219524 04/24/2013 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: $1,453.11
+ �+ INDIANAPOLIS IN 46266-0088 CHECK NUMBER: 219524
«ON
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 1718931 1, 453 . 11 FOOD & BEVERAGES
ACCOUNT . INVOICE INVOICE CUSTOMER PURCHASE. ORDER SALES SALES DATE �
N . ��C REP ORDERED
9O569922- L718931 O4/O5/13 �9O56� 575 29609 W54 006
O4/O4/17
Route: ORDER NUMBER: B24717
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�p 1411 E, 114TH ST � 11215VENTRAL. PARKDRIVE E L To:
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IN Sh!Q: 04/05113 Page 02 of 02
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' Spcial ENTER.[FF OF 111TH STREETWI
NET j{ DAYS Jns1r: '
�ty qtv Sales Product Pack Size Label C Weight Pricing Unit Extended
}rdered .Shipped Unit Number Unit Price 7rice
*** INV6ICE SUMMARY ***
SURCHARGE
TOTAL WGT SHIPPED: 5SK8O PIEW CROWD: 48 PIECES SHIPPED: -45 ITEMS SHIPPED: ' 12
-
PRODUCT TOTAL $ 1446
.—
CHARGES �
TAXABLE AMOUNT $ �O
GEN SALES TAX % 6
� Thi
Vamount n estimate attime of shipping prior to any adjustments wade at delivery: $ ;453
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ACCOVNT T �VOICE INyOICE C.-u C"T 0 Ityl ER ORDER SALES 84111LES DATE |
�� NO. DATE NO- NU�rER LOC . REP GRDERED
9O569922 1�1B9�1 O4/5J l:1 9O569575 4 (}54 O@6� O4/O4/1�
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�ty �ty DeB�cr ize Label r W ight Pricing Unit [xten(Jp�
�r�ere� S�ipped Unit Moea�r � �rit Price e
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1 1~ EA 4O53 36 CANDY, B MILK CHOC 36/1. 55� HERSHEY �A 26 88O� $
4 4/ CS 426O238 SA�CE, CH�� N�CH� SHLF STABL 4�1O7 8Z ORTEG� CS 54 55OO
2 2v/ CS 4329397 KETCH�P, TMTO FCY SS FOIL PKT 500/9 GR hON4RCH CG 14960S ^ ~ ^~
2 5605472 C�IP, MUL RN CH�DR S3 S4S ��/15 UI SUH CHIPS CS 30� 890O �` `/
2 2~/ EA 621077? CANDy. KT-r VHDG STD 1 5 Z �6 EA KIT KAT
8��31�6 C, !.JD RE- 36 E8 �EE�E'S �A 25 �20O ^ c '
9089O�9 POP�0RN, `~� �OlL � SALT26}8 OZ FANCY FARn CS 26 �100 ' ' �
C9 9463688 TORTLA COKN YLA KND 6/2 LD EL P�SADO CS 24 36O0 ' ' ~
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3�414 CORN , AM C� FZ� 48/� O% STATE
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5741228 DUH� HOT DUG �" klHGE 0LCD ���12'�2 E� HILLTOP HR . C5 �2 ��S0 I�S ��
TDTAL DRY PfE��s CR���[D� 2O �I[CES �HI�PED� - �TE�S SKIPPED �
� T3TAL FROZEN PIECES OKDERE� 28 rIECES SHIPPED
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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
4/5/13 1718931 Concessions 29609 $ 1,453.11
I I
Total $ 1,453.11
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$
$ 1,453.11
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-1 1718931 4239040 $ 1,453.11 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
18-Apr 2013
Signature
$ 1,453.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund