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Home My WebLink About194218 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $216.53 CARMEL, INDIANA 46032 PO BOX 660579 DALLAS TX 75266 -0579 CHECK NUMBER: 194218 CHECK DATE: 2/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 30839450115 216.53 MATERIALS SUPPLIES 1- 800 -4- WATERS 492 -8377 www.HinckleySprings.com Upcoming Delivery Dates efvrl. Hincklit.a.vire we January February March 5prings:, Bottled Water Filtration Coffee Thursday, 27 Thursday, 10 Thursday, 10 Put a smile on your employees' faces by starting your Thursday, 24 Thursday, 24 office coffee service. From single -serve coffee machines to energy saving commercial brewers, we will provide you with the perfect selection of products to brew the perfect cup. Callus today! Customer Account 17209463083945 JOE ACCOUNTS PAYABLE Invoice Date: 01 -15 -11 CITY OF CARMEL UTILITIES Invoice 3083945 011511 9609 HAZEL DELL PKWY INDIANAPOLIS, IN 46280 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 407.35 12 -24 -10 P192463 Payment Check 192463 Thank You 276.88 Remaining Balance 130.47 R103641797710 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00 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 12 -30 -10 T103643042003 HINCKLEY SPRINGS 5G DRINK NON -SPILL 5.0 9.99 49.95 CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 14.0 3.29 46.06 5.0 GAL BOTTLE RETURN -4.0 6.00 -24.00 5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00 01 -13 -11 T110133042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 7.0 9.99 69.93 5.0 GAL BOTTLE RETURN -7.0 6.00 -42.00 5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00 Rec'd By: Not Available or Refused 01 -13 -11 59868153 ENERGY SURCHARGE 1.0 2.09 2.09 Total New Charges 216.53 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 products, check your next delivery a our bill and much more. Log on today[ 3W56 -P -0034 Previous Balance Payment Total New Charges =PayThis mount 07.35 $276.88 $216.53 00 Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www.HinckleySprings.com How to Read Your Statement =••aw. =Eas °w mm Important Monthly Promotions: °a °m we Derived Register online for access to your Delivery Calendar: ty9 Au•„ WS mq account. You can view and pay your bill, Your scheduled deliveries for M° s check delivery schedule and order the next three months. products all online. Customer Account Number: w' Bottle Deposits: For prompt service, please use this number when referring to your account. Highlights bottle deposits and returns. "LL m„ "�,o., 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. m° 2 Total New Charges:'a This information provides totals for Mail Remittance With Payment To: various products and transactions. Please detach remittance and mail mom Nti n e j using business envelope provided. Important Monthly MessageE 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 You do not have to pay any amount in question while we are investigating, but on your check gives us permission to debit your checking account electronically you are still obligated to a the amount of our bill that is not in question. While for the uncollected amount. Payment by check constitutes your acceptance of y g pay y q 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 106961 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 30839450115 01- 7202 -05 $216.53 Voucher Total $216.53 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 property 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 1/2512011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/25/2011 3083945011,` $216.53 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 e