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164955 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 359366' Page 1 of 1 t` ONE CIVIOSQUARE SYSCO FOOD SERVICES CARMEL. INDIANA 46032 PO sox 7137 CHECK AMOUNT: $3,174.66 INDIANAPOLIS IN 46206 -7137 CHECK NUMBER: 164955 CHECK DATE: 10/1612008 DEPARTMENT AC COUN T PO NUMBER INVOICE NUMBE AMOUNT DESCRIP 1047 4239099 806170676 1,252.85 OTHER MISCELLANOUS 1047 4239099 606209067 36.25 M;ISCELLANOUS 1047 4239040 806249055 83.49 FOOD &BEVERAGES 1150 4239040- 809330735 1,047.00 F60D BEVERAGES 1150 42390:40 81007.0`886 579.48 FOOD BEVERAGES 1150 423:9040 810071037 175.61' FOOD BEVERAGES I s .Aw CONFIDENTIAL PROPERTY OF SYSCO O�LY CL3S1€)kER h1V $ROOKSHIRE GOLF CLUB 1R s oP. 12120 BROOKSHIRE PKWY 412940 810070886 9 1 SYSCO FOOD SERVICES o CARMEL IN 46033 OF INDIANAPOLI LLC Rt7ilE 4000 W 62ND S� '.PASTDUE'Bi1iANCES `TIRE SSJRJEC`E T(7: o 317 844 1415 INDIANAPOLIS, IN 46268 30 DAYS FROM DATE OF INVOICE 0 CITY OF CARMEL Z 1 CIVIC SQUARE DRIVER: MAY, JEFF I fl OTY a N AC S1Y'. R? ear untrr ExR3RV1�R R� p 'z €TNi DESGRIPTION o :.:T. GC3DE PRICE: PR1C� k DAIRY r 7 C5 3903 S OZ HLFARM CREAMER �L,..HALF CUPS ESL 3162400 9095035 62 .,16 16.62 i GR }HP 'TOTALS* 1:6.62: MEATS D 1 G :S 4Q$ OZ AB BEEF GROUND STEAK BRGR PTY 99738$51 52.74163 54 -36 54.36 o 0 S �110 RMOUR FRANK ALL MEAT 5X1 GRILL 5010031218 1074384 2144" 64.32 n 11.1 m S 533 OZ NES D SAUSAGE PORK PTY DELI WIDE. BRN 018.743 9315631 26 10 26.1Q ALI;NOSHOW0$ ..00 :00733 P CS 5.. 2;5 GROUP TOTAL 144.53 A !FRO: EN CS 1212 ,GT'. BRLCLS. SIJN. HOT.1� ©G ::;b 5361 4748986.!:2... 5 2 5.5:4 I 12 CT: HOMAS MUFFIN ENGLISH' OR.IG..2,<;OZ 940,1 153'5368.:::18 *:97 18.9:; A GROUP TOTAL 44. 1. CANNED &TRY *I o N CS :316. GT' .ELL4GG .BiAR ASS!T.:NU`PRI: =GRAIN 3800 421'5883 :::26..4:5. 26.:4;5. n 11 Z 0 C:S 6.41 5.. Q':Z. U1ICHIP CHIP: MJLTIGRAIN HRVS'T CHED LSS. 44427 674 ;24.76. ;24.7<6 1.11 r. CS 6.'2 OZ OLGOL.D PRETZEL T1AlY. TWIST CL LSS X43.91 67 8$45.: 23 ;8 <23 98: A GROUP "TOTAL* __.I 75:1.9 A DI:iS.POSAHLE p ':GS 2:025 .CT; ART::! GUP FQAM:.HORZH .B.GIIBERRY 20 .<:OZ 2.O J1;5 .7. &3:73(}9..;.: 7:7 26.71 Z ALLNOSHOW08 000073387 P 25 25 CS '20 CT IXIE CUP PAPER HOT PER, TOUCH 12 OZ 5342C, 8090268 02 97 ""102.97 11 CS 4100 CT YSCO GLOVE POLY DISP CAST Mgt 104- FHCT14CPS 8477671 16 76 16 76 m CS 10100 C IXIE LID PLAS DOME FOR. 12/16 OZ :CUP D9542 535:0657 59 56 59 '56. Z "r r I CS 101ObCT ART LID PLAS LOCK STRAW 24OZ 16FTLS 5632005 17 99 17.99 m GRGUP TOTI�L m A m A N i a fiMl# 1'a 1 16 23.4 183 PNDYAN�POLIS7 I IN sus 4206 7137 TOTAL TAX NO. PCS T. SIGN D INVOICE EVIDENCES RECEIPT OF ALL ITEMS. NIA PCs TOTAL DRiVER'S DELVO. SIGN GN 'a REC. INVOICE 1. c IMPORTANT PACA PROVISION: THE PERISHABLE AGRICU TURAL COMMODITIES LISTED ON TH IN ICE ARE OLD SUBJECT TOTAL Tp 7HE S7g7U7pRY_ T q�THORIZ'n gY gECTIpN 5 C� pF Tµ� PERISHgg gGRICU TURAL CpMMOpiTfES qC7 19O�UFS.C. PAYABLE ON OR BEFORE 499E�C)I. THE SEI.CtR OF ESE COMMODITIES RETAIN A TRUST CLAIM OWtl THESE COMMODITIES, ALL INVEtJTbRIEE ONT QN PAGE 2 FOOD OR OTHER PROOUCYS DERIVED FROM THESE COMMOOI7EE5. �+ND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTiL FULL PAV MENT IS RECEIVED. �r ysco CONFIDENTIAL PROPERTY OF SYSCO f7UV -DATE CUSTOMER C SI<.. 'G•' BROOKJHIRE GOLF CLUB 1 7 1212.0 BROOKSHIRE PKWY qQ TR �P.! 41294D $10070$86 9 2 SY5C0 FOOD SERVICES 0 CARMEL IN 46033 OF INDIANAPOLIS LLC -R°U?E 4000 W 62ND $`f' PtSr.OVE'BfciAN£ES ske.stt j�e; Ta� 0 317 —$44 -1415 INDIANAPOLIS, IN 46268 30 DAXS FROM DATE OF INVOICE 0 m CITY OF CARMEL 1 CIVIC SQUARE DRIVER; MAY, JEFF Z I. AT?mp.r, IN 46032 0 CY :PAS $IZE €`fE11A ©ESCRIRTION E1N� ExEENI�E17 i t= C F:: Gt3fl f..R C RRICE... ?C .I PRODUCE T m CS I10 LB YS IMP ONION 'YELLOW 7 J 'MBO FR5H` 80130 $399966 9 T2. 9 72: 1. GRf UP TO`�AL* 9 72 m D.ISPENSER.. C$ 422 OZ., BEST CF COFFEE..GRND,..SEATTLE BEST 000923022 0726414 58 17 58 17 0 GROUP TOTAL1.* 5'$ 7 1. MI, S CHARGES S HGS f. JEL SURCHARGE 7 0 0 r y (?RD RY 1. .......`:..3$.522 0 T m 0 I A m 1. :..a: 111 ::o 1 Z 1J �:2 is c it lip .:I a 0 A A .I A m Z .1 n O D C r. ...l... e. m ..''i' J:. m Z m 0 T ::C: S m E rn 1. :i. r AEMti Y-. P.O. BOX 7137 2 1.1 16 INDIANAPOLIS IN SUB 4206 7137 TOTAL 579.48 1 1$ 24.5 199 TAX NO. PC$ OUST. SIGNED INVOICE EVIDENCES RECEIPT OF ALL ITEMS. NO, PD$ TOTAL DRIVER'S DELVD. SJON Y REC. SIGN INVOICE 579.48 IMPORTANT PACA PROVISION: THE PERISHABLE AGRICU TURAL COMMODITIES LISTED ON THIS INVOICE ARE SOLD SUBJECT TOTAL ip THE S7g7U7pIV IR T ITHORIZE gy gECTIpN S +C� pF iF{ PERISHgg F q�ftICULTUBAL CAM 0 IT'U W 1230 !F5.C. pgYABLE ON OR 6EFORE 499E 1€11. THE SELLcR OF THESE COMn ODITIES RETAINS A TRUSCLAIM OVER THESE COMMODITIES ALL 1NVEtJibRIEE33 tai j /08 LAST PAGE FOOD ON OTHER PRODUCTS DERIVED FROM THESE COMMO DITtES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF 11 /QE THESE COMMODITIES UNTIL FULL PAYMENT IS RECEIVED.