178429 10/14/2009 a. CITY OF CARMEL, INDIANA VENDOR: 00353399 Page 1 Of 1
„E ONE CIVIC SQUARE TRI -STATE COCA COLA BOTTLING CHECK AMOUNT: $148.50
CARMEL INDIANA 46032 INDPLS SALES CENTER #114
'tip >oH 2329 PAYSPHERE CIRCLE CHECK NUMBER: 178429
CHICAGO IL 50674 -2329
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 3386310708 146.50 FOOD BEVERAGES
I
r A COCA COLA ENTERPRISES BO'FILER
r
NVO ICE PAGE 1 OF 2
;SHIP TO: REMIT 10:
BROOKSHIRE GULF CLUH TRI- SIAIES COCA -COLA BUIILING
icl[Y OF CARMEL INDIANAPOLIS SALES CENTER
x12120 BROOKSHIRE PKWY 2329 PAYSPHERE CIRCLE
CARMEL, IN 460333314 CHICAGO, IL 60674.2329
317-243-3771
OU�FLET 1866 1615 I NVO I CE" :336631 CJ708
ARM 1866466
RTE- 375 DRIVER- 3747 LUAD- ISL13 SEQ 00008 DATE 10101 f09
DOC9 338631117083 PL- 101 TIME 09:05:46 CHARGE NET 15 PROX
XLL EARKE Si• 9 6y
PALL ET RLPIK E 99
PNiTH AHRIf
SALES
OESCRIN ION ARIM QTY PRICE AUJu HAZE NEI EXIENULO
200L PET LS C:SI] W TEA NO /DEP
20LSPETS CNTR CLASSIC 5768 2 34.00 9017 -15.15 14 d5 29.70
9019 -4.00
2OLSPETS CNIH Olkl COKE 5789 Ti 34,00 9017 15.15 14.85 118 80
9019 4.00
SUBTOTAL 10 148.50
DEPOSITS ON SALES
UESCRIPI16N ARI# QIY PRICE ADJM RATE NET EVENUED
SHELLS 16120 OZ 0606 10 0.00 IMPLIED» 0.00
SUBTOTAL 10 0.00
CONTINUED
A COCA COLA I.NItRPRISES YU I'ILER
1 NVO 9 CE PAGE 2 OF 2
SHIP TO: REMIT TO:
bkOUKSHIHE GULF CLUB 1R1-STAIES COCA-COLA BOTTLING
CITY UI CARMEL INDIANAPOLIS SALES CENTER
1212u BROOKSHIRE PKWY 2329 PAYSPHERE CIRCLE
CARMEL IN 460333314 CHICAGO, IL 60674-2329
317- 243 -3771
OUTL1 7 _'I i c&i6466 I NVO I CE# 3:3663 10 7?013
ARM 1866466
RTE 375 DRIVER- 3707 LOAD IS0 3 SEQ- O0u08 DATE 10 I 0 1 09
DOCK 33663107083 PL- '101 TIME: 09:05:46 CHARGE NFT 15 PROX
HLL EHIRKE 18- 9
PELLET BB K d W9,Z
ANITA AU
NET PRODUCI UTY 10 TOTAL PRODUCT 340.00
TOTAL ADJUSTMENTS 191.50
SUB -TOTAL 148.50
T 0031201550
AMOUNT DUE i4B .SO
I
THE UNDERSIGNED CONFIRMS AGREMENI
TO THE TERMS AND CONDITIONS AND IS
AUTHORIZED TO SIGN,
ROUTEPERSON CUSTOMER
LAST PAGE
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.
Payee
C' i TT�s C /)x Purchase Order No.
23 R��C f�r`sPE Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4x YY
Total
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 N WARRANT NO.
ok ALLOWED 20
I NS UM OF
M"
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or DEPT INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
Y4d 5 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
20 C� 9
rf� Si gnat ur L{/
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund