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235116 07/22/14 �,qMf� CITY OF CARMEL, INDIANA VENDOR: 131130 v. \ ******R x .�� ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $ 533.67 ;. l CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 235116 9M�___.„/, DALLAS TX 75266-0579 CHECK DATE: 07/22/14 �roN�°' DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 12553186062 533.67 OTHER EXPENSES 1-800-4-WATERS - - - Upcoming Delivery Dates Hinckley 6UMA%Springs We Deliver! July August September Bottled Water• Filtration • Coffee Thursday, 10 Thursday, 7 Thursday,4 It's summertime-sunshine, blue skies,tropical climates Thursday,24 Thursday,21 Thursday, 18 and...Fiji bottled water!This month buy three 6-packs 500mL bottles and get one FREE!*Ask your RSR for details and for other great offers on Fiji products. Chill out and et Fi'i toda ! *$7.99 Customer Account#: 172094612553186 DAVE DYE Invoice Date: 06-28-14 CITY OF CARMEL UTILITIES Invoice#: 12553186 062814 9609 HAZEL DELL PKWY Purchase Order#: INDIANAPOLIS, IN 46280 Date Transaction# Details Qty. Each Amount Previous Balance 1,146.89 06-23-14 P233252 Payment-Check-233252-Thank You -483.86 Remaining Balance V i I O'b 663.03 06-12-14 T141633043037 HINCKLEY SPRINGS 5G DRINKING WATER 10.0 9.99 99.90 HINCKLEY SPRINGS 5G DISTILLED WATER 4.0 8.99 35.96 5.0 GALLON BOTTLE DEPOSIT 10.0 6.00 60.00 5.0 GALLON BOTTLE RETURN -24.0 6.00 -144.00 5.0 GALLON BOTTLE DEPOSIT 4.0 6.00 24.00 ENERGY SURCHARGE 1.0 3.14 3.14 Total 79.00 Rec'd By:Not Available or Refused R1416310140866 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 Total 74.71 06-26-14 T141773043050 HINCKLEY SPRINGS 5G DRINKING WATER 15.0 9.99 149.85 HINCKLEY SPRINGS 5G DISTILLED WATER 23.0 8.99 206.77 CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 6.0 3.89 23.34 5.0 GALLON BOTTLE DEPOSIT 15.0 6.00 90.00 5.0 GALLON BOTTLE RETURN -38.0 6.00 -228.00 5.0 GALLON BOTTLE DEPOSIT 23.0 6.00 138.00 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-0036- Previous Balance Payment CTotal New Charges © Pay This Amount $1,146.89 $483.86 $533.67 1196.70 ©1Nrite_the complete.accountnumber.on.your_check-Detach.remittanceand mail.with pa_yment_ln the enclosed envelope:ro pay.online:go,.to�www.HinckleySprings-111 How to Read Your Statement Important Monthly Promotions: Upcoming Delivery Register online for access to your We Delivd ""'°°' °"" account.You can view and pay your bill, Delivery Calendar. laky M�may IbMry6 ��,6�„Rm.��;w„m Your scheduled deliveries for �°”""u """°"`° „�,,;,,; .6�.�y6�mm�aP,m°t�.ne check delivery schedule and order the next three months. products all online.- �°T°°•^� " Pm"I.— Customer I.—Customer Account Number: _ Bottle Deposits For prompt service,please use this Highlights bottle deposits and returns. number when referring to your account. an nn " Easy to Pay: RUM 1P°a` Pay your invoice through the mail,online at Summary: ,�a www.water.com or call us to expedite your Previous balance and posted remittance with automatic credit card payments payments since last bill. ymn�nmyr.wa..m,mmemiem mr.wn•e.unm°..Rw.)ae-yaniawnDISCOVER N.�IiMAN ----------------- _ EiR E66 Nt".n� � t,W � yen �e en 110oDo •,••• .w,mm nniuu®nmrCgg„2[ R�,Kyf,�lh�d ea¢Jy„ye R.�.gRr S;orlr sPwnn�rmng Total New Charges: This information provides totals for � �"" w°°:� Mail Remittance With Payment To: various products and transactions. ra mr p Please detach remittance and mail ❑�:� ❑fir=-,8 g" r _t(_'_,. p_� using business envelope provided. IlrrrlLlrrIrlIlrrIIILrrrlrLlrrIlIrrlrrllrLrLdl fano RnmiOnnee wan Payment Toil Important Month ly_Meosage— - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 t 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 • Your name and complete account number. program,please write to us on a separate sheet at: � 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. Vl/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 Services of America,Inc.at P.O.Box 660579,Dallas,TX 75266-0579 I Customer Account#:.172094612553186: - - Invoice M. .12553186 062814 ,Date Details Qty.: Each Amount Total 379.96 Rec'd By:Not Available or Refused Total New Charges 533.67 23 C1140628 BC10-143-000000407 Page 2 of 2 VOUCHER # 145053 WARRANT # ALLOWED 131130 IN SUM OF $ HINCKLEY SPRINGS PO BOX 660579 DALLAS, TX 75266-0579 i Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR i 1 Board members PO# INV# ACCT# AMOUNT Audit Trail Code 12553186062 01-7202-05 $533.67 i Voucher Total $533.67 Cost distribution ledger classification if claim paid under vehicle highway fund CA -71?Iy 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 7/15/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 7/15/2014 1255318606'9 $533.67 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and I have audited same in accordance �with .IpC 5-11-10-1.6 7//d/Y ^`�n�� Y-Yom.-,--g- Date Officer