212619 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $384.24
? DALLAS TX 75266-0579
CHECK NUMBER: 212619
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 30839450825 384 . 24 OTHER EXPENSES
m
Upcoming Delivery Dates HInCkiey .RMMAP
Springs We Deliver! v
September October November
Bottled Water• Filtration • Coffee
Thursday,6 Thursday, 4 Thursday, 1
Thursday, 20 Thursday, 18 Thursday, 15 Cool off with great-tasting Arizona Tea.-For a limited time
Thursday, 29 only, buy two cases(12 cans/case)for only$12.Ask your
y' RSR or call 800.4.WATERS to order today!
Ns
Customer Account#: 17209463083945
JOE ACCOUNTS PAYABLE Invoice Date: 08-25-12
CITY OF CARMEL UTILITIES Invoice#: 3083945 082512
9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
7� Previous Balance 786.89
07-30-12 P211115 Payment-Check-211115-Thank You -377.23
�\ Remaining Balance 409.66
R122221797710 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 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
08-09-12 T122223042005 HINCKLEY SPRINGS 5G DRINKING WATER 16.0 9.99 159.84
HINCKLEY SPRINGS 5G DISTILLED WATER 1.0 10.49 10.49
5.0 GALLON BOTTLE DEPOSIT 16.0 6.00 96.00
5.0 GALLON BOTTLE RETURN -17.0 6.00 -102.00
5.0 GALLON BOTTLE DEPOSIT 1.0 6.00 6.00
Rec'd By: Not Available or Refused
08-23-12 T122363042007 HINCKLEY SPRINGS 5G DRINKING WATER 12.0 9.99 119.88
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 8.0 3.69 29.52
5.0 GALLON BOTTLE DEPOSIT 12.0 6.00 72.00
5.0 GALLON BOTTLE RETURN -12.0 6.00 -72.00
Rec'd By: Not Available or Refused
08-23-12 77679083 ENERGY SURCHARGE 1.0 3.01 3.01
Effective on your next billing invoice,there will be a price increase of up to$1.00 on our
equipment rental.We appreciate the opportunity to serve you and thank you for your continued business.
30356-P-0034
P Payment Total New Charges Pay This Amount
$377.23 $384.24 $793.90
�Write.the.complete account,number on.your-check..Detach.remittance and.mail.with.payment in.the.enclosed envelope.=To pay.online.go.to-WWW.HinckleySprings.com�
How to Read Your Statement Important Monthly Promotions:
UP10 m9 Delivery Dates „�-!�' We Deliver! Register online for access to your
,une 2009 M"� "°9MSt 3009 '"�°�`°"°� account.You can view and pay your bill,
Delivery Calendar: Mme'"° ^ , .p,
Your scheduled deliveries for "° "�;," �� 'aN» check delivery schedule and order
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. '°'° °"'RM
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.
Total New Charges: ._.•...
This information provides totals for .'u'�° °°'o"°""""
p .o,.By.. »gym Mail Remittance With Payment To:
� °�.nm
various products and transactions. Please detach remittance and mail
❑,-- ❑m -„:� s 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 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 # 125645 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
30839450825 01-7202-05 $384.24 1
Voucher Total $384.24
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 9/5/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/5/2012 3083945082! $384.24
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
g'4/, v
Date Officer