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193009 12/21/2010 CITY OF CARMEL, INDIANA VENDOR: 358595 Page 1 of 1 ONE CIVIC SQUARE CARMEL CLAY FOOD NUTRITION SERA CARMEL, INDIANA 46032 5201 E MAIN STREET CHECK AMOUNT: $12,597.64 CARMEL IN 46033 CHECK NUMBER: 193009 CHECK DATE: 12/21/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4239040 NOV10 12,597.64 FOOD BEVERAGES Carmel Clay Schools Food Nutrition Service Invoice SCHOOL: Parks and Recreation DATE: 12/8/10 FUNCTION: Breakfast /Snacks November 2010 BU TO: Ben Johnson Name: Amy Anderson Address: ESC ORDERED NUM DESCRIPTION COST TOTAL Before School Breakfast 400 Free $0.00 $0.00 164 Reduced $0.30 $49.20 1,982 Paid $1.25 $2,477.50 TOTAL $2,526.70 After School Snacks 1,552 Free $0.00 $0.00 462 Reduced $0.33 $152.46 15,028 Paid $0.66 $9,918.48 TOTAL $10,070.94 GRAND TOTAL $12,597.64 Purchase 6 r v✓��� DescrO P or F P.O. G,L. It r Budget V QJ�. Line Descr E 1�t Date L 0 a _j Purchaser Date�41 o Approval T ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 358595 Carmel Clay Schools Food Nutrition Terms 5201 E. Main St. Date Due Carmel, IN 46033 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 1218110 Nov'10 Breakfast/Snacks Nov'10 12,597.64 'Total 12,597.64 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. 358595 Carmel Clay Schools Food Nutrition Allowed 20 5201 E. Main St, Carmel, IN 46033 In Sum of 12,597.64 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -99 Nov'10 4239040 12,597.64 I 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 16 -Dec 2010 Signature 12,597.64 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I