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193230 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1 ONE CIVIC SQUARE SYSCO FOOD SERVICES 0 CHECK AMOUNT: $112.97 CARMEL, INDIANA 46032 PO BOX 7137 INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 193230 CHECK DATE: 12/22/2010 DEPARTME ACC OUNT P NUMBER INVOICE NUMBER A MOUNT DESCRIPTION 1207 4239040 011019003 112.97 FOOD BEVERAGES Good things DELIVERY COPY CONFIDENTIAL PROPERTY OF SYSCO j gm �ornr DFSV DA �i3S3Qk&R J INV 121 WY 412940 011019003 0 1 TEL CK AP CARMEL IN 16033 400H WND62NDPSTIST LLC ROUg INDIANAPOLIS IN 46268 L 317 846 7431 3G DAYS EROqjA E WILL CALL GARY LEVERENZ CITY OF CARMEL 1 CIVIC SQUARE rARMEL QfY FAC Sl�ic I TEM DESCRIPTION 1T�N1 UtdIT TAX EXTENDW P INV61M! Al) Ct30E PE#, AMOUNT PRfCE FROZEN F :r S 5 LB y TM w CHILI 'TEXAS JACK S' 43030' 4871 49.60: AN' PR 4. �y t Ti/+ GROUP.-TO�AW *fit x a C xv. N 2 v Y'r PRODUCE �}r S'::. 5 LB YS,I DICED I 4 2 N 40425 65i4003' 13.7.7, „x 77 7 x 0 v 'Nou a', 2 Ont P ,`S umo RX 17963 a x a of S:J ti p 1 ...%.f '.o i n n ♦.iv3.2.=l S, h.' f L.,,,,n v „F 2 h b ..a,oto,8,E..1 v:� ,L„2,2. ....a �Qi. c w v v y q n a• a a o N a` o nSn, r' w'v.o, a•f.,�`. .5.`.. ,a,, r,w xaw J N P g I 4b e,, vy� ,y ..m ,t,o, 2 x`+ao- a ,r+.' 9 a �S w,w la 110% A 4 w r n n J w J J a,,2 a, n r ,ti`,al R +ax J �m v="T,, n i'� w ,:o �'r i Y `a r ,w ,r, r n „2, AS' y2 ,'?,1, ay.'a,d �L„a..$.t3 .,J�„2x, Sa:�( w d, n.� .oM V.9 vKO o S x,� ro`w p M`1,ro, s J.! .r .yh `Se.'J n, m, J, .n rn „r,,, Jaw a ou u+ 0.0. SOX 7137 x 3 1.9 48 INDIANAPOLI IN SUB h$206 -7137 TOTAL 112.97 3 1.9 48 TAX DRIVER'$ NO PCs CUST 1 N p Ev mud A" T�'L PCS TOTAL GEL SIGN fit S IGN MPOR ANT T PA p A R PR ION k1 Z P E� RI HHA RI f T �p RA H O T 017 F N N �R T 1i15 C I OIC OLO SUB EC 1 1 2 .97 T 49EIG1 �AE�ELLR O TRtI�SrCL ��G�tMS01TiE�PI �t ORI�ESTDsc PAYABLE ON OR BEFORE F OD A O1H A PRODUCT OERIVEB FROM THESE COMMODITIES ANO ANY RECEIVABLES OR PROCEED$ FROM v THE $ALE OF TO TAL 12/01x1© LAST PAGE THGSC COMMOOITIES UNTIL PAYMENT 15 RECEIVED VOUCHER NO. WARRANT NO. ALLOWED 20 Sysco Indianapolis LLC IN SUM OF 4000 W 62nd Street Indianapolis, IN 46268 $112.97 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1207 011019003 42- 390.40 $112.97 1 hereby certify that the attached invoice(s), or bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Tuesday, December 14, 2010 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)) 11/01/10 011019003 Food $112.97 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