167629 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
s 0 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $561.72
CARMEL, INDIANA 46032 ND Box 660579
V off �o DALLAS TX 75266 -0579 CHECK NUMBER: 167629
CHECK DATE: 1/7/2009
DEPARTMENT ACCOUNT P N UMBER INVOICE NUMB AMOUNT DESCRIPTION
651 5023990 12081720946 561.72 MATERIALS SUPPLIES
Hinckley Springs For Customer Service and Account Inquiries,
a
a b rand 1- 800 -444 -PURE (7873) or visit
(n Waters of America, Inc.
PO Box 660579 www.hinckleysprings.com
Dallas, TX 75266 -0579
Customer Account 17209463083945
ACCOUNTS PAYABLE Your Next Deliveries: Invoice Date: 12 -20 -08
CITY OF CARMEL UTILITIES 01 -15 -09 Invoice 1208 1720946 3083945
9609 HAZEL DELL PKWY 01 -29 -09
INDIANAPOLIS, IN 46280 Purchase Order
Date Details Qty. Each Amount
Previous Balance 1,317.12
11 -24 -08 Payment Check 165800 Thank You 689.84
Remaining Balance 627.28
TRANSACTION 090011797710
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
12 -04 -08 TRANSACTION T083393042004
HINCKLEY 5.OG DRINK NON -SPILL 5.0 9.49 47.45
HINCKLEY 5.OG DISTILLED NON SPILL 20.0 9.99 199.80
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 1.0 4.49 4.49
5.0 GAL BOTTLE DEPOSIT 20.0 6.00 120.00
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
5.0 GAL BOTTLE RETURN -25.0 6.00 150.00
Rec'd By:
12 -18 -08 TRANSACTION T083533042010
HINCKLEY 5.OG DRINK NON -SPILL 7.0 9.49 66.43
HINCKLEY 5.OG DISTILLED NON SPILL 21.0 9.99 209.79
5.0 GAL BOTTLE DEPOSIT 7.0 6.00 42.00
5.0 GAL BOTTLE RETURN -28.0 6.00 168.00
5.0 GAL BOTTLE DEPOSIT 21.0 6.00 126.00
Rec'd By:
12 -18 -08 TRANSACTION 36907633
ENERGY SURCHARGE 1.0 2.26 2.26
Finding your next scheduled delivery day just got easier!
Go to My Account at www.water.com. Login or register for Self Service today.
Click on Printable Calendar to view print your 2009 Delivery Calendar online. soss6- P -oo2s
Previous Balance Payment I Total New Charges Pay This Amount
$1,317.12 1 $689.84 1 $561.72 i $1,189.00
Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www.hicnkleyspdngs.com
A M1081220_BM10-12679-000601885
How to Read Your Statement 1 Visit Our Website•
Register online for access to your
l'l- w...n »»s°e» GII Lua,°m•r 9•MCn or
°.rM»
�.°W,w• account. You can view and pay your bill,
check delivery schedule and order
Customer Account Number: products all online.
For prompt service, please use this
number when referring to your account. 4
Bottle Deposits:
Summary: I Highlights bottle deposits and returns.
Balance from p revious bill
(previous balance minus payments).
I
Easy to Pay:
You can pay through the mail, online, or call us
Easy to Read: 1_ _i_ to expedite your remittance with automatic credit
All charges and credits are easy ^yam /card payments.
to understand. o
,LE311GN
E%
Total New Charges: W
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
is X1 1 [p using business envelope provided.
Important Monthly Message
r ue:o 2-13 22782366 -3 fir .Cn t c9o.70 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"
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 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.
Please print only new address or credit cam information below n l ^c4 the k imp
F Customer Account 17209463083945 Invoice 1208 1720946 3083945
Date Details City. Each Amount
Total New Charges 561.72
612749
M1081220_BM1 0- 1 26 81 000 001 88 5 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 �1
HINCKLEY SPRINGS Purchase Order No. I ^J
PO BOX 660579 Terms
DALLAS, TX 75266 -0579 Due Date 12/30/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/30/2001-1208172094( $561.72
2!
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 086982 WARRANT ALLOWED
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
I ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
12081720946 01- 7202 -05 $561.72
Voucher Total $561.72
Cost distribution ledger classification if
claim paid under vehicle highway fund
j