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236404 08/27/14 CITY OF CARMEL, INDIANA VENDOR: 131130 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $"'""'"44.33" CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 236404 DALLAS TX 75266-0579 CHECK DATE: 08/27/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 44.33 2677859081614 1-800-4-WATERS(1-800-492-8377) www.HinckleySprings.co Upcoming Delivery Dates Hinckley. &MA%Springs We Deliver! August September October Bottled Water• Filtration •Coffee Thursday, 21 Thursday, 4 Thursday, 2 Put a little sparkle in your day! Now offering Ferrarelle- Thursday, 18 Thursday, 16 Italy's#1 Sparkling Water delivered to your door.Take Thursday, 30 advantage of this month's special pricing of 2 cases for just$39.99! Ask your RSR for details or order now and enjoy the crisp refreshing Ferrarelle Sparkling Water today!. Customer Account#: 17220042677859 PAM BAKER Invoice Date: 08-16-14 CARMEL CITY COURT Invoice#: 2677859 081614 1 CIVIC SQ CARMEL,IN 46032 Purchase Order#: Date Transaction# Details Qty. Each Amount Previous Balance 24.41 Payment 0.00 Remaining Balance 24.41 R1420310140050 EVEREST BLACK HOT AND COLD COOLER WITH CUP 1.0 11.25 -11.25 Total 11.25 07-24-14 T142053042051 HINCKLEY SPRINGS 5G DRINKING WATER 1.0 9.99 9.99 5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00 5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00 ENERGY SURCHARGE 1.0 3.11 3.11 Total 7.10 Rec'd By:Not Available or Refused 08-07-14 T142193042051 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98 5.0 GALLON BOTTLE RETURN -1.0 6.00 -6.00 5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00 Total 25.98 Rec'd By:Not Available or Refused ,Total New Charges 44.33 R ady to streamline your life? View your delivery schedule andjwrAunt history,manage your pay nt options,pay your bill and much more with your ow ine.a. ou at water.com/myaccount. 30356-P-0038 Previous Balance Payment Total New Charges Pay This Amount $24:41 $0.00 $44.33 $68.74 C7 Write the complete account number 1nyour check.Detach remittance and_mail_with payment in t nc pe.To pay online�o to www Hi ckle S nr� s com �w_q Y;_P 9 How to Read Your Statement a°�wA�a � I .»a�.� Important Monthly Promotions: Vpcominq DNivery Dates � • We Deliver) Register online for access to your �„`;�°° "'°s' "9""°°' �°"°"� � account.You can view and pay your bill, Delivery Calendar: �> �m.�as�a,�,.,r.m, Your scheduled deliveries for """" "° "�'"" delivery ae= .{. °;��, . check delive schedule and order ""�" products all online. the next three months. °°a,°za,,,°°,r Customer Account Number: Bottle Deposits: For prompt service,please use this Highlights bottle deposits and returns. number when referring to your account. °° °°'° "m " ° OVIM° ,m n 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. ^ may�OISCOYEN �,� �------ MP- -- r..a..law,winni...-------------- ,m.m.,mlwrt mvwlrr Cryzta!�., ro�iey Y,�h'0e,.�Fjav;6 nol.•wxr S;.nm s+nmu�"ewpi Total New Charges: a-•�• ° eq� This information provides totals for Mail Remittance With Payment To: various products and transactions. %= s �n Please detach remittance and mail ❑ :�: ❑�; ;®® SY, , E s using business envelope provided. B© IIIILIIIInIIIIAlI,II,IL,IILImp rano enmle.nce wlln P.,-T.1 -important.Monthly - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 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 Services of America,Inc.at P.O.Box 660579,Dallas,TX 75266-0579 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) 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. U U C) X fri ' g Terms �?ao_pq_s �X 7 Jr�66 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) — D Total 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 IN SUM OF $ P6 /3 I, s rX 75z6 ti $ g4. 33 ON ACCOUNT OF APPROPRIATION FOR i Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or # bill(s) is (are) true and correct and that the 0� ilo/ a39v: `7`¢,33' materials or services itemized thereon for which charge is made were ordered and received except OEN 20 Si re Cost distribution ledger classification if e claim paid motor vehicle highway fund