223964 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS
CHECK AMOUNT: $28.31
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266-0579 CHECK NUMBER: 223964
CHECK DATE: 9/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 081713 28 . 31 OTHER MISCELLANOUS
1-800-4-WATERS 1-800-492-8377 www.Hinckle S rin s.com
Upcoming Delivery Dates Hinckiey" 8UMA%
Springs We Deliver!
August September October Bottled Water- Filtration - Coffee
Thursday, 22 Thursday, 19 Thursday, 17 Back to School. Back to the Office. Back to H2O Basics!
Summer's ending &that means vacations give way to packing
school and work lunches. Stock up on plenty of individual
.5 liter bottles for a convenient way to keep everyone
hydrated all day. It's the 0-calorie way to stay refreshed!
Customer Account#: 17220042677859
PAM BAKER Invoice Date: 08-17-13
CARMEL CITY COURT
1 CIVIC SO Invoice#: 2677859 081713
CARMEL, IN 46032 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 74.55
07-19-13 P221544 Payment-Check-221544-Thank You -36.32
Remaining Balance 38.23
R1320410140050 EVEREST BLACK HOT AND COLD COOLER W ITH CUP 1.0 11.25 11.25
".07-25=13 T132063042035 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98
5.0 GALLON BOTTLE RETURN -3.0 6.00 -18.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00
ENERGY SURCHARGE 1.0 3.08 3.08
Rec'd By:Not Available or Refused
Total New Charges 28,31
Ready to streamline your life? View your delivery schedule and a count history,manage your
payment options,pay your bill and much more with your own on ount at water.comlmyaccount.
30356-P-0037
Previous Balance tal New Char es o Pay This Amount
$74.55 0 C:� $28.31 $66.54
0 Wrfte the complete account number on your check.Detach remittance and mail with payment in th enclosed.e lope_To"pay-online.go,to www.HinckleySprings.com 0
How to Read Your Statement 14011.11TERS Important Monthly Promotions:
°a^m, °e'14Pfr°a'P5 We oee e, ��� Register online for access to your
Delivery Calendar: °°"°°' Nola, Mo ,3 a�a p�m account.You can view and pay your bill,
aN�NFMu
tea,'„ 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 „o o„ Highlights bottle deposits and returns.
number when referring to your account. ^
Mos ,�n,—.,,< E„^,s Easy to Pay:
Pay your invoice through the mail,online at
Summary. www.water.com or callus to expedite your
Previous balance and posted remittance with aufomatic credit card payments
payments since last bill.
Total New Charges:
PP„,n,.
This information provides totals for m,".,a. Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
: 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 9 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.
o^^ �•�+��i„naw dr!ress or credit card infnrmaflon Lalow a�PCk the annronriate box on reverse side. Thank you.
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
N C k� i' 5ler n! G S
Purchase Order No.
AD _86Y to OJ 1 Terms
��r✓L�� ' /' / � Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
/ I 67n5y o�lj 13 GU a r co 4� ���3
I
Total
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.
I ALLOWED 20
14 INCk LE 1J Sp�'��GS
IN SUM OF $
PU 66 S7
�4L(-f fiX 7 5-Z)(� �
$- 31
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
30 J & 011 715 bill(s) is (are) true and correct and that the
39D .9 - 3 materials or services itemized thereon for
which charge is made were ordered and
received except
6- 20 (7
tur
Cost distribution ledger classification if
e
claim paid motor vehicle highway fund