170427 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $741.84
CARMEL, INDIANA 46032 PO BOX 660579
raN DALLAS TX 75266 -0579 CHECK NUMBER: 170427
CHECK DATE: 411/2009
DEPARTMENT ACCOU PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
651 5023990 03091720946 676.14 OTHER EXPENSES
1301 4239099 030.91722004 65.70 OTHER MISCELLANOUS
N
L
1
HINCKLEY SPRINGS WATER
800- 444 -PURE
WATER.COM
MODIFIED(1)
CUSTOMER a 1722004 TICKET a 090783042028
LOCATION a 2677868 POn:
CARMEL CITY COURT Date: 03119/2009 Time: 08:55:35 AM
1 CIVIC SQ ROUTE «3042 DAVID
CARMEL, IN 46032
Last Payment Date: 0212012009 Last Payment Amount: 43.47
Product Delivered QTY PRICE AMOUNT($)
HS 5G DR NS 3 9.49 28.47
BOT S.OG PLS 3 6.00 18.00
BOT S.OG PLS -3 6.00 -18.00
5CuFlat9zHSP 5 1 4,49 22,45
(3 Duttles Delivered 3 Cngjty Dottles RetU MULL 0 Duttlet, Dgjuu ited)
Subtotal Sales 50.92
Sales Tax 0.00
DELIVERY TICKET TOTAL 50.92
Previous Account Balance 46.81
Total Balance Due 97.73
Payments 0.00
ENDING BALANCE 97
Next Oelk ery Date 04116/2009
We bill monthly by summary Invoice.
Retain for your records.
y H i b n r ckley an springs For Customer Service and Account Inquiries,
a d o f Call 1- 800 444 -PURE (7873) 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: 03 -21 -09
CARMEL CITY COURT 04 -16 -09 Invoice 0309 1722004 2677859
1 CIVIC SQ 05 -14
CARMEL, IN 46032 Purchase Order
Date Details Qty. Each Amount
Previous Balance 33.81
03-20-09 Payment -Check 169463 -Thank You 33.81
Remaining Balance 0.00
TRANSACTION R090642494748
HOT AND COLD COOLER RENTAL 1.0 13.00 13.00
03 -19 -09 TRANSACTION 39438143
ENERGY SURCHARGE 1.0 1.78 1.78
03 -19 -09 TRANSACTION T090783042028
HINCKLEY 5.OG DRINK NON -SPILL 3.0 9.49 28.47
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 5.0 4.49 22.45
5.0 GAL BOTTLE RETURN -3.0 6.00 -18.00
5.0 GAL BOTTLE DEPOSIT 3.0 6.00 18.00
Recd By:
Total New Charges 65.70
30356 -P -0023
Previous Balance Payment Total New Charges Pay This Amount
$33.81 $33.81 $65.70 $65.70
Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www,hicnk[syspdngs.com
How to Read Your Statement Visit Our Website:
/Register online for access to your
�M°.w•� account. You can view and pay your bill,
check delivery schedule and,grder
Customer Account Number: products all online.
For prompt service, please use this
number when referring to your account.
Summary: „L.,, I Bottle Deposits:
Y: 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 payments.
to understand. .m o
Total New Charges:
This information provides totals for I ",fin u -Nw. v w Mail Remittance With Payment To:
various products and transactions. E Please detach remittance and mail
V using business envelope provided.
Important Monthly Message Mn u—
1cub.0 '0 "i.1 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
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
y ou are still obligated to a the amount of our bill that is not in q uestion. While for the uncollected amount. Payment by check constitutes your acceptance of
Y 9 p ay 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.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form Ho. 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
�94m'4%' p Purchase Order No.
0. 660-57? Terms
CA. g':) 73a?66 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or biil(s))
5
r. ?e
�oU
Total r, w
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
Y
U GGa s �9
L S- 70
ON ACCOUNT OF APPROPRIATION FOR
Board Members
P09 or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
o,? 09 7d Zoo
Ilk l 9a 99 65, 70 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
2 0 0 T
r-
re
Tit e
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Hinckley Springs For Customer Service and Account Inquiries,
nc Ax py, a brand of
I'li1 DS Waters ofAmerica, Inc. Call 1- 800 444 -PURE {7873) or visit
PO Box 660579 www.hinckleysprings.com
Dallas, TX 75266 -0579
Customer Account 17209463083945
ACCOUNTS PAYABLE Your Next Deliveries: Invoice Date: 03 -14 -09
CITY OF CARMEL UTILITIES 03 -26 -09 Invoice 0309 1720946 3083945
9609 HAZEL DELL PKWY 04 -09
INDIANAPOLIS, IN 46280 Purchase Order
Date Details Qty. Each Amount
Previous Balance 1,058.94
02 -20 -09 Payment -Check 168511 -Thank You 553.92
Remaining Balance 505.02
02 -26 -09 TRANSACTION T090573042007
HINCKLEY 5.OG DRINK NON -SPILL 4.0 9.49 37.96
HINCKLEY 5.OG DISTILLED NON SPILL 28.0 9.99 279.72
5.0 GAL BOTTLE DEPOSIT 4.0 6.00 24.00
5.0 GAL BOTTLE DEPOSIT 28.0 6.00 168.00
5.0 GAL BOTTLE RETURN -32.0 6.00 192.00
Rec'd By:
TRANSACTION R090571797710
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
03 -12 -09 TRANSACTION T090713042010
HINCKLEY 5.OG DRINK NON -SPILL 13.0 9.49 123.37
HINCKLEY 5.OG DISTILLED NON SPILL 19.0 9.99 189.81
5.0 GAL BOTTLE DEPOSIT 13.0 6.00 78.00
5.0 GAL BOTTLE DEPOSIT 19.0 6.00 114.00
5.0 GAL BOTTLE RETURN -30.0 6.00 180.00
Recd By:
03 -12 -09 TRANSACTION 39282245
ENERGY SURCHARGE 1.0 1.78 1.78
30356 -P -0023
Previous Balance Payment Total New Charges Pay This Amount
V563 -92__. 676.14 $1 181.16
M_,
y r
How to Read Your Statement Visit Our Website:
"s`" Register online for access to your
-bol- account. You can view and pay your bill,
Customer Account Number: check delivery schedule and order
For prompt service, please use this products all online.
number when referring to your account.
Bottle Deposits:
Summary: I 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: I to expedite your remittance with automatic credit
All charges and credits are easy card p
to understand. t o.<a�R
°D =D
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
using business envelope provided.
T
Important Monthly Message u�. td� ,�.,�.�..���n,u,,...r,�,d�d �•u,��,dt�,,.d,d „u, ,��e�,n.��,nn�
i
]c �f.a �I10413 .S42z X023 L64 L "i Ofl +C° A Lbii:7C]
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.
It 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 writ DS Waters of America Inc. at P.O. Box 660579 Dallas. TX 75266 -057
§2b e +�s.+ .a avv'v ,b
CustomerAccount# 1172494634839` 45� la�voice "#�.4309�17209�463083945'
a a �asvE hazrg.r+u s»,
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`a 's t7r`t 9i >I c6 v+ N $afi Irsi r x
Dated Deta is �p .ff E46h un
z�,.�,� Qty Amot
w
Total New Charges 676.14
M1090314_BM10- 21543 -000000683 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 3/24/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/24/2009 0309172094E $676.14
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
212-1,11,
Date Officer
VOUCHER 095296 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
�0 INV ACCT AMOUNT Audit Trail Code
03091720946 •01- 7202 -05 $676.14
1 Voucher Total $676.14
Ci st distribution ledger classification if
claim paid under vehicle highway fund