215607 12/18/2012 f CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1
0 ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP CHECK AMOUNT: $165.00
CARMEL, INDIANA 46032 PO BOX 34783
SEATTLE WA 98124-1783 CHECK NUMBER: 215607
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 111774019754 165 . 00 ORGANIZATION & MEMBER
EXECUTIVE BUSINESS MEMBERSHIP
ANNUAL RENEWAL NOTICE
ness,PrimaryCardholder •., $55 RENEWAL MONTH:FEBRUARY 2013 MEMBER NUMBER: 000111774019754
CardholderFREE:. CARDHOLDER'S NAME AMOUNT HOUSEHOLD MEMBER AMOUNT
Add-on CardHolder each,
ROBERT HIGGINS $110.00 KEN MILLER $0.00
Add on HouseholdCardhulder, FREE PAM LISTER $55.00 MELISSA A MONTGOMERY $0.00
ExecuhveUpgrade, +$55, :-
TOTAL RENEWAL FEE $165.00
membership;;RENEW=ONLINE AT ,
COSTCO COAA $imply log on to costco com,
-type:RENEW ir%;tfie produot se arch'.boz;`and.
follow the simple mstruotioris to renew your
membershrp.today Please see Instructions on reverse to add,remove or replace a cardholder.
JOIN THE MORE THAN 2 MILLION `'
MEMBERS USING C00"'STC0 SERVICE
CONSUMER .SERVICES
Auto& Home Insurance Online Investing
Boat & RV Loans and Refinancing a Personal Checks .. ,r '
Costco Auto Program Personal Health Insurance
High=Yield Savings.Accounts & CDs
onlyin GA,i4 PA&1X °"' ~ ,•"
Group Qental Plan for Individuals
Identity Protection,= ontyin ca '
Visit Costco.com and search: Services Costcodoes not provide services;all services are provided by third parties.
urzo2ls_e 10/10
126
Renewal of your membership constitutes acceptance of Costco's Privileges and Conditions of Membership and its Privacy
Policy and Practices,which are available at our membership counter or online at Costco.com.Please provide all cardholders
with this information.
Renewal Policy—Memberships renewed within 2 months after expiration of the current membership year will be extended for
12 months from the expiration date.Memberships renewed more than 2 months after such expiration will be extended for 12
months from the renewal date.
All cardholder changes will be effective upon receipt of renewal payment.
New membership cards will not be sent unless new cardholders are added or changes are made to the account_
CHANGES TO YOUR ACCOUNT. Fill in the necessary information in the space provided below and adjust payment accordingly.
Changes to your membership cannot currently be made online at Costco.com.
If adding household member cardholder: Add household member's name in space below the primary cardholder.
*A household member card is available to primary cardholder's household member,domestic partner,or immediate family
member overthe age of 18 and living at the same address.Household member cardholders will be asked to present proof that
they live atthe same address as the primary or add-on cardholder.
NOTE: Limit one Executive Membership per household and/or business.
EdGSNR 1(12
VOUCHER NO. WARRANT NO.
ALLOWED 20
Costco Membership
IN SUM OF $
P.O. Box 34783
Seattle, WA 98124-1783
$165.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 1 0001117740197 I 43-553.00 I $165.00 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
Monday, December 17, 2012
Director, Broo hire 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))
12/17/12 1000111774019754 Dues I $165.00
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