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239999 12/09/14
�ot.Foxy Jy F. CITY OF CARMEL, INDIANA VENDOR: 131130 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $*******400.77* 9 �; CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 239999 M��roN�°' DALLAS TX 75266-0579 CHECK DATE: 12/09/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 12553186111 400.77 OTHER EXPENSES 1- . Upcoming Delivery Dates HInCKIey 8TAMA% Springs We Deliver! November December January . Bottled Water• Filtration • Coffee Friday,21 Thursday, 11: Thursday, 8 Fall is here and cozying up to the perfect cup of coffee Friday, 19 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& i --R for details Customer Account#: 172094612553186 DAVE DYE Invoice Date: 11-15-14 CITY OF CARMEL UTILITIES Invoice#: 12553186 111514 9609 HAZEL DELL PKWY INDIANAPOLIS IN 46280 Purchase Order#: Date Transaction# Details Qty. Each Amount Previous Balance 1,057.75 10-24-14 P237862 Payment-Check-237862-Thank You -463.05 Remaining Balance 594.70 10-30-14 T143033043065 HINCKLEY SPRINGS 5G DRINKING WATER 8.0 9.99 79.92 HINCKLEY SPRINGS 5G DISTILLED WATER 10.0 8.99 89.90 CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 15.0 3.89 58.35 5.0 GALLON BOTTLE DEPOSIT 10.0 6.00 60.00 5.0 GALLON BOTTLE RETURN -18.0 6.00 -108.00 5.0 GALLON BOTTLE DEPOSIT 8.0 6.00 48.00 ENERGY SURCHARGE 1.0 3.04 3.04 Total 231.21 Rec'd By: Not Available or Refused R1430310140866 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 11-13-14 T143173043025 HINCKLEY SPRINGS 5G DRINKING WATER 5.0 9.99 49.95 CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 10.0 3.89 38.90 5.0 GALLON BOTTLE DEPOSIT 5.0 6.00 30.00 5.0 GALLON BOTTLE RETURN 4.0 6.00 -24.00 Total 94.85 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-0038 Previous Balance Payment Total New Charges © Pay This Amount o . - C7 r--=,--- ritethexomolete•accountnumberanvourcheck:Detach:remittanceand�mailwith�oavmentlnthe-enclosed'envelopeTopaYoninego`to-www:.ince _pnngs:com_________ How to Read Your Statement 1400+WATERS D-1—w— Important Monthly Promotions: upcoming Deliveq Da:H We Deliverl s Register online for access to your lune 2M Jul,- A12W Delivery Calendar: f Mme° t e account.You can view and pay your bill, Your scheduled deliveries for .� _ �� � 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. "° °" °°° �a """° ° IN N . Easy to Pay: Pay your invoice through the mail,online at Summary: „tea www.water.com or call us to expedite your Previous balance and posted remittance with automatic credit card payments payments since last bill. DOm ����DISCOVER WPFSS a S,00W nvf100m ' Total New Charges: a"�ARRu.°U," ` ��°���r!`'ma s<MF This information prLtransactions. for °"PoT�,' Mail Remittance With Payment To: various products a � e„a; Please detach remittance and mail ❑=� w m ❑ ;; �� $ using business envelope provided. II..,III„,IIInllnllniII,IdIAI„IIILII t-1 R1111—ce Wlln P° --1 -- ImportanfiVionthl ^m��° �,as „Il la 1111 l lifnlill lrl� n — — --- ---_- . N. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 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 VOUCHER # 146107 WARRANT # i 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 12553186111 01-7202-05 $400.77 i I i Voucher Total $400.77 Cost distribution ledger classification if claim paid under vehicle highway fund I Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL j 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 � 1 0 13 13 , HINCKLEY SPRINGS Purchase Order No. PO BOX 660579 Terms DALLAS, TX 75266-0579 Due Date 12/3/2014 Invoice Invoice Description Date Number (or note attached i'nvoice(s) or bill(s)) Amount I i 12/3/2014 1255318611' $400.77 i 1 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