211477 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
10� ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $1,707.40
Sly, CARMEL, INDIANA 46032 PO BOX 7137
INDIANAPOLIS IN 46206-7137 CHECK NUMBER: 211477
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 207200699 751 .24 FOOD & BEVERAGES
1207 4239040 207261126 956 . 16 FOOD & BEVERAGES
Good things CUSTON?hER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
come from t ELV, DATE cusT,btER
BROOKSHIRE GOLF CLUB+++ 1
12120 BROOKSHIRE PKWY ®sc L+.ucKS oP 412940 207261126 8 1
SYSCO INDIANAPOLIS, LLC All
CARMEL IN 46033 4000 W 62ND ST
INDIANAPOLIS, IN 46268 4448 -qFRVI
317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER
AL DELIVERY
CITY OF CARMEL '
1 CIVIC SQUARE DRIVER: JOHNSTON, LEWI
CARM Tj IN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFIR 60-1.4 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE.
CITY PAC SIZE ITEM DESCRIPTION ITEnn urvlr EXTENDED
CODE :PRICE PRICE:
'
:4 x
DAIRY
C I S D NL 5. LB BB RLCLS CHEESE AMER YEL 1 20 SLI 28131 6697114 17.80 17.80
** MEATS ***
GROUP TOTAL** * 17.80
F 1.10 LB BBRLCLS FRANK ALL-MEAT 5X1 6 IN 37736-070 113.7736 25.32 75.96
F S 276.1.0,1..Z DVANCE PORK FRITTER BRD RAW:1, 6606 2205383 39.98 39 98.
** FROZEN ***. _
GROUP TOTAL ..* 11.5.94
F S 244 250Z KRSIMP MUFFIN ASST BL/BAN/CHOC/CH I/W 07.3473021825 7813114 23 94. 23.94...
F 1 CS 42..5LB ANTLZR ONION RING BEER BTR 5/8" 30423 0855296 26.71 26,71.
F C 65 LB SYS IMP POTATO FRY 318 SKON PHANTM PLU SY003108 4356465 31.62 31.62
GROUP TOTAL**** 82.27
** CANNED & DRY ***1
C .. S D N LY 48 CT NICKER CANDY BAR SNICKER 2.07 OZ 01202 4348389 32.61 32.61
D S 641.1252 KDLAYS CHIP POTATO BKD REG BIG GRAB 443968 6725313 29.85 29.85
D I S _X60 CT AYS CHIP VARIETY SYSCO/FRITO LAY 31831 6586721 26 98 26.98
D CS 122.1 OZ RIZ0NA DRINK TEA ARNOLD PALMER LITE 0554968 18.67 186.70'
D C S 162402 4SE REC KETCHUP SQUEEZE BTL HOUYA24 9617218 26.76 26.76
T
D S 121 LTR JR PR MIX COCKTAIL BLDY MARY 47700 8087470 46.30 46.30
D CS 101" LB qBRLCLS SNACK MIX SPICY CREOLE 91069 9960329 33.97 101.91
GROUP TOTAL**** 451.11
** PAPER & DISPOSABLE
D 5 ,, NL 500CT YSCO: FOIL SHEET 9X10.751N SILVER.. W69372 6938500 12.98 25.96
D CS 181500CT EORG P TISSUE TOILET CORELESS 2PLY WH 19378 6092605 59.05 118.10
D CS, T EORG P TOWEL ROLL ENMOTION LRG 4AUTO 89460 9627761 69.99 139.98°
0
LLL N aErnrr ra; ..
P.O. BOX 7137
2E 4 32 29.3 537 INDIANAPOLIS IN SUB
q IMPORTANT: PERISHABLE PRODUCTS ARE NOT ELIGIBLE FOR RETURN AFTEF 4206-7137 TOTAL
E FF R ANY SHORTAGE AFTER YOU(HA°VIE E$IGNEO(PIECES RECE RECEIVED MUSTS
TAX
AGREE WITP NO. PCS CUST. NO. PCS
TOTAL
DRIVER'S DELVD.
SIGN E c C E SIGN p `7 REC. INVOICE
o qTU HPER7ISD ggLY SI CTIIONL T5II OF HM 081TISHABSE7EAGRICULTIURA LV�OMMOD ITIESLDC$LUBI ET( °U S CE 499EIC)OR HET RSE��`ER O TOTAL
7HS�RC OEMMODITIES RETAINA TRUST CLAIM OVER THESE COMMODITIES, ALL INVENTORIES OF FOOD OR �THER PRODUCTS PAYABLE ON OR BEFORE
1 DERIVED FROM THESE COMMODITIES. AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL ONT. ON PAGE 2
a FULL PAYMENT IS RECEIVED.
Good things CUSTOMERS ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
comefrom aELV D6/A1. cusroER 1 1 BROOKSHIRE GOLF CLUB+++
12120 BROOKSHIRE PKWY ... 412940 207261126 8 2
Si IR GK iS QP
SYSCO INDIANAPOLIS, LLC
CARMEL IN 46033 4000 W 62ND ST ROU;.E
INDIANAPOLIS, IN 46268
317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: J HNST N, LEWI
EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 FIR 60-1.4, 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE.
QTY PAC SIZE ITEM Dl SCRIPTION ITEM UNET EXTENDED T
r., CODE PRICE PRICE x 11.: ...
GROUP TOTAL 2 4. 4 11 MI;S H RG .S... 4G5 ;FOR FUEL SURCHARGE 5 00
ORD S RY
31187
.... . ...... _ _ ......... . __. . ........ _ __. .... _._ _ _ .. .....'......l.".'....., . . ._ ... .. . .... .11 0
I v 1 N %REMIT 70 .. ..
P.O. BOx 7137
= INDIANAPOLIS IN SUB
` IMPORTANT: PERISHABLE PRODgUCTS ARE NOT ELIGIBLE FOR RETURN gAFTEF 4 206-7137 TOTAL 956.16
E 2 4 32 29.3 537 FOR VANY SHORTAGE AFTER YIOU HVAOVIE ES IGNEO WILL NOT RECE NEED MUSTE
TAX
NO. PCS COST. NO. PCS TOTAL
DRIVER'S 0ELVO. SIGN REC. INVOICE
qTUSIGN �Ig17Ig gg gq�GCRI N L� MM p17�g E7 GoR g p ARE SEppS Cg EgC3 o c 9E �) F gEgL TorAL 956.16
EH Qk%j�MODITIESTR�ETAS�CS OFTRTUHE�PE AISM A�VERDTHESEL TCOMMOD MIES,DALL IDErI`rTORIE�I of SFpOD90R�C0YHER pROD RC OF PAYABLE ON OR BEFORE
I TEES SS CCC 8/24/12 LAST PAGE
I DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODIllES UNTIL
o FULL PAYMENT IS RECEIVED.
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))
07/26/12 207261126 Food $956.16
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
Sysco Indianapolis LLC
IN SUM OF $
4000 W 62nd Street
Indianapolis, IN 46268
$956.16
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#(TITLE AMOUNT Board Members
1207 ( 207261126 I 42-390.40 I $956.16 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, July 27, 2012
i
Director, Brookshir olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Good things CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
i e from 1 Lv,;DArp CUSTOMER �,
BROOKSHIRE GOLF CLUB+++ S� 7
12120 BROOKSHIRE PKWY TR cK s oP 412940 207200699 8 1
SYSCO INDIANAPOLIS, LLC
CARMEL IN 46033 4000 W 62ND ST RO3E
INDIANAPOLIS, IN 46268 Q`
317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER VERY
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: V EL, DENNI
EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 FIR 60-1.4 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE.1. I
{ ITEVf tJNtT EXTENDED T 11 QTY PAC SIZE; ITEM DESCRIPTION
_ COD ::;;PRICE PRICE
A
... :r. ...... .._..::: ::: .. :. x ..
DAIRY **
C S NI..5 LB BRLCLS CHEESE 'AMER `YEL I20 SLI 28131 6697114 17.80 17.80
** MEATS :.***
GROUP TOTAL**:'�* 17.8.0 :::
F I S 605.3302 AB BEEF PATTY GRND STKBRGR FRZN 9976315.1 6703049 67 88 67 88 999
F S 110 LB HNSVLE BRATWURST 5X1 PRCK SKLS 3188 2199198 33 97 67.94
F % S 110 LB . BRLCLS FRANK ALL MEAT 5X1 6 IN 37736 070 1137736 25 32 I01 28
....:: GR.OUP_TOTAL**�`* ....... ........ 2370:.;
* POULTRY **:* :
C S 42 5 LB BRLCLS TURKEY .BRST SLI 3.L4Z MESQT SMK MST...99r B 4860003 43 98 48-98
;; GROUF..T.O,. AL**�* _... 43 98..;
*.*..FROZEN ***
F 0 S 12CT RCTYBK COOKIE .CHOC .CANK DWNHM 302 IW 8349439
.r UT/S'T`OCK ! 1
F':;.. S 2,5LB ANTLZR ONION RING ;BEER BTR 5/8°. 304:2:3 085:5296 ;::26.71 26.7:1
F S 5 .LB YS :;I:MP P.QTATO ;FRY 3 8 :SK:ON PH.ANTM PLU SY00310;8 4356465 31.62 31 62'1. ****
GROUP TOTAL 58. 3
** :CANNED &. :DRY * *
C NL 36 CT:; RS> CANDY BAR MILKY WAY 436;7363 >;27,74 :27 74:r.r
C: NL 4$ CT. NICKER .;CANDY>BAR .SNI.CKER' 2.07:: OZ 0120'2 348389 ;::32.:6:1 32 '6>1
D j . S 160 CT; AYSi CHIP VARIETY SYSCO/FRlTO LAY 31831 6586721 26 98 !26 9;8!
D ' .. ... S 602 5 O:Z RANDMA COOKIE CHOC:!;CHIP ,IW 45092 6925806 `19.:95 19.9<5;
D >:S 1 23 OZ; RIZONA DRINK TEA ARNOLDiPALME.R LITE 055:4968 18 6:7: 112 0'2i
C ; L 15 GAL:: CHW.RTZ PICKLE CRS ::CUT KO! *;*** ; 29658':27075'6 10;2:$919 .::;39.8'>6: `39 .'86!
GROUP TOTAL
25 .16
N .. REM IT'tQ•
P.O. BOX 7137
] .1 3 22 14.6 347 INDIANAPOLIS IN SUB
I IMPORTANT: PERISHABLE PRODUCTS ARE NOT ELIGIBLE FOR RETURN gAFTE 4206-7137 TOTAL
�OR ANVSHOR7AGE AFTER YIOU HgOVIE E$IGNEO I IECEOST RECEIVED MUSTE TAX
r,RE WITH NO. PC$ CUST. NO. PCS TOTAL
DRIVER'S OELVD.
:g SIGN
O I S R �l�y ,yE, DEI Eg Lg E7 GROI LH�JS SIGpCNM p gE q REC. INVOICE
THESE C M IT T��t T AFTRUSTOPC RAIMAOVER�TITESUE TCO MMOD T,MSf�ALL�INVEMT 1 .SP OAS gAEE77 ORY EETRgUESLT�E p TOTAL
D�OR�CTHER PRODUCTS PAYABLE ON OR BEFORE
1 DERIVED FROM THESE COMMODITIES• AND ANY RECEIVABLES OR PROCEEDS FROM THE SALE OF THESE COMMODITIES UNTIL ONT. ON PAGE 2
o FULL PAYMENT IS RECEIVED.