172504 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 354115 Page 1 of 1
i ONE CIVIC SQUARE PURE BEVERAGE COMPANY CHECK AMOUNT: $375.12
CARMEL, INDIANA 46032 3902 E 16TH ST, SUITE B
INDIANAPOLIS IN 46201 CHECK NUMBER: 172504
CHECK DATE: 5/1312009
R EPARTMENT ACCOUNT PO N UMBER INVOICE NUMB AMOUNT DESCRIPTION
1207 4239040 205379 175.12 FOOD BEVERAGES
"1207 4239040 213552 200.00 FOOD BEVERAGES
PURE BEVERAGE .COMPANY
-3902 E 16TH s'r SUITE B Invbice No: 205379
INDIANAPOLIS, IN 48201 Date: 4/ 2/2009
(317) 3 -•9925
SOLD. BROOKSHIRE GOLF CLUB SHIP BROOKSHIRE GOLF CLUB
TO.- PAM I_ I STER TO PAM LISTER,
12120 BROOKSH I RE PARKWAY 1 2 1.20 �lf�Cltr7N.Sl -I I RE PARKWAY
CARMEL IN 460-33 CARMEL IN 46033
t317)846-7431 .(3,17) 846 -7431
Acct No. Date Slip ahippe'd Via F.O.B.' Pur Order
BRKGOLf' NET 30 DAYS 12/6 �.,05
Qty oty Item Unit Extended
Ordered- Shipped Unit De3c Description P ice Amount
1 i CS 24/80oz ARNOLD .13REEN T LEI`iON 22'. 0 22.00
w, UPC: 61300872.3484
2 CS 2:4 /20oz ARNOLD POMEGRANATE /LEM 22,00 44.00
1JPC 61300,8725468 22 2 2 Cs 2:4/2 0o I�'LASTIC. ARIZONA NA SWEET 00 44.
UPC- 61300872',3644
1 S, CS ;s4 /20oz PLASTIC AR1 f4A8pn 2�2. 00 22.00
UPC: 61300872:3593
1 1 CS ;2 Pl-i'-1STIC ARIZONA GREEN E2. 00 22.00
UPC: 61 3008723606
1 1 CS 24/21boz PLASTIC ARIZONA POIAEGR 210 12 21.12
UPC: 613P08723668
A ARNOLD` LITE AND AZ LEMON
BACK ORDERED
ORDERED: 8 SL1f -TOTAL 175.12
ROUTE 1 W Received by TOTAL 175.12
Gash ,t ar r c.
PURE BEVERAGE COMPANY Pagev 1
1835 STOUT FIELD W. DR. SUITE 101' Invoice No: 213552
INDIANAPOLIS IN 46241
Date: 5/ 7/2009
(317) 37579925
SOLD BROOKSHIRE GOLF CLUB SHIP BR8OKSH%RE GOLF CLUB
TO: PAM LISTER TU: PAM LISTER
12120 BRnOKSHIRE PARKWAY 12120 BROAKSHIRE PARKWAY
CARMEL IN 46033 CARMEL IN 460�3
(317)646-7431
Acct No. Date Shp Shipped F.O.B. T Order
BRKQ8LF 24020
Qty Qty Item Unit Extended
Ordered Shipped Unit Desc Description Price Amount
2 2 CS '24/20oz PLASTIC ARIZONA ARNOLD 22.00 44.00
UPC: 613008723460
2 2 CS 24/20oz ARNOLD GREEN T LEMON 22.00 44.00
UPC: 613008723484
2 2 CS 24/20oz ARNOLD POMEGRANATE/LEM 22.00 44.00
UPC: 613008725488
1 1 CS 24/20oz PLASTIC ARIZONA SWEET 22.00 22.00
UPC: 613008723644
1 CS E4/ EEH C'Z22.00 22. 00
�v UPC: 610008723606
1 1 CS 24/20oz PLASTIC ARIZONA LEMON 22.00 22.00
'UPC: 613008723569
1 1 CS 24/20oz PLASTIC ARIZONA POMEGR 22.00 22.00
UPC: 613008723668
1 1 CS FUEL SURCHARGE 2.00 2.00
ORDERED: 11* -TOTAL 222.00
ROUTE 12 1 'Received by TOTAL 22
Cash Charge ���T 00
Prescribed by State Board of Accounts City Farm No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
D C ��.Uere,1�a P Purchase Order No.
LIU U Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6 s-3-7 t1 i oz
Total 3
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.
ALLOWED 20
L e l.-
f3k!'exg;"`� (1 IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
z:N orup -1 -z
Board Members
Pp# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
�a7 .205 3 3 D �lo bill(s) is (are) true and correct and that the
.21 5 :-a 3 z1 co materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund