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248370 08/1 2/1 5 CITY OF CARMEL, INDIANA VENDOR: 131130 CHECK AMOUNT: $***""**653.89" ONE CIVIC SQUARE HINCKLEY SPRINGS CARMEL, INDIANA 46032 PO BOX 660579 CHECK NUMBER: 248370 4v�'i9nei- ?' DALLAS TX 75266-0579 CHECK DATE: 08/12/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 506 4239099 43.63 CORRECTION 651 5023990 -43.63 OTHER EXPENSES 651 5023990 12553186072 653.89 OTHER EXPENSES 1-800-4-WATERS 1-800-492-8377 www,.Hinc1kIey6Rr ings. m Upcoming Delivery Dates Hmkiey JqTAMW.. Springs We Deliver! tJ August September October Bottled Water• Filtration • Coffee Thursday, 6 Thursday,3 Thursday, 1 Beat the summer heat with cool and tasty Sqwincher Thursday,20 Thursday, 17 Thursday, 15 Squeeze Pops. Chill out with a variety of cool flavors Thursday,29 that taste great and help replace lost electrolytes.And all July long,you can get 4 bags for$10-ten pops per bag, two of each flavor!Ask your Route Sales Rep for details. Customer Account#: 172094612553186 TARA WASHINGTON Invoice Date: 07-25-15 CITY OF CARMEL UTILITIES Invoice M 12553186 072515 9609 HAZEL DELL PKWY INDIANAPOLIS , IN 46280 Purchase Order M Date Transaction# Details Qty. Each Amount Previous Balance 1,182.63 06-29-15 P246345 Payment-Check-246345-Thank You -554.12 Remaining Balance 628.51 R1519010140866 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 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 07-09-15 T151903043052 HINCKLEY SPRINGS 5G DRINKING WATER 9.0 9.99 89.91 HINCKLEY SPRINGS 5G DISTILLED WATER 12.0 9.99 119.88 CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 20.0 3.89 77.80 5.0 GALLON BOTTLE RETURN -21.0 6.00 -126.00 5.0 GALLON BOTTLE DEPOSIT 12.0 6.00 72.00 5.0 GALLON BOTTLE DEPOSIT 9.0 6.00 54.00 ENERGY SURCHARGE 1.0 2.41 2.41 Total 290.00 Rec'd By:Not Available or Refused 07-23-15 T152043043033 HINCKLEY SPRINGS 5G DRINKING WATER 10.0 9.99 99.90 HINCKLEY SPRINGS 5G DISTILLED WATER 17.0 9.99 169.83 CUP PLASTIC FLAT 9 OZ MULTI BRAND 50 CT 5.0 3.89 19.45 5.0 GALLON BOTTLE DEPOSIT 10.0 6.00 60.00 5.0 GALLON BOTTLE RETURN -27.0 6.00 -162.00 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 CPrevious Balance Payment C�Tbt�a[New Charges Ca7y This Amount $1,182.63 C $554.12 3.89 1,282.40 OWrite the complete account number on our check.Detach remittance and mail_with- a merit in the_enclosed envelo To. a online.go to,www.Hinckle rin s.com How to Read Your Statement Important Monthly Promotions: We Deliver) UpcoMng Delivery Dates - V V Register online for access to your '�_' J—8009 my 2M �" Delivery Calendar: ,. 3°°' �.. sem.wD mow, account.You can view and pay your bill, Your scheduled deliveries for """" ;; �° '�`�°'" delivery"R�.roR" ,,... check delive schedule and order the next three months. products all online. Customer Account Number: v- ...w Bottle Deposits: For prompt service,please use this Highlights bottle deposits and returns. number when referring to your account. w"."a" .. Easy to Pay: " � �M Pay your invoice through the mail,online at Summary: ,�a www.water.com or call us to expedite your Previous balance and posted remittance with automatic credit card payments since last bill. payments �`��oIfCUVER awaux J -moi -O Total New Charges: This information provides totals for "q Mail Remittance With Payment To: various products and transactions. =- ^: Please detach remittance and mail ❑e�� ❑ - -„�© s using business envelope provided. IIIII„IIIIIIIIIIIIII,I„IIII„II r a.n R.mR,....wo R.,-1 r.:1 -- --- Important-Monthly-Message------- - mportant-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 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 # 156029 WARRANT # ALLOWED 131130 IN SUM OF $ HINCKLEY SPRINGS PO BOX 660579 DALLAS, TX 75266-0579 r Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR I Board members PO# INV# ACCT# AMOUNT Audit Trail Code 12553186072 01-7202-05 $653.89 I `1 Voucher Total $653.89 Cost distribution ledger classification if claim paid under vehicle highway fund 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 i Purchase Order No. PO BOX 660579 Terms DALLAS, TX 75266-0579 Due Date 8/5/2015 i Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/5/2015 1255318607 1 $653.89 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