HomeMy WebLinkAbout214095 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
` ONE CIVIC SQUARE SYSCO FOOD SERVICES CHECK AMOUNT: $523.97
CARMEL, INDIANA 46032 PO BOX 7137
INDIANAPOLIS IN 46206-7137 CHECK NUMBER: 214095
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 210120788 523 . 97 FOOD & BEVERAGES
Good things CUSTOMER'S ORIGINAL INVOICE CONFIDENTIAL PROPERTY OF SYSCO
come from D lv RATE cu$wMFR
Ain come
OOKSHIRE GOLF CLUB+++
120 BROOKSHIRE PKWY TRCKsQP 412940 210120788 0 1
RMEL IN 46033 40000 WND62NDPOTIS, LLC
ROUTE I I'll
INDIANAPOLIS, IN 46268
317-846-7431 DUE FRIDAY 4 WEEKS AFTER ORDER
CITY OF CARMEL
1 CIVIC SQUARE DRIVER: EDWARDS, DANNY
EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60-1.4 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE.
EXTENDED
QT.,Y '. PAC SIZE ITEM DESCRIPTION P n�E
ITEM
CODE RRICE
.MEATS::::: _.
F S. 11.0 LB . BRLCLS FRANK ALL MEAT 5X1 6 IN. 37736 070 1137736 25 32:: 50 64`
F $ 276 OZ DVANCE PORK FRITTER RAW 6606 2205383 39.98 . 39.98
.. .<_ .......:
** FROZEN ***
GROUP TOTAL**** 90.62
F �-
5 42.5LB ANTLZR ONION RING BEER BTR 5/8I' 30423 0855296 26 71 : 26 71
>:.
G ,:
F S 5.11B- YS IMP POTATO FRY 3 .8 5KON P M PLU SY003108 4356465 31.62 31 b2C�'; c`�
:
* CANNED::& ..DRY ***::. _ _.
C S NL 36 CT._ ARS ._ CANDY BAR MLLKY WAY 4367363 27.74 21.74.
4 D S 135 LB YS REL SHORTENING FRY LIpp CREAMY ZTF 99947 COM 4119509 29.98 59.96
GROUP.TD.`PAL** 87, 70
**
** PAPER & DISPOSABLE ***
.;:
.:
"'LLD 5 ,.. NL .5.000T YSCO FOIL SHEET 9X10.751N SILVER W69372. 6938500 12.98- 12.98
6 S NL 50OCT ERENE STRAW PLAS WRPD JMBO STRP 7 75YSTWJ77SSER24 0191516 1.99 11.97
** 'PRODUCE *** :.
GROUP TOTAL**.':* _ 24.95
C C 15X6 YS IMP TOMATO 1:1 YER FRESH 1008630 14.82 T4 82
** DISPENSER ***GRO U P TOTAL** >* 14.$2
F S 1.25LT OUWEGB COFFEE LIQ DECAF COL 1009
7220107477 3370566 125.89 125.89
5 1 25LT OUWEGB COFFEE LIqQ I00% COLOMBIAN 7220197465 9388117 116.66 46.66
GROUF TOTAL****
....
MIS:....H RG S HGS ..FOR FUEL SURCHARGE 5.
ORI) S X 24:02
.
_.
.
AEMIT To
P.O. BOX 7137
1 5 15 6.7 184 INDIANAPOLIS IN SUB
R IMPORTANT: PERISHABLE PRODUCTS ARE NOT ELIGIBLE FOR RETURN ggAFTE 4206-7137 TOTAL 523.97
E 1 5 15 6.7 184 FOR ANY SHORRTAGE AFTER YIO UI HAOVIE SIGNED(PIECES RECEIVED MUSTE
v TAX
NO. PCs CUST. I NO. PCs TOTAL
DRI VER'S DELVD.
I SIGN REC. INVOICE
I qS I7EG NSgEHp gg�yE ggEGC ry 5� )q FC 7MHME EI Egg LggL 7E gpGOR L L ryEMpRE qC Eg C37p g7 C' qg g E7 �1 H E g ESL p
THESECOMMODITIES�IR�ETAINCS A TORUSTO�CLAIMAOVER THESEOMMO�TIES,D IALSINVEM'ORIESI70� FoOD90R�CO7HER PROOUCTS PAYABLE ON OR BEFORE TOTAL 523.97
I DERIVED FROM THESE COMMODITIES, AND ANY RECEIVABLES OR PROCEEDS FROM THE $ALE OF THESE COMMODITIES UNTIL 11/09/12 LAST PAGE
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))
10/12/12 I 210120788 I Food $523.97
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
$523.97
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 210120788 I 42-390.40 I $523.97 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
Monday, October 22, 2012
Director, Brookshire olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund