175144 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 362955 Page 1 of 1
`.l. ONE CIVIC SQUARE SOUTHERN FOOD SYSTEMS
CARMEL, INDIANA 46032 PO BOX 19635 CHECK AMOUNT: $194.22
INDIANAPOLIS IN 46219 CHECK NUMBER: 175144
CHECK DATE: 7/22/2009
DEPARTMENT A CCOUNT P O NUMBER INVOI NUMBER AMOUNT DESCRIPTION
1047 4350000 120050 194.22 EQUIPMENT REPAIRS M
SUN
29 ?ODg INVOICE NUMB 1200050
P.O. Box 19635 I VOICE DAT
Indianapolis, Indiana 46 06/ ?.5/09
22_5800 PAGE 1
SOLD TO CARMEL CLAY PARKS REC. dba NORM M SHIP TO IMONON CBA1T$R
114 E. 116TH STREET 1235 CENTRAL PARK DRIVE BAST
CARMEL, IN 46032 CARPEL, IN 46032
(317) 571 -4140
CUSTOMER I.D.: 113022
SHIP VIA: SERVICE P.O. NUMBER:
SHIP DATE: 06/24/09 P.O. DATE:
DUE DATE: OUR ORDER NO:
TERMS: C.O.D. SALESMAN: Dave Deck
PRODUCT I.D. DESCRIPTION ORDERED SHIPPED. U/M UNIT PRICE AMOUNT TX
7071196185 NOZZLE SERRATED 6 6 2.1 2 12.72
7071138836 NOSE TRANSFER RED 1 1 6.50 6.50
2 FLOURS 2.000 2.000 65.00 130.00
TRIP CHARGE 45.00
In of a subtotal 1. _?9
Sales to 7.000% 1.35
In total 195.57
SIGNATURE:
P AGREE THAT R LNG LISTED ON INVOICE IS ACCOUNTED FOR UNDAMA GEC, UNLESS OTME RWSE NOTED.
Purchase
Description
P.O. P no ciiO
G.L. 0. 1
Budget
Line Descr
Purchaser Date
Approval Date
WHITE COPY SOUTHERN FOOD SYSTEMS YELLOW COPY CUSTOMER
C V
Repair Order,
212 -3g 2
Account Phone Z)kl 4 ;7.3 Date:
Account (Name&Location) tv\0t-1g CC1-%TEz-
P.O. Box 19635 tA
Indianapolis, IN 46219 r 2—
Phone: 317-322-5800 Bill to:
Toll Free: 800-776-5100
REASON FOR CALL: VA &J I i-LA 1 S -4 Con6&te By:
CAo(,)co, Too 1 A A a- 0. Qty Part Description Unit Price Total
PROBLEM FOUND: MV'
/961/gs SW 11JOZZLE
KlY, S?O(LCA CENTER. 61SN.�N�c SL,6T<-tA 13963L RMT '+Ao5C G-S 6•so
CuT oF A6.'risr milWr.
WORK PERFORMED: bf<, ASS C-Mi�LEO C1-C A10fk4
�MT S "c->SF A v T E f) 5 0 c-T I bi�j F �A E AZ
pp- E sc, s. T �A -t JUL 0 Z tuu'
COMMENTS: 0-\/CLN� NoPMAL
MODEL SERIAL Tirnein TirneOut Hours. Rate Parts Total 1 �oZ�
iz tl-NT V)at-- (L11- TOO 11: C0 FLaborTotal 30 6)0
Zvi Z 3 ov o'A SIGNATURE (I hereby acknow!edge completion of the Trip Charge �S. �U
above described work.)
/7 "ax
T�chnician:
-�2LI 69
E Date: Balance Dueins-
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.
362955 Southern Food Systems Terms
P.O. Box 19635
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/25109 120050 Repair soft serve machine 22136 F 194.22
Total 194.22
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_
Clerk- Treasurer
Voucher No. Warrant No.
362955 Southern Food Systems Allowed 20
P.O. Box 19635
Indianapolis, IN 46219
In Sum of
194.22
i
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 120050 4350000 194.22 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
16 -Jul 2009
Signature
194.22 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund