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209183 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $226.64 CARMEL, INDIANA 46032 PO BOX 660579 DALLAS TX 75266 -0579 CHECK NUMBER: 209183 CHECK DATE: 5122/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 267785902041 2.42 OTHER MISCELLANOUS 1301 4239099 267785904281 45.88 OTHER MISCELLANOUS 651 5023990 30839450505 178.34 MATERIALS SUPPLIES 1- 800 -4- WATERS 492 -8377 www.HincklaySprings.com Upcoming Delivery Dates Hinckle 8 V May June Jam °iirta1 Bottled Water Filtration Coffee Thursday, 10 Thursday, 7 Thursday, 5 The Athena Warriors are here! Thursday, 24 Thursday, 21 Thursday, 19 Join us in the fight against breast cancer. Check out athenawater.com. Customer Account 17220042677859 KIM ROTT Invoice Date: 04 -28 -12 CARMEL CITY COURT Invoice 2677859 042812 1 CIVIC SQ CARMEL, IN 46032 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 148.57 04 -03 -12 P207480 Payment Check 207480 Thank You -72.78 Remaining Balance 75.79 R120942494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50 04 -12 -12 T121033042004 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 04 -26 -12 T121173042003 HINCKLEY SPRINGS 5G DRINKING WATER 1.0 9.99 9.99 5.0 GALLON BOTTLE RETURN -1.0 6.00 -6.00 5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00 Rec'd By: Not Available or Refused 04 -26 -12 73954044 ENERGY SURCHARGE 1.0 2.41 2.41 Total New Charges 45.88 wee a 3v Effective May 14th, 2012, there will be a price increase on our cups due to rising costs. We appreciate the opportunity to serve you and thank you for your continued business. 30356 -P -0036 Previous Balance Payment Total New Charges Pu $148.57 $72.78 $45.88 Write the canplete account number on y our check. Detach remittance and mail with payment in the enclosed envelope. To pay online g o to www.Hinckle How to Read Your Statement Ise.- WATBBA Important Monthly Promotions: Upcoming Delivery Dates We Deliver! Register online for access to your lu� Au9u,l X109 B°NaE W er F'Jtr.o°n' Collee Delivery Calendar d F� d W 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: For prompt service, please use this Bottle Deposits: number when referring to your account. Pm Highlights bottle deposits and returns. M. M. Easy to Pay: Pay your invoice through the mail, online at Summary: u• www.water.com or call us to expedite your Previous balance and posted remittance with automatic credit card payments payments since last bill. O� C-:-S-D- O �0 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. II... I. I. I... LIM II.I.. I I.I.dL WB B.mitl.n°. WBn P.Ym.m Toil iam sun. ,a una srn.er Important Monthly Message u+w«c "e -os ""s°'°• IILILIIIL. IIIIIIIIII1111111 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). For further information, please write DS Waters of America, Inc. at P.O. Box 660579, Dallas, TX 75266 -0579. www.HinckleySprings.co Upcoming Delivery Dates Feb March ndc!e 4 prll 1Ur! ar} w Thursday, 16 Thursday, 1 Thursday, 12 Bottled Water F Coffee Thursday, 15 Thursday, 26 Every time you purchase Athena bottled water, you join the Thursday, 29 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. FO tomer Account 17220042677859 RTT MEL CITY COURT Invoice Date: VIC SQ Invoice 02 04 12 CARMEL, IN 46032 2677859 020412 Purchase Order Date Transaction Details Previous Balance Qty. Each Amount 01 -13 -12 P205195 Payment Check 205195 Thank You Remaining Balance 65.71 -35.82 29.89 R WHITE HOT AND COLD COOLER RENTAL 01 -19 -12 T120193042018 HINCKLEY SPRINGS 5G DRINKING WATER 1'0 13.50 13.50'%'"e 5:0 GALLON BOTTLE RETURN 2.0 9.99 19.98 5.0 GALLON BOTTLE DEPOSIT -2 6.00 -12.00 Recd By: Not Available or Refused 2 0 6.00 12.0'0 02 -02 -12 T120333042011 HINCKLEY SPRINGS 5G DRINKING WATER CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 3.0 9 29. 97v' 5.0 GALLON BOTTLE RETURN 5 0 3.49 17.45 5.0 GALLON BOTTLE DEPOSIT -3.0 6.00 -18.00 Recd By: Not Available or Refused 3 0 6.00 18.00 02 -02 -12 71403426 ENERGY SURCHARGE .0 2.37 2.37 Total New Charges `s3.27 itAanaging 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! Previous Balance P Total New Charges 30356 "P -0036 $65.71 9 Pay This Amount 1, nvel pe. o p ay onlin Write the c omplete account n umber on your check. De re and m with a me in the encl eo T o to $113.16 Y 9 S rin m Y- nvel g� www.Hinckle s.co P_ A M1120204_BM10 -2298 -000000992 Customer Account ©IIIIIIIB(DIIIIIpIII IIII� I��IIII�IIIIII �I �I�I �1611� II 17220042677859 Ill Due By: U 1 7 2 2 0 0 4 2 6 7 7 8 5 9* Late Fees May Apply After: Upon Receipt Y PP Y 02 -27 -12 6750 DISCOVERY BLVD. Total Amount Due: $113.16 MABLETON, GA 30126 6 '71 t Check here and see reverse for Check here and see address and phone corrections.' reverse if paying by credit card. 002298 0000009921 �y d -1 11 Mail ReMittance With Payrnent.To;' CARMEL CITY COURT .1 KIM Ills' Elllli�l�ll' I1011l' lll lslll° I °'II�IIIIB'llllli "IIIIIII 1 CIVIC IC S Q CARMEL IN 46032 -2584 HINCKLEY SPRINGS PO BOX 660579 DALLAS' TX 75266 -0579 021310 091404 00172200426778599 0011316 8 0008327 6 1 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 5/14/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/14/2012 3083945050' $178.34 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 117299 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 30839450505 01- 7202 -05 $178.34 Voucher Total $178.34 Cost distribution ledger classification if claim paid under vehicle highway fund 1- 800 -4- WATERS (492 -8377) www.HinckleySprings.com Upcoming Delivery Dates Hlnckiey We Deli May June Jam( t Bottled Water Filtration Coffee Thursday, 17 Thursday, 14 Thursday, 12 Enjoy premium coffee and tea brands at your home or office. Thursday, 31 Thursday, 28 Thursday, 26 With the addition of Standard Coffee to our service options, customers can benefit from a complete beverage program from one delivery source. Learn more at water.com Customer Account 17209463083945 JOE ACCOUNTS PAYABLE Invoice Date: 05 -05 -12 CITY OF CARMEL UTILITIES 9609 HAZEL DELL PKWY Invoice 3083945 050512 INDIANAPOLIS, IN 46280 Purchase Order Date Transaction Details Qty. Each Amount Previous Balance 230.71 Payment 0.00 Remaining Balance 230.71 R121101797710 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 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 04 -19 -12 T121103042005 HINCKLEY SPRINGS 5G DRINKING WATER 6.0 9.99 59.94 5.0 GALLON BOTTLE RETURN -7.0 6.00 -42.00 5.0 GALLON BOTTLE DEPOSIT 6.0 6.00 36.00 Recd By: Not Available or Refused 05 -03 -12 74222358 ENERGY SURCHARGE 1.0 2.47 2.47 05 -03 -12 T121243042006 HINCKLEY SPRINGS 5G DRINKING WATER 7.0 9.99 69.93 5.0 GALLON BOTTLE RETURN -7.0 6.00 -42.00 5.0 GALLON BOTTLE DEPOSIT 7.0 6.00 42.00 Rec'd By: Not Available or Refused Total New Charges 178.34 Effective May 14th, 2012, there will be a price increase on our cups due to rising costs. We appreciate the opportunity to serve you and thank you for your continued business. 30356 -P -0036 Previous Balance Payment Total New Charges Pay This Amount $230.71 $0.00 $178.34 $409.05 V Write the complete acco nu mber on your check. De tach remittance and mail with payment in the enclosed envelope. To pay online go to www.Hinckley5prings.com D How to Read Your Statement Important Monthly Promotions: Upcoming �ellvery date° We Deliver! Register online for access to your l ne 3009 lul, 1009 A­11 B^NeOw er'FUVav,'CO!1 Delivery Calendar: M° 9 ..ryr..F ,FU w account. You can view and pay your bill, check delivery schedule and order Your scheduled deliveries for the next three months. 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. m 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. O Total New Charges: This information provides totals for o m� Mail Remittance With Payment To: various products and transactions. a Please detach remittance and mail 0:1 using business envelope provided. I1 „I,III.I L.I1 1.11 I.I.J- 1l.l„L..II IWU na,„ma^ce wun 1e —T.I w S E. Important Monthly Message F "E.OS i'°"6p° IIJd TLLIIIII, IIIIIIIL .IOL.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 our letter, give 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 Purchase Order No. n 0 t!0 0 9 Terms L,a f 75a &L Date Due Invoice Invoice Description Amount C/ Date Number (or note attached invoice(s) or bill(s)) '7 �O77�S `I We l.� r�� h o2. 2 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 o IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members Po# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or ''o. S9 S 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 W/ 20 S) re Cost distribution ledger classification if je claim paid motor vehicle highway fund