217376 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
` ONE CIVIC SQUARE U S FOODSERVICE, INC CHECK AMOUNT: $1,941.97
CARMEL, INDIANA 46032 PO BOX 660086
INDIANAPOLIS IN 46266-0088 CHECK NUMBER: 217376
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 2049302 495 . 46 FOOD & BEVERAGES
1095 4239040 2366523 901 . 54 FOOD & BEVERAGES
1095 4239040 2696619 544 . 97 FOOD & BEVERAGES
`
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES - ES DATE
NO. W DATE NO. NUMBER LOC . REP . ORDERED
90569922 2049302 01/ 11/ 11 90569575 1054 0062 01/10/ 13
Route: 5291 / 9 ORDER NUMBER 747619
8ill Ship Remit
CARMEL CLAY PARKS&RECREA11'' CARMEL CLAY PARKS&RECREW US Foods, Inc .
/ o: 1411 E. 116TH ST To: 1235 CENTRAL PARK DRIVE E To: BOX 660088 -
46032 46032 INDIANAPOLIS IN
Att: MICHELLE COMPTON 317 S43 3S73 46266-0080
DEPT # 0 0 000 428 2118
--
�� �pFrm� 12301 CUMBERLAND RD FISHERS IN ShipD�� 01/11/13 ---- Page 02 of 02
WtTrms �
� Spcial ENTER OFF OF 111TH STREET ! ! !
ytTrms: NET 30 DAYS Instr:
Aty Qty Sales Product Descripton Pack Sire Label C Wight Pricing Unit Extended
rdered Shipped Unit Number D Unit Price Price
INVOICE SUMMARY
FUEL SURCHARGE 6. 25
TOTAL WST SHIPPED: 158. 58 PIECES ORDERED: 15 PIECES SHIPPED: Is ITEMS SHIPPED: 11-3
PRODUCT TOTAL 4S9, 21
a Federal Occupation ,Safety and Health Standards. Section 1910. 1200 on Hazard
x Communication requires manufacturers and distributors to provide Material
* Safety Data Sheets on non400d products defined to be hazardous. Products CHARGES 6. 25
* such as cleaning products and pesticides are included in the scope of the
* Standard. In Umpliance with the law. MGDS are available to US Foods, Inc.
* customers and can be obtainyd bV contacting the Procurement Manager in our TAXABLE AMOUNT .00
* district office or bt ad '
Ja ,vising your sales representative. W GEN SALES TAX . 00
You maV contact KEV RTON at phone N (371) 585 - 6822.
ThAamount is an estimate at time of shipping pribr to anv adjustments made at delivery: 49S. 46
'
ACCOUNT INYQICF INVOICE CUSTOMER PURCHASE ORDER SALES SALES D/\TE
NO NO . DATE NO. NUMBER LOC . REP , ORDERED
90569922 2049302 O1l11/13 90569575 v _/.� -7 -� —7 1O54 0062 01/10113
~ ^ -/ �
Route: 5291 / 9y ORDER NUM8ER� 747619
8ilI ShiP Remit �
To: To: ARK DRIVE E To: -- � - - --� Inc .BOX O
1 46032 46032 !NDIANAPOLIS IN
317 843 1873 46261-0088
Atti I MICHELLE COMPTON DEPT # 00 800 428 2118
hipFrm: 12301 CUMBERLAND RD FISHERS IN Shlp& 01/ 11/13 Page 01 of 02
WtTrms � '
� Spcia2 ENTER OFF OF 111TH STREET ! } }
ytTrms: NET 30 DAYS Instr:
�ty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
rdered Shipped Unit Number D ' Unit Price Pcice
DRY
1 1 CS 0791590 CONTAINER, FM 12 Z SQT WHT 20/25 EA NOMOGRAM CS 19. 9200 19. 92
1 1 CS 1206424 PASTRY, POP TART STUBY FRTD 2 72/2 EA KELLOGG'S CS 43. 4000 Q. &D
1 1 CS 5597968 CHIP, CORN ORIG TFF SS BAG 64/2 OZ FRITOS, CS 30. 8900 30. 89
1 1 CS 5605431 CHIP, MULTGRN GRDN SALSA SS 64/1. 5 OZ SUN CHIPS 17-1 C')0 0. 89
11 CS 5605472 CHIP, NULTGRN CHEDR SS BAG 64/1. 5 OZ SUN CHIPS 02 30. 8900 30. 89
I CS 5605322 CHIP, MULTGRN ORIG SS BAG 64/1 . 5 OZ SUN CHIP14'� CS 30. 89100 30.811,
1. CS 6260665 COOKIE, FUDGE STRPE MIN! SS 60/2 OZ KEEDLER CS 26. 1600 26. 16
READY TO EAT - Please Refer to Return Polivy-
2 2 CS 3041423 EORN DOG, AM CN FZN 46/4 GZ STATE FAIR CS 33. 9300 67- 86
2 2 CS 3330099 NOT DOG, AB 6: 1 6" RLR GRIL 10 LB PATUXENT CS 2T. 1200
52 90
1 1. CS 5S09708 PIZZA, CHS 7" DEEP DISH FZN U/36/10, 22 OZ BOSCO'S CS 61 . 7800 003
I I CS 5741228 BUM, HOT DOG 6n HINGE SLCD TFF12/12 EA HILLTOP CS 31. 3300 31. 33
PRODUCT CLASS RECAP *-q
TOTAL DRY PIECES ORDERED: 7 PIECES SHIPPED: 7 ITEMS SHIPPED: 7 213. 04
TOTAL REFRIGERATED PIECES ORDERED: i PIECES SHIPPED: I ITEMS SHIPPED: 1 23. 75
TOTAL FROZEN PIECES ORDERED: 7 PIECES SHIPPED: 7 ITEMS SHIPPED: �3
use INVOICE
Page 3 of 4
ACCOUNT NUMBER INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER PURCHASE ORDER# SALES LOCATION SALES REP DATE ORDERED
90569922 2366523 01/22/2013 90569575 1054 62 01/21/2013
FREIGHT TERMS ORDER NUMBER PAYMENT TERMS ROUTE NUMBER SPECIAL INSTRUCTIONS
756875 NET 30 DAYS 2251 ENTER OFF OF 111TH STREET!!!
PRODUCT CLASS RECAP
PRODUCT CLASS TOTAL PIECES TOTAL PIECES TOTAL PIECES TOTAL PIECES TOTAL ITEMS TOTAL WEIGHT TOTAL EXTENDED
ORDERED SHIPPED ADJUSTED DELIVERED SHIPPED SHIPPED PRICE
FROZEN 11 11 1 10 8 129.11 $335.78
DELIVERY SUMMARY TOTALS 31 31 1 30 27 349.90 $895.29
DELIVERY SUMMARY
AS SHIPPED DELIVERY AMOUNT $950.18
Product Total Adjustments $48.64 CR
Total Charges Adjustment $0.00
Total Allowance Adjustment $0.00
Sales Tax Adj: Rate:VAR $0.00
TOTAL ADJUSTMENT 48.64
DELIVERED AMOUNT $901.54
INVOICE SUMMARY
Product Total $895.29
FUEL SURCHARGE $6.25
Sales Tax Rate: 0.00 $0.00
PLEASE REMIT THIS AMOUNT BY 02/21/2013 $901.54
Page 3 of 4
1
INVOICE Page 4 of 4
ACCOUNT NUMBER INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER PURCHASE ORDER# SALES LOCATION SALES REP DATE ORDERED
90569922 2366523 01/22/2013 90569575 1054 62 01/21/2013
FREIGHT TERMS ORDER NUMBER PAYMENT TERMS ROUTE NUMBER SPECIAL INSTRUCTIONS
756875 NET 30 DAYS 2251 ENTER OFF OF 111TH STREETM
CUSTOMER ACCEPTANCE
Interest shall accrue on all unpaid balances exceeding established credit terms at a rate equal to the lesser of(a) 1-1/2%per month or(b)the maximum rate that the customer may lawfully contract to pay,and in
all events calculated in accordance with applicable law.
CUSTOMER SIGNATURE: patrick m
SIGNED AT: 01/22/2013 01:22 PM(UTC)
We appreciate your business.Please visit our website www.usfood.com for a fast and easy way to order. Or contact customer service at: (877)583-9659
Page 4 of 4
ISO INVOICE
m._ Page 1 of 4
ACCOUNT NUMBER INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER PURCHASE ORDER# SALES LOCATION SALES REP DATE ORDERED
90569922 2366523 01/22/2013 90569575 1054 62 01/21/2013
FREIGHT TERMS ORDER NUMBER PAYMENT TERMS ROUTE NUMBER SPECIAL INSTRUCTIONS
756875 NET 30 DAYS 2251 ENTER OFF OF 111TH STREET!!!
BILL TO SHIP TO REMIT TO
CARMEL CLAY PARKS&RECREAT CARMEL CLAY PARKS&RECREAT US Foods,Inc.
1411 E. 116TH ST 1235 CENTRAL PARK DRIVE E BOX 660088
CARMEL, IN 46032 CARMEL,IN 46032 INDIANAPOLIS,IN 46266-0088
ATTN:MICHELLE COMPTON Dept.:0 (800)428-2118
(000)000-0000 (317)843-3873
SHIPPED FROM: 12301 CUMBERLAND RD,FISHERS,IN DRIVER NAME: Ryan Kingseed ROUTE NUMBER: 2251
SHIPPED DATE: 01/22/2013 DRIVER ID: 3220226 STOP NUMBER: 4
INVOICE LINE DETAILS
QUANTITY I SALES PRODUCT DESCRIPTION LABEL PACK SIZE I CODE I WEIGHT PRICING UNIT EXTENDED
ORD SHP ADJ UNIT NUMBER UNIT PRICE PRICE
DRY
1 1 0 CS 791616 CUP,FM 32 Z WHT MONOGRAM 25/20 EA CS $35.4300 $35.43
1 1 0 CS 1287747 SNACK BAR,CRL ASST IW SS KELLOGG'S 3116/1.3 OZ CS $28.5100 $28.51
1 1 0 CS 1695212 TRAY,PAPR BORD FOOD 5 LB POLY MONOGRAM 2/250 EA CS $44.1200 $44.12
1 1 0 CS 2404325 GLOVE,POLY LG TXTD AMBDX MONOGRAM 10/100 EA B CS $38.8000 $38.80
1 1 0 CS 4180923 COOKIE,VNL CREME SNDWH SNCWL SNACKWELLS 48/1.7 OZ CS $26.2300 $26.23
1 1 0 CS 4508560 SNACK BAR,CRL TRIX IW SS GENL MILLS 96/1.4 OZ CS $34.4300 $34.43
1 1 0 CS 5597604 CHIP,CHS CNCHY PLN SS BAG CHEE-TOS 64/2 OZ CS $30.8900 $30.89
1 1 0 CS 5601943 CHIP,PTATO KTL BBQ SS BAG MISS VICKI 64/1.375 OZ CS $31.2000 $31.20
1 1 0 CS 5704077 COOKIE,NUTTR BUTR 1 Z SS NUTTR BUTR 48/1 OZ CS $28.8200 $28.82
1 1 0 CS 9089079 POPCORN,RAW KIT W/OIL&SALT FANCY FARM 36/8 OZ CS $26.0700 $26.07
2 2 0 CS 9463688 CHIP,TORTLA CORN YLW RND EL PASADO 6/2 LB CS $24.3600 $48.72
JAN 2'8 2013
BY:-
Page 1 of 4
ur. 56: INVOICE
FOOM Page 2 of 4
ACCOUNT NUMBER INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER PURCHASE ORDER# SALES LOCATION SALES REP DATE ORDERED
90569922 2366523 01122/2013 90569575 1054 62 01/21/2013
FREIGHT TERMS ORDER NUMBER PAYMENT TERMS ROUTE NUMBER SPECIAL INSTRUCTIONS
756875 NET 30 DAYS 2251 ENTER OFF OF 111TH STREET!!!
INVOICE LINE DETAILS
QUANTITY SALES I PRODUCT DESCRIPTION LABEL PACK SIZE CODE WEIGHT PRICING UNIT EXTENDED
ORD SHP ADJ UNIT NUMBER UNIT PRICE PRICE
REFRIGERATED
1 1 0 CS 654269 HUMMUS,RSTD RED PPR NONDARY SABRA 12/4.56 OZ CS $23.7500 $23.75
READY TO EAT-Please refer to return policy
1 1 0 CS 654301 HUMMUS,GRLC RSTD NONDARY REF SABRA 12/4.56 OZ CS $23.7500 $23.75
READY TO EAT-Please refer to retum policy
1 1 0 CS 2000453 SALAD,CHIX CRMY REF PIERCE 2/5 LB B CS $39.9800 $39.98
READY TO EAT-Please refer to return policy
1 1 0 CS 4800843 MILK,2%REDUC FAT PLST REF PRAIRIE FM 12/1 PT CS $11.4500 $11.45
1 1 0 CS 4800884 MILK,CHOC 1%LOW FAT PLST REF PRAIRIE FM 12/1 PT CS $11.3600 $11.36
1 1 0 CS 5332242 LETTUCE,ICBRG SHRD 1/4"CLND CROSS VALY 4/5 LB B CS $20.5300 $20.53
READY TO EAT-Please refer to retum policy
1 1 0 CS 7197775 YOGURT,ASST BLNDED LOW FAT YOPLAIT 12/6 OZ CS $10.3400 $10.34
1 1 0 CS 9331380 APPLE,RED DLC 138 CT XFCY CROSS VALY 138 EA CS $45.1300 $45.13
FROZEN
4 4 0 CS 2011278 PRETZEL,KING SOFT BKD FZN SUPR PRTZL 50/5 OZ CS $32.5500 $130.20
1 1 0 CS 2372928 CHILI,W/BEAN HEAT&SRV FZN WHITYWNDSR 4/5 LB CS $55.9700 $55.97
1 1 -1 CS 4636718 SOUP,CHIX NDL TFF RTU POUCH CLSC TUREE 4/8 LB CS $48.6400 $0.00
1 1 0 CS 5741228 BUN,HOT DOG 6"HINGE SLCD TFF HILLTOP HR 12112 EA CS $32.0100 $32.01
1 1 0 CS 6005003 BAGEL,PLN 2 Z SLCD TFF HEAT& LENDERS 72 EA CS $24.4800 $24.48
1 1 0 CS 6153027 BROWNIE,CHOC 2.5 Z UNSL BKD OREO 48/2.5 OZ CS $41.5500 $41.55
1 1 0 CS 8187999 ICE CREAM BAR,CHOC TACO&VNL KLONDIKE 2414 OZ CS $25.5500 $25.55
1 1 0 CS 8552317 MUFFIN,COF CAKE PECN CIN IW SARA LEE 24/4 OZ CS $26.0200 $26.02
PRODUCT CLASS RECAP
PRODUCT CLASS TOTAL PIECES TOTAL PIECES TOTAL PIECES TOTAL PIECES TOTAL ITEMS TOTAL WEIGHT TOTAL EXTENDED
ORDERED SHIPPED ADJUSTED DELIVERED SHIPPED SHIPPED PRICE
DRY 12 12 0 12 11 104.32 $373.22
REFRIGERATED 8 8 0 8 8 116.47 $186.29
Page 2 of 4
ACCOUNT INVOICE INVOICE CUSTOMER PURC ORDER SALES SALES DATE
Nu. NO DATE NO� NVpi�ER LOC RI�P ORDERED
90569922 269661� O2/01/13 90569575 1054� 0062� 01/31/13
Bill Ship Route: 5282 / 9 Remit ORDER NUMBER: 766339
To'
� 1411 E, 116TH ST / o: IE35 CENTRAL PARK DRIVE E To:
BOX 660088
46032 46032 INDIANAPOLIS
Att: | eOO 420 2118
!
� � ....... �'.....��������. ���������������
7hipFrm: 12301 CUMBERLAND RD FISHERS IN Shjp& 02/01/13 Page 02 of 02
7rtTrms -
spcia2 ENTER OFF OF 111TH STREET } } }
`ytTrms: NET 30 DAYS Instr.
Qty Qty Sales Product Descriptun Pack Size Label C Weight Pricing Unit Extended
hdered Shipped Unit Number D Unit Price Price
INVOICE SUMMARY
FUEL SURCHARGE 6. 25
TOTAL
PRODUCT TOTAL S 538. 72
CHAR6ES 6. 25
TAXABLE AMOUNT $
OEM SALES TAX .00
This amount is an estimate at time of shipping prior to any adjustments made at delivery: 544, 97
/
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
N8 NQ DATE UMBER LOC . REP- ORDERED
90569922 2696619 02/01/13 90569575 d- 1054 0062 01/31/13
~� / i / ORDER NUMBER: 766339
Gill Ship
Route: 5262 Remit
To: To� - -- - Tj US Fuods, Inc ,
IN
46032 1 .46032 INDIANAPOLIS, IN
Att: |
__
ThipFrm: 12301 CUMBERLAND RD FISHERS IN Shjp& 02/01/13 Page {}1 of 02
-rtTrms.- spcial ENTER OFF OF 111TH STREET ! ! }
'ytTrms: NET 38 DAYS Instr:
�ty Qty Sales Ppoduct Descripton Pack Size Label C Weight Pricing Unit Extended
rdered Shipped Unit Number D Unit Price Price
DRY
1 3429305 JUICE, GRAPE 100Z PET PLST OTL24/10 OZ THIRSTER CS 22. 6700 22. 67
2 4260238 SAUCE, CHS MACHO SHLF STABL 44107 OZ ORTEG-A CS 54.6200 109.24
1 C-1 5601679 CHIP, PTATO-REG PLN SS BAB 64/1. 5 OZ LAY 'S CS 30. 8900 30051
1 E6 626066S COOKIE, FU06E STRPE MIN! SS 6012 OZ KEEBLER CS 26. 1600 26. 16
1 EA 6717219 CANDY, BAR SNCRR SS DMSTC 1. 868/48/1. B6 OZ SNICKERS EA 34. 2?00 34. 27
10 CS 9089079 POPCORN, RAW KIT W/ OIL 8 SALT36/8 OZ FANCY FARM CS 26, 0700 26. 07
2V C'S 9463688 CHIP, TORTLA CORN YLW RND 6/2 LB EL PASADO CS 24. 3600 48. 72
FROZEN
2 pv- CS 2011278 PRETZEL, KING SOFT BKD FZN 50/5 0Z SUPR PRTZL CS 32.5500 65- 10
I CS 2014652 MUFFIN, BLBRY 1W 24/4 OZ SARA LEE CS 22. 0000 22. 00
1 V CS 3041423 CORN DOS, AM CM FZN
y 48/4 OZ STATE FAIR CS 34. 6300 34. 63
v* PRODUCT CLASS RECAP
TOTAL DRY PIECES ORDERED: 12 PIECES SHIPPED: 12 ITEMS SHIPPED: 10 360, 35
TOTAL FROZE14 PIECES ORDERED: 5 PIECES SHIPPED: 5 ITEMS SHIPPED: 4 170. 37
............._-_____-__ _--______-__'____'___-________-
�
i
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
29358 $ 495.46
1/11/13 2049302 Concessions 29382 $ 901.54
1/22/13 2366523 Concessions __ _544:97
2/1/13 2696619 Concessions 29413 _ $
Total $ 1,941.97
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.
353824 U S FoodService, Inc. Allowed 20
Box 660088
Indianapolis, IN 46266-0088
In Sum of$
$ 1,941.97
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#rrITLE AMOUNT Board Members
Dept#
1095-1 2049302 4239040 $ 495.46 1 hereby certify that the attached invoice(s), or
1095-1 2366523 4239040 $ 901.54 bill(s) is (are)true and correct and that the
1095-1 2696619 4239040 $ 544.97 materials or services itemized thereon for
which charge is made were ordered and
received except
7-Feb 2013
?.av17-
Signature
$ 1,941.97 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund