225101 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 359366 Page 1 of 1
ONE CIVIC SQUARE SYSCO FOOD SERVICES
CARMEL, INDIANA 46032 PO BOX 7137 CHECK AMOUNT: $573.39
INDIANAPOLIS IN 46206-7137
CHECK NUMBER: 225101
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 309261125 573 . 39 FOOD & BEVERAGES
CUSTOMER'S ORIGINAL INVOICE Good things CONFIDENTIAL PROPERTY OF SYSCO
gm
come from
V/S c
BROOKSHIRE GOLF CLUB... Aft
12120 BROOKSHIRE PKWY
412940 309261125 a 4 1
SYSCO INDIANAPOLIS, LLC 4010
CARMEL IN 46033 4000 W 62ND ST .;t3OUTE:+_:.::j.�.j:::
I : , 11 1................
......... 7.11 97� ...........I................
INDIANAPOLIS, IN 46268 __A44R
317-846-7431 —DUE FRIDAY 4 WEEKS AFTER ORDER
RMAL DELIVERY
CITY OF CARMEL _MA',' S GA Y LEVERENZ
1 CIVIC SQUARE DRIVER: SCALES, JOHNNY
CARMET. IN 46032 EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION CLAUSES OF 41 CFR 60-1.4 60-250.4 AND 60-741.4 ARE INCORPORATED HEREIN BY REFERENCE.
:jTEM':::::
SIZE �i�i�:�::ITEM SCRIPTION:::
PAC14 .. ....'' ��: I.:::::.::.:::: :::::::: :::::: " .: :: �f i:
q a
X
MEATS
.................
q.
I CS: 6 0 5...3. 0 F I REI MP BEEF GRND PTY HMS:TYLE TJ 8 62231 X. 64 1`2* 64++'. ..........
q
-::+:.: -5: .....................
............. ....
... .............
...............
1 CS 110 LB JHNSVLE BRATWUR5T X. PRCK SKLS 100:Q:21 J
3 7
........... —
V . X:
...
...
.....................
—---
F CS 11Q..LB BRLCLS FRANK ALL7MEAT x IN 3773.6.— , 1137.73d .....24.97 74.911" . ........................
...... .....
X
14: 1 S 2 O OLTEN PORK `Fl+�fT: Ttk+ B:NL§ HMSTY 200094 6583710......39.75. ...
212 ......................
T..O.TA..L* . ......d.d ... +.................d.
...
........................
CAN NED & DRY ........ .
..... .........
.... ............ .......... .............d::::::d:
... .......
'2
iC S DNLY48 CT NICKER CANDY BAR SNICKER�' 1.86 OZ n 1
' 256479793837 ..........2:9_•98... ... .98'
X:+.:::20 92:CS 1612.75ZEINZ MUSTARD SPICY BRWN SQZ CLASC 802310! 152381...6 .....20.92'
..........
.. ......... ...........
:X
...... ......
............
_2..
.... . ......
CS i753 OZ + "—ASASOL SAUCE CH89SE MACHO POUCH ZTP 761 7132 _02 11 i 0387763 "69.98 ..... ...69.9811
.............
..... 0
2 CS 135 LB SYS +9EL ,SHORTENING'F CLR'ZTF 10 5 2 1 451901 2`5...98 61
... .. ................
1 ...... ..... .............
........................
..........
PAPgk++& DISPOSABLE T*9
...... .............dd..:
L-9 2S jkLY500CT SYSCO FOIL ++S+ f0 IN SILVEk::" . ....... W" 6 911 *98 8:50 0..... ........ 2 5.'9'6
.................. .......
.......... ...............
..........d....... ... ..... .
+FT 3EORG P TOWEL ERMOTI*ON LRG 4AUTO++. '6 9.98; 13
CS : :686160 9.96;-
7761
... GROUP TOT .......... ...
.......... . ................... ......
PRODUCE 4 d +++..*
.................................
.......d ............ .. ........
.....
I CS 15 LB SYS: IMP ONION RED FRE S H....J . . .UMBO '+++++ ........d.............
X
xx
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..............ddd
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:wwp.............. .............. ...... ...........
MIS CHhRGES :HGS FOR FUEL+ SURCHARGE ...... 5.00
X.:+++ ................
X X ............. ...
X:
x
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.. . ......... .. .... .... + .
. ....
:::ORD S 1 ... ..... .. ....
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NE i00 AM +
01 IT TQT Prr Llju6N: 2:uu
P.O. BOX 7137
J.1 3 16 10.6 267 INDIANAPOLIS IN SUB
R IMPORTANT:
PER�ISHABLE PRODa UCITS IARE NOT ELIGIBLE BLE FOR REJTPURN IAF
T
E 46206-7137 TOTAL 573.39
v 1 3 10.6 267 F OVNY S H AADCAFTER I I U HAVE E,IWNE WIPL ECEOT RECEIVED TAX
DRIVER'S.ER'S NO. PCs ICUST.-AZ No. PCs TOTAL
I DELVD.
SIGN SIGN REC.
1. INVOICE
TH N A ��Ul_ t FONIP lt�E I TOTAL
573.39
C, C R T , g�I�A� C j4g I C K6f�'� '640 RIC
RX0?D
M I I T cy _gl PAYABL� ON OR BEFORE
H � U T LAM R AL I V 0" S 0 '
PAY E OF THESE COMMODITIES UNTIL
,V�rog�gq
I DERIVED THESE M CITIES, AND ANY RECEIVABLES FROM M THE SAL LAST PAGE
FULL PA NT is RECEIVED. ! 1 10/25 13
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))
09/26/13 309261125 Food $573.39
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.
ALLOWED 20
Sysco Indianapolis LLC
IN SUM OF $
-R 37
Indianapolis, IN 4fr2.68 '7c37
$573.39
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 309261125 I 42-390.40 I $573.39 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
Thursday, September 26, 2013
72nif A 411A ,
Director, Brook . ire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund