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211604 08/14/2012 - CITY OF CARMEL, INDIANA VENDOR: 359290 Page 1 of 1 ONE CIVIC SQUARE MONARCH BEVERAGE CO INC CARMEL, INDIANA 46032 3737 WALDEMERE AVE CHECK AMOUNT: $572.20 INDIANAPOLIS IN 46241 CHECK NUMBER: 211604 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 572 . 20 FOOD & BEVERAGES A Monarch Beverage Company, Inc. World Class Beer, Inc. 9347 East Pendleton Pike Indianapolis, IN 46236 (317) 612-1310 www.nionarch-beverage.coni www.worldclassbeer.com Permit Numbers W49-08938 ' W49-87358 • IN-P-1983 ------------------------------------------------------------------- INVOICE 2586623 CUSTOMER 89924 08/17/12 10:480 PAYMENT TERMS: COD Sold By Marcella Moremar Deliver To Delivered By Tim Schlegel Brookshire Golf Club 12120 Brookshire Pkwy Carmel, IN, 46032 License RR2903542 Permit Info: Beer #RR2903542 Expires on 10/13/12 Wine #RR2903542 Expires on 10/13/12 Liquor #RR2903542 Expires on 10/13/12 ------------------------------------------------------------------- Delivered Goods [MBC] Item Pack UNet Qty Amount Coors Light 2/9pk 16oz 20627 CB 18.35 3 55.05 Alum CAN Coors Light 24 Lse Can 20610 CB 17.30 6 103.82 Lite 2/9/16oz Alum 10117 CB 18.35 5 91.75 Lite 24 Lse Can 10110 CB 17.30 12 207.62 Samuel Adams Lager 1/6 Bbl 24569 QK 58.00 1 58.0E 30.00DPST 30.02 Total [MBC] 516.20 27 546.22 Total Delivered 516.20 27 546.22 -2irked-W-LMBQ--------------------------------------------------- Misc $30 Empty Keg Return 31164 RE 0.00 -1 0.02 30.00DPST -30.02 Total Picked Up [MBC] 0.00 -1 -30.02 Total Picked Up 0.00 -1 -30.00 ------------------------------------------------------------------- Received by: Total Less Deposits 516.20 Total Deposits Collected 30.02 r� Total Deposits Redeemed -30.02 $516.20 Total Tax 0.22 Invoice Total 516.22 Payment -572.22 Credit -56.02 Payment breakdown Check #211604 $572.20 ------------------------------------------------------------------ Delivery discrepancies on this order Item Pack Ordered Shippec Leinenkugel Shandy 2112 can 11069 CB 2 2 ------------------------------------------------------------------ Return discrepancies on this order Misc $30 Empty Keg Return 31164 RE 0 -1 ------------------------------------------------------------------ I AFFIRM THAT, BY LAW, I AM AUTHORIZED TO PURCHASE AND RECEIVE THE ALCOHOLIC ITEMS ON THIS INVOICE. VOUCHER NO. WARRANT NO. ALLOWED 20 Monarch Beverage Inc. IN SUM OF $ 9347 E. Penleton Pike Indianapolis, IN 46236-0000 $1,244.80 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1207 2586623 42-390.40 $516.20 1 hereby certify that the attached invoice(s), or 1207 2586738 42-390.40 $728.60 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, August 24, 2012 Director, Brook ire Golf 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)) 08/17/12 2586623 Beer $516.20 08/24/12 2586738 Beer $728.60 I 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