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187048 06/23/2010
CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1 •5�` ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $1,442.77 CARMEL, INDIANA 46032 PO BOX 7137 w IoN `a INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 187048 CHECK DATE: 6/23/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 006090469 373.00 FOOD BEVERAGES 1207 4239040 006180731 1,069.77 FOOD BEVERAGES r Nt Good things E4id /€FRS 'ORIGIN L II U1710E CONFIDENTIAL PROPERTY OF SYSCO come from pIV i]ATE i; CllST(7MER, INU IC NUMBER ".PAGE 1. BROOKSHIRE GOLF CLUB �l /Sco 1 12120 BROOKSHIRE PKWY TR cx _s OP 412940 006090469 5 1 SYSCO INDIANAPOLIS, LLC A_. CARMEL IN 46033 4000 W 62ND ST R INDIANAPOLIS IN 46268 PAS:t Due $A aN�cs aRE s3B�ECr7o 317 846 7431 30 DAYS FROM DATE OF INVOICE DE VER CITY OF CARMEL DRIVER: PARKER, JEFF Z 1 CIVIC SQUARE 9 1, v 'UNEF TAX EX7:£ND£D P QTY PAC SIDE €TEM..DECRIPT:ION o ITEM: r:, CODE? PRfCE ?AMOUNT. P:RIC£ X E :7 n DAIRY m C...I:,:..5 NL 5 LB BRLCLS CHEESE AMER YEL 120 5L1 28131: b697114 13 98 13 98. i GRO.UI? TOTALS 13 98 m MEATS_ s. n .rl F 110 LB BRLCLS.FRANK ALL —MEAT 5X1 6 IN 37 3,6 070 1 37736 19 55,. 58 65. z 1,1 C$: GROUP .TOTALS Si6.65 FROZEN 1p F G5 44 2502 KRSIMP MUFFIN ASST BLl.BAN CHOC I W 07347 021825 7 13114 2. 25. 21 25 N 1. :R 2.; .15 .:i€ o CANNED DRY A C_ S NL,48 CT NICKER. CANDY BAR 5N_ICKER 2 07 OZ ,01202,4348389 29 30 29 30 r. D CS 23 CT LAYS CHIP VARIETY PK BAKED BFY 32198`55$1863 '29 15 29 15 0 I. 1. D CS 160 CT: AYS._ CHIP VARIETY FRITO LAY 31831; 658672126'9 8 26 98 Irl CS, 1212_QZ,,, RENCHS CLS SQUEEZE 415 0 4736070 20 50 20 50 0 .11 n C PLI 15 GAL CHWRTZ PICKLE CRS CUT KO 2965 270756.1028919 34 00 34 00 D CS 101" LB BRLCLS SNACK MIX SPCY ''0' mimlp GROUF T TAL *X 91069 996329 6 62'.7 2 20 >2.. 6. ;:II A s; PAPER DISPOSABLE ;F A 1. b D S NL 5�O0.CIT YSCO FOIL SHEET 9X10 751N 5ILVER W69372 6938500 12 .'98 '12.9$ 1. CI D CS 41OOCT YSCO GLOVE LATEX PWDRFREEMD X00 H14 CP 9 39796 35 05 35 05 GROUP TOTAL 4$.03 o PRr)DUCE D m C CS 112CT ACKER APPLE RED DEL FCY 1344092 8 28 8 28 C CS 15 LB ACKER BANANA GRN TIP FRESH REPACK 158542`1 00965 6 39` 6 39 M r. C CS 15 LB YS IM' O RED FRESH JUMBO 1039494 13 77' 13 71 GROUP TOTAL m r 1 m r. S r F.O. BOX 7137 1 3 17 12.5 17.9 INDIANAPOLIS IN SUB ;01 4206 -7137 TOTAL C TAX NO. PCS CUS y��E� INVOICE EVIDENCES RECEIPT OF ALL ITEM$. NO PCS TOTAL DRIVER'S DELVD. SIGN y am RE. INVOICE SIGN IM TAINT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODI TIE$ LISTED ON THIS INVOICE ARE SOLO SUBJECT TOTAL Tp 7HE S7g7UYp�Y TF2UST T O IZE By SE CTIpN C OF TH PERI'IlyLN q�,gICULTURAL CpM�ry0DIT 1ES AC7 1 0`U S. C. 499EIC11. THE SELLER OF 7HSE COMf�ODITIES RETAIN& A TRUSCLAIM OVER THESE COMMODITIES, ALL INVEFJTORIES OF PAYABLE ON OR BEFORE ONT. QN PAGE 2 FOOD OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED. Good things CONFIDENTIAL PROPERTY OF SYSCO nE .V ATE cLSTOn ER V fOE 'Nl1MBER' 'PA E... S ii 1 :412940 006090469 5 2 12120 BROOKSHIRE PKWY TR crc -s o� 5YSC0 INDIANAPOLIS, LLC o- CARMEL IN 46033 4000 W 62ND ST�`�' D INDI IN 46268 Pasli oue'eailaNC�s sLC i Ta. o 317 846 7431 30 DAYS FROM DATE OF INVOICE o T m CITY OF CARMEL z 1 CIVIC SQUARE DRIVER: PARKER, JEFF z v �6JN13 TAX EXTENDED 3 z �1 QT'f PAC S[ZE €TEI19 €1ESCRIPTI ©N o C. r:. C00E i?RICE ArADUPET PRICE X n Ok2D S RY X4:26 b 0 n I D r: 1. N P A 37 -I 1. C N N O :i D Z .—I.''....... 11 T A 1. m 'i 1. c is .,i. 'i: D :.:::v i, m .-1. 7J T DO m v:i... m CLOSE a RE1ttT TO; m P•0. BOX 7137 INDIANAPOLIS IN SUB 46206 -7137 TOTAL 373.00 1 3 17 12.5 179 c TAX NO. PCS OUST `DIED INVOICE EVIDENCES RECEIPT OF ALL ITEMS. NO. FCS TOTAL DRIVER'S DELVO• SIGN A y SEC. SIGN INVOICE IMPORTANT PgCA PROVISION: THE PERISHABLE IgpGRIC(U T COMMODI gTgI E S l ON THIS I C❑ LoNMVOI C ARE SO SUBJECT O E LLO SgU3B TOTAL 373.00 T C S7TgH7EU L R L Y TRU I C RI F�� B gE C ftETAINS C TAUST CL RM R OVER TH SE OALLI�NVEr�TORIES O�U C. FOOD OR OTHER PROBUCTSREOERIVEO FROM TT COMMODITIES. ANO ANY RECEIVABLES OR PROCEEBS FROM THE SALE OF PAYABLE ON OR BEFORE /09/10 LAS PAGE THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED. VOUCHER NO. WARRANT NO. ALLOWED 20 Sysco Indianapolis LLC IN SUM OF 4000 W 62nd Street Indianapolis, IN 46268 $373.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1207 006090469 42- 390.40 $373.00 1 hereby certify that the attached invoice(s), or 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, June 11, 2010 Director, Broo ire Golf Club Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev 19E 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/09 /10 006090469 Food $373.1 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 20 Clerk- Treasurer