189528 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $2,422.04
CARMEL, INDIANA 46032 PO BOX 7137
INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 189528
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 008200599 517.97 FOOD BEVERAGES
1207 4239040 008261353 1,904.07 FOOD BEVERAGES
I
Good things CONFIDENTIAL PROPERTY OF SYSCO
comefrom �ELV,<baTE CDST,DME
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BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PKWY ®3��® TR CK s op 412940 008200599 2 1
SYSCO INDIANAPOLIS, LLC o r.
CARMEL IN 45033 4000 W 62ND ST
INDIANAPOLIS, IN 4626$ P auE.saiA CES SAE. stsBg TO
317 -846 7431 30 DAYS FROM DATE OF INVOICE
0
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: PARKER, JEFF z
P AX EXTENDED
QFY S PAC Slzl='. [TEM DESCRIPTION o CODE C e t CODE p�IGE AhflOL1NT PRICE X I
DAIRY I 1.1
C S NL LB BRLCLS CHEESE YEL 1:20 SLr 28131 6697114 14 63. 14,63, 1
GROUP fiOTAL *I<* 14 63< m
MEATS.: n
C CS 42 5LB BRL BEEF ROAST TOP RND SLL C /OFD' 20614 1962869 56'r67-.1 .56,67, 0 r.
F CS 110 LB BRLCLS FRANK ALL -MEAT. 5X.1 6�IN 37 36 070 1 37736 20 03 40.18 b
lF GROUP. TQ;TAI, y
96 85:
POULTRY
C CS 42 5LB BRLCLS TURKEY .BREAST SLI OVEN RSTD 20643 1960434 39 9$ 39 9 8. r.
L .GROUP 'I'L)TAL >39 98.>
FROZEN
o
F CS 2 5 LB YS IMP ONION RING BATTERED 3/8I 4 010044 9272469 36 24 36 I. A
E CS 45 LB BRLC LS PO RK BBQ PULLED W 5AU 09634 7691140 79 98 79 9$ a
RU[ P......... .2;: N 1.
CANNED
0
1.
D I 230 CT �AYS' CHIP VARIETY PK BAKED BFY 32198 5581863 '2 5 9.1 29.15 z 1.1
D
CS 160 CT L A YS CHIP VARIETY SYSCO /FRLTO LAY 31831 6 86721 "26 98 26 98
0
D CS 101 LB BRLCLS SLACK MIX SPCY CREOLE' 91069 9960329 31 36 62 72 r. :.GROUP TOTAL 11::8,$5;::
PAPER m
Z
D CS 10056 GAL YSCO LLNER TRASH 43X47 7ML BLK H 647HBS 4075966 32 83 65.66 0 "I I GROUP TOTAL r 6:5.66 0
SUPPLY &'EQUIPMENT i
D CS 12CT YSCO MOP HE AD BLND LPD ALL PURP MED M 181SYS 4 79545 1$ 71 18 71 0
GROUP TOTAL 8 7l::
PRODUCE m
m
C CS 15 LB ACKER BANANA :FRESH 6 66221 6 65 6.65
m I.
C CS 110 LB YS NAT LETTUCE ROMAINE CROWN LEAVES 640494 6640494 26 65 26 65. m I.
P.O. BOX 7137
1 1 16 14.2 166 INDIANAPOLIS IN SUB
4H206 -7137 TOTAL
TAX
SIGNED INVOICE EVIDENCES NECEIPT OF ALL ITEMS. NO. PC5 .GUST. NO. PCS TOTAL
DRIVER'S
DEL VD. SIGN X REC. INVOICE
SIGN
IMPORTANT PACA PROVISION: THE PERISHABLE AORICU TURAL COMMODITIES LISTED ON THIS INVOICE ARE q S O S TOTAL
Tpo P7y STAT';2RY TR gT AUTHORIZED 1 SECTION 5�CA 9'R T"IE PF F{fj�ULTURAL c�MMORLTI�NVE NTOR�IESOP-C. PAYABLE ON OR BEFORE
499EfC)1. THE SELLER �F TRESEE COMMMMODITIES RETAIN A US CL IM O ER Irtta COMMODITI ONT, ON 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.