178803 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 360622 Page 1 of 1
ONE CIVIC SQUARE OLINGER DIST CO
CARMEL, INDIANA 46032 PO Box 151 CHECK AMOUNT: $167.74
INDIANAPOLIS IN 46206
CHECK NUMBER: 178803
CHECK DATE: 10/28/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
_1207 4239040 7133007 130.98 FOOD BEVERAGES
1207 4239040 7137693 36.76 FOOD BEVERAGES
i H I M �USTOMER ORIGINAL COPY
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7 ODE: RC 02 6 BROKEN ON DELVERY 06. CUSTOMER DIDN'T WANT /ORDER 13. INCORRECT DISCOUNT 44. INCORRECT VIN G ALLOWED WITHOUT DRIVER'S'SIGNATURE AT TIME OF DELIVERY" PAY THIS
03. STORE CLOSED ON ARRIVAL 08. NO MONEY FOR COD 14. LgTE(RME STOP AMOUNT
'ROUTE t I 1 5 STATE AND FEDERAL TAXES RAID
This invoice is payable in rl ION L i C Exp. Q 7 13 aO l o
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DR 1VERrS1 GNATURE DATE DELIVERED C'&6TOMER NAME (PLEASE PRINT).' CUSTOMER SIGNATURE DATE RECEIVED.'
TERMS AND CO NDITIONS
CLAIMS FOR SHORTAGE OR DAMAGE WILL NOT BE HONORED UNLESS NOTED-ON THE RECEIVING DOCUMENT
AT TIME OF DELIVERY. MERCHANDISE AS ORDERED NOT RETURNABLE. THE PURCHASER REPRESENTS THAT,
HE HAS NO UNPAID DEBTS MORE THAN THIRTY DAYS OLD FROM THEIR DATE OF INVOICE, FOR ANY ALCOHOLIC
BEVERAGES PURCHASED FROM ANY LIQUOR QR WHOLESALER IN INDIANA. "BY EXECUTION OF`'THIS
DELIVERY CERTIFICATE, MERCHANT WARRANTS THAT THEY HOLD A VALID RETAIL MERCHANT CERTIFICATE
ACCOUNT WITH THE INDIANA DEPT. OF EV'ENU'E'.' THIS PURCHASE i FOR RESALE AND NOT SUBJECT TO.
INDIANA SALES TAX." THE ABOVE SIGNED AGREES TO THE TERMS AND CONDITIONS OF CREDIT ESTABLISHED BY OLINGER DISTRIBUTING COMPANY FAILURE TO REMIT PAYMENT WITHIN THESE TERMS WILL MAKE THE
ABOVE SIGNED SUBJECT TO A DELINQUENT' RATING WITH OLINGER DISTRIBUTING COMPANY NON PAYMENT
OF OUTSTANDING -DEBT AILL BE- SUBJECT TO 3RD PARTY COLLECTIONS, AND'ABOVE SIGNED WILL 'BE
RESPONSIBLE FOR THE D.EBT.AND ALL COLLECTION FEES ASSIGNED. BY OLINGER DISTRIBUTING COMPANY.
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�-S#I' SALESMAN NAME rf 'AMOUN' BRA NOi J
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01. TRUCK SHORT ON DELIVERY 04. BILLED RIGHT /FILLED WRONG 12. DUPLICATE -ORDER n. MERCH. NOT AUTHORIZED .,NO CLAIMS FOR BREAKAGE OR SHORTAGE WILL BE PAY THIS
RETURN CODE: RC 02. BROKEN ON -0ELIVERY O6. CUSTOMER DIDN'T WANT /ORDER 13. INCORRECT, DISCOUNT 44. wcORRECT.VINTAGE ALLOWED WITHOUT DRIVER'S SIGNATURE AT TIME OF DELIVERY
03. STORE CLOSED ON ARRIVAL 08. NO MONEY FOR COD 14. LATE/TIME STOP i AMOUNT
C 1D=..'T E #I:. Z i}- 1 STATE AND FEDERAL TAXES PAID
This invoice is paybbie in MAR I ON L i E &p O7 1 1 c 0 "i
DRIVER SIGNATURE DATE DELIVERED CUSTOMER NAME (PLEASE PRINT) CUSTOMER SIGNATURE, DATE RECEIVED
%TERMS AND
CLAIMS FOR SHORTAGE OR•DAMAGE`WILL NOT BE HONORED:UNLESS. NOTED ON THE RECEIVING DOCUMENT
AT TIME OF DELIVERY. MERCHANDISE AS ORDERED NOT RETURNABLE. THE PURCHASER REPRESENTS THAT
HE HAS NO UNPAID DEBTS MORE THAN THIRTY DAYS OLD FROM THEIR DATE OF INVOICE, FOR ANY ALCOHOLIC
BEVERAGES PURCHASED FROM ANY LIQUOR OR WINE WHOLESALER IN. INDIANA: "BY EXECUTION OF THIS
DELIVERY CERTIFICATE, MERCHANT WARRANTS THAT THEY HOLD A VALID RETAIL MERCHANT CERTIFICATE
ACCOUNT WITH THE INDIANA DEPT. OF REVENUE. THIS PURCHASE IS FOR RESALE AND NOT SUBJECT TO
INDIANA SALES TAX." THE ABOVE' SIGNED AGREES TO THE TERMS AND CONDITIONS OF CREDIT' ESTABLISHED
BY OLINGER DISTRIBUTING COMPANY. FAILURE TO REMIT PAYMENT WITHIN THESE TERMS WILL MAKE THE
ABOVE SIGNED SUBJECT TO A DELINQUENT RATING WITH OLINGER DISTRIBUTING COMPANY NON PAYMENT
OF OUTSTANDING DEBT WILL-BE SUBJECT TO.3RD PARTY. COLLECTIONS, AND ABOVE SIGNED WILL BE
RESPONSIBLE FOR THE DEBT AND ALL COLLECTION FEES ASSIGNED BY OLINGER DISTRIBUTING COMPANY.
P escri$ed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Payee
a l Lx L 2 f Purchase Order No.
a 1 a Leff Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total `(p �`f
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
0 UCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
aa
-741
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
d� 33007 ago -S11� 30, 9� bill(s) is (are) true and correct and that the
D 7 7/3 74, 9g ge 0 7t materials or services itemized thereon for
which charge is made were ordered and
received except
20 d 5
SJonature
v
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund