178466 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 362445 Page 1 of 1
0 ONE CIVIC SQUARE DOMINO'S PIZZA
CARMEL, INDIANA 46032 841 S RANGELINE ROAD CHECK AMOUNT: $169.99
CARMEL IN 46032
CHECK NUMBER: 178466
CHECK DATE: 10/14/2009
DEPA ACCOUNT PO NUMBER IN VOICE NUMB AMOUNT D
1046 4239040 002 169.99 FOOD BEVERAGES
Carmel c Clay
Parks &Recreation CHECK REQUEST
Date:
Check payable to
Name: Nn M t n ej S 2 Z7 o
Address. `A j O
City, State, Zip k ZI
Mail check to payee Return check to requestor
Check Amount lD q vt i Date Required 09
Check needed for
aLl x n M P -)A
To be paid from
PO (if applicable) ii 2(� j
Budget account GL jj 23go
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Budget Line Description �a
1 7
Supporting documentation or receipt(s) MUST be attached. OC T 0 6 2009
Requested by (print) nn
Requested by (signature):
Approved by (signature of Division Manager):
on this date
Form revised 1 -21 -08
APR -16 -2007 08;46 PM P. 1
DOMINO'S PIZZA PURCHASE ORDER
841 S. RANGELINE RD,
CARMEL, IN 46033
Phone (317)846 -6100 Fax (317)816 -5305
The following number must appear on all related
correspondence, shipping papers, and invoices:
P.O. NUMBER: 002
TO:SHAVONNE
Towne Meadow
10850 Towne Rd.
(317) 698 -7950
P.O. DATE REQUISITIONER SHIPPED VIA F.O.B. POINT TERMS
10 -23 -09
QTY UNIT DESCRIPTION UNIT PRICE TOTAL
8 14" Cheese 6.00 48.00
12 14" Pepperoni 6.00 72.00
8 14" Sausage 6.00 48.00
SUBTOTAL 168.00
SALES TAX 0.00
SHIPPING HANDLING 1.99
OTHER 0.00
(-1 TOTAL 169.9 9
r l�
1. Please send two copies of your invoice.
2. Enter this order in accordance with the prices, terms, delivery Y OCT C 200
method, and specifications fisted above, V
3. Please notify us immediately if you are unable to ship as
specified. lis
4. Send all correspondence to:
Andrea
Phone (317)846 -6100 Fax (317)816 -5305
Authorized by Date
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.
Domino's Pizza Terms
841 S Rangeline Rd
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/22/09 002 Schools out camp 10/23/09 TM 169.99
Total 169.99
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.
Domino's Pizza Allowed 20
841 S Rangeline Rd
Carmel, IN 46032
In Sum of
169.99
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1046 002 4239040 169.99 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
7 -Oct 2009
Signature
169.99 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund