239275 11/19/14 oys�q
�� MF
v! �• CITY OF CARMEL, INDIANA VENDOR: 131130
(=® 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $********48.15*
CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 239275
DALLAS TX 75266-0579 CHECK DATE: 11/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 42677859 48.15 17220042677859
1-800-4-WATERS(1-800-492-8377) www.HinckleySprings.com
Upcoming Delivery Dates Hinckiey- &MA%
Springs We Deliver!
November December January Bottled Water• Filtration •Coffee
Thursday, 13 Thursday, 11 Thursday, 8 Fall is here and cozying up to the perfect cup of coffee
Wednesday, 26 Wednesday, 24 Thursday, 22 is easy with robust options available from Standard Coffee.
Brew up the perfect cup of joe at home or in the office
with Starbucks, Green Mountain Coffee, Peet's Coffee&
Tea, Javarama and more! Ask your RSR for details.
Customer Account#: 17220042677859
PAM BAKER - Invoice Date: 11-08-14
CARMEL CITY COURT Invoice#: 2677859 110814
1 CIVIC SQ
CARMEL,IN 46032 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 90.37
10-14-14 P237403 Payment-Check-237403-Thank You -46.07
Remaining Balance 44.30
R14287_10140050 EVEREST BLACK HOT AND COLD COOLER WITH CUP 1.0 11.25 11.25
Total 11.25
10-16-14 T142893042053 HINCKLEY SPRINGS 5G DRINKING WATER 1.0 9.99 9.99
CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 1.0 3.89 3.89
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 3.04 3.04
Total 16.92
Rec'd By:Not Available or Refused
10-30-14 T143033042050 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98
5-0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00
Total 19.98
Rec'd By:Not Available or Refused
Total New Charges 48.15
Ready to streamline your life? View your delivery schedule an a ou is ory,manage your
payment options,pay your bill and much more with your own online ccount at water.comlmyaccount.
30356-P-0038
Previous Balance Payment Total New Charges Pay This Amount
$90.37 $46.07 � $48.15 $92.45
V Write the complete account number on your check Detach remittance and all with payment in the enc ose erne ope. o pay online go to www. inc ey pnngs.com
How to Read Your Statement d00d-WATEPS a°I °...gym Important Monthly Promotions:
Upcoming Delivery Dates ;r We DeliverI g Register online for access to your
Delivery Calendar:
account.You can view and pay your bill,
Your scheduled deliveries for —q ""yl° Mme 17 .m s sa�"�a 9 �" check delivery schedule and order
the next three months. P
« � " roducts all online.
Customer Account Number: Bottle Deposits
For prompt service,please use this Highlights bottle deposits and returns.
number when referring to your account. 11 11
°� °
90.m Easy to Pay:
IT— Pay your invoice through the mail,online at
Summary: a Po www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
s.w,..+�•ul"...,x.....d.x�..�.sew..a�,.lw<.w..,m.., �oucovsrs
=v...,....G,.......-.m
,,m.m,AnIW(IEUIOAT Cly,72(�.,�i"Y`�xmy Y,e�lymd n.-¢Jy�PevnPr S;.nc sP+D-•t+�.'°"'g
Total New Charges:
This information provides totals for b """ °w°;,'...9 Mail Remittance With Payment To:
various products and transactions. mm Please detach remittance and mail
❑ �� ❑ ,„�® s using business envelope provided.
II..LIALIIIIIII.I,II,,,IILIIILIII 1-1 R—t—..Wim Payment Taal
la uux sMxEEr
_ 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
• 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.
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
SPSGS
Purchase,Order No.
PC) 15 v y Terms
Date Due
Invoice Invoice Description Amount
Date NumberC, (or note attached invoice(s) or bill(s))
Total If g/,
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.
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
INS $
PC) � -JOS CP Cr�O
ON ACCOUNT OF APPROPRIATION FOR
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
Ito ( materials or services itemized thereon for
i
which charge is made were ordered and
received except
I
20
I
itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund