236866 09/10/14 r t_AA
*" CITY OF CARMEL, INDIANA VENDOR: 131130
® i ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: S"'"""'545.15'
s. a CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 023680664
DALLAS TX 75266-0579 CHECKDATE:
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 545.15 172094612553186
1-800-4-WATERS(1-800-492-8377) www-Hinrkh-3j1;prenq-.
Upcoming Delivery Dates Hinckley �T
Springs We Deliver!
September October November Bottled Water• Filtration • Coffee
Thursday, 4 Thursday,2 Thursday, 13 Put a little sparkle in your day! Now offering Ferrarelle-
Thursday, 18 Thursday, 16 Friday, 21 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
en'o the crisp refreshing Ferrarelle Sparkling Water today!
Customer Account#: 172094612553186
DAVE DYE Invoice Date: 08-23-14
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice#: 12553186 082314
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 1,138.74
08-11-14 P235116 Payment-Check-235116-Thank You -533.67
Remaining Balance 605.07
08-07-14 T142193043062 HINCKLEY SPRINGS 5G DISTILLED WATER 1.0 8.99 8.99
5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00
5.0 GALLON BOTTLE RETURN -1.0 6.00 -6.00
ENERGY SURCHARGE 1.0 3.11 3.11
Total 12.10
Rec'd By: Not Available or Refused
R1421910140866 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
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 11.25 11.25
Tota 1 74.71
08-19-14 T142313043037 HINCKLEY SPRINGS 5G DRINKING WATER 16.0 9.99 159.84
HINCKLEY SPRINGS 5G DISTILLED WATER 18.0 8.99 161.82
CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 30.0 3.89 116.70
5.0 GALLON BOTTLE DEPOSIT 18.0 6.00 108.00
5.0 GALLON BOTTLE RETURN -34.0 6.00 -204.00
5.0 GALLON BOTTLE DEPOSIT 16.0 6.00 96.00
Total 438.36
Rec'd By: Not Available or Refused 01. 7 a Da.v S
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30356-P-0038
Previous Balance Payment To�Charges Pay This Amount$1,138.74 $533.67 $1,150.22
OWrite the com tete account number-on, our-check..Detach.remittance.and.mail.with. a ment in.the.enclosed.enyeIo e.To. online o-to nn szom
P __ Y P Y P PaY 9� ySP 9
How to Read Your Statement Important Monthly Promotions:
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Delivery Calendar: =yl. �,� "" 11,2. =N•t•,-F'= •• . account.You can view and pay your bill,
°mmvo Sp.p x.wnN��F�.�•.
Your scheduled deliveries for """° M � `
A. o�„�x check delivery schedule and order
the next three months.
" "' products all online.
Customer Account Number: �N Bottle Deposits
For prompt service,please use this 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.
Total New Charges:
This information provides totals for ZMail Remittance With Payment To:
various products and transactions. s^�^a°�°�w b: Please detach remittance and mail
❑�� ❑�„� a�.� $ using business envelope provided.
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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.
e 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 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 9/3/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/3/2014 1255318608 $545.15
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
g/5/,-, � ��0.�"-
Date Officer
VOUCHER # 145426 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
12553186082 01-7202-05 $545.15
Voucher Total $545.15
Cost distribution ledger classification if
claim paid under vehicle highway fund