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244723 04/29/15 4 y�•..�r�gMff CITY OF CARMEL, INDIANA VENDOR: 051125 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $********17.81 CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 244723 PO BOX 856680 CHECK DATE: 04/29/15 LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 0119252823 17.81 15DO119252823 service.icemountainwater.com ti D 3 #215 6661 DIXIE HWY,SUITE 4 03/13/15-04/12/15 15D0119252823 ' LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED II'I II I II'II'II'�'I I I I I I I I I 1111111 I I III THU- MAY 07 0119252823 MON- JUN 08 WED- JUL 08 Access your delivery calendar at THU- AUG 06 service.icemountainwater.com CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-472-9888 BONNIE CALLAHAN Pay your bill online at:service.ice mountainwater.com or 3400 W 131ST ST by phone at:1-800-472-9888.It's freel CARMEL IN 46074-8267 I��I��III��JJ�IIII�II�I�III'��IIII�I'I'I'�I��IIII�I��J�III� S nr — g Forward"antl saver Save 2 00 wren ou bu our choice ofi neatly to drink Iced tea Nestea, Sweet x"�r33r a Ea Deaf, or TraddWindsl Visit Service icemou ►tainwater oom r „ .-- „ Ab 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 31.97 3/30 544157 PAYMENT-THANK YOU -31.97 4108 0932321078 3 9 OZ PLASTIC CUP 50C/SLV 9.87 4/12 0934566787 1 DELIVERY FEE 3.95 D8357863 RENT 3.99 TOTAL 17.81 T ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 31.97 — 31.97 + 17.81 _ 17.81 BILLING RIGHTS SUMMARY IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FpR YOUR INVOICE-4 A REPORT ON WATER QUALITY AND INFO 1. Please remember payment is ids ds byOth I P US SERVE y CALL]-800-q72-gggg OR WRITE US AT: RMAT[ON,PLEASE OU BETTER 2. Remember,if You Pay by"date noted to ensure the smoothest service. ICE MOUNTAIN SPRING 1VgTER CO. Y are renting equipment, our e #216 your 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 enclose y qutPment rental is charged one month in advance.That means LOUISVILLE,KY 40258 If you prefer, include your account number on you can pay your bill Online at serviee.icemountainwater.comr check, and Ifyou think your bill is wrong 4• Never hesitate to do not send cash. a transaction on ga or ifyou need more information about call us with comments, Your bill,write us questions,or concerns. must hear from you in writing no later thanthirtyto sheet of paper.We, sent you the first bill on which the error or n ie (30)days after we telephone us,but doing so will notpreserve your rights.In your letter, appeared You can give us the following information: • Your name,address,telephone and account numbers. SAMPLE INVOICE • The dollar amount of the suspected error. • Describe the error and explain ifyou can Why Date range of this invoice an error. y 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.During the investigation,we cannot report your account as delinquent or take anyaction 10 collect the amount in question. ' 00100!00-90/00/00 7234167890 Your Account Number GENERAL INFORMATION ].Payments received after the billing123456789 Your next invoice.Past (�VOICE)date will a tae-OC`la NOV 21 billing due invoices appear on Important MON-OCT 29 (not paid.within 30 days of TUE DEC 18 -- g date)may be assessed a late fee as allowed by law not to exceed$20 r Y news and n;itaaisatiaivatniaiJ,ntb"aun»ti„noon personatch here for a per month Additional!, c°aa a se c1 eDo-oz-9888 personalized account expenses may be assessed at Y third Patty by Offers 123 Doe unpaid balance a rate no[to Y 123 Main Sc Thd—lo°rusing lce M°un alnp 6dum messy e or the maximum allowed by iexceed 100%of the orystale D0oo0 any•emaa. g 2.Each ret an t J m,.,.Jt,n.iti:Jt"t n.,t,,bt Lt.J"n or check is subject to a service charge subject to the 3maximum check return charge allowable in your State. . All bottle rnm.,n _ ,n°rnpnk, ,n,an+�«r+�nnma,rearao> 9 xt -_ and equipment deposits are shown as CURRENT =kms°+na44�np«n�««Na�MTw_rte. ACTIVITY. Y°` n"'binu`n"""n Pay electronically 4• Equipment replacement costs will be charged for bottles lost, Activity stolen,damaged or not ret since your 5, stele', accordance with returned. accouNrArnvm • u2"6M ". >ww�• �e� NWNA's Terms and last invoice Make sure this Equipment Lease and/ Conditions("T&C", Der"9ryAaare,,:Job,Doe123Mainsveecc+tystateoa000 amount has subject to minimum or Service Agreement )your P o,e lance been account may be Pa ment-n nkr6u axx paid in full to monthly purchases and/ 0&31 4fi1B� avoid late fees fees, q co or early cancellation m 3vsns+44 4 5 5G ib Na ml5pang Wacer ( complete version of current T&C n+ 3+7eesI_ 5 Re Mn"nram5 a al Depot � website listed below U may be viewed on the a9m 3vaB5Ia4' s Ice Mountam56iRen Pon service discontinuation,rent for the 09112 3,B263een E"etsnra re "9p Monthly oil Leased Equipment is charged through 09"7 166 0°" a°` in which service is discontinued. tl e end of the billing cycle Surcharge,Fuel 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or rorAt Surcharge or Delivery Delivery Fee as described in Fee{see#6 Under will apply to each account, your T&C, Only one of these fees The fee that a Payment stub 7aD 0°: "� PAS NnAwu u + " " — "General is stated on the front ofthe invoice applies to RxxR — _X • oice.F Your account ACCOUNT SUMMARY ,� — ,ayR visit the website listed or further information le "^”°'°'°° "°' "`°""<"° '""` �°" ° " "" Information-) customer service 7.ce e food r AccouNr Nu4+aEa Par Br PAY TNIS AMOUNT Product, bottled 1234567690 001001M 10"01 water is subject to the rules and INVOICE NUMBER BILUNG DATE ENCLOSED regulations promulgated b 1234562890 00M0100 Administration Y the Federal Food and Drug 8.Your first invoice indicates the 04206963(17 04282712619 (100391049 2004 10 dehve products delivered on your first Amount due ry,along with any applicable bottle and account deposits, 'CE MOUNTAIN WATER COMPANY Iobn Doe redemption fees,and any dispenser chuture z3 Mamst OM will reflect charges for water delivered anis dispenser rent al,bottle invoices etystate US Y deposits and credits plus charges for an PP J6.t.,t..64..Jh.,JL.J166..k.,L466J„n FORNSTOMRSRWCECALLI OW)3"9888 Subtnit our ordered b y additional "Products ❑v6N0PEDREBEEAu 0PA sgnupB 4<D Rn a a ❑PantA Mga4bM n 94 payment by this y you. Deliveries are made every three or four a total of 16-17 deliveries per year.You will date 12 times per year, y receive invoices weeks,for two deliveries. so aonly 5 of those invoices will reflect I ©2008 Ice Mountain Spring Water Company,a Division of Nestle Waters North A Q service.icemountainwater.co o�"- m merica Inc. Form No.NW 709 02114 -a VOUCHER NO. WARRANT NO. I ALLOWED 20 Ice Mountain IN SUM OF$ P. O. Box 856680 Louisville, KY 40285-6680 $17.81 I ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO.:]ACCT#!TITLE I AMOUNT Board Members 2201 115DO119252823 I 42-389.001 $17.81 1 hereby certify that the attached invoice(s), or 0 11 -102 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 T � s 15 e Title 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)) 04/14/15 15DO119252823 $17.81 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 5-11-10-1.6 120 Clerk-Treasurer