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248384 08/1 2/1 5 CITY OF CARMEL, INDIANA VENDOR: 051125 I, ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $********89.10* CARMEL, INDIANA 46032 PROCESSING CENTER CHECK NUMBER: 248384 PO BOX 856680 CHECK DATE: 08/12/15 LOUISVILLE KY 40285-6680 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 15GO11782108 67.40 OTHER MAINT SUPPLIES 1701 4239099 15G722032704 21.70 15G7220327048 service.icemountainwater.com wag IN 9 b C ° #215 6661 DIXIE HWY,SUITE 4 07/01/15-07/31/15 1560117821082 ' LOUISVILLE, KY 40258 ADDRESS SERVICE REQUESTED IIIIIIIIIII'IIIII'IIIIIIIIIIIIIIII THU- SEP 03 0117821082 MON- OCT 05 TUE- NOV 03 Access your delivery calendar at FRI- DEC 04 service.icemountainwater.com Customer Service: 1-800-472-9888 CITY OF CARMEL STREET DEPATMENT For your convenience,you can pay your bill online.It's 3400 W 131ST ST fast and easyl CARMEL IN 46074-8267 Ilnn�ll�lll�ll�l�ulll'IIT��"��'Illul�l�����"Ill��l��lnll a t 5x��x,� �i ��x'�'' �a mr sr�f"r,�.� �a r Irr gust,you ii�"ll knowausfas ReadyRefresh by Nes.# I#'s the same service and products you love with �c,s. xa'a a rare. r�z , ,m,z„".;.,a ¢, r �.aa�.n:::q r.�r* .r �l°�"R,--cP .!rg, -x k ��,,:z�3 � 5 re t f at irres It ce cwstom c el�rrery option for any be erage you choose Foy m vire in#otmaf on visit Ty ps I,ICS.:iG£tTiclt3ln#s�ttt'1[�Ir.£�.GP►�r;r �`���, �s� � �, ,� a�r �s � ,�, .�� ��� �,�, - -- .., $. mE'G4 '.e:r"L�.-t� 6 ,�° dsr�fl3� ?° A. ""c ."a,r'� "s' ,rx'" �>' °"isz ,"'�z'A`"�' s f '^moi . �x... ✓,r't�,w huyz El.�x 'rN,;,, ��a� .:u aYi i z .�� g,.:.�, ,�"', ��<c ��'f��/•s,7 ^°'y ,.rr�,.�-� � ��?��.�, f rF:'s� ��'%' 1W AW, �`"'��� .S �,:�.,`�'"�.',a, � ����'�r.K/a��,�,1�: r„r �" cg�f����� ✓�d,�����„ -� rrF u3 � a, �,.r .'ro5g .c � ', do a, 4Hrr Z rx�.rP"y9 .' cr rcQrr✓". rZK4g„`? � e'rt'µ��'S, �' �' €,cl 6°rw s r 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,3400 W 131TH ST,CARMEL IN 46074 PREVIOUS BALANCE 21.13 7/23 200396 PAYMENT-THANK YOU -21.13 7/08 0946329075 12 5 GAL ICE MOUNTAIN DRK W/HANDLE 41.88 12 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 72.00 2 9 OZ PLASTIC CUP 50C%SLV 6.58 10 5 GALLON ICE MOUNTAIN DEPOSIT RETURN. -60.00 7/31 0951651942 1 DELIVERY FEE`, 3.95 G8806446 RENT _ , : 2.99 TOTAL 67.40 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 21.13 — 21.13 + 67.40 = 67.40 BILLING RIGHTS SUMMARY INCASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR YOUR INVOICE-4 WAYS TO A REPORT ON WATER QUALITY AND INFORMATION,PLEASE 2. US SERVE YOU BETTER CALL 1-800-472-9888 OR WRITE US AT: 1• Please remember payment 1S due by the"pay by"date noted t0 ensure the smoothest seryice. 2. Remember,if you are renting equipmen t,Your ICE MOUNTAIN SPRING WATER CO. Yow first invoice will include a pro-rated fee for gthe current month,pluipment rental is nsethe next month's rentale.That means #216 3. Kindly fill in the amount enclosed include your account number on your check, and do not send 6661 DIXIE IiWY,SUITE 4 LOUISVILLE,KY 40258 if You prefer,you can pay your bill online at service.icemountainwater.com 4. Never hesitate to call us with comments, cash. If you think your bill is wrong,or ifyou need more information about meets, a transaction on Your bill,write as on a se questions,or concerns. mus[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 q/� �y telephone us,but doing so will not preserve Your rights.In your letter, S/'•p M give us the following information: LE INVOICE • Your name,address,telephone and account numbers. INVOICE • The dollar amount of the suspected error. Date range of this invoice • Describe the error and explain ifyou call, 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 toa p y the disputed amount while it is being investigated.During the investigation,we cannot report Your account as delinquent or take any action to collect the amount in question. ' 00/00/00-0070000 1234567890 your Account Number GENERA[,INFORMATION TI OD`� TION R-OC Oq 123456789 1.Payments received after the billingMDN-DC7 29 (INVOICE)data will appear on Important W E6 NOV11 Watch here for a Your next invoice.Past due invoices(not paid within 30 days of news and DE-DECDEc,R billing date)may be assessed a late fee as allowed by law not to H;FI lu titidltQ(ilnt111,1, t 1.�HEiNq�:tltfp.-' CunomerSaWce:1-8004719888 personalized account eexe-"dS20-tlenmomh..Additionaolleq Offers Oran ooe nd„eM,•,,Iny lte MnN"a1nP�° message expenses may be assessed at a rate[not Rorx teed 100%Uomeyof the - 23 Ma n St Stae 00000 a°d aerWaz. unpaid balance or the maximum allowed by law. IaJa1 1 Ht H Jt E!Fp{ F.Glld n 2.Each returned check is subject to a service charge subject to the - maximum check return charge allowable in your State. a ee< Pay electronically 3. All bottle and equipment deposits are shown as CURRENT eA °`� ACTIVITY Activity , 4. Equipment replacement costs will be charged for bottles lost, since our Make sure this Y aeeour4rarnvin 4a �••e �raaam' - stolen,damaged or not returned. last invoice amount has been S.In ,Delivery Atldtess:John Doe,113 Main Street Ciry,6[are 00000 ' accordance with NWNgs Terms and Conditions M&C"),your xxn paid in full to Equipment Lease and/or """°raRalanee Service Agreement accountma oen, 461898 Pa Ment-ThankYou avoid late fees subject to minimum monthly purchases and/or earl lla Y be n, 3neRs144a4 5 6Gall°nNaNralSpringWater �� fees.(q complete version of the current T&C may be viewed ontionthe "' 3jjgg5jgp01 s "eM°rntai sG ID Yo I )DW69fII 31>88514444 5 Mountal 6G IR website listed ,rent for the 09nz 31826 8811 we 6°tee 9 a E Monthly Oil Leased Equipment is charged through the end of the billing below)Upon service discontinuationcycl091 [6600492 Ra"' Surcharge,Fuel e in which service is discontinued. TOTAL a ° Surcharge or Delivery 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or Fee(see#6 under Delivery Fee as described in o »1M04N "General Your T&C. Only one of these fees ArMw yA°1u M N l r0 N nom _ xxx will a Pu 005 a4 AN E > kR l A _ Par pply to each account. The fee that applies Payment stub ACCOUNT SUMMARY - z oa w N � yyae r hes to Informatiod) lsstated onthe front ofthe inv Pp your __ ______ ___. invoice.For further information please ---- visit the we —"�-'-- PAY Or PAY mis nmouNT website listed below 1ia0Artrvm Nwpp ACCOUNT NUMBER center, or contact our customer service 1134567890 BaoaoB 7. As a food Product, bottled water is subject to the rules and NV1234 67890OIcEN BIW100100 DATE T.ENCLOSED I 123456]890 00/00!00 regulations promulgated by the Federal Food and Drug Administration(FDA), 0420n96307 04282712619 D00391049 2004 bB 8.Your first invoice indicates the products delivered on your first Amount due delivery, ono Doe ry,along with any applicable bottle and account deposits, g,'YIOU� AiNWATERCOMPANV 13 Man St redemption fees,and any dispenser charges.All future invoices NN�A " C s7d1e 00000 will reflect charges for water delivered and dispenser rental,bottle )ana.,t•mn m..1!•u.sa:;t,>tI,I6I+n OR NSTOMERS RV10E ALL1 800.2D9088 Submit your deposits and credits plus charges for any additional products P`'"t ryChang 0"k n 9"` Payment by this ordered by ❑51GNUPRDRfAFEANDPA sig" R "oma"Rereusme date y You. Deliveries are made eve - ° '- - ry 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. 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 $67.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 115GO117821082 I 42-389.001 $67.40 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 r'day, ust 07, 2015 Ll� — SSssloner 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)) 08/03/15 15G0117821082 $67.40 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 service.icemountainwater.com®® # 215 6661 DIXIE HWY, SUITE 4 e 07/01/15 - 07/31/15 1567220327048 AWWJL' LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII FRE- SEP 04 7220327048 TUE- OCT 06 WED- NOV 04 Access your delivery calendar at MON- DEC 07 service.icemountainwater.com CITY OF CARMEL OFFICE OF THE CLERK TREASURER ANN DAVIS 1 CIVIC SQ CARMEL IN 46032-2584 "I�I'VIII'III�III"I�'I�I'I�I�III�I'��I'�I�""I'I'll'll'I�I Customer Service: 1-800-472-9888 For your convenience, you can pay your bill online. It's fast and easyl ACCOUNT ACTIVITY For questions or a report on water quality and information, call 1-800.472-9888 or visit service.icemountainwater.com. ACCOUNT SUMMARY I PREVIOUS BALANCE PAYMENT / ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 21.70 — 21.70 + 21.70 = 21.70 Delivery address: CITY OF CARMEL, 1 CIVIC SQ, CLERK TREASURER OFFICE, CARMEL IN 46032 PREVIOUS BALANCE 21.70 7/23 200401 PAYMENT -THANK YOU -21.70 7/08 0946478948 3 5 GAL ICE MOUNTAIN DRK W/HANDLE 10.47 3 5 GALLON ICE MOUNTAIN -BOTTLE DEPOSIT _ .00 1 9 OZ PLASTIC CUP.50C/SLV 3.29 3 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00 7/31 0951778018 1 DELIVERY FEE 3.95 G8849530 RENT 4 . - 3.99 1. TOTAL 21.70 ACCOUNT SUMMARY I PREVIOUS BALANCE PAYMENT / ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 21.70 — 21.70 + 21.70 = 21.70 BILLING RIGHTS SUMMARY IN CASE A ORTFONRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR WATER QUALITY AND INFORMATION,PLEASE YOUR INVOICE_4 1. Please remember a WAYS Ty HEI,p US SERVE YOU BETTER CALL 1-800-472-9e88 OR WRITE-us AT.. Payment is due by the" a 2. Remember,if you are renting e P y by"date noted to ensure the smoothest service, ICE MOUNTAIN SPRING fVATER CO. your first invoice will include a Pro-rated nt,fee forthe currerentalnt monis thcha #216 us t one month in advance,That means 6661 DIXIE HWY,SUITE 4 3• Kindly fill in the amount enclosed include Plus the next month's rental. LOUISVILLE,KY 40258 If prefer,you can a Your account number P y your bill online at service.icemountainater.com If you think o 4. Never hesitate to call us Your check, and do not send cash. Your bill is wrong,or if you need more information about With comments, a transaction on your bill,write us on a QlleSt]OpS,or concerns, must hear from you in writing no later than ty(3o)days after we te sheet of paper We sent you the first bill on which the error or problem appeared.You can telephone us,but doing so will not preserve give us the following information; yO°r rights.In Your letter, SAMPLE • Your name,address,telephone and account numbers, INVOICE • The dollar amount of the suspected error, • Describe he error and explain if you can,wh Date range of this invoice an error- YYou believe there is You are obligated to pay the parts ofyour bill that are not in question, You do not have to pay the disputed amount while it is being investigated,During the investigation,we c as delinquent or take an annot report your account 1° dim y action to collect the amo 2 00(00100-00!00100 234567890 GENE unt in question. Your Account Number I.Payments INFORMATION yments received after the billin TNR-a w 123456789 Your next invoice,P geINVOICE appear Important Past due invoices not )date will a MON-NM 39 billing date)may be assessed paid within 30 da TUE.DEC 21 Watch here exceed date) per a late fee as allowed °f flews and TUE.DEC 19 for a P monh,Addi[ionalt, by law not to It lbtlt t(G�itiRJ 1AtIaiR�(dllan±hkldJp. eesmme,seMca:1-soon-9aee ersona' offers John one P hZed account expenses ma Y tBtot to exec ection/attorney 123 Main 5t Thankyoef°r°sLglceM-u h`pn°-- # message y be assessed at a rate not to exceed 100%of the unpaid balance or the maximum allowed by law. o yswee 00000 .na Eemce.. I dad t pLCriJi II U.hn..h..141!Iatt_ 2,Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State. r+ et,atrm 3. All bottle and equipment deposits are shown as CURRENT k• °° Y�� exm"'sA"Y4P9 ACTIVITY, aaaK°« a«ka0" °€°°� ""0" Pay electronically 4. Equipment P Activity , 4 pment re lacement costs will be charged for bottles lost, since Your >aw ,mpmAeeem e stolen,damaged or not returned, ACCOUNTACmiIY aR«M Make Buie this 5.In accordance with N last invokeu'�Y1 WNA°s Terms and ConditionsYour DeI(veryAtlEress:J°hnDoe.123MaIn5tree4 Y.Sta[e00000 amount has been Equipment Lease and/or Service Agreement account may be pewnu,eaiane axz paid in full t0 subject to minimum month! -rnankrno fees- Acorn Y Purchases and/or earl Deni 46,e9a Paymen w w n 3va9e— 5 SOelbn o,(.1 SpDoP054 r , avoid late fees ( complete version of the current T&C Y viewed on the m 317 x514 5 Jm1.MWIMM5619M st website listed below)Upon service discontinuation rent for he 09"t 3190851`44 mMWnNinSGalP mm ov+ "B263B01t E us°m To _ '°"01 Monthly Oil Leased Equipment is charged through the end of the billing cycle 091' 16 p 9J Rent I!_ y of wup in which service is discontinued. ;, Surcharge,Fuel TOTAL 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or '{ Surcharge or Delivery Delivery Fee as described in your T&C. Only one of these fees _ Fee(see g'under will apply to each account The fee that a _ _ °AY PisAMou n General is stated on the front of the i applies to your account Payment stub •M^° cE '"" "ACCOUNT SUMMARY -t- lOExx wIXA visit the invoice.For further information m�6be"°° "° ' Information-) website listed please °°"°°"""°'°'°"°'°°—°"�`°•""re°'°•°'— "` mation'7 below or ---------------NTNUMB--------------- --- center. contact our --- i� • �"0i°ine�°°�i°"yp1°P°�°' ACCOUNT NUMBER PAY BY DAY THIS AMOUNT customer service 1224563890 00 W 00 7. Asa food product, bottled water is subject to the rules and MCHCENUMBER BIWNG DATE ENCLOSED regulations promulgated h 113456]890 00/00/00 s AdministratioEi(FDA), Y fire Federal Food and Drug i S.Your first invoice indicates the products delivered on your first D42Da963D7 04282712619 (00391049 2a04 16 delivery,along with an a nnnD°e Amount due Y pplicable bottle and account deposits, CEM 1UUMAN WATER COMPANY redemption fees,and any dispenser charges.All future invoices a `9a�' � ,23Maio St C(ty,State 00000 will reflect charges for water delivered and dispenser rental,bottle Uaay°tom_.u..dG„±l�naM.4L1JuI•Q' MRCUSTOMERSWCECALL140 72,9808 Submit your deposits and credits plus charges for any additional products [3 � ordered by you. Deliveries are made every(Brea or four weeks,for ”0"En E °`"nn9.unR� O R vu. payment by this a total of 16-17 deliveries per year.You will only receive invoices - -- -- date 12 times per year,so approximately 5 of those invoices will reflect -_ _.__. - two deliveries- ©2008 Ice Mountain Spring Water Company,a Division of Nesfld Waters North America Inc. service.icemountainwater.com --------_ Form No.NW 709 02114 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Fortn No.201(Rev.1995) 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. M Payee ' `' � Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 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 VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF $ ON ACCOUNT OF APPROPRIATION FOR � 9 aqq CVS PL Board Members Po#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), lea Aq 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 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund