226336 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
`4 0 ONE CIVIC SQUARE HINCKLEY SPRINGS
CARMEL, INDIANA 46032 PO BOX 660576 CHECK AMOUNT: $56.00
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DALLAS TX 75266-0579 CHECK NUMBER: 226336
CHECK DATE: 11/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 56 . 00 2677859110913
1-800-4-WATERS(1-800-492-8377) www.HincklaySprings.com
Upcoming Delivery Dates Hinckiey &MA%
Springs We Deliver!
November December January Bottled Water• Filtration • Coffee
Thursday, 14 Thursday, 12 Thursday, 9 Sparkling Water! We now offer Italy's#1 sparkling water,
Ferrarelle, for delivery! Order convenient 12-pack(750ml-)
glass bottles or 24-pack(330mL)glass bottles of Ferrarelle
and put a little sparkle in your day. Ask your Route Sales
Representative to add a case to your next order.
Customer Account#: 17220042677859
PAM BAKER Invoice Date: 11-09-13
CARMEL CITY COURT
1 CIVIC SQ Invoice#: 2677859 110913
CARMEL, IN 46032 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 106.33
10-25-13 P224920 Payment-Check-224920-Thank You 5
Remaining Balance 54.29
R1328810140050 EVEREST BLACK HOT AND COLD COOLER WITH CUP 1.0 11.25 11.25
10-17-13 T132903042036 HINCKLEY SPRINGS 5G DRINKING WATER 3.0 —_9.99 -___.29.97—-
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 3.0 3.89 11.67
5.0 GALLON BOTTLE RETURN -3.0 6.00 -18.00
5.0 GALLON BOTTLE DEPOSIT 3.0 6.00 18.00
ENERGY SURCHARGE 1.0 3.11 3.11
Recd By: Not Available or Refused
Total New Charges 56.00
ea y to streamline your in e?. View your clelivery Schedule ancYaccount history,manage your
payment options,pay your bill and much more with your own onlir account at water.com/myaccount.
30356-P-0037
Previous Balance Payment Total New Charges ° Pay This Amount
$106.33 $52.04 $56.00 0 $110.29
n e e comp e e accoun number on your chec . e ac rem ante an mail with payment in t e enc ose enve ope. o pay online go to vmw. inc ey pnngs.com Q
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How to Read Your Statement eop.-W—RS Important Monthly Promotions:
Upcoming Delivery Dates we D.Wed Register online for access to your
Delivery Calendar: 0 6 account.You can view and pay your bill,
p X17 "� A"° 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 ro,o,,,, % Highlights bottle deposits and returns.
number when referring to your account °" o
.—,.,a„ "s 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. "
0- ¢Q=O
Total New Charges:
This information provides totals for „� Mail Remittance With Payment To:
various products and transactions. ^= nr. Please detach remittance and mail
❑=-,X a s�` : using business envelope provided.
II„.I.I,I1III11,.II,AII„IIII,IIIIII 1 u.n namwm..w„n r•.ymem*o:�
Important Monthly Message ""�'"'cne,°S iP1iS°1°9 IL,IIL,JdIIp1IILIIII,ILIII„I.II
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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.
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 /�
C 1< L[ SP21 A/G s Purchase Order No.
PO 6L � bo S 7 � Terms
L�-- -5 /\ -7 1 t Date Due
Invoice Invoice Description Amount
D to Number (or note attached invoice(s) or bill(s))
6 77 S 5ry" 10 C.O o L
Totalf�j.
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-,
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
KLG SP2i�y s ALLOWED 20
IN SUM OF $
$ VC7
ON ACCOUNT OF APPROPRIATION FOR
Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
�,(fU the materials or services itemized thereon
for which charge is made were ordered and
received except
20
n ture
"t
Cost distribution ledger classification if
claim paid motor vehicle highway fund