225125 10/08/2013 - CITY OF CARMEL, INDIANA VENDOR: 353824 Page 1 of 1
ONE CIVIC SQUARE U S FOODSERVICE, INC CHECK AMOUNT: $797.82
CARMEL, INDIANA 46032 PO BOX 660088
INDIANAPOLIS IN 46266-0088 CHECK NUMBER: 225125
CHECK DATE: 10/812013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4239040 1317046 797 . 82 FOOD & BEVERAGES
ACCOUNT INVOICE "INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO DATE — NO. NUMBER LOC . REP. ORDERED
90569922 1317046 '09/27/E3 90569575 36199 1054 0062 09/25/13
Route: 5282 / 9 ORDER NUMBER: 4198
8ill Ship Remit
To: 1411 E. 116TH ST To: 1235 CENTRAL PARK DRIVE E To:
BOX 6600%
CARMEL IN CARMEL - - IAN
46032 46032 INDIANAPOLIS IN
317 843 3873 46266-0088
Att: MICHELLE COMPTON DEPT # 00 800 428 2118
3'hioFrm. 12301 CUMBERLAND RD FISHERS IN ShjpQ 09/27/13 Page 02 of O2
7ptirms� SpczaJ ENTER OFF OF 111TH STREET ! ! !
" t7rms � NET 10 DAYS � ' '�- Instr '
Oty � Qty Sales Product Descripton // —/] —J-5—pack Size Label C Weight Pricing Unit Extended
)rdered Shipped Unit Number '^ D Unit Price Price
INVOICE SUMMARY
FUEL SURCHARGE 6. 2S
TOTAL WOT SHIPPED; 318. 12 PIECES ORDERED: 22 PIECES SHIPPED: 22 ITEMS SHIPPED: 13
PRODU CT TOTAL 791. S7
CHARGES 6. 2S
TAXABLE AMOUNT . 00
GEN SALES TAX, . 00
This amount is an estimate at time of shipping prior to any adjustments made at delivery: $
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ACCOUNT INVOICE INVOICE CUSTOMER PURCHASE ORDER SALES SALES DATE
NO. NO. DATE NO. I NUMBER LOC . REP. ORDERED
90569922 1317046 09/27/13 90569575 36199 1054 0062 09/25/13
Route: 5282 / 9 ORDER NUMBER: 4198
8ill Ship Remit
. US Foods, Inc .
To: 1411 & 116TH ST To: 1235 CENTRAL PARK DRIVE E To:
BOX 660088
CARMEL IN CARMEL IN
46032 46032 INDIANAPOLIS IN
317 843 1873 46266-0088
/
Atd MICHELLE COMPTON DEPT # 00 800 428 2118
��i Frm� 12301 CUMBERLAND RD FISHERS IN Shi D� 09/27/13 Page 01 of 02
��tTrms: Spcia2 ENTER -OFF OF 111TH STREET ! ! !
" tTrms: NET 30 DAYS Ins tr� '
Oty Qty Sales Product Descripton Pack Size Label C Weight Pricing Unit Extended
]rdered Shipped Unit Number D Unit Price Price
DRY
I CS 181121S PEPPER, JLP SLCD NACHO HOT 4/1 GA ELPA/DELPA B CS 3S. 1100 $ 35. 11
i I CS 2404325 GLOVE, POLY LG TXTD AMBDX 10/100 EA MONOGRAM B CS 404200 40. 62
3 CS 4260238 SAUCE, CHS NACHO SHLF STABL 4/107 OZ ORTEGA CS S4. 9900 164. 97
1 CS 5597604 CHIP, CHS CNCHY PLN SS BAG 64/2 OZ CHEE-TOS CS 313100 31. 31
I CS SS97851 CHIP, TORTLA NACHO CHS TRGLE 64/1. 75 OZ DORITOS CS 31. 3200 3132
1 C'S ES97968 CHIP) CORN ORIG TFF SS BAG & 64/2 OZ FRITOS CS 31. 3200 31. 32
3 3 CS 9089079 POPCORN, RAW KIT W/ OIL & SALT36/8 OZ FANCY FARM CS 26. 6100 79. 83
1 1 CS 9341223 CREAMER, HALF & HALF UHT DARY -360/.375 OZ GLNVW FRNS CS 17- 200 1705
2 2 CS 9463688 CHIP, TORTLA CORN YLW RND 6/2 LB EL PASADO CS 24- 0500 48. 10
FROZEN
3 3 CS 2011278 PRETZEL, KING SOFT BKD FZN 50/s OZ SUPR PRTZL CS 344000 10320
PRODUCT CLASS RECAP
TOTAL DRY PIECES ORDERED: is PIECES SHIPPED: ITEMS SHIPFSD: 10 04. 21
TOTAL FROZEN PIECES ORDERED: 7 PIECES SHIPPED: 7 ITEMS SHIPPED: 3 207, 36
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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
9/27/13 1317046 Concessions 36199 $ 797.82
Total $ 797.82
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$
$ 797.82
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or Board Members
Dept#
INVOICE NO, CCT#/TITL AMOUNT
1095-1 1317046 4239040 $ 797.82 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
3-Oct 2013
$ 797.82 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund