HomeMy WebLinkAbout198771 06/22/2011 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
ONE CIVIC SQUARE SYSCO FOOD SERVICES
CHECK AMOUNT: $3,350.86
CARMEL, INDIANA 46032 PO BOX 7137
INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 198771
CHECK DATE: 6/22/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 106030297 536.25 FOOD BEVERAGES
1207 4239040 106100800 1,156.11 FOOD BEVERAGES
1207 4239040 106170702 1,658.50 FOOD BEVERAGES
CUSTOMERS ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
Good things
&IIIIIIIIIII
comrom DEIv tsAT :.tfiER
BROOKSHIRE GOLF CLUB l pi
1212 0 BROOK5HI RE PKWY TR cic ::s oP 1 MY 412940 106030297 1
CARMEL SYSCO INDIANAPOLIS, LLC
IN 46033 4000 W 62ND ST f7
317- 846 -7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 WEEKS AFTER ORDER
CITY OF CARMEL
1 CIVIC SQUARE DRIVER:
CARMEL TN 46019 EOUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60- 1,4 60 -250.4 AND F0 -741.4 ARE INCORPORATED HEREIN BY REFERENCE. 1.
CITY T*AC St E ITEM pESCT�TPTION oEiE pRi E E PR GE x
DAIRY
C NL 5 LE,.,.. BRLCLS C1489 SE AMER YEL 1.20 SLT 28131 6697114 15 97 15 97:
O LF& cC S HOWCASE
0001:D636$ P /UN 50: 50>
MEATS
GROUP TOTAL 15,47 llrlrl F.
;a l;:.0 LB. HNSYLLE BRATWURST'. 5X1 PRC SKLS 3188,!. 2199198 44;!
;88.32:; 1. F S 1`0 LB, BR CLS FRANK ;ALL MEAT. SXl.. I'N 377;3!6 137:736.:',!20 ..52 61.56:,:: 1.
OLF CC SHOWCASE 000106369, P /CS 2 00- 6 00=
:GROUP TQ'ITAL 14;3..8..; 1. FROZEN I "I
F S 2 3., OZ KRSIMP DANISH ASST_RND IW 15913 1952597 18 7.2.. 18 72 r.
F r.
S 2 4 2502 KR51l�P MUFFIN ASST BL /BAN /CHOC /CH I /W 073473021825 7813114 21 67 21 b7
F S 2'5LB_ ANTIZR ONION RING BEER $TR 5/8" 30423 0855296 26 71 26 71 1.
Ir F j.. S.„ LB YS IMP POTATO FRY 3/8 SKON PHANTM SYO03,08 4356465 31 24 31 24 1.
F S 2 3'9402 NPRIDE SANDWICH SAUS EGG CHS CROIS IW 482` 5196581 29 29 41 1. GROUP TOTAL *�u* 12:7 75 rr. CANNED
DRY
C NL_4:8 CT' NICKER 'CANDY_'BAR SNICKER 2,07 `OZ 01202 4348389 32 61 65 22`
D S 60 CT SAYS' CHIP VARIETY SYSCO LAY 31$31 65$6721 2b 98 26 98
OR.O.UI?..TO:TAL r.. 92.20
PAPER &DISPOSABLE
D 5 100 YSCO GLOVE POLY D SP CAST MED 104-FHCT1:`4CPSY 8477671 17 73 17 l3.
D S 15 33GAL_, YSCO LINER TRASH 33X39 5 1 1 L "WHT H6639TWS 4047031 39 87 39 $7
GROIJP...TOTAL 57 60 1.
11 SUPPLY::& EQUIPMENT
D S 2 EACH YSC0 FUEL CANNED HANDY "4HOUR HW030045 3956786 3b 45 36 45
r GROUP TO:1'A 3'S 4 5 rr. N P.O. BOX 7137
1 3 18 10.b 184 INDIANAPOLIS IN SUB
R IMPORTANT: PERISHABLE PRODUCTS ARE NOT ELIGIBLE FCR RETURN gg BB AFTE 46206 -7137 TOTAL
E FF V ANY SHOA� GE AFTER Y UI INVOICE E SIGMED I P EC E S RE C E IVES NIUSTE TAX
V
NO. PCS GUST. NO PCs TOTAL
DRIVER'S ❑EwD. SIGN I SI GN REe. INVOicE
I T �H 7 E H PEE A ftIC LT R L CO OD 7I g IS Ep oN TH INVpIC ARE gpLID gU9 JF 7 TO }'H TORY rRU T p PAYA TOTAL
I ES R TIO� 5 pF 7NHMF PE L7E AGRICU TRAL CO Mp63TIE$ �4CT 19 1J.5.C. CII THE FLI.ERCTS
THEE SSE COMMODITIES RETAINA TRUST CLAIM �VER THES OMMODI IES, ALL I VENTOR[EE OF FOO OTNER I�RODU BLE ON OR BEFORE 7TH
I DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE DF THESE COMMOOITIFS UNTIL ON 1 ON PAGE 2
o FULL PAYMENT IS RECEIVED.
CUSTOMERS ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
Good things
si j t q D SATE GUSTCiMER TH sK eP 412940 106030297 1 2
CARMEL i YSCNDIANAPOLIS, LLC
IN 46033 4000 W 62ND ST
INDIANAPOLIS, IN 46268 DUE FRIDAY 4 WEEKS AFTER ORDER
317 846 -7431
CITY OF CARMEL
1 CIVIC SQUARE DRIVER;
EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60 -1.4 60 -250.4 AND 60 -741.4 ARE INCORPORATED HEREIN BY REFERENCE.
r I. Q7Y x F�AC SIZE, ITEM DESCRIPTION ca PRISE...;; Ex�TR c x 1.
PRODUCE
C f. S 12CT ACKER APPLE RED DEL FCY FRESH 1344:092 9 27 9 27
C S LB.,. YS IMP ONION 1- ED FRESH JUMBO 1039.494 8,76 8 76.
C S 5. LB BRLLMP SALAD CHICKEN 51071 2510717 39.87 39 87.
GROUP::TOTAL 5:70
.MLS RG„S HGS „FOR FUEL SURCHARGE 5 00... 1.
Ir
QRD S RY.... SY333
P.O.' BOX 1137
3 1.0 26 INDIANAPOLIS IN SUB
fl IMPORTANT: PERISHABLE PROD ARE NOT ELIGIBLE FOR RESTURN AAFTE 4 206 7137 TOTAL 536.25 NOT BE E 1 3 21 11.6 210 FOR ANY $HORi A V N VE E $IGNEO. I PIECES RECEIVED M B T E TAX
v
NO. PCS ?Sll OST. rt N0. PCs TOTAL
DRIVER'S
i UELVO. 'S' REC.
SIGN I NVOICE 536.25
TH PE 1 A R c LT R L c O TI s Eo o TVOIC AaE k RlV4'T,'l'j5 B 0 O Y RU T TOTAL o quT g B�y E gp�GC7II0LM 51C p�MM RI L aGR cl�L COAq DITTp 7 9T7 �1 R HE SE p PAYABLE ON OR BEFORE THESEM061TIES RETAINA TRUSTLAIMVR THSE MODI IEg, AL S O O PR OpUC7S 7�01�11 LAST PAGE
6ERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM 7HE SALE OF THESE COMMODITIES UNTIL
o
FULL PAYMENT IS RECEIVED.
Good things CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
ifft come from DEtu ;DATE: cus7bMER
BROOKSHIRE GOLF CLUB
121201 BROOKSHIRE PKWY
T RUC K,: 5 QP.. 412940 106100800 7 1
CARMEL IN 46033 SYSCO INDIANAPOLIS, LLC
4000 W 62ND 5T°
317- 846 -7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 WEEKS AFTER ORDER
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: DIALL THIERN
.ARMEL IN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CER 60- 1.4 60 -250.4 AND 60 -741.4 ARE INCORPORATED HEREIN BY REFERENCE.,
t1TY' FAG..,: 51ZI: I.1 EM DESCRIPTION eoo PR, E .xFR co u
DAIRY
C NL 5 LB AWLS CHEESE AMEP YEL 120 SLI 28131 6697114 15'.'97 15'' 97
OLF CC »SHOWCASE 00.0:10636:$ P 54' 50;
GROUP TOTAL 15 47
MEATS
F 'S 6 5.3OZ: AB, REEF P}1TTY GRND :;;'PKBRGR FRZN.... 99:7:.6315] 670:31049.. ;6.3.4;0 126.80
OLF_ CC. 000106371 P C$ 2 00. 4 00-
F
f
5 1.0 LB. HNSVLE BRATWURST 5X1 PRCK SKLS 3188 2199198 29 44 '29 44
F S 10 LB BRLCLS FRANK ALL 5X1 6 IN 3773'06 6 070 1137736 20 52 20 52`
OLF:& CC !SHOWCASE 000!1C;S :.2 00- 1702 64.W
:FROZEN`.
GROUP TOTAL 7
F:: 5 5 LB Y.S I'MP P.(?TATO.k RY 3 f 8 SRON PHANTM ::'PLU SY0031;0;8... 35 3i. 24
3.1 24
F ..2:: 6 4 OZ' $RUCLS. SANDWICH::BISC SAUS .E HS <IW 170.:3. 3.381'092 4....3:0 1. :30
GROUP TOTAL* 71.54
>CANNED DRY.
D
S 16 CT. ELLOGG BREAKFA!ST.:BAR ASST NUTRI GRAIN 38000058TZ 21:5893
CA:: 1 NL 24T ERSHEY CANDY BAR RAY DAY,:: :$0723 703;0414 :15.62:, 15 6:2!;.
D S 12.. ,.4 :OZ LANTER CRACKER:; PEANUT BTR TOAST ROUND 751;3 7029192
D S 106 flZ' ELPASfl. PEPPER <JALAPENO :S`LI JUG PAC:::. 46000$8232. 797:7;150 52..55: ;:52 5:5:1.
D S 6. 1.75 Z': M SNACKm: Ml; CHEX TRDTNL LVR 1240000 7592:348 29. &T 29 .$.7:
D
141. LB.;: BRLC;LS. SNACK :MIX SPCY. CREOLE 9105:9.. 6 ::32 62 ,72<;
GROUP TOTAL 214.61
PAPER DISPOSAHLE
D S 2 204 GT WHRART CUP FAP,BR WTR. CONICAL <4 OZ..' 4R 205:0. 92$9:711 109 92 21 84-
T.... YS I:MP F.(JRK PLA BC HVX; FULL;: I�NGTH Yp;YFESX:S 7989:207 :49 29 <49 29';
-i: R MtT TQ
P.O. BOX 7137
Y 1 2 17 14.4 257 INDIANAPOLIS IN SUB
q IMPORTANT: PERISHABLE PROD ARE NOT ELIGIBLE FOR RETURN g AFTE 46206 -7137 TOTAL
�OR V ANYSHORAGE AFTER V HAV ES`IGNE� ILL IECES RECEIVED MU
TAX
RI[ Fn
DRIVER'S NO. PCs I COST. OF NO. PCS TQTAL
SIGN SIGN f REC, INVOICE
TI I E Q p A QJ�� L Tgu(R L p7MyM @O TIES Ig Ep o LJT��{IgR INVpIC ApE gp gB Eg c37p TQ gVE N �1 O R7YH E7 R g U �L T �E p TOTAL
gAUFH gg�yEl g �.ET IN Q R S �RkSHA�L AGR E TU CO MpDITI u
ES ,'4CT �R ES F FO_O C OTHER PODUCTS n
TH S CaM OD TI A A T U T LAIM OVER TFi S C MMODI IES, AL IrvVENTp p PAYABLE ON Qfl BEFORE ON ON PAGE 2
I DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL
u FULL PAYMENT IS RECEIVED.
Good CUSTOMERS ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
come from DE(v:�Ar cusrL�MER
BROOKSHIRE GOLF CLUB...
W
12120 BROOKSHIRE PKWY TR 12940 106100800 7 2
4 Ali
CARMEL IN 46033
SySC W ND 62ND PO�IS, LLC
.317 846 7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 AFTER ORDER
ICE
4 NORMAL DELIVERY
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: DI LL THIERN
RMEL TN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60 -1.4 60 -250.4 AND 60 -741.4 ARE INCORPORATED HEREIN BY REFERENCE.
PAC SIDE fT�M f3ESCRiRTION UNIT
QT COQE. PRICE. E XPR C ED
D d S :.1(3Q..C..T YS,CC�. GLOVE.:P:�7LY DlSP..QAST MED 10�'= FHGTi] 4Ck�S'X 47!7671 .7 7
17.
D QO!.! CT YS !IMP K9 :PEAS. BLK' HVY FULL' LENGTH Y.PWKESYS 20'2644 :`49.2:9 49 2<9:
D
5...2::3 00CT YSCO LID 'PEAS 'CLR F 1::'S 2 OT PRTN YLS'2FRSYS. 7.7.910795 45.1Y :45,1:1:
D 5 :.125CT YS.:TMI?:P:LATE: PEAS BLx.:IMPACT i10,25 PII,OESYS: 2$1$110. .98 27 9$ 27
D 5 .a#] YS <IMP 'SPOQN. PEAS BI,x..HVY FUEL :LENGTH..: YPWSESY5 17:;4122 49 29.. 49.:23
GROUP TOTAL 528 82
D S 3202. EYS;TON :CLEANER MULTY SURFACE.: >RTU :6100.063 ?6:828.02 .:::.29:58 29 5:8
GROUP TOTAL 29.58
'PRDDUCE. *>F
C S :1.2CT PACKER. APPLE :<RED.::DEL FCYs; FRESH 9,27!
C S 5,B..i;.AOKER BANANA :;!FRESH:.. >I `,!:..6.45:6221 6., 94 6 .9:41
C ",'S I2 CT:i' .ACKER .DEMON'IRESH 103947:8 03 >9178
C :S..... 12 CT<? .ACKER LIME FRESH 128;3787 ::10 10 ,9:2
103. 4.94 8. 76: 8 7:6;
C S 5.. LB YS ;IMP QNION..RED FRESH {7UMB0
C1.. S :5 LB' BRLII�IP SALAD CHICKEN :j 510T:1 251Q717 :39.87 39 $7
C :5.. 2 S,LB YS MP TOMATO:: >SLICED.l- ;!:40451 6113765 :>.36:59 >36,59
GROUP TOTAL 120 33
MfiS RG.::S FQ FUEL .SURCHARGE 5 00
ORD ....S MRI RY...._.. 86523
0 OP N: :UU CLOSE: f2�M13 74
v P.O. BOX 7137
1 13 7.6 128 INDIANAPOLIS IN SUB
q IMPORTANT: PER PgOO ARE NOT ELIGIBLE FOR RE gg AFTE 4206`7137 TOTAL 1156.11
e 2. 2 30 22.0 385 FFOR V ANY�SHOR AGE AFTER Y N HgV E E $IGNEO, I P IECES RECEIVE
TAX
No. PC cusix NO. PCS COST. O. PCs TOTAL
DRIVER'S
❑ELVD. SIGN Ec.
SIGN INVOICE 1156.11
g ggEGCRIICLryLTSLI�R L �0 OpEIYftI I. E u T HI U S Rg IN I, VpIC MApF� g gU8 C 3 T p OLD 7H T Y HE TR S U L p TOTAL
THESE A P CLAM A Q ER SE lESDA T hITI IES OF HER P OpUCTS PAYABLE ON OR BEFORE
1 DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL 7/0$/11 LAST PAGE
a FULL PAYMENT IS RECEIVED.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 199E
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))
06/03/11 106030297 Food $536.2
06/10/11 106100800 Food $1,156.1
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. WARRAN NO.
ALLOWED 20
Sysco Indianapolis LLC
IN SUM OF
4000 W 62nd Street
Indianapolis, IN 46268
$1,692.36
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1207 106030297 42- 390.40 $536.25 1 hereby certify that the attached invoice(s), or
1207 106100800 42- 390.40 $1,156.11 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
Wednesday, June 15, 2011
t
Director, Broo shire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Good things CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
comp from
2
1 120 BROO GOLF CLUB...
12120 BROOKSHIRE PKWY 1 Tfl cK s oP 412940 106170702 0 1
SYSCO INDIANAPOLIS, LLC
CARMEL IN 46033 4000 W 62ND ST ROUE
317- 846 -7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 AFTER ORDER
CITY OF CARMEL EVERENZ
1 CIVIC SQUARE DRIVER: MAY, JEFF
CARMEL IN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60 -1.4 60-250.4 AND 60 -741.4 ARE INCORPORATED HEREIN BY REFERENCE.
CITY pA.. SIZE T CR1P1lON o E PRNCE x
E1V1 fSS i EX PRIC DEO
C
DAIRY
I ONLY 5 LB BRLCL5 CHEESE'AMER .YEL 120 SLY 2$131 6697114 15 97 15,97,
aLF i& CC: SHOWCASE 00010368 5 P /UN :50 5'G'
GRO UP TOTAL 1.5 47
MEATS;
✓F S 5 5.3Q'z AB BEEF PATTY „ORND S'FKBRGR FRZN X39 763151 6703049 63;40: 1:?6 80.
OLF CC 0 106.371 00
P CS 2.00 4
_S 10 LB HNSVLE BRATWURST 5X1 PRCK SKLS 3188 2199198 29 44 58,88
vl: S 110 LB. BRLCL5 FRANK ALL MEAT 5Xl 6 IN 377,36 070 1137736 20.52 82.08
aLF:a� cc; HawASr
00010636:9 R /.CS 2.:00'
5. 2
SIAB RI,CLS.HAM SLZCED HNY..WT;R ADI ?!<FRESH ..7.2735 70. 28;5429 ::42'.:86' 42.86'
OLF CC SHOWCASE 3 0
r,ROU :295.6
000106372 P /C5 3 00
POULTRY
C S 2 5 LB BRLCLS TURKEY BRST 3/4Z MESQT.SMK MSTB940SLB 4860003 42 86 42 86
OLFT' CC SHOWCASE.. 000 0537,2. /C;S 3. 00 3 00<
FROZEN
GROUP TOTAL 39 .6
F S 12.::2 OZ KRS:I'MP BI S.01- .BUTTBRMI:L C RNI3' 2 7 L3$46$Oa: 3$4;b805 ;:27 0: 27
<S 12CT RCTYHK CG.OKIE HOC:CHNK `OWNHM.' 3ZOZ IW 8343439 57.82 57 8i
✓F..::: S 2 5LB ANTDZIZ:.OFII.OFI..RI.NG..BEER :BTR..5 /8
t.
;3042;3 0.855296 >26, 77 ::26.7.1
S 5 LB YS IMP P(?TATa .';FRY. 3 :SRQN.. PHANTM PLU SYQ0310$ 435,465 31, 24 31 24i
f
GROUP TOTAL 143.7
I)RY.
1/C NL .:36 CT ARS j CA:NDY BASIFLKY` W AY :;01101 43:6i73fi3
✓C NL. 2 CT' ERSHEY CANOY :BAR PAY. DAY:;. :80723 7030414 .:'15.;52: 1x,62:
NL:.4$ CT NICKER CANDY BAR SNICKER> 2.07 flZ 0120.: 43.98389 32 'S1 32 611
P.O. BOX 7137
1 4 18 9.6 229 INDIANAPOLIS IN SUB
a IMPORTANT: PER PRODUCTS ARE NOT ELIGIBLE FOR RETURN Sg��AFTE 4 206 -7137 TOTAL
FFOR ANY SHORTAGE AFTER Y HAVE SIGNED I PIECES RE CE I VEO MUSTE TAX
DRIVER'S NO. PCs CUST. NO. PCS TOTAL
C.
SIGN DELVC. SIGN RE
qU j g g L y E S I� y 5U( q F C M pI ES LIg p p }{IS q Mp SE C E g C 3 7 p LJ g7 HE SE o INVOICE
ThtSECOMMOOITIE�R�ETAIM1' A T O HE�PC RaSM AB VR AGR E$ ULT C U OMOD O IIES�A T LLEN DA VEN 'TORIES OF F OD�CO7HER PRODUCTS PAYABLE ON OR BEFORE TOTAL
DERIVE❑ FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEp$ FROM THE SALE OF THESE COMMODITIES UNTIL O NT. ON PAGE 2
a FULt PAYMENT IS RECEIVED.
Good things CUSTOMERS ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
come from DEIv bA. CUSTOME
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PKWY /Sc ®w TR CK s oP :412940 106170702 0 2
SYSCO INDIANAPOLIS, LLC
CARMEL. IN 46033 4000 W 62ND ST go E
317- 846 -7431 INDIANAPOLIS, IN 46268 DUE FRIDAY 4 AFTER ORDER
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: MAY, JEFF
EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 FIR 60 -1.4 60-250.4 AND 60 -741.4 ARE INCORPORATED HEREIN BY REFERENCE. 11 QTY PAC: SIZE ITEM: Df SCRIPTION ITE'nn urvrI. EXp I CDED a Nvol
CODE ?RICE
1. 6;4 CT. AY5.: CHIP.. VARIETY! SYSCO/FRITO LAY ;31831;.658:6721 26. 98,... ;53 .96 V. LL S #10 HFMATE:.GRAVY.- .:SAUSAGE .COUNTRY >:RTU 500;0:0.0 :5.228: 4.95!8:542...69..88:: b9 88>
Vll .:x:.:.:
0 6.0 7I;4! 12 l 16.3 3
5.. :1. 1.5..2OZ :ROPCNA..JUICE:ORANGE:::.PET :.1006.:.. 008 8 6 ..33<
5 00 7 GM YS.:REL KETCHUP;.PACKET .POTTY SYRY57G 42.74:981 7Q. 22 70. 1. 5 .0 D 4. 5. G Y5... REL .MUSTARD; PKT
5912837:. 5912.837' .97
24 97
'LL 0770:8: 9549379 21.9'6:. 21 98: 1. VD..` S 4 1:..7502 CANTER. PEANUT..;SALT.E.
i�
>S .:1 1 LB BRL.CLS..SNACK::MIX..S:PCY CREOLE i.:.: 91069:.9.960:329 ;31 36 94..08>
S T 2; OZ LANTER SNACK TRAILMIX FRUIT .NUT;; 19.3 2:00002;5;.493:6698; 3.5. 10 35 1.0;..
S 7: 2: OZ LANTER S ACK TRAIL <MIX N:UT &'::CHOC <1932!00002:7 93 <;35 10; 3.5 10'; 1. S 2:: 2:3OZ RI ZONA .T;EA I:CED..ARNOLD.. PALMER: :CITE.: ?193T; 987Q494 21. 59: 1 1 3>
GROUP TOTAL 598
..PAPER DISPOSABLE
APER 412R N= 4 4 7 5 9'.0> ;85 .90!: 1. .::S .....2.. 5;0 C OL0 CUP P.:..:.. HQT 1.2 .OZ BARE
C ::J8 :.8: B.33 :963 .8
7 .4 .11
S 1 .8:4 CT YSCQ... CUP..PLAS TRANS .1602 SOFT YE160SY5. 3,.5.830 59 98> 9 96
NL 500CT YSCO: F03L SHEET 9X10.751N S LVER: W69372! 6938500..;12 9'8: 25 96 I.
9
S. .:1:00. CT Y.S:CLS GLQVE :;DATER FDSUC`:PWDRFREE:<MED 3.04 :75002:2. 834:7;841 39. _6.: 39.96:
S 1 5(10 C`P ORKA ➢V NAPKIN :DI$P :XPRE5,SNAP WHT DX9O.. 1330687 69 26 1I8 52,
Y I :MP WRAP DRY WAX. <DEL >I :.1 Xl:! 7 FW 15 Y:SP:: 044:4:075 4.6 .90': 46. 0
:::.5 500 :C 5...._ 5 ..5
99
GROUP TO`PAL S 437
PRODUCE..:.
C .S I: CT ACKER ..AP;PLE RED: °IIEL F.CY :.FRES:H 134:4;092, 9. 27 9 27:
S 1Q LB: YS :NAT LETTUCE:. ROMAINE :CROWN ;LEAVES 6:640494: 6644494 29 29 49! V.
0
P.O. BOX 7137
2 2 2 IN SUB
R IMPO PERISHABLE P RODU C TS
30 34.6 594 INDI ANAPOLI4�206 -7137 TOTAL
RTANT: P THI$ I ARE NOT ELIGIBLE FOR V E P E N4$ 1�RgL
�OR ANY SHOR> AFTER VIOU I N V OICE. E SIGNE� PIECES RECEIV P MUST
TAX
DRIVER'S NO. P CUST. NO. PCS TOTAL
SIGN SIGN REC.
q IV R� gg gg��yy EE gg II II 55UU,, F c 7 M M E I7 ES L g g L 7 E GR UL �J MEMp g p C g Eg C 9 7 p U g 7 HE C. p INVOICE DRY TRUST
THESECOMMODITIES�R�ETAIN T LAIM SETCOMMOD T IES,��ALL `R INVE T NiORIES I OFF OO O C O7 TER PR06UCTS PAYABLE ON OR BEFORE TOTAL
1 DERIVED FROM THESE COMMODITIES, AND ANV RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL ONT ON PAGE 3
1. FULL PAYMENT IS RECEIVED.