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220715 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1 ONE CIVIC SQUARE MID AMERICA BEVERAGE INC 0 CARMEL, INDIANA 46032 PO BOX 2856 CHECK AMOUNT: $318.90 KOKOMOIN 46904-2856 CHECK NUMBER: 220715 CHECK DATE: 6/4/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4239040 318 . 90 FOOD & BEVERAGES MIMIMERICA INVOICE BEVERAGE CITY OF ,CARMEL ,NCE ? dba BROOKSHIRE GOLF CLUB 12120 BROOKSHIRE PARKWAY 2755 Commerce Dr.• CARMEL IN 46032 P.O. Box 2856 Kokomo, IN 46904-2856 765-459-3117 RR2903542 EXP. 07/13/13 800-382-0675 Fax: 765-457-7967 BEER W3409212 INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE O6JO6J13 523545 Dustin Smith 13 800 13 PRICE DEPOSIT AMOUNT ••oe BASE October 7, 2012 PROMO #0613 Wine; W342887 Pump $45/$40 Refundable 109 b Budweiser 24 Lse Can 9.7.80 106.80 209 12 Bud Lt 24 Lse Can 17.80 213.60 225 1 Bud Lt 1/4 BBL 48.00 30.00 78.00 7025 2 Goose 312 2/12 Can 24.75 49.50 no l Cases 20 1/4 Barrels 1 TOTAL SALE 447.90 10303 EMPTY AB 1/6 30.00 1po©" 10304 EMPTY AB 1/2 30.00 00 H 10405 EMPTY AB 1/4 30.00 A 9230 PUMP DEPOSIT 33.00 9270 IMPORT PUMP DEPOSIT 33.00 ,N GNU 447.90 IM I IN ® D` �. r V ® CREDITS - �(� L ❑ Cash! ❑ EFT ❑ Escrow ❑ Check Number U /} / L Driver iY Received By MIWAMERICA INVOICE BEVERAGE . . . CITY OF- -CARMEL- . . INC. dba BROOKSHIRE GOLF CLUB 12120 .BROOKSHIRE PARKWAY 2755 Commerce Dr. CARMEL I N 46032 P.O. Box 2856 Kokomo, IN 46904-2856 RR2903542 EXP. 07/13/13 765-459-3117 800-382-0675 Fax: 765-457-7967 BEER W3409212 INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE 05/23/13 521963 Dustin Smith 13 800 13 •® e b QUANTITY o •• • BASE October 7 2012 PRO110 #0513A Wine: W342887 Pump $40/$33 Refundable 109 4 Budweiser 24 Lse Can 17.80 71 .20 225 1 � Bud Lt 1/4 BBL 48.00 30..00 78.00 „ V Cases 4 1/4 Barrels -o • e e - - o I • TOTAL SALE 149.20 10303 EMPTY AB 1/6 30.00 T 10304 EMPTY AB 1/2 30.00 H 10405 EMPTY AB 1/4 30.00 A 9230 PUMP DEPOSIT 33.00 N 9270 IMPORT PUMP DEPOSIT 33.00 K 149 20 ® ®,: V ' ® CREDITS ❑ Cash ❑ EFT ❑ Escrow Check Number U. Driver �� Received By VOUCHER NO. WARRANT NO. ALLOWED 20 Mid America Beverage Inc. IN SUM OF $ P.O. Box 2856 Kokomo, IN 46904-2856 $507.10 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 521963 42-390.40 $149.20 1 hereby certify that the attached invoice(s), or 1207 523545 42-390.40 $357.90 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, June 17, 2013 Director, Bro kshire 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)) 05/23/13 521963 Beer $149.20 06/06/13 523545 Beer $357.90 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