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246844 06/30/1 5 CITY OF CARMEL, INDIANA VENDOR: 051125 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $ .....'18.21' CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 246844 PO BOX 856680 CHECK DATE: 06/30/15 LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 15FO11925282 18.21 15FO119252823 r service.icemountainwater.com I, O ' #215 6661 DIXIE HWY,SUITE 4 05/13/15-06/12/15 15F0119252823 AimLOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED e B e 'I' 1111111111111111111111111111 II I"I�'lI I�'I I I I I(I I IN I'I 'll WED- JUL 08 0119252823 THU- AUG 06 FRI- SEP 04 Access your delivery calendar at TUE- OCT 06 service.icemountainwater.com CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-472-9888 BONNIE CALLAHAN For our convenience,you can a 3400 W 131ST ST Y Y pay Your bill online.It's CARMEL IN 46074-8267 fast and easy! ILII'�III�I��II��ll�ll��l�l�ll�ll��l��ll�llllll�llll�llll��ll�l Ii 01 -lice, is changing the name of itsseivice.-We're=becoming"Re'adyRefresh,by Nestle so�that` , l,_ .. = we-can serve you better. It's.the same great service you love, along with some_new features: For more info, visit eservice.icemountaindi,rectdelivery:com v 9' ..,_.. -_ ^P'F#v...- mgt _ .. _ o acacfzs-"' -i�- =.;m'_^2z.-+^-�•- -�--..- -... .�r^S e=Y.."�..+€✓ Cio'�.'+�' .�+'-'-v- m-.Mn... - --_ ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800-472-9888 or visit service.icemountainwater.com. - _ - - _ - - - .a_-.. ..--- - - �--- - -...._ ®. �.. . ° e - ® , e ® . UVIP AURNIM Delivery address: CITY OF CARMEL STREET DEPARTMENT,1 CIVIC SQUARE,CARMEL IN 46032 PREVIOUS BALANCE 3.99 6/09 0941701062 2 5 GAL ICE MOUNTAIN DIRK W/HANDLE 6.98 2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00 1 9 OZ PLASTIC CUP 50C/SLV 3.29 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -12.00 6/12 0944172162 1 DELIVERY FEE 3.95 F8682930 RENT 3.99 TOTAL 22.20 PREVI BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMO ACCOUNT SUMMARY •US UNT Subject to terms on reverse side. 3.99 — 0.00 + 18.21 = 22.20 •r— 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. 6661 DIXIE HWY.,SUITE 4 If you prefer,you can pay your bill online at service.icemountainwater.com 6661 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 he later than thirty app days after we an SAMPLE INVOICE sent you the firs[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. 1234567890 Your Account Number You do not have to pay the disputed amount while it is being 00/00/00.00/00/00 investigated.During the investigation,we cannot report your account k .-- 23456789 as delinquent or take any action to collect the amount in question. -oa o MON 29 Watch here for a WE4 NOV 21 GENERAL INFORMATION TUE-MC'e personalized account 1.Payments received after the billing(INVOICE)date will appear on Important servlee 1-eoo-02'9888 message I1,U»dll»UI„IIIUd»d1U.1,1n6mlllU»n»t1Jdn anomer ,dounuln Ppducu g your next invoice.Past due invoices(not paid within 30 days of news and T"ank7p^'«^•'^9'ee °na 1,M exceed date)may he assessed a late fee as allowed by law not to offers Tn�s'woro t+ . exceed$20 per month.Additionally,third party collectionlattorney °ty'Sid1P »6U»L»66L4d»a expenses may be-assessed at a rate not to exceed 100%of the - - '"'- vmpr�a^"1°ow.`a. ------ -�:a"" - "' � aiaa- dr. unpaid balance or the maximum allowed by law. —fix omueUe""mak . B,ua a e mw ° j Pay electronically 2.Each returned check is subject to a service charge subject to the se,+u93rou" ederctawoiP�"•sa,A""I`"'"wa' maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity - "°°° '- aPw »» »-^» ma, ==T amount has been ACTIVITY. since your ACCOUNTACTIVITI' •• .,. r1"-+•° '- 4. Equipment replacement costs will be charged for bottles lost, paeeryAddras:IohnOoe.123Main5veeoGry,Aate00� xXxX paid in full to stolen,damaged or not returned. last invoice P B U"a avoid late fees payment-Thank Vou 5.In accordance with NWNA's Terms and Conditions("T&C"),your eey3, 46,e98 s scano"N,1o,alspa"9wam, xxx Itl 3170851a4M 3Gal Dep"Pt Equipment Lease and/or Service Agreement account may be y„ 3nees1a.44 s "ta,nsGalPeium Monthly Oil Surcharge,Fuel subject to minimum monthly purchases and/or early cancellation o9m 3"�" ; welwBl+ar9e . 89/T2 318263881' fees.(A complete version ofthe currentT&C may be viewed on the 091'2 .6648.9' Xxn 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 "General in which service is discontinued. 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or s _ Information") Delivery Fee as described in your T&C. Only one of these fees Payment stub ACCOUNT SUMMARY °•c Y aE"°u _- Y __ pqY TN15 AMOUNT will apply to each account. The fee that applies to our account _-•_a- PAY By PPY PP Y -- ••�y,a�W wm»m'e°"'p•M"s° ACCOUNr NUMBER WIN l� XXX% is stated on the front of the invoice.For further informationP lease 12N567-90 'LUNG AIT.ENCLOSED INVOICE NUMBER BDATE visit the website listed below or contact our customer service Do/Doleo 123456)890 center. 7. As a food product, bottled water is subject to the rules and 0420096307 04261712619 000391099 2004 16 Amount due regulations promulgated by the Federal Food and Drug 0.Doe Administration(FDA). ICEMouNTA�IN wATE�;°,MpA„n,. 23 5la�eS`00000 8.Your first invoice indicates the products delivered on your first ADM'"""" Lw°m' .�9.,72.9B88 Submit your delivery,along with any applicable bottle and account deposits, wPcusroMEPSER41cEwu a t b this 4JWL.J»UM«dlwdL»n.6U.,4.6644J»n sw'• �Enm AOT e�»„9e,D^"�•"`DOe P Ymen )♦ redemption fees,and any dispenser charges.All future invoices onreEEAulopAns9nop •e4onne.•>• date will reflect charges for water delivered and dispenser rental,bottle 51N0p` 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 Nestl6 Waters North America Inc. Form No.NW 709 08/12 �service.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)) 06/15/15 15FO119252823 $18.21 1 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 $18.21 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 2201 115FO119252823 I 42-389.001 $18.21 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 6 / hur 2015 StrCAet-3'?�imSi's°Mer Title Cost distribution ledger classification if claim paid motor vehicle highway fund