222987 08/13/2013 \,f CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $299.00
DALLAS TX 75266-0579
CHECK NUMBER: 222987
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 12553186072 260 . 77 OTHER EXPENSES
1301 4239099 267785907201 38 . 23 OTHER MISCELLANOUS
1-800-4-WATERS 1-800-492-8377 www.HinckleySprings.com
Upcoming Delivery Dates Hinckley gTAND V
Springs We Deliver!
July. Au ust September
Bottled Water• Filtration • Coffee
-- .......-
Thursday, 25 Thursday, 22 Thursday, 19 With temperatures rising, July's the perfect time for
brewing a pitcher of delicious iced tea for all your
picnics, parties and meals outside. Make it amazing
with our crisp and refreshing water, the perfect starting
point for mixing up a glass of this summertime classic!
Customer Account#: 17220042677859
PAM BAKER Invoice Date: 07-20-13
CARMEL CITY COURT Invoice#: 2677859 072013
1 CIVIC Purchase Order#:
CARMEL, I N 46032
Date Transaction# Details Qty. Each Amount
Previous Balance 98.75
06-21-13 P220643 Payment-Check-220643-Tank You -62.43
Remaining Balance T/� 3 36.32
R1 31 761 01 40050 EVEREST BLACK HOT AND COLD COOLER W ITH CUP 1.0
06-27-13 T131783042034 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 1.0 3.89 3.89
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12-00
ENERGY SURCHARGE 1.0 3.11 3.11
Rec'd By: Not Available or Refused
Total New Charges 38.23
/�Pf
It's now easier than ever to manage your account online.A new&i proved website has been created
with enhanced features.Please visit water.comlmywater to take ptivantage of the many time-saving
options available.Your username&password will remain a or you can create a new one.
30356-P-0037
CP7rev�iou�sBalance C__P�;,yment Total New Char es Pay This Amount 75 52.43 $38.23 $74.55
0 Write the complete account number on your check.Detach remittance and mail with-payment in he enclosed env -pe.To pay online go to _ ._www.HinckleySprings.cam-
How to Read Your Statement Important Monthly Promotions:
Upmmi„g Delivery Dates We Deliver! g � Register online for access to your
Delivery Calendar: M°�'°°' -0 yI wre account.You can view and pay your bill,
y �, N:�F-
Your scheduled deliveries for
M.-," °°""° flBe" check delivery schedule and order
the next three months. °°� Po products all online.
Customer Account Number: T°•
For prompt service,please use this Bottle Deposits:
number when referring to your account. '°� '°'° w tee, Highlights bottle deposits and returns.
NT-
TU
° Easy to Pay:
Pay your invoice through the mail,online at
Summary: ., w www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
,..,.0
„tr.NIN.N m,wn.ro� a%•`•.aa'^�- ml pd.-4 ..e...,s qp
Total New Charges:
wye,..e...
This information provides totals for -M Mail Remittance With Payment To:
various products and transactions. ^—s^ .«^ w Please detach remittance and mail
f Z using business envelope provided.
II,.,I,1,I.,,I,I,II,,,II„II„..I,II,IIIIIIIIII ,Men nemmmce wnn aeyme I t°:e
,n weirvsneE,
Important Monthly Message °Ny""Ene,°514" 1°' II,IdLLlllllvll»IIIII!I,I!IIII
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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.
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
f� Sj�►'Z r Al C, S
__ 1 I1 tic-14- � Purchase Order No.
Terms
,DftLL- / �o Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 .10779rS_9-7 3 Gjx q Crry le� (-tn 0_1A4 ��'• C:P3
Total �• o?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.
141 6 ALLOWED 20
s
IN SUM OF $
dy C7
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
130 r a 3q&99 3 g,a3 bill(s) is (are) true and correct and that the
7a0 materials or services itemized thereon for
which charge is made were ordered and
received except
20
S' n
3g, a3
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1-800-4-WATERS (1-800-492-8377) www.HinckleySprings.com
Upcoming Delivery Dates Hinckiey 61kMA%
Sprinc�s We Deliver!
August September October Bottled Water• Filtration • Coffee
Thursday, 8 Thursday, 5 Thursday, 3 With temperatures rising, Julys the perfect time for
Thursday, 22 Thursday, 19 Thursday, 17 brewing a pitcher of delicious iced tea for all your
Thursday, 31 picnics, parties and meals outside. Make it amazing
with our crisp and refreshing water, the perfect starting
point for mixing up a glass of this summertime classic!
Customer Account#: 172094612553186
JOE ACCOUNTS PAYABLE OS Invoice Date: 07-27-13
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY �'�� Invoice#: 12553186 072713
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 610.03
07-08-13 P221079 Payment-Check-221079-Thank You -305.91
Remaining Balance 304.12
07-11-13 T131923043025 HINCKLEY SPRINGS 5G DRINKING WATER 6.0 9.99 69.94-
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 5.0 5.39 26.95
5.0 GALLON BOTTLE RETURN -6.0 6.00 -36.00
5.0 GALLON BOTTLE DEPOSIT 6.0 6.00 36.00
ENERGY SURCHARGE 1.0 3.08 3.08
Rec'd By: Not Available or Refused
R1319210140866 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.49 11.49
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.49 11.49
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.49 11.49
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 9.99 9.99
WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.25 11.25
07-25-13 T132063043047 HINCKLEY SPRINGS 5G DRINKING WATER 8,0 9.99 79.92
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 3.0 5.39 16.17
5.0 GALLON BOTTLE RETURN -8.0 6.00 -48.00
5.0 GALLON BOTTLE DEPOSIT 8.0 6.00 48.00
Rec'd By:Not Available or Refused
Total New Charges 260.77
It's now easier than ever to manage your account online.A new&improved website has been created
with enhanced features.Please visit water.comlmywater 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-0037
Previous Balance Payment Total New Charges ° Pay�$564.89
$610.03 $305.91 $260.77
Q Write the complete account number on your check.Detach remittance and mail with payment in the enclosed envelope.To pay, go to www.HinckleySprings.com 0
How to Read Your Statement a°°..w.,Eas °—, Important Monthly Promotions:
0pcorn1ng De° ,y D.,e° W,,Deliver! ^ Register online for access to your
Delivery Calendar:
"°9,u'"°°° account.You can view and pay your bill,
Your scheduled deliveries for ,�,.�jz w 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.
.-°,° .E„„° 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 O ,..,
.,�.,�..ruiuw an,,om r�.!��i„•.'ry Nepl�md� ...,,..,sy,.,,,x�..�°°e.
Total New Charges:
Wvp wv..••-
This information provides totals for =,,.I,�,,.M 1,°.m Mail Remittance With Payment To:
various products and transactions. ^- 1_1««„1'K Please detach remittance and mail
using business envelope provided.
IIIIIIIIIIIIIIII,IIIIIIIIII I Mau—Itt....wun P.ym..,1°:I
'wvwre �sEi:xsmes IIIIIIAIIllllllllllllltlll
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 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.
VOUCHER # 136176 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
i
12553186072 01-7202-05 $260.77
I
`i
1
1
i
I
'I
I'
Voucher Total $260.77 j
d
Cost distribution ledger classification if
Q
claim paid under vehicle highway fund
5)
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 8/8/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/8/2013 1255318607 $260.77
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
2 1 glf3
Date Officer