244500 04/21/15 �y�r..44N:M
r:; t� CITY OF CARMEL, INDIANA VENDOR: 131130
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $""""'630.18'
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CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 244500
9M7rbe- � DALLAS TX 75266-0579 CHECK DATE: 04/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 12553186040 630.18 OTHER EXPENSES
1-800-4-WATERS(1-800-492-8377) www.kincklevSr)rings.com
Upcoming Delivery Dates Hinckley V�xp
April May June
Springs We Deliver!
Bottled Water• Filtration • Coffee
Thursday, 16 Thursday, 14 Thursday, 11 No fooling,April is all about cooling down with Sqwincher
Thursday, 30 Thursday,28 Thursday,25 Sqweeze Pops.A variety of flavors help to hydrate and
replace electrolytes when you need it most.And for a
limited time,you can get 4 bags for$10!
Ask your Route Sales Rep for details.
Customer Account#: 172094612553186
TARA WASHINGTON Invoice Date: 04-04-15
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice#: 12553186 040415
INDIANAPOLIS IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 1,083.52
03-11-15 P242535 Payment-Check-242535-Thank You -511.05
04-01-15 P243229 Payment-Check-243229-Thank You -572.47
Remaining Balance 0.00
R1507810140866 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.99 9.99
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 11.25 11.25
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
Total 74.71
03-19-15 T150783043051 HINCKLEY SPRINGS 5G DRINKING WATER 8.0 9,99 79.92
HINCKLEY SPRINGS 5G DISTILLED WATER 12.0 9.99 119.88
CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 23.0 3.89 89.47
5.0 GALLON BOTTLE DEPOSIT 12.0 6.00 72.00
5.0 GALLON BOTTLE RETURN -20.0 6.00 -120.00
5.0 GALLON BOTTLE DEPOSIT 8.0 6.00 48.00
ENERGY SURCHARGE 1.0 2.47 2.47
Total 291.74
Rec'd By:Not Available or Refused
04-02-15 T150923043052 HINCKLEY SPRINGS 5G DRINKING WATER 13.0 9.99 129.87
HINCKLEY SPRINGS 5G DISTILLED WATER 14.0 9.99 139.86
5.0 GALLON BOTTLE DEPOSIT 13.0 6.00 78.00
5.0 GALLON BOTTLE DEPOSIT 14.0 6.00 84.00
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.
30356-P-0038
Previous Balance CPayment DTotal New Charges _ Pay T�Amount$1,083.52 $1,083.52 $630.18 $
V Write the complete account number on your check.Detach remittance and mail with payment in the enclosed envelope.To pay online go to www.HinckleySprings.com�7
How to Read Your Statement 0-w 5 Important Monthly Promotions:
upmming Delivery Dates we D.Wetl S--Z Register online for access to your
Delivery Calendar: '"°"°°' M"lye+M M"'"a'3�' �E.b°w e..,ma��Ew account.You can view and pay your bill,
m�ayy eea y "
Do aay s� m,p check delivery schedule and order
Your scheduled deliveries for R „„ "�°,,z.,�e,
the next three months. products all online.
Customer Account Number: ”" Bottle Deposits'
For prompt service,please use this , Highlights bottle deposits and returns.
number when referring to your account. .e.a.a e. a
,aa 0 W 11. Easy to Pay:
Pay your invoice through the mail,online at
Summary. „w., www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill. Ft�
�• DISCOVER N
Total New Charges: 1. me.
This information provides totals for °- Mail Remittance With Payment To:,
various products and transactions. ZPlease detach remittance and mail
❑m ;� ❑ S using business envelope provided.
ILIIdIIdLII11I1IIIIIILL,Ill fDall Remn,aece wnn r.y—,roil
__.Important Monthly Message _ __ IL..LLL,ISI,IL..ll.plelllull,ullu �____
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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 a on your check gives us permission to debit your checking account electronically
you are still obligated to a the amount of our bill that is not in question.While for the uncollected amount. Payment by check constitutes your acceptance of
y g pay y q 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
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VOUCHER # 155341 WARRANT # ALLOWED
I
IN SUM OF $
131130
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266-0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
j Board members
PO# INV# ACCT# AMOUNT i Audit Trail Code
12553186040• 01-7202-05 $630.18
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Voucher Total $630.18
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Cost distribution ledger classification if Q
claim paid under vehicle highway fund ;I
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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 j Purchase Order No.
PO BOX 660579 Terms
DALLAS, TX 75266-0579 r Due Date 4/15/2015
i
Invoice Invoice Description
Date Number (or note attached i�nvoice(s) or bill(s)) Amount
I
4/15/2015 1255318604( ; $630.18
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I hereby certify that the attached invoice(s), or bill(s) is (are)true and
correct and I have audited same in accordance with IC15-11-10-1.6
Date E Officer