161862 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660576 CHECK AMOUNT: $705.62
DALLAS TX 75266 -0579
CHECK NUMBER: 161862
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 07081720946 664.68 OTHER EXPENSES
1301 4239099 07081772004 40.94 070817720042677859
1
i
��I�n�k�ce- Hinckley Springs For Customer Service and Account Inquiries,
a brand of
DS waters of America, Inc. Call 1 -800- 444 -PURE (7873) or visit
SpLOngs��
PO Box 660579
Dallas, TX 75265 -0579 www.hinckleysprings.com
Customer Account 17220042677859
KIM ROTT Your Next Deliveries: Invoice Date: 07 -12 -08
CARMEL CITY COURT 08 -07 -08 Invoice 0708 1722004 2677859
1 CIVIC SO 09 -04 -08
CARMEL, IN 46032 Purchase Order
Date Details Oty. Each Amount
Previous Balance 40.66
Payment 0.00
Remaining Balance 40.66
TRANSACTION 081782494748
HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
07 -10 -08 TRANSACTION 31632588
ENERGY SURCHARGE 1.0 2.47 2.47
07 -10 -08 TRANSACTION T081923042009
HINCKLEY 5.OG DRINK NON -SPILL 3.0 8.49 __25747
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
5.0 BOTTLE RETURN -3.0 6.00 -18.00
Rec'd By:
Total New Charges 40.94
Please note that effective August 1, 2008 the Energy Surcharge will be updated on a
monthly, rather than a quarterly basis. If you have any questions, please contact 30356 -P -0015
customer service at 800.4.wATERS or visit us online at: www.water_comlenergysurcharge
Previous Balance Payment Total New Charges Pay This Amount
0
$40.66 0 $0.00 $40.94 $81.60
v Write the complete account number on your check. Detach remittance and mail w ith pa yment in the enclosed envelope. To pay online g o to www hinckle ysphng_� s co_ v
How to Read Your Statement
Visit Our Website:
Register online for access to your
account. You can view and pay your bill,
check delivery schedule and order
Customer Account Number: r products all online.
For prompt service, please use this
number when referring to your account.
Summa Bottle Deposits:
rY: 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. l
0¢
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
o��� a w5P using business envelope provided.
Important Monthly Message
Leue.o _oo c13 :S�x2�ee36�1 t93 nL.:i.,Ln E LJO: ]L] L r
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 Ileu 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.
e The dollar amount of the suspected error.
Describe the error and explain why you believe there is an error. It 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 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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
a 4 �C 94
Total d.9SF
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
0, /3,a;C,
,D-4t,U4
-//0 9j
ON ACCOUNT OF APPROPRIATION FOR
&4"
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
0 Joel 7WOo
3 p S'5 C C�C 0. 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
Signatu e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Hinc ILJ I -�I�I� \`A 0 brand Springs For Customer Service and Account Inquiries,
L�L a of
Spp gp �g� DS Waters of America Inc. Call 1- 800 -444 -PURE (7873) or visit
PO Box 660579
Dallas, TX 75266 -0579 www.hinckleysprings
Customer Account 17209463083945
ACCOUNTS PAYABLE Your Next Deliveries: Invoice Date: 07 -05 -08
CITY OF CARMEL UTILITIES 07 -17 -08 Invoice 0708 1720946 3083945
9609 HAZEL DELL PKWY 07 -31 -08 Purchase Order
INDIANAPOLIS, IN 46280
Date Details Qty. Each Amount
Previous Balance 1,090.61
06 -09 -08 Payment Check 159912 Thank You 549.03
Remaining Balance 541.58
TRANSACTION 081711797710
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
06 -19 -08 TRANSACTION T081713042003
HINCKLEY 5.OG DRINK NON -SPILL 8.0 8.49 67.92
HINCKLEY 5.OG DISTILLED NON SPILL 26.0 8.49 220.74
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
5.0 GAL BOTTLE RETURN -34.0 6.00 204.00
5.0 GAL BOTTLE DEPOSIT 26.0 6.00 156.00
Recd By:
07 -03 -08 TRANSACTION T081853042014
HINCKLEY 5.OG DRINK NON -SPILL 1.0 0.00 0.00
HINCKLEY 5.OG DRINK NON -SPILL 11.0 8.49 93.39
HINCKLEY 5.OG DISTILLED NON SPILL 24.0 8.49 203.76
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 10.0 4.49 44.90
5.0 GAL BOTTLE DEPOSIT 11.0 6.00 66.00
5.0 GAL BOTTLE DEPOSIT 24.0 6.00 144.00
5.0 GAL BOTTLE DEPOSIT 1.0 6.00 6.00
5.0 GAL BOTTLE RETURN 36.0 6.00 216.00
Rec'd By:
Please note that effective August 1, 2008 the Energy Surcharge will be updated on a
monthly, rather than a quarterly basis. If you have any questions, please contact 30356 -P -0015
customer service at 800.4.WATERS or visit us online at: www.water.com /energysurcharge
Previous Balance Payment Total New Charges Pay This Amount
r._
$1090.61 $549.03 $664.68 $1,206.26
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
Fo,� .,o�.,��•ro� •oun I Visit Our Website:
Register online for access to your
Y° e I qa 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.
Summar 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: to expedite your remittance with automatic credit
All charges and credits are easy card payments.
to understand.
+a= ol
Total New Charges: M{ xm
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
<1 w using business envelope provided.
.,.11,II..I. h
Important Monthly Message
zue:o zooi3 aaarsa a6a¢ia n[a =..[n t c7aa]c] v
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 D5 Waters of America, Inc. at P.O. Box 660579, Dallas, TX 75266 -0579.
°CustomerAccount #'17209463083945' M3Ir ivoiae #10708;x17209�4�63083945
w +A �s" 4 3
ia,ar ;`w�p►�,��m Na 4 �A.?p:� �A"�
.yz., x M 3w+� f .�ux>'.0 '.s &r[.A, +i"'s >A`V�,XdM�
07 -03 -08 TRANSACTION 31506121
ENERGY SURCHARGE 1.0 2.47 2.47
Total New Charges 664.68
M1080705_BM10- 11713 000001717
Page 2W42
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
131130
4
HINCKLEY SPRINGS Purchase Order No.
PO BOX 660579 Terms
DALLAS, TX 75266 -0579 Due Date 7/15/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/15/2008 0708172094E $664.68
t
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
7API. 11
Date Officer
f
VOUCHER 085908 WARRANT ALLOWED
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
J�
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
07081720946 01- 7202 -05 $664.68
Voucher Total $664.68
Cost distribution ledger classification if
claim paid under vehicle highway fund