192606 12/08/2010 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
j ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $109.12
`+o CARMEL, INDIANA 46032 PO BOX 7137
INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 192606
CHECK DATE: 12/8/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 011181378 109.12 FOOD BEVERAGES
Good things DELIVERY COPY CONFIDENTIAL PROPERTY OF SYSCO
e rom #?Etw i7ATE cLlszatAEx
BROOKSHI RE GOLF CLUB
S ii TR 412940 01
1181378 8 1
SYSCO INDIANAPOLIS, LLC
CARMEL IN 46033 4000 W 62ND ST 7fluE
317 846 -7431 INDIANAPOLIS, IN 46268 DAY FR DATE F
m m
1
E
CITY OF CARMEL
CIVIC SQUARE DRIVER:
w
6, F FENt ularr rlt��a T 1. 4 PA 51Z ITEM DESCRIP -li Cp33E... b1i t sC.g
O. 569273 1. HEALTHCAR
DA bNPR(3p C{ARGE `REIT F1Gl4T 008::104 :25.72::... 25. Z2;
ROP SHI P
GROUP TC?TAL�r 2:5.72 r. s
PAPER DISpO$ABLE
D S 40 CT.. M MONITbR:SHORTENING PAPR H 10.04 40 3353471 83 40 63 4.0. r. ROP SHV
_:...GROUP TO 1 83,
:ORD S
3 X153
BOX 7137
f MtT TO.:
P.O.
2 .7 4 INDIANAPOLIS IN SUB
IMPORTANT: PERISHABLE PRODUCTS ARE NOT ELIGIBLE FOR RETURN AFTEF 46206 -7137 TOTAL 109.12
R OELIVERV. PLEA E CHECK THIS INVOICE WE WILL NOT BE RESPONSIBLE
e 2 7 4 FOR ANV HOR AG AFTER YOU HAVE SIGNED. PIECES RECEIV E MUUSST TAX Fn
DRIVER'S NO. PCs COST. NO. PCs TOTAL
❑ELVO.
I SIGN SIGN REC. INVOICE
qq 77 I IIICCQQU��LT5r�U�JR L O 7 M E O E LgISL E GpRCUTLHIIJSF�IgNLV IC A LD sUB TO E 3TA u �1 O R s� L O TOTAL 109 12
THESE COMMODITIE �RETAIIN AT RU �CLAIM R�TH SE T COMM��1 7I�s, D A T L It•vi u I op'�S'OD (c UTH Y P ODUCTS PAYABLE ON OR BEFORE p
DER IVEO FROM THESE COMMODITIES. AND ANV RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL 12 /1V /10 LAST P
FUtL PAYMENT IS RECEIVED.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Sysco Indianapolis LLC
IN SUM OF
4000 W 62nd Street
Indianapolis, IN 46268
$109.12
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 011181378 42- 390.40 $109.12 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
Tuesday, November 23, 2010
!�h 6 64
Director, Brook hire Golf Club
Title
,n ledger classification if
Dr 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))
11118!10 011181378 Test Strips $109.12
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