228558 1/28/2014 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $294.90
i° CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266-0579 CHECK NUMBER: 228558
CHECK DATE: 1/28/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 12553186011 260 . 59 OTHER EXPENSES
1301 4239099 267785901041 34 . 31 OTHER MISCELLANOUS
1-800-4-WATERS 1-800-492-8377 www.HinckleySprings.com
Upcoming Delivery Dates Hinckley. 611MA%
Springs We Deliver!
January February March Bottled Water- Filtration - Coffee
Thursday, 9 Thursday, 6 Thursday, 6 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: 01-04-14
CARMEL CITY COURT Invoice#: 2677859 010414
1 CIVIC SQ
CARMEL, IN 46032 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 44.36
Payment 0.00
Remaining Balance 44.36
R1334410140050 EVEREST BLACK HOT AND COLD COOLER.WITH CUP 1.0 11.25 11.25
12-12-13 T133463042040 HINCKLEY SPRINGS 5G DRINKING WATER 2.0 9.99 19.98
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
ENERGY SURCHARGE 1.0 3.08 3.08
Rec'd By:Not Available or Refused
Total New Charges 34.31
0
' 1\
Rea y to streamline your life? View your delivery schedule and account history,manage your
payme options,pay your bill and much more with your own online account at water.comlmyaccount.
30356-P-0037
Previous Ba ante Payment Total New Charges o Pay This Amount
$44.36 0 $0.00 -0. $34.31 0 $78.67
O Write the complete account number on your check.Detach remittance and mail with payment in the enclosed envelope.To pay online go to wvnv HinckleySmngs.00m 0
How to Read Your Statement —...w",Ee. Important Monthly Promotions:
upcoming Delivery Dares - we Delver! Register online for access to your
M,� Ms' "� account.You can view and a our bill,
Delivery Calendar: =ya ^^� .,.y�—y17 �, ��°^`v;:��d��°�°� pay Y
Your scheduled deliveries for "°^°°y" '"""°y'° - y, �s ��a• � check delivery schedule and order
the next three months.
products all online.
Customer Account Number: "u T-1 Bottle Deposits
For prompt service,please use this Highlights bottle deposits and returns.
number when referring to your account.
°. Easy to Pay:
Pay your invoice through the mail,online at
Summary: ., b 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: e
This information provides totals for Mail Remittance With Payment To:
various products and transactions. ^ " mcr Please detach remittance and mail
❑ •-- ❑�� - - $ using business envelope provided.
II.I,IIII,IIIIIII,IIIII.I.IIIIII ,�•u A^m�^•^e.wun n.ymmt r°:I
Important Monthly Message "'"'"°`""'
nvmmens.us„��,°e IIILIILIL.ILIIILI„IIILIIILII
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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
You do not have to pay any amount in question while we are investigating,but on your check gives us permission to debit your checking account electronically
you are still obligated to a the amount of our bill that is not in question.While for the uncollected amount. Payment by check constitutes your acceptance of
Y 9 pay Y q 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.
r
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.
ill C
`� Purchase Order No.
j
�(3_x �� OS� Terms
DIA-LL-11 S TY j S0-(a Date Due
Invoice Invoice Description Amount
Pate Number (or note attached invoice(s) or bill(s))
/ I 71S15'9 016V I TSR ,elf) Co a &_2 '3 C/. 3 /
Total 3
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
r VOUCHER NO. WARRANT NO.
ALLOWED 20
AJ C IN SUM OF $
)Ov f3t� ( 6S-7 q
$ .� 3
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#DEPT.
INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s),
��? o�oy/ Y3�c`I`� JV. 3 or bill(s) is (are) true and correct and that
the materials or services itemized thereon
for which charge is made were ordered and
received except
l 20 /
To �
Sire
77- 3
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 Hinckley.
Springs We Deliver!
January February March Bottled Water- Filtration - Coffee
Thursday, 23 Thursday, 6 Thursday, 6 Athena bottled water supports the fight against breast
Thursday, 20 Thursday, 20 cancer all year'round. Special -buy two cases of Athena
bottled water, get one free! $7.99 per case
(24.51- bottles/case). Offer ends 2/28/14.
Customer Account#: 172094612553186
JOE ACCOUNTS PAYABLE Invoice Date: 01-11-14
CITY OF CARMEL UTILITIES
9609 HAZEL DELL PKWY Invoice#: 12553186 011114
INDIANAPOLIS, IN 46280 Purchase Order#:
Date Transaction# Details Qty. Each Amount
Previous Balance 447.03
12-23-13 P226695 Payment-Check-226695-Thank You -266.97
Remaining Balance 180.06
R1 33601 01 4 0866 WHITE ROOM TEMP AND COLD COOLER RENTAL 1.0 11.25 11.25
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 11.49 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
12-27-13 T133613043050 HINCKLEY SPRINGS 5G DRINKING WATER 12.0 9.99 119.88
CUP COLD FLAT 9 OZ HINCKLEY SPRINGS 100 CT 5.0 5.39 26.95
5.0 GALLON BOTTLE RETURN -12.0 6.00 -72.00
5.0 GALLON BOTTLE DEPOSIT 12.0 6.00 72.00
ENERGY SURCHARGE 1.0 3.08 3.08
Rec'd By: Not Available or Refused
01-09-14 T140093043053 HINCKLEY SPRINGS 5G DRINKING WATER 3.0 9.99 29.97
5.0 GALLON BOTTLE DEPOSIT 3.0 6.00 18.00
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
Rec'd By:Not Available or Refused
Total New Charges 260,59
Ready to streamline your life? View your delivery schedule and account history,manage your
payment options,pay your bill and much more with your own online account at water.com/myaccount.
3035CrP-0037
Previous Balance Payment ��tt��, Total New Charges o Pay This Amount
$447.03 c' $266.97 `v' $260.59 $440.65
V 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 0
How to Read Your Statement 14444 WATERS a -.,", Important Monthly Promotions:
""y" s° e Register online for access to your
ay+ We Deliver!
Delivery Calendar: J4442444 "'� " ^_'449 +4W,�F, 4�°. 0 account.You can view and pay your bill,
rZ �W" 4 w4s Fon.
Your scheduled deliveries for " "" =:w; 44e,a^ 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.
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
since last bill.
payments
�`'�o E6RE55
Total New Charges: yKnt d 4� :R...:R:i;,;n
This information provides totals for ".' '""""' ..m Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
❑ „- ❑ - � _ using business envelope provided.
a
Important Monthly MessageE"E.°.,,r�,� ,,,i.i,iii„gep,.d,i,!,.,ii,i,.i,,,ii,i„!,,,
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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:
o Your name and complete account number. P.O. Box 660579,Dallas,TX 75266-0579.
I, The dollar amount of the suspected error.
o 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 # 137228 WARRANT # ALLOWED
i
131130 i IN SUM OF $
HINCKLEY SPRINGS
PO BOX 660579
DALLAS, TX 75266-0579
i
I�
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
I
i
12553186011 01-7202-05 $260.59
i
1
i
I'
1
Voucher Total $260.59
Cost distribution ledger classification if
claim paid under vehicle highway fund
i
i1
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 12/30/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/30/201; 1255318601' $260.59
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance
vwith
`IIC 5-11-10-1.6
Date Officer