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Home My WebLink About218991 04/09/2013 `'*f CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1 ONE CIVIC SQUARE PETTY CASH-BROOKSHIRE GOLF CO�q� `, =a CARMEL, INDIANA 46032 C/O PAM LISTER GFiECK AMOUNT: $148.71 CHECK NUMBER: 218991 CHECK DATE: 4/9/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4342100 9 . 20 POSTAGE 1207 4350000 603916 81 . 00 EQUIPMENT REPAIRS & M 1207 4239040 CLASSIC SPIR 23 . 97 FOOD & BEVERAGES 1207 4239040 ENTENMANNS 5 . 75 FOOD & BEVERAGES 1207 4239040 MEIJER 9 . 03 FOOD & BEVERAGES 1207 4239040 O'MALIA 19 . 76 FOOD & BEVERAGES INVOICE Grooms Tire Recycling INVOICE NUMBER P. O. Box 319 • Plainfield, IN 46168 Office 238-0388 • Fax 238-5257 603916 INVOICE DATE j 6/TO �' � �I .G 11 - 1 - 13 PO # COD ❑ 10th Prox. ❑ QUANTITY DESCRIPTION PRICE AMOUNT Minimum Pickup Charge Truck Tires Mounted Truck Tires Car Tires Q � Mounted Car Tires Pick-Up/SUV Tires Mounted Pick-Up/SUV Tires ) 4 Z L i oo � Off Road it A: size: size: size.- Tires in kind may be returned and service charges billed if not PAID according to terms. . X TOTAL ' � � SIGNATURE Thank You! WASTE TIRE MANIFEST Stale Form 47273(R2 170-06) Indiana Department of Environmental Management Rio INSTRUCTIONS: 1. Use of this form is required by 3291AC 15-4-13 and IC 13-20-14-5. 2. The Waste Tire Transporter must complete this form for each shipment of waste tires. 3. Fill in af!information. Generator, transporter, and receiving facility information may be pre-printed 4. Give a copy of this form to the generator(source)of the waste tires. 5. Give a second copy of this form to the receiver of the waste tires as listed in IC 13-20-14-4. 6.Keep a copy of this form for your records for at least one(1)year. 7.For help with this form contact IDEM's Office of Land Quality, Solid Waste Permits Section, at(317)232-0066. GENERATOR (SOURCE OF WASTE TIRES) Name F� Telephone(including area code) V-j/� �/ /,l ( '/ Z �lil e11 -MJ- 2/WA 1,56- b//l Address f Generator's Prinr)Name Authorized City State Zip Code Agent Signa A , ttrr� DESCRIPTION OF SHIPMENT Pickup Date Time Tire Types Lellvl an A moue �O ❑ Passenger Tires, / ❑ Truck Tires ;Pickup Location Ll I I I 1~. ^�p �❑ 1 r - L'0acl Type ❑ Light Truck Tires ❑ Floats/Off Road Tires checKone. ® Whole Tire Count ❑ Weight in Pounds g J ) ❑ Volume Cubic Yards ❑ Weight in Tons ,❑ ❑ TRANSPORTER Name Telephone (including area code) Grooms Tire Recycling, Inc. 317-238-0388 Address 1315 S. Drover St. Permit/Registration No. State City State Zip Code 049-T-00053 Indiana Indianapolis I IN 46221 I CERTIFY,UNDER PENALTY OF PERJURY AS PROVIDED IN IC 35.44.2.1,THAT THE MATERIAL DESCRIBED ABOVE WAS PICKED UP AT THE SITE DESCRIBED ABOVE AND,TO THE BEST OF MY KNOWLEDGE,THIS INFORMATION IS TRUE AND ACCURATE. — lot, At,1W Driver's Name Signature DESTINATION Name Telephone(including area code) Grooms Tire Recycling, Inc. 317-238-0388 Address 1315 S. Drover St. Permit/Registration No. State City State Zip Code 049-P-00054 Indiana Indianapolis IN 46221 I CERTIFY,UNDER PENALTY OF PERJURY AS PROVIDED IN IC 35.44.2.1,THAT THE MATERIAL DESCRIBED ABOVE HAS BEEN ACCEPTED AND,TO THE BEST OF MY KNOWLEDGE,THIS INFORMATIO_N IS TRU ND A/CCURATE,AND THAT I AM AN AUTHORIZED AGENT OF THE REGISTRANT. Anver Grooms/Vicki Mitchell Name of Authorized Agent Sig lake U Receipt Date VOUCHER NO. WARRANT NO. ALLOWED 20 Petty Cash IN SUM OF $ $81.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 I 603916 I 43-500.00 I $81.00 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 Wednesday, April 03, 2013 Director, Brook ire 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)) 04/01/13 603916 Tire Recycling $81.00 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 CARMEL RETAIL STORE CARMEL, Indiana 460329998 1740350814-0097 03/28/2013 (800)275-8777 08:57:22 AM Sales Receipt Product Sale Unit Final Description Qty Price .Price (Forever) 1 $9.20 $9.20 Four Flags Double Sided Bklt/20 Total : $9.20 Paid by: Cash $10.00 Change Due: -$0.80 BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices. In a hurry? Self-service kiosks offer quick and easy check-out. Any . Retail Associate can show you how. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-USPS. Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com/poboxes. Bill#:1000300500781 Clerk:l5 All sales final on stamps and postage Refunds-for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS Customer Copy VOUCHER NO. WARRANT NO. ALLOWED 20 Petty Cash IN SUM OF $ $9.20 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members 1207 I I 43-421.00 I $9.20 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 Wednesday, April 03, 2013 Director, Brookshire 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)) 03/28/13 Stamps $9.20 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 W RALIA #206 4755 E. 126TH ST, CARMEL., IN 46033 (3110844-4372 1854 N OWN HTOG BTR BUN PC 2.79 F 1854 N OWN HTDG BTR BUN PC 2.79 F CUSTOMER NUMBER 40003033880 SC 713 N OWN H1'CIG BTR BUN 1 .54-F SC 713 N OWN H1'OG BTR BUN 1 .54-F ** * TAX .00 BAL 2.50 CASH 20.00 CHANGE 17.50 TOTAL NUMBER OF ITEMS SOLD = 2 4/07/13 10: 16 AM 0206 03 0059 132 YOUR CASHIER WAS OLIVIA )'10LI SAVED $ :3 . 08 ( 55% ) ON YOUR ORDER TODAY * ** * YOUR SAVINGS COUPON PLUS SAVINGS 3.08 TOTAL SAVINGS (55%) 3 3.08 YOUR SAVINGS ** *** THANK YOU FOR SHOPPING 011Al_IA CHECK US OUT: ttttp://www.omalias.com a:. W MALIA #206 4755 E. 126TH ST. CARMEL, IN 46033 (317)844-4372 CUSTOMER NUMBER 40020008370 2313 N OWN BTR HAM BUN PC 2.79 F SC 713 N OWN BTR HAM BUN 1 .54-F 1854 N OWN HTOG BTR BUN PC 2.79 F SC 713 N OWN HTOG BTR BUN 1 .54-F 1854 N OWN HTOG BTR BUN PC 2.79 F SC 713 N OWN HTOG BTR BUN 1 .54-F 3368 VALUTI HOTDOG BUNS .99 F **** TAX .00 BAL 4,74 CASH 5.00 CHANGE .26 TOTAL NUMBER OF ITEMS SOLD = 4 4/06/13 8,52 AM 0206 02 0012 121 YOUR CASHIER WAS ANNE YOU SAVED $ 4 . 62 ( 49% ) ON YOUR ORDER TODAY YOUR SAVINGS ** *****#* COUPON PLUS SAVINGS 4.62 TOTAL SAVINGS (49%) $ 4.62 ****# **�► YOUR SAVINGS THANK YOU FOR SHOPPING O ' MALIA CHECK US OUT: http://www.omalias.com With your Marsh Fresh Idea Card You saved $124.89 in 2012. You have saved $43.65 in 2013. Marsh Fresh IDEA Lard required for all offers. Thank you for Shopping Marsh! VOUCHER NO. WARRANT NO. ALLOWED 20 Petty Cash IN SUM OF $ $7.24 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 O'Malia 42-390.40 j $4.74 1 hereby certify that the attached invoice(s), or 1207 O'Malia 42-390.40 $2.50 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, April 08, 2013 l Director, Brook ire 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)) 04/06/13 O'Malia Bread $4.74 04/07/13 O'Malia Bread $2.50 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 f . � SPIRITS ��_ u��'� �� ^p� u 03/25/13 #OOOOOi 38 ?.99 MIX 23.97 SUBTTL 23.9? TAX i 1.68 TOTAL 25.65 CHASGE CRD 25.65 3 #ITEMG OOii #Oi #OOOi 11:37 PLEASE COME AGAIN! ` ` O U KA IA #206 ' 4755 E, -1126TH DT. CHR�EL. I� 46033 ' (317)O44-4373 ` no oezoY J0on mcnm 5.69 F 3 @ 3/2.o0 1063 CALIF LEMONS 2.0 0 F **** TAX oo DoL 69 ________________---,_ O'MALTA #2Cl6 ' 1755 E 126rx ST v ' � CeRm[L. Jw q60J3 (317)81�-*372 EFT DEBIT pURCxoSE 03/26/13 10. 13 AM 08 CoKO % XKKyX�KXKX-Xk8019 TOTAL T8nwSnCrI0w nmOUwr 7.69 REF:311623 ______ --- _____ _______ vp DEBIT r.69 . Cxows[ .00 TOTAL NUMBER OF I)EM3 SOLD ~ 4 3/26/13 10:13 8H 0206 OJ 0018 163 YOUR CASHIER WAS MeRGE ' THANK YOU oFOR SHOPPING 0 / MA To CHECK U3 OUT: http'//www.omallmo.cvn VOUCHER NO. WARRANT NO. ALLOWED 20 Petty Cash IN SUM OF $ $31.66 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 Classic Spirits 42-390.40 j $23.97 1 hereby certify that the attached invoice(s), or 1207 O'Malia 42-390.40 $7.69 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 Wednesday, March 27, 2013 Director, Brooks Ire 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)) 03/25/13 Classic Spirits Mixers $23.97 03/26/13 I O'Malia I Food $7.69 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 ENTENNANNS PAl,'-'ERY 5016 Er' 62W) ST 1NDIANAPM15 IN 2,2 1"P*! P,!*"R 3/13 00-7507 002 DIANA 01087 . 950400739554 Moo @ $1 M OUT ILL!: LINEM3.27 SL 20OZ 5900.99 BB 240Z jl�i$1.49 M. 10 1) . '?5 - CASH 0.-()0 CHANGE 4.2-5 THANKS FOR SHOPPING AT ENTENMANNS BAKERY OUTLET STORES t CLASSIC SPIRITS 12588 GRAY RD CARMEL, IN 46033 0326/2013 11:37:00 Merchant ID: 000000000648551 Terminal ID: 00924067 231560632888 CREDIT CARD VISA SALE CARD# XXXXXXXXXXXX0376 INVOICE 0004 Batch#: 001845 Approval Code: 000054 Entry Method: Swiped Approved: Online SALE AMOUNT $25.65 CUSTOMER COPY meojer 1424 West Carmel Dr. Carmel, IN 46032-#130 i3'17j573-8300 meijei.com The Meijer Team appreciates your business 04/04/13 Your fast and friendly checkout was provided by KALA K---SAVINGS TODAY-i—c— TOTAL NON-COUPON SAVINGS 3.33 -- -SAVINGS TOTAL 3 . 33- GROCERY 4061 LETTUCE .99 F 4082 MOM RED ONION 1.71 F 1.15 lb @ 1 lb / 1.49 *70882014036 TOMATOES was 2.69 now 1.33 F 1.37 lb ® I- lb / - .97 0131400598 BUNS 3 ® 3 / 5.00 was 5.97 now 5.00 N TOTAL TOTAL TAX .00 TOTAL 9.03 PAYMENTS CASH TENDER 9.25 CASH CHANGE .22 NUMBER OF ITEMS 6 See meijer.com or the Service Desk for current return policy. For additional savings and details visit mPerks.Meijer.com. IIII III III IIIIIIII VIII III I IIIIIIII I I I I IIIIIIII A013004PSF2X355 Tx:47 Op:2039655 Tm:22 St:130 13:53:45 I LUI 1101 IVl QI1&U1 [VI IO UI 11 k"MI MIS u limited to):alcohol,tobacco,ammunition,prepaid cards,and open collector sports cards or blood glucose monitors. Meijer reserves the rightto restrict or refuse returns. Full Return Policy is available at Meijer.com. Return Policy Returns are subject to lowest sale or promotional pricing,including bundled offers,and will be refunded in the original purchase tender type. Returns without receipt may require a valid ID and will be issued a rvieijer Merchandise Return Card forthe refund value. Meijer stands behind our name;any productwith the "Meijer"brand may be returned with orwithout a receipt,provided it is not a state-approved WIC item. We will provide a full refund for all non-WIC approved food items with or without a receipt. For WIC approved food items we will provide a refund if you have a receiptthat shows the item was not purchased in a WIC transaction. Meijer cannot provide refunds forfood items,including produce and formula,which may have been purchased with WIC. Meijerwill honor General Merchandise refunds and exchanges within 90 days of purchase. Returns of electronic items,media and items powered by flammable liquid or gas must be made within 30 days. Returns of open electronic items,media and items powered by flammable liquids or gas are subjectto additional fees,restrictions or refusal. Items not eligible for return include(but are not limited to):alcohol,tobacco,ammunition,prepaid cards,and open collector sports cards or blood glucose monitors. Meijer reserves the right to restrict or refuse returns. Full Return Policy is available at Meijer.com. Return Policy Returns are subject to lowest sale or promotional pricing,including bundled offers,and will be refunded WMALIA #206 4755 E. 126TH ST. CARMEL, IN 46033 (317')844--43 1:2 CUSTOMER NUIIB*--R 40020008370 18 MONI'GIMERY BBQ PC 2.69 F SC 1165 MONTGOMERY BBQ 1 .36-F TAX .00 BAL 1 .33 CASH 1 .33 CHA1\113= 00 TOTAL NUMBER OF ITEMS SOLD = 1 4/04/13 1: 33 PM 0206 03 0147 163 YOUR CASHIER WAS MARGE YOU S 0 V D $ '1 . 36 C 51 ON YOUR ORDER TODAY YOUR SAVINGS COUPON PLUS SAVINGS 1 ,36 TOTAL SAVINGS. (51%) S 1 .36 . YOUR SAVINGS THANK YOU FOR SHOPPING WMALIPi CHECK US OUT: h,ttp://www.omalias.com With your Marsh Fresh Idea Card You saved S124.39 in 2012. You have saved $37.115 in 2013. Marsh Fresh IDEA Card required For all offers. Thank You for Shopping Marsh! 0 ' III Pi L lIII #x.016 4755 E. 126TH ST. CARMI:::L, IN 46033 ( 3 F?)84,1-1372 25;' AM BUN HKi!! Cl— KSR PC 3.39 F CUSTOMER NEIMBL`-Et 40020008370 SC 711 AM :BUN IiRTH CL KSR 1 .39—F 38711 KRF r OE IG BE!W SCE PC 1 .69 F SC 1001 KRI='I CII,,'IG BBQ SCE .19—F **3 TAX .00 BAL 3.50 CASH 3.50 CHANGE. .00 TOTAL NUMBER iiF IEEMS SOLD = 2 4/05/13 9: 22 AM 0206 01 0026 101 YOUR Cl;':'HIER W11S THERESA 1 OlU SAVED $ 1 . 58 ( 31y, ) ON YOUR ORDFIR TODAY YI:IIJR SAVINGS ***+****** COUPON PLU'S SAVINGS 1 .58 TOTEIL SAVINEii'i (31%) S 1 .58 ****;i;***at* 'YI:IIJR SAVINGS THANK Y131tJ Fl31'-} SHOPPING CHECK EIS OUT: http://www.oma[ias.com With WoLr Marsh Fr,,:-;h Idea Card You saved :612,1.89 in 2012. You have saved $39-03 in 2013. March Fresh ILA Card renurrEC for alJ offers. Thank :nu for ShOPF'irii3 Mi_irsh! VOUCHER NO. WARRANT NO. ALLOWED 20 Petty Cash IN SUM OF $ $19.61 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 Entenmanns 42-390.40 $5.75 1 hereby certify that the attached invoice(s), or 1207 Meijer 42-390.40 $9.03 bill(s) is (are) true and correct and that the 1207 O'Malia 42-390.40 $1.33 materials or services itemized thereon for 1207 O'Malia 42-390.40 $3.50 which charge is made were ordered and received except r Friday, April 05, 2013 1 Director, Brook ire 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)) 04/03/13 Entenmanns Bread $5.75 04/04/13 Meijer Food $9.03 04/04/13 O'Malia Food $1.33 04/05/13 I O'Malia I Food $3.50 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 5-11-10-1.6 120 Clerk-Treasurer