205648 01/18/2012 CITY OF CARMEL, INDIANA VENDOR: 361108 Page 1 of 1
ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTCp
CARMEL, INDIANA 46032 PO BOX 5219 CHECK AMOUNT: $413.17
CAROL STREAM IL 60197 -5219
CHECK NUMBER: 205648
CHECK DATE: 1/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 PARKS 413.17 7003 -7311- 0007 -2984
Please Direct Inquiries To: 1- 800 220 -8594
MO COSTCO
Wlt�LESALE
Account Number New Balance Payment Due Amount Past Due Due Date
7003 7311 0007 -2984 $413.17 $.00 $.00 01/20/2012
Billing Date Credit Line Available Credit
12/26/2011 $5,000 $4,586.83
TDD /Hearing Impaired: 1- 800 365 -0186
STATEMENT OF YOUR ACCOUNT
FINANCE CHARGE SUMMARY
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
Reg 00014 $27.54 0.00000% 00.00% $.00 00.00% $413.17 S.00 01126/2012
Mm
ACCOUNT DETAIL
Transaction Transaction Invoice User P.O. Transaction
Date Description Number ID Number Amount
11/29/2011 COSTCO WHOLESALE -346 043198 00005 $413.17
00005 SUBTOTAL: $413.17
12/23/2011 PAYMENT THANK YOU 00001 $92.79
Track your spending anytime during the holidays You deserve to be in control Log on at www.hrscommercial.com o
HSBC is committed to the long -term success of the company, as well as the communities in which we operate. Our commitment to
sustainability incorporates not only economic, but also social and environmental considerations.
M
v
n
N
JAN 0 3 2012
BY........................
Return the below portion with payment. For billing errors or questions please refer to the back of the statement. Page 1 of 2
i
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
�vj C) DD c1
mw
#316 CASTLETON, IN
6110 EAST 86TH STREET
CASTLETON, IN 46250
MEMBER #111782210075
RESALE ON
546233 STEEL SHELF 62.99.
506612 6 TIER SH 119.99
E 539142 KS ORG S SA 7.49
E 539142 KS ORGi ALSA 7.49
E 39036 ROMAIN 3.79
E 39036 ROMAINE 3.79
535618 CHINK WHITE 8.99
E 331222 SOURICREAM 4.39,
E 44004 KS TORTILLA. 3.69
E 44004 KS TORTILLA .3.69
E 44004 KS TORTILLA 3.69
720 STD,1 FOIL 2PK 15.99
..5.16.435 %KS NAPKINS*...:. _:.___7._. -99.
18695 CHINET LUNCH 12.85
E 2304 QB (,CHZ SAUCE '7.79
E 654001 PENNE RIGATE 7.49
E 58077 TWIZZLERS 7.59
E 2304 Q&CHZ SAUCE 7.79'
E 2304 QBOHZ SAUCE 7.79
E 2304 QB CHZ SAUCE 7.79
E 88739 GRD` CH 15.59
E 88739 GRD BEEF CH 15.59
E 919157 FRUIT' :SNACKS 10.7
E 676977 FRUIT BY FT
E 261078 -BLACK BEAN`"
C'3
E 64Fd
E
V000
CHAN 0000 �3 00
lk N E
E R UMV 0 OF I
I1 S Ens Sa ao
�5 D (�f� REG� tt
"V�� O C �TC® COSTCO
PLEASE COME no- -y
ACCOUNT SUMMARY BALANCE SUMMARY
1 -29 DAYS PAST DUE 30 -59 DAYS PAST DUE Outstanding
Transaction $92.79
+New
$.00 $.00 $.00 Purchase(s)/Debit(s) $413.17
60 89 DAYS PAST DUE 90 119 DAYS PAST DUE 120 149 DAYS PAST DUE +New Fees $.00
Finance Charges 00
$.00 $.00 $.00 Payment(s) $92.79
150 -179 DAYS PAST DUE 180+ DAYS PAST DUE Credit(s) $.00
$.00 $.00 New Balance $413.17
1.
E
N
rA
IT
n
N
O
C
Page 2 of 2
New address or phone number?
Please check box and complete reverse side.
Wks e
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
STMT222C (10/07)
TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING ZIPPER -CASE LETTERS
AND NUMBERS ONLY!
c Name
`t
Email Address hp;
Sl if an Street Nam o the w B�OXD Unit or P BO Number ODDEL -1
a�x
t
n
Business Phone
❑❑❑C
a
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.
(Costco)
Terms
361108 HSBC Business Solutions
Date Due
P.O. Box 5219
Carol Stream, IL 60197 -5219
Invoice Invoice Description Amount
or note attached in PO
Date Number voice(s) or bill(s)) 413.17
7003731100072984 General Program supplies
l
Total 413.17
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
(Costco)
361108 HSBC Business Solutions Allowed 20
P.O. Box 5219
Carol Stream, IL 60197 -5219
In Sum of
413,17
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -3 7003731100072984 4239039 413.17 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
413.17 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I