202285 09/27/2011 a CITY OF CARMEL, INDIANA VENDOR: 364942 Page 1 of 1
ONE CIVIC SQUARE REPUBLIC NATIONAL DIST COMPANY
CHECK AMOUNT: $331.24
it CARMEL, INDIANA 46032 Po eox 660357
INDIANAPOLIS IN 46266 -0357 CHECK NUMBER: 202285
CHECK DATE: 9/27/2011
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 921172 -3 331.24 FOOD BEVERAGES
REPUBLIC NATIONAL DISTRIBUTING COMPANY
INDIANAPOLIS
P.O. BOX 1602 INDIANAPOLIS, INDIANA 46206
ORDER DESK (317) 636 -4880 1- 800 772 -7347
IN LIQUOR PERMIT IM WINE PERMIT ,_l
INDIANAPOLIS W49 -09133 w49-15036 ADMINISTRATION (317) 636 -6092 1- 800 -562 7359.,
R k EVANSVlLLE 812 I
CROWN POINT W49 -09133 W49.15036
SOUTH BEND W71 -87478 W71 -87479 p T r p�� �7, A I 86 7 -7441 1- 800 -742 -3910
D I S 1 �+Tp f1 BU 1 Nfi, I II Q IrI�r `A'I V Y. CROWN POINT (219) 661 -9970 1- 800 552 4085
CUST 00741 I I I I I SOUTH BEND (574 ),232- 3001 1- 800 -552 -2571
Iilll III Id IIII
LICENSE RR"'2' 9- 0`35A2 FT. WAYNElCROWN POINT /SOUTH BEND
CUSTOMER SERVICE 1 -977- 775 -2573
CUST. NAME CI T`V OF C APMIEL
PAGE INVOICE NUMBER
GUST. D.B:A- B�cuO�S�I'F;i= GOLF C'LU�3 1
ADDRESS 1 BR OC.KSHIRE PKWY i s It. 0010 9 30 11 921172 3
0002 IN ACCORDANCE WITH INDIANA LAW
CARMEL IN 4603 1'150 1151 11.50
ASSURE SPECIAL IN INVOICE NUMBER PAYMENT SALESMAN'S l 151 1 �J i 1 1'SO I I
INSTRUCTIONS
i 151 1 150 list
Q UANTITY
o -DESCRIPTION e
CASES BTL 3524 3 175L 6 BACARDI P.D. MAI TAI 01 225592 A13 7 15.08 1.64 40: 32
61 S2", /0/ 5.00
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071D, 3 175L 6 BACARDI P.D. RUM RUNNER 01' 225602 42'-5 1 G 1. 13. 40.32
6152 /0/000 5.00 Y
Ai37 2_ 175L 6 BACARDI P-0. MAI TAI 01-225592 3�� 72. 9. 62.6S 125.30
6152 10/000 S.00...; 10.4; Y
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B09 2 175L 6 BACARDI P.D. RUM RUNNER 01 e22 5 42 57 72.5 9. BS 62,65 12S.30
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INVOICE. 921172`•--3 AMT `I 331. 24" WINE LIQUOR, 331.24 I
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RECEIVED BY
CUSTOMER'S INVOICE PLEASE REMIT PAYMENTS TO'
ALL CLAIMS FOR DAMAGES MUST BE DE ON RECEIPT OF GOODS P.O. BOX 660357, INDIANAPOLIS, IN 46266 -0357
VOUCHER NO. WARRA NO,
ALLOWED 20
Republic National Distributing Company
IN SUM OF
P.O. Box 1602
Indianapolis, IN 46206
$331.24
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1207 921172 -3 42- 390.40 $331.24 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, September 15, 2011
Director, Brooks re Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 199.`
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be property 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))
09/15/11 921172 -3 wine Spirits $331.2
1 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