216005 01/09/2013 a CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1
` ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP CHECK AMOUNT: $200.00
CARMEL, INDIANA 46032 PO BOX 34783
a SEATTLE WA 98124-1783 CHECK NUMBER: 216005
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4355300 PARLS 200 . 00 ORGANIZATION & MEMBER
BUSINESS MEMBERSHIP
ANNUAL RENEWAL NOTICE
0,000 598M
Elam
Business Primary Cardholder` $55 RENEWAL MONTH:FEBRUARY 2013 MEMBER NUMBER: 000111782210072
HousehoidGardholder FREE ' CARDHOLDER'S NAME AMOUNT HOUSEHOLD MEMBER AMOUNT
Add on Cardholder +$55each AUDREY KOSTRZEWA $55.00 JENNIFER SEWELL $0.00
Add on HcuseholdCa�dholder. FREE BEN JOHNSON $55.00 MATT LEBER $0.00
MICHELLE COMPTON $55.00 LINDSAY ATKINSON $0.00
TRACI PETTIGREW $55.00 BROOKE TAFLINGER $0.00
TOTAL RENEWAL FEE $220.00
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If-you don t have any_°changes to your � ;,., . • ,
membership,;YRENEW:ONLINE AT Descr
COSTCO CO,M Simply log-oR to costco com,
type RENEW"in the product search boz;and r'urcha;er, o _Date
follow the simple instructions to,renew your `.
membership today �0I4W"ee,4nstructi on rove 'o add,remove or replace a cardholder.
JOIN THE MORE THAN 2 MILLION ^ '• Fp
MEMBERS USING C 0 TCu" S 1 C E� 1
t
a
CONSUMER SERVICES
o Auto&Home Insurance o Online Investing ; .
o Boat&RV Loans and Refinancing o Personal Checks
Costco Auto Program o Personal Health Insurance s ,,
High-Yield Savings Accounts&CDs
on yin GA,/4 PA&TX
Idelath Prottion o Group Dental Plan for Individuals
oniyin CA
Visit Costcoxom and search; Setivices Costco does not provide services;all services are provided by third parties.
11EX0213_B 10/10
126
i
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 eff ective 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 over the 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.
EnEGSNR 1112
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.
354720 Costco Membership -- NOT HSBC Terms
P.O. Box 34783
Seattle, WA 98124-1783
Invoice invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
12/17/12 111782210072 Annual Membership renewal $ 220.00
r
Total $ 220.00
1 hereby certify that the attached invoice(s),or biil(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.
354720 Costco Membership -- NOT HSBC Allowed 20
P.O. Box 34783
Seattle, WA 98124-1783
In Sum of$
$ 220.00
ON ACCOUNT OF APPROPRIATION FOR
101 - General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 111782210072 4355300 $ 220.00 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
3-Jan 2013
Signature
$ 220.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund