175727 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
i ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $52.72
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 175727
CHECK DATE: 8/6/2009
DEPARTMENT ACCO PO NUMBER INV OICE NUMBER AMO UNT DESCRIPTION
1301 4239099 52.72 OTHER MISCELLANOUS
�t
HINCKLEY SPRINGS WATER
800 -444 -PURE
WAIER.COM
ORIGINAL
COS'iiTIMER 1722004 TICKET 092043042008
LOCA110N 2677868 PO
CARMEI. CITY COURT Date: 117123120119 lime: 09:110:46 AM
1 CIVIC SQ ROUTE #3042 DAVID
CARMEL, IN 46032
Last Paynvent Date: 00131112009 I „st Paymcnit Amourl: 43.23
Product Delivered QTY PRICE AMOUNT($)
HS 5G DR NS 2 9.49 18.98
BOT 5.OG PLS 2 6.00 12.00
BOT 5.OG PLS -2 6.011 -12.00
(2 Duttles 14:;;i. it rd 2 Fo ty Duttles Ruiuined 0 Dottles IL
Subtotal Sales 18.98
Sales Tax 0.00
IIFLIVERY TICKET IOIAL 18.98
P(evious Account Balance 31.98
Total Balance Due 50.96
Payments 0.00
ENDING BALANCE 50.96
Next Delivery Date 08106/2009
We bill munthly by summary Invoice.
Retain for your records.
FIT
P.O. Box 96259
Chicago, IL. 60693
Fed Tax Id 20-5743877
Phone 773-586 -8600 ext 3588
ORIGINAL
CUS'iUMER 1!?ZUii4 TICKET 0919030421106
LOCAIION 2677868 PO
CARMf L CITY 1 :001 T Date: 117/090109 Tire: (18:21:49 AM
1 .IVII: SO ROUTE #3U42 DAVID
CARMEL• IN 46032
Last Payirent D. +le: 116131112009 ;,st n, uvount: 43.23
Product Delivered OTY PRIIT AMOUNT($)
HS 5G OR NS 2 18.98
801 5.OG PLS 2 uU 12.00
BOT 5.OG PLS -2 6.U0 -12.00
(2 11" tUe:; n Iive C, n tlles Ret1,-,1 +:d 0 nullle.; n,:;,.,siteJ)
Subtotal Sales 18.98
Sales Tax 0.00
DELIVERY IICKEI TOTAL 18.98
Previous Account Balance 13.00
Total Balance Due 31.98
Payments 0.00
ENDING BALANCE 31.98
Next Oelivery Date 07/23120N
We bill irunthly by suuunary Invoice.
Retain fur your records.
r 1 -8 0-4- WATERS 492 -8377 m
Upcoming Delivery Dates We g)e liver!
August September October Springsf B ottled Water Filtration Coffee
Thursday, 6 Thursday, 3 Thursday, 1 Introducing the industry's first compostable cup
Thursday, 20 Thursday, 17 Thursday, 15
Thursday, 29 products manufactured by Solo cup company.
Made from at least 80% renewable resources, these
products are a great compliment to any work environment
providing a green solution to your drinking water needs.
Customer Account 17220042677859
KIM ROTT Invoice Date: 07 -25 -09
CARMEL CITY COURT
1 CIVIC SO Invoice 0709 1722004 2677859
CARMEL, IN 46032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 43.23
06 -30 -09 P173864 Payment Check 173864 Thank You -43.23
Remaining Balance 0.00
8091762494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
07 -09 -09 T091903042006 HINCKLEY 5.OG DRINK NON -SPILL 2.0 9.49 18.98
5.0 GAL BOTTLE DEPOSIT 2.0 6.00 12.00
5.0 GAL BOTTLE RETURN -2.0 6.00 -12.00
Recd By:
07 -23 -09 T092043042008 HINCKLEY 5.OG DRINK NON -SPILL 2.0 9.49 18.98
5.0 GAL BOTTLE RETURN -2.0 6.00 -12.00
5.0 GAL BOTTLE DEPOSIT 2.0 6.00 12.00
Rec'd By:
07 -23 -09 43316243 ENERGY SURCHARGE 1.0 1.76 1.76
Total New Charges 54.72
Managing your account is now at your fingertips. Take advantage of many time saving
options available on water.com. Save paper when you sign up for elnvoice, order additional
p roducts, check your next delive !y, pay your bill and much more. Loci on toda 1
30355 -f' -0034
Previous Balance Payment Total New Charges Pay This Amount
$43.23 $43.23 $52.72 $52.72
Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www.Hlnckie Spnnas cum V
How to Read Your Statement Important Monthly Promotiom:
UP 1 D 11 D— We Deliver! Register online for access to your
�9 "tea F.,.^.
ane2009 C account. You can view and pay your bill,
Delivery Calendar:
Your scheduled deliveries for M...„3, check delivery schedule and order
the next three months. products all online.
Customer Account Number: Bot tle Deposits'
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account. s aPo o
Easy to Pay:
Pay your invoice through the mail, online at
Summary: m www.watercom or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill. E.E ,a
Total New Charges:
This information provides totals for T< ":e Mail Remittance With Payment To:
various products and transactions. av° �h Please detach remittance and mail
using business envelope provided.
IL.. 1I6LIJLJLII „LI,IJL.. rMeu e.mwmc. -1 a.rmeni T.I
�=Wn
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 ive our letter, 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.
Prescribed 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
L D 57 9 Terms
.(Q ti 7Sd&6 oS 7 9 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
r• gg
1. 7L
Total
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
0,5;
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE A OUNT
DEPT. I hereby certify that the attached invoice(s), or
,3v1 r,�o X10.19
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
I
1 20 0
4it C, Cost distribution ledger classification if
claim paid motor vehicle highway fund