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Home My WebLink About156553 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1 ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP CHECK AMOUNT: $130.00 X7,2 CARMEL, INDIANA 46032 PC BOX 34535 SEATTLE WA 98124 -1535 CHECK NUMBER: 156553 CHECK DATE: 212112008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 R4355300 17984 130.00 PARKS DEPT MEMBERSHIP �x i Carmel a Clad �EIVED Parks &Recreation CHECK REQUEST JAN 3 1 2008 Date: `J�/ -D� c�G Check payable to Name: sTC p Address: 1 C'6 /f"' City, State, Zip /l'�yL� l.s f� 'S/�a f Mail check to payee Return check to requestor Check Amount oo Date Required As'<r -P Check needed for j pe*- ,be vs r1 ,0 '(z q�J7` t Z ivy G as e 's s 4 c- Supporting documentation or receipt(s) MUST be attached. To be paid from PO# Budget account GL Budget Line Description 'z .4 Requested by (print): aj Requested by (signature): Approved by (signature of Division Manager): on this date Form revised 1 -21 -08 t Carmel Parks &Recrea ion Administrative Offices 1411 E 116th Street Carmel, IN 46032 P 317.848.7275 F 317.571.4136 www.carmelclayparks.com MEMORANDUM TO: FROM: COSTO CUSTOMER SERVICE AUDREY KOSTRZEWA, MICHIGAN ROAD LOCATION BUSINESS SERVICES MANAGER Phone: 317 -532 -1654 Phone: 317 -573 -4021 Email: audreyk @carmelclayparks.com Enclosed you will find a Costco membership application.for CARMEL CLAY PARKS RECREATION. The following individuals will be authorized users on this account: Audrey Kostrzewa, PRIMARY CONTACT Colleen Broderick Kate Schneider Emily Randell Ben Johnson Jennifer Sewell Business Membership 1 6t two cards $50.00 2 add'I cards 40.00 2 add'I cards 40.00 TOTAL DUE $130.00 jLY IviK7G OAIvfPAVGIJ CODE WvIT. PAID TENDER TYPE. CLERK TILL# GATE GDSTco PCN U50 MEUB. OSTCO BUSINESS MEMBERSHIP APPLICATION PCB. InaL a [ication for The TrueEarnings Business Card from Costco and American Express pp BUSINESS MEMBERSHIP $50 a year including a BUSINESS NAME /1 SS LICENSE NUMBER NUMBER OF EMPLOYEES rreeHouseholdCard 'ur�� '�eC� Business License fora pieces yy u. business 101 required to BUSWESS MAILING ADDRESS CITY STATE ZIP COUNTRY AREA CODEI BUSINESS PHONE EXT apply for membership Y'rl�e1 //V h/� 03a usfl -3/9- 57.f RESALE PERMIT NUMBER #1 STATE EXP. DATE EXECUTIVE MEMBERSHIP E -MAIL .ADDRESS loptionaIr UPGRADE is an additional l 00 3 /oZ 0 $50 a year, including a free Receive special offers and hob buys from custco. coin. Household Card, Limit one STATE EXP DATE 'TDBACCO RESALE PERMIT N JMBER (SEE BELOWI STATE EXP GATE Er:ecutive Membership per RESALE PERMIT NUMBER #2 household anti business. !ES ✓Ip0 RESALE/TAX EXEMPT AUTHORIZED.' YES NO PRIMARY CARDHOLDER INITIAL NAME LEGAL FIRST NAME MI DRIVER'S LICENSE NUMBER' STATE (AREA CODE) HOME PHONE NAME PREFIX NAME SUFFIX HOME MAILING ADDRESS CITY STATE ZIP 0001JTRY Mr Mrs Ms Miss Or Other Jr Sr II Other card [opuenal)cirpleone [optibnak)circlea e IPO Box;requiredlfapplicablel :ANq (op Household Ca'rdns avada le to pri ary ar edd'on CardhoYder•s spouse domestic pa ner'or immediate fami4yrnemher P same address `iHouseholdGa wil be asked to thaf�ihey live'at -the same add the ess the- primary N0 wRESALE/TAX EXEMPT AUTHORIZED. YES N(1 PRIIUARY CARDHOLDER INITIAL YES NA PREFIX NAME SOFfIY,` AE LEGAL RRSTiNAME MI DRIVERS LICENSE S UMBER TATE NICKNAME M Mr Mrs Ms Miss Dr Other Jr Sr II Other �G .0 'OepI �QGLG N ortaanal cireleione' [name to��lnt an membership card) IoptVOrial) circle one l I I 1 4 5 A'Up OfV `CRRU You, may add Additlol�al CardhoI pf!r to your mernbe f hip for 40,each YES N0;RESA EftAX EXEMPT AUTHORIZED: YES N0 PR, „a y STATE (AREA�CODE)'HOMEPHDNE Q'ti LEGAL FIRST:NA.ME r. F NAME j W ALL J 6�!A//V o NAMEaPREFIX.: I NAfv1,S FFIX OMEIv1A1LING.ADDRFS5'' CITY STATE Z!P COUNTRY Mr Mrs Ms Miss Dr Other Jr Sr II Other hard) lopnonal] mrcle one r loptlonall circle one IPO Boz requlradrihappli' able) �'aa KsC'L of Buys from costc&!G oin I) and Receive speciahoffers h yr t''' y s ;au. �R. 4,a,.' s_. .i a� 4,, a i' i `seio tl!Ca d' s availzble to apnmary on Cardho9ders spouse domestic partner immediate family,member over the CAND'(optional) A n ar•tf e'. "sam address as the primary ar.+add,on Cardholder r t it Y e same address'!' Household Cardholders willrbe asked I o present p thatrthey live A d r +ak"",a e #kv,. If r k,ei ?"''k•>),.xzE t v UE ALE� AX'EXEMPTtAUT,HORIZEb YES I NO,',�,fr� RIMARY�CARDfiOnDER,INTIAL 4, YES NDs y RES /T kta t." t x e r PREFIXp NANErSUF -fIX LEG °F BSR AME MI DRIVER65tLICENSE?NUMBER ;STATE NICKNAME" m1 Mr Mrs Ms Miss Dr Other Jr Sr II Other o tronaq circle one lop ions} circle one -r p gal mine to print i',memhership card) p I 7AR9 ENT FO R COSTCO M EMI B ERSHIP: Please Include sales tax in NY HI AZ, NM UT NJ plus all other applicable states. fees are 3 t change. r ?"xSfr� �.�?anaEessrGard s L:�.�as'. k"""'• t�'�.:E;E�t?.:�' -.,w,A kS` sap '.0 u�,�r"�`a�.' s ,.5��E- A. FOR COSTCO USE ONLY MKTGCAMPA1Gi4CODE AMT.PAJD 1EIJDERTYPE CLERK TVLL# DATE casrco PON D❑❑❑❑❑❑ usD rnErnB. COSTCO BUSINESS MEMBERSHIP APPLICATION with optional application for The TrueEarnings Business Card from Cl and American Express BUSINESS MEMBERSHIP $50 a year mduding a BUSI ESS NAME S1 NSE NUMBER NUMBER OF EMPLOYEES iq/kCd.ESAte free Household Card. Business License (ur 3 pieces 1Z of business required to eU64NESS MAILING ADDRES CITY STATE ZIP COUNTRY (AREA CODE) BUSINESS PHONE +EXT apply for membership EXECUTIVE MEMBERSHIP E MAIL ADDRESS (optional) RESALE PERMIT NUMBER #1 STATE EXP DATE "ffil UPGRADE is an additional 550 a year, including a free hold Card Limit one Receive special ctfers acid hot buys from cosico.com. Executive Membership per RESALE. PERMIT NUMBER #2 STATE EXP DATE TOBACCO RESALE PERMIT NUMBER °(SEE GEL0tNI STATE EXP DATE household and/or business_ BUYING FOR RESALE; YES,, NO RESALE/TAX. E /EMPTAUTHORIZED: YES NO PRIMARY CARDHOLDER INITIAL NU GATE OF BH LAST NRME LEGAL FI ST NAME MI DRIVER'S LICENSB MBER IRT STATE (AREA CODE) NOME PHONE NICKNAME ,'NAME PREFIX NAME SUFFIX HOME NAIL'�NGADDRESS CITY STATE ZIP CDUh1TRY Mr Mrs Ms Miss Dr Other Jr Sr II Other (name to print on memberh p card) (ophonall circle one 4 (optiona 1):circle one YPO L Box regwretl if applicable) FREE HOUSEf10LD A:Nouseheld Card is avalEable to a primary or add,on Cardholders spouse; damesEic partner or Immediate family member pvardhe age of 18 and living at thesarne adtlressi Household Cardholders.will be asked to present proof thar�they'hve at he `same,aadress as tihe prunarY or'add on -AraliolUer. BUYING FOR RESALE YES N0 +RESALE/TAX EXEMPT AUTHORIZED` YES, IV,O PRIMARY CARDHOLDER INITIAL DATE OF BIRTH 1A51, AME LEGAL FIRST NAME Kk DRIVER'S LICENSE: N0ill STATE NICKNAME NAME PREFIX NAME SUFFIX Mr Mrs Ms Miss Or Other Jr Sr II Other /i, „/14 Iname to print on membership card] lops ogall cirele,one= (optional) circle one c+' z Av- t 1 r a'" h z f $4U Bi15INE5S *$AqD 0E wCRRDYou, may add Addltlonal Cartlho,lders tO youre Fri eimbershlpor $40 each srt ,S.fc rtii FIRST NAME.,'. NU' P iIMARY CARDHOLDER INITIAL BUYING FOR RESALE.'. YESt NO RESALE/TAXEXEMPT AUTHORIZED YES. d DATE OF BIRTH LAgT tJ4A'AF �LE MI DRIVER 5 LICENSE NUMB STATE (AREA•G0.DE) HOME PHONE NICKNAME NAME;PREfIX NA =1 HOME 'AILINGA DRESS. CITY STATE "ZIP COUNTRY Mi Mrs Ms Miss Or Other Ji Sr II Other (name to print an menhershlpcad)t loplonallcircleone` t r, IpptionallcircleoneIPO ?8orregurreofif applicablel 1 E- MAILAODRESS (optlonal) a s Aece ve spaclaltoffers and srir`omrcostco"tcori iew �o F :tom v' �'nY .G �i• �S .'t�° .9.�• k 4 FREEHOUSBHDLD CAfiDt(ppuonal)- A„HouseholdCard is�avallablefto on blders spouse; domastic�pa trier or immedlaxe l 4" "''T• v ✓i Itbeaskedao3 resent roofEhat ^ilia liveat as.tf a primary oF:add on Cardholder wv age if 1 B andal arthe same address old Cardholde sr I p p ,r d s; K y i gi a ;3 �T t c$ g at .aE asti a 48` R SALE?n YES tiS NOS 'R ESA LE/TAkEXEMPTfAUTH0RIZEM I YESr x NOS a sPRINIARY R INITIAL k BUYING+FOR E x a M'F 1t utp 1 5�r,,� rH p 3Rs MI S# ti� NUMBER STATE NICKNAME 0. NAMEPREFIX N SUFFIX DATE Of BIRTH LAST NAME r Y LEGAL,FIRST NAME Tyr E, DRI,VER'S�NISENS ,E s Mr Mrs Ms Moss Or Other Jr Sr II Other nnton member card_)loptionei) circle one F< (optieriall GiEce ones' l� Ne-1 cu a,c.�GV✓I 7`rJr c3 �rc lr.�fG'l M E I HOD OF PAYMENT FOR COSTCO MEMBERSHIP: Please include sales tax in NY, HI, AZ, NM, UT, NJ, plus all other applicahle stat e n,Ex s Fe ara subject to cha ¢je ,�'Sar'`;.�cx�i; ms s. rnE x' s S��ave�[ime;andr osta� =check +here torenew your£annual iremhershl automatmally ,en,,y.ouraAmncapress Gard. at s, ��t +�x a z _"'.y- t �r"n Ata,.+ c 6� Y 'e�•i sa. �,I�'S.e 1`'�.t�u':� ��J' i :.'ri:. ?��rL�acL,��.` E9.,'t"+.�>�w.�'.,''a ACCOUNTS PAYABLE VOUCHER 5 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. Costco Terms 9010 Michigan Rd. Indianapolis, IN 46268 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/31/08 ck request Membership 130.00 Total 130.00 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. Costco Allowed 20 9010 Michigan Rd. Indianapolis, IN 46268 In Sum of 130.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept 17984F ck request 4355300 130.00 1 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 18 -Jan 2008 Si nat e 130.00 Business rvices Manager Cost distribution ledger classification if Title claim paid motor vehicle highway fund