233760 06/18/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 131130
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $*******663.03*
CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 233760
DALLAS TX 75266-0579 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 . 12553186053 663.03 OTHER EXPENSES
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Upcoming Delivery DatespRn
HISpCkgs we Deliver!
June July August Bottled Water• Filtration • Coffee
Thursday, 12 Thursday, 10 Thursday,7 Get grab n'go convenience with .51-individual bottles of
Thursday,26 Thursday,24 Thursday,21 water. No matter the activity, it's perfect size for your
busy schedule--whether slipping in a quick workout,taking a
walk around the block,eating lunch outside or just looking
for guick refreshment.Stock up on individual bottles toda !
Customer Account#: 172094612553186
DAVE DYE Invoice Date: 05-31-14
CITY OF CARMEL UTILITIES Invoice M 12553186 053114
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 1,132.73
05-09-14 P231707 Payment-Check-231707-Thank You -648.87
Remaining Balance 483.86
05-05-14 T141253043049 HINCKLEY SPRINGS 5G DISTILLED WATER 25.0 8.99 224.75
5.0 GALLON BOTTLE RETURN -19.0 6.00 -114.00
5.0 GALLON BOTTLE DEPOSIT 25.0 6.00 150.00
ENERGY SURCHARGE 1.0 3.18 3.18
Total 263.93
Recd By:Not Available or Refused
R1413510140866 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 9.99 9.99
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
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
Total 74.71
05-15-14 T141353043054 HINCKLEY SPRINGS 5G DRINKING WATER 10.0 9.99 99.90
HINCKLEY SPRINGS 5G DISTILLED WATER 4.0 8.99 35.96
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 8.0 3.89 31.12
5.0 GALLON BOTTLE DEPOSIT 4.0 6.00 24.00
5.0 GALLON BOTTLE DEPOSIT 10.0 6.00 60.00
5.0 GALLON BOTTLE RETURN -14.0 6.00 -84.00
Total 166.98
Rec'd By:Not Available or Refused
Ready to streamline your life? View your delivery schedule and account history,manage your
payment options,pay your bill and much more with your own online account at water.com/myaccount.
30356-P-0037
C7$1
ious Balance Payent Total New Charges o Pay This Amount
1.32.73 (_$64M8.87 $663.03 $1,746.89
Write,the-complete.accountnumbeton youucheck,Detach remittance and.mail.with.paymentin the enclosed envelope_To payonline;go-to-----www.Hinckle4ndnas.rom®
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How to Read Your Statement a°—p. I a� Important Monthly Promotions:
Upcoming Delivery Dates , We Deliverl peum z Register online for access to your
'"°"°°° "'„°°' „"�,�;°°' °"° account.You can view and pay your bill,
Delivery Calendar: M dzY6 ° ��% -
MorWaYll MonE•Y3° ":-y 17 rv°re.Nb°mhrsNrp Povm hxfwitN:•vW>rrY
Your scheduled deliveries fors = °P•em . check delivery schedule and order
°�»I "°� products all online.
the next three months.
col o 12— =C.Ord.-1111 112311117W
Customer Account Number: �. Y°° Bottle Deposits:
For prompt service,please use this µ° Highlights bottle deposits and returns.
number when referring to your account.
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. F°^�w��� - �^•^ n °� a��
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Total New Charges: "��� ` � ire' Aa".a�T... .
This information provides totals for a M-" An.,.o '" °op.°gym Mail Remittance With Payment To:
various products and transactions. =s : ¢m Please detach remittance and mail
❑� ; ❑ „ga® _ ;m-�-* using business envelope provided.
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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 pay the amount of your bill that is not in question.While for the uncollected amount.Payment by check constitutes your acceptance of
we investigate your questions,we cannot report you as delinquent or take any these terms.
action to collect the amount you question.
e 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.
-'Customer Account# 172094612553186 Invoice# 12553186 053114
-:Date =Details Qty Each Amount
05-29-14 T141493043064 HINCKLEY SPRINGS 5G DRINKING WATER 7.0 9.99 69.93
HINCKLEY SPRINGS 5G DISTILLED WATER 8.0 8.99 71.92
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 4.0 3.89 15.56
5.0 GALLON BOTTLE DEPOSIT 7.0 6.00 42.00
5.0 GALLON BOTTLE RETURN -15.0 6.00 -90.00
5.0 GALLON BOTTLE DEPOSIT 8.0 6.00 48.00
Total 157.41
Rec'd By:Not Available or Refused
Total New Charges 663.03
24
C1140531 BC10-123-000000396
Page 2 of 2
VOUCHER # 138206 WARRANT # ALLOWED
131130 IN SUM OF $
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266-0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR '
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
12553186053 01-7202-05 $663.03
i
I
Voucher Total $663.03
i
Cost distribution ledger classification if
claim paid under 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 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 6/11/2014
s
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
6/11/2014 1255318605; $663.03
f I
I 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
G/ia//�' C""�✓ —
Date Officer