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Home My WebLink About218084 03/13/2013 +.F CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CARMEL, INDIANA 46032 Po Box 660576 CHECK AMOUNT: $55.43 DALLAS TX 75266-0579 CHECK NUMBER: 218084 CHECK DATE: 3/13/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 55 . 43 2677859030213 1-800-4-WATERS (1-800-492-8377) www.HinckleySprings.com Upcoming Delivery Dates Hinckiey 8TAIIDAlb pr March Ail May Springs We Deliver! Bottled Water• Filtration • Coffee . ............ - -- - - - _............ ...... Wednesday, 13 Wednesday, 10 Wednesday, 8 We are doubling our commitment to the cause! Athena announces a minimum contribution of$2 million to support breast cancer care, awareness, research and education by 2014. Support the cause by adding a case of Athena to your order today! Customer Account#: 17220042677859 KIM ROTT Invoice Date: 03-02-13 CARMEL CITY COURT Invoice#: 2677859 030213 1 CIVIC SQ CARMEL, IN 46032 Purchase Order#: Date Transaction# Details Qty. Each Amount Previous Balance 76.23 02-07-13 P216739 Payment-Check-216739-Thank You. /02 / -34.44 Remaining Balance r 41.79 R130362494748 EVEREST BLACK HOT AND COLD COOLER W ITH CUP 1.0 11.25 11.25 02-13-13 T130443042034 HINCKLEY SPRINGS 5G DRINKING WATER 3.0 9.99 29.97 CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 3.0. 3.69 11.07 5.0 GALLON BOTTLE DEPOSIT 3.0 6.00 18.00 5.0 GALLON BOTTLE RETURN -3.0 6.00 -18.00 ENERGY SURCHARGE 1.0 3.14 3.14 Rec'd By: Not Available or Refused Total New Charges 55.43 It's now easier than ever to manage your account online.A new&improved website has been created with enhanced features.Please visit water.com/mywater to take advantage of the many time-saving options available.Your username&password will remain the same or you can create a new one. 30356-P-0031 Previous Balance Payment Total New Charges o =HincklFy7S571R_L__ $76.23 L� $34.44 $55.43 c 7 Write the complete account number on your check.Detach remittance and mail with payment in the enclosed envelope.To pay online go to V How to Read Your Statement °,s,—1 Important Monthly Promotions: °a°m^9°e'.ery°de° WeDeh,e,! ^� Register online for access to your Delivery Calendar. -Y ° yl ' .. 1 a°11—M^. account.You can view and pay your bill, Your scheduled deliveries for "°"'" "°'""'° �F„ � ...°.,,,,^.°.°°�.,.,.„. check delivery schedule and order 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: Pay your invoice through the mail,online at Summary. .m ^ „ w., www.water.com or call us to expedite your Previous balance and posted remittance with automatic credit card payments payments since last bill. I0.✓rVK4' F7 Total New Charges: ° �... This information provides totals for .�.�,,.°„M,p „mm Mail Remittance With Payment To: various products and transactions. Please detach remittance and mail using business envelope provided. Important Monthly Message µ ERE°=, T1 11- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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. 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. Pay � k� �s Purchase Order No. ED— Terms �DaLLI+ -S Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) O A,uJ Cn C Coo LER Au v CLk PS 5 S 43 Total �~ 3 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 ��c k��.c�� S2e��l.GS ro (3q 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 bill(s) is (are) true and correct and that the Q •( �j`� 3 materials or services itemized thereon for which charge is made were ordered and received except 20 Z tur Cost distribution ledger classification if itle claim paid motor vehicle highway fund