238837 11/05/14 o
CITY OF CARMEL, INDIANA VENDOR: 131130
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECKAMOUNT: $`**"**594.70`
CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 238837
DALLAS TX 75266-0579 CHECK DATE: 11/05/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 12553186 594.70 172094612553186
1-800-4-WATERS 1-800-492-8377 ww
Upcoming Delivery Dates Hinckley 611MA%October November December
Springs We Deliver!
Bottled Water- Filtration - Coffee
Thursday, 30 Thursday,, Thursday, 11 October Special:Athena Buy 2 Get 1 Free! Now you can drink
Friday,21 Friday, 19 pink every day&save money with this refreshing special.
Buy 2 cases of Athena bottled water and get one FREE!*
Fight breast cancer with every bottle.*$7.99 per case.
Offer ends October 31,2014.
Customer Account#: 172094612553186
DAVE DYE Invoice Date: 10-18-14
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice#: 12553186 101874
INDIANAPOLIS IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 1,008.20
09-22-14 P236866 Payment-Check-236866-Thank You -545.15
Remaining Balance 463.05
10-02-14 T142753043051 HINCKLEY SPRINGS-5G DRINKING WATER 10.0 9.99 99.90
HINCKLEY SPRINGS 5G DISTILLED WATER 20.0 8.99 179.80
CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 5.0 3.89 19.45
5.0 GALLON BOTTLE RETURN -25.0 6.00 -150.00
5.0 GALLON BOTTLE DEPOSIT 20.0 6.00 120.00
5.0 GALLON BOTTLE DEPOSIT 10.0 6.00 60.00
ENERGY SURCHARGE 1.0 3.04 3.04
Total 332.19
Rec'd By:Not Available or Refused
R1427510140866 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
Total 74.71
10-16-14 T142893043022 HINCKLEY SPRINGS 5G DRINKING WATER 8.0 9.99 79.92
HINCKLEY SPRINGS 5G DISTILLED WATER 12,0 8.99 107.88
5.0 GALLON BOTTLE RETURN -20.0 6.00 -120.00
5.0 GALLON BOTTLE DEPOSIT 8.0 6.00 48.00
5.0 GALLON BOTTLE DEPOSIT 12.0 6.00 72.00
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.
30358-P-0038
Previous Balance Payment Total New Charges o Pay This Amount
$1,008.20 $545.15 $594.70 $1,057.75
®write the complete account numberodourcheck.petach.remittanceandmallwith,paymant in,the.enciosed.envelope.To,pay.online-go-to -HinckleySpdngs.ccm V
How to Read Your Statement Important Monthly Promotions:
Upcoming Delivery Dates �'' We Deliverl S° i Register online for access to your
M rye°°' M"°� " ""'°°' S°°"""'`"°e a`°"„ account.You can view and pay your bill,
Delivery Calendar. � rya �� ,�F�
cru ° I, �E s,,P°m,,,,,,,, check deliveryschedule and order
Your scheduled deliveries for M°°ry" roa„ 'Rv�I products all oline.
the next three months.
Customer Account Number: maws'^
__ Bottle Deposits:
For prompt service,please use this
Highlights bottle deposits and returns.
number when referring to your account.
,�,aa 1°, °� 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.
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Total New Charges:
This information provides totals for "^ Mail Remittance With Payment To:
various products and transactions. :"saw w
P Please detach remittance and mail
❑:„M ❑ ,„-„B ; using business envelope provided.
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---Important Monthly Py SSBge
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Billing Rights Summary Electronic Funds Transfer Notice
In case of Errors or Questions About Your Bill: 1 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 days1 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
VOUCHER # 145866 WARRANT # ALLOWED
131130 +, IN SUM OF $
HINCKLEY SPRINGS '
PO BOX 660579
DALLAS, TX 75266-0579
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Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
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PO# INV# ACCT# AMOUNT Audit Trail Code
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12553186101 01-7202-05 $594.70
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Voucher Total $594.70
Cost distribution ledger classification if
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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 10/30/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/30/201, 1255318610' i $594.70
i
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
Date Officer