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205871 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $188.17 CARMEL, INDIANA 46032 PO BOX 660579 DALLAS TX 75266 -0579 CHECK NUMBER: 205871 CHECK DATE: 1/31/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 2677859 29.89 OTHER MISCELLANOUS 651 5023990 30839450114 158.28 OTHER EXPENSES 1- 800 -4- WATERS (492 -8377) www.HinckleySprings.com Upcoming Delivery Dates Hinckle W. [Oliver Janua February March Bottled Water Filtration Coffee Thursday,, 19 Thursday, 2 Thursday, 1 Thursday, 16 Thursday, 15 What's your New Year's resolution? Thursday, 29 Make sure drinking more water is part of it. Customer Account 17220042677859 KIM ROTT Invoice Date: 01 -07 -12 CARMEL CITY COURT Invoice 2677859 010712 1 CIVIC SQ CARMEL, IN 46032 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 91.63 12 -16 -11 P204253 Payment Check 204253 Thank You -55.81 Remaining Balance 35.82 R1 1 3472494 748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50 12 -22 -11 T113563042007 HINCKLEY SPRINGS 5G DRINK NON -SPILL 1.0 9.99 9.99 5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00 5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00 Rec'd By: Not Available or Refused 01 -05 -12 T120053042037 HINCKLEY SPRINGS 5G DRINK NON -SPILL 1.0 9.99 9.99 5.0 GALLON BOTTLE RETURN -1.0 6.00 -6.00 5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00 Rec'd By: Not Available or Refused 01 -05 -12 70584407 ENERGY SURCHARGE 1.0 2.41 2.41 Total New Charges 29.89 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 today! 30356 -P -0036 Previous Balance Payment t Total New Charges Pay This Amount $91.63 $55.81 `!I' $29.89 $65.71 p Write the complete account number on your check. Detach remittance and mail with payment in the enclosed en To pay online go to www.HinckleySprings.com 0 How to Read Your Statement w• "s Important Monthly Promotions: Upcoming Delivery Daces it100 We Deliver! Register online for access to your ne 2009 My 11109 Mu9tl a °r� Waler• FAYa4° Delivery Calendar: M m"da account. You can view and pay your bill, Your scheduled deliveries for M -maa check delivery schedule and order the next three months. products all online. Customer Account Number: service, lease use this Bottle Deposits: For prompt p Highlights bottle deposits and returns. number when referring to your account. m m,e m °m 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 m aw a n ®o,�a ..•,�N Total New Charges: This information provides totals for F "IM "M� ,,.a°a Mail Remittance With Payment To: various products and transactions. °tea n, Please detach remittance and mail using business envelope provided. IIIIITIIII11111111111111 ,III e�ep nem,uence Witn Peymsm Te:1 sulr„ ,n mu „sine¢* Important Monthly Message urvw „ane. us insmn hIIII,II „III ILI ,ILIIJIIIIIII 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 9 9 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. 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 "mac G Purchase Order No. 0.5'7 Terms �(tli jtl/_O �U "0 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 77 (Ts Total a y 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# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 3 D a (0 7785 03 �l� 7 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 1 ig Cost distribution ledger classification if 4itle claim paid motor vehicle highway fund 1- 800 -4- WATERS (492 -8377) www.HinckloySprings.com Upcoming Delivery Dates HInCkif� y e V�,������ January February March fr t.g, Bottled Water Filtration Coffee Thursday, 26 Thursday, 9 Thursday, 8 Thursday, 23 Thursday, 22 What's your New Year's resolution? Make sure drinking more water is part of it. Customer Account 17209463083945 JOE ACCOUNTS PAYABLE Invoice Date: 01 -14 -12 CITY OF CARMEL UTILITIES Invoice 3083945 011412 9609 HAZEL DELL PKWY INDIANAPOLIS, IN 46280 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 460.69 12 -16 -11 P204253 Payment Check 204253 Thank You 242.57 Remaining Balance 218.12 R113631797710 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 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 -29 -11 T113633042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 5.0 9.99 49.95 5.0 GALLON BOTTLE DEPOSIT 5.0 6.00 30.00 5.0 GALLON BOTTLE RETURN -5.0 6.00 -30.00 Rec'd By: Not Available or Refused 01 -12 -12 T120123042007 HINCKLEY SPRINGS 5G DRINK NON -SPILL 4.0 9.99 39.96 CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 4.0 3.49 13.96 5.0 GALLON BOTTLE RETURN -4.0 6.00 -24.00 5.0 GALLON BOTTLE DEPOSIT 4.0 6.00 24.00 Rec'd By: Not Available or Refused 01 -12 -12 70813699 ENERGY SURCHARGE 1.0 2.41 2.41 Total New Charges 158.28 M anaging 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 today! 30356 -P -0036 Previous Balance Payment L Total New Charges Py This A ount am $460.69 $242.57 �J $158.28 $376.40 Write the complet a ccount number on your check. Detach remittance and mail with pay in the enclosed envelo To pay online g to www.Hinckle y How to Read Your Statement Important Monthly Promotions: uo °m� ^9 oer.e, Date. We Deliver! Register online for access to your account. You can view and pay your bill, Delivery Calendar: fiw ZZ Your scheduled deliveries for M°^d,. �m,,T° check delivery schedule and order the next three months. products all online. m Customer Account Number: Bottle Deposits' For prompt service, please use this Highlights bottle deposits and returns. O number when referring to your account. II NN 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. /`�J DISCOVER Total New Charges: This information provides totals for °m o.. Mail Remittance With Payment To: various products and transactions.`' Please detach remittance and mail aol using business envelope provided. IIIIIIIIIlllllll.IIIIIIIIII 1 Melt Pemltunce —h veymmt Toil .ary "sMi ,n Mnm s.nee, Important Monthly Message ^nw«e "s. us as.uzas IIII, IJLIIJIIIILIIILJIIl .lo.11 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 9 9 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. 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 HINCKLEY SPRINGS Purchase Order No. PO BOX 660579 Terms DALLAS, TX 75266 -0579 Due Date 1/24/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/24/2012 3083945011 $158.28 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 ro i ff A r VOUCHER 116628 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 30839450114 01- 7202 -05 $158.28 Voucher Total $158.28 Cost distribution ledger classification if claim paid under vehicle highway fund