182869 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CHECK AMOUNT: $566.35
CARMEL, INDIANA 46032 PO BOX 660579
'c, Ego DALLAS TX 75266 -0579 CHECK NUMBER: 182869
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 021017209463 566.35 OTHER EXPENSES
1- 800 -4- WATERS (492 -8377) www.Hinckle S rin s.com
Upcoming Delivery Dates
February March April Springsf Bottled Water Filtration Coffee
Thursday, 25 Thursday, 11 Thursday, 8 Save time and money by adding coffee to your delivery
Thursday, 25 Thursday, 22 service! With several national brands and private roasts
available, we are sure to have the right blend to fit your
employees' needs. Call us to schedule an appointment with
one of our coffee specialists today.
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 02 -13 -10
CITY OF CARMEL UTILITIES Invoice 0210 1720946 3083945
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 1,216.19
01 -25 -10 P181241 Payment Check 181241 Thank You 594.85
Remaining Balance 621.34
R100281797710 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 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
01 -28 -10 T100283042002 HINCKLEY SPRINGS 5G DRINK NON -SPILL 5.0 9.49 47.45
HINCKLEY 5.OG DISTILLED NON SPILL 20.0 9.99 199.80
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 4.0 2 -99 11.96
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
5.0 GAL BOTTLE RETURN -25.0 6.00 150.00
5.0 GAL BOTTLE DEPOSIT 20.0 6.00 120.00
Rec'd By: Not Available or Refused
02 -11 -10 T100423042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 7.0 9.49 66.43
HINCKLEY 5.OG DISTILLED NON SPILL 18.0 9.99 179.82
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 6.0 2.99 17.94
5.0 GAL BOTTLE RETURN .-25,0 6.00 150.00
5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00
5.0 GAL BOTTLE DEPOSIT 18.0 6.00 108.00
Rec'd By: Not Available or Refused
02 -11 -10 49513138 ENERGY SURCHARGE 1.0 1.95 1.95
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30356 -P -0034
Previous Balance Payment Total New Charges Pay This Amount
$1,216.19 $594.85 $56fi.35 $1,187.69
Wr the complete account numbe on y our check. Detach remittan and mail with payment in the enclosed_ envelope. To pay online go to
How to Read Your Statement >,.ro° Important Monthly Promotions:
ax °m"p oerve,vwies We Daiver! Register online for access to your
A°9a# 3 009
account. You can view and pay your bill,
Delivery Calendar. M °s�, a P check delivery schedule and order
Your scheduled deliveries for
the next three months. products all online.
Customer Account Number:
For prompt service, please use this Bottle Deposits:
Highlights bottle deposits and returns.
number when referring to your account.
Easy to Pay:
Pay your invoice through the mail, online at
Summary: www.water.corn or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill o
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
using business envelope provided.
Important Monthly Message 111d 11
a.
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"
It 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
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.
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Customer,A': ount# 17209463083945 x 3ed
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Total New Charges 566.35
M1100213_BM10-8757-000001517 Page 2 of 2
VQUCHER 097364 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
1720946 30K 01- 7202 -05 $566.35
Voucher Total $566.35
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 r i
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 2/22/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/22/2010 1720946 308 $566.35
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 fficer