197663 05/26/2011 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $188.26
CARMEL, INDIANA 46032 PO BOX 660676
j or DALLAS TX 75266 -0579 CHECK NUMBER: 197663
CHECK DATE: 5/26/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 30839450507 188.26 OTHER EXPENSES
1- 800-4- WATERS (492-83771 www.HincklaySprings com
Upcoming Delivery Dates ear
May June July Sprrngs
Bottled Water Filtration Coffee
Thursday, 19 Thursday, 2 Thursday, 14 Put smiles on your employees' faces by starting your office
Thursday, 16 Thursday, 28 coffee service. From single -serve FLAVIA coffee machines
Thursday, 30 brewing premium ALTERRA coffee to energy saving commercia
brewers, we will provide you with the perfect selection of
products to brew the perfect cup. Call us today!
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 05 -07 -11
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice 3083945 050711
INDIANAPOLIS, IN 46280 Purchase Order M
Date Transaction Details Qty. Each Amount
Previous Balance 184.96
05 -02 -11 P196817 Payment Check 196817 Thank You 184.96
Remaining Balance 0.00
04 -21 -11 T1 1 1 1 1 3042001 HINCKLEY SPRINGS 5G DRINK NON -SPILL 7.0 9.99 69.93
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 12.0 3.29 39.48
5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00
5.0 GAL BOTTLE RETURN -8.0 6.00 -48.00
Rec'd By: Not Available or Refused
R111111797710 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
05 -05 -11 T1 1 1 253042007 HINCKLEY SPRINGS 5G DRINK NON -SPILL 4.0 9.99 39.96
5.0 GAL BOTTLE DEPOSIT 4.0 6.00 24.00
5.0 GAL BOTTLE RETURN -4.0 6.00 -24.00
Recd By: Not Available or Refused
05 -05 -11 63232892 ENERGY SURCHARGE 1.0 2.39 2.39
Total New Charges 188.26
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 delive !y, pay your bill and much more. Loq on today!
30356- P-0034
Previous Balance Payment Total New Charges Pay This Amount
$184.96 $184.96 $188.26 $188.26
Write th e 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 a °w° °m Important Monthly Promotions:
uu<om.,y o<u< „oa,e, a e we Deliver! Register online for access to your
Delivery Calendar: `ry °Q9 Au Wa~ F
account. You can view and pay your bill,
N Ra check delivery schedule and order
Your scheduled deliveries for
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.
9. Easy to Pay:
e' 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.
Grj-7
C n
o�ovEa
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. r,„ Please detach remittance and mail
a Ewa Ca 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 our letter, give 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.
VOUCHER 115112 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
30839450507 01- 7202 -05 $188.26
Voucher Total $188.26
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 properly itemized must show, hind 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 5/12/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/12/2011 3083945050 $188.26
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