173864 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
0 CHECK AMOUNT: $754.90
CARMEL, INDIANA 46032 PO BOX 660579
'tea o „zo DALLAS TX 75266 -0579 CHECK NUMBER: 173864
CHECK DATE: 6/24/2009
DEPARTMENT ACCOUNT PO N UMBE R INVOI NUMBER AMOUNT DES CRIPT I ON
651 5023990 06091720946 711.67 OTHER EXPENSES
1301 4239099 2677859 43.23 OTHER MISCELLANOUS
1- 800-4- WATERS (492 -8377) www.Hinckle S rin s.com
Upcoming Delivery Dates
1nkJe'® We WV
June July August Springs Bottled Water Filtration Coffee
Thursday, 25 Thursday, 9 Thursday, 6 Looking for an easy way to stay refreshed this summer?
Thursday, 23 Thursday, 20 We Deliver! From .5 liter to 24 oz bottles in convenient
24 -pack cases, we've got the sizes you need to fit your
active lifestyle or busy office environment. Get the
convenience of single -serve bottles delivered today!
Customer Account 17220042677859
KIM ROTT Invoice Date: 06 -13 -09
CARMEL CITY COURT Invoice 0609 1722004 2677859
1 Civic SQ
CARMEL, IN 46032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 33.68
06 -05 -09 P172866 Payment Check 172866 Thank You -33.68
Remaining Balance 0.00
R091482494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.00 CED
06 -11 -09 T091623042007 HINCKLEY 5.OG DRINK NON -SPILL 3.0 9.49 8. Z
5.0 GAL BOTTLE RETURN -3.0 6.00 1 &.00
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
Rec'd By:
06 -11 -09 42053382 ENERGY SURCHARGE 1.0 1.76 1.76
Total New Charges 43.23
Managing your account is now at your Fingertips. Take advantage of many new self- service features available
on water.com. Order additional products, view your next delivery, register for elnvoice and much more. Log in
today! j
30356 -P -0034
Previous Balance Payment Total New Charges Pay This Amount
$33.68 $33.68 $43.23 $43.23
V Write the complete account number on y our check. Detach remitt and mail with payment in the enclosed en _v_elope._To p ay_ online .go_to_w ww.Hinckley.Spnngs.com V
How to Read Your Statement •we.Ea4 Important Monthly Promotions:
Register online for access to your
a rm m,,e w.,b FI«,. �a,
Delivery Calendar: ,.e „w.w, account. You can view ind pay your bill,
Your scheduled deliveries for M,,; °mee check delivery schedule and order
the next three months.
products all online.
Customer Account Number:
For prompt service, please use this Bottle Deposits:
Highlights bottle deposits and returns.
number when referring to your account- 18
I. KOUK K
Easy to Pay:
N Pay your invoice through the mail, online 'at
Summary: www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
Z
ZE E2
Total New Charges:
This information rovides totals for
p P F 4 Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
s using business envelope provided.
Ilk i.i,i..l,iu, u.,u..I.[i „u.i „i..u,i i „3i M. A «m,,. °.w, «P<. —r
.u.wr 11 1.1 1.— I dlI— II..II ..J J.11 JIJ..II �,IIJ1.11 Al
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 our letter, give us the following information: OPT OUT NOTICE: If you do not wish to participate in this check conversion
y 9 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.
_TI Ida -16 -12009 07:5 HINCKLEY SPRINGS 7117 5 70 9585 P.01101
DELIVERY TICKET
HINCKLEY
800- 444 -PURE
www,water.com
Customer# 1722004 Ticket# :091623042007
Location# :2677868 PO#
CARMEL CITY COURT Date 06/11/09
1 CMC SQ Route 3042
CARMEL, IN, 46032
Product Delivered Qty Price Amount
BOT 5.OG PLS >BOTTLE 5.0G PLASTIC 3 6.00 18.00
5CuFIat9zH5P >CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT (25 0 .00 .00
SLEEVES PER CASE)
HS 5G DR NS-- >HINCKLEY S -OG DRINK NON -SPILL 3 9.49 28.47
BDT 5.0G PIS >BDTTLE S.OG PLASTIC -3 6.00 -18.00
(3 Battles Delivered 3 Empty Bottles Returned 0 Bottle Deposits)
Subtotal Sales 28.47
Sales Tax .00
Delivery Ticket Totai $28.47
Payment Total $.DO
Customer Signature
Not Available
OR
Refused
http:Herp.water.com: 9930 /OA_HTML/RF. j sp ?functi on_id =34603 &resp_id= 50906 &resp_... 6/15/2009
TOTAL P.01
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
7T Terms
75 6 Date Due
r
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04071Wopq2677151 00
A,
7
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
o 5-
�:�4 ,5 -05
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
59 3q o 5 3. 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
1
o
t/ �N Vn
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1- 800-4- WATERS (492 -8377) www.HinckleySprings.com
Upcoming Delivery Dates erl
Hinckl June July Augu Spnngs. Bottled We Water Filtration Coffee
Thursday, 18 Thursday, 2 Thursday, 13 Looking for an easy way to stay refreshed this summer?
Thursday, 16 Thursday, 27 We Deliver! From .5 liter to 24 oz bottles in convenient
Thursday, 30 24 -pack cases, we've got the sizes you need to fit your
active lifestyle or busy office environment. Get the
convenience of single -serve bottles delivered today!
15 ustomer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 06 -06 -09
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice 0609 1720946 30$3945
INDIANAPOLIS, IN 46280 Purchase Order M
Date Transaction Details Qty. Each Amount
Previous Balance 1,213.63
05 -11 -09 P171870 Payment Check 171870 Thank You 651.07
06 -05 -09 P172866 Payment Check 172866 Thank You 562.56
Remaining Balance 0.00
05 -21 -09 T09 1 41 3042 002 HINCKLEY 5.OG DRINK NON -SPILL 8.0 9.49 75.92
HINCKLEY 5.OG DISTILLED NON SPILL 19.0 9,99 189.81
5.0 GAL BOTTLE DEPOSIT 19.0 6.00 114.00
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
Recd By:
R091411797710 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
06 -04 -09 T091553042010 HINCKLEY 5.0G DRINK NON -SPILL 5.0 9.49 47.45
HINCKLEY 5.OG DISTILLED NON SPILL 17.0 9.99 169.83
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 10.0 2.99 29.90
5.0 GAL BOTTLE DEPOSIT 5.0 6.00 30.00
5.0 GAL BOTTLE DEPOSIT 17.0 6.00 102.00
5.0 GAL BOTTLE RETURN -23.0 6.00 138.00
Recd By:
06 -04 -09 41883688 ENERGY SURCHARGE 1.0 1.76 1.76
m anaging your account is now at your fingertips. Take advantage o many new self-service features avai a e
on water.com. Order additional products, view your next delivery, register for einvoice and much more. Log in
today!
3(1�5G:P
How to Read Your Statement Important Monthly Promotions:
uycennng oerive,yoaies We Deliver!
Re gister online far access to OUr'
Delivery Calen a o N ,o g y
ry Ca a dar: ..�,F q account. You can view and pay your bill,
Your scheduled deliveries for check delivery schedule and order
the next three months. h products all online.
Customer Account Number: m M
For prompt service, please use this Bottle Deposits:
number when referring to your account. o. Highlights bottle deposits and returns.
Easy to Pay:
Pay your invoice through the mail, online at
Summary: www- water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
mw.•,., i ISfOVFR E�
Total New Charges:
This information rovides totals for DI"
p ..�..��m Io Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
_�e- s using business envelope provided.
II.. IIII1. II... IIIIIJ .I.Ihll,lll.l..11 ,u•u n.m I-. wun P— ",r "r
>iMa'ii ranee.
Important Monthly Message µmmEP•. a =N «s4 L. dd,L.. L I ll,,,n.dl„ I,I I..II,1.,1 ,11 „I 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).
Customer`A' c iihi 17209463083945 n 'InaoiceA# 0609 4720946 3083945
u
�Date
Total New Charges 711.67
M1090606_BM10- 8885- 000001531 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
HINCKLEY SPRINGS Purchase Order No.
PO BOX 660579 Terms n
DALLAS, TX 75266 -0579 Due Date 6/15/2009 1t
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/15/2009 0609172091( $711.67
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 095817 WARRANT ALLOWED
131-130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
N ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
06091720946 01- 7202 -05 $711.67
Voucher Total $711.67
Cost distribution ledger classification if
claim paid under vehicle highway fund