210524 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 364942 Page 1 of 1
ONE CIVIC SQUARE REPUBLIC NATIONAL DIST COMPANY
r 0 CHECK AMOUNT: $422.06
CARMEL, INDIANA 46032 Po eox 660357
INDIANAPOLIS IN 46266 -0357 CHECK NUMBER: 210524
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 1042896 422.06 FOOD BEVERAGES
COMP
Lip� ANY COPY
10 08U S HI RE GOLF CLUB U LJ LI lJ f 1 f�l O 1 m I L 31 CUSTOMER NO. CUSTOMER P.O. NUMBER INVOICE NUMBER
CITY OF CARMEL y INVOICE- 7916 1042896
D6STRIDUTING
22120 SR00145HIRE PKWY CHNNY LLC ORDER N0. PERMIT I LICENSE N0,
TYPE INVOICE DATE
P.O. BOX 160E RR9 -03542 ALL 06/14/12
a 2 INDIANAPOLIS, IN 46206
CARMEL, TN, 4603 ROUTE STOP .EXPIRATIONDAT TERMS
(317) 291 -9042 .(31'7)7636-4880 610 007 07/13%12 'NET 15 DAYS
1B STATE PERMIT W49 -09133 SHIPMENT N0. DIV. N0. SALES N0. IV. NO. 'SALES NO. IV. N0. SALES N0. DIV. N0. SALES N0.
SPECIAL. INSTRUCTIONS:
2769 13219 .12.1.9 13219 122i9
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DELIVERY NOTES: VENDOR ID NUMBER INVOICE TYPE OUE DATE
x.°
,c TtEF Invoicet)t25�1
PRINTED 20:12 06 13 `19.; 32: 57
ITEM NUMBER LINE LOC. DESCRIPTION SIZE CASES BOTTLES LIST DISCOUNT NET BOTTLE
„BULK IOC. ,a xUPC tt 4 wt a o VINTACiE r' 4 k a s PRICE =UEAL NET PRICE
PACK UNIT COST- ti COST
ri.
73433 0010 BACARDI SUPERIOR .1.OL 12 2...2, 18.38 18.38 18- ^3,A 36.76
r is x u r
5 1 EL OWS 1. 0 12 KAL Or{DE K C? PLE 98 DO !KO i REORDER
j
4083 1$ Vt]D� A� I. 0L 12 1 Y. 18 9.18 9.18 9., 18
y n>I.,, d,st �G,G7,64O1i".7 F``'.'_' ^r r a•'-. '.-,pewc
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9 3 1C FI Es UALL BLOWY nARY .N 1.0L 12 2 5.60 5. 0 5.60 11.20
0091801
4
Y 1 4 275 F 4r 3 C ALL LES L J� 1.0L
12 J -5.60 5.60 5.60 16.80
11 F 9 �N^. .r'm' 0 d
3 3 63C 13REY GOOSE VODKA 6 [3 .0L 6 4 96.83 36.83 .36.83 147.32
Oi304,0280fF
5413 033E JACK DANIELS ELK 1.0L 12 3 30.50 30.50 30.50 91.50
K F G`
4020 J 0290 JIM BEAM 80 BAR 1.0L 12 2 19.88 19.88 19.68 39, 76
`i y�,',`.;
7
97083 173D MAKERS MARK 90 1.0L 12 2 34.77 34, .77 34.77 69.54
z F "k» °,l ^'£,zt c..Ft>6�±'1�*,"T "�,F dC E n 11 1 q.�
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Tc1'f,trel NbC be mc,eta�+�rottttal.2 sy1Y►d t+ 0 e;�el b ectL1=ir g your deliveries:
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RETURN CODES:
LIQUOR LITERS GALS. WINE LITERS GALS. BEER LITERS GALS. O-Did not order D- Damaged on T ruck
t -Billed Wrong E-No Money
2- Pricing Error F-Of oe Cancel 19 CASH AMOUNT
3 70 3-Out of Business WDefective j' Y 422. 06
4- Ouplicate J -Shod on Tmck
6 -Won't scan or not authorized HECK
HIGH WINE LITERS I GALS. LOW WINE LfTER GAL SPARKLING LITERS GALS. A -Out of Stock
B- Picking Error
C Tao Eady/foo late
Y
ACCEPTED "f¢ws r {.?yeCK AMOUNT k WAGE 1 RECEIVED BY J V
I, as the licensee, agent of this licensee, or employee thereof of the business accept the merchandise
shown on the invoice and certify that to the best of my knowledge there has been no change in DATE: TIME:'
ownership of this business without notification to the State Alcohol Board and is the holder of an
effective permitticense There will be a $50 service, charge, for any dishonored check. RNDC is not
m
responsible for breakage, loss, or damage to merchandise after delivery or acceptance by DRIVER SIGNATURE
It r r r n n n o Common Carder.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Republic National Distributing Company
IN SUM OF
P.O. Box 1602
Indianapolis, IN 46206
$422.06
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 I 1042896 I 42- 390.40 I $422.06 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
Tuesday, June 19, 2012
Director, Brookshivibolf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/14/12 I 1042896 I Spirits and wine I $422.06
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