188073 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
ONE CIVIC SQUARE SYSCO FOOD SERVICES
e CARMEL, INDIANA 46032 PO BOX 7137 CHECK AMOUNT: $2,408.25
INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 188073
*I IOM GO
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 007011219 1,821.18 FOOD BEVERAGES
1207 4239040 007090566 587.07 FOOD BEVERAGES
Good things CONFIDENTIAL PROPERTY OF SYSCO
come from E?ELY gATE c�srrM€R rNiv cE >RtLf7V16 rc
BROOKSHI RE GOLF CLUB C�® 1 1
12120 BROOKSHIRE PKWY TR cc s °B 412940 007011219 8 2
SYSCO INDIANAPOLIS, LLC a
CARMEL IN 46033 4000 W 62ND ST Rou
INDIANAPOLIS, IN 46268 PAST DUE BALANeES. ;ARE: SBBJEr To
CHAR 0
317 846 7431 30 DAYS FROM DATE OF INVOICE
MA RMAL DELIVERY 0
M
CITY OF CARMEL z
1 CIVIC SQUARE DRIVER: TASCA, JOHN z
CARMEL IN �6032
QTY M: PAC S #�E
'ITEM:::: EXiT6�1t�ED.i P a
€T11A bESCRIPT #OPf v
F: CDDE PRICE..:' AMDllki7 'PRICE X
b
T
T
U 1201..4. Q AAiTER CRACKS t .P'EANUT BTR TOAS`Y'..ROUND..::; 75]:3 Z x:9192 !;:24::95
n
D >.5... 1' -2403 SE.REC:.KETCHUP SQLIEEZE.::B:TG.. OUYA24 9 1`::2278 >26.7.0': 26.7:0:.. m
n
D CS...1.2 2 .OZ?.:RENCHS::.M]STARD YELLCIW.CLS. S.QUEEZE :::415 :0.7567::7 4 3'6070...'::.20:50: <20:.50.
D CS CANTER PEANU'' Z
07:74 4:9.379. 21.9;8'
n
r
y
1.0 LB MI CLS ..S MIX S PC Y..CREOLS 62 72: m
91.059 9 61032.9 3.1:.3E
N
D CS 722..OZ LAN:TER SNACK TRAIL :M11 FRUIT IIUTaa 193 ?000026.:4 .3!669$ '35 0
1.0 J35.10.
p
D 7!22..03..:< LANTER �SNAC.K.TRAIL':;MIX <NUT &.::GROG.:::.
19.3> 00.002:7. 4 .366$6 33.82'. 33::.82'
2423 50 >Z RIZtJNA :TEA. i.C:B. ARNQLD...PALMER L`PE: :.740:6.9 .7:0434 21...59. .:.215 90.: A
4
GROUP TOTAL 578.27
:.I< PAPER': DI
m
0
A CS ...1!: 80.. CT: YSCO C 7P. PLAS TRANS 15:0 :.SOFT Y :I60SYS 71 13:04 €:59...98.. 5g., 98
A L. 5O0u. S. CQ F:O I, S..I E2'.:9XlQ .7!5IN S:ILVER< X16937;2..6 -3.:5 p
z
YS I;MP'F()RK.PLA Ir'K.HW FULL:: Y';WFESYS. 7 8:9207 45, 45.50;
U...: ;S JOOC`� YSC GLOVE IR'E %:PWDRFREE MFIZ ;1D0 H14 G ?..9 3;9796 35 O.a 70.10;
I3 1Q0 CT XSCQ GIQVE POLY. ;III SP :CAST :MED 104;FHC 14CPSY 8 7:7671 17 73 35 45; p JL1 GROUP TOTAL 237.00
;PRODUCE.
0
..12CT ACKER APPLE RED .DEL FCY F'RE5H..... 1344092 o
D
C .CS U--.PACK R...gANANA :FRESH.... 6 6.!6221. 6.'6a 6..65:. o
C CS.. .10 LB YS N;AT LETTt10E' ROMAINE C!ROWN:?LEAVE'S X540494 6 4Q494 €26.55 26, 65'
m
Z
C :'3 �+B AGKER...LE�I TCE°SFRSG M H
201;3 x.09
5 ::'i1. 12 7 6.
C OU CS LB YS IMP ONION RED FRESH DUMB A' 1 39494.,: m
UT /STOCK 1
;T.O
P.O. BOX 7137
S 2 2 30 22.4 580 INDIANAPOLIS IN SUB
4206 -7137 TOTAL
TAX
NO. PCS �CUSTsl NV OIGE EV IGENCES RECEIPT OF All ITEMS, N0. PC$ TOTAL
DRIVER'S NO. P,. NO INVOICE
SIGN
IMPORTANT PACA PROWSION: THE PERISHABLE AGRICU TURAL COMMODITIES LISTED ON THIS INVOICE ARE SOLD SUBJECT TOTAL
Tpo 77yyEE S7g7U77pp��V TRU AUTHORIW gECTIpN 5�C� pF Ti C �ERISHggLe q��ICU TURAL Cp MMORIILUis WO 7S C. PAYABLE ON OR BEFORE
439EICI). THE SELLER O THEESEE COMMMM DITIES RETAIN A TRU AM OVER THESE �OMMODETIEESS LL NVRIEE3 ONT. ON PAGE 3
FOOD OR OTHER PRODUCTS CTS DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF
THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED.
Good things CONFIDENTIAL PRaPERTY OF SYSCO
comefrom £SELY: 1TE cusT.ciER iluv CE <`UineE fGE.
BROOKSHIRE GOLF CLUB...
12120 BROOKSHIRE PKWY TF� 412940 007011219 8 1
CARMEL IN 46033 4000 WND62NDPOTIS, LLC Rrue b
INDIANAPOLIS, IN 16268 PAST Due eaLaNCas •aRE sL1�J:cr Ta. o
317 846 7431 30 DAYS FROM DATE OF INVOICCE ER
383U4b NORMAL
0
a
1 SQUARE DRIVER: TASCA, JOHN Z
CARM J, IN 46032
UNIT 7AX; EXTENDED: P
CITY 4 :rr PAG Sift [7EM D €SO v
CDC
C E <PRICE' AMOLlbET PRIG£ X
r PRIPTIN n
DAIRY T
C S NL 5LB BRLCLS CHEESE'AMER:YEL 120 SIFT 28131 6697114 13 98
Z7 96 A
C 5 NL.S LB ASASOL CHEESE CHDR..JACK SHRD FCY 0999CS 2 06189 14 98 14 98 D
GROUP .-T TAL'� 4 2 4
MEATS z
F C 60, 3302 AB BEEF PATTY GRND STKBRGR FRZN 9 763151 6703049 56 79 227 16
F CS I O LB HNSVLE BRATWUR5m 4X1 PREC OOKED 199 1611243 29 44 117,75 N
F CS 11 LB BRLCLS FRANK ALL M 5X1 6 IN 37 36 07,0 1 37736 .,19 55 97 75
C CS 2 5LB BRLCLS HAM 8LI 2DOZ HNY 20660 1963289 39 29 7$ 58
GROUP. TOTAL..::. L 521.25 ci o
POULTRY
C CS 2
5 Et BRLCLS TURKEY BREAST SLI OVEN RSTD 20643 196 '39 98 79 96
GROUP.. T0. 1; 7 9
_FROZEN
A
2CT RCTYBK COOKIE` CHNK`DWNHM 30Z IW 8349439 57 82 57 $2 n
F CS 82 7502 KR5CL5 BANISH ASST APLE %STRAW /CHSE IW 2118 4 59814 31 65 31 65
F CS ;2 4 2502 KRS7MP MUFFTN'ASST BL /BAKfCHOC /CH I/W 0734T 021825 7 13114 21 25 21 25
F CS 5LB Y5 IMP ONION RING BATTERED 3 %8" 4 010044 9272469 36 24 36 24' m
:i
F CS 5 LB LAMB POTATO WEDGE PINWHEEL L3057 5230432 29. 10 87. 30 0
GROUP TOTAL
o
'CA E &DRY D
m
C S NL 36 CT RS A ANDY BAR MILKY WAY 0110 4367363 24 41 24 41 z.
C S.', NL f8 CT NICKE ANDY BAR SNICKER 2."0701 01202 4348389 29 30 29.30
C 5 NL 4$ CT &M CANDY M &M PLAIN 1" 69 OZ 01231 4364774 28 93 28 93
XX
m
D CS I60 CT AYS CHIP VARIETY SYSC0 FRIT m
O LAY 31$31 6 86721 26 98 53 96 p
RlrPAIT T.
m
P.O. BOX 7137
2 6 32 22.0 426 INDIANAPOLIS IN SUB
4206 -7137 TOTAL
TAX
SIGN 0 INVOICE EVIDENCES RECEIPT OF ALL ITEMS. TOTAL
NO. PCs OUST. NO.
DRIVER'S PCS
❑ELVD. S IGN REC. INVOICE
SIGN
IMPORTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SOLD SUBJECT TOTAL
Tpp 77HEE S7q7 UT I T TR�JgT A�JT}{ORIZE� gy gECTIpA S C) V THE PERUSHgg E q AEULTURAL [AMMO LTEES Ek7 19330bUFS.C. PAYABLE ON OR BEFORE
499EICl). 7HE SELLER OF THES@ COMMODITIES RETAIN A TRUST CLAIM pVE`R THESE COMMODITIES, ALL INVEtJTORIE ONT. ON PAGE 2
FOOD OR OTHER PROD UCTS DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF
THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED.