168029 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CHECK AMOUNT: $62.71
CARMEL, INDIANA 46032 PO BOX 660579
o .�o
I N DALLAS TX 75266 -0579 CHECK NUMBER: 168029
i CHECK DATE: 1/21/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 083573042031 62.71 OTHER MISCELLANOUS
WATER COM
PIGINAL
I ISTOMER 1722004 TICKET 083573042031
!cation k 2677868 POa: f
?MEL CITY COURT Date: 12!22108 Time: 1:12.:26 pm
:IVIC SQ ROUTE# 3042 DAVID
'MEL. IN 46032
I Payment Date: 1112412008 Last Payment AIPUUnt: 44.01
Iuct Delivered QTY PRICE AMOUNT
G OR NS-->H 5 $9.49 $47.45
G Deposits 5 $6.00 $30.00
I .OG PLS >B -5 $6.00 $-30.00
-ltles Oelivered r Empty Duttle� Retained 0 Dottie De!wsits
i tal Sales 47.45
Tax 0.00
RY TICKET TOIAL 47.45
It s Account Balance 47.41
3alance Due 94.86
is:
I BALANCE 94.86
Next Delivery Date:
monthly I,y swnnary invoice Rf. yuu, iecuIkis.
r Hinckley Springs For Customer Service and Account Inquiries,
1- k 1 a brand of Call 1- 800 -444 -PURE 7873 or visit
S S� DS Waters of America, Inc.
P 9 PO Box 660579 www.hinckleysprings.com
Dallas, TX 75266 -0579
Customer Account 17220042677859
KIM ROTT Your Next Deliveries: Invoice Date: 12 -27 -08
CARMEL CITY COURT 01 -22 -09 Invoice 1208 1722004 2677859
1 CIVIC SQ 02 -19 -09
CARMEL, IN 46032 Purchase Order
Date Details Qty. Each Amount
Previous Balance 34.41
12 -22 -08 Payment Check 166708 Thank You -34.41
Remaining Balance 0.00
TRANSACTION 090082494748
HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
12 -22 -08 TRANSACTION T083573042031
HINCKLEY 5.OG DRINK NON -SPILL 5.0 9.49 47.45
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
5.0 GAL BOTTLE RETURN -5.0 6.00 -30.00
Rec'd By:
12 -25 -08 TRANSACTION 37026341
ENERGY SURCHARGE 1.0 2.26 2.26
Total New Charges 62.71
Finding your next scheduled delivery day just got easier!
Go to My Account at www.water.com. Login or register for Self Service today. 30356 -P -0023
Click on Printable Calendar to view print your 2009 Delivery Calendar online.
Previous Balance Payment Total New Charges Pay This Amount
$34.41 $34.41 $62.71 $62.71
V Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www.hicnkieysprings.com V
How to Read Your Statement Visit Our Website:
Register online for access to your
°."3. �n"•w.e account. You can view and pay your bill,
R a° check delivery schedule and 05ar,.
Customer Account Number
products all online.
For prompt service, please use this
number when referring to your account.
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: r to expedite your remittance with automatic credit
All charges and credits are easy w „p.'.,— card payments.
to understand.
'0 +F VIM
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. y maw Please detach remittance and mail
o using business envelope provided.
Important Monthly Message
I—A 2—A nnv... e coo—,n
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
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 Boa�i� 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
05 Terms
II�LR.l l� `s� 75a6& (9 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
�a 0 0835 0 3. Op
or
a.a
y7Ys'
Total 71
1 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.
F
ALLOWED 20
a
1 IN SUM OF
(P, .71
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
.3e�(aQ3
-39 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 O
^Sinatre
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund