162771 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $665.86
ro CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 162771
CHECK DATE: 8/20/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION
651 5023990 08081720946 616.23 OTHER EXPENSES
1301 4239099 082203042012 49.63 OTHER MISCELLANOUS
Hinckley Springs
LH�LncLk�ey® a brand of For Customer Service and Account Inquiries,
DS Waters of America, Inc. Call 1- 800 -444 -PURE (7873) or visit
Spnngs PO Box 660579
Dallas, TX 75266 -0579 www.hinckleysprings.com
Customer Account 17220042677859
KIM ROTT Your Next Deliveries: Invoice Date: 08 -09 -08
CARMEL CITY COURT 09 -04 -08 Invoice 0808 1722004 2677859
1 CIVIC SQ 10 -02 -08
CARMEL, IN 46032 Purchase Order
Date Details Qty. Each Amount
Previous Balance 81.60
07 -25 -08 Payment Check 161394 Thank You -40.66
Remaining Balance 40.94
TRANSACTION 082062494748
HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
08 -07 -08 TRANSACTION 32576601
ENERGY SURCHARGE 1.0 2.67 ,i 2.67
08 -07 -08 TRANSACTION T082203042012
HINCKLEY 5.OG DRINK NON -SPILL 4.0 8.49 ✓33.96
5.0 GAL BOTTLE DEPOSIT 4.0 6.00 24.00
5.0 GAL BOTTLE RETURN -4.0 6.00 -24.00
Rec'd By:
Total New Charges 49.63
Refer your family and friends and receive a $25 credit on your account!
Now at the click of a mouse, it's never been easier to earn account credits.
Go to www.water.com /referrals and start earning your referral credits today. 30356 -P -0015
Previous Balance Payment Total New Charges Pay This Amount
$81.60 0 $40.66 $49.63 0 $90.57
v 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 v
How to Read Your Statement
Visit Our Website:
Register online for access to your
�^��°w•^�• account. You can view and pay your bill,
.Wmlaee,w.: J %11JC::OFi t4l
check delivery schedule and order
Customer Account Number: products all online.
For prompt service, please use this .,r.,,,,„
number when referring to your account. p7w
Summer r Bottle Deposits:
Y: Highlights bottle deposits and returns.
Balance from previous bill
(previous balance minus payments).
Easy to Pay:
You can pay through the mail, online, or call us
Easy to Read: r C4~ to expedite your remittance with automatic credit
All charges and credits are easy M: °k, card payments.
to understand.
Total New Charges: RA
This information provides totals for Mail Remittance With Payment To:
various products and transactions. fP6G "1 Please detach remittance and mail
:-a e� using business envelope provided.
Important Monthly Message
Jc116:0 =.00113 SV221623LLL113 Of P..0 f C9mn L
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
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
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 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
/JJ J Aa4 ZALW,,�2 Purchase Order No.
5 �1 Terms
762bb `05 9 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
33. (o
/4,tq -4 Nu �Z 1, 1 3,00
a.6 7
Total q q-63
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
IN SUM OF
/t ,d i1
49.63
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3 O) 320d') 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
20 O
Sig ure
Ti
Cost distribution ledger classification if
claim paid motor vehicle highway fund
4
Hinckley Springs
ilinck�e -1,V® a brand of For Customer Service and Account Inquiries,
DS Waters of America, Inc. Call 1- 800 -444 -PURE (7873) or visit
sp nngsG PO Box 660579
Dallas, TX 75266 -0579 www.hinckleysprings.com
Customer Account 17209463083945
A CCOUNTS PAYABLE Your Next Deliveries: Invoice Date: 08 02 08
C ITY OF CARMEL UTILITIES 08 14 08 Invoice 0808 1720946 3083945
609 HAZEL DELL PKWY 08 -28 -08
INDIANAPOLIS, IN 46280 Purchase Order
Date Details Qty. Each Amount
Previous Balance 1,206.26
07 -14 -08 Payment Check 160902 Thank You 541.58
Remaining Balance 664.68
07 -17 -08 TRANSACTION T081993042006
HINCKLEY 5.OG DRINK NON -SPILL 8.0 8.49 67.92
HINCKLEY S.OG DISTILLED NON SPILL 19.0 8.49 161.31
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 1.0 4.49 4.49
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
5.0 GAL BOTTLE DEPOSIT 19.0 6.00 114.00
5.0 GAL BOTTLE RETURN -27.0 6.00 162.00
Rec'd By:
TRANSACTION 081991797710
ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
07 -31 -08 TRANSACTION T082133042014
HINCKLEY S.OG DRINK NON -SPILL 10.0 8.49 84.90
HINCKLEY S.OG DISTILLED NON SPILL 21.0 8.49 178.29
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 15.0 4.49 67.35
5.0 GAL BOTTLE DEPOSIT 21.0 6.00 126.00
5.0 GAL BOTTLE DEPOSIT 10.0 6.00 60.00
5.0 GAL BOTTLE RETURN -28.0 6.00 168.00
Rnnecp'd By:
�1 d�R ,ul�
07 -31 -08 TRANSACTION 32420043
Refer your family and friends and receive a $25 credit on your account!
Now at the click of a mouse, it's never been easier to earn account credits.
Go to www.water.com /referrals and start earning your referral credits today. 30356 -P -0015
Previous Balance Payment �fL Total New Charges Pay This Amount
$1,206.26 0 $541.58 11 $616.23 1 0 $1,280.91
v Write the complete account number on your check. Detach remitt and mail with pa yment in the enclosed envelope. To pay online go to www.hinckleysprings.com v
Flow to Read Your Statement visit Our Website:
Register online for access to your
p account. You can view and pay your bill,
check delivery schedule and order
Customer Account Number: products all online.
For prompt service, please use this
number when referring to your account.
Summa rn ��A. Bottle Deposits:
Summary: Highlights bottle deposits and returns.
Balance from previous bill
(previous balance minus payments).
Easy to Pay:
You can pay through the mail, online, or call us
Easy to Read: to expedite your remittance with automatic credit
All charges and credits are easy card payments.
to understand.
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
0=j„a o using business envelope provided.
i.. u... u. aL... n,.i,1111.,,i..1.,,n.u.,n,.,.d.i, die LAM ,aid,.:.d „i,.u.. .n.a....u.uaa.d
Important Monthly Message x... Z
32116:0 200113 A4227E2316-3 nril „En f COOC3C3 L J
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.
tc
WATER.COM
7RIGINAL
"USiOMER 1722004 TICKET 082203002012
Location 2677868 PO
-ARMEL CITY COURT Oale: 08107/08 Time: 11.16:13 am
1 CIVIC SU ROUTE# 3042 DAVID
ARMEL, IN 46032
Last Payment Date: 7/2512008 Last Payment Anoint: 40.66
3 roducl Delivered OTY PRICE AMOUNT
IS 5G OR NS-->H 41 $8.49 $33.96
IS 50 Deposits 4 $6.00 $24.00
30T 5.01] PLS >B -4 $6.00 $14.00
(4 Bottles Delivered 4 Emply DOttles Refurned 0 Bottle Deposits)
Subtotal Sales 33.96
Sales Tax 0.00
]ELIVERY TICKET TOTAL 33.96
previous Account Balance 53.94
Total Balance Due 87.90
payments:
-NDING BALANCE 87.90
Next Delivery Date: 9/412008
We bill monthly by swtnoaiy invoice. Retain for your r'ecurds.
.'Customer Account 17209463083945 Invoice 080.8 1720946 3083945
ENERGY
SURCHARGE 1.0 2.47 2.47
Total New Charges 616.23
M1080802 M10- 10851 -0000017 6
Page 2 of 2
Prescribed by State Board of Accounts City Form No. 201 (R0
ACCOUNTS PAYABLE VOUCHER
r
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.
t'
Payee
131130
HINCKLEY SPRINGS Purchase Order No.
PO BOX 660579 Terms
DALLAS, TX 75266 -0579 Due Date 8/13/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amourl
8/13/2008 0808172094E $616.2
I
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
a Z/y
Date Officer
VOu
W6092 WARRANT ALLOWED
13113
IN SUM OF
p O BMX Box6Y SPRINGS
O'AIL,�S' TX 5 5266 -0579
Carmel Wastewater Utility
ON CCOU NrOF APPROPRIATION FOR
Board members
p0
INV ACCT AMOUNT Audit Trail Code
0808j 2 0946 01- 7202 -05 $616.23
I
I
I
tal
Q,. cher To $6 16.23
4--ra, 4n ledger classification if
bier vehicle highway fund