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180922 12/30/2009 a CITY OF CARMEL, INDIANA VENDOR: 355333 Page 1 of 1 ONE CIVIC SQUARE PEPSI -COLA GEN BOT IN CARMEL, INDIANA 46032 75 REMITTANCE DRIVE SUITE 1884 CHECK AMOUNT: $250.00 CHICAGO IL 60675 -1884 CHECK NUMBER: 180922 CHECK DATE: 12/30/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 4239040 9404933117 250.00 FOOD BEVERAGES PEPSI COLA GEN. BOT. Carmel Clay Parks Recreation 5411 WEST 78TH STREET 1235 Central Park Or E INDIANAPOLIS, IN 46268\ Carmel, IN, 46032 -4421 (317) 876-3464 /i INVOICE 9404933117 P.O. M: DRIVER: 628464 Sullivan,Orvill STORE: DELIVERY: 2009 -11 -27 11:57:59 -JIST PT: 8008584 DUE DATE: 2009 -12-27 CUST 10: 649907 ORDER: 40032174 TAX ID: 0119683083 -001 ROUTE: 711 VENDOR/DUNS: ASH: 606818 UNIT DISC NET DEP NET NET ITEM DE SCRIPTION UPC QTY PRICE PRICE AMOUNT EACH SALES 721 AQUAF I NA 20OZ NR 012000001598 20 40.00 27.50 12.50 0.00 250.00 480 SUBTOTAL 200ZNRPLS24 250.00 20 CS 480 TOTAL SALES 250.00 20 CS 480 PLEASE REMIT PAYMENT TO: PEPSI COLA GEN.BOT.IN 75 REMITTANCE DRIVE SUITE 1884 CHICAGO,IL 60675 -1884 TOTALS SALES QTY 20 CS SALES AMOUNT 800.00 RETURN QTY 0 CS RETURN AMOUNT 0.00 EMPTIES QTY 0 CS MISC AMOUNT 0.00 ALLOWANCE AMOUNT -550.00 DEPOSIT AMOUNT 0.00 NET DUE 250.00 TERMS: CHARGE NET 30 DAYS THANK YOU 940493311 2543.01 D C L 3 2009 -By.-JI CUSTOMER SIGNATURE u 1480135007119404933117080085849331111 o ACCOUNTS PAYABLE VOUCHER 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. 355333 Pepsi Cola Gen. Bot. Terms 75 Remittance Drive, Ste 1884 Chicago, IL 60675 -1884 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 11/27/09. 9404933117 Vending 22966 F 250.00 Total 250.00 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. 355333 Pepsi Cola Gen. Bot. Allowed 20 75 Remittance Drive, Ste 1884 Chicago, IL 60675 -1884 In Sum of 250.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members Dept 1047 9404933117 4239040 250.00 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 23 -Dec 2009 Signature 250.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund