233059 05/28/14 CITY OF CARMEL, INDIANA VENDOR: 051125
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $*********7.31*
�q. CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 233059
PO BOX 856680 CHECK DATE: 05/28/14
LOUISVILLE KY 40285-6680
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 04EO11925282 7.31 04EO119252823
service.icemountainwater.com e_ 'M1 ® T °
#215 6661 DIXIE HWY,SUITE 4
04/13/14-05/12/14. 04E0119252823
' LOUISVILLE KY 40258
ADDRESS SERVICE REQUESTED
FRI- JUN 06 II'I II I I"II' I'I'I 1111 IN
I I II'I 'II TUE- JUL 08 0119252823
WED- AUG 06
FRI- SEP 05
CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-472-9888
BONNIE CALLAHAN Pay your bill online at:service.icemountainwater.com or
3400 W 131ST ST by phone at:1-800-472-9888.It's freel
CARMEL IN 46074-8267
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Try-,the Great NE tU.taste of NESTEA NOW!."-,;,Save$3 offa',12 12 pack of 12-oz cans fora promoted price of$3 99
AND$3 off a 12ack,of Nestea 1/2.'lter bottles;for a pramoted prlceof $5:99! Ca11:1-80d-472 9888 or vlslt
;,servlce,icemountainwater com to add to your order)
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ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800-472-9888 or visit service.icemountainwater.com.
Delivery address: CITY OF CARMEL STREET DEPARTMENT,1 CIVIC SQUARE,CARMEL IN 46032
PREVIOUS BALANCE 53.60
5/11 745225 PAYMENT-THANK YOU -53.60
5/07 0881753818 4 9 OZ PLASTIC CUP 50C/SLV 13.16
2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -12.00
5/12 0884097023 1 OIUFUEL SURCHARGE 3.16
E6557642 RENT 2.99
TOTAL " , 7.31
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
'I Subject to terms on reverse side. 53.60 — 53.60 �- 7.31 = 7.31 w
BILLING RIGHTS SUMMARY
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR YOUR VOICE-4 WAYS TO HE
A REPORT ON WATER LP US SERVE YOU BETTER
QUALITY AND INFORMATION,PLEASE 1• Please remember payment is due by the 44 a
CALL 1-&0o a72.9ss8 OR WRITE US AT: 2. Remember,if you are renting equipment,Your bequipmeny"date otrental is charged one month aed to ensure the smoothest ldvance.
ICE MOUIYTAih]SPRING 1yATER CO, orf first invoice will include a pro-rated fee for the current month, 1
#216 3. Kindly fill in the That means
6661 DIXIEE,K SUITE 4 Y amount enclosed, include your account numberonyour check and do not send cash.
LOUISVILLE,KY 40258 If you prefer,you can pay your bill online at service.icemountainwater.com
If you think your bill is wrong or ifyou need more information about 4 Never hesitate to call us With comments,
a transaction on your bill,write us on a separate sheet of paper.We QUe5t10riS,Or concerns.
must hear from you in writing no later than thirty(30)days after we
sent you the first bill on which the error Dr problem appeared.You can
telephone us,but doing so will not preserve your rights, c
give us the following information: In your letter, SAMPLE INVOICE
• Your name,address,telephone and account numbers,
• The dollar amount of the suspected error. Date range of this invoice
an error.
• Describe the error and explain if you can,why You believe dlere is
You are obligated to pay the parts of your bill that are not in question.
You do not have to Pay y the disputed amount while it is being
as a delinquent
During the investigation,we cannot report your account
as delinquent or take any action to collect the am ootOo/oo•ooroDioo 7234567890 4 Your Account N
amount in question, umber
GENERAL INFO
NA��A
1. TION im
NR.DETD4 123456769
Payments received after the billing(INVOICE)date will appear on Important MON.00T z9
Your next invoice,Past due invoices not `"Nf N0V 21 Watch here for a
( paid within 30 days of news and WE.DEC 18
billing date may be assessed__a late fee as allowed by law not to tbtiMttt HUH 1 tI1lJlfb IUtI dutlalq uxM a,1 eoo47zgsae 4 personalized account
exceed$20 per month.Addi - -
tionally,third Party collection/---�a� offers t°en Die
123 Ma Sl Thantyou for uilng lee MDunWnprodum message
expenses may ttomey -----__ory,S,° enduMma.
y be assessed ata rate not to exceed 100%of the
unpaid balance or the maximum allowed by law. 4�Ltwd U6 J1 it:al en 6�46i'a;t----- _�`„ f
2.Each returned check is subject to a service charge subject to the —' S '
maximum check re
turn charge allowable in your State. Pay electronically
3• Al] bottle and equipment deposits are shown as ' Y 1 ,
ACTIVITY CURRENT Activity t
4. Equipment replacement costs will be charMake sure this
since your .
stolen,damaged or not recharged for bottles lost accouNrarnvm t��.°K^ ^°�^" "
5.In actor turned, last invoice DeR,aYAedress,�,"D,e,,�„aa,nS, C"ySa1e 6D9oo # amount has been
dance with NWNA°s Terns and Conditions("T&C'),your paid in full to
Equipment Lease and/or Service Auf0a�
subject to minimum month] Agreement account may be Den, 4Mdae Pa meM-nnntYD avoid late fees
y purchases and/or earl n, 3+7ees,4444 5 38aI1DnNaN,alSpl gW
fees.(A complete version of the current T&C may be view d olntthe
oPn+ 3+2ees4a4 5 keMau,daln5Ga1R +w,D� s Monthly 0i1
on
website listed below)Upon service discontinuation,rent for the 31e2s3ee11 "e"wreelii6lfl
Leased Equipment 0911 jbp91 ��y Surcharge,ui ment is charged through the end of the billing cycle g,Fuel
in which service is discontinued. Surcharge or Delivery
6.You will be charged a monthly oil Surcharge,Fuel Surcharge or
Delivery Fee as described in our T&C. Fee(see#6 under
will a y Only one of these fees „a W,e4uwcE_MMD nADNs MDT = `"'" "General
N➢v£MACTN"Y
apply to each account The fee that a Fayerent stub accouur suMMaar " ��a
is stated on the front of applies to your account
AMWNf
the invoice,For further information _^_••_ _ _ """"p1Ntlje__. Infor 'on')
>«� 1o<wc
visit the website listed below or contact our customer service
center. °"d N°"°"°°° "°°"" ` A[COONr 890 PAY BY PAYTNI3 AMOUNT
1]34567890 00 W 0 .ENCLOSED ,j
7.As a food NVOICBIWNODAn
Product, bottled water is subject to the rubs and 1z34S67890 s67690 oaooi00oo `.
regulations promulgated by the Federal Food and Drug 4
Administration(FDA), g 0420096307 04282712619 000391049 2004 16
8.Your first invoice indicates the products delivered on your fust " Amount due
del' ICE MOUNTAIN WATER COMPANY o�n Doe
ry,along with any applicable bottle and account deposits, DM AN p4Wm Non^ "t+ 123 Main St
redemption fees,and any dispenser charges.All future invoices
1vill reflect charges for water delivered and dispenser rental,bottle a as ate Da9oo
deposits and credits plus charges for an laautple it��6 dt r°I4:1MG41•�d U' PoRCUSTOMER SE MCE CA El t064P2Aadd
`�� Submit your
payment by this
eks,for
ordered b y additional products UP=
aaTpEEAv DMnsq uPRrna ao t u4td """yO qe0" "`S°` date
are
e every three or four
a total of 1617 deliveries per year.you you will only receive invoices �� - - ����� --- -�-
12 times per year,so approximately 5 of those invoices will reflect
two deliveries.
2068 ice Mountain Spring Water Company,a Division of Nestlis Waters North America Inc.
service.icemountainwater.com
Form No.NW 709 08112
VOUCHER NO. WARRANT NO.
ALLOWED 20
Ice Mountain
IN SUM OF $
P. O. Box 856680
Louisville, KY 40285-6680
$7.31
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 104EO119252823 I 42-389.001 $7.31 1 hereby certify that the attached invoice(s), 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
ur 2014
StFeet e - W
Street CommlSs Ner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/14/14 04EO119252823 $7.31
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