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190986 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 362632 Page 1 of 1 ONE CIVIC SQUARE TREAT AMERICA FOOD SERVICES CHECK AMOUNT: $124.30 O CARMEL, INDIANA 46032 8500 SHAWNEE MISSION PARKWAY MERRIAM KS 66202 CHECK NUMBER: 190986 CHECK DATE: 10/13/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4239099 643223 18.30 OTHER MISCELLANOUS 852 5023990 643223 106.00 OTHER EXPENSES INVOICE #643223 ROUTE 70604 70604 DRIVER 70046 FIELD, WILLIAM 10/0112010 10:08am. 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 [65523] MAXWELL HOUSE MASTERBLEND 42/1.1 86636 42 26.50 4 106.00 [56638] AD CREAMER NON-DAIRY 1202 SHAKER 1 1.76 6 8.75 [56640] AD SUGAR CANISTER (24/2002) 1 1.91 5 9.55 TOTAL DELIVERED 14 124.30 TAX EXEMPT TOTAL DEPOSIT .00 INVOICE TOTAL 124.30 NO PAYMENT RECORDED "Thank you for your business" Prescribed by State Board otAccounis ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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)) 10/1/10 643223 payment for coffee 124.30 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 Treat America IN SUM OF 9702 East 30th Street Indianapolis, IN 46229 124.30 ON ACCOUNT OF APPROPRIATION FOR police general fund police gift fund Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 643223 390 -99 1.8.30 bill(s) is (are) true and correct and that the materials or services itemized thereon for 852 643223 8 106.00 which charge is made were ordered and Z received except October 6 20 10 Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund