212751 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 364942 Page 1 of 1
ONE CIVIC SQUARE REPUBLIC NATIONAL DIST COMPANY
CARMEL, INDIANA 46032 PO Box 1602 CHECK AMOUNT: $424.25
?� INDIANAPOLIS IN 46206 CHECK NUMBER: 212751
«OM�
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 1118684 424 . 25 FOOD & BEVERAGES
H HUM llM M Mfll � N ��.. . o U
COMPANY COPY
SOR&IK5HmE: GOLF CLUB. REPORT. Nfliffift
54 CUSTOMER NO. CUSTOMER P.O.NUMBER INVOICE NUMBER
+ CITY OF CARTEL �--� :•,�'_ � INVOICE 7916 1118684
12120 BROOKSHIRE PKWY HISTH���IING COMPH�� �� ORDER NO. PERMIT/LICENSE N0, TYPE INVOICE DATE
,A CARMEL, IN, 46032 INDIANAPOLIS, IN 46206 RUH 11011101PH I ROUTE STOP R29XP035oN DAT ALL 109/07/12�
_w - (317)-291--9042 (317)-636-4880 619 004 10/13/12 NET 15 DAYS
B SPECIAL INSTRUCTIONS: STATE PERMIT W49-09133 SHIPMENT NO. DIV.NO.SALES NO.DIV.NO.SALES NO.DIV.NO.SALES N0, DIV.NO.SALES NO.
13219 12219 13219 12219
DELIVERY NOTES: VENDOR ID NUMBER INVOICE TYPE DUE DATE
,c REF # invoice 09/22/12
# PRINTED 2012 09 06 20:20:00
ITEM NUMBER LINE LOC. DESCRIPTION SIZE CK CASES BOTTLES LIST DISCOUNT UNIT COST NET BOTTLE
PA NET PRICE
BULKLOC::'`. i:'i'"" .?'g;': g:; zr;'. -UPG,^k''ts'i rt":" :VINTAGE f ',: PRICE DEAL# COST
340043, 0033 GREY GOOSE VODKA 6PK 1. OL 6 1 212. 00 7. 80 204. 20 34. 03 404. 2V
- _
°:�-°_ ,-080481i2840_f7,,. ;.• 1685
34,1,E 001C.:; BACARDI SUPERIOR
°'- . ,,r : 1. 0L 12 2 18. 38 18. 38 18. 38 36. 76
:.-2.. . _,,.. _._ .,...-..., ,,b,., ;.:_am.;_�;,.`:,.,,�-'.;`�.;._ �'.."-`Q�048QQ15�€)5_ .. :"- ,'.. , :" .. ,'.. ;.,"`',-. '•- ::".`-: - r�-
4058 2188 BELLOWS BBN 1. 0L 1? i 10. 66 i0. 66 10. 6r5 0. 66
4059 041B BELLOWS GIN t 1. 0L 12 1 ' 9. 24 9. 24 9. 24 9. 24
-.08t3B8fi:4852tk9'; :° - y- B iLANCE OF PREVIOUS..-.)NVOICE: 0[.042896/0 02
270063 135B .. BOMBAY SAPPHIRE 94 1. OL 12 1 26. 25 26. 25 2b. 25 2b. 25
J
.r
73283 147A' CASTILLO SPICED RUM 70 1. 01L 12 2 8. 05 1. 30 6. 7S 6. 75 13. 50
0 8 0 7 1"M7:75-
y.
340953 205C DEWARS WHT LBL 1. 0L 12 2 32. 00 32. 00 32. 00 64. 00
h
4020 029C JIM BEAM. 80 BAR 1. 0L 12 3 19. 813 19. 88 19. 88 59. 64
!�` ,; ...:, .:":':. �.:,:.',w„',i„E:,.,.":x,;:,:�,r'r,,..:.3�,:�,4.,�� `t,•��:.�,p,'.`OV..�BLi,V�S,G;..�.'•,,.._-..,. ..",..,.._.e.�,...r-x,; - "`°".:.',..- :.";,,,'a'` .; .
°7084 211C MAKERS MARK 90 750Mi .121 2 BTTL S BACKORDE RED PLEASE DO NO ' REORDER
.' , 8 2461'39.43.] 0
To ah; l_p' R�1EiC;;;b.e.:"�:Or `=e vir,vn,r ei - all"y :#?ri"E.rtidl;y:�„'pl-ea"'e""Y elp by c nsol-idatir g your de Liveries.
r
RETURN CODES:
LIQUOR LITERS/GALS. WINE LITERS/GALS. 'BEER LITERS/GALS. 0-Did not order D-Damaged on Truck
'-Billed Wrong E-No Money 1 12 CASH AMOUNT
2-Pricing Error .F-Office Cancel
_ 4, 7m 3-Out of Business H-Defective ® 424. 255
4-Duplicate J-Shod on Truck
HIGH WINE LITERS GALS. LOW WINE LITER AL.' P LIN TER AL, 6-Won't scan or not authorized CHECK#
A-Out of Stock
B-Picking Error
C-Too EadyRoo Late r
ACCEPTED ,;�; CHECK AMOUNT .
RECEIVED BY PAGE 1
I,as the licensee,agent of this licensee,or loyee thereof of the business accept the merchandise
shown on the invoice and certify that to th est of my knowledge there has been no change in DATE: TIME:
' n ownership of this business without notificati to the State Alcohol Board and is the holder of an
''•d U!lJ.1PA� UV effective penniUlicense.There will be a$60 service charge tar any dishonored check.RNDC is not
responsible for breakage, loss, or damage to merchandise after delivery or acceptance by
®' 0 0 0 0 D "Common Carder. DRIVER SIGNATURE
. t
VOUCHER NO. WARRANT NO.
ALLOWED 20
Republic National Distributing Company
IN SUM OF $
P.O. Box 1602
Indianapolis, IN 46206
$424.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 1118684 I 42-390.40 I $424.25 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, September 07, 2012
/44� A d./'
Director, Brookshir olf 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))
09/07/12 1118684 Wine and Spirits $424.25
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