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HomeMy WebLinkAbout175935 08/06/2009 yf CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
0 ONE CIVIC SQUARE U S FOODSERVICE, INC
CARMEL, INDIANA 46032 PO BOX 660088 CHECK AMOUNT: $2,346.06
INDIANAPOLIS IN 46266 -0088
CHECK NUMBER: 175935
CHECK DATE: 8/6/2009
DEPARTMENT ACCOUNT PO NUMBER I NVOIC E NUMBER AMOUNT D
1047 4239040 2771535 636.54 FOOD BEVERAGES
1047 4239040 2855736 117.60 FOOD BEVERAGES
1047 4239040 2855737 1,667.12 FOOD BEVERAGES
1047 4239040 2993492 -55.30 FOOD BEVERAGES
'F 1047 4239040 90569575 -19.90 FOOD BEVERAGES
;r ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NUMBER LGC. REP. ORDERED
9056992 2$55737
2 0 S6S75 22190 l0'54 0062'. 07109/(39
Yoii� partner be the plate! 28!53 ORDER NUMBER: 6614BB
r
BILL CARMEL CLAY PARKS&RECREAT SHIP CARMEL CLAY PARKS&RECREAT REMIT S. FOODSERVI :''`INC.
TO: 1411 E 116TH ST TO: 1235 CENTRAL :'PARK DRIVE. E TO:
IINDIANAPOLI S X 660088
CARMEL IN CARMEL IN
46032 46032 IN
66 —OOSS
ATT. MICHELLE GOMPTON DEf?? 04 "'t 2111
SHIPPED FROM: X301 CUMBERLAND FISHERS INs DATE 07 /10/09 Page 02 of 02
FREIGHT TERMS: i SPECIAL DR I VER CANNOT DELIVER ON THE ROUNDABOUT OUT IN
PAYMENT TERMS: NET 30 DAYS INSTRUCTIONS:
QTY. QTY. SALES PRODUCT p PRICING UNIT EXTENDED
ORDERED SHIPPED UNIT NUMBER DESCRIPTION PACK SIZE LABEL D WEIGHT UNIT PRICE PRICE
E
INVOICE SUMMARY
TOTAL WGT SHIPPED: 712.30 PIECES ORDERED: 58 PIECES SHIPPED: 58 ITEMS SHIPPED: 24
n PRODUCT TOTAL S3 1667.1'2
Federal Occupatio. Safety/ and Health Standards. Section 1910 #200'on Hazard
Communication requires manufacturers and distributors to provi °de Material,
Safety.Data Sheets on non -food products defined to be hazardous. Products
such as cleaning products and pesticides are included in the .0 ope of the
Standard. In compliance with the law. MSDS are available to�'U:5•.'Foodservice
Inc. customers and can be� obtained by contacting the Procurement Manager in our TAXABLE AMOUNTi" .00
district office or by advising your sales representative. GEht SALES TAX, 00
You may contact Procurement Helpdesk at phone 0 (317) 585 6749.
t
PLEASE REMIT THIS AMOUNT BY 08109109 101AMOUNT 1667. 12
Purc srriion
G.L 3_�_'� y a o�4O 5 2009
Budget �(1''r1('
Line Destx PY
Purchaser Datee rt
Approval Date_
Interest shall accrue on all unpaid balances exceeding establishad credit terms at a rate equal to he lesse(of (a) 1!h %per momh or 'Promotonal allowances,' cash discounts, prompt pay discounts growth programs and all other incentives are retained by U.S. Foodservicel-
(b) the maximum rate that the customer may lawfully contract to pay, and in all events calculated in accoidance with applicable law. and do rwt reduce product cost. Product cost is tl a into as the supplier, packer or any other vendor delivered cost or f.o.b. unit price plus x y i•
standard freight less ofhinvo,ce discounts or off- invoice allowances (i.e.; manufacturer generated discounts or allowances on particular
items for set periods of time and which are specifically reflected on the invoice):' CUSTOMERS' SIGNATURE'
4 Visit www.usfood. for a fast and easy way to order.
•Ir r1 Z(/ellfylr ?eecate;?loua v�ualaceaq.
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES DATE
NO NO. DATE NO. NUMBER ORDERED
Y
f Sb• ,A" 855 0/
.?37 071109 9056 b 575 22 '.40 1054` 0062 07/09/09
a
V 90 "y
Your partnerbeyond
DELIVERY ROUTE: 2P3`33 ORTfER .NUMBER: 661488
BILL CARMEL CLAY PARK$ &RECREAT SHIP CARMEL CLAY` PARKS &RECREAT REMIT U. S.' FOODSERVICE, INC,.
TO: 1411 E. 116TH ST-. TO: 1235 CENTRAL PARK DRIVE E TO:
CARMEL IN CARMEL IN BOX 6600E�A
46032 46032 INDIANAPOL'iS IN
46266-008&.
ATT. 'MICHELLE COMPTON DEPT 00 800 428 21.18
4!
SHIPPEDFROM: 12301 CUMBERLAND RD f xsHERS IN SHIRDATE:07 /,10109 Page 01 of 02
FREIGHT TERMS: SPECIAL DR I VER CANNOT DELIVER ON THE ROUNDABOUT OUT IN
PAYMENTTERMS: NET 30 DAYS INSTRUCTIONS:
QTY. QTY. SALES PRODUCT C
O PRICING UNIT EXTENDED
ORDERED SHIPPED UNIT I NUMBER DESCRIPTION PACK SIZE LABEL E WEIGHT U PRICE PRICE
DRY
1 1- CS 0445098 TAPE, THRML ,CASH RGSTR WHT 50 'RL. MONOGRAM CS "74.4500 74.45
1 1� CS 05885,09 CHILI, MEAT ,HOT DOG 6/110 OZ HOME TASTE CS .4 4;...4500 -44: 45
3 3 CS 0814236 CUP, FM 16 Z WHT 20/25 .EA MONOGRAM CS '"18 55.20'
1 1-** EA 2380186 PEPPER, JLP•NACHO SLCD #10' PACKER B EA 6.0183 6.42
1 1s' CS 3017001' CIRCLE, PIZF 12" 10th' -EA PACKER CS 13.6400 13.64
4 4 CS 4260238 SAUCE, CHS NACHO SHLF STABL 4/107 .OZ ORTEGA CS 47.2200 •188.88
1 17 CS' 5311600 CONE, ICE CRM CAKE 22S FLAT 36 /20'EA JOY COME CS-, 34.4500 34.45
1 10 CS 9328311 WRAP, FOIL 12X10.75 INFLD 12/240 EA MONOGRAM "B CS 74 "8700 74.87
4 45° CS 9463688., CHIP, TORTL4, CORN YLW RND 6 /2 12 EL ,PASADO CS 18.7000 74.:80.,
REFRIGERATED;
1 1o' CS 3254901 MILK, LOW FAT 2% PLST REF CHU012 /1• -PT DEAN'S CS 9.9500 9.95
READY TO EAT-- Please Refer to Return..Polic
1--' 1 1 CS 500655 BANANA, GRN FRESH 10 L KACKER CS 7.6100 7.61
3 3i CS 7332372 CHEESE, MOZZ•SHRD FTHR PS BAG 4/5 LB ROSELI, B CS 49.0500 147.15
READY TO EAT'!- Please Refer to Return Policy
FROZEN
3 3® CS 1190107 CRUST, PIZA NEPLT THIN 12" RS 40/9 OZ BONICI CS 30.4000 91.20
4 4 CS 2011278: PRETZEL, KING SOFT BKD.FZN 50 /5'OZ SUER PRTZL CS 27.6600 110.64
1 1 CS 2014652 .MUFFIN, BLBRY IW 24/4:.75 07 SARA LEE CS 19.4800 19.48
1 10" CS 2333276 SAUSAGE, ITLN SPICY CRBL CKD 14,LB. ROSELI GS 33.4700 33.47
4 4- CS 4690392• ICE CREAM CUPS, ITTIBITZ COTN CS 25.1000 100.40
4 4- CS 4690525 ICE ,CREAM CUP, ITTIBITZ CK &CR O CPJ CS 25.1000 100.40
4 4- CS 4694519 ICE CREAM CUP, IT >3ANA SPLT .24n
�AEMPS� CS 25, 1000 100.40
4 4s CS 4875571 HOT DOG, AB 5:1 6" CKD FZN 10`1 TYSN CS 25.1500 140:
4 4- CS 4904603 ICE CREAM CUP, CKY DOUGH ITTjB 47 ,t' �C M CS 25. 1000 11
3 3v CS 5186963 POPSICLE, ASST FLVR HTHCL ON 1'11 1 7 DZ OFSICLE CS 27.7800 83.34
1 1-- CS 7279003 SANDWICH, PNT BUTR JELLY GRP Z R69` CS: 38.6500
3 3� CS 8187999 ICE CREAM BAR', CHOC TACO 8 VNL 14LONDIKE CS 18.8900 56.67
n PRODUCT CLASS RECAP
TOTAL DRY
PIECES ,ORDERED: J 17 PIECES SHIPPED: 17 ITEMS SHIPPED:: 9,,. 566.76`=
TOTAL REFRIGERATED PIECES,ORD3ERED: 5 PIECES SNIPPED: 5 ITEMS SHIPPED 3 164.71
TOTAL FROZEN PIECES ORDERED: 36 :PIECES SHIPPED: 36 ITEMS ,SHIPPED 12 935.65`,
Interest shall accrue on all unpaid balances exceeding established credit tens at a rate equ51 to the lesser of (a) 1!h% per month or 'Promotional allowances, cash discounts, prompt pay discounts, growth programs a. all other incentives are retained by U.S. Foodservlc f
(b) the maximum rate that the wstomer may lawful contract pay, and in all events calculated in accordance with applicable law. and do not reduce product cost. Product cost is defined as9he supplier, packer or any other vendor delivered cost or f.o.b. unit
standard freight less off invoice discounts or o invoice ellowances li.e:, manufacturer generated discounts or allows
Items for set periods of time and which are specifically rellected on the mvobe) CUSTOMERS SIGNATURE:
Vlslt www.usfood.COM for a fast and easy way to order
r
ACCOUNT INVOICE INVOICE _'CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO. DATE NO. NUMBER LOC :,:REP. ORDERED
90569922 2875736 D7/19/09 0569x75 SPECIAL OR 105A 0062 07/08/09 70
Your partner beyond the plate! DELIVERY ROUTE: 2 8,53 4 --ORDER_ NUMBER 660029
BILL CARMEL CLAY PARKS&RECREAT SHIP CARMEL CLAY PA REMIT U.S. FOODSERVICE'� INC.
TO: 1411 E. 116TH ST TO: 1.235 CENTRAL PARS( DRIVE E TO 1
5
CARMEL IN CARMEL IN (30,X: 6600E8
46032 46032 INDIANAPOLIS IN
46266 ttt38.
ATT. CHARLES REDMON DEPT 00 a
SHIPPED FROM: 2301
CUMBERLAND RU F S HERS I N N rSHIPDATE: O7fIGf�9 5 Pa OI of OS
FREIGHT TERMS: SPECIAL SPEC I'AL, ORDERS CAN NOT T31 RJETURNED
PAYMENTTERMS: NET 30 DAYS INSTRUCTIONS:
QTY. QTY. SALES PRODUCT
DESCRIPTION :DESCRIPTION PACK SIZE LABEL 0 WEIGHT PRICING UNIT EXTENDED
ORDERED SHIPPED UNIT NUMBER D UNIT PRICE PRICE
E
DRY
1 1 CS 3024700 SYRUP, FONTN'CHRY SNOW CONE 4/1 GA LYONS MAO CS 39..2000 39.20
1 1 CS 8312571 SYRUP, FONTN RSP BLU SLUSH RTU4 /1 GA LYONS MAO CS 39.2000 39.20
1 1- CS 9139098 SYRUP FONT" :LIME CONE 4 /1 -GA LYONS MAO CS 39. 2000 39.20
l
PRODUCT GLASS RECAP
TOTAL DRY f PIECE ORDERED: 3 PIECES SHIFPED: 3 ITEMa SHIPPED':. 3 117.60
INVOIC SUMMARY
TOTAL WGT SHIPPED: 125.80 PIECES ORDERED: 3 PIECES SHIPPED 3 'ITEMS SHIPPEV: „3
#94 f4d41F# ��i4#### f4## i�i4iffltiEiFit��##### �L•# i4�3 F�' J4t�#• 14�• ik## 14# 94# 9t• i4#### �F# i4## iEi4i4#iF1f�f #�iFSE ##!F #34 if i4�r #i4
cu anon Safett PRODUCT TOTAL `117 b0
.Federal Oc
p and Health Standards. Section 1910.1200 on Hazard
Communication requires manufacturers aOd distributors to provide 'Material
Safety Data Sheets an non -food products defined to be hazardous. Products
such as cleaning produc ts and pesticides are included ibr the' si co i cif the
Standard. In compliance with the law.. MSDS are available to U a. Foodservice
Inc. customers and can be obtained by contacting the Procur6 ent.11anager in our TAXABLE AMOUNT w .00
district office•or by advising your sales representative. GEN SALES TAX: .00
You. may contact Procurement Helpdesk -phone (317) 585 _'6719:
��4�ta4�r�t���a��s�t4�4�e�at��4��tt4a���tt4������t�e�s4����4��4�s4sr��4�at���4t4�s�4�t4�ftf4��4��• e��4����4��4�t��ta��a4����t��:�
PLEASE” RE IT TkiS AMuNT 8Y 08/09f09 AMOUNT 1.17: b4 r
1 11 10
0
�--E^1 l00 -4 JUL JUL 1 5 2009`
BY. k`
interest shall accrue on all unpaid balances exceeding established credit terms at a ratis equal to the lesser of (a) 7!/ per month or "Promotional allowances, cash discounts, prompt pay discounts, growth programs and all other incentives are retained by U.S. Foodservicer"
(b) the maximum rate that the customer may lawfully contract to pay, and in all events calculated in accordance with applicable law. and do not reduce product cost. Product cost is defined asrthesupplier, packer orany other vendor delivered cost or Lo b. unit plus 1"e,. t
standard freight less off- invoice discounts or off- invoice allowances (i,e., manufacturer generated discounts or allowances on particular
f items for set periods of time and which are specifically, effected on the invoice).' CU TOMERS SIGNATURE.
Visit www.usfood.com for a fast and easy way to order. 1'
ZUe� {y�eecate�luu�c$'ccaeaedd
a•.1 r 1 Y.F'
V
ACCOUNT I NVOICE' INVOICE CUSTOMER PURCHASE "ORDER SAALES SALES DATE
NO NO DATE s t NO. NUMBER L0�C mac. REP. ORDERED
90569928 2771535 0710 311)9 X905695? L 1`054 +a0 071QZ10�3
Your partner beyond the plate! �u 1 .OFZ DERNUP'4S ER 656259 DELIVERY ROUTE:
BILL. C Risk`: ',:•LA'v PARKSE.RECREAT SHIP': CARMEL. RAL PA
CLAY PARKS9 RECREAT REMIT U. S FOODSERVICE, INC.
4 116TH ST 1 `3'5 'CENTRK R,
11 Y VE E
TO. TO. .TO
BO b60a$$
.CARMEL N "�MEL
INDIANAPOLIS Ids_
y 46$66 -•0088
ATT. r ;..':,1 t' C OMP'Tt Jul DEPT Ut? ti (3,0 4 8 S 11$
SHIPPED FROM:^ r t' Vi 'L`IERi�...iriNY� FISHERS I��, SHIPD TE Q� fC?31Q9 t -a Page Q1 of Q1' L
FREIGHT TERMS: wi i SPECIALQ IV'ER CANNOT DELI W��t ON'THE ROUNDABOUT OUT IN
hlE 30 DAYS
PAYMENTTERMS: a INSTRUCTIONS:
QTY. QTY. SALES PRODUCT PRICING UNIT EXTENDED
ti
ORDERED SHIPPED UNIT NUMBER DESCRIPTION •PACK SIZE LABEL ,z- O WEIGHT
UNIT PRICE PRICE
1 E
REFRIGERATED
2 2 CS 4322665 t !CE CREAM MIX, SOFT SRV VNL 572./2 5� GA �kAIRIE,.i-M r. CS 28.840 57: 68
2 2 CS 6329676 PEPPERONI, SLCD 14 -1.6 CT NO `125 LS ROSELI 4. CS 311.3'�fl{y, 60 c44
.G �4 CS 7332372 CHEESE, MOZZ SHRD .FTHR FS BAG 4f.5 1B ROSELI B CS 49. 0500 196. 2Gr
READY TO EAT Please Refer to Return Polic
-2 k., 1 rr.
2' Cs 7451354 ~ICE: f1ILt4 MIX, SOFT SR'J .CHOC 4X�.1�. 5`GA F'RAa,�.IE .FM .CS .'29.E3400
FROZEN. 5•
4 CS .20,112 7! CR ETZEL, KING FZN RS 56-A OZ.'. SUPR fir.. C$, 27. 6600.,:. A10:b
4 n ti 6 6
r 4 4 CS 1111�7� FRET..
2 2 CS .52188621. ICE CREAM SANDWICH, 'VNL, 4 6 BLUE RUNNY C$' 16.0500 32. 10
fi..'. PRODUCT. CLASS RCAF
TOTAL. REFRIGERATED PIECES ORDERED: 10 �IECES SHIPPED: 10 ITEMS SHIPPED: 4'. 372,:'20
TOTAL FROZEN PIECES ORDERED: 10 ;PIECES SHIPPED: 10 ITEMS SHIPPED: 3 264.34
INVOICE SUMMARY r
TOTAL WCST SHIPPED: 436.24. PIECES ORDERED: 20 01rCES'SHIPPED: 20 ITEMS SHIPPED: 7
o w
PRODUCT TOTAL 136.. 54
F; deral Occupation and He alth Standards. Section 191'0.1200 on 'Hazard
€3' munication requires manufacturers and distributors to provide Material
Sa ety Data Sheeti on non -food products defined to be hazardous. Products
such as cleaning raducts -and esticides are included in the scoppe of the
Standard. In-co )nce with the law.- MSCS are available`tb U.S. Foodservice
n Inc. customers at, to be cab ained by contacting the Procur�emert Manager in our TAXABLE AMOUNT .00
district office or by advising your sales rppresentativt. GEN SALES TAX X .00
You may contact Procurement Helpdesk at .phone (317) 6719.
Pumhaes
��xi��tac# �a���at�t�����• 1f���ri�ar��s> �����a���r��a��tat����a������r� #�t��•���pf� •r E �t: :�t j
E`L ASEP_a' t„ a' P r ':81121 AMOUNT 636.54
�J del n, �G1J- _y�:�
JUL l 5 2009
nterest shall accrue on all unpaid
I balances exceeding established credit terms et a rate equal to the lesser of (a) 1 -'A% per month or Pswrpti swun s,
(b) the maximum rate that the customer may lawfully contract to pay; and in all events calculated in accordance with applicable law. end tlo p onal allowances, cash discounts, prompt pa g.
'bt reduce protluct co P(o��yc� costi diffined as the supplier, packer or any other vendor delivered cost or f.o.b. unit fine plus
sfentlar freight less off invoice discounts or o invoicwallowances (i.e., manufacturer generated discounts or allowances on particular X
it for set periods of time and which are specifically reflected on the invoice)." CU TO HS"SIGNATURE'
Visit www.usfood.com for a fast and easy way to order. e�g�Zloue�uatxead
A COU r D DMICS cuyroLm P'URCHASH ORDM 2AL88 &A MIS
90569922 2971650 06/01/09 90569575 X 1054 0062 06/01/09
=X /Rywum ORDER NUMBER: 630400
CARMEL CLAY PARKS &RECREAT CARMEL CLAY PARKS&RECREAT U.S. FOODS ERVICE, INC.
BIU 1411 E. 116TH ST SHIP 1235 CENTRAL PARK DRIVE E REMIT
TO: TO: TO: BOX 660088
CARMEL IN CARMEL IN
46032 46032 INDIANAPOLIS IN
46266 -0088
ATTCHARLES REDMON DEPT 00 800 428 2118
X12301 CUMBERLAND RD FISHERS IN 05/29/09 Page 01 of 01
pmmr.• UgXM IL
PAn(NET 30 DAYS >zvarax"nowL.
7%W&.
Qw- Q1Y. LV.M MOD[IL'f PRDaNO3 UKU ffitI�S18D
mtomm SiOM UNLT N ulem D86QsII'TI4N PACK SM LABM VANE= Ulm PUM FRnS
CREDIT MEMO
REFERS TO ORIGINAL INVOICE NUMBER: 2328173 DATE: 05/29/09
REFRIGERATED
1- CS 3254901 MILK, LOW FAT 2% PLST REF CHUG12 /1 PT DEAN'S CS 9.9500 9.95
READY TO EAT Please Refer to Return Policy
2 Found Later (Found After Stop)
1- CS 6291207 MILK. CHOC LOW FAT 1% PLST REF12 /1 PT DEAN'S CS 9.9500 9.95
READY TO EAT Please Refer to Return Policy
2 Found Later (Found After Stop)
INVOICE SUMMARY
TOTAL WGT SHIPPED: 30.50- PIECES SHIPPED: 2- ITEMS SHIPPED: 0
PRODUCT TOTAL 19.90CR
JU 2 9 9 TAXABLE AMOUNT .00
GEN SALES TAX .00
B7..
AMOUNT 19.90CR
i
AnCOL1Nr vgv0Im DMOIC3 CUS'I+0 ak PU2C:HASS ORDMt "LBB Lum RATS
•Y1
'Or' vn NCBu[B� 1r^ Rvo ^Z7
H 90569922 2993492 06/10/09 90569575 1054 0062 06/10/09
I7 X1RTXDUnL ORDER NUMBER: 638099
$ILl r E E. C AY PASTS&RECREAT C A R MEL C EN TRA L P PARK DRIVE E REMIT U.S. FOODSERVICE INC.
TO TO: TO: BOX 660088
CARMM IN CARMEL IN
46032 46032 INDIANAPOLIS IN
46266 -0088
ATrCHARLES REDMON DEPT 00 800 428 2118
X12301 CUMBERLAND RD FISHERS IN�UVAM- 06/09/09 Page 01 of 01
Psmmr_ Knxvr
PI,YWET 30 DAY$
TmuLs
QTY. QTY. Mal MET= IIBSfR>PTHON PACK S= LABEL PRaSNC3 UNIT BYI�IDffiT
MIUM HD H�HIPP'Iil1 UWT NULMEM Ulm pmm F=
CREDIT MEMO
REFERS TO ORIGINAL INVOICE NUMBER: 2457102 DATE: 06/09/09
DRY
2- CS 6531594 CRANBERRY, DRIED INFSD 5 LB YLLWFRM FR CS 27.6500 55.30-
2 Found Later (Found After Stop)
INVOICE SUMMARY
TOTAL WGT SHIPPED: 10.00- PIECES SHIPPED: 2- ITEMS SHIPPED: 0
i
PRODUCT TOTAL 55.30CR
TAXABLE AMOUNT .00
GEN SALES TAX .00
t
JUL u
1��� AMOUNT 55.30CR
JP M
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.
Box 660088 Date Due
Indianapolis, IN 46266 -0088
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7/3/09 2771535 Concession /food beverage 22234 F 636.54
7/10/09 2855736 Concession /food beverage 117.60
7/10/09 2855737 Concession /food beverage 22190 F 1,667.12
6/10/09 2993492 Credit from inv. 2457102 6/9/09 (55.30)
6/1/09 90569575 Credit from inv. 2328173 5/29/09 (19.90)
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 TOTAL 2,346.06
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Allowed 20
353824 U S FoodService, Inc.
Box 660088
Indianapolis, IN 46266 -0088 In Sum of
2,346.06
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 2771535 4239040 636.54 1 hereby certify that the attached invoice(s), or
1047 2855736 4239040 X117.60 bill(s) is (are) true and correct and that the
1047 2855737 4239040 f' 1,667.12 materials or services itemized thereon for
1047 2993492 4239040 (55.30) which charge is made were ordered and
1047 90569575 4239040 (19.90) received except
30 -Jul 2009
Signature
2,346.06 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund