212606 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 361108 Page 1 of 1
ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTC
CARMEL, INDIANA 46032 PO BOX 17698 HECK AMOUNT: $194.90
BALTIMORE MD 21297-1698 CHECK NUMBER: 212606
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 PARKS 194 . 90 7003-7311-0007-2984
C 3203
siO®m�
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#346 CASTLETON , IN
6110 EAST 86TH/STREET
CASTLETON, ,`IN/46250
MEMBER #111.787,920129
RESALE ON
5 @ 19.49
E 1160 SKITTLES 97.45
5 @ 19.49 r
E 1151 STARBURST 97.45
RESALE TOTAL 194.90
.NON RESALE TOTAL .00
TOTAL I1'fI
VF Costco Wholesale 194.90
----------.-----r_! L_______ ________. ___
XXXXXXXXXXXX2984. � SWIPED
07/26/12 17:44 '�,,'
Sew#: 005010 App#: 026469
Costco Wholesale rResP:"AA
Tran ID#: 220821201000
Merchant ID 99034611
APPROVED - PURCHASE
AMOUNT: $194.90
0346 010 0000000044 0279
--------------------------------------
CHANGE .00
TOTAL NUMBER OF ITEMS SOLD = 10
CASHIER: JOE S REG# 10
11MU411K 17:44 0346 10 0279 44
THANK YOU !
F'LEASE COME AGAIN !
yc COS7 Co —
Please Direct Inquiries To: 1-800-220-8594 cos
iMF#OLESALE —
Account Number New Balance Payment Due Amount Past Due Due Date °
7003-7311-0007-2984 $920.23 $717.78 $245.40 09/20/2012
Billing Date Credit Line Available Credit —
08/26/2012 $5,000 $4,079.77 =—
TDD/Hearing Impaired: 1-800-365-0186
STATEMENT OF YOUR ACCOUNT
FINANCE CHARGE SUMMARY
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo =
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due —
Reg 00014 0.00000% 00.00% 5.00 00.00% S245.40 5245.40 07/26/2012
Reg 00014 56.29 0.00000% 00.00% S.00 00.00% S468.70 S468.70 08/26/2012
Reg 00014 S13.06 0.00000% 00.00% 5.00 00.00% S202.45 S.00 09/26/2012 =
Reg 0.00000% 00.00% 1 S.00 1 00.00% 1 53.68 I 53.68
ACCOUNT DETAIL
Transaction Transaction Invoice User P.O. Transaction
Date Description Number ID Number Amount
08/26/2012 LATE CHARGE ASSESSMENT 00000 53.68
08/13/2012 COSTCO WHOLESALE-347 001853 00005 S202.45
00005 SUBTOTAL: S202.45 0
07/26/2012 COSTCO WHOLESALE-346 026469 00013 S194.90 0
00013 SUBTOTAL: S194.90 a0
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Return the below portion with payment.For billing errors or questions please refer to the back of the statement. Page 1 of 2
STMT222C(10/07)
TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER-CASE LETTERS
AND NUMBERS ONLY!
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Email Address
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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
(Costco) Purchase Order No.
361108 HSBC Business Solutions Terms
P.O. Box 17698 Date Due
Baltimore, MD 21297-1698
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8126112 7003731100072984 Concessions $ 194.90
Total $ 194.90
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.
(Costco)
361108 HSBC Business Solutions Allowed 20
P.O. Box 17698
Baltimore, MD 21297-1698
In Sum of$
$ 194.90
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-1 7003731100072984 4239040 $ 194.90 i 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
6-Sep 2012
1,
Signature
$ 194.90 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund