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Home My WebLink About180834 12/30/2009 (2) CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 4 ONE CIVIC SQUARE HINCKLEY SPRINGS CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $33.91 DALLAS TX 75266 -0579 CHECK NUMBER: 180834 CHECK DATE: 12/30/2009 DEPARTMENT ACCOU PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 1722004 33.91 OTHER MISCELLANOUS i HINCKLEY SPRINGS WAIIR 800 -444 -PURE WATER.COM ORIGINAL CUSTOMER s 1722004 TICKI -1 a 043443042007 LOCATION 2677868 POa: CARMEL CIIY COURT Date: 12110(2009 1iire: 118:36:14 AM f 1 Civil.' SO ROUTE X13042 DAVID I CARMEL, IN 46032 last Pa;:ocnt N te: 17!041200`1 Last Payment Awu'nit: 37.38 Product Delivered OlY PRICE AMOUNT($) HS 5G DR NS 2 9.49 18.98 ROT 5.0G PLS 2 6.00 12.00 BOT 5.OG PLS -2 6.00 -12.00 (2 Dotti Dr.liverol 7 Frpl.. ".:lmne:d R;,lt Ii.isiterll Subtotal Sales 18.98 Sales Tax 0.00 DELIVERY TICKLT IUTAI_ 18.98 PIQYIUUs Account Balance 28.49 Total Balance Due 47.47 Payrren t s 0.00 ENDING BALANCE 47.47 We bill monthly by su,rwary Invoice Retain for your records. Na,t DeIives .te, 12!2412009 I i We bill aunlhly by summeuy Invoice. Retain, for your Js. I l 1- 800 -4- WATERS (492 -8377) www.HinckleySprings.com Upcoming Delivery Dates n December Janua February Spnngs, Bottled Water Filtration Coffee Thursday, 24. Thursday, 7 Thursday, 4 Help us make a difference in the fight against breast Thursday, 21 Thursday, 18 cancer. Now through December 31, 2009, when you refer your friends or family to start new service with any one of our Komen Budget Plans, we'll donate $30 to Susan G. Komen for the Cure. Visit Water.com /KomenReferral today! Customer Account 17220042677859 KIM ROTT Invoice Date: 12 -12 -09 CARMEL CITY COURT Invoice 1209 1722004 2677859 1 CIVIC SQ CARMEL, IN 46032 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 52.87 12 -04 -09 P179699 Payment Check 179699 Thank You -37.38 Remaining Balance 15.49 R093212494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.00 13.00 12 -10 -09 T093443042007 HINCKLEY SPRINGS 5G DRINK NON -SPILL 2.0 9.49 18.98 5.0 GAL BOTTLE RETURN -2.0 6.00 -12.00 5.0 GAL BOTTLE DEPOSIT 2.0 6.00 12.00 Rec'd By: Not Available or Refused 12 -10 -09 47650107 ENERGY SURCHARGE 1.0 1.93 1.93 Total New Charges 33.91 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 -0035 Previous Balance Payment Total New Charges Pay This Amount $52.87 $37.38 $33.91 $49.40 0 Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope To pay online g to www.Hinckle com How to Read Your Statement we,Ea Important Monthly Promotions: We Delver! Register online for access to your Delivery Calendar:' e z a °na account. You can view and pay your bill, Your scheduled deliveries for "a( s z° check delivery schedule and order the next three months. products ail online. 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 tail us to expedite your Previous balance and posted remittance with automatic credit card payments payments since last bill, ezvxess C Total New Charges: This information provides totals for mo-m o-. M ail Remittance With Payment To: various products and transactions.' A.,..,.,. Please detach remittance and mail 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 ive our letter, 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. 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. T_ /�1_r �D-S7 9 Terms 6v jv '7 S EGG 0 '1 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) a 9 r dl, 7 7f 9� /3. ap Total 33. T 1 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 3 s.s1 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or Z 30 1 7.1 o 09 �3 `�l 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 2 S TIG i Cost distribution ledger classification if Title claim paid motor vehicle highway fund