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191380 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1 ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $811.80 CARMEL, INDIANA 46032 PO BOX 7137 o INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 191380 CHECK DATE: 10/2712010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 010150428 447.04 FOOD BEVERAGES 1207 4239040 010220664 364.76 FOOD BEVERAGES Good things CONFIDENTIAL PROPERTY OF SYSCO comefrom )Et1 a7ATE CDSTOMER NV ICE.;:.. p BROOKSHIRE GOLF CLUB cc 12120 BROOKSHIRE PKWY 1�r7��® rR cK;s aP 412940 010150428 0 1 SYSCO INDIANAPOLIS, LLC zau o CARMEL IN 46033 4000 W 62ND ST as INDI ANAPOLIS I 4 6268 rtR pa.si DUE eA�aNs PRE soeJ�.c':r To 317 846 7431 30 DAYS FROM DATE OF INVOICE MANIIT� 393116 NO 0 CITY OF CARMEL Z 1 CIVIC S DRIVER: YARBERRY, JIM E QTY SAC SEt= IFEM. DESCRIPTION DAIRY C AMavr�T Ex r a "c ,I ITEM UNIT z CdnE:; .PRICE o T S NL, LB ASA50L CHEESE CHDR ;;7ACK.5HRD ICY..... 0.999CS 2j­ 06189 15 53;. 15 53: n S NL 5. LB OL CREAM SOUR DAIRY BLEND.LITE.,_ 64422 1061.290 l4 49. 14 49 GROUP 'TOTAL 30.2 ;I 1 m. ME z CS 605. 3302 AB BEEF PATTY GRND FRZN 9 763151. 6703'049 56 79 56 7 9. GROUP 1lX,TAL:7�C 71C :6 POULTRY s. F CS. 25 LB YS CLS CORN D0G CHKN MINI HNY BTR .67 78051 167$051 27 45. 54 90 FROZEN GRaUF TOTAL 54 90 I> 0 F CS 45 LB TM CHILI TEXAS JACK'S 43030 60 4 71372 49160 49 FI CS 5 LB YS IMP ONION RING BATTERED 3J8" 4 010044 9272'469 36 24 36 24 F CS. 5 LB YS IMP POTATO FRY 51/ SKON "PHANTM PL S 4356473 28 24 2$ 2" o RQUP TOTAL 11:4 Q8. z CANNED DRY C S NL 36 CT ARS CANDY BAR MILKY WAY 01101 4367363 24 74 24 74 OZ 29 a C S... NL 48 CT NICKER CANDY BAR SNICKER 2 07 01202 4348389 29 30 30, mme llqlq S NL 1 OZ ANDRUN CHIVE "M'-DRY 828$'8620023 2.98 2.98 m I D CS 5002 PK 5E REC CRACKER SALTINE 2162 4204996 15.74 15. 74 GROUP TOTAL 72 76. ;i: o *X PAPER DISPOSABLE D D CS 4100 CT YSCO GLOVE POLY DISP CAST MED 104 -FHC 14CPSY 8 77671 17 73 17 73 G m RQUP TOTAL *x* 1 PRODUCE Z C CS 25 LB BRLIMP SALAD CHICKEN 51071 2510717 36 58 36 58 p GRQFIP Tt?TAL�E. 36 ,5$ m AM 4 00 PM P.O. BOX 7137 5 14 7.9 159 INDIANAPOLIS sun 46206 -7137 TOTAL TAX NO. PCS COST_ SIGNED INVOICE EVIDENCES RECEIPT OF ALL ITEMS. NO PCS TOTAL DRIVER'S DELVD. SIGN X I RFC. SIGN INVOICE IMPORTANT PACA PROVISION: THE PERISHABLE AGRICUL TURAL COMMODITIES L15TED ON THIS INVOICE ARE SOLO SUBJECT TOTAL T H S77gq77UTp1Y TRH T A THOR llL,&CTI N 5 Q TH PERISHA�L A FtI UI�TURAb COMry�OpITIF�S ACT 1930bU�S.C. PAYABLE ON OR BEFORE L� 499E THE SELLER OF THESE C MMODIIItSS RETAIN A RUS CLAIM OO EE T S OMM gITIES, ALL NVENTORIEE SS QNT. 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 15 RECEIVED. Good things CONFIDENTIAL PROPERTY OF SYSCO come from ZLYldAT 1 CUS_T ©MER I V ICE BROOKSHIRE GOLF CLUB... l C��° 12120 BROOKSHIRE PKWY TR CCS 412940 010150428 0 2 SYSCO INDIANAPOLIS, LLC cs CARMEL IN 46033 4000 W 62ND ST R °fie INDIANAPOLIS, IN 46268 PASr nLE �aaNCes A13E sees rO:. 317 846 -7431 30 DAYS FROM DATE OF INVOICE 0 a 1 SQUARE DRIVER; YARBERRY, JIM z TN 46032 QI1( ti.; PAC SERE ITErw DESCRIF�`E'ION o STEM UNET TAJ� EXTENDED T P CODE: F?FiICE AMOtJN'C PFIICE X I DISPENSER n D CS 2 GAL, TRYTIM DRINK.. MIX LEMONADE 139800 4800807 58­45 58 45 S ONLY1 00 CT. SE REC TEA BAG IND ENV HOT 19326 4202214 5,73 4 5 73 GRO.U.P..TOTAL 0 ORD S RY 68 r m d A eim T 3] Qf N Z A D m Z Q 1 a D m rD 2 -c. T mi FIT ?ERE:MIT P•0. BOX 7137 1 2 •7 15 INDIANAPOLIS IN SUB 4206 -7137 TOTAL 447.04 1C 6 16 8.6 174 TAX NO. PCS CUST. SIGNED INVOICE EVIDENCES RECEIPT OF ALL ITEMS NO, PCs TOTAL DRIVER'S OELVO. SIGN REC. SIGN IN IMPORTANT PACA PROVISION: THE PERISHABLE AGRICU TURAL COMMODITIES LISTED ON THIS INVOICE ARE SOLD SUBJECT TOTAL 447.04 Tpp 7Tyy S7g7U7p RY TRUST THORI �p gy SEC7Ip 5 C� pF THE PERIS:I& p�RICUtTUBAL C�MMOpITIES AC7 1 0(U S.C. PAYABLE ON OR BEFORE 499E(�I. THE SELLER 6 THISE COMMODITIES RETAIN q TRUST CLAIM OVEF TFIESE COMMODITIES, ALL INVENTORIES OF FOOD OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF 11/14/10 LAST PAGE THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVEO. VOUCHER NO. WARRANT NO. ALLOWED 20 Sysco Indianapolis LLC IN SUM OF 4000 W 62nd Street Indianapolis, IN 46268 $447.04 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1207 010150428 42- 390.40 $447.04 1 hereby certify that the attached invoice(s), or 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 Monday, October 18, 2010 Director, Broo ire 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)) 10/15/10 010150428 Food $447.04 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 r. Good things CONFIDENTIAL PROPERTY OF SYSCO rom DEw,: DATE cusTtMER v E >I> e .11 BROOKSHIRE GOLF CLUBS 1 22 1 12120 BROOKSHIRE PKWY s ij TR �K s DP 412940 010220664 6 1 YSCO INDIANAPOLIS, LLC o CARMEL IN 46033 4000 W 62ND ST °E INDIANAPOLIS, IN 46268 Parr DE�E t3ALANCES tkE .suffjtcT.TC 317 846 7431 30 DAYS FROM DATE OF INVOICE a CITY OF CARMEL 1 CIVIC SQUARE DRIVER: MAY, JEFF z P TAX..:': $XTEN6t6 P z QTY ti M PAC $ICE; ITEM DESCRIPTIL311E a C r.. GDD P��ICE' I< AMbtlN7 PRIG X DAIRY. I .11 3 C S ONLY 5 LB BRLCLS CHEESE AMER. YEL 120 SLI 28131 6697114 14 63 "14 63 1. GROUP' TOTAL 14 63'I m MEATS ..-V 1. C CS „42 5LB BRLCLS HAM SLI 2 /3O.Z HNY 20660 1963289 39 29 39 29 g CROUP TOTAL* FROZEN 39. 9 c 1. F CS 45 LB TM CHILI TEXAS .JACK'S 43030 4 71372 49.60 49.60: y 1. GROUP TOTAL 49 60!;. 1.1 CHEMICAL A r. C.S 403 2 4Z CTHBRT CLEANER.GRL pUICKCLEAN.,PCKT H 70 3 20Z 6643258 ..38'1 38 97 GRO:UPi 'TOTAL *�r 38. 37 o i.r SUPPLY EQUIPMENT A t' D OU CS 320 CT CTH9RT­PAD GRIDDLE .POLISH 4X6 H -4 6-4X5'.'25 6006266 66 57 0 1. EMOTE ST.00K ....3 N *:'PRODUCE z *,fir GROUP TOTAL o 1. D Z G 1:5 LB YS QNION.;RED F::R.ESH .JUMBO_'; ..1 .3 !:12...67 <12., 7 67 1. 12 GROUP TOTAL .6 L .ICI SPEKSER 1. 11 I' A F C!5 1 ,2 1-1- ROUP TOTAL 209 .60,.. m 11 :i.... O RD MAR ::i! l tl 0 .11 0 A D m 1. Z '.i a I. M m n REMIT TO m P.O. BOX 7137 1 7 2.2 71 INDIANAPOLIS IN SUB 46206 -7137 TOTAL 364.76 1 7 2.2 71 TAX NO. PC OUST, 51_GN�D INVOICE EVIDENCES RECEIPT OF ALL ITEMS. NO PAS TOTAL DRIVER'S OELVD. SIGN X REC. SIGN INVOICE IMPORTANT PACA PROVISION: THE PERISHABLE AGRICULTURAL COMMODITIES LISTED ON THIS INVOICE ARE SOLO SUBJECT TOTAL 364.76 Tp 7HE S7g7U7p RY TRUST AuTHORIZ�p gY gECTIpN 5 C� pF THE PERISHqq EE p�,�ICULTUBAL C�MMOpIT F00 IES 1 30 U S.C. PAYABLE ON OR BEFORE 499EIC)I. THE SELLER OF THESE COMMODITIES RETAINS A TRUST CLAIM O�R THESE COMMODITIES, ALL INVENTORIES �P 11/21/0 LAST PAGE 0 OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED. F, VOUCHER NO. WARRANT NO. ALLOWED 20 Sysco Indianapolis LLC IN SUM OF 4000 W 62nd Street Indianapolis, IN 46268 $364.76 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1207 010220664 42- 390.40 $364.76 1 hereby certify that the attached invoice(s), or 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 Monday, October 25, 2010 4f-� t 11,I/ Director, Brookshire olf 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)) 10/22/10 010220664 Food $364.76 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