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236160 08/19/14 CITY OF CARMEL, INDIANA VENDOR: 051125 j; ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $********71.91* x ?4 CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 236160 PO BOX 856680 CHECK DATE: 08/19/14 LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2200 4239099 04GO12004852 41.78 04GO120048525 1801 4350900 04GO12197559 30.13 04GO121975593 service.icemountainwater.com ®B #215 6661 DIXIE HWY,SUITE 4 07/01/14-07/31/14 04GO121975593 LOUISVILLE KY 40258 8► B ° 9 ►, S ADDRESS SERVICE REQUESTED IIIIIIIII1111111111111111111111111 FRI_ AUG 08 0121975593 TUE- SEP 09 WED- OCT 08 WED- NOV 05 CARMEL REDEVELOPMENT COMMISION DON CLEVELAND Customer Service: 1-800-472-9888 30 W MAIN STREET Pay your bill online at:service.icemountainwater.com or SUITE 220 by phone at:1-800-472-9888.Irs free] CARMEL IN 46032-1938 IIIIIIIIJ��IIIIIL����I��I�IIII��I�III�'I��III�IIII���I���I���II � ra rr ,��, ;���a,�� ��a y Take advantage of these HOS Summer Savings for a I mited time onlyi These savings are on a i6 y of prtsiluc'ts+nclQadistg refrestiir>�i teas and lern�nacle, Sparkling=tdattiral SpringxWater and"great°on theos`izeS visit ser$inceicemountamwa#er comorcaN1-80:© 47 9888toorderi � . — r w m — r `x 1 a ., ,, ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800.47279888 or visit service.icemountainwater.com. . ®� s • e ® • e Delivery address: CARMEL REDEVELOPMENT COMMISSION,30 W MAIN ST STE 220,CARMEL IN 46032 PREVIOUS BALANCE 61.78 7/11 094764 PAYMENT-THANK YOU -29.31 7/25 176838 PAYMENT-THANK YOU -32.47 7/14 0891409773 2 5 GAL ICE MOUNTAIN DIRK W/HANDLE 15.98 2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -12.00 7/31 0896037397 1 OIL/FUEL SURCHARGE 3.16 G6918759 RENT 10.99 i TOTAL 30.13 1 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 61.78 — 61.78 + 30.13 = 30.13 BILLING RIGHTS SUMMARY IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR YOUR VOICE-4 WAYS TO HELP US SERVE YOU BETTER A REPORT ON WATER QUALITY AND INFORMATION,PLEASE l Please remember payment is due b the" CALL 1-800-472-9888 OR WRITE US AT: y Pay by"date noted to ensure the smoothest service. 2. Remember,if you are renting equipment,your equipment rental is charged One month in advance.That means ICE MOUNTAIN SPRING WATER CO, your 11216 first invoice will include a pro-rated fee for the current month,plus the next month's rental, 6661 DIXIE HWY,,SUITE 4 3• Kindly fill in the amount enclosed, include your account number on LOUISVILLE,KY 40258 If you prefer,you can pay your bill online at service.icemountainwater.com check and do not send cash. Ifyou think your bill is wrong, must hear froror ifyou need more information about 4. Never hesitate to call us with Comments,questions,or concerns. a transaction on your bill,write us,or?a-separate sheet of paper.We iryou in writing no later than ihirty(30)days after' sent you the first bill on which the error or problem appeared.You can pp we telephone us,but doing so will not preserve your rights.In your letter, SAMPLE P give us the following information: LE INVOKE • Your name,address,telephone and account numbers. - • The dollar amount of the suspected error. Date range of this invoice • Describe the error and explain if you can,why you believe there is an error. You are obligated to pay the parts of your bill that are not in question. You do not have to pay the disputed amount while it is being investigated.During the investigation,we cannot report o 0/ as delinquent or take Your account 00100/00 00/00100 iz34sb,sg° XourAccount any action to collect the amount in question. E Number GENERAL INFORMATION 7HR-0a 04 123456789 1.Payments received after the bilin MON OCT 29 Your next invoice.Past due invoices(INVOICE)date will appear on Important wEo-"�':' Watch here for a ( Pa m 30 days of news and RIE-ITEC 18 billing_date)maybe assessed a late fee asallowed by law not to exceed S20 per month.sewedAddftioaalat third c _ P 61 au p1n1".find IA4 iftantlytlddG' LU°mer5 u.,�°g A,zesBB personalized account expenses ma Party ollection/attorney Offers 19tno TwN I°u,°u n91 eMeunanProduW t message --�23M IR St 7-07 td servlus. # g y be assessed at a rate not to exceed 100%of the Gmt t „Fti tl�tm�-tla:b?nil' — unpaid balance or the maximum allowed by law. ,v L 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State, ammag<7«�u w IT inn°7 �aPh o9�row an m xe 3. All bottle and equipment deposits are shown as CURRENT er l Pay electronieaIIy ACl bottle n 4 Activity et 4. Equipment replacement costs will be charged for bottles lost since your "°"" Make sure this accoun rarnvnv P maw •=�^R ° '"^ " stolen,damaged with not returned. last invoice amount has been 5.In accordance with NWNA's Terms and Conditions("T&C"),your ,oeP�r�ess Johnone,luMamsvee+.o[rstate Oooao Pte°�,an a >� paid in full to Equipment Lease and/or Service Agreement account may be n, yae subject to minimum month) °a 1 °61� pa,,­n, avoid late fees /11 3+788514444 5 SGall°ONawral$Pring Water µX M�1''.fOI '- 1 fees.(A complete version of the current T&C may be viand/or early cewed cancellation 717eas,daa 5 I eM°°n aln SGal Oep-s — t 09/11 31)88514M4 5 ke M°unlalnSGal Rewm eF > Monthly O@ website listed below)Upon service discontinuation,rent for the °9 42 31a263eeu + wds b`ha g t-� i 09/1 16640497 Ren[ Ifii4 i'S ib3 T -Vy %%]Ot Leased Equipment is charged through the end of the billing cycle i YYY Surcharge,Fuel in which service is discontinued. WTAI `""'' ` Surcharge or Delivery 6.You will be charged a monthly Oil Surcharge, —Fuel Surcharge or a Fee(see#6 under Delivery Fee as described in your T&C, Only will a y one of these fees Payment stub Atmw. P Y4RISM40°M 1 apply to each account. The fee that applies to our AccouNr suMMaav ����� is stated on the front of the invoice,For Y account ----,=e.e_e._[.�•— __-__-__ Informaho vera _ l n' further information please 0.CCOUNrNUMBER PAYv ParlNsnB4ouNr visit the website listed below or contact ow °e""�w"�•i4rt�'�'�`� ---------- customer service 00 00 k center. OuN"7e96 .ENLEosro 7. As a food product, bottled water is subject to the rules and INVOICENUMBERBIWNre GATE )234567890 00100/00 regulations promulgated by the Federal Food and Drug Administration(FDA), 04¢0096307 04282712619 000393049 2004 18 8.Your first invoice indicates the products delivered on your first Amount due delivery,along with any applicable bottle and account deposits, 'CEMOUMANWATFR[OMPANY °hn� redemption fees,and any dispenser charges All fu ° """°"""° " Iz3 Main St will reflect chargesu v ate°P°Bo future invoices Submit your for water delivered and dispenser rental,bottle )a.m�4� r�•t��t�tt�tp��!i.LLGt+twEl fOR CUSTOMER 5fRV1<E(ALL 1lOWRABBB deposits and credits plus charges for any additional ❑swNw oR awmPAn 9nuPn 9lnao ReR esue ❑ • 9�� s^` # payment by this ordered by you. Deliveries are made every three or four weeks,fordate a total of 16-17 deliveries per year.You will only receive-invoices 12 times per year,so approximately 5 of those invoices will reflect two deliveries. 1©2008 ice Mountain Spring Water Company,a Division of Nestle Waters North America Inc. service.icemountainvv ater.corn Form No.NW 709 02114 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 Ce 1 0/1Id1l 01,1-e64 Purchase Order No. I U0 X S 6 SQ Terms L. V) Ile ,K Y f D 2- 95— (W Date Due Invoice Invoice, Description Amount Date Number (or note attached invoice(s) or bill(s)) 0960017S,93 ►� r �� Total 3 a.13 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. ALLOWED 20 la Agn16PI IN SUM OF $ P )_1jo 8s66�D 30.13 ON ACCOUNT OF APPROPRIATION FOR 1y 01 / �35096b Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT I herebycertify that the attached invoice(s), DEPT.# cert 'y 06012,)9715T T350906 50,1 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 Sig ure AA Title Cost distribution ledger classification if claim paid motor vehicle highway fund service.icemountainwater.com ®® ° #215 6661 DIXIE HWY,SUITE 4 ° / LOUISVILLE KY 40258 07/01/14-07/31/14 0460120048525 kk 21111 ADDRESS SERVICE REQUESTED ® ® • IIIIIIIIIIIIIIIIIIIIIIIIII IIIIIII SEP 05 0120048525 MON- " OCT 06 MON- NOV 03 THU- DEC 04 CITY OF CARMEL DEPT OF ENGINEERING Customer Service: 1-800-472-9888 LISA SCOTT OR JUDY STOHLER Pay your bill online at:service.icemountainwater.com or 1 CIVIC SQ by phone at:1-800472-9888.It's freel CARMEL IN 46032-2584 �I'I��"Illl���lllrl�l�lllll'ISI'I�IIJ�I��IIII��I�III���II�III�I . fake�atlantage of these HO i.StimmerSaVtngs,far a lirriitecitlmeonlyl These�savingsare on a�ariety of productsmclu3cfingW-refreshing teas and lemonade SparkhnNaturalS rin Water anti reatan-the-go si es ' sex tce e ountam r:corn or ca111 800-472 8888 to ortlerl ACCOUNT ACTIVITY. For questions or,a report on water quality and information,call 1-800.472-9888 or visit service.icemountainwater.com. P POP 1-0- Delivery address: 'CITY OF CARMEL,1 CIVIC SQ, CITY ENGINEERING DEPT,CARMEL IN 46032 PREVIOUS BALANCE 42.88 7/11 094762 PAYMENT-THANK YOU -24.93 7/25 176833 PAYMENT-THANK YOU -17.95 7/09 0890890981 8 5 GAL ICE MOUNTAIN DRK W/HANDLE 27.92 8 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00 8 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00 7/11 0892370370 3 9 OZ PLASTIC CUP 50C/SLV x&,16678970 7/31 G6852361 RENT 1>� 3.99 TOTAL 1'Fj 41.78 n woo•Jejumu leluno wool•eolmes VUZO 60L MN'ON w10=1 'Oul BOu2wV 41JON SJeWAA 911SON jO uoism.iQ B'AuEdwoo jajeM BuudS uielunOW eol 8002 OO BILLING RIGHTS SUMMARY IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR YOUR INVOICE-4 WAYS TO A REPORT ON WATER QUALITY AND INFORMATION,PLEASE SLI'US SERVE YOU BETTER 1. Please remember payment is due by the"pay by"date noted to ensure the smoothest service. CALL(-800-472.98gg OR WRITE US AT: 2. Remember,if you are renting equipment, our a ui ICE MOUNTAIN SPRING WATER CO. Your first invoice will include a pro-rated fee for the current month,plus the next month's rental. 13216 Y equipment rental is charged one month in advance.That means 6661 DIXIE HWy,SUITE 4 3• &'Idly fill in the amount enclosed, include your account number on LOUISVILLE,KY 40258 If you prefer,you can pay your bill online at service.fcemoun umber ton a check, and do not send cash. Ifyou think your bill is wrong,or ifyou need more information about 4• Never hesitate to call us with comments,questions, a transaction Un'.ow bill,' On q Oi Concerns, must hear from you in'J1 wgtno later than tahrke.sheet of paper:We, ' sent you the first bill on which the error or problem a�Sys after we telephone us,but doing so will not preserve our rights.PP ed.You can give us the following information: yIn your letter, SAMPLE INVOICE • Your name,address,telephone and account numbers • The dollar amount of the suspected error. Date range of this invoice • Describe the error and explain if you can,why you believe there is an error. You are obligated to pay the parts of your bill that are not in question, You do not have to pay the that amount while it is being investigated.During the investigation,we cannot report as delinquent or take an P Your account , o0100fo0.00/00too 1234s6769D your Account Number y action to collect the amount in question. GENERAL INFORMATION ffimmmm 123456789 1.Payments received after the billingTNR OCT x 9 d your next invoice.Past due invoicesNnOICE)date will appear on Important Wo Na 29 billing date)may be assessed a late fee as allowed by law not to wEo-Nov=+ Watch here for a (not paid within 30 days of news and TDE-DEL,O exceed$20date) per urolith.Additionally,third tl nsAan a!tn1l1;611t1 l ln6 atln„tL€t2¢if C°n6m S Mm 1-60o-02-9900 personalized account offers 12A Main rnenk r M9�ce MoM>nL.P�°°U messy expenses may be assessed at a rate not to exceed 100%o the 123 Main St rv°°f U5 message Gry,Stat 110000 an=f' E unpaid balance or the maximum allowed by law. Lapa a Ab n u%::n t U 1 btet«iLn 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State. P t `” 3. All bottle and equipment deposits are shown as C r Pay electronically air' sa Yo ^•x� i ACTIVITY. URRENT Activity ` 4. Equipment replacement costs will be charged for bottles lost since your uP,.•�' ^° stolen,damaged or not reACCOUNTArnvnY � ��,'^••""""' Make sure this 5.In accordance turned. last in with NWNA's Terms and ,D6O gAddr urn^D°e,123M°inStteeG atv,srare ooODB amount has been Conditions("T&C"),your PM�,;=°k' paid in full to Equipment Lease and/or Service Agreement account may be ThaOxm4 subject to minimum 0B 1 °61898 P,vme t- n o avoid late fees monthly purchases and/or ear] m 317885114N 5 SGIb^New^'SDd^9W° fees.(Acompleteversionofthec early n1 3+leesI4449 5 'reManwmswiDwsn 9 current may be viewed on the o9n, 317885+�+ 5 ireM°°nams6elamm 1 Monthly0il website listed below)Upon service discontinuation,rent for the 09++ 31e763Beti + 7°e+su durBe � } O9n2 +66x0491 Bent l i{AI}'0 \ina i f' M%X2 Leased Equipment is charged through the end of the billing cycle I Surcharge,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 Your T&C, T ; Fee(see#6 under wlll apply to each ace y OnIli one of these fees is stated on t Dunt The fee that applies PBYment stub PnmwstwAea PpMFMGPNtneeAT.t NYPFMACIIVT ,� "General he front of i PP s to your account ACCOUNT SUMMARY theinvoice.Forfitrttterinformationplease °°•'`"•`°';L;a°'—°"_--• •",t."-- " ""° :. j Information') VISit the website listed below Of For Our c °ebd1"b m0Y1d R0°"'"^'�P'"`m' ACCOUNT NUMBER PAY BY PAYTIISAMOUNT 1 center. customer service o0 0 10"8 1234567990 E,.IgO5E0 ' 7,As a food product bottled INVOICENUMBER B11 NG DATE regulations water is subject to the rules and 1234567890 Dw9N00 promulgated by the Administration(FDA), Federal Food and Drug 0420046307 04262712619 000391049 2004 16 8.Your first invoice indicates the products delivered on your first Amount due delivery,alongICEM0U-MNWATERCcMM. 1,h,D°e with any applicable bottle and account deposits, Dew^^ "°°"° Mmainst redemption fees,and any dispenser charges.All future invoices will reflect charges for water delivered and dispenser rental,bottle city's—Do0o0 deposits and credits I 1 anu«1;ncw� I6 tt tnAt;..t,�l l;an: f00.NSi0MFA SDMCECALLiBOW7h9889 ; Submit your plus Charges for an swnwroBmawc nnvP uvBrne 80 4 n•°e ❑Pa°ta va 9hD n n sur.. payment by this ordered by you. Deliveries are made every threedor pour weeksufo _ date a total of 16-17 deliveries per year.You will only receive invoices "`" "`" " " '"_.. m __. 12'Imes per year,so approximately 5 of those invoices will reflect two deliveries. 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 Ice Mountain Purchase Order No. POB 856680 . Terms Louisville, KY 40285-6680 Date Due Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s) Amount 8/5/2014 04G0120048525 water cooler $ 41.78 Total $ 41.78 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. Ice Mountain ALLOWED 20 POB 856680 IN SUM OF $ i Louisville, KY 40285-6680 i $ 41.78 ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#rrITLE AMOUNT DEPT# � I hereby certify that the attached invoice(s), or 0 04G01200485 2200-4239099 $ 41.79 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 I i 8/18/2014 Signature City Engineer Cost Distribution ledger classification if ; Title claim paid motor vehicle highway fund