165787 11/12/2008 ,,r CITY OF CARMEL, INDIANA VENDOR 36110e Page 1 of 1
6 ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTC gHECK AMOUNT: $323.07
CARMEL, INDIANA 46032 PO Box 5216
CAROL STREAM IL 60197 -5219
CHECK NUMBER: 165787
'L CHECK DATE: 11/12/2008
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NU AMOUNT DESCRIP
1150 4239040 023045 166.42 FOOD BEVERAGES
1150 4239040 034212 156.65 FOOD BEVERAGES
No u. E._ c 200E 12 40PM Cosfco Wholesale #346 No. 4320 P. I/1
9:31:;05 11/08/08 Sales Audit TKansaction Detail INP2709 PAGE 1
warehouse: 346
Sales Date: 10 /16 /OB Reg 10 Trans Type. Tender
Time: 12.19 Iran 110 Tender;
Total. 156.65 Operator: 70 Block:
Member 000111784913819 MILLER, KEN Mbr Type; Business
Tax: Resale Total: 156.65
FSA/
EBT Item Description Amount Units
1202 SNICKERS 48CT *Resale 38.56 2
1232 M &M PEANUT 48CT *Resale 41.78 2
117986 MARS CHOC SNGLS VAR 30 CT *Resale 22.98 2
15916 SOUFFLE CUPS 2 OZ 1500 CT *Resale 16.59 1
15917 PORT CUP LID 2 OZ 1500 CT *Resale 16.59 1
617029 ICE MOUNTAIN 35/.5 LITER *Resale 10.36 2
235817 LIQUID PAPER DRYLINE COR. *Resale 9.79 1
Costco CR 156.65
END OF REPORT
WHSE 346 -SALES AUDIT
COSTCO
Plea:ia Direct Ingwnes To 1- 800 220 -8594 cbsm
WHOLESALE
Account Number New Balance Payment Due Amount Past Due Due Date
7003-7311-0007-4683 $323.07 $.00 $00 11/20/2008
Billing Date Credit Line Available Credit
10/26/2008 $1,000 $676.93
This communication serves as official notice that all calls to /from our offices may be monitored and /or recorded for quality
assurance purposes.
STATEMENT OF YOUR ACCOUNT
FINANCE CHARGE SUMMARY
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
Reg 00014 S21.54 0.00000% 00.00% S.00 0000% $32307 $.00 11/26/2008
ACCOUNT DETAIL
Transaction TranSe0ion Invoice User P.O. Transaction
Data Description Number ID Number Amount
10/09/2008 COSTCO WHOLESALE -346 023045 00001 $166.42
10/16/2008 COSTCO WHOLESALE -346 034212 00001 $15665
00001 SUBTOTAL $323.07
10/23/2008 PAYMENT THANK YOU 00001 $738.16-
1
Return the below portion with payment. For billing errors or questions please refer to the back of the statement. Page 1 of 2
I
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or unautho-
rized purchases. It you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases, this
statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
t
cosmo COSTCO
Mff/OLESALE
ACCOUNTSUMMARY BALANCE SUMMARY
CURRENT 1 -29 DAYS PAST DUE 30 -59 DAYS PAST DUE Ora action $736 16
♦New
00 00 00 Purchase(s)/Debit(s) $32307
60 -88 DAYS PAST DUE 90 -119 DAYS PAST DUE 120.149 DAYS PAST DUE t New Fees 00
Finance Charge, 00
00 $.00 00 Payment(s) $736 16
150.179 DAYS PAST DUE 180* DAYS PAST DUE credit(,) 00
00 00 New Balance $323 07
Page 2 of 2
i
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or unautho-
rized purchases If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases, this
statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1 -800- 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
PreKr,bed by Stale Boerd of Accowte 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
�n5 1��0 liJ/l�t'SaIC' 3�� Purchase Order No.
Terms
Date Due
Invoice IFweiee Description Amount
Date Number (or note attached invoice(s) or bill(s))
/v /6 Vg .2 /Z jS(a 65
Total 3�
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._
ALLOWED 20
IN SUM OF
3.z 3
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO #or INVOICE NO ACCT #/TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
/S(J 0,23t��{S �fZ39�=/� %(v, 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
20
0/ 1 0
Signature
Director of G olf
Cost distribution ledger classification it Title
claim paid motor vehicle highway fund