187854 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $712.47
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 187854
CHECK DATE: 7121/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 06101722004 65.53 OTHER MISCELLANOUS
651 5023990 17209463083 646.94 7202
r�
1- 800-4- WATERS (492 -8377) www.Hinckle S rin s.com
Upcoming Delivery Dates l
July August September in
ri B ottled Water Filtr ation Coffee
Thursday, 8 Thursday, 5 Thursday, 2 Finding your next scheduled delivery day just got easier!
Thursday, 22 Thursday, 19 Thursday, 16 Go to My Account at water.com and log in or register for
Thursday, 30 Self Service. Click on Printable Calendar to view and
print your 2010 Delivery Calendar online.
Customer Account 17220042677859
KIM ROTT Invoice Date: 06 26 10
CARMEL CITY COURT Invoice 0610 1722004 2677859
1 CIVIC SQ
CARMEL, IN 46032 Purchase Order M
Date Transaction Details Qty. Each Amount
Previous Balance 39.88
Payment 0.00
Remaining Balance 39.88
R101522494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50
06 -10 -10 T101613042007 HINCKLEY SPRINGS 5G DRINK NON -SPILL 3.0 9.99 29.97
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
5.0 GAL BOTTLE RETURN -3.0 6.00 -18.00
Rec'd By: Not Available or Refused
06 -24 -10 T101753042006 HINCKLEY SPRINGS 5G DRINK NON -SPILL 2.0 9.99 19.98'
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
06 -24 -10 53509754 ENERGY SURCHARGE 1.0 2.08 2.08
Total New Charges 65.53
*A reminder that your invoice shows a previous unpaid balance. Please remit payment by mail, online at water.com, or
call Customer Service at 1- 800 -492 -8377. If payment has been sent, we Thank You!
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 einvoice, order additional
products, check your next delivery, pay your bill and much more. Log on todayl
30355 -P -0034
Previous Balance Payment otal New Cha es Pay This Amount
$39.88 $0.00 $65.53 $105.41
O Write the compl accou numberon yo check. D etach remittance and mail with payment in close .en elope. To pay online go to ww
How to Read Your Statement 1 -0 WATER3 Important Monthly Promotions:
aom °9�1VP �d1P5 we Deliver! Register online for access to yore
Delivery Calendar: :;a M M Z �3 �p °.�aFe� account. You can view and pay your bill,
Your scheduled deliveries for Ma;; gym„ check delivery schedule and order
the next three months. products all online.
Customer Account Number: a
For prompt service, please use this Bottle Deposits:
number when referring to your account. .m N E s R'„° as u Highlights bottle deposits and returns.
Easy to Pay:
Pay your invoice through the mail, online at
Summary: N www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill. dW b� °,z� o -ER
Total New Charges: aM.
This information provides totals for Mail Remittance With Payment To:
various products and transactions. E,a -A Please detach remittance and mail
using business envelope provided.
ILLIIJJ,I II LII,.,I JAI IL L.1.161IJI .-1 Remount„ Won Pe —T °a
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 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.
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.
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
,d 76 266— c Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) n
75 Q a2 Co 7 e
�7
,.Ob'
Total
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.
ALLOWED 20
A IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
&JL4
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
O jqo 6T 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
I JA 0
i
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1- 800-4- WATERS 492 -8377 www.HinckleySprings.com
Upcoming Delivery Dates s h y er,
July Au ust September inckle
Bottled Water Filtration Coffee
Thursday, 15 Thursday, 12 Thursday, 9 Finding your next scheduled delivery day just got easier!
Thursday, 29 Thursday, 26 Thursday, 23 Go to My Account at water.com and log in or register for
Self Service. Click on Printable Calendar to view and
print your 2010 Delivery Calendar online.
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice pate: 07 -03 -10
CITY OF CARMEL UTILITIES Invoice 0710 1720946 3083945
9609 HAZEL DELL PKWY Purchase Order
INDIANAPOLIS, IN 46280
Date Transaction Details Qty. Each Amount
Previous Balance 1,314.49
06 -11 -10 P185778 Payment Check 185778 Thank You 620.57
Remaining Balance 693.92
06 -17 -10 T101683042002 HINCKLEY SPRINGS 5G DRINK NON -SPILL 8.0 9.99 79.92
HINCKLEY 5.OG DISTILLED NON SPILL 18.0 10.49 188.82
5.0 GAL BOTTLE RETURN -26.0 6.00 156.00
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
5.0 GAL BOTTLE DEPOSIT 18.0 6.00 108.00
Rec'd By: Not Available or Refused
R101681797710 WHITE ROOM TEMP AND COLD COOLER RENTAL. 1.0 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
07 -01 -10 53814791 ENERGY SURCHARGE 1.0 2.08 2.08
07 -01 -10 T101823042005 HINCKLEY SPRINGS 5G DRINK NON -SPILL 10.0 9.99 99.90
HINCKLEY 5.OG DISTILLED NON SPILL 18.0 10.49 188.82
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 10.0 3.29 32.90
5.0 GAL BOTTLE DEPOSIT 10.0 6.00 60.00
5.0 GAL BOTTLE DEPOSIT 18.0 6.00 108.00
5.0 GAL BOTTLE RETURN -26.0 6.00 156.00
Rec'd 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 einvoice, order additional
p roducts, check your next delivery, a our bill and much more. Log on toda l
30355 -P -0034
Previous Balance Payment Tot�Charges Pay This Amo unt $1,314.49 $620.57 $1,340.86
W ritethecompleteaccount number onyourcheck.. Detach- remittance_a nd.mailwith. payment. intheenclosedenvelope .To.pay_online.goto www,Hi1)ck1eySphngs.com17
How to Read Your Statement 1—TERS Important Monthly Promotions:
deliver! Register online for access to your
account. You can view and pay your bill,
Delivery Calendar:
Your scheduled deliveries for "a•�•� check delivery schedule and order
the next three months.
products all online.
Customer Account Number: Bottle Deposits
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account, m
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.
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
43- using business envelope provided.
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 9 9 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.
or credit card information below and check the appropriate b^,
MD e" x xh"'3,�,E,.rcd r;: °u e r' O �.wa.,»g�«::w+
Customer Account# y 17209463083945, 3��E�r� Invoice 0710 17209 "46 3083945
F, i. 4^ t 6n���i: R .y. 83 k b :i, :F�i.w ii M .s Ivm...n ',.i6 n yam tA�'s�AaL!r ".3+ .w, xi w, "w`ui
m :F _.�sxxa:,�„$ :iii€ x Y p
Oate �3 �eta�ls ;l �3
s EdCh Amount,e
Total New Charges 646.94
*A reminder that your invoice shows a previous unpaid balance. Please remit payment by mail, online at water.com, i ir
call Customer Service at 1 -800 492 -8377. If payment has been sent, we Thank Youl
M1100703_BM10- 10235 000001097 Page 2 of 2
VOUCHER 106842' WARRANT ALLOWED
131.130 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
17209463083 01- 7202 -05 $646.94
Voucher Total $646.94
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Ferm 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 7/15/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/15/2010 1720946308: $646.94
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