229499 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
rONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $339.50
CARMEL, INDIANA 46032 PO BOX 660579
.oN.o DALLAS TX 75266-0579 CHECK NUMBER: 229499
CHECK DATE: 2/25/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 125531860208 339 . 50 OTHER EXPENSES
1-800-4-WATERS (1-800-492-8377) www.HinckloySprings.com
Upcoming Delivery Dates Hinckiey. &MAR8
Springs We Deliver!
February March Aril
Bottled Water• Filtration •Coffee
Thursday, 20 Thursday, 6 Thursday, 3 It's"Fe-brew-ary"and we're celebrating custom brews!
Thursday, 20 Thursday, 17 In addition to our great coffee options you already enjoy at
home or the office, you can customize your brew with single
serve coffees featuring traditional &gourmet options.
Ask your RSR for details.
Customer Account#: 172094612553186
JOE ACCOUNTS PAYABLE Invoice Date: 02-08-14
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice#: 12553186 020814
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 440.65
01-21-14 P227740 Payment-Check-227740-Thank You -180.06
Remaining Balance 260.59
R1402310140866 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.99 9.99
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.25 11.25
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.49 11.49
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.49 11.49
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.49 11.49
01-23-14 T140233043070 HINCKLEY SPRINGS 5G DRINKING WATER 12.0 9.99 119.88
5.0 GALLON BOTTLE DEPOSIT 12.0 6.00 72.00
5.0 GALLON BOTTLE RETURN -10.0 6.00 -60.00
ENERGY SURCHARGE 1.0 3.04 3.04
Recd By: Not Available or Refused
02-06-14 T140373043047 HINCKLEY SPRINGS 5G DRINKING WATER 13.0 9.99 129.87
5.0 GALLON BOTTLE RETURN -13.0 6.00 -78.00
5.0 GALLON BOTTLE DEPOSIT 13.0 6.00 78.00
Rec'd By: Not Available or Refused
Total New Charges 339.50
Ready to streamline your i e? iew your delivery sc e u e and account history,manage your
L (- payment options,pay your bill and much more with your own online account at water.com/myaccount. )J
3D356-P-0037
(��$44�0.65
Payment Total New Charges o Pay This Amount
0 $180.06 $339.50 r= $600.09
0 Write the complete account number on your check.Detach remittance and mail with payment in the enclosed envelope.To pay online go to WWW.HmckleySprings com 0
i
How to Read Your Statement Important Monthly Promotions:
U-9DO- Daces We Deliver! 5U�"� Register online for access to your
Delivery Calendar: M°a'°°' M—Y6 A-11
3 n--I ,- z account.You can view and pay your bill,
ry
Your scheduled deliveries for "° " "°°'"'° """;' �� °nSt—, n.�
.1 m21.; check delivery schedule and order
the next three months. "' "'" products all online.
Customer Account Number:
For prompt service,please use this - Bottle Deposits:
number when referring to your account. "" ' . °° Po Highlights bottle deposits and returns.
.—,—,°,a Easy to Pay:
Pay your invoice through the mail,online at
Summary: www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
O_O+O_O �oo
Total New Charges:
This information provides totals for sz .m °o°" „gym Mail Remittance With Payment To:
various products and transactions. =---se ,�:° ppm Please detach remittance and mail
❑�, �- ❑; p„a� $ using business envelope provided.
P.rP—T.,
Important Monthly Message
Billing Rights Summary Electronic Funds Transfer Notice
In case of Errors or Questions About Your Bill: If you pay by check,it will be converted into an"Electronic Funds Transfer"
If you think your bill is incorrect,or if you need more information about a (EFT),a process in which your financial institution is electronically instructed to
transaction on your bill,write us as soon as possible on a separate sheet,at transfer funds from your account to ours in lieu of processing the check.By
P.O.Box 660579,Dallas,TX 75266-0579.We must hear from you no later sending your completed check to us,you authorize us to use the account
than 60 days after we sent you the first bill on which the error or problem information therein to create an EFT for the amount indicated on the check. If
appeared.Your bill shall be deemed correct unless disputed within 60 days the EFT cannot be processed for technical or other reasons,you authorize us
from receipt.You can telephone us,but doing so will not preserve your rights. to process an image replacement document,draft,or copy of your check.
In your letter,give us the following information: OPT OUT NOTICE:If you do not wish to participate in this check conversion
program,please write to us on a separate sheet at:
• Your name and complete account number. P.O.Box 660579, Dallas,TX 75266-0579.
• The dollar amount of the suspected error.
• Describe the error and explain why you believe there is an error. If you need Insufficient Funds Notice
more information,describe the item you are unsure about.
If your check is returned for insufficient or uncollected funds(NSF),your signature
You do not have to pay any amount in question while we are investigating,but on your check gives us permission to debit your checking account electronically
you are still obligated to a the amount of our bill that is not in question.While for the uncollected amount.Payment by check constitutes your acceptance of
Y 9 pay Y q these terms.
we investigate your questions,we cannot report you as delinquent or take any ,
action to collect the amount you question.
We appreciate your business.
As a food product,bottled water is subject to rules and regulations promulgated by the Federal Food and Drug Administration(FDA).
For further information,please write DS Waters of America,Inc.at P.O.Box 660579,Dallas,TX 75266-0579.
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
131130
HINCKLEY SPRINGS Purchase Order No.
PO BOX 660579 Terms
DALLAS, TX 75266-0579 Due Date 2/18/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/18/2014 1255318602( $339.50
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
Date ficer
VOUCHER # 137398 WARRANT # ALLOWED
131130 IN SUM OF $
HINCKLEY SPRINGS
PO BOX 660579 i
DALLAS, TX 75266-0579
I
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
12553186020 01-7202-05 $339.50
i
Voucher Total $339.50
Cost distribution ledger classification if
claim paid under vehicle highway fund
f