176267 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660576 CHECK AMOUNT: $654.03
DALLAS TX 75266 -0579
CHECK NUMBER: 176267
CHECK DATE: 8/19/2009
nEPARTMENT AC PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 08091720946 654.03 OTHER EXPENSES
1- 800-4- WATERS 492 -8377 www.HinckleySprings.com
Upcoming Delivery Dates liver!
Hin lqy® We
August September October Spnngs, Bottled Water Filtration Coffee
Thursday, 13 Thursday, 10 Thursday, 8 Put a smile on your employees' faces by starting your office
Thursday, 27 Thursday, 24 Thursday, 22 coffee service. From single -serve coffee machines to energy
saving commercial brewers, we will provide you with the
perfect selection of equipment and products to brew the
perfect cup. Call us today to start your service!
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 08 01 09
CITY OF CARMEL UTILITIES Invoice 0809 1720946 3083945
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 602.58
Payment 0.00
Remaining Balance 602.58
R091971797710 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
07 -16 -09 T091973042006 HINCKLEY 5.OG DRINK NON -SPILL 4.0 9.49 37.96
HINCKLEY 5.OG DISTILLED NON SPILL 24.0 9.99 239.76
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 6.0 2.99 17.94
5.0 GAL BOTTLE DEPOSIT 24.0 6.00 144.00
5.0 GAL BOTTLE RETURN -28.0 6.00 168.00
5.0 GAL BOTTLE DEPOSIT 4.0 6.00 24.00
Rec'd By:
07 -30 -09 43606943 ENERGY SURCHARGE 1.0 1.76 1.76
07 -30 -09 T092113042012 HINCKLEY 5.OG DRINK NON -SPILL 8.0 9.49 75.92
HINCKLEY 5.OG DISTILLED NON SPILL 21.0 9.99 209.79
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 10.0 2.99 29.90
5.0 GAL BOTTLE DEPOSIT 21.0 6.00 126.00
5.0 GAL BOTTLE RETURN -29.0 6.00 174.00
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
Rec'd By:
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30356 -P -0034
Previous Balance Payment Total New Charges Pay This Amount
$602.58 c
$0.00 s $654.03 $1,256.61
V Write the complete account number on your cherl Detach.remittance_and -mail with payment in the enclosed envelope. To_pay online_gc to m".hinckley5prings com V
How to Read Your Statement Important Monthly Promotions:
UO—M, D6b Dates jj'' We Deliver' Register online for access to your
Delivery Calendar: •M .a "w.: account. You can view and pay your bill,
Your scheduled deliveries for „«,e.'"
check delivery schedule and order
l ducts al online.
pr
the next three months. o
Customer Account Number: Bottle Deposits:
For prompt service, please use this ro
number when referring to your account. g °R° Highlights bottle deposits and returns.
Easy to Pay:
Pay your invoice through the mail, online at
Summary: w 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: W°
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
e o e� f 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 a the amount of our bill that is not in question. While for the uncollected amount. Payment by check constitutes your acceptance of
Y g 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.
F
h° Customer Account# '17209463083945 R P 3 „Invoice 08.0,9 172ft946�3083945
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Dated betafls d,� F a Q! Each lamount�
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Total New Charges 654.03
M1090801 BM10- 9911 -000001724 Page 2 of 2
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) r
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 8/10/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/10/2009 0809172094( $654.03
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
E
VOUCHER 096159 WARRANT ALLOWED
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
08091720946 01- 7202 -05 $$654.03
Voucher Total $654.03
Cost distribution ledger classification if
claim paid under vehicle highway fund