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241521 01/27/15 CITY OF CARMEL, INDIANA VENDOR: 051125 3j ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $*********3.99* =a; CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 241521 9gj�7'Oiil ; PO BOX 856680 CHECK DATE: 01/27/15 LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 0119252823 3.99 OSA0119252823 service.icemountainwater.com #215 6661 DIXIE HWY,SUITE 4 12/13/14-01/12/15 05A0119252823 / LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED 'I'I II I I"II I II'I"I'I I I I I I II' I 'II FRE- FEB 06 0119252823 TUE- MAR 10 WED- APR 08 Access your delivery calendar at THU- MAY 07 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 freel CARMEL IN 46074-8267 �Irll�rlllllll��l�lll�lrl�l���llll���lllll�����llllrlll��ll�����1 i Start the year off right and save! Save$2-.00 when you,buy 12oz Ice Mountain Natural.Spring Water,perfect for ori the go!Visit ese_rvlce icemountalnwater com f __ x 'z,':.�,.,. _ °moi z+� s ,+ ,Y✓" 5 -eft .P, ,.s•1i rise` ��*� , .�,�.w.� e a.-.�!„ :d,.S �f. � ,�P � � *�,a ^Y �rv��✓,. 5" �"slYz:ar'.,''ol��;'s�aa,.�e�,�tF F ::Y,.? ?%rk,�e o �'� ,u�s� 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 3.99 1/12 A7867129 RENT 3.99 TOTAL 7.98 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT r]r Subject to terms on reverse side. 3.99 — 0.00 + 3.99 = 7.98 BILLING 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 QUq]ITY AND INFORMATION, PLEASE 1• please remember payment is due by the" a b " CALL I-800-472-9888 OR WRITE US AT: 2. Remember,if you are renting equipment,your equipmentdate trental is barged one month in aed to ensure the smoothest rdvarice.That mean ICE MOUNTAIN SPRING WATER Co. Your first invoice will include a pro-rated fee for the current month,plus the next month's rental. k216 s 6661 DIXIE HWY.,SUITE 4 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. LOUISVILLE,ICY 40258 If You prefer,you can pay your bill online at service.icemountafnwater.com If on think 4. Never hesitate to call us with comments,questions,or concerns. Y your 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. telephone us,but doing so will not.preserve our ri s.In yo You can SAMPLE give us the following information: Y ��In Your letter, E 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 an error. ,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 investt f gated.During the investigation,we cannot report your account 72;4567890 as de]inquentor take any action to collect the amount in 3 00100too-0o/00100 Your Account Number question. GENERAL,INFORMATION THR-OCi 04 123456789 1.Payments received after the billingMON OCT 29 Your next invoice.Past due invoeesA(Doottlpaid withinte 130pdays of n µs and Important wEnNov:, Watch here for a -b]]Iing-date)-ma 7uE-0Ec 1R Y be-assessed-a_late-fee-as-allowed_by law-not_to__ 9i,tfp111„hlglllfth Illbl,ll G.GIIIn NLnJdtl' _ ., emtome<56,vice„-6Goo-„z9BBB � personalized account exceed S20 per month.Additionally,third a offers - _ ioriR 006 4 message expenses may be assessed at a rate not o exceedc]00%fof the ^t23P Ne^ky6R oEueR9 uM•6^mi^9�„� unpaid balance or the maximum allowed by law. a r.swre = 6remax Z.Each returned check is subject to a service charge subject to the maximum check return chaige allowable in your State. o roxx«mtaRr�yne 3. All bottle and ,,"° — „e6T Pay electronically equipment deposits are shown as CURRENT i ACTIVITY Activity 4. Equipment replacement costs will be chargedsince your Make sure this for battles lost, AccouNracrwm R 6m„�,.=•^�^n�^°° stolen,damaged or not returned, last invoice amount has been 5.In accordance with NWNA's Terms and Conditions{"T&C", D,Ii q'AEdm �^^�•123M61RSt t,ChYS”6 0M j your a ao els"� 0 a 1 paid in full to Equipment Lease and/or Service Agreement account may be Th6RkY•6 wwc 08131 461898 P6^'- wEx« avoid late fees subject to minimum monthly purchases and/or earl cancellation n1 317BB8144A4 s 5G n6RN u e 5PAR9M re } "0 fees.(A complete version ofthe current T&C may be viewed onthe 11 31 514460 s oeP6v r , 09/11 317805144Aa 6 keMwnuinBG IR wtXR -( Monthly Gil website listed below U oil 3102638811 R im2na9e �1� t {rl t, gt'F ow Leased Eqrent for the uipment is)charged through the end of the ntinuation'billing cycle �' ,6E4o197 Y Surcharge,Fuel in which service is discontinued. t Surcharge or Delivery 6.You will Fe charged a monthly Oil Surcharge,Fuel Surcharge or J Fee(see#6 under Delivery Fee as described in your T&C. _ "General tvifl apply to each account. Only one of these fees .RIY1o",RAUNa_EAEMv1E7A0N3EMUR+NN4NE's"”" _ � AMWNT The fee that a Payment stub ACCOUNT SUMMARY xx a won is stated on the front applies to your account „".,°•,"6„°e„,..--- ^mow^^^"___. Information') u4 invoice For further information please --�-----_—_— PAY BY PAY THIS AMOUNT F visit the website listed below or contact our c °”"N p6e0nb "”"P"" ACCOUNT NUMBER 7x0 customer service 00 ao center. 123156UM .ENCLOSED 7. As a food product, bottled water is subject to the rules and INVOICE NUMBER BIWNCDATE 1234567890 00100100 Administratioregulations po(FDA)ated by the Federal Food and Drug _ 0420096307 04282712619 000391049 2004 18 8.Your first invoice indicates the products delivered on your fist L i Amount due delivery,along with an a redemption fees,and any dispenser bhazgesnd a count depoices apEMounaNwAERcoMPANr O',S Mum drlwew.ms r,mrmn^.h.me 1231 Sl M.I.I. 00000 future will reflect charges for water delivered and dispenser rental,bottlem:;ttiaf4a.,r„Gt,rta n' EORNS70ME0.SERV CE CALL i-000.112.9888 Submit your deposits and credits plus charges for any additional products a"fOR"oEAOo`A"v'n0p"° a� �^ Payment by this ordered by you.Deliveries are made every three or four weeks,for date a total of 16-17 deliveries per year.You will only receive invoices __.___ 12 times per yearso approximately two deliveries. 5 of those invoices will reflect ©2008 Ice Mountain Spring Water Company,a Division of Nestld Waters North America Inc. service.icemountainwater.com _ Form No.NW 709 02/14 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 i Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 05AO119252823 42-389.00 $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 I which charge is made were ordered and received except ary 015' f nw..W C[ b'�mil el��I�r�CP Street Commissioner Title i 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)) 01/14/15 05AO119252823 $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 f