177878 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 00353399 Page 1 of 1
ONE CIVIC SQUARE TRI -STATE COCA COLA BOTTLING
CARMEL, INDIANA 46032 INDPLS SALES CENTER #114 CHECK AMOUNT: $339.22
2329 PAYSPHERE CIRCLE CHECK NUMBER: 177878
CHICAGO IL 60674 -2329
CHECK DATE: 9/29/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 3376319716 339.22 FOOD BEVERAGES
/4
A COCA COLA ENTERPRISES BOIILER
I,NVO I CE PAGE 1 OF 3
SHIP TO: REMIT TO:
BROOKSHIRE GULF CLUB 1R1-SIAIES COCA-CULA BUTILING
CITY OF CARMEL INDIANAPOLIS SALES CENTER
12120 BROOKSHIRE PKWY 2329 PAYSPHERE CIRCLE
CARMEL IN 460333314 CHICAGO, IL 60674 -2329
317-243-3771
OU I LE F 1866466 I NVO I CL& 33
ARM 1866466
RTE- 375 OHIVEH- 3707 I.OAU- ISL17 SL 00016 13 ATE 09 17 09
DOC# 3,1763197168 PL- 101 MIME: 12:16:34 CHARGE NEI 15 PHOX
SHELL RICE 10- 91IM19
PALLET BALANC d 9115109
ANITA AHERN
SALES
DESCHIPIIUN AHIM QlY PRICE AUJM HAIE NEI EXIENUEU
DASAN 1 -24 BO I'TLE CASE
20PET24L DASANI WATER 5063 4 34.00 9017 -20.1U 9.90 39.60
9019 -4.00
SUBTOTAL 4 39.60
20OZ PET LS CSD W I TEA NO /L]EP
20LSPSPRTY OT SPRIIE ZRU 4806 2 34.00 9017 -15.15 14.85 29.70
9019 -4.00
20LSPTSPRPTY SPRITE 4320 2 34.00 9017 -15.15 14.85 29.70
9019 -4.00
201-SPETS CNTR CLASSIC 5788 6 34.00 9017 -15.15 14.85 69.10
9019 -4.00
201-SPETS CNIR DIET COKE 5789 6 34.00 9017 -15.15 14.85 69.10
9019 -4.00
SUBTOTAL 16 237.60
GLACEAU 20OZ 241 -S
2UPTLWM GLA VWTR 10 ESSN 2294 1 34.00 9018 -9.04 22.96 22.96
9020 -2.00
SUBTOTAL 1 22.96
20OZ POWERADE
20PET6PK PA ZERO MXD ORY 7634 1 34.00 9018 -13.9U 16.10 16.10
9020 -4.00
SUBTOTAL 1 16.10
20OZ LS GLACEAU
20PTLA GLA VWTR XXX 6526 1 34.00 9016 -9.04 22.96 22.96
9020 -2.00
SUBTOTAL 1 22.96
CONTINUED
A COCA COLA ENTERPRISES BUl1LER
INVOICE PAGE 2 OF 3
SHIP TO: REMIT TO:
BRUOKSHIHE GULF CLUB IRI-STAIES CULA-CULA UUIII_ING
CITY OF CARMEL INDIANAPOLIS SALES CENTER
12120 BROOKSHIRE PKWY 2329 PAYSPHERE CIRCLE
CARMEL IN 460333314 CHICAGO, IL 60674-2329
317-243-3771
OUTLET 1666466 1 NVO ICE# 33763 '197 16
ARM 1866466
RTE- 375 OHIVEH- 3707 LOAD- ISL17 SEU 00016 DA I E 09 I 1 7 109
DOCM 33763197168 PL 101 TIME: 12:18:34 CHARGE NEI 15 PROX
SHELL MLANCE 10 9111109
PALLET BALK 0 9115109
ANITA MR
SALES
DESCHIPIIUN AHIM UIY PRICE AUJM RAZE NEI EXIENUEU
DEPOSITS ON SALE:
DESCRIPTION AHIM QIY PRICE AUJM HAIE Ni:l FXIENUEII
SHELLS 16 /20 OZ 0606 16 0.00 W MPLIED» 0.00
SUBTOTAL 16 0.00
NET PRODUCT QTY 23 IUTAL PRODUCT 782.00
TOTAL ADJUSTMENTS -442.78
SUBTOTAL 339.22
0031201550
AMOUNT DUE 339.22
CONTINUED
A COCA COLA ENTERPRISES BOIILER
INVOICE PAGE 3 OF 3 a
SHIP T0: REMIT TO:
BROOKSHIRE GULF CLUB 1R1-STAIES COCA-COLA BUIILING
CITY OF CARMEL INDIANAPOLIS SALES CENTER
12120 BROOKSHIRE PKWY 2329 PAYSPHERE CIRCLE
CARMEL IN 460333314 CHICAGO, IL 60674 -2329
317- 243 -3771
OUTLET .1'866-4(56 INVOICE# 3376319716
ARM 1866466
RIE- 375 OHIVER- 3701 LOAD- ISL17 SEQ-'00016 D A I E 09 1 7 09
DOCM 33763197168 PL- 101 TIME: 12:1834 CHARGE NET 15 PROX
SHELL BALKE 157 9115109
PALLET BALANC d 9115109
ANITA AHERN I
THE UNDERSIGNED CONFIRMS AGREEMENT
TO THE TERMS AND CONDITIONS AND IS
AUTHORIZED TO SIGN.
V'
ROUTEPERSON CUSTOMER
LAST PAGE
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (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
(�40 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
�W_3 j 76514"6'
Total
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.
ALLOWED 20
IN SUM OF
373 7
n
0339 �2a
ON ACCOUNT OF APPRO FOR
(S6/--Y", �i� D
(o6 �Ottif2 N
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
j �20 3376fj Y2 390 339. -s 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
_A 20
Z-1 6
L
)Signatur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund