216279 01/14/2013 CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1
0 ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP
CARMEL,INDIANA 46032 PO BOX 34783 CHECK AMOUNT: $20.00
' 1? SEATTLE WA 98124-1783
CHECK NUMBER: 216279
CHECK DATE: 1/1412013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4355300 PARKS 20 . 00 ORGANIZATION & MEMBER
CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1
` ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP
CARMEL, INDIANA 46032 PO BOX 34783 CHECK AMOUNT: $200.00
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
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BUSINESS MEMBERSHIP
ANNUAL RENEWAL NOTICE
RENEWAL MONTH:FEBRUARY 2013 MEMBER NUMBER: 000111782210072
: HouseholdCardkiolder,; ,: :FREE. CARDHOLDER'S NAME AMOUNT HOUSEHOLD MEMBER AMOUNT
Addn'Cardholder' +;$55each'; $AUDR Y KOSTRZEWA 55-00 JENNIFER SEWELL $0.00
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dd=on'HouseholdCardholder..,:_:, ;..FREE.: BEN JOHNSON $55.00 MATT LEBER $OAO
MICHELLE COMPTON $55.00 LINDSAY ATKINSON $0.00
TRACI PETTIGREW $55.00 BROOKE TAFLINGER $0.00
TOTAL RENEWAL FEE 220A0
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'follovv; e'simple:instructions.fo;reneWyour.
membership today` ry "`.':' 'PiBW4jsee-lnstructf _on reYeFs6;to a_dd,remove or replace a cardholder.
JOIN THE MORE THAN 2 MILLION k
MEMBERS USING COSTC® SE YICES
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CONSUMER SERVICES
• Auto & Home Insurance o Online Investing
o Boat& RV loans and Refinancing a Personal Checks � �y
• Costco Auto Program o Personal Health Insurance u.� .
onl in%IL,PA&TX.
High-Yield Savings Accounts & CDs
Group Dental Plan for Individuals
o ident Protection oni in CA '
Visit Costco.eom and search: Services Costcodoes not provide services;all services are pro%ded by.third parties.
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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 fromthe 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 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-
EnEGSNA 1/72
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
Total $ 220.00
1 hereby certify that the attached invoice(s), or biN(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