219076 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
ONE CIVIC SQUARE U S FOODSERVICE, INC
CARMEL, INDIANA 46032 PO BOX 660088 CHECK AMOUNT: $177.17
INDIANAPOLIS IN 46266-0088
,.o CHECK NUMBER: 219076
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 1300238 177 . 17 FOOD & BEVERAGES
ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE`�
NO. NO. DATE NW NUMBER LOC. REP . ORDERED/
90569922 1300238 03/22/13 90569575 MCOO�5946 1054— 0062 03/21/13
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Route: 5272 ORDER NUMBER 812241
�1ll Ship Remit
/ o: 1411 E. 116TH ST ' 1235 CENT To:
ICARMEL
4603-2 46072 - INDIANAPOLIS 1N
017 343 3871
Att� MICHELLE COMPTOIN .m�' 12301 C �PT 0
� �A - SW42S 2119
��ipF� (JM8ERLNl} RD FISHERS ' IN5�i�D�' - O3/22�1��� '—` ' Page 01 of 01
FitTr -
r ms Spcial ENTER QFF'-
OF 111TH SWEET0 '
PytTrms: NET 30 DAYS
�ty ' Qty Sales Product Des�ripton Pack Size Label C Weight Pricing Unit Extended
Ordered Shipped Unit Number ' ' � D ~^� Unit Price Price
1 CS 2766026 COFFEE, GRND WAF 100Z COLON 42/2. 5 OZ RYKDF.''::' CS 85. 7700 85. 77
1 CS 9764002 COFFEE, GRND DONUT HOUSE CAFFN4213 OZ RITUALS CS 85. 1500 85- 15
**.PRODUCT CLASS RECAP
�JOTAL DRY PIECES ORDERED: 2 PIECES SHIPPED: 2 QMS SHIPPED: 2
iNVOICE SUMMARY
FUEL SURCHARGE 6125
TOTAL WGT SHIPPED: 14. 44 PIECES OROERED: 2 PIECES SHIPPED: -ITEMS SHIPPED! 2
PRODUCT TOTAL $ 170.92
""AROES 6. 25
MAR 2 7 2013
TAXABLE AMOUNT . 00
This amount is. an estimate at time of hipping prior to any. adjustmentB made at delivery: S 177. 17
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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
3/22/13 1300238 Concessions $ 177.17
Total $ 177.17
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
Voucher No. Warrant No.
353824 U S FoodService, Inc. Allowed 20
Box 660088
Indianapolis, IN 46266-0088
In Sum of$
$ 177.17
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-1 1300238 4239040 $ 177.17 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
4-Apr 2013
6k&MV
Signature
$ 177.17 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund