156553 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,.+
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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