183831 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $626.39
,.o CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 183831
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 0310720946 626.39 OTHER EXPENSES
1- 800 -4- WATERS 492 -8377 www.HinckleySprings.com
Upcoming Delivery Dates
H1�1 1 �1W we
March April May iprin5,; Bottled Water Filtration Coffee
Thursday, 25 Thursday, 8 Thursday, 6 Save time and money by adding coffee to your delivery
Thursday, 22 Thursday, 20 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: 03 13 10
CITY OF CARMEL UTILITIES Invoice 0310 1720946 3083945
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 1,187.69
02 -19 -10 P181933 Payment Check 181933 Thank You 621.34
Remaining Balance 566.35
R100561797710 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
02 -25 -10 T100563042002 HINCKLEY SPRINGS 5G DRINK NON -SPILL TO 9.49 66.43
HINCKLEY 5.OG DISTILLED NON SPILL 28.0 9.99 279.72
5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00
5.0 GAL BOTTLE DEPOSIT 28.0 6.00 168.00
5.0 GAL BOTTLE RETURN 35.0 6.00 210.00
Rec'd By: Not Available or Refused
03 -11 -10 T100703042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 5.0 9.49 47.45
HINCKLEY 5.OG DISTILLED NON SPILL 19.0 9.99 189.81
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
5.0 GAL BOTTLE DEPOSIT 19.0 6.00 114.00
5.0 GAL BOTTLE RETURN -24.0 6.00 144.00
Rec'd By: Not Available or Refused
03 -11 -10 50358795 ENERGY SURCHARGE 1.0 1.98 1.98
Total New Charges 626.39
Effective April 5th, 2010, there will be a price increase on some of our water
products, equipment rental, and cups from Hinckley Springs due to rising costs.
We appreciate the oeportunity to serve you and thank you for your continued business.
30355 -P -0034
Previous Balance Payment Total New Charges Pay This Amount
$1,187.69 $621.34 $fi26.39 $1,192.74
Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www_Hinckle& V
How to Read Your Statement »eR.- w.TERS a °Im °I „gym Important Monthly Promotions:
oaemmy oerve,voa,y: We Deliver! Register online for access to your
Delivery Calendar:. e: °9 :y3 soel.°w�„ F,I I account. You can view and pay your bill,
N z N °Rp
Your scheduled deliveries for ;a•m«�Pomp••� check delivery schedule and order
the next three months.
products all online.
Customer Account Number: Bottle Deposits:
For prompt service, please use this m M �ro1B A,n. Highlights bottle deposits and returns.
number when referring to your account. U N. „o m
"MIFT Easy to Pay:
Pay your invoice through the mail, online at
Summary: www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
r o,smn EmaRss
row i
Total New Charges:
This information provides totals for I= Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
d a e�, using business envelope provided.
IIII,I.,,I,IIIII. III.. .IIIIII..I..IIIIII °Nell Raml„anc, wl,n Raymen Teal
wew sum,
in wwsa,o••,
Important Monthly Message uuwmeae II..I dllI IL11 .III16.IIA.1...II JI.II
T 1-11
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
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 105129 WARRANT ALLOWED
R aiJ
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
Pb INV ACCT AMOUNT Audit Trail Code
03101720946 01- 7202 -05 $626.39
Voucher Total $626.39
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 Purchase Order No.
PO BOX 660579 Terms
DALLAS, TX 75266 -0579 Due Date 3/22/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/22/2010 0310172094( $626.39
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