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181241 01/13/2010 a "N CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS 1; �i+ CARMEL, INDIANA 46032 Po BOX 660579 CHECK AMOUNT: $594.85 .7*, DALLAS TX 75266 -0579 CHECK NUMBER: 181241 CHECK DATE: 1/13/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 12091720946 594.85 MATERIALS SUPPLIES o0-a_ IERS_(_4.92= 8.3.7-7-} www.HinckleySprings.com Upcoming Delivery Dates Hinckley December January February Spnits; Bottled Wa ter Filtration Coffee Thursday, 31 Thursday, 14 Thursday, 11 Help us make a difference in the fight against breast Thursday, 28 Thursday, 25 cancer. Now through December 31, 2009, when you refer your friends or family to start new service with any one of our Komen Budget Plans, well donate $30 to Susan G. Korhen for J the Cure. Visit Water.com/KomepReferral_to.day!', J Customer Account 17209463083945 JOE ACCOUNTS PAYABLE Invoice Date: 12 -19 -09 CITY OF CARMEL UTILITIES 9609 HAZEL DELL PKWY Invoice 1209 1720946 3083945 INDIANAPOLIS, IN 46280 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 622.27 Payment 0.00 Remaining Balance 622.27 R093371797710 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50 12 -03 -09 T093373042001 HINCKLEY SPRINGS 5G DRINK NON -SPILL 6.0 9.49 56.94 HINCKLEY 5.OG DISTILLED NON SPILL 21.0 9.99 209.79 5.0 GAL BOTTLE RETURN -27.0 6.00 162.00 5.0 GAL BOTTLE DEPOSIT 21.0 6.00 126.00 5.0 GAL BOTTLE DEPOSIT 6.0 6.00 36.00 Recd By: Not Available or Refused 12 -17 -09 TO93513042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 7.0 9.49 66.43 HINCKLEY 5.0G DISTILLED NON SPILL 21.0 9.99 209.79 CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 3.0 2.99 8.97 5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00 5.0 GAL BOTTLE RETURN -28.0 6.00 168.00 5.0 GAL BOTTLE DEPOSIT 21.0 6.00 126.00 Rec'd By: Not Available or Refused 12 -17 -09 47905484 ENERGY SURCHARGE 1.0 1.93 1.93 Managing your account is now at your fingertips. Take advantage of many time saving options available on water.com. Save paper when you sign up for elnvoice, order additional C products, check youur_next_delivety.,.pay_y. our_ bilLand .much_more._Log_on_today! J 30356 -F -0035 Previous Balance C $622.27 o C Payment Total New Charges Pay This Amount $0.00 u C $594.85 $1,217.12 g lMnte the complete.aocount•numberon your•check Detach remiHan and mail wit in th e enclosed envelope.- To;pay online ;goto- www:NinckleySprings:com UStom Accoudl# i a r, �sF�"�' _„�'''�',1: t 209463083945, et6i N l ff d 7. 0 lnvaice 4 946 3©839451" ,;Date Total New Charges 594.85 M1091219_BM10- 12023 000000607 Page 2 of 2 VOUCHER 097044 WARRANT 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 12091720946 01- 7202 -05 $594.85 Voucher Total $594.85 Cost distribution ledger classification if claim paid under vehicle highway fo o a /(200 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 12/30/2009 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/30/200! 1209172094E $594.85 hereby certify that the attached invoice(s), or bill(s) is (are) true and Drrect and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Officer