236874 09/10/14 CITY OF CARMEL, INDIANA VENDOR: 051125
.;, d ='• ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $**...****3.99*
CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 236874
PO BOX 856680 CHECK DATE: 09/10/14
LOUISVILLE KY 40285-6680
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4239099 14H722032704 3.99 14H7220327048
imsery ice.icemountainwater.com ®®
#215 6661 DIXIE HWY,SUITE 4 08/01/141- 08/31/14 14H7220327048
LOUISVILLE KY 40258
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ADDRESS SERVICE REQUESTED
MON- OCT 06 7220327048
MON- NOV 03
THU- DEC 04
THU- JAN 08
CITY OF CARMEL OFFICE OF THE CLERK TREASURER Customer Service: 1-800-472-9888
ANN DAVIS Pay your bill online at:service.icemountainwater.com or
1 CIVIC SO by phone at: 1-800-472-9888.It's free!
CARMEL IN 46032-2584
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Save onjantast�c Back-to-School;Essentials-gGetgae,$1-OO;off wl en`yo"u purchase;.(1•}�8oz 48=packwor(2-} 12 '_
sr�•.�.., " a .b,�'-. t'€a^'� a '� - �E ''•'�'" � ^�.i'z'sre nt ' -rt
24 Pack:,botflest 8 oz is lunch':bdi friendly aril _12=oz is':perfectgfor,teens:&fib su y moms Call 1;800 4.72=9888zor,
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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.
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Delivery address: CITY OF CARMEL, 1 CIVIC SO, CLERK TREASURER OFFICE,CARMEL IN 46032
PREVIOUS BALANCE 3.99
8/22 334516 PAYMENT-THANK YOU -3.99
8/31 H7046833 RENT 3.99
TOTAL 3.99
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
--- Subject to terms on reverse side. 3.99 — 3.99 + 3.99 = 3.99
BILLING RIGHTS SUMMARY YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETTER
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR 1. Please remember payment is due by the"pay by"date noted to ensure the smoothest service.
A REPORT ON WATER QUALITY AND INFORMATION, PLEASE 2, Remember,if you are renting equipment,your equipment rental is charged one month in advance.That means
CALL 1-800-472-9888 OR WRITE US AT: your first invoice will include a pro-rated fee for the current month,plus the next month's rental.
ICE MOUNTAIN SPRING WATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash.
#216 If you prefer,you can pay your bill online at service.icemountainwater.com
6661 DIXIE HWY.,SUITE 4
LOUISVILLE,KY 40258 4. Never hesitate to call us with comments,questions,or concerns.
If you think your bill is wrong,or if you need more information about
a transaction on your bill,write us on a separate sheet of paper.We
must hear from you in writing no later than thirty(30)days after we SAMPLE INVOICE sent you the first bill on which the error or problem appeared.You can
telephone us,but doing so will not preserve your rights.In your letter,
give us the following information:
Your name,address,telephone and account numbers. Date range of this invoice
• The dollar amount of the suspected error.
• 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. 1 1234567890 I Your Account Number
You do not have to pay the disputed amount while it is being 00100100-00100100
investigated.During the investigation,we cannot report your account 1t
as delinquent or take any action to collect the amount in question. TNR 0a M 123456789
MON 00 29 Watch here for a
GENERAL INFORMATION WE6NDV='
,vE-DEE,B personalized account
1.Payments received after the billing(INVOICE)date will appear on Important ph"111^st 1d141,.dIll.lda4„dSluntl;dlddp cvst«3aseMc°`1-800''72vBee
message
your next invoice.Past due invoices(not paid within 30 days of news and rn.nx yRl t°°"�'^9"°Mn4mam p[1B1"c'
1123 Doe ane semces.
billing date)may be assessed a late fee as allowed by law not to Offers 123Ma,lst
exceed$20 per month.Additionally,third party collection/attorney Ow'stme 00000
L,dud,.d„uL,...IL,,.II..,il"bu,.L.LLLI.dau
expenses may be assessed at a rate not to exceed 100%of the
p y y, ze��rte.
unpaid balance or the maximum allowed by law. '>"'A'°g” -gyp"y,,,pul3me�!"." Yyw!� „Jy�'; ;;,, Pay electronically
�ioi3nwx Ycu +3rchy34..,_. mewm;s3lrr`�
2.Each returned check is subject to a service charge subject to the
maximum check return charge allowable in your Slate.
Make sure this
3. All bottle and equipment deposits arc shown as CURRENT Activity amount�.,,a°+P"°""
ACTIVITY. ACCOUNT ACTIVITY
�• amounthaSbeen
since your Acco
4. Equipment replacement costs will be charged for bottles lost, •Del,,,enAaalxsx i^n^°Oe•113Ma,3sneeLE1[r•stac°0°°°° xxxx paid in full to
last invoice
stolen,damaged or not returned. Prew'n4s8ala"`e xxxx avoid late fees
Payment-ThankVPu
5.In accordance with N WNA's Terms and Conditions("T&C"),your 08131 4fi,B9e s0a111nNaw,alsp339Wa,ee - x";<
5 Icn[a,nSGalDeplsit Monthly Oil
/11 31)085,0444 S
Equipment Lease and/or Service Agreement account may be eMou0.3nees,44a4 5 IceMln3ta,nsGalRe„+m 00 -
�/„ 3,'1805144M Renl5urt6ar9e
subject to minimum monthly purchases and/or early cancellation 09na 3182fi3Be„ , � Surcharge,Fuel
fees.(A complete version of the current T&C may be viewed on the 0932 166.1049] xxxx
Surcharge or Delivery
website listed below)Upon service discontinuation,rent for the TorAL _ Fee(see#6 under
Leased Equipment is charged through the end of the billing cycle "General
315 Mount
in which service is discontinued. —N^"`IMTM = •Ax x""" Information")
6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or .4[AN -xx r -� ,
Delivery Fee as described in yourT&C. Only one of[hese fees Payment stub AccouNTsuMMAaY
----____--
Y PAY THIS AMOUNT
pAY BY
will apply to each account. The fee that applies to your account _____--µ p ,,,,,m„,N,a,�wp�^�" ACCOUNT NUMBER xxxx
elzn u 891111 w ENCLOSED
DATE
is stated on the front of the invoice.For further information please
0 8
fonna[ion please 1,.ryOICE NUMBER
visit the website listed below or contact our customer servicea01um00
123456)890
center.
7. As a food product, bottled water is subject to the rules and 0420°96307 042627la619 000391049 2°04 is Amount due
regulations promulgated by the Federal Food and Drug I1n3 Doe
Administration(FDA). Ice MouNTaN wATEN Co 11ry s��e0oo00 Submit your 8.Your first invoice indicates the products delivered on your first aDn"'°""NeOf=T
Epp cUSTOME0.S61NKE ULL 1E00-42'9008 b this
delivery,along with any applicable bottle and account deposits, sd•
I„dcd�d.aL»"IL.,dL.,n„ba..L.61ad.a.a e � payment Y
redemption fees,and any dispenser charges.All future invoices �PAr5ign0PRe,.�,eao"R�,e1es,B _ date
will reflect charges for water delivered and dispenser rental,bottle 5iLN0PropIREEA -
deposits and credits plus charges for any additional products
ordered by you. Deliveries are made every three or four weeks,for
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.
(920 08 Ice Mountain Spring Water Company, a Division of Nestl6 Waters North America Inc. Form No.NW 70902/14
service.icemountainwater.com
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
IN SUM OF $
TO ��, 90
i ��� �sn (Z � 46�8G
$ 3 -M
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
I 7 D 'IQ 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund