174888 07/22/2009 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: $179.94
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CAROL STREAM IL 60197 -5219 CHECK NUMBER: 174888
CHECK DATE: 7/2212009
DE PART M ENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4238000 GOLF 173.95 7003731100074683
1207 4239040 GOLF 5.99 7003731100074683.
A
1
COSTCO
Please Direct Inquiries To: 1- 800 220 -8594
iA/@di>A4iES�lALE
accaunt,Number N13w Balance Payme »tDue Amouftt:Past Due: Due.?ate
70Q3 73i 1 ,000? A5$3 $18Q 30 $'OO QO 07�217g09
Boling [?ate Credit Line Available Credit
06/26(2009 $2 000 $1.819 70
1 his communication serves as official notice that all calls to /from our offices may be monitored and /or recorded for quality
assurance purposes.
0
STATEMENT OF YOUR ACCOUNT
FINANCE CHAR SUMMARY
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Descripti on Number Balance Rate APR Periodic Rate RATE Due
Reg 00014 0.00000% 00.00% $.00 00.00% $.36 $.00 06/26/2009
Reg 00014 $11.61 0.00000% 00.00% $.00 00.00% $179.94 $.00 07/26/2009
ACCOUNT DETAIL
Transaction; Transaction Envace Usdr: R O Transaction
Date Desercptton Number< tD Number Amount
XXXX: o
05/28/2009 COSTCO WHOLESALE -346 030636 00003 $79.99 0
06/11/2009 COSTCO WHOLESALE -347 039526 00003 $93.96 0
06/15/2009 COSTCO WHOLESALE -346 010447 00003 $5.99
00003 SUBTOTAL: $179.94 0
06/05/2009 PAYMENT THANK YOU 00001 $1,433.17- o
06/18/2009 PAYMENT THANK YOU 00001 $111.74
Track spending, pay your bill and update personal information online with Account Access. Registering is fast and secure: c
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I
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or unautho-
rized 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.
i
COSTCO
ACCOUNT SUMMARY BALANCE SUMMARY
Outstanding
CURRENT_;: 129 DAYS PAST Dt1E: 3tl 59 DAYS;:PAS7 DU=:: Transaction $1,545.27
$.00 +New
$.00 $,00 Purchase(s)/Debit(s) $179.94 �O
New Fees $.00
60?88 RAYS PAST 9Q -119) YS PAST QUE 120;1ii9 DAYS PAST DUE.
Finance Charges $.00
$.00 00 $.00
Payment(s) $1,544.91
150 179 DAYS PAST DUE 18U+ pAY$ PAST D11E is Credits) $.00
$.00 $.00 New Balance $180.30
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Page 2 of 2
New address or phone number?
Please check box and complete reverse side.
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or unautho-
rized 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 UPPER -CASE LETTERS
AND NUMBERS ONLY!
Com an Name
Ernad Address
I L-1,
Sh,e.
C' r
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
j Payee I
Purchase Order No.
Terms
C� <4 L,
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6� 1 OD 51 Wb'l b %3
Total 1_719�_111
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�_
1
IN SUM OF
�C(.
ON A COUNT OF APPROPRIATION FOR
�D C U-b
�a 1 -6be-�-4,93 Board Members
PO# or
r
DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
3ko -C'O
3: Q� materials or services itemized thereon for
which charge is made were ordered and
received except
a
20 D
`S i atu re
Titl
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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4347 NW INDIANAPOLIS
MEMBER #111791434655
RESALE ON
342752 BEVERAGE JAR 25.99
342752 BEVERAGE JAR 25.99
342752 BEVERAGE JAR 25.99
188426 MICRO FIBER 15.99
RESALE TOTAL 93.96
NON RESALE TOTAL .00
TOTAL _j1
VF Costco Wholesale 93.96
XXXXXXXXXXXX4683 SWIPED
Se9 001992 Ref 03952600
Costco Wholesale ResP: AA
FID Y: 13216
APPROVED
AMOUNT: $93.96
0347 010 0000000099;0081
w.
CHANGE 00
TOTAL NUMBER OF ITEMS SOLD m�4
CASHIER: ken REG# 10
9 -fAN 46; 11 :31 0347 10 0081 99
J
Thank You!
Please Come Again!
t
r•
it 3.46 CASTL- TON, IN
MEMBER #1 91434655
RESALE ON
968988 1650T, bLER 79.99
RESALE T L. 79.99
NON RESALE FlL .00
TOTAL
VF Cost h` 1esa1e 79.99
YaF
XXXXXXAXXXXX 3 SWIPED
Se9# 0(` ')4 of 03063600
Costco 4 s ale ResP: AA
FID Y: 1,.)
APPROVED
AMOUNT: $79.99
0346 013 0000000008 0374
CHANGE .00
TOTAL NUMBER OF ITEMS SOLD 1
CASHIER: ANDREW M REG# 13
l• h'� TZ01o} 19:33 0346 13 0374 8
THANK YOU!
PLEASE COME AGAIN!
COS7VO
A to
CHSTLETON. IN
MEMBER #111 1434655
21277 BUTTER 5.99
TOTAL wom
VF Costco Who 5ale 5.99
SW IPED
cp 01044700
Costco Whol ale ResP: AA
FTD Y 0 V
PROVED
AMOU
NT: $5'99 0346 013 0000000073 0414
CHANGE .O0
TOTAL NUMBER OF ITEMS SOLD
VONNE S REG# 13
MAKNoUk 19;56 0346, 13 0414 73
THHNK YOU!
rLE-:70sc- Come nGnzw!