165344 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: 359164 Page 1 of 1
0 ONE CIVIC SQUARE KEN MILLER
CARMEL, INDIANA 46032 768 GRACE COURT CHECK AMOUNT: $338.31
CARMEL IN 46032
CHECK NUMBER: 165344
CHECK DATE: 10/2912008
DEPA ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1150 4237000 188.55 REPAIR PARTS
1150 4343004 149.76 TRAVEL PER DIEMS
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4 31 ?49829885
ATLAS RC4STfIi iT�T SUPPLY
33 ^9 N SHADPE1_;1ND
ING °IAe;Rr"Gi_15 Iii 4t352b
31.7 -541 -1111
MERLNANT 3139 3871MR33604 001.
DiVIOICE 4' 0,77 ;6'
ACICOUNT t
?1.' 9 CE
HTCH 29HP01
RUTH 685.533
S AL E
1 PGR.''E T` ABOVE TOTAL RMOUNT
ACCDRDI i CA) IS` ER AGREEMENT
!.hi�RCli� PaE, JIT. VIOULHC "I:i
%�i`' H._tllLi_ER
TCP COPT' MERCH gOT1911 -C1.01
52245 STATE RD. 933 NORTH 2244 S. DIVISION PLEASE REMIT TO
SOUTH BEND, IN 46637 GRAND RAPIDS, MI 49507 1 7077
(574) 272 -3343 1- 800 -552 -ATLAS (616) 248 -2888 1 -800- 492 -8527 ATLAS RESTAURANT SUPPLY
RESTAURANT SUPPLY P.O. BOX 4075
3329 N. SHADELAND AVE. 929 N. COLISEUM SOUTH BEND, IN 46634 -4075 1
INDIANAPOLIS, IN 46226 FORT WAYNE, IN 46805
FOOD SERVICE EQUIPMENT SUPPLIES (317) 541 -1111 1 -800- 333 -2001 (260) 467 -1788. 1 -866- 467 -1788
10/ 16/08
200000 TEMP
INDY HOUSE CUSTOMER BROOKSHIRE: GOLF CLUB
12120 BROOKSHIRE:. PKWY
CARMEL, IN 46033
REFERENC NUMBER SHIP DATE SALESPERSON TERMS FTAX C ODE I
1
10/16/08 06 RICH VAVUL GOD -M IG D04549 02 PREPAID COUNTER SALE
ITEM DESCRIPTION ON. "M M-w�1win);111
005250 CMTSW4 4 oz. CHAIt1PAGNE GLASS .100 100 .000 CS 120.00 CS 12. 00
20PK /CS, (500 /CS) 2--PC. PLASTIC
297140 STF SS PAN HALF 4 "D. 1.000 1.000 .000 EA 13.15 EA 13.1
220A ANTIJAM NSF
295210 HALF SIZE DRAIN CRATE 1.000 1.000 .000 EA 2'. 23 EA 2.23
CHR. PLATED 10" x8" WI RE (48/CS)
297540 STPA6144 1/4 SZ 4" DEEP 2.000 2.000 .000 EA 10.60 EA 21. 20
ANTI JAM STEAM TABLE PAN
297570 1/4 SZ. STEAMTABLE PAN COVER 2.000 2.000 .000 EA 5.96 EA 11.92:
SOLID 12 /CS
297170 STPA7120C SOLID 1 /2SZ COVER 1.000 1.000 .000 EA 8.05 EA tl
SS
700120 6055A FULL_ SIZE WARMER 22 OT 1.000 1.000 .000 EA 12'0.00 EA
W /T -STAT WET /DRY 12'0V 12_00W 1 C
Ser 69418 -•7 1.000 N
SECURITY AGREEMENT. Purchaser hereby grants and conveys to Seller a MERCHANDISE MISCELLANEOUS 111109=41eNk I
security interest in the goods described above and their proceeds pursuant to the 061
terms and conditions contained on the reverse side of this document. r_ r Z_ r
DATE Company:
8. 00 00 00 188. 5,,
By: CUSTOMER COPY
Signature Title j
EXCLUSION OF WARRANTEES. EES. 'TTTHIIE PURCHASER AND SELLER AGREE THAT THE IMPLIED
WAIRIRANTIIIES '*OIF. MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE AND
AILI O TIF-IIIIJIIg,d�ARRAfi1'I I ES. IE'XP ESS OR IMPLIED, ARE EXCLUDED FROM 71;IFIf��t ANSAC.°
�TT.RON AND TIk�AILII� I�Q 'Ir P lIDTI THE GOODS SOLD, k"RO TRD ETLD ILI OW E.,VIETI$, THAT 'Tl'1 IS
EXCLUSION OIF ;W. AR- -8AN TT>IJF —APP Lff ES ONLY TO SELLER AND THAT THE GOODS SOLD
PURSUANT TO THIS TRANSACTION ARE OR MAY B E SUBJECT TO THE WARRANTff ES,
IEXP'IRTESS OR IMPLIED, tGR VIEN BY THE MANUFACTURER THEREOF.
Purqb,aser agrees. to purch se,;the. described goods and to:g�y, Atlas, Restaurak�t Supply, jl c.. (So.ler) the
total price stated herein for the above described goods, including sales tax, in accordance with the Sale Terms.
Sale Terms are net cash seven °(V), days after delivery, with interest thereon at the rate' of one and one half per
cent (l��Io) per'i onth- the'�-tlnpaid total "price-, commencing seven (7) clays dcliveiyi of the described aoacls
for eachpi.onth nortlon thereof durl.nl� wh'ch an outstandi.na. balaflee Ic.3f tlle. total 7l Price I:Cmalns Ptt:rClld5t.1'
C. assumes all i is of damages or destruction to'the goods upon delivery. Purchaser a�re� .to py'.elier
sonal�le ttorrtW Fees 'an'0: gusts of coilec.t'ion of anv',,a�pount not paid when due...Purcn�i�er �p�ees that i} y
return of the goods' sold hereunder.may be made to Seller without express. written -S ller and that
Sellai'may �irgL a red%,., e stocking 'for all goods scl:.:returned.
SIECU�BIIFIP�' A�IEIE(IEI`I�1Ca Purchaser'lieref�� grants and conveys to"Seller a security rnei=est' and to'the
described goods, eon, in and to the rod, s thereon, .to,, Secure the a z e;n.t o ..Pureba ser fog' tli C__ S §61d p a., p
,hereunder. Purchaser authorizes Seller to execute on its behalf and file array financing statements deemed nec.,-
essary Seller}.to perfect�its.sQcuri.ty interpst.in said goods: Purchaser: that ,the,. d ti,Tall b .zna n;
ied in good condition and repair. The failure to pay when due of any amount payable. haeunder shall eoi:-
sfitute a default under this agreement. U}»ii default, Seller have and may exercise all the rights and- ren ed"ies
"ofa secured party under the Uniform Commercial Code or any other applicable law.
ii it' Nj% F YT
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Prescribed by State Boat 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.
Pay
Purchase Order No.
670 /1 Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
J
Total
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
A -45 A
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
0 7' 1 S bill(s) is (are) true and correct and that the
2 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sigr��ure���
Cost distribution ledger classification if T 1 ilt tle
claim paid motor vehicle highway fund
I
Pv. ib.d by Stat. Hoard o: Acbo=u.
.,.a W Fom No. :O! Ut*d
MILEAGE CLAIM
(GOVERNMENTAL UNIT) TO pQ
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION) ON ACCOUNT OF APPROPRIATION N0. FOR_
DATE FROM
TO I SPEEDOMETER
READING+ AUTO MILEAGE
DINT POINT NATURE OF BUSINESS I TRAVELED @ER MILE
START rINISN
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IZ I Cam cv
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8
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AUTO LICENSE NO.
TOTALS l III`✓ W
+SPEEDOMETER READING columns are to be used "only when distance between points cannot be determined by fixed mileage or official highway map,
Pursuant to the provisions and penalties of Chapter 155. Acts 1953. I hereby certify that the foregoing account is just and correct, that the a�-nount claimed is y due. after allowing. all just cred
and tha no part of the same has been paid.
Dcte /l�
Ciaim No, Warrant No. I have examined the within -claim and hereby
IN FAVOR OF certify as follows.
That it is in proper form.
That. it is -duly authenticated as required
by law.
That it is based upon statutory 'authority.
That it is apparently correct
incorrect
Disbursing
On Account of Avppropriation No. for
Of icer J
p n
G 0 R
Allowed 19 0 0 a.
in the sum of ts-
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to
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(Board or Commission) a
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FILED n
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Dirwor of Golf
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