215208 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
0 ONE CIVIC SQUARE USFOODSERVICE, INC CHECK AMOUNT: $751.61
CARMEL, INDIANA 46032 o BO e
INDIANAPOLIS IN 46266-0088 CHECK NUMBER: 215208
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 246214 160 . 64 FOOD & BEVERAGES
1095 4239040 246215 590 . 97 FOOD & BEVERAGES
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO, DATE NO. NUMBER LOC . EP ORDERED
90569922 0246215 11/09/12 90569575 1D5� 0062� 11/08/12
Route: 5291 / 10 ORDER NUMBER� 692762
8ill Ship Reooit
UMBER: 692762 3J -
To: To� �5ncE ��� . L� ''--'--'�� � � ~S ' ~~~ ~' I n c
� � E / o: I BOX 660088
CARMEL IN
46032 460!2 INDIANAPKIS
317 843 Att: i � DEPT # ~ - - }
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��ipFrm: 12301 CUMBERLAND RD FISHERS IN ShjpD� i 1/O9/12 ------- ---
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Qty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
rdered Shipped Unit Number D Unit Price Price
*** INVOICE SUMMARY ***
TOTAL WGT SHIPPED: 240. 81 PIECES ORDERED: 21 PIECES SHIPPED: 21 ITEMS SHIPPED: 21
PRODUCT TOTAL $ 590. 97
TAXABLE AMOUNT $ . 00
GEN SALES TAX % . 00
This amount is an estimate at time of shipping prior to any adjustments made at deIive y $ 590 97 >
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Purchase -
Gescrotlon NOV 16 2012
G 1.# At?I e =IBAY:
Budget
Line Descr
Purchaser Dato______
Approval Dmo______
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ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO Ng. DATE NQ. NUM8ER LOC . EP ORDERED
90569922 0246215 11 /09/12 90569575 /n � {_ /} 1O5�. OU� �-_ 11/D8/12
'
Route: 5291 / 10 /V\ �~ ~- / �' ORDER NUMBER 692762
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ARME �LAY PARKS&RECREAT -
Tm — ' -- --� -' '116TH ST To: US Foods, Inc .
Tod
46022 146032 INDIANAPOLIS IN
0.1-1 80430 3877, 46266-008e
A t t DEP T # 00 J| 2 1 10
PhipFrm: 12301 CUMBERLAND RD FISHERS IN Ship& 11/09/ 12 Page 01 of O2
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qty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
rdered Shipped Unit Number D Unit Price Price
_ __...... ...... ____ ..... ......... ......._______________________________________________________
DRY
1 1"' CS 12O6424 PASTRY, POP TART STWBY FRTD 2 72/2 EA KELLOGG'S CS 43. 4000 $ 43 40
1 1 CS 2404325 GLOVE, POLY LO TXTD AMBDX 10/100 EA MON-GRAM B CS 42� 10OO 42� 10
1 1v EA 4004289 CANDY, BAR SNCKR 2�07 OZ 48 EA SNICKERS EA 34� 2700 34� 27
1 1v~ CS 5597604 CHIP, CHS CNCHY PLN SS BAG 64/2 OZ CHEr-703 CS 30. 0900 30 89
1 1v> CS 5601943 CHIP, PTATO KTL BBQ SS BAG 64/1 . 375 OZ MIS� VICKI CS 31� 2000 31� 2O
1 1v' EA 6210777 CANDY, KIT KAT VNDG STD 1 . 5 Z 36 EA� KIT 01 EA 25�94O0 25� 94
1 CS 8429292 JUICE, APPL 100% VITMN C ADDED24/10 OZ THIRST/MOM � �
*SUB** IV CS 9029067 JUICE, APPL i00% PLST BTL SHLF24/10 OZ TROPICANA CS 21. 0600 21, 06
1 1v\ CS 9089079 POPCORN, RAW KIT W/ OIL 1 SALT3618 OZ FANCY FARM CS 24� 720O 1-4 72
1 1v/ CS 9463688 CHIP, TORTLA CORN YLW RND 612 LB EL PA3ADO CS 24� 36O0 24� 36
/
REFRIGERATED
1 1/ CS 0654301 HUMMUS, GRLC RSTO NOHDARY REF 12/4.56 OZ SABRA CS 23, 7300 23. 75
°/' READY TO EAT - Please Refer to Return Policv �
1 r' EA 2000453 SALAD, CHIX CRMY REF 5 LB PIERCE B EA 26.9900 26 99
- o c
READY T0 EAT Please Refer to Return P li � �
1 1,/ EA 3000452 SALAD, TUNA ABCR TFF REF 5 LB ' SIERCE B EA 26, 9600 26. 96
READY TO EAT - Please Refer to Return Policy �
1 S 4800843 MILK, 2% REDUC FAT PLST REF 12/1 PT PRAIRIE FM CS 11. 3000 11. 30
1 S 4800884 MILK, CHOC 1% LOW FAT PLST REF12/1 PT PRAIRIE FM CS 11.2100 17�11 21
1 � 1"' CS 5332242 LETTUCE. lC100 SHRD 1/4" CLND 4/5 LB CROSS VALY B CS 17 9900 99
READY TO EAT - Please Refer to Return Policy
� �
1 1/ CS 7197775 YOGURT, ASST STRWBNA & RSP8RY 12/6 OZ - TOPLAIT CS 0. 3400 1O34
FROZEN
1 1 V, CS 2011278 PRETZEL, KING SOFT BKD FZN 50/5 OZ SUPR PRTZL CS 32.5500 32 55
� 1 CS 2014652 MUFFIN, BLBRY 11,1 24/4 OZ SARA LEE CS 21'78O0 21�7Q
1 1»' CS 2372928 CHILI, W/ BEAN HEAT & SRV FZN 4/5 LB WHITYWNDSR CS 55� 97O0 55� 97
1 i*� CS 4636718 SOUP, CHIX #DL TFF RTU POUCH 4/0 LB CL8C TUREE CS 48. 6400 48� 64
1 1v CS 8187999 ICE CREAM BAR, CHOC TACO & VNL24/4 OZ KLONDIKE CS 25. 5500 25. 55
** PRODUCT CLASS RECAP **
TOTAL DRY PIECES ORDERED: 9 PIECES SHIPPED 9 ITEMS SHIPPED: 9 277. 94'.
TOTAL REFRIGERATED PIECES ORDERED: 7 PIECES SHIPPED: ITEMS SHIPPED� 7 228� 54
TOTAL FROZEN PIECES ORDERED: 5 PIECES SHIPPED: ITEMS SHIPPED� 5 184. 49 }
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER , ' SALES SALES DATE
NO NO, DATE NO. NUMB ER LOC . REP ORDERED
90569922 0246214 11 /09/12 90569575 —7 1054 OO6�'- 11/08/12
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. Route: 5291 / 1D /«\( ' �� ~� �� / ORDER NUMBER: 692163
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To 411 E ' ' — —'� — � ' US Foods, Inc .
� � �� / n / / o� �� pAxn DRIVE E To: BOX 6600SE3
CARMEL ^.` I`: .'
317 843 3873 46266-0008
Attl DEPT # 00 SOO 42e 2118
?hip Frw ShQD: 1 1/O9/ 12 — age 01 of 01
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Qty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
rdered Shipped Unit Number D Unit Price Price
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PRODUCT CLASS RECAP
TOTAL DRY PIECES ORDERED: I PIECES SHIPPED: 1 WENS SHIPPED: 154.3?
INVOICE SUMMARY
FUEL SURCHARGE 6. 25
TOTAL WOT SHIPPED: 25. 00 PIECES ORDERED: I PIECES SHIPPED: I IVEMS SHIPPED:
Purchase PRODUCT TOTAL $ 154.39
CHARGES 6. 25
Budget
We Descr TAXABLE AMOUNT
GEN SALES TAX % . 00
Purchaser Date_
This amount is in estimate at time Q shipping prior to any adjultments made at delivery:
__-- ______--______
E ECE
OV 16 01
NOV 16 2012
/
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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
Purchase Order No.
353824 U S FoodService, Inc. Terms
Box 660088
Indianapolis, IN 46266-0088
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
11/9/12 246215 Concessions 29161 $ 590.97
11/9/12 246214 Concessions 29161 $ 160.64
: t
Total $ 751.61
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
Voucher No. Warrant No.
353824 U S FoodService, Inc. Allowed 20
Box 660088
Indianapolis, IN 46266-0088
In Sum of$
$ 751.61
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-1 246215 4239040 $ 590.97 1 hereby certify that the attached invoice(s), or
1095-1 246214 4239040 $ 160.64 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
29-Nov 2012
Signature
$ 751.61 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund