207480 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $297.35
DALLAS TX 75266 -0579
'a
CHECK NUMBER: 207480
CHECK DATE: 3/26/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 2677859 72.78 OTHER MISCELLANOUS
651 5023990 30839450310 224.57 MATERIALS SUPPLIES
1- 800 -4- WATERS 492 -8377 www.HinckloySprings.com
Upcoming Delivery Dates Hinckley W e
March A0 May
Bottled Water Filtration Coffee
.I
Thursday, 15 Thursday, 12 Thursday, 10 Together, we raised almost $800 to fight breast cancer
Thursday, 29 Thursday, 26 Thursday, 24 in 2011.
Thanks for making a difference!
Customer Account 17220042677859
KIM ROTT Invoice Date: 03 -03 -12
CARMEL CITY COURT
1 CIVIC SQ Invoice 2677859 030312
CARMEL, IN 46032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 113.16
02 -10 -12 P205871 Payment Check 205871 Thank You -29 89
Remaining Balance 83.27
R120382494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50
02 -16 -12 T120473042009 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 2.0 3.49 6.98
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6 -00 12.00
Rec'd By: Not Available or Refused
03 -01 -12 72248408 ENERGY SURCHARGE 1.0 2.35 2.35
03 -01 -12 T1 2061 304 200 7 HINCKLEY SPRINGS 5G DRINKING WATER 3.0 9.99 29.97
5.0 GALLON BOTTLE RETURN R EC E IVED -3 6,00 -18 -00
5.0 GALLON BOTTLE DEPOSIT 3.0 6.00 0
Total New Charges MAR 16 2012 72.78
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, a our bill and much more. Lou on today!
3035fi -P -0033
Previous Balance Payment Total New Charges Pay This Amount
$113.16 $29.89 �Ir: $72.78 $156.05
V W rite the complete account number onyour check_ Detach remittance and mail wit h.payment i the enclosed e nvelo pe. To_ p ay _online, o to www.Hinckle 5 r m s eo
How to Read Your Statement a. °wee`' °m Important Monthly Promotions:
❑FC °min. mw-fines We Deliver! Register online for access to your
line 1009 1u�1009 Mugest 3009 OaNeC Wme. "FlaNeoon'C011w
Delivery Calendar M "a, 1N N� account. You can view and pay your bill,
Your scheduled deliveries for •d «:o• check delivery schedule and order
the next three months. m SL products all online.
Customer Account Number: Bottle Deposits:
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account. s o�
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.°° A
Total New Charges:
ow..�
This information provides totals for Mail Remittance With Payment To:
various products and transactions. �„fl�am,ro Please detach remittance and mail
using business envelope provided.
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 9 9 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 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
r K L6 'i SPQ /1'f S Purchase Order No.
Po 8Gy 6 o S7q Terms
D/}LL -14 5 �x O�a�d 5 7 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 t -1 S S CoLt> CooLE2 flC c, 1 7-�- -7 k
Total 7a 7
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.
,ff ALLOWED 20
I�T /�1G1 {LE7� Sf�/2��lGs
Po IN SUM OF
0 80 (0057 q
D41 L A-5 TX 7
-7 7 1?
ON ACCOUNT OF APPROPRIATION FOR
C a a R
Board Members
PO a INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s) or
l o a 779 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
j �CV r 20 l
Si
Ie
Cost distribution ledger classification if
claim paid motor vehicle highway fund
1- 800 -4- WATERS (492 -8377) www.HinckleySprings.com
Upcoming Delivery Dates Hinckl
March r L May F Bottled Water Filtration Coffee
Thursday, 22 Thursday, 5 Thursday, 3
Thursday, 19 Thursday, 17 Together, we raised almost $800,000 to fight breast cancer
Thursday, 31 in 2011.
Thanks for making a difference!
Customer Account 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 03 -10 -12
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice 3083945 031012
INDIANAPOLIS, IN 46280 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 342.49
02 -10 -12 P205871 Payment Check 205871 Thank You _158.28
Remaining Balance 184.21
02 -23 -12 T120543042003 HINCKLEY SPRINGS 5G DRINKING WATER 7.0 9.99 69.93
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 10.0 3.49 34.90
5.0 GALLON BOTTLE RETURN -7.0 6.00 -42.00
5.0 GALLON BOTTLE DEPOSIT 7.0 5.00 42.00
Recd By: Not Available or Refused
81 20541 79771 0 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
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
WHITE ROOM TEMP AND COLD COOLER RENTAL 1 -0 11.00 11,00
03 -08 -12 T120683042006 HINCKLEY SPRINGS 5G DRINKING WATER 6.0 9.99 59.94
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 5.0 3.49 17.45
5.0 GALLON BOTTLE RETURN -8.0 6.00 -48.00
5.0 GALLON BOTTLE DEPOSIT 6,0 6.00 36.00
Recd By: Not Available or Refused
03 -08 -12 72489581 ENERGY SURCHARGE 1.0 2.35 2.35
Total New Charges 224.57
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! �j
30356 -P -0036
�$342 Payment Total New Charges Pay This Amount
$158.28 $224.57 :6408.78
V W rite the c omplete accoun number on your check. Detach remittance and mail with pay ment in the enclosed envelo To pay online go to www,HinckleySprings.com V
i
How to Read Your Statement Important Monthly Promotions:
uvwminy oer ".r o.s, We Deliver! Register online for access to your
Delivery Calendar: account. You can view and pay your bill,
M a s w,.
Your scheduled deliveries for M3 check delivery schedule and order
the next three months. products all online.
ate.
Customer Account Number: Bottle Deposits
For prompt service, please use this my o Highlights bottle deposits and returns.
number when referring to your account. "I U RINT
U 11
Easy to Pay:
Pay your invoice through the mail, online at
Summary: b 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:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
aw e� c using business envelope provided.
Important Monthly Message µx "E "E °s „us
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.
VOUCHER 116976 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
30839450310 01- 7202 -05 $224.57
Voucher Total $224.57
Cost distribution ledger classification if
claim paid under vehicle 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 3/19/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/19/2012 3083945031( $224.57
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
f r
Date Officer