205432 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1
ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP
j CHECK AMOUNT: $275.00
CARMEL, INDIANA 46032 PO BOX 34783
SEATTLE WA 98124 -1783 CHECK NUMBER: 205432
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4355300 111782210072 275.00 ORGANIZATION MEMBER
1
BUSINESS MEMBERSHIP
ANNUAL RENEWAL NOTICE
o
Business Pnin Cardholder $55 RENEWAL MONTH: FEBRUARY 2012 MEMBER NUMBER: 000111782210072
Household Cardholder`: FREE
Add on Cardholder +�5areacli CARDHOLDER'S NAME AMOUNT HOUSEHOLD MEMBER AMOUNT
AUDREY KOSTRZEWA $55.00 JENNIFER SEWELL $0.00
Add on Household Cardholder FREE BEN JOHNSON $55.00 MATT LEBER $0.00
Purchase TAM[ POWELL $55.00
Descripton �N1�UF}L Ml9ECdSH /P` dO la' SARAH CARLING $55.00 CRYSTALALLEN $0.00
MICHELLE COMPTON $55.00 LINDSAY ATKINSON $0.00
PO z Po�F
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TOTAL RENEWAL FEE $275.00
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Description
Purchaser D` Date
DEC 1 20 11 a! P.O. P or F
Approval Date ao
If you don t have y changes to your
membership YR EW ONLINE AT Buor,e t
GOSTCO COM' Simply log on to costao coin, 4 ;n u Line Descr
type RENEWridthe productsearch box arid'i f;
n follow the srm le mstruci7ons to renew our
S
P Y Purchaser D_,
membership today Please see Instructions on reverse to add, emove or replace a car o er.
JOIN THE MORE THAN 2 MILLION
MEMBERS USING COSTC® SERVICES
CONSUMER SERVICES
Auto Home Insurance Online Investing
$oat w Loans and Refinancing e Personal Checks
6 Costco Auto ram Pro Personal Health Insurance'
Program P
o High -Yield Savings Accounts :CDs o"ry ca, /4 PA& rx
Identity. fion Group Dental Plan for Individuals T
onlyin CA
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Visit Costco.com and search: Services Costco does not provide services all services are provided by third parties.
11 EX0213 0 10110
236
Renewal of your membership constitutes acceptance of Costco "s Privileges and Conditions of Membership and its Privacy
which are available at our membership counter or online at costco.com. Please provide your household member cardholder
with this information.
Renewal Policy Memberships renewed within 2 months after expiration of the current membership year will be extended for
12 months from the expiration date. Memberships renewed more than 2 months after such expiration will be extended for 12
months from the renewal date.
All cardholder changes will be eff ective upon receipt of renewal payment.
New membership cards will not be sent unless new cardholders are added or changes are made to the account.
CHANGES TO YOUR ACCOUNT: Fill in the necessary information in the space provided below and adjust payment accordingly.
Changes to your membership cannot currently be made online at costco.com.
If adding household member cardholder: Add household member's name in space below the primary cardholder.
*A household member card is available to primary cardholder's household member, domestic partner, or immediate family
member over the age of 18 and living atthe same address. Household member cardholders will be asked to present proof that
they live atthe same address as the primary or add -on cardholder.
If upgrading to Executive Membership:
1. Add the $55 Upgrade Fee to the Primary Membership Fee ($55).
2. Please add sales tax in NY, HI, AZ, NM, UT, and all other applicable states.
3. Check the box on the front of the remittance portion of this Renewal Notice.
NOTE: Limit one Executive Membership per household and /or business.
Have questions about your renewal? Call us at 1- 800 -774 -2678.
EnNEGSNR 1/09
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.
354720 Costco Membership NOT HSBC Terms
P.O. Box 34783
Seattle, WA 98124 -1783
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/19/11 111782210072 Annual Membership renewal 275.00
Total 275.00
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.
354720 Costco Membership NOT HSBC Allowed 20
P.O. Box 34783
Seattle, WA 98124 -1783
In Sum of
275.00 4
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 111782210072 4355300 275.00 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
11 -Jan 2012
Signature
275.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund