179242 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
1 CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $692.19
DALLAS TX 75266 -0579
CHECK NUMBER: 179242
CHECK DATE: 11/11/2009
QEPARTMENT ACCOUNT PO N UMB ER I NVOIC E N UMBER AMOUNT DESCRIPTION
651 5023990 10091720946 692.19 MATERIALS SUPPLIES
1- $00-4- WATERS (492 8377) www.HinckleySprings.com
Upcoming Delivery Dates
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Customer Account M 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 10 -24 -09
CITY OF CARMEL UTILITIES Invoice 1009 1720946 3083945
9609 HAZEL DELL PKWY Purchase Order
INDIANAPOLIS, IN 46280
Date Transaction Details Qty. Each Amount
Previous Balance 645.26
Payment 0.00
Remaining Balance 645.26
8092811797710 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
10 -08 -09 T092813042005 HINCKLEY SPRINGS 5G DRINK NON -SPILL 5.0 9.49 47.45
HINCKLEY 5.OG DISTILLED NON SPILL 28.0 9.99 279.72
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 4.0 4.49 17.96
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 2.0 2.99 5.98
5.0 GAL BOTTLE DEPOSIT 28.0 6.00 168.00
5.0 GAL BOTTLE RETURN -33.0 5.00 198.00
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
Recd By:
10 -22 -09 46236237 ENERGY SURCHARGE 1.0 1.91 1.91
10 -22 -09 T092953042005 HINCKLEY SPRINGS 5G DRINK NON -SPILL 7.0 9.49 66.43
HINCKLEY 5.OG DISTILLED NON SPILL 22.0 9.99 219.78
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 4.0 2.99 11.96
5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00
5.0 GAL BOTTLE DEPOSIT 22.0 6.00 132.00
5.0 GAL BOTTLE RETURN -29.0 6.00 174.00
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30356-P -0035
Previous Balance Payment ..��tt�, Total New Charges o Pay This Amount
$645.26 $0.00 `it" $692.19 $1,337.45
�7 Write the complete accou number on your check. Det ach remittance and mail with payment in the enclosed envelope. T m^^ '��,�www.NinckieySpring s.com D
How to Read Your Statement m Important Monthly Promotions:
°aomiogoehveryodtPS we Derverl
Re online for access to y our
ne1o09 Dulyx°p9 Pu9ustEW9 Bunktl'xale'FUnn4nn'CpHee
Delivery Calendar:
a.ys account. You can view and pay your bill,
Your scheduled deliveries for w check delivery schedule and order
the next three months. products all online.
Customer Account Number:
For prompt service, please use this Bottle Deposits:
number when referring to your account. °iLP1L Highlights bottle deposits and returns.
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.
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. v» uw,. Please detach remittance and mail
4sa w m; q �;a= s 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 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
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
you are still obligated to pay the amount of your bill that is not in question. While for the uncollected amount. Payment by check constitutes your acceptance of
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.
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Customer Account 17209463083945® Invg X1009 1720946 3083945
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Date s, Details „i3 a Qty Each Amountg
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Rec'd By:
Total New Charges 692.19
MI091024_BM10- 9017 000001557 Page 2 of 2
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 11/2/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1112/2009 1009172094E $692.19
77
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- 111- 10 -1.6
Date Officer
VOUCHER 096671 WARRANT ALLOWED
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIAT {ON FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
10091720946 01- 7202 -05 $692.19
Voucher Total $692.19
Cost distribution ledger classification if
claim paid under vehicle highway fund