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163419 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1 ONE CIVIC SQUARE SYSCO FOOD SERVICES 0 CARMEL, INDIANA 46032 PO BOX 7137 CHECK AMOUNT: $4,675.31 INDIANAPOLIS IN 46206 -7137 �o CHECK NUMBER: 163419 CHECK DATE: 913/2008 DEPARTMENT ACCOUNT PO N IN VOIC E NUMBER AMOUNT DESCRIPTION 1150 4239040 807180626 676.13 FOOD BEVERAGES 1150 4239040 807250566 1,116.74 FOOD BEVERAGES 1150 4239040 808120693 967.00 FOOD BEVERAGES -1150 4239040 808139064 92.23 FOOD BEVERAGES 1150 4239040 808190712 1,182.59 FOOD BEVERAGES 1150 4239040 808260761 640.62 FOOD BEVERAGES [�Tf7��R'� C]R[C l(tUO�C CONFIDENTIAL PROPERTY OF SYSCO BROOKSHI RE GOLF CLUB s��v2 A cvsr�naER u E3 12120 BROOKSHIRE PKWY 412940 808260761 8 2 m O R SYSCO FOOD SERVICES k a CARMEL IN 46033 OF INDIANAPOLIS LLC R s�uE D 4000 W 62ND St 2062 fem:ms:;�lil e.stJBcT ro 317 844 -1415 INDIANAPOLIS, IN 4b268 30 DAYS FROM DATE OF INVOICE 1 318192 NO AL DEL 0 a CITY OF CARMEL GARY LEVERENZ i 1 CIVIC SQUARE DRIVER: MILLER, STEVE Q3Y SAC ITEM DESCRIRTION rrEtvt ur[Ir: �xrErioEa' o GROUP TOTAL**** 146 31 r CUP FOAM.. H01?�N.:BiLU:BERRY 20 '03 20J16 7.637309 26.7:1. 26. H1 1 CS 2'.025 C'I` ART�� m ALLNOSH4W08 000073387 P CS 25 25 !!N ON R A ON Tuns mrso not; C$ 4.100 CT Y5C0 GLOVE POLY.,DISP.CASTM.ED 104. FHCTI4CPS 8477671... 16 76 lb 7b Z low CS 4100 CT YSCO GLOVE 16 76 POLY .DI SP CAST POLY LRG104 FHCT16CP5 847797$ 16 7.b GOUF..TOTAL* V) PRODUCE 4tkiF y CS 15 LB YS IMP ONION DICED 1L4'" 40425 6524003 13 20 11:2 0 IS !Ross 1 GR a�r :7`OTAL* MEMO. 2 U DISPENSEI2 C5 422 OZ BESTCF COFFEE GRNO SEATTLEBEST 000923022 0726414 58 17 E 58 17 to njup 1015 8, ":r p of 91119 all, on SAO: C, H RG 5 HG5: FOR- _FUEL SURCHARGE....., sms O 1 2 0011 UMMA RX111M ithow 2 -:i: 1 to M �i 0 I A 0 8 Mims 101 loci 22MINX :;I< n OPEN 1 NSA: aml::Iltlltifl of A OEM= aft Mal q TNT P.O. BOX 7137 5 7.0 2 5 INDIANAPOLIS IN SUB 4 ;206 -7137 TOTAL 640.62 2 1 23 29.5 285 TAX DRIVER'S ND. PCS CusT. SIGN G INVaICE EVIDEN {ES RECEIPT OF ALL ITEMS. NO PCS TOTAL SIGN DELVD. SIGN REC. INVOICE IMPORTANT PICA PROVISION: THE PERISHABLE AGRICU TURAL COMMODITIES LISTED ON THIS INVOICE ARE SOLD SUBJECT I TOTAL 640.6 Tp 7�e 'TAMMY TRUST T q�THORIQ gy gECTI N 51C� THE P RISR LLEE q�RICULL=A COpMMMMODITIES qC7 1930bU C. PAYABLE ON OR BEFOAE 499EICkl. THE SELLER OF HESE COMMODITIES RETAINS A TRUST CLIM ��ER THESE COMMODITIES, ALL INVEtJTORIEESS 9/25/08 LAST PAGE FOOD OR OTHER PRODUCTS IL DERIV ED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNT F PAYMENT IS RECEIVED. c CONFIDENTIAL PROPERTY OF SYSCO sysco f11cLV SATE CI3$7t7MER C BROOKSHIRE GOLF CLUB... 2 12120 BROOKSHIRE PKWY Tft eK op 412940 808260761 8 1 0 00 SYSCO FOOD SERVICES a CARMEL IN 46033 OF INDIANAPOLIS LLC °�E C 4000 W 62ND Si 20 :PAST. DUE�:.BALANCES`:ARE''SEI�:IECF .70.E r 317- 844 -1415 INDIANAPOLIS, IN 46268 30 DAYS FROM DATE OF INVOICE IFE5T# 318192 NORMAL DEEOMRY 0 z CITY OF CARMEL MA -qNU� GARY LEVEREN I CIVIC SQUARE DRIVER: MILLER, STEVE P 5 nti7 Ex��v�r: [ITY ti x SAC S{ LTEM RESCRIRTION o GQDE RICE P.R10E E X i; DAIRY YV IV I 3 LB S:_ O NL Y 5 9RLCLS,CHEESE AMER YEL 120 SLI 28.131 16.62 16. i ALLNOSHOW08 0:0:0.073:3:85 PUN :.05.. .45 m D 4.5..20 CS .1801.5 :OZ Y.S:.<CLS EGG 'PATTY :O:VER E:wZ LG 74:865 5:6946 :fl x.4':34299 45..;20.. 1 ALLNOSIHOW08 000073385 P /CS ,25 25 Z GROUP T 61.2 n m CS 408 OZ. AB BEEF GROUND. STEAK BRGR PTY. 99738$51 5274163 52.5.0 .105.00 N xx 0 C _110 LB HNSVLE BRATWURST 4X1 PRECOOKED...... _199 16I1243 29 44 f5 .4 4 S XX CS 110 LB RMOUR...FRANK..ALL 5X1 GRILL 5010031218 1074384, 21 44 42 8.8 C5 533 OZ J ONES D SAUSAGE PORK PTY DELI WIDE BRN .018743 9315631 26 `10 26.10 ALLNOSHW08 00:007386 PfCS 25. 2:5 A TOTAL GROUP S 203 17 F CS al 2 .C:T YS :;CLS BU N.. HA!MBI1RGiER PLAI1..4l 7,;202 517:46 41 24636 21. 22 21 2:2 A D C-T BRLCL$ ;BUN HQ:T DOG 6 53 1. 474$986 25.'5`4 51 .{36 o P 5 7 2 CT HOMAS MUFFIN ENGLISH ORIG 2!> Z 94.0 5 153536 .9!7 A GROUP TOTAL* 1 2 7 CANNED &DRY I m <CS... 76. 64 .:5OZ UIVCHI.P.. I4IP'NIULTXsGRAI T..'QRIG:>flIC, GRAB 44425 :67!:4.41.02:: 24.7:6 2�k... Z n O GB. 6:41.3752 SVICKI I?;OTATO SALT N VNGR KE'TLE 444.46 6743530,< 24.7 24 7b o GE..1201 4 !OZ LAXTER.:C!RACKER PSANUT $:TR.:TOAST 'ROUND 7.029182 24.;9:5 24.9;5. m C ;41 GAI RE.N..CHS MUSTARI} YELLOW CTS 415:004533 40Q6748 23,1'0 23.7:0 5 .6: 2 OZ OLGOLD .PRETZEL TINY .TWIST CIS LSS< 443:91 ;67,9$845;?;: 23.98 a: mu:m C 642.QZ HEET{35.;SNACK;CHEESE::.CRNCH BGGRB >LSS 443:6 6743086: 24 7b 24...76. T m m RE P.O. BOX 7137 22.5 260 INDIANAPOLIS -7137 SUB TAX NO PC$ (�`U J^T. SIGNED F$ffi.ON RECEIP o ALL ITE N() PCS DRIVER'S X AL SIGN DELVD. SIGN C. INVOICE I iMPf)RTANT PAC{A PROVISION: THE PERISHABLE AORICU4TURAL COMMODITIES INVO CE ARE SOLD SUBJECT TOTAL TS [WEE STnjljT?pR Y TRUgT AI�TpORIZE. jJ BY SECTION AI 5C1 O THE PERISHABL C�VIMOpITI ��.OR C. PAYABLE ON OR BEF 499 ICI)THE SELLER 6F THISt COMrvIODITIE3 RETN A RUST CLAIM OVER DITIES, ALL INV ONT. ON PAGE FOOD OR OTHER PRODUCTS DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF 2 THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 SS 5e0 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 6� v8 �ya �z Total 2 o 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 VOUCHER NO. WARRANT NO. ALLOWED 20 J IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or SD Z 7 -1 �o y0 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 I nature i� v/7 file a�- Cost distribution ledger classification if Title claim paid motor vehicle highway fund I.. 'f`l I:S n g Rt[,'jNA I I CONFIDENTIAL PROPERTY OF SYSCO BROOKSHI RE GOLF CLUB v.. E c��rvM� B 12120 BROOKSHIRE PKWY 00 0 T eKa ap<;; 412940 807250566 5 1 SYSCO FOOD SERVICES 0 CARMEL IN 46033 OF INDIANAPOLIS LLC R v e D 4000 W 62ND S� .FF1'ST.OUE .BA3.ANCES; S33RJPC'f 70.:' r 317 844 -1415 INDIANAPOLIS, IN vmekmW�E 0 m 9 I. QTY m PAC SIZE ITEM DESCRIPTION j o 1. C ::r `GbDE PR G �XPAICE X DAIRY C S NL_5 LB BRLCLS CHEESE AMER M 120 SLI 28131 6697114 16 62 16 62 i m F .CS 1.8. 5 Q$ YS,CLS E. PATTY OVER E -Z LG 1--- 45 143.4299 45 20 45 20 D GROUP TOTAL 61.$2:: 1. MEAT$ 0 11 F CS 49$ OZ AB, BEEF GROUND_STEAK BRGR PTY 99738851 527:4163.52 5b 105 00 F S 110 LB, HNSVLE BRATWURST 4X1 PRECOOKED t/ 19 1611243.29,44 58,6.8 o F C.S 110 L8 RMOUR FRANK ALL MEAT 5X1 GRTLL �j 5010.03121:8 10A 21 44 85..5 n 1. F S 110 LB HNS..VLE SAUSAGE ITAL LNK.541 MILD1/ 258 1817766 29.98 59 9 6 .1 m 1. F CS 533 OZ ONE5 D SAUSAGE PORK PTY DELI WIDE BAN i. 018743 93 15631 26 10 52 20 I GRfJt3P TOTAL 361. 80 p 11 *...FROZEN N F CS 1"012 YS CLS BUN HAMBURGER PLAIN 4 1.7 ....51706 0124636 21.22 21,22 0 1. F CS 1212 CT B12LCLS BUN HOT DOG 6" 53612 4748986 25 `76 -I.., 62 F CS 12 CT THOMAS MUFFIN ENGLISH ORIG 2 OZ V 94015 153'5368 la 97 37.94 .::RflUp TOTAL.* x:85.7 p 11 DRY 11 A r D CS 601.502 UNCHIP CHI"WLTI GRAIN ORIG BIG GRAB (r 11171 5513452 ''2"3 37 23 .'3 7 11 D ,S 601 1252 KDLAYS CHIP POTATO._BKD REG BIG GRAB' 11201 550 23 37 23 37 o D CS 601 Z AYS CHIP PQTATO:REG LSS 11154 5508098 23 37 23 37 D D S 601 375 SVICKI CHIP POTATO VGR 42460 6448035 24 28 24 2$ D S 601 75OZ ORITOS CHIP_TORTILLA NACHO CH LSS?!'` 1121 5509740 23 37 23:37 z ...GROUP 1:17..76 "PAPER DISPOSABLE I -1,11.,.....r....." 1-1 1. 1. I...... .::::::::::::::::::::::::::::::::;:r;::I I.% r'. 1. I i�:�:�:�i::�.�: m D CS 2025 CT ART CUP FOAM HO N BLUBERRY 20 OZ 20J16 7637309.26 71 53 42 p 1. Z 0 2 1 27 39.9 323 P.4. BOX 7137 UPEN f/. INDIANAPOLIS IN SUB 4620b 7137 TOTAL i TAX DR I VER'S NO CS C T. SIGNED I V IDEWCES RECEIPT EMS. NO. PCs TOTAL S f V DELVO. S IGN A REC• INVOICE IM,90RTANT PACA PROVISION: THE PERISHABLE AGRICU{TURAL COMMODITIES LISTEO ON THIS INVOICE ARE SOLO SUBJECT TOTAL Tpp (rU° S7g7UT ©RY TRUST q�THORlZED gY gECTIpN S +CI p� THE PERISHA LLEE q�q CULLTURAL ppMMMMO ITIES qC7 I93DIU pgyggLE ON OR BEFORE 493E1�1). THE SELLER OF THESE COMMODITIES RETAINS A TRUST CLAIM OER THEE COMMODSTIES, Ali INVENTORIES 00 FOOD OR OTHER PRODUCTS ©ERIVEO FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF ONT. ON PAGE 2 THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED.