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190390 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 359290 Page 1 of 1 0 I ONE CIVIC SQUARE MONARCH BEVERAGE CO INC CHECK AMOUNT: $815.80 CARMEL, INDIANA 46032 3737 WALDEMERE AVE o� Loy INDIANAPOLIS IN 46241 CHECK NUMBER: 190390 CHECK DATE: 9/29/2010 DEPARTMENT ACCOUNT PO NU INVOICE NUMBER AMOUNT DESCR 1207 4239040 815.80 FOOD BEVERAGES MONARCH BEVERAGE CO. INC. PERMIT #W4908938-INP1983 9347 E PENDLETON PIKE INDIANAPOLIS, IN 46236 -0000 (317)612-1310 Account 89924 License R2903542 Time: 07:53 AZ GOLF MANAGEMENT CORP. Invoice#: 0585449 PO# BROOKSHIRE GOLF CLUB Load 5040 Date: 10-01-2010 12120 BROOKSHIRE PKWY Terms B.COD /W.CHARGE CARMEL, IN 46032-0000 Driver VB PHILLIPPO,C (317)846.7431 Salesman: 16 J CHAPMAN 16 ITEM# QTY DESCRIPTION U.P.C. PRICE DISC DEP AMOUNT 10180 1 LITE KEG 03410057154 41.00 0.00 30.00 71.00 LITE 114 BBL 24569 0 SAM ADAMS KEG 00000000000 LAGER 116 BBL Original Qty: 1 Reason: 08 WAREHOUSE WRONG PRODUCT Cases: 0 Beer$: 71.00 Content$: 41.00 Btls: 0 Wine$: 0.00 Deposit$: 30.00 Kegs: 1 Soda$: 0.00 Discount$: 0.00 Misc: 0 Misc$: 0.00 Gals: 7.8 Total Sales 71.00 Total Credits 0.00 Total Tax 0.00 INVOICE 71.00 PAYMENT INVOICE# PAYMENT TYPE AMOUNT 0585448 Cash/Check 689.30 0585449 Cash/Check 71.00 Total Cash/Check 750.30 PAYMENT TYPE AMOUNT Check# 2 760.30 Inv1: 0585448 689.30 Inv 0505449 Z 00 Customer's Signature Driver's Signature "Your signature is acceptance that allthe product listed above was received and delivered in good condition` "Drivers cannot pickup product unless proper pickup form has been completed.'" Not Responsible fur shortage or breakage after merchandise is delivered and accepted'`` VALID Ink MONARCH BEVERAGE CO. INC. PERMIT #W4908938-INP1983 9347 E PENDLETON PIKE INDIANAPOLIS, IN 46236-0000 (317)612-1310 Account B9924 License R2903542 Time: 07:53 AZ GOLF MANAGEMENT CORP. Invoice 0585448 PO# BROOKSHIRE GOLF CLUB Load 5040 Date: 10 -01 -2010 12120 BROOKSHIRE PKWY Terms B.CODlW.CHARGE CARMEL, IN 46032.0000 Driver VB PHILLIPPO,C (317)846 -7431 Salesman: 16 J CHAPMAN 16 ITEM# CITY DESCRIPTION U.P.C. PRICE DISC DEP AMOUNT 20610 15 COORS LIGHT 07199031600 16.35 0.00 0.00 245.25 24 LSE CAN 20627 4 COORS LIGHT 07199030104 18.10 0.00 0.00 72.40 219116OZ ALUM 30975 2 HEINEKEN 07289000020 27.00 0.00 0.00 54.00 12 CAN 10110 15 LITE 03410057306 16.35 0.00 0.00 245.25 24 LSE CAN 10117 4 LITE 03410057023 18.10 0.00 0.00 72.40 2191160Z ALUM Cases: 40 Beer$: 689.30 Content$: 689.30 Btls: 0 Wine$: 0:00 Deposit$: 0.00 Kegs: 0 Soda$: 0.00 Discount$: 0.00 Misc: 0 Misc$: 0.00 Gals: 90.0 Total Sales 689.30 Total Credits 0.00 Total Tax 0.00 INVOICE TOTAL 689.30 PAYMENT INVOICE# PAYMENT TYPE AMOUNT 0585448 Cash/Check 689.30 0585449 Cash/Check 71.00 Total Cash/Check 750.30 PAYMENT TYPE AMOUNT Check# 2 760.30 [nv f15B544B 689. 3U Inv1: 0985449 'I1. 00 Customer's Signature Driver's Signature "Your signature is acceptance that allthe product listed above was received and delivered in good condition" "Drivers cannot pickup product unless proper pickup form has been completed. Not Responsible for shortage or breakage after merchandise is delivered and accepted VA I D n VOUCHER NO. WARRANT NO. ALLOWED 20 Ma` larch Beverage Inc. IN SUM OF 9347 E. Penleton Pike Indianapolis, IN 46236 -0000 $760.30 ON ACCOUNT OF APPROPRIATION FOR Brookshire Goff Club PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1207 0585449 42- 390.40 $71.00 I hereby certify that the attached invoice(s), or 1207 0585448 42- 390.40 $689.30 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, October 01, 2010 Director, Brook Y e 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. 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 Purchase Order No. Terms Date Due invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 01/10110 0585449 Beer $71.00 10101/10 0585448 Beer $689.30 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