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241034 01/13/15 CITY OF CARMEL, INDIANA VENDOR: 051125 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $********20.99* CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 241034 ' PO BOX 856680 CHECK DATE: 01/13/16 4roN`° LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4239099 14L722032704 20.99 OTHER MISCELLANOUS service.icemountainwater.com #215 6661 DIXIE HWY,SUITE 4 12/01!14-12/31/14 141-7220327048 ' LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED IIII IIIIIIIIIII FRE- FEB 06 7220327048 IIIII IIIII IIII IIIII TUE MAR 10 WED APR OS Access your delivery calendar of THU- MAY 07 service.icemountainwater.com 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 SQ by phone at:1-800-472-9888.It's free! CARMEL IN 46032-2584 !!I'In'ill'I!I!'ll! !!'I!I'iu'!!!'!1!Jill !I'In'!i'iliilli'i!!' Bring In theH" with Sparkling Celebratlghs! Enjoy premium brands including San Pe!!egnno,. Perrier ancf�/�cqua�Panna Loali for>spec�ai liollday sn from nowmuntil the endaf the year Call avings goingo 7�SY(1A�17r � r�ea.c: p►�a�a�t^a..z'�3-Ls'�•�itfnr.......tiJ'u+aF..7.�x' - s> r ���, ._..- ,. ,,., • t'fr �`��' ,v�t�°ro�i Y -2 a it l �,� � ' . ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800-472-9888 or visit service.icemountainwater.com. . o e ® ® e Delivery address: CITY OF CARMEL,1 CIVIC SQ, CLERK TREASURER OFFICE,CARMEL IN 46032 PREVIOUS BALANCE 17.88 . 12/04 898948 PAYMENT-THANK YOU -13.89 12119 003291 PAYMENT-THANK YOU. -3.99 12/09 0915360341 4 5 GAL ICE MOUNTAIN DRK W/HANDLE .13.96 4 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN, .00 12/31 0918940966 1 OIL/FUEL SURCHARGE 3.04 L7704808 RENT 3.99 TOTAL 20.99 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS'AMOUNT Subject to terms on reverse side,: 17.88 — 17.88 + 20.99 = 20.99 I IBILLING RIGHTS SUMMARY IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,ORF YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETTER A REPORT ON WATER QUALITY AND INFORMATION,PLEASE I. Please remember a CALL 1-800-472-9888 OR WRITE US AT: Payment i5 due by the"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 first invoice will include a pro-rated fee for the current month,pias the next month's rental. #216 6661 DIXIE HWy,,SUITE 4 3. Kindly fill in the amount enclosed include our account number on LOUISVILLE,KY 40258 If you prefer,you can pay your bill online at serviee.icemountainwater,Your check, and do not send cash. Ifyou think our i 4. Never hesitate to call us with comments,questions,or concerns. Y bill is wrong,or Ifyou 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 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: SAMPLE INVOICE • Your name,address,telephone and account numbers. v • The dollar amount of the suspected error. Date range of this invoice • Describe the error and"plain an error if you can,Why you believe there is 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.Duringthe investi anon,we cannot report g eP your account 7 2 345 6 7890 as delinquent or take any action to coiled the amount in question. ' 00100100-00=100 Your Account Number GENERAL INFOI�1��� 1.Pa RMAT ION TNR-OCT W 123456769 Payments received ager the billing(INVOICE)date will a MON-Oa 29 Your next invoice.Past due invoices not appear on Important �pNO°" Watch here for a billing date)may be assessed a late fee as 2-I owedhby lour not to news and TME xc 1B exceed$20 tl,tla�ltl St1,tI1Nd«iN1id<Itt6 lilgtltLd7.lsi(1 cot—Servcea 800.472.9888 personalized account Per month.Additional]et 2-r offers John Doe 'D,ankyouwwIng11, aanw.pnadN message expenses may be assessed at a rate not�o exceed c100°/R of the attorney 123 Main sL anaa4mu:. aty,5t i o°ooe 1 unpaid balance or the maximum allowed by law. -duo a at'IIw�G.p In IwuEt,gaaH 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State, " ° a a 9n umWxlogo mnaa4 �- 3. All bottle and equipment deposits are shown as CURRENT Yoae at6v96rx s � �p Pay electronically ACTMas awo mmwrx*Se4tr�'l�p x+4 ,ten' >z , TY. Activity �� { 4. Equipment replacement costs will be charged for bottles lost, since your AccouNrAcmrr �a M.c mw "°" "°° a°°'" " Make sure this stolen,damaged or not re last invoice u a amount h S.In accordance with t°r131'd JohnOce.123Main5Sree4Ciry,StateO°0°0 as been NWNA's Te aid i Terms and Conditions yourPre°,aa:ealaM< x,[1o[ P n full to Equipment Lease and/or Service Agreement account may be pan<n[-mankvaa a° subject to minimum Ben, a61B9e w° avoid late fees month] 31780514944 5 6Galton Naturzl5p ing Water %XXX y purchases and/or early cancellation m 3ves5,4 44 5 IceMauntainSGalDeposit fees.(A complete version ofthe current T&C may be viewed on the o9n, 3naas,aw4 5 [mMcan a,n'GNR website listed below)Upon service discontinuation rent for the �1+2 318238011 1 FoalSu¢Nr9e Monthly Oil 03/12 16690497 Pent F t;f 4A i' Leased Equipment is charged through the end of the billing cycle Surcharge,Fuel in which service is discontinued. a rornL _. j � Surcharge or Delivery 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or DeliveryF i Fee(see#6 under Fee as described in your T&C. Oni "General will apply to each account. li one of these fees Payment stub A oNsnMANCE_PA*MD ra D +4u•"� e '^`TMIFa N The fee that m is stated on the front of the' further i s to your account ACCOUNT SUMMARY 1010[ Information) visit the website low or.For further information please °'•`—°°° 6� +•^ M° °"e. n►ation'� ------------------ lisled below tact Our customer xG 1,sure Mwwm N a p ACCOUNT61.92-NUMBER 0PAY BY000 PAY lN1A5 AMOUNT center. or.con tomer service 1234567890 00 00 00 7. Asa F°Od ..ENCLOSED INVOICENUMBFR BIWNG DATE Product, bottled water is subject to the rules and 1234567890 0o16610e regulations promulgated by the Federal Food and Drug Administration(FDA). 0420096307 04282712619 000391049 2004 16 8.Your first invoice indicates the products delivered on your first Amount due delivery,along with an applicable bottle and account deposits, ICE MOUMAN WATER COMPANY J123 ahn 2-i redemption fees,and an pP M,wamNmae Wain,Ne"A a" c,,,S.n st Will reflect charges for water d livered and dispenser rental,bottle ❑ry,srate oeooO charges.spenser future invoices deposits and credits 1 !«aaasa,at�.iG 6.,tt„{iOdtmGGGE,d,Ja' iOR CUSTOMER SEANCE CpLLI.806472.9688 Submit your ordered b pus charges for any additional products ❑SIGNUP ONFP EAUNPAtlSIgnUpR quLMOnPenrs Side. ❑p ntA9EN ngnOnB n sMe. payment by this y you. Deliveries are made every three or four weeks,for date a total of deliveries per year.You Will only receive invoices two deliveries. 12 times parer year,so approximately 5 of those invoices will reflect ©2008 Ice Mountain Spring Water Company,a Division of Nestle Waters North America inc. Q service.icemountainwater.com -— -- - _ ---- Form No.NW 709 02/14 y Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.199 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 n � Purchase Order No. v� Terms Date Due Invoice Invoice Description Amount Date Number (or note attached in oice( or bill(s)) WMq OS J19) 'q q 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 20Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF $ ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT./# I hereby certify that the attached invoice(s), l I 7 U�' de,Q 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 i i 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund