227978 1/14/2014 CITY OF CARMEL, INDIANA VENDOR: 354720 Page 1 of 1
ONE CIVIC SQUARE COSTCO WHOLESALE MEMBERSHIP
CARMEL, INDIANA 46032 PO BOX 34783 CHECK AMOUNT: $165.00
SEATTLE WA 98124-1783 CHECK NUMBER: 227978
SON�
CHECK DATE: 1/14/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4355300 111782210072 165 . 00 ORGANIZATION & MEMBER
BUSINESS MEMBERSHIP
ANNUAL RENEWAL NOTICE ®-
. .
Business Pnmary Cardholder $55 RENEWAL MONTH:FEBRUARY 2014 MEMBER NUMBER: 000111782210072
Household Cardholder FREE CARDHOLDER'S NAME AMOUNT HOUSEHOLD MEMBER AMOUNT
Add on Cardholder + h AUDREY KOSTRZEWA $55.00 JENNIFER SEWELL $0.00
Add on Household Cardholder; FREE ` BEN JOHNSON $55.00 MATT LEBER $0.00
N TRACT PETTIGREW $55.00 BROOKE TAFLINGER $0.00
TOTAL RENEWAL FEE $165-00
PorF
b DEC r g 2013 G.L.#_�ja5�l-p�- 43
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membership,RENEW:ONLINE AT �— ` =u;chaser_ _Bute
GOSTCO COM Simply log ori to Costco coin,
type RENEW 1n the product search box;and /,r_; rc,�al __ ____ ,^ac X02
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follow the simple instructtons to renew your
membership today Please see Instructions on reverse to add,remove or rep e a cardholder.
Think Costco First
MY BUSINESS SERVICES
•401(k)Plans •Business Phone Services •Payroll Services
•Business Checks •Merchant Credit Card •QuickBooks'Online
"FProcessing
•Business Health •Water Delivery
z &Dental Insurance
Only in CA,Hl.OR&WA
13IX0420 A 3/13 --
1 ! i
Renewal of your membership constitutes acceptance of Costco's Privileges and Conditions of Membership and its Privacy
Policy and Practices,which are available at our membership counter or online at Costco.com. Please provide.all•cardholders
with this information.
Renewal Policy—Memberships renewed within 2 months after expiration of the current membership year will be extended for
12 months from the expiration date.Memberships renewed more than 2 months after such expiration will be extended for 12
months from the renewal date.
All cardholder changes will be effective upon receipt of renewal payment.
New membership cards will not be sent unless new cardholders are added or changes are made to the account.
CHANGES TO YOUR ACCOUNT Fill in the necessary information in the space provided below and adjust payment accordingly.
Changes to your membership cannot currently be made online at Costco.com.
If adding household member cardholder: Add household member's name in space below the primary cardholder.
*A household member card is available to primary cardholder's household member,domestic partner,or immediate family
member overthe age of 18 and living atthe same address.Household member cardholders will be asked to presentproof that
they live atthe same address as the primary or add-on cardholder.
NOTE: Limit one Executive Membership per household and/or business.
Have questions about your renewal? Call us at 1-800-7742678.
EnEGSNR 1/12
BUSINESS MEMBERSHIP
ANNUAL RENEWAL NOTICE
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��tBus�nessPnmaryCardholder' $55 t RENEWAL MONTH:FEBRUARY 2014 MEMBER'NUMBER 0001:11782210072•;
s HouseholdCardholde� , 't FREE r`F�' '
CARDHOLDER,S NAME AMOUNT HOUSEHOLD MEMBER AMOUNT
+ Add on Cardholder4 k` SSS +$SSeach
AUDREY KOSTRZEWA $55.00 JENNIFER SEWELL $0.00
s #zAdd-0n Household Cardholder ! �t� `FREEs sBEN JOHNSON $55.00 MATT LEBER $0.00
TRACT PETTIGREW $55.00 BROOKE TAFLINGER $0.00
lyrs ,vV,�; Ir.� kr e � .v5l ,mkr'a.vn Fk�mt. _c,. ---�a
TOTAL RENEWAL FEE 165,
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Ifsyou Bort t have any changes to your"fir MR
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membership RENEWitONLiNE AT�� _ —
,�->r GO$TC:O'COM,�Sfm`ply>log on totcostco com � s�- .
type RENfWfr%ttie protluct search box ands rf /. =_._�a Lg/%3
followkthe simple instcuoUons tp renew'your
membership today w ; ^`,rl k Please see Instructions on reverse to add,remove or rep e a cardholder.
Think Costco First
MY BUSINESS SERVICES '
f
•401(k)Plans • Business Phone Services •Payroll Services
•Business Checks •Merchant Credit Card •QuickBooks®Online
a Processing +
•Business Health •Water Delivery
&Dental Insurance '
Only in CA,Nl,OR&WA
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13D(0420 A 3/13
KNOW
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Yesl l d:like,to u rade,to an Executive Membership'and have mcludedian addieonal$55�;
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w ,Costco s:coMmuaii developing new and'excding:progiams and sennci at substanitai avmgs forour members
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4 �� ��o��y{t .•.rte` ����">:' �"'�?�`"�� 5 ,�,-icy 3> - ' '�the:tobacco;manutacturers•.tre resentative to process retail incentives tion our Business mpmaers The!ntormanon Ness s S Ye l , ;t 3 ,t ih +; > mac. v, P d J.:R 1
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AB 01 071858 97260 B 246 A Remit to:
IIIII�IJ��41�1�11111114�441�11'I'I�'I'II'�I��'414�iII�IJ�14��11 �CO$TCO'AAEAABERSHIP
000111782210072 ;,PO BOX 34783
CARMEL CLAY PARKS & RECREATION / 00346 (SEATTLE WA 913 ze-- 83 `;"
AUDREY KOSTRZEWA
1411 E 116TH ST
CARMEL IN 46032-3455 003460001117822100729016500
r
Renewal of your membership constitutes acceptance of Costco's Privileges and Conditions of Membership and its Privacy
Policy and Practices,which are available at our membership counter or online at Costco.com.Please provide all cardholders
with this information.
Renewal Policy—Memberships renewed within 2 months after expiration of the current membership year will be extended for
12 months from the expiration date.Memberships renewed more than 2 months after such expiration will be extended for 12
months from the renewal date.
All cardholder changes will be effective upon receipt of renewal payment.
New membership cards will not be sent unless new cardholders are added or changes are made to the account.
CHANGES TO YOUR ACCOUNT. Fill in the necessary information in the space provided below and adjust payment accordingly.
Changes to your membership cannot currently be made online at Costco.com.
If adding household member cardholder: Add household member's name in space below the primary cardholder.
*A household member card is available to primary cardholders household member,domestic partner,or immediate family
member over the age of 18 and living atthe same address.Household member cardholders will be asked to presentproof that
they live atthe same address as the primary oradd-on cardholder.
NOTE: Limit one Executive Membership per household and/or business.
Have questions about your renewal? Call us at 1-800-7742678.
y EnEGSNR 1112
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AUDREY KOSTRZEWA .�55 OO JENNIFER sEWECL $iLpWN
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s BEN JOHNSON ,$55 ® Tf LEBER y
AOD=Uhi 4` ROHOLD&k A`N.itH ••� 710U9ENtll8ME61BER C�"'.AAD� 94E'RS i�F`E� H6�libCD�AdEMAEA 3':NAW��4!��!:�^.AL),. <HdME�ADbR�„�,t`mr>'�trz Ti F . M �. g �4�
2 rRAci PEfi�i6REW BRO MALI $5J 0® f C MOVE
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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.
354720 Costco Membership -- NOT HSBC Terms
P.O. Box 34783
Seattle, WA 98124-1783
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
12/18/13 111782210072 Annual Membership renewal $ 165.00
Total $ 165.00
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.
354720 Costco Membership-- NOT HSBC Allowed 20
P.O. Box 34783
Seattle, WA 98124-1783 '
In Sum of$
$ 165.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#orBoard Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1125 111782210072 4355300 $ 165.00 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
9-Jan 2014
Signature
$ 165.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund