212239 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
� CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $452.15
DALLAS TX 75266-0579
CHECK NUMBER: 212239
CHECK DATE: 8128/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 267785908181 42 .49 OTHER MISCELLANOUS
651 5023990 30839450728 409 . 66 OTHER EXPENSES
1-800-4-WATERS (1-800-492-8377) www.HinckleySprings.com
Upcoming Delivery Dates HlnCkiey 8TANDAF6 Au ust September October SPI Inds We Deliver!
Bottled Water• Filtration • Coffee
Thursday, 30 Thursday, 13 Thursday, 11 Cool off with great-tasting AriZona Tea. For a limited time
Thursday, 27 Thursday, 25 only, buy two cases(12 cans/case)for only$12. Ask your
RSR or call 800.4.WATERS to order today!
Customer Account#: 17220042677859
KIM ROTT Invoice Date: 08-18-12
CARMEL CITY COURT
1 CIVIC SQ Invoice#: 2677859 081812
CARMEL, IN 46032 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 89.87
07-20-12 P210398 Payment-Check-210398-Thank You -43.93
08-10-12 P211316 Payment-Check-211316-Thank You -45.94
Remaining Balance 0.00
R122062494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50
08-02-12 T122153042008 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00'
5.0 GALLON BOTTLE RETURN -1.0 6.00 -6.00
Recd By:Not Available or Refused
08-16-12 77432405 ENERGY SURCHARGE 1.0 3.01 3.01 .
------------------------------------------------------------------------------------------------------
Total New Charges 42.49
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-P-0036
Previous Balance Payment Total New Charges o Pay This Amount
$89.87 $89.87 $42.49
How to Read Your Statement <w.,ERS Important Monthly Promotions:
Vpcoming Delivery Dates We Deliver! Register online for access to your
)une2M luy2— August 3009 ® Bon eU Weter'Filtrawn'C°Hee
Delivery Calendar: o � •N.,°n.F M.� account.You can view and pay your bill,
,e s :m check delivery schedule and order
Your scheduled deliveries for "°"°"" M°„ °.,"„"„�,��°;�•
the next three months. products all online.
Customer Account Number:
For prompt service, please use this - Bottle Deposits:
number when referring to your account. "° ”'°'° ° Highlights bottle deposits and returns.
,E U,= ...o b 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
.� a
O-O CO O
Total New Charges:
This information provides totals for Mail Remittance With Payment To:
various products and transactions. awn.� Please detach remittance and mail
o�w ❑ � „e�- : using business envelope provided.
Important Monthly Message
,a„d.d„.,,,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 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
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
you are still obligated to a the amount of our bill that is not in question.While for the uncollected amount. Payment by check constitutes your acceptance of
y g pay 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 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.
Terms
-Dl+ S �X / ��°� CO Date Due
Invoice Invoice Description Amount
Dat Number (or note attached invoice(s) or bill(s))
a6 -7?' 16S F P-
or f- cc)L ook Zvi /3. 56
r ,0 A6, 9f 9
11 L
Total '�o?
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
P6 b6"1- IN SUM OF $
T-x -7 5a��
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PD#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
J O 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
20
Si r
Itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund
-800-4-WATERS,(1-800-499-8377) wuwuw HimckleySprings
m
Upcoming Delivery Dates HlnCkiey 6TIMA%
August September October Springs We Deliver!
Bottled Water• Filtration • Coffee
Thursday, 9 Thursday, 6 Thursday, 4 Cool off and replenish this summer with our
Thursday,23 Thursday, 20 Thursday, 18 super-size Sqwincher Squeeze Electrolyte Freeze
Pops. Now 50%off for a limited time only.
Ask your RSR or call 800.4.WATERS to order today.
Customer Account#: 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 07-28-12
CITY OF CARMEL UTILITIES Invoice#: 3083945 072812
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 377.23
Payment 0.00
Remaining Balance 377.23
8121941797710 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 9.50 9.50
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.00 11.00
07-12-12 T121943042004 HINCKLEY SPRINGS 5G DRINKING WATER 13.0 9.99 129.87
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 3.0 3.69 11.07
HINCKLEY SPRINGS 5G DRINKING WATER 1.0 0.00 0.00
5.0 GALLON BOTTLE DEPOSIT 13.0 6.00 78.00
5.0 GALLON BOTTLE RETURN -13.0 6.00 -78.00
5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00
Rec'd By: Not Available or Refused
07-26-12 T122083042008 HINCKLEY SPRINGS 5G DRINKING WATER 15.0 9.99 149.85
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 10.0 3.69 36.90
5.0 GALLON BOTTLE DEPOSIT 15.0 6.00 90.00
5.0 GALLON BOTTLE RETURN -13.0 6.00 -78.00
Rec'd By: Not Available or Refused
1-Sao -Os
07-26-12 76810573 ENERGY SURCHARGE 1.0 2.47 2.47
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How to Read Your Statement °°°," °,e Important Monthly Promotions:
Up11-9 De1lvery D-1 e We Deliver! Register online for access to your
june 2O jvN2 o 1oo9
3 o ea "c°nee
Delivery Calendar: Mo�rb �. account.You can view and pay your bill,
check delivery schedule and order
Your scheduled deliveries for "° -" y„ �,
the next three months. products all online.
Customer Account Number:
For prompt service,please use this Bottle Deposits:
Highlights bottle deposits and returns.
number when referring to your account.
Easy to Pay:
ey Pay your invoice through the mail,online at
Summary: o°„°,5,,., www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill. n:.;a:er. fao„°ova.
Total New Charges: «°°^
This information provides totals for >`', .;'o'"""°” Mail Remittance With Payment To:
various products and transactions. °�Faw"'new Please detach remittance and mail
❑,m,,; b ❑�q,W :a 5 using business envelope provided.
ILJLLdddLllll„IJLIIJdIILJ �� IM°Il R—Itt.—Wlm Pry—T.I
Important Monthly Message ,C,,”
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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.
Customer Account#: 17209463083945 Invoice#: 3083945 072812
Date Details Qty. Each Amount
Total New Charges 409.66
z
M1120728 BM10-71-000000387
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 8/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/20/2012 3083945072f $409.66
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC 5-11-10-1.6
Date Officer
VOUCHER # 125501 WARRANT # ALLOWED.
131130 IN SUM OF'$
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
30839450728 01-7202-05 $409.66
Voucher Total $409.66
Cost distribution ledger classification if
claim paid under vehicle highway fund