverage supplies supplies
V# 361108 Invoice 4239040 4239039 4239039
1095 -1 1082 -7 1081 -6
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
(Costco) Purchase Order No.
361108 HSBC Business Solutions Terms
P.O. Box 5219 Date Due
Carol Stream, IL 60197 -5219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5120110 7003731100072984 Food Beverage 231.05
5120110 7003731100072984 General Program supplies 126.97
5/20110 7003731100072984 General Program supplies 126.97
Total 484.99
1 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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
(Costco)
361108 HSBC Business Solutions Allowed 20
P.O. Box 5219
Carol Stream, IL 60197 -5219
In Sum of
484.99
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1095 -1 7003731100072984 4239040 231.05 i hereby certify that the attached invoice(s), br
1082 -7 7003731100072984 4239039 126.97 bill(s) is (are) true and correct and that the
1081 -6 7003731100072984 4239039 126.97 materials or services itemized thereon for
which charge is made were ordered and
received except
17 -Jun 2010
Signature
484.99 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund