181933 02/03/2010 a c-1,„ CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $621.34
k /a CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 181933
CHECK DATE: 2/3 /2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 01101720946 621.34 OTHER EXPENSES
1- 800 -4- WATERS (492 -8377) www.HinckleySprings com 7.‘ '1 Upcoming Delivery Dates v 1
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January February March Bottled Water Filtration Coffee
Thursday, 28 Thursday, 11 Thursday, 11 For a complete list of all future delivery dates, you
Thursday, 25 Thursday, 25
can view your delivery schedule online by logging
into your account-at water.com today!
NOW, THAT'S CONVENIENT!
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Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 01 -16 -10
CITY OF CARMEL UTILITIES Invoice 0110 1720946 3083945
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 1,217.12
12 -21 -09 P180115 Payment Check 180115 Thank You 622.27
Remaining Balance 594.85
12 -31 -09 T093653042002 HINCKLEY SPRINGS 5G DRINK NON -SPILL 6.0 9.49 56.94
HINCKLEY 5.0G DISTILLED NON SPILL 26.0 9.99 259.74
5.0 GAL BOTTLE RETURN -32.0 6.00 192.00
5.0 GAL BOTTLE DEPOSIT 6.0 6.00 36.00
5.0 GAL BOTTLE DEPOSIT 26.0 6.00 156.00
R093651797710 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
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
01 -14 -10 T100143042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 6.0 9.49 56.94
HINCKLEY 5.0G DISTILLED NON SPILL 19.0 9.99 189.81
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 5.0 2.99 14.95
5.0 GAL BOTTLE DEPOSIT 19.0 6.00 114.00
5.0 GAL BOTTLE RETURN -25.0 6.00 150.00
5.0 GAL BOTTLE DEPOSIT 6.0 6.00 36.00
Recd By: Not Available or Refused
01 -14 -10 48704866 ENERGY SURCHARGE 1.0 1.96 1.96
Total New Charges 621.34
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options available on water.com. Save paper when you sign up for elnvoice, order additional
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30356 -P -0035
C Previous Balance Payment N l Total New Charges) C Pay This Amount
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$1,217.12 $622.27 J $621.34 $1,216.19
V w the.complete.account nurninnon. your. c etach. rernittanSg .and.maii.with.payment n the en d enut Inpo Tn. nav,online,ao to__ www HmrklevSorinas cam_
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How to Read Your Statement 1.800.DVATERS Important Monthly Promotions:
t Upcompng Del.eryDares We Deliver! Register online for access to your f!
Delivery Calendar: '"°`no, 0.,1`'rs°°' account. You can view and pay your bill," s
Your scheduled deliveries for °r" ep ,e� check delivery schedule and order
the next three months. products all online.
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Customer Account Number: ^z Ea 'N Bottle Deposits:
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account. -i
,t,,.�s ^.a ago Easy to Pay:
Pay your invoice through the mail, onlinetat
Summary: z: www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill. P. i o. �47,71 Epl.=
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Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. r� °�,=w Please detach remittance and mail
12==.?: ..'7.:;.:=.';; r: using business envelope provided.
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Important Monthly Message „r,...,.
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:
o Your name and complete account number. P.O. Box 660579, Dallas, TX 75266 -0579.
o The dollar amount of the suspected error.
o 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
on your check gives us permission to debit your checking account electronically
You do not have to pay any amount in question while we are investigating, but for the uncollected amount. Payment by check constitutes your acceptance of
you are still obligated to pay the amount of your bill that is not in question. While 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 Waters of America, Inc. at P.O. Box 660579, Dallas, TX 75266 -0579.
VOUCHER 097158 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
01101720946 01- 7202 -05 $621.34
Voucher Total $621.34
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 k .:a.'
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 1/25/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/25/2010 0110172094E $621.34
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
L
Date Officer