168511 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $597.39
CARMEL, INDIANA 46032 Po BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 168511
CHECK DATE: 2/4/2009
DEP ARTMENT ACCOUNT PO NU MBER INVOICE NU MBER AMOUNT DESCRIPTION
651 5023990 01091720946 553.92 MATERIALS SUPPLIES
1301 4239099 010917220042 43.47 OTHER MISCELLANOUS
WATER.COM
]RIGINAL
'USTOMER p: 1722004 TICKET 090223042018
Location a: 2677868 PON:
:ARMEL CITY COURT Date: 01122109 Time: 9:50:02 am
1 CIVIC so. ROUTE# 3042 DAVID
.ARMEL, IN 46032
Last Payment Dale: 12122/2.008 Last Payment Amount.: 34.41
product Delivered UTY PRICE AMOUNT
3S 513 DR NS -->H 3 $9.49 $28.47
-IS 5G Deposits 3 $6.00 $18.00
30T 5.OG PLS >B -3 $6.00 -18.00
(3 Bottles Delivered 3 Empty Bottles Relutned 0 Bottle n,�, siI. s)
Subtotal Sales 28.47
Sales Tax 0.00
)ELIVERY TICKET TOTAL 28.0
i
previous Account Balance 75.71
Total Balance Due 104.18
payments:
ENDING BALANCE 104.18
Next Delivery Date: 2119/2009
We hill monthly by suinnary invoice. Retain tut your tecu"ds.
H! Hinckley springs For Customer Service and Account Inquiries,
gs DS brand
Waters of America Inc. Call 1- 800 444 -PURE (7873) or visit
PO Box 660579 www.hinckleysprings.com
Dallas, TX 75266 -0579
Customer Account 17220042677859
KIM ROTT Your Next Deliveries: Invoice Date: 01 -24 -09
CARMEL CITY COURT 02 -19 -09 Invoice 0109 1722004 2677859
1 CIVIC SO 03 -19 -09 Purchase Order
CARMEL, IN 46032
Date Details Qty. Each Amount
Previous Balance 64.71
Payment 0.00
Remaining Balance 62.71
01 -07 -09 TRANSACTION T090073042030
HOT AND COLD COOLER Installed Serial #0641003561 1.0 0.00 0.00
HOT AND COLD COOLER Removed Serial #0641003561 -1.0 0.00 0.00
Recd By:
Sppecial Order by: KIM ROTT
P{� (317) 571 -2408
TRANSACTION 090362494748
HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
01 -22 -09 TRANSACTION T090223042018
HINCKLEY 5.OG DRINK NON -SPILL 3.0 9.49 28.47
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
5.0 GAL BOTTLE RETURN -3.0 6.00 -18.00
Recd By:
01 -22 -09 TRANSACTION 37756791
ENERGY SURCHARGE 1.0 2.00 2.00
Total New Charges 43.47
30356 -P -0023
Previous Balance Payment Total New Charges Pay This Amount
$62.71 $D.00 $43.47 $lor.18
v
Write the complete account number on your check: Detach remittance and mail with paymenYln the enclosed envelope. To pay online go to" www:hicnkleysprings:com
How to Read Your Statement Visit Our Website•
Register online for access to your
F NIi I e Po"'Y
F. C—t EN EYr1 9eM
account. You can view and pay your bill,
check delivery schedule and order
Customer Account Number: o
e... products all online.
For prompt service, please use this
number when referring to your account.
Summa Bottle Deposits:
Summary: 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.
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
c• s gyp. using business envelope provided.
Important Monthly Message
oe:o =oou3 svxnea abwa nn-.[n t [eozn i
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 9 program, please write to us on a separate sheet at
Your name and complete account number. P.Q. 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 the amount of our bill that is not in question. While for the uncollected amount. Payment by check constitutes your acceptance of
Y a 9 PY 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)
r' 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.
0 OS 9 Terms
75d6 6 .0 ,5 7 7 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total �3
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
�L
C2� t�j_TL (a 0 579
ON ACCOUNT OF APPROPRIATION FOR
l�lw�gfr
Board Members
D E PT INVOICE NO. ACCT /TITLE AMOUNT I hereby cert ify that the attached invoice(s), or
1 3 D Diogr7 v 4 Sd. J 9 17 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
200
I
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
n Y
Hinckley Springs For Customer Service and Account Inquiries,
ckleil a brand of
Spr DS Waters of America, Inc. Call 1- 800 -444 -PURE (7873 or visit
ings PO Box 660579 www.hinckleysprings.com
Dallas, TX 75266 -0579
Customer Account 17209463083945
ACCOUNTS PAYABLE Your Next Deliveries: Invoice Date: 01 -17 -09
CITY OF CARMEL UTILITIES 01 -29 -09 Invoice 0109 1720946 3083945
9609 HAZEL DELL PKWY 02 -12 -09
INDIANAPOLIS, IN 46280 Purchase Order
Date Details Dty. Each Amount
Previous Balance 1,189.00
12 -22 -08 Payment Check 166708 Thank You 627.28
Remaining Balance 561.72
TRANSACTION 090291797710
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
01 -02 -09 TRANSACTION T090023042031
HINCKLEY 5.OG DRINK NON -SPILL 3.0 9.49 28.47
HINCKLEY 5.OG DISTILLED NON SPILL 26.0 9.99 259.74
5.0 GAL BOTTLE DEPOSIT 26.0 6.00 156.00
5.0 GAL BOTTLE RETURN -29.0 6.00 174.00
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
Rec'd By
01 -15 -09 TRANSACTION T090153042013
HINCKLEY 5.OG DRINK NON -SPILL 5.0 9.49 47.45
HINCKLEY 5.0G DISTILLED NON SPILL 14.0 9.99 139.86
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 10.0 4.49 44.90
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
5.0 GAL BOTTLE RETURN -19.0 6.00 114.00
5.0 GAL BOTTLE DEPOSIT 14.0 6.00 84.00
Rec'd By:
01 -15 -09 TRANSACTION 37625345
ENERGY SURCHARGE 1.0 2.00 2.00
30356 -P -0023
Previous Balance Payment 1 Total New Charges Pay This Amount
$1,189.00 $627.28 $553.92 $1,115.64
write.the_complete.account number- on.your_check. Detach remittance and�m, in the enclosed.envelope. To pay_online.go to_www.hicnkleyspn m-
ngs. r 0
.q..`,.,• ^1'°...'�OS=- (';„`;`U J4 a�u0w�ue ey
f
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: w w• products all online.
For prompt service, please use this
number when referring to your account.
Summa 1� Bottle Deposits:
Summary: 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 ^ice I, card payments.
to understand.
-C+
Total New Charges:
�'r'
This information provides totals for Mai! Remittance With Payment To:
various products and transactions. Please detach remittance and mail
-,:�a a r” using business envelope provided.
L.IL.ILJL...IL.Lq.L.,LJ..I l.ILIL .LI.ILI I.IL��.nll.�.l..� L.IL. ...IL.L,IIA.Lh L.I
Important Monthly Message
�zu_e =o aooun svzz°ez3.eei"a n[ 15,rn t csoz �c� c i
I
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"
It 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 a the amount of our bill that is not in question. While for the uncollected amount. Payment by check constitutes your acceptance of
Y 9 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.
Customer Account 17209463083945 Invoice 0109 1720946 3083945
Date Details Qty. Each Amount
Total New Charges 553.92
I I
M1090117_BM10- 11597 000001741 Page 2 olf1l9
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 1/27/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/27/2009 0109172094E $553.92
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 er
VOUCHER 087188 WARRANT ALLOWED
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
1.
Board members
PO INV ACCT AMOUNT Audit Trail Code
01091720946 01- 7202 -05 $553.92
Voucher Total $553.92
Cost distribution ledger classification if
claim paid under vehicle highway fund