172866 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $596.24
CARMEL, INDIANA 46032 PO BOX 660579
.o� zo DALLAS TX 75266 -0579 CHECK NUMBER: 172866
CHECK DATE: 5/27/2009
D EPARTM EN P ACCOU PO NUMB IN NU AMOUNT DESCRIP
1301 4239099 0509 33.68 OTHER MISCELLANOUS
651 5023990 05091720946 562.56 OTHER EXPENSES
Hinckley Springs For Customer Service and Account Inquiries,
c P a brand of Call 1- 800 -4- Waters (492 -8377) or visit
DS Waters of America, Inc.
PO Box 660579 www- hinckleysprings -com
Dallas, TX 75266 -0579
Customer Account 17220042677859
KIM ROTT Your Next Deliveries: Invoice Date: 05 -16 -09
CARMEL CITY COURT 06 -11 -09 Invoice 0509 1722004 2677859
1 CIVIC SQ 07 -09 -09
CARMEL, IN 46032 Purchase Order
Date Details City. Each Amount
Previous Balance 33.72
05 -11 -09 Payment Check 171870 Thank You -33.72
Remaining Balance 0.00
TRANSACTION R091202494748
WHITE HOT AND COLD COOLER RENTAL 1.0 13.00 3.00
05 -14 -09 TRANSACTION 41168931
ENERGY SURCHARGE 1.0 1.70 1.70
05 -14 -09 TRANSACTION# 7091343042010
HINCKLEY 5.OG DRINK NON -SPILL 2.0 9.49 18.98
5.0 GAL BOTTLE RETURN -2A 6.00
5.0 GAL BOTTLE DEPOSIT 2.0 6.00 12.00
Rec'd By:
Total New Charges 33.68
30356 -P -0023
Previous Balance Payment Total New Charges Pay This Amount
$33.72 0 $33.72 $33.68 $33.68
Write the complete.account number on .your check ..Detach.remittance.and.mail with payment in theenclosed envelope To pay_oniine_go to www.hicnkleyspnngs_com V
How to Read Your Statement Visit Our Website•
C Register online for access to your
x account. You can -view and pay your bill,
o° check delivery schedule and order
Customer Account Number
products all online.
For prompt service, please use this
number when referring to your account.
i lBottleDeposits:
Summary: Highlights battle deposits and returns.
i P
Balance from P revious bill
(previous balance minus payments).
Easy to Pay:
You can pay through the mail, online, or call us
Easy to Read: to expedite your remittance with automatic credit
All charges and credits are easy card pay
to understand. .',r o
Total New Charges:
This information rovides totals for
P Bail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
°r„ UJ using business envelope provided.
Important Monthly Message
u..n _noia „vz2: e23e u93 nC P. -[P t f7i is ?L]
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 followin 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.
MAY-14-2009 19;05 HINCKLEY SPRINGS 317 570 9565 P.01/01
DELIVERY TICKET
HINCKLEY
ON-444-PURE
Customer# 1722004 Ticket# 091343042010
Location# 2677868 PO#
CARMELCM COURT Date 05/14109
1 CMC SQ Route 3042
CARMEL, IN, 46032
Product Delivered Qty Price Amount
BOT 5,OG PLS>BOTTLE 5.0G PLASTIC 2 6,00 I2.00
SCuFlat9zHSP >CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT (25 0 .00 .00
SLEEVES PER CASE)
HS SG DR NS-- HINCKLEY 5.015 DRINK NON-SPILL 2 9.49 18.98
BUT 5.013 PLS ;;-BOTrLE 5,0G PLASTIC .2 6.00 -12.00
(2 Bottles Delivered 2 Empty "e5 Returned 0 Baffle Deposits)
Subtotal Sales 18.98
Sales Tax .00
Delivery Ticket Total $18.98
Payment TOW $.00
Customer Signature
Not Available
OR
Refused
http://erp.water.com:99301OA 5/14/2009
TOTHL P.01
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
0. o 6o Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
l Le P-509 1 3 a
70
Total
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.
ALLOWED 20
IN SUM OF
P
ON ACCOUNT OF APPROPRIATION FOR
Board Members
POD or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
C) 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
n
20
re W/
r
Tit e
Cost distribution ledger classification if
claim paid motor vehicle highway fund
o Hinckley Springs For Customer Service and Account Inquiries,
a brand of Call 1- 800 -444 -PURE (7873) or visit
Springs DS Waters of America, Inc.
PO Box 660579 www.hinckleysprings.com
Dallas, TX 75266 -0579
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Your Next Deliveries: Invoice Date: 05 -09 -09
CITY OF CARMEL UTILITIES 05 -21 -09 Invoice 0509 1720946 3083945
9609 HAZEL DELL PKWY 06 -04
INDIANAPOLIS, IN 46280 Purchase Order
Date Details City. Each Amount
Previous Balance 1,327.21
04 -14 -09 Payment Check 170427 Thank You 676.14
Remaining Balance 651.07
04 -23 -09 TRANSACTION T091133042003
HINCKLEY 5.OG DRINK NON -SPILL 8.0 9.49 75.92
HINCKLEY 5.OG DISTILLED NON SPILL 18.0 9.99 179.82
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 5.0 4.49 22.45
5.0 GAL BOTTLE DEPOSIT 8.0 6.00 48.00
5.0 GAL BOTTLE RETURN -26.0 6.00 156.00
5.0 GAL BOTTLE DEPOSIT 18.0 6.00 108.00
Rec'd By:
TRANSACTION R091131797710
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
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 10.50 10.50
05 -07 -09 TRANSACTION T091273042013
HINCKLEY 5.OG DRINK NON -SPILL 6.0 9.49 56.94
HINCKLEY 5.OG DISTILLED NON SPILL 17.0 9.99 169.83
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT -10.0 4.49 -44.90
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 20.0 2.99 59.80
5.0 GAL BOTTLE DEPOSIT 6.0 6.00 36.00
5.0 GAL BOTTLE DEPOSIT 17.0 6.00 102.00
5.0 GAL BOTTLE RETURN -23.0 6.00 138.00
WHITE ROOM TEMP AND COLD COOLER Installed Serial #0079235237469 1.0 0.00 0.00
Recd By:
30356 -P -0023
Previous Balance Payment Total New Charges Pay This Amount
$1,327.21 $676.14 c $562.56 $1,213.63
-Write the complete account on;your check Detach remittance and mail with payment -in the enclosed envelope. To pay online go to- www.hicnkleyspnngs.com
How to Read Your Statement �m °rc„x'lteA' °au °•m1np
Visit Our Website:
Register online for access to your,,
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.
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: to expedite your remittance with automatic credit
All charges and credits are easy card p
to understand. o
Total New Charges:- z
This information provides totals for a Mail Remittance With Payment To:
various products and transactions &w Please detach remittance and mail
I p-:.; r� ;;�.,,�;.a s' using business envelope provided.
Important Monthly Message
t ue.o _nori3 .sv eeraa aces tea nn= rn e c0000 c 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.
5
:W+ i a .v'ag'ue w .o, :F n3 W� ��rPorn.' i' s±� �i. AV
Customer ,Account voce 050,9 a1720J46 30939�5�
""e v -e,I a
Date Details s �in�d ��a Q€ Each Amount
rs�. n ,�,1 .4�_� RSA, ".Or
05 -07 -09 TRANSACTION 41019275
ENERGY SURCHARGE 1.0 1.70 1.70
TRANSACTION R091271797710
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
Total New Charges 552.56
M1090509_BM1 0-9017-000001571 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
DALLAS, TX 75266 -0579 Due Date 5/19/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/19/2009 0509172094E $562.56
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 095683 WARRANT ALLOWED
131130 IN SUM OF
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266 -0579
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
I
l Board members
PO INV ACCT AMOUNT Audit Trail Code
05091720946 01- 7202 -05 $562.56
Voucher Total $562.56
Cost distribution ledger classification if
claim paid under vehicle highway fund