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240707 01/07/15 CITY OF CARMEL, INDIANA VENDOR: 051125 d { ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: S''"'""'3.99' CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 240707 PO BOX 856680 CHECK DATE: 01/07/15 LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 04LO11925282 3.99 04LO119252823 service.icemountainwater.com #215 6661 DIXIE HWY,SUITE 4e 11/13/14- 12/12/14 04L0119252823 49 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED WED- JAN 07 0119252823 FRI- FEB 06 TUE- MAR 10 Access your delivery calendar at WED- APR 08 service.icemountainwater.com 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 free) CARMEL IN 46074-8267 "I'tl'�"III'Il�l��l�ll�ll�ll�lll��'ll�"I'll�l��'lllll�lllll'll P_ ringan the:Hotiday, eason:.., Sparkling_Celebrationst Enjoy*premium brands including;San.Pellegri"rio;' Perrier grid Acqua Parina:,Lookfor special fioli&yisavings going.on from riow;until the end_of the yea"r, Calk, �-: ; -�?0�-Q 77 A�$$MOC U!S t Se►VIGA !�Pm4!ln6 mwate! Gom t0_Qrde ! r, . "�°?:. awe ..: ..i n'�.� r v .. � ;5�.`.. .. •"s:', ; .;, . . -�°'� e,.,;.s��'.": .. � X, 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 2.99 12/04 898783 PAYMENT-THANK YOU -2.99 12/12 L7702474 RENT 3.99 TOTAL 3.99 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 2.99 — 2.99 + 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 QUALI'T'Y 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 aero-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 I N VO I C E 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. •' You do not have to pay the disputed amount while it is being 0010 0.00l00l00 ,234567890 Your Account Number investigated.During the investigation,we cannot report your account t as delinquent or take any action to collect the amount in question. THR-Da o4 123456]89 MON-or179 Watch here for a GENERAL INFORMATION W D.MOrI nE DE ,B personalized account I.Payments received after the billing(INVOICE)date will appear on Important u,n^,nt„nl„pnl,h,,nn,l.lnu.,mn„n.,paan cr5<rv¢e,-Roo-+n-98B message your next invoice.Past due invoices(not paid within 30 days of news and Tn kY^umrusm9meMou^'a'"P'°d""` John Doeand a 1c billing date)may be assessed a late fee as allowed by law not to offers 123 M111 St ""S'a 00000 exceed$20 per month.Additionally,third party collection/attorney apt a{ at„d,,,,p Np..{,.u6{.La.0 _- expenses may be assessed at a rate not to exceed 100%of the unpaid balance or the maximum allowed by law. 4:; ;, '';d,Sr`,, trAY«.!',w!'E'!!`�r ',.,, 'eyv«s,�q°"'-'"=B:`z.`-�"y»,t»:"'':- Pay electronically t -," R4,4,;. ,al.. Ya®n0,ed Ywr n,Nmiuh;, ".i, 2.Each returned check is subject to a service charge subject to thea:`.' J g J "sr�,::z:-aetr:Fez«ee",Ilo.�,✓,��6, 0€ '.,,rr.,a.._�.'�'a�`�.a:�.�: , maximum check return charge allowable in our State. -3' Make Sure this 3. All bottle and equipment deposits are shown as CURRENT Activity `-p .•a 4'� »p� =✓ "'°"" ACTIVITY. rACnwTv amount has been since your ACCOUN paid in full to 4. Equipment re replacement costs will be charged for bottles los[, D<e9<rypddr<sa lonnD«, 123 Main S—L C"Y'State DD000 p g last invoice x%%x stolen,damaged or not returned. rr<„o",Baia^« xx0 avoid late fees Payment-Thank You X%%X 5.In accordance with NWNA's Terms and Conditions("T&C"),your �3, 46�E9s 5 SGanooNat"raise^^9Wa=<' xxxx t,l 117R851a4M I<e Mou^,ainSGal OePosR Equipment Lease and/or Service Agreement account may be 1„ 3nees,a4aa s ^,,,^sGaiR<,��^ - xzs: Monthly 0i1 subject to minimum monthly purchases and/or early cancellation �,,, „B263BB„ Surcharge,Fuel fees.(A complete version ofthe current T&C may be viewed on the 09nz Surcharge or Delivery website listed below)Upon service discontinuation,rent for the TOTAL Fee(see#6 under Leased Equipment is charged through the end of the billing cycle in in which service Is discontinued. '"""`^ _ ""TNI'x"Kz"T Information") 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or --xxx...a<H1 _. „ Delivery Fee as described in your T&C. Only one of these fees Payment stub ACCOUNT SUMMARY EbuEeo -_- y ppY BY PAY THIS AMOUNT will apply to each account. The fee that applies to your account ___ --a e,b, ----.w+M^`r ACCOUNT go AY V xxxx 123156]890 MT,ENCLOSED is stated on the front of the invoice.For further information please IW010E NUM BER Bit. DATE visit the website listed below or contact our customer serviceDo10o100 123x56]890 center. 7. As a food product, bottled water is subject to the rules and 0920o963U7 04262712619 oao391o49 zo04 16 Amount due regulations promulgated by the Federal Food and Drug n^Oce Administration(FDA). Icp McUNTA,N—TER C M'AN' 123-1,S1�D Submit your S.Your first Invoice indicates the products delivered on your first """°" "" OMERwRNCE ull Leon-47296Be delivery,along with any applicable bottle and account deposits, cu e' apayment by this 1.An�L,d.• 4p.,L.6Rk,l.a.n ❑yr,n • date redemption fees,and any dispenser charges.All future invoices IEpur�„s,g^^,Re,a��m0^R�°"a4de �^ will reflect charges for water delivered and dispenser rental,bottle :w"°RFOR R 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. ©2008 Ice Mountain Spring Water Company,a Division of Nestle Waters North America Inc. Form No.Nw 709 02/14 Sservice.icemountainwater.com 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)) 12/31/14 04LO119252823 $3.99 I 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. ALLOWED 20 Ice Mountain IN SUM OF $ P. O. Box 856680 Louisville, KY 40285-6680 $3.99 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members 2201 104LO119252823 I 42-389.001 $3.99 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 n ' 4 / / N uao,oednes �� 1 14 Styeat Gemmissie Street Commissioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund