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188558 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 362632 Page 1 of 1 ONE CIVIC SQUARE TREAT AMERICA FOOD SERVICES CHECK AMOUNT: $107.00 CARMEL, INDIANA 46032 8500 SHAWNEE MISSION PARKWAY MERRIAM KS 66202 CHECK NUMBER: 188558 CHECK DATE: 8/3/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 852 5023990 642677 107.00 OTHER EXPENSES INVOICE #642677 ROUTE 70604 70604 DRIVER 70045 FIELD, WILLIAM 07/23/2010 10:56am 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 [55523] MAXWELL HOUSE MASTERBLEND 42/1.1 86635 42 26.50 3 79.50 [55521} MAXWELL HOUSE DECAF 42/1.1 OZ 39039 42 27.50 1 27.50 TOTAL DELIVERED 4 107.00 TAX EXEMPT TOTAL DEPOSIT .00 INVOICE TOTAL 107.00 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)) 7/23110 642677 payment for coffee 107.00 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 T reat ::America IN SUM OF 9702 East 30th Street lndi=polls, IN 462ZV 107.00 ON ACCOUNT OF APPROPRIATION FOR police gift fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 852 642677 852 107'100 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 July 23 20 10 &,�kmx 1 Signature Chief of Pol ce Cost distribution ledger classification if Title claim paid motor vehicle highway fund