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Home My WebLink About199047 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $35.93 CARMEL, INDIANA 46032 PO BOX 660579 DALLAS TX 75266 -0579 CHECK NUMBER: 199047 CHECK DATE: 7/6/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 2677859 35.93 OTHER MISCELLANOUS 1- 800 -4- WATE (492 8377) www.HinckleySprings.com Upcoming Delivery Dates llver July August September S Bottled Water Filtration Coffee Thursday, 7 Thursday, 4 Thursday, 1 Put smiles on your employees' faces by starting your office Thursday, 21 Thursday, 18 Thursday, 15 coffee service. From single -serve FLAVIA coffee machines Thursday, 29 brewing premium ALTERRA coffee to energy saving commercial brewers, we will provide you with the perfect selection of products to brew the perfect cup. Call us today! Customer Account 17220042677859 KIM ROTT Invoice Date: 06 -25 -11 CARMEL CITY COURT Invoice M 2677859 062511 1 CIVIC SID CARMEL, IN 46032 Purchase Order#;!: Date Transaction Details Qty. Each Amount Previous Balance 45.86 Payment 0.00 Remaining Balance 45.86 81 1 1 51 2494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50 06 -08 -11 T111593042040 HINCKLEY SPRINGS 5G DRINK NON -SPILL 2.0 9.99 19.98 5.0 GAL BOTTLE DEPOSIT 2.0 6.00 12.00 5.0 GAL BOTTLE RETURN -2.0 6.00 -12.00 Recd By: Not Available or Refused 06 -23 -11 64651965 ENERGY SURCHARGE 1.0 2.45 2.45 Total New Charges 35.93 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, pay your bill and much more. Log on todayl 30356 -P -0034 Previous Balance Payment Total New Charges Pay This Amount $45.86 $0.00 $35.93 $81.79 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 Important Monthly Promotions: uo<emtr,g�eilve,yoee. We Deliver! °ry•° Register online for access to your M;„ 'a°' Delivery Calendar: account. You can view and pay your bill, a M C,a check delivery schedule and order Your scheduled deliveries for 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. oisco�ert Total New Charges: This information provides totals for Mail Remittance With Payment To: various products and transactions. 0-4- =1 I1 Please detach remittance and mail :1 Z 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 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 y 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. 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. Y o (a0 'T7 Terms L a�' Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) a e In Total 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 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# DEPT. INVOICE NO. ACCT #/TITLE AMOUNT nEPr. I hereby certify that the attached invoice(s), or 3_LL I ag59 390 .99 ,?5,5 3 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 i 20 1 I Signature Cost distribution ledger classification if Itle claim paid motor vehicle highway fund