191231 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $55.50
DALLAS TX 75266 -0579
CHECK NUMBER: 191231
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 2677859 55.50 OTHER MISCELLANOUS
prings.com
1- 800-4- WATERS 492 -8377 www.HinckfeyS
Upcoming Delivery Dates
Hinckley
October November December S p rin g s- f` Bottled Water •Filtration
Thursday, 28 Thursday, 11 Thursday, 9 Help us make a difference in the fight against breast
Thursday, 23 cancer. From now through December 31st, 2010, for every
referred customer who starts new service with any Komen
Budget Plan, we will donate $30 to Susan G. Komen for the
Cure. Visit Water.com /KomenReferral today!
Customer Acdouht' 17220042677859
KIM ROTT Invoice Date: 10 -16 -10
CARMEL CITY COURT Invoice 2677859 101610
1 CIVIC SQ
CARMEL, IN 46032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 35.50
10 -08 -10 P190301 Payment Check 190301 Thank You -35.50
Remaining Balance 0.00
R102642494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50
09 -30 -10 T102733042006 HINCKLEY SPRINGS 5G DRINK NON -SPILL 3.0 9.99 29.97
5.0 GAL BOTTLE RETURN -3.0 6.00 -18.00
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
Recd By: Not Available or Refused
10 -14 -10 T102873042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 1.0 9.99 9.99
5.0 GAL BOTTLE RETURN -1.0 6.00 -6.00
5.0 GAL BOTTLE DEPOSIT 1.0 6.00 6.00
Recd By: Not Available or Refused
10 -14 -10 57074888 ENERGY SURCHARGE 1.0 2.04 2.04
Total New Charges 55.50
You can make a difference in the fight against Breast Cancer! DS Waters is continuing its support to
find a cure by adding Athena Waters to our family and making a contribution on EACH bottle of Athena
sold. Ask y our Route Sales Rep about purchasin a case of Athena or call us today at 800- 4- WATERSI
30356 -P -0035
Previous Balance c Payment ^i, Total New Charges Pay This Amount
$35.50 $35.50 $55.50 $55.50
0 Write the.complete.accountnumber_on, your, check ..Detach,remittance.and.mail with payment in the enclosed envelope To_ pay_ online.go_to_www.HinckleySpnngs com
How to Read Your Statement °Wm Important Monthly Promotions:
°m ^9 °e1ivefyOePS we Denver) A Register online for access to your
Delivery Calendar: account. You can view and pay your bill,
Moa.
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Your scheduled deliveries for check delivery schedule and order
M° ...a° s�°^° products all online.
the next three months.
Customer Account Number: Bottle Deposits
For prompt service, please use this
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.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 Mai] Remittance With Payment To:
various products and transactions. Please detach remittance and mail
❑rw; ❑;W using business envelope provided.
Important Monthly Message
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Prescribed by State 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
Purchase Order No.
Terms
as T Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
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
k 0,99 L .5 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 0
"i Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund