211054 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 365548 Page 1 of 1
ONE CIVIC SQUARE STANDARD COFFEE SERVICE CO
;� ro CARMEL, INDIANA 46032 PO BOX 4 CHECK AMOUNT: $66.85
PENDLETON IN 46064-0004 CHECK NUMBER: 211054
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 121746560021 66 . 85 FOOD & BEVERAGES
STANDARD COFFEE SERUICE COMPANY
800-962-7006
WWW.COFFEESERUICE.COM
ORIGINAL
CUSTOMER ACCOUNT #: 554278411911176
CUSTOMER #: 5542784 TICKET 121796560021
LOCATION #: 11911184 PO#: -
CARMEL CLAY PARKS & RECREAT D e: 06/22/2012 :46:08 PM
1195 CENTRAL PARK OR E ROUTE #6560 SCOTT
CARMEL, IN 46032-0000
Lst Pymnt Ot: Lst Pymnt Amt: 0.0
K
Product Delivered QTY PRICE AMOUNI($)
--------------- --- ----- ------
Luzianne Filter Packs 32/3 Oz 1 33.00 33.00
Standard Coffee Iced Tea Sugar 1 31.38 31.38
1222-Oz
Energy Surcharge 4 1 2.47 2.47
---------------------------=-----------------------------
5ubtotal Sales 66.85
Sales Tax 0.00
DELIUERY TICKET TOTAL 66.85
Previous Account Balance 0.00
Total.Balance Due 66.85
Payments r= 0.00
ENDING BALANCE 66.85
We bill monthly by summary Invoice
Retain for your records.
Nuxt Delivery Date : 07/16/2012
E il Payments To:
d Coffee Ser:-ice Co
PO BOX 952718
UIS. MO 63195-2798
Please include customer account number on check
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.
365548 Standard Coffee Service Co. Terms
P.O. Box 4
Pendleton, IN 46064-0004
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
6/22/12 121746560021 Concessions $ 66.85
Total $ 66.85
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.
365548 Standard Coffee Service Co. Allowed 20
P.O. Box 4
Pendleton, IN 46064-0004
In Sum of$
$ 66.85
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-1 121746560021 4239040 $ 66.85 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
12-Jul 2012
Signature
$ 66.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund