184315 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
i, ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $43.43
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 184315
CHECK DATE: 4/1412010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 2677859 43.43 OTHER MISCELLANOUS
HINCKLEY SPRINGS WATER
800 444 -PURE
WATER.COM
ORIGINAL
CUSTOMER 1722004 TICKET 100773042005
LOCATION 2677868 PO
CARMEL CITY COURT Date: 0311812010 Time: 08:36:23 AM
1 CIVIC SO ROUTE #3042 DAVID
CARMEL, IN 46032
Last Payment Date: 0310512010 Last Payment Amuunt: 49.42
Product Delivered OTY PRICE AMOUNT($)
HS 5G OR NS 1 9.49 9.49
BOT S.OG PLS 1 6.00 6.00
BOT S.OG PLS -1 6.00 -6.00
(1 Buttles Delivered 1 Enpty Bottles Returned 0 Duttles Deposited)
Subtotal Sales 9.49
Sales Tax 0.00
DELIVERY TICKET TOTAL 9.49
Previous Account Balance 81.43
Total Balance Due 90.92
Payments 0.00
ENDING BALANCE 90.92
We bill monthly by summary Invoice
Retain for your records.
Next Delivery Date 04/0112010
We bill monthly by summary Invoice.
Retain for your records.
FEW a
HINCKLEY SPRINGS WATER
800-444-PURE
WATER.COM
OR CG I NAL
CUSTOMER 1722004 TICKET 100913042004
LOCATION 2677868 PO
CARMEL CITY COURT Date: 04/01/2010 Time: 08:24:25 AM
1 CIVIC SO ROUTE #3042 DAVID
CARMEL, IN 46032
Last Payment Dale: 03/24/2010 Last Payment Amount: 68.43
Product Delivered OTY PRICE AMOUNT($)
HS 5G OR NS 2 9.49 18.98
BOT 5.013 PLS 2 6.00 12.00
BOT 5.OG PLS -2 6.00 -12.00
(2 Bottles Delivered 2 Ew ty Bottles Returned 0 Bottles Deposited)
Subtotal Sales 18.98
Sales Tax 0.00
DELIVERY TICKET TOTAL 18.98
Previous Account Balance 22.44
Total Balance Due 41.47
Payments 0.00
ENDING BALANCE 41.47
We bill monthly by summary Invoice
Retain for your records.
Next Delivery Date 04/1512010
We bill monthly by summary Invoice.
Retain for your records.
1- 800 -4- WATERS 492 -8377 www.HinckleySl2rinas.co
Upcoming Delivery Dates 1►'� t
f 1►�
April May June 5pnngs,, Bottled Water Filtration Coffee
Thursday, 15 Thursday, 13 Thursday, 10 Stock up: As the weather starts heating up, make sure you
Thursday, 29 Thursday, 27 Thursday, 24 have As
of crisp, refreshing bottle water on hand.
From 3 or 5- gallon bottles to single -serve cases, we've
got what you need to help keep you cool all summer long.
NOW THAT'S REFRESHING!
Customer Account 17220042677859
KIM ROTT Invoice Date: 04 -03 -10
CARMEL CITY COURT
1 CIVIC SO Invoice 0410 1722004 2677859
CARMEL, IN 46032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 68.43
03 -24 -10 P183322 Payment Check 183322 Thank You -68.43
Remaining Balance 0.00
R100682494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
03 -18 -10 T100773042005 HINCKLEY SPRINGS 5G DRINK NON -SPILL 1.0 9.49 9.49"
5.0 GAL BOTTLE RETURN -1.0 6.00 -6.00
5.0 GAL BOTTLE DEPOSIT 1.0 6.00 6.00
04 -01 -10 T100913042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 2.0 9.49 18.98
5.0 GAL BOTTLE RETURN -2.0 6.00 -12.00
5.0 GAL BOTTLE DEPOSIT 2.0 6.00 12.00
Rec'd By: Not Available or Refused
04 -01 -10 50959555 ENERGY SURCHARGE 1.0 1.96 1.96'
Total New Charges 43.43
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 o ortuni to serve you and thank you for your continued business.
30358 -P -0034
Previous Balance Payment Total New Charges Pay This Amount
$68.43 $68.43 $43.43 $43.43
Write t he complete account number on your check. Detach remittance a_nd mail with payment in the enclosed envelope _T.o -pay- online- g n- to- www- Hinckle
How to Read Your Statement ERA Important Monthly Promotions:
-1111y °a,e, we Deliver! Register online for access to your
Maw �r9a„ 3� ^mow.,,,- F, °n
Delivery Calendar: °.a.°w account. You can view and pay your bill,
Your scheduled deliveries for M° „°:a 1,v
check delivery schedule and order
the next three months. products all online.
Customer Account Number: Bottle Deposits
'52
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account. s
s,�, o a 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. a w'�;y ra; m, o. .F,. •,��o Ea
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. ':E.auwm Please detach remittance and mail
e -Ds using business envelope provided.
n.• i., d,,, ni, in ..u,.n,,,bi,n.nd.d„ni,n.di r..n.mn.... wi,n n.vm. ",r °.r
Important 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 ive our letter, us the following information: OPT OUT NOTICE: If you do not wish to participate in this check conversion
y g g 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.
Prescribed by Slate Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
j gz:�� 11 Purchase Order No.
0 �4 to 1 Terms
0AL4, dAll ZJ266 "0 S 77 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total t41
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.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
A
ALLOWED 20
r
1 IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
3g D ,9 5 �3•'13 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
l
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund