205622 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
b t` ONE CIVIC SQUARE U S FOODSERVICE, INC
CARMEL, INDIANA 46032 PO BOX 66008e CHECK AMOUNT: $362.29
nor
INDIANAPOLIS IN 46266 -0088 CHECK NUMBER: 205622
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 1984136 391.69 FOOD BEVERAGES
1095 4239040 2964294 —29.40 FOOD BEVERAGES
12301 CUMBERLAND RD TERRITORY STATEMENT
PO BOX 8000 70SN0„ MANAGER
(800)253 -02 77
FISHERS, 46038 90569922 0062 12/19/11
RETURN SERVICE REQUESTED
o
PlSXBR00200225 GlSXBR00200225- 095294869 3 201
111111111IIII1 III' �Il�lllllll����l���l�lllll111111111l��ll�l�ll ,l DEC 2
CARMEL CLAY PARKS &RECREAT
1411 E. 116TH ST
CARMEL, IN 46032
No TRANSACTION ORIGINAL pEBITlCREDIT" PAYMENTS BALANCE': DUE DATE_ PAYMENT
z a 1
OATENNUMBER .pM TYPEAMOUNT�ADJUSTMENTS
"CUSTOMER PARKS &RECREAT "CUSTOMER# 90569575 SOLD BY INDIANAPOLIS /3V LOCATION: 1235 CENTRAL PARK DRIVE E, CARMEL, IN 460320000
2 12/13/11 1984136 INV (29'40),
91 69 t/. T 0.00 0.00 391 69 m 09/1 0 30 2/12 NET D AYS
.08/02/ 11
Subtotal 362.29
CURRENT
U,
R DAYS'PAST DUE TOTAL
7� ,...s 8 '3.
391.69 0.00 0.00 0.00 (29.40) 362.29
*For customer inquiries�, 1780.0 -253- 0277
We reserve the right to assess service charges on any amount not paid when due at an interest rate of 1 1/2% per month or the
maximum rate permitted by law, whichever is less.
X' Please detach and return the bottom portion with vour remittance. J< Page 1 of 1
AUNT Amim DMCICR CUSI+pbm PURCHASE ORDER 2AL88 MESS IIATH
fiT'1 Afil T1�9 v!1 jd11►Aaq �v Rao nvnQOan
H 90569922 2964294 08/02/11 90569575 SPECIAL ORDER 1054 0062 08/02/11
Vmx /aTItum ORDER NUMBER: 279370
CARMEL CLAY PARKS &RECREAT CARMEL CLAY PARKS &RECREAT U.S. FOODSERVICE, INC.
8 IU 1411 E. 116TH ST 9 HI' 1235 CENTRAL PARK DRIVE E REMIT
TO TO: TO: BOX 660088
CARMEL IN CARMEL IN
46032 46032 INDIANAPOLIS IN
317 843 3873 46266 -0088
A77 MICHELLE CCMPTON DEPT 00 800 428 2118
X12301 CUMBERLAND RD FISHERS IN�UDAM. 07/15/11 Page 01 of 01
PREIGBT_ SPBQAL
PA -TiVET 30 DAYS nvsnmjeqmm
7EPJn
QW. QTY. aAr PROB'[1Cf PRCMgG uml
OR Dmm Suam Lm NUl(B8R DBSCRIPTI4N PAQS Si7B LAS$I {i9�illl DWI PRDM PR=
CREDIT MEMO
REFERS TO ORIG INVOICE NUMBER: 465871 DATE: 07/15/11
DRY
1 EA 8548406 SYRUP, FONTN ORNG RTU JUG ICE 1 GA LYONS MAG EA 29.4000- 29.40-
32 Price Only Correction
INVOICE SUMMARY
TOTAL WGT SHIPPED: 10.87 PIECES SHIPPED: 1 ITEMS SHIPPED: 1-
PRODUCT TOTAL 29.40CR
TA-yA 3LE AMOUNT .00
GEN SALES TAX .00
AMOUNT 29.40CR
ACCOUNT INVOICE INVOICE '`CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. N0. NUMBER LOC. REP. ORDERED
90569982 1984136 12/13/11 90569575 1054 0062 12/12/11
Your partner beyond the plate..'
TE: 2251 3 GIRDER IUMBER: 344445
BILL CARMEL CLAY PARKS &RECREAT SHIP CARMEL CLAY PARKS &RECREAT REMIT US Foods, Inc.
TO: 1 11 E. 116TH ST TO: TO:
1235 CENTRAL,:.. PARK DRIVE E
CARMEL IN CARMEL IN BOX 660088
46x332 46032 INDIANAPOLIS IN
317 843 3873 46266 -0068
ATT. MIC14ELLE COMPTON DEPT 00 800 428 211
SHIPPED FROM: 1230 CUMBERLAND RD FISHERS. 1, N SHIP DATE: 12/1:3/11. Page 02 of 02
FREIGHT TERMS: SPECIAL ENTER OFF OF 111'1'' ;a EE I L
PAYMENT TERMS: NET ;36`, DAYS INSTRUCTIONS:
QTY. QTY.', WEIGHT SALES PRODUCT p PRICING UNIT EXTENDED
ORDERED SHIPPED UNIT NUMBER DESCRIPTION PACK SIZE LABEL E UNIT PRICE PRICE
INVOICE SUMMARY
FUEL SURCHARGE 6.25
r
TOTAL WGT SHIPPED: 163.00 PIECES ORDERED: 13 PIECES SHIPPED: 15 ITEMS SHIPPED: 14
PRODUCT TOTAL 385.44
CHARGES 6.23
TAXABLE AMOUNT .00
Purchase GEN SALES TAX X .00
Desrjiption W1 elA1, W 5s
P.O. __����1 P of j
G.L. IO 9 ,1 I- y239 XJV Dp
0 40 PLEASE REM4YT THIS AMOUNT BY 01/12/12 AMOUNT 341.69
(iii Delsor k'
�lC i
Purchaser Date
Approval Date 9
Thepe%sfableagno lWmlcommotli9eslistedonNis lnvoicewe m soldsublecttothestatu[ aytrustawhoritedbyseection5 (c)ofthe Visit www.usfood.eom for a fast and easy way to order.
Perishable Pgrfattural Comotlities Pct 1930 (7 U.S.C. 499e(c)). The seller of these commodities retains a trust claim over these X ��r _•t �1
mmmodlbes, all inventories of food or other products derived from these commodties, and any receivables or proceeds from the sale of D
these commodities un9l full payment is received. CUMERE IGNATURE:
Interest shall a,, on ell unpeld taelances exceeding established credit terms al a aqual to Ne lesser of (a) 1!h% per month or S
(b) the maximum rale that the custom ma
e, y lawfully contract to pay, anti in all a en s rote calculated in accordance wrlh applicable law.
W6�)(Z)U3CC[Q.ZC Z�O[!2 �C(4COLF.QC J
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO. DATE NO. NUMBER LOC. REP. ORDERED
90 1 9✓13✓11 90569575 1'054 0062 12/12/11
Your partner beyond the plate! DELIVERY ROUTE I
2251 1 3 rl" A it- R IN111 III R FR 4P4445
BILL CARMEL CLAY PARKS&RECREAT SHIP CARMEL CLAY PARKS&RECREAT REMIT US Food/Is, Inc.
TO: 1411 E. 116TH ST TO: 1235 CENTRAL PARK DRIVE E TO:
CARMEL IN CARMEL IN BOX 6)0135
46032 46032 IN
D 22#1 APOLIS IN
317 843 3873 4
%0088
6
O.,--4PF;
,MICHELLE COMPTON 00 P
SHIPPED FROM: SHIP DATE:
1E301 CUMBERLAND RD FISHERS IN 12/13/11. Page 01 o"f 02
FREIGHT TERMS: SPECIAL ENTER OFF OF 111TH S-tWEET I I I
PAYMENT TERMS: NET 30 DAYS INSTRUCTIONS: h_____
C_
QTY. QTY.' SALES PRODUCT 0 PRICING UNIT EXTENDED
ORDERED SHIPPED UNIT NUMBER DESCRIPTION PACK SIZE LABEL D WEIGHT UNIT PRICE PRICE
E
DRY
A CS 4190923 COOKIE, VNL CREME SND1JH SNCWL 48-'/j I x T ,7 O Z SMACKWELLS CS 21.9400 S 21.94
1 1 CS 5597604 CHIP, CHS CNCHY PLN SS BAG 602 OZ CHEE-TOS CS 29.8500 29. 85,
1 1 CS 55978.5 CHIP, TORTLA MACHO CHS TRGLE 64/1r 75 OZ DORITOS CS 28.5500 28.55
1 1 CS 5605472 CHIP, MULTORN CHEDR SS BAG
64/1.5 OZ SUN CHIPS CS 29.8500 29.8
I EA •6210777 CANDY, KIT KAT. VNDG STD 1.5 Z 36 EA KIT KAT EA 25.9400
I CS 8429292 JUICE, APPL 10-OX VITMN C ADDED24/1.0 OZ THIRSTER ES 20.0600
I REFRIGERATED
1 1 CS 4800843 MILK, 2% REDUC FAT PLST REF 12/1 PT PRAIRIE FM CS 10.8300 10.83
I I CS 4800884 MILK, CHOC 1% LOW•FAT PLST REF12/1,PT PRAIRIE FM CS 10.8300. 10.83
I I CS 7197775 YOGURT, ASST STRUBNA A RSPBRY 12/6 07- YOPLAIT I's 10.1600 10.16,
FEN
2 2 30 4?
-1 20 11278 P ZEL, KING SOFT BKD FZN 50/5 0z SUPR PRTZL* CS 20.7000 .40
CHILI, W/ BEAN HEAT A SRV FZN 4/5..LB WHITYWNDSR CS 53. 8 5 .89
C 304 423 ;CORN DOG, All CN FZN 48/44 OZ STATE FAIR CS 32.850 3 .85
Cod C MUFFIN 1 4/4'OZ SPUNKMEYER 1. s 0 LB PATUXENT CS 28.960 .96
0-
PeHOT O AB :1 LR I o ®r''
G, BANA 6 NUT 6 IW R FZM GRIL 2 24.3300 24.33
PRODUCT CLASS RECAP
TOTAL DRY- PIECES ORDERED: 6 PIECES SHIPPED: 6 ITEMS SHIPPED: 6 156.19
TOTAL REFRIGERATED PIECES ORDERED: 3 PIECES SHIPPED: 3 ITEMS SHIPPED: 3 31.82
TOTAL FROZEN PIECES ORDERED: 6 PIECES SHIPPED: 6 ITEMS SHIPPED: 5 197.43
The ble a
perishable cmmodities listed an this invoice are sold subj t authorized by the he Agm itural Commodities (C Visit www.usfood.com for a fast easy way to order.
Partsha
Act, 1930 (7 U.S.C. 499e The go of auth retuns a trust X
conernDdIrlies, all inventories of food a other products derived from these commodities, and arty receivables or proceeds from the sate of
1. cammoddies until tug payment is received. CUSTOMERS SIGNATURE:
Irderest s hag acerue on an u exceeding established credit terms at a rate equal to the lesser of (a) 1 per month or
(b) the maximum rate mat th y lawfully Whom to pay, and in all events calculated in accordance with applicable law.
X
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.
353824 U S FoodService, Inc. Terms
Box 660088
Indianapolis, IN 46266 -0088
Invoice Invoice Description
Date '-Number (or note attached invoice(s) or bill(s)) PO Amount
8/2/11 2964294 Credit (29.40)
12/13/11 1984136 Concessions 30297 391.69
Total 362.29
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_
x,. Clerk- Treasurer
Voucher No. Warrant No.
353824 U S FoodService, Inc. Allowed 20
Box 660088
Indianapolis, IN 46266 -0088
In Sum of
362.29
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1095 -1 2964294 4239040 (29.40) 1 hereby certify that the attached invoice(s), or
1095 -1 1984136 4239040 391.69 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
LlabjL4
Signature
362.29 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund