206696 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $251.50
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 206696
CHECK DATE: 2128/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 2877859 63.29 OTHER MISCELLANOUS
651 5023990 30839450211 188.21 OTHER EXPENSES
1- 800 -4- WATERS (492 -8377) www.HinckloySprings.com
Upcoming Delivery Dates Hen IC�e E)eliver!
February March Aril
10 Bottled Water Filtration Coffee
Thursday, 16 Thursday, 1 Thursday, 12 Every time you purchase Athena bottled water, you loin the
Thursday, 15 Thursday, 26 fight against breast cancer. A minimum of $1 million related
Thursday, 29 to the sale of Athena will go to support breast cancer
awareness, education, and research by 2014.
Customer Account 17220042677859
KIM ROTT Invoice Date: 02 -04 -12
CARMEL CITY COURT
1 CIVIC SO Invoice 2677859 020412
CARMEL, IN 45032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 65.71
01 -13 -12 P205195 Payment Check 205195 Thank You -35.82
Remaining Balance 29
R120102494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50
01 -19 -12 7120193042016 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19,98
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00
Recd By: Not Available or Refused
02 -02 -12 T120333042011 HINCKLEY SPRINGS 5G DRINKING WATER 3.0 9.99 29.97✓
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 5.0 3.49 17.45 t✓
5.0 GALLON BOTTLE RETURN -3.0 6.00 -18.00
5.0 GALLON BOTTLE DEPOSIT 3.0 6.00 18.00
Recd By: Not Available or Refused
02 -02 -12 71403426 ENERGY SURCHARGE 1.0 2.37 2.37
Total New Charges 83,27
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 einvoice, order additional products,
check your next delivery, pay your bill and much more. Log on today!
30356- POV36
Previous Balance Payment Total New Charges o Pay This Amount
$65.71 $35.82 $83.27 $113.16
7 Write the complete account number on your check. Detach remittance and mail with pa in the enclosed envelo To pay online go to !m Ainckley5pr ngs.com 0
How to Read Your Statement Important Monthly Promotions:
Upcani ^goelivety �x,es We Deliver! Register online for access to your
MOM
Delivery Calendar: PN �,aw�. account. You can view and pay your bill,
Your scheduled deliveries for check delivery schedule and order
the next three months. products all online.
Customer Account Number: 9 Bottle Deposits:
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account.
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. F- �.:Ma"°
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
n
various products and transactions. Please detach remittance and mat!
0 q Ll �U s using business envelope provided.
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Important Monthly Message.._�,� L.•I,I,II,,,I,,II,,,I,I,I„III „I„II,I „I„II
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 NOTI
write y ou
o d o not
on a s w to
a sheet to in this check conversion
program,
Your name and complete account number. plea
P RC- 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 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.
4S Terms
4 Uw Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4 a v-
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
-a-5 79
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
l 301 X3779 3W,5 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
f 20
Si r
le
Cost distribution ledger classification if
claim paid motor vehicle highway fund
1- 800 -4- WATERS (492 -8377) www.HincklaySprings.com
Upcoming Delivery Dates liver,
Hinckieyo We ole
February March April Bottled Water Filtration Coffee
Thursday, 23 Thursday, 8 Thursday, 5 Every time you purchase Athena bottled water, you join the
Thursday, 22 Thursday, 19 fight against breast cancer. A minimum of $1 million related
to the sale of Athena will go to support breast cancer
awareness, education, and research by 2014.
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 02 -11 -12
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice 3083945 021112
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 376.40
01 -13 -12 P205195 Payment Check 205195 Thank You 222.12
Remaining Balance 154.28
01 -26 -12 7120263042003 HINCKLEY SPRINGS 5G DRINKING WATER 7.0 9.99 69.93
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 4.0 3.49 13.96
5.0 GALLON BOTTLE RETURN -7.0 6.00 -42.00
5.0 GALLON BOTTLE DEPOSIT 7.0 6.00 42.00
Recd By: Not Available or Refused
R120201797710 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
02 -09 -12 T120403042005 HINCKLEY SPRINGS 5G DRINKING WATER 5.0 9.99 49.95
5.0 GALLON BOTTLE RETURN -5.0 6.00 -30.00
5.0 GALLON BOTTLE DEPOSIT 5.0 6.00 30.00
Recd By: Not Available or Refused
02 -09 -12 71641678 ENERGY SURCHARGE 1.0 2.37 2.37
Total New Charges 188.21
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 products,
check your next delivery, pay your bill and much more. Log on today!
30356 -P -0030
Previous Balance Payment Total New Charges Pay This Amount
$376.40 $222.12 $188.21 $342.49
V Write the comple account number on y our check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www.Hinckley5pr)ngs.com 0
How to Read Your Statement Important Monthly Promotions:
�otomh we oe lver! Register online for access to your
lone 5009 bl,l09 Ry9us[2 -9 Nea Yle °r'FIN°
Delivery Calendar m9 a M�ro mew „3 N,F. m account. You can view and pay your bill,
Your scheduled deliveries for m° check delivery schedule and order
the next three months. products all online.
Customer Account Number: a a" Bottle Deposits:
For prompt service, please use this wog Highlights bottle deposits and returns.
number when referring to your account.
Easy to Pay:
Pay your invoice through the mail, online at
Summary: 4 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: a
�.n,
This information provides totals for ,am,�W Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
a a] using business envelope provided.
III J.I..AIII IIAI„IIIIII..I.ILIIII I melt R-13— -1 F.M.ni T.:
wrvry sm.x
Important Monthly Message "^'*'E ^E.b91p"3i°' IL.,LI,LJL III „IL.IL..JII ILL,I,,,II.I „L „II
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.Q. Box 660579, Dallas, TX 75266 -0579.
VOUCHER 116805 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
30839450211 01- 7202 -05 $188.21
Voucher Total $188.21
Cost distribution ledger classification if
claim paid under vehicie highway fund
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 2/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/20/2012 3083945021' $188.21
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 icer