209378 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
ONE CIVIC SQUARE U S FOODSERVICE, INC CHECK AMOUNT: $1,301.33
CARMEL, INDIANA 46032 PO BOX 660088
o� INDIANAPOLIS IN 46266 -0088 CHECK NUMBER: 209378
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 189049 308.91 FOOD BEVERAGES
1095 4239040 418077 992.42 FOOD BEVERAGES
ACCOUNT INV[]ICE INVOICE CUSTOMER PURCHASE ORDER S SALES DATE
NO. �O. DATE NO. NUMBER REF
D4/27/12 PO569575 OR DERED
9D569922 DI8��4�
1054 0062 04/26/12
Ruute:5291 18 ORDER NUMBER: 510571. 8ill _ShiP Remit CARMEL CLAY PARKS&RECREA''I'' US Foods, Inc.
To: To: 1235 CENTRAL PARK DRIVE E To�
I Box 660008
CARMEL 1N CARMEL.- IN
460?2 INDIANAPOLIS
Att: 317 843 3873 46266-OOeS
MICHELLE COMPTON DEPT 00 eOO 42a 2118
��ipFrm 12�O1 CUMBERLAND RD FISHERS IN S�i l7 O4/27/1E� p
Page 02 of 02
rt7rms
spcial ENTER OFF OF 111TH STREETW
'yt7rms: NET 30 DAYS instr:
Wy qty Sales Product Descripton Pack Size Label C Weioht Pricing Unit Extended
rdered Shipped Unit Number. D Unit Price Price
INVOICE SUMMARY
FUEL SURCHARGE 5.00
TOTAL. W3T SHIPPED: 133:11 PIECES ORDERED: 16 PIECES SHIPPED: 16 ITEMS SHIPPED: 16
PRODUCT TOTAL 330.12
01ARGES 5.00
TAXABLE AMOUNT .00
This amOunt is an estimate at time of shipping prior to any adjustments made at deliyerV: 335-12
Purchase
Description
`=L.°
Budget Vl&ye
Li
uan�____�
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO, NO. DATE NO. NUMBER LOC. REP ORDERED
90569922 0189049 04/27/12 90569575
0/� 1054 006 O4/26/12
2ill Ship uf
oute:5291 10 ORDER NUMBER: 51O571
Remit
/o: 1411 E. 116TH ST To: 1235 CENTRAL PARK DRIVE E To:
CARMEL IN CARMEL IN BOX 660088
46032 1
46032 INDIANAPOLIS IN
317 041 %7 46266-0088
Att: MICHELLE COMPTON 00 900 428 2118
Q i pFr FISHERS IN Ship& 04/27/12 Page 01 of 02
111TH STREET!;f
f ytrrms: NET 30 DAYS FM NY 11 ZM2 instm
°=sc'iv Extended
~^^ppy. ~°i^ Price
DRY
1 EA 4053336 CANDY, BAR MILK CHOC 36/1,53 OZ HERSHEY TQ)un o�f bit EA 26.2100 S 26,21
1 CS 5601943 CHIP, PTATO KTL BBQ GS BAG 64/1.375 OZ NISS VICKI, CS 30.1500 30.15
1 EA 6210777 CANDY, MIT KAT VNDG ETD i.5 Z 36 EA KIT MAT EA 25,9400
I CS 6260665 COOKIE, FUDGE STRPE MINI SS 60/2 OZ KEEBLER CS 22.7200 12.72
1 CS 9341223 CREAMER, HALF 8 HALF UHT DARY 360/.375 OZ GLMVW FRM0/ CS 16.7600 16.76
READY TO EAT Please Refer to Return Polic
READY TO EAT Please Refer to Return Paiick�
READY TO EAT Please Refer to Return Palic
0 CS 4800843 MILK, 2% REDUC FAT PLST REF 12/1 PT IRAIRIE FM
*SUB*R 1 CS 4804381 MILk, SNH PLST REF FT/FR 12/1 PT PRAIRIE FN CS 11.8500 11.05
1 1 CS 4800884 MILK, CHOC 1% LOW FAT PLST REF12/1 PT PRAIRIE FN I CS 10.9000 10.90
READY TO EAT Please Refer to Retbpn Policv
1 1 CS 7197775 YOGURT, ABET STRUBMA RSPBRY 12/6 OZ YOPLAIT
FROZEN
1 1 CS 5218862 ICE CREAM SANDWICH, VML 24/6 OZ BLUE BUNNY V CS 17.1400 17.14
PRODUCT CLASS RECAP
TOTAL DRY PIECES ORDERED: 7 PIECES SHIPPED: 7 ITEMS SHIPPED: 7 165.5
TOTAL REFRIGERATED PIECES ORDERED: 7 PIECES SHIPPED: 7 ITEMS SHIPPED: 7 122,9
TOTAL FROZEN PIECES ORDERED: 2 PIECES SHIPPED: 2 !TENS SHIPPED: 2 41.62
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO. DATE NO. NUMBER LOC. REP. ORDERED
90569922 0418077 05/04/12 90569575 1054 0062 05/03/12
Route:5251 1 ORDER NUMBER: 516505
Bill Ship Remit
To: To: 1235 CENTRAL PARK DRIVE E To�
.BOX 660088
CARMEL IN CARMEL IN
46032 46032 INDIANAPOLIS IN
317 843 3873 46266-0088
Att: MICHELLE COMPTON DEPT 00 800 428 21,18
ShipFr 12301 CUMBERLAND RD FISHERS IN ShipD.* 05/04/12 Page 02 of 02
ShipFrm�
FrtTrms. Spcial ENTER OFF OF 111TH STREET!!!
FrtTrms�
Pyt7rms: NET ]O DAYS 1nstr,�
PytTrms
Qty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
Ordered Shipped Unit Number D Unit Price Price
INVOICE SUM�IARY
FUEL SURCHARGE 5.00
TOTAL WGT SHIPPED: 393.19 PIECES ORDERED: 30 PIECES SHIPPED: 29 ITEMS SHIPPED: 19
PRODUCT TOTAL 987,42
CHARGES 5.00
TAXABLE ANOUNT .00
GEN SALES TAX .00
This amount is an estimate at time of shipping prior to ant/ adjustments made at delivery: ?92 42
Purchase
Description
G`�#
Budoet
Purchaser Date_____'
Dute______-
ACC:C7t.11\T INVC3ICE INVOICE CUSTOMER PURCHASI•I ORDER SALTS SALES DATE
N0 NO. DATE 1\10. NUMBER LOC REP ORDERED
90569922 0412077 05/04/12 90569175 1054 _-2 (r+q 0062 05/03t12
Route: 5251 1. t3 ORDER NUMBER: 516505
B ill S h i p R e yin i L
CARME:L CLAY PARIVS&RECREAT CARME:L. CLAY PARK,S&RECREAT US Foods, Inc.
TG: 1411 E. 116TH S'I" To: 1235 CENTRAL DRIVE: E To
BOX 660)0)88
CARMEL IN CARMEL.. IN
46 032 46032 I NDJ ANAPOL I S IN
31 843 387: 46266-0088
Att: MICHELLE CCJM!'a'1 "CI!! DEPT 00 800 428 2118
ShipFrm: 12:301 CUMBERLAND RD FISHERS IN Shap& 05/04/12 Page tkl o 002
F' I: 7 "�',�n s: pe :-.i E NTER OFF F' LJF' 111TH STREET!
PytT NET' 30 DA YS MAY 9 2012
ptl/ Nt Sales Product Des .riptan Facia Size Label C; Weight. Prising Unit Extended
Ordered Shipped Unit N13rnbFyr D Unit Price Price
DRY
CS 0445098 TAPE, THRML. CASH RGSTR WHT 50 RL MONOGRAM CS 85.7800 171.56
1 CS 1206424 PASTRY, POP'' 'TAR'T STUDY FRTD 2 72/2 EA KELLOGG'S CS 42.64300 42.68
I CS 2404325 GLOVE, POLY LO TXTD ANB DX 10/100 EA MONOGRAM B CS 39.7100 39.71
0 EA 4053336 CANDY, BAR MILK CHOC 36/1.55Z HERSHEY
./4 4 CS 4260238 SAUCE, CHS NACHO SHLF STABL 4/107 OZ ORTEGA CS 50,1600°, 200:64
/1 I CS 4508560 SNACK BAR, CRL. TRI:X IW SS 96/ OZ GENL. HILLS CS 34.2400 34.24
�L I CS 5429303 JUICE, ORNG 100% PET PLST BTi._ 24/10 OZ T 4-4 IRSTER CS 20.2300 20.23
1 CS 5704077 COOKIE, NUTTR BUTR 1 Z SS 4811 OZ NUTTR RUTR CS 28,8200 2082
J;3
3 CS 9463656 CHIP, TORTLA CORN YLW RND 6/2 LB EL PASADO CS 19.0200 57.06
REFRIGERATED
I C S 0654269 HUMMUS, RSTD RED PPR NClNDARY 12/4.56 OZ. SARRA CS 22.9000 22:90
READY TO 'EAT Please Refer to Return Police
�l. 1 CS 0654301 HUMMUS, GRLC RSTD NONDARY REF' 12/4.56 OZ ABRA CS 22.9000 22.90
READY TO EAT Please Refer to Return Polic
I EA 2000453 SALAD, CHIX CRNY REF a LB FIERCE B EA 26.9900 26.99
READY TO EAT Please Ref=er to Return Policy
1 1 EA 3000452 SALAD., TUNA ALHCR TFFF REF 5 LB FIERCE D EA 26.9600 26.96
READY TO EAT Please Refer to Return Poliof
A 1 CS 4800843 MILK, 2% REDUC FAT PLST RE=F 12/1. PT PRAIRIE FM CS 10.4600 10.46
FROZEN
i 4 CS 2011278 PRETZEL., KING SOFT HIED FZN 50/5 OZ SUPR PRTZL CS 31.6000 126.40
1 C; 2014652 MUFFIN, BLBRY IW 24/4 OZ SARA LEE CS 21.6700 21.67
1 1 CS 4058707 MUFFIN, BANA NUT IW FZN 24/4 OZ SPUNKNEYER CS 24.:3300 24.33
2 CS 5741228 BUN, HOT DOG 6" HINGE SLCD T'FF'12 /12 EA HILLTOP HR CS 29.9600 59.92
1 CS 5187999 ICE CREAN BAR, CHOC TACO VNL24/4 O7 KLONDIKE CS 24.3300 24.33
f 1 CS 8552 317 MUFFIN, COF CAVE PECN CIN IW 24/4 OZ SARA LEE. CS 25.6200 25.62
PRODUCT CLASS RECAP
TOTAL CORY PIECES ORDERED: 15 PIECES SHIPPED: 14 ITEMS SHIPPED: 43 594.94
TOTAL REFRIGERATED PIECES ORDERED: 5 PIECES SHIF'T'ED: 5 ITEMS SNIF'F'ED: 5 110.21
TOTAL. FROZE=N PIECES ORDERED: 10 PIECES SHIPPED: 10 ITEMS SHIPPED: 6 282.27
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. Terms
Box 660088
Indianapolis, IN 46266 -0088
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/27/12 189049 Concessions 30757 308.91
-514112- 418077 Concessions 30767 992.42
Total F$
1,301.33
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,
353824 U S FoodService, Inc. Allowed 20
Box 660088
Indianapolis, IN 46266 -0088
In Sum of
1,301.33
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1095 -1 189049 4239040 308.91 1 hereby certify that the attached invoice(s), or
1095 -1 418077 4239040 992.42 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
17 -May 2012
Signature
1,301.33 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund