184781 04/27/2010 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
0 CHECK AMOUNT: $644.31
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 184781
CHECK DATE: 4/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 04101720946 644.31 MATERIALS SUPPLIES
1-800-4-WATERS 492 -8377 www.HinckleySprings.com
Upcoming Delivery Dates r!
Hinckley We De
April May June Spnngs-,j
Bottled Water Filtration Coffee
Thursday, 22 Thursday, 6 Thursday, 3 Stock up: As the weather starts heating up, make sure you
Thursday, 20 Thursday, 17 have plenty 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 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 04 -10 -10
CITY OF CARMEL UTILITIES Invoice 0410 1720946 3083945
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 1,192.74
03 -22 -10 P182869 Payment Check 182869 Thank You 566.35
04 -07 -10 P183831 Payment Check 183831 Thank You 626.39
Remaining Balance 0.00
R1 00841 79771 0 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
03 -25 -10 T100843042002 HINCKLEY SPRINGS 5G DRINK NON -SPILL 8.0 9.49 75.92
HINCKLEY 5.0G DISTILLED NON SPILL 21.0 9.99 209.79
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 8.0 2.99 23.92
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
5.0 GAL BOTTLE RETURN -29.0 6.00 174.00
5.0 GAL BOTTLE DEPOSIT 21.0 6.00 126.00
Recd By: Not Available or Refused
04 -08 -10 51207625 ENERGY SURCHARGE 1.0 1.96 1.96
04 -08 -10 T100983042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 4.0 9.99 39.96
HINCKLEY 5.0G DISTILLED NON SPILL 24.0 10.49 251.76
5.0 GAL BOTTLE RETURN -28.0 6.00 168.00
5.0 GAL BOTTLE DEPOSIT 24.0 6.00 144.00
5.0 GAL BOTTLE DEPOSIT 4.0 6.00 24.00
Recd By: Not Available or Refused
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
p roducts, check your next delivery, a our bill and much more. Log on today!
30356 -P -0034
Previous Balance Payment Total New Charges o Pay This Amount
0
$1,192.74 $1,192.74 $644.31 $644.31
O Wdte .the.complete.accountnumberon_ y our_ check.. Detach. remittance. and. mail. with. pay mentin .the.enclosed.envelo pay online www.Hinekle 0
How to Read Your Statement Important Monthly Promotions:
uP—.y oeime,yoe,es We Deliver' Register online for access to your
Ivry zaaa a ^n ioos
Delivery Calendar: You can view and pay your bill,
M`�
Your scheduled deliveries for "°:�b check delivery schedule and order
products all online.
the next three months.
Customer Account Number:
For prompt service, please use this Bottle Deposits:
number when referring to your account. 'may °ro'° a Easy to Pay:
Highlights bottle deposits and returns.
,�,,.m, m
Pay your invoice through the mail, online at
Summary: www.wateccom or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.w
n� O
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
w
various products and transactions. .v Please detach remittance and mail
o� m p- 5 using business envelope provided.
II.., III„ 13JIdllllld,,li,ll,,.II, I,.I.II sMeu n.mmence wn" Peymem ion,
us,.�xsmcrr
Important Monthly Message L. ILIIIIIIII.III
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.
��r ^4 he appropriate box on reverse sill T':
R'.' :,s
Customer Account y1,7209463083945 �F�� ,Invoice£# 041A 1720946 3083945
.n; NN e ._s. a. ms�� e M 3
a m� r�A�.�,._ a
E Ag a a 3 u.?z B a� 1 Y'b
.Date .M v e r tt{ t':, OUnt
o Each Am
Total New Charges 644.31
M1100410_BM10- 8765 000001573 Page 2 of 2
VOUCHER 105278. :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
04101720946 01- 7202 -05 $644.31
Voucher Total $644.31
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 19951
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 4/19/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/19/2010 0410172094E $644.31
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