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Home My WebLink About251230 11/04/15 1°�"C4Nb �`/ ,�•- CITY OF CARMEL, INDIANA VENDOR: 369794 ® ONE CIVIC SQUARE READY REFRESH BY NESTLE CHECK AMOUNT: $********80.94* s ?� CARMEL, INDIANA 46032 PO BOX 856680 CHECK NUMBER: 251230 9.y��oN„�� LOUISVILLE KY 40285-6680 CHECK DATE: 11/04/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 506 4239099 05JO12580552 63.19 05JO125805523 2201 4238900 15JO11925282 17.75 OTHER MAINT SUPPLIES Vqa y eservice.readyrefresh.com BILLING PERIOD INVOICE NUMBER Refresh #215 6661 DIXIE HWY,SUITE 4 09/13/15- 10/12/15 15JO119252823 LOUISVILLE KY 40258 ' AND DUENCN ��- UNT NUMBER, ADDRESS SERVICE REQUESTED UPCOMING • II'I II I I"II I II'11'I III I I' 1111111111WED- DEC 04 0119252823 NOV MON- DEC 07 FRI- JAN 08 Access your delivery calendar at eservice.readyrefresh.com CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-274-5282 BONNIE CALLAHAN For your convenience,you can pay your bill online.It's 3400 W 131ST ST fast and easyl CARMEL IN 46074-8267 ��I�I�n�rli�lll�llnnilun�l�r�il�i�lil�lil�lnill�il��ln�i Stock up=for,spirited}celebrations_Order Perrler:Sparkling;Natural Mineral=Water-today!_Vlslt . r � _ eservice:reatlyi'efreshcom =--� m - ' _ - = _ _, `a ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1.800-274.5282 or visit eservice.readyrefresh.com. DATE REFERENCE# QTY DESCRIPTIONAMOUNT Delivery address: CITY OF CARMEL STREET DEPARTMENT,1 CIVIC SQUARE,CARMEL IN 46032 PREVIOUS BALANCE 3.99 10/08 620142 PAYMENT-THANK YOU -3.99 9/11 0956095095 3 5 GAL ICE MOUNTAIN DRK W/HANDLE 10.47 3 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 18.00 1 9 OZ PLASTIC CUP.-50C/SLV 3.29 3 5 GALLON ICE MOUNTAIN-,DEPOSIT`RETURN, + -18.00 10/12 J9351771 RENT ! ;- I - 3.99 E TOTAL - � 17.75 ,t , E IJ tt F ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 3.99 — 3.99 + 17.75 = 17.75 BILLING RIGHTS SUMMARY IN CASE OF ERRORS OR QUESTIONS ABOUT YOU BILL, OR FOR A REPORT ON R Date range of this invoice A INFORMATION, PLEASE VISIT OURQWEBSI EAAT..• SAMPLE INVOICE ESERVICE.REA;YREFRESH.COM OR WRITE US AT: READYREFRESHBYNESTLEYh A#¢ �9n�rSii #216 00100/0040100100 IZ34567890 'four Account Number 6661 DIXIE ` HWY.,SUITE 4 /Nn-OCT M 123458789 LOUISVILLE,Ky4b2$g Important MON OC739 news and 914 6d Phi�1 dnlvl9r d p P1411IrrvIP m' WE..DEC 18 Watch here for a If you think offers personalized account Our 1z3 Mains` c4elpmpr 1 e9Yl :,-s0o-z74-szaz nt Y bill is °'h,5""�° message information about a transaction on our bill, nl I,ai I 1 n 1 n Th wr D,Dr D.ing n<ayae6D nP^0 if Y need more d fiind inl I I I dllhll I diu d �D separate sheet ofpaper.We Y write us on a later must hear fro �,ma � than thirty I m you in writing no pay electronically `7 130 days after we 'a 'a „a ays3nsar,Y,� w»ruu ,ka, y w�n"a . which the error Or sent you the first bill on Activity butdoin Problem appeared.You = = g so will not can telephone us, since your =' Make sure rhs us the Preserve o ACCCUMAC7N57Y Pey yowtm"mre ee eaaMwA OyWI B.com wby Pbn0at,d001148 .Il'a Fme1 amount your rights.In last invoice has been followin g your letter,give paid in full to g information: Delivery Redress:JDhnOce,lZ3 MaInR Ciry,State 00000 , avoid late fees �j, a6,ggg PrymentBalance • Your n O9/II 31]8g51MM S Payment Thank You X%XY name,address,tele hone 11-1— s sGaBon Nan alSpengwate,'„ , woo • The dollar P and account nn 09"' "18851"" 5 SG i10°`°Dill amount of the numbers. 5G II B t 09/13 310)638011 1 l0[X% � W/ti I65f0e91 Deli ryi XX:�% Describe the error and explaineif you can,why you T WI xX.1X �:1: believe there is an error. t. You are v �DDae An" >A M M/ABI M M k NeNMA Ng FAY m54 WM e obit ated to Payment stub ACCCUM SUMMARY F — XW + yx a uoa question. You d pay the parts of your biII that are not �<""'""'"""'D.�------------ ------ -------------------- in .< o not - - deo "�P ;. while have to a the ACCOUMNUMBFA PAY BY PAYTNISA10UNT it is being investi ated. pay disputed amount 13456 890 oo/�P]ge - - cannot report your accognt a During the investigation, we 123456189. el owmoo v a0u — to collect the a s delinquent or take any action = mount in question. _ 0428096307 84282712619 000393049 80407010. GENEINFORMATION — ohO00Amount due RAL INFO — ,21 M.I.lt. ; RMATION Gry.Btnte 00000 1• Past due' ngIInI 11111iii1nI11I1 I1 I11IlIIn1II I11i1llllnlllllil FOB NSTOMFRS AY EGLL1EOb1145]01 invoices(not paid within 30 days of billing date)may be assessed ❑SIGNU9 fOflFeEEAUfOFM1Yi519nUpee9Wre00n rs<s a< ❑P4mAmo4*wappx<. s^< a late fee as allowed bylaw not tSubmityaur to exceed 20 ,.. _ r _,. _ _. • $ per month.Additionally,third party payment by collection/attorney expenses may be assessed at a this date rate not to exceed 100%of the unpaid balance or the maximum allowed bylaw. YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETT ER 2• Each returned check is subject to a service charge Please remember smoothest service.Payment is due by the "pay by" date not to ensure the subject to the maximum check return charge allowable2. in your State. Remember,if you are rentingequipment, month in advance, That q Pment,your equipment rental is charged one 3 Equipment replacement costs will be charged for the current means your first invoice will include a pro-rated fee for bottles lost,stolen,damaged or not returned. month,plus the next month's'rental. 4• Register or log-in to amageseryd r no 3 Kindly fill in the amount enclosed,include Yrefresh.com to and do not send cash.If you prefer,you can Your account n manage your account,see the variety eservice.readyrefresh.comumber on your check excitingty of beverages and 4. Never hesitate to call us with comments pay Your bill online at: promotions. >questions,or concerns. Follow us on Facebook'to Iearn more! ��'• Facebook.com/ReadyRefresh Let's talk,follow us on Twitter! @ReadyRefresh VOUCHER NO. WARRANT NO. ALLOWED 20 Ready Refresh By Nestle' IN SUM OF$ P. O. Box 856680 Louisville, KY 40285-6680 $17.75 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department �I PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 115JO119252823 I 42-389.001 $17.75 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 Th r da cqb e 2015 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)) 10/14/15 15JO119252823 $17.75 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-qady eservice.readyrefresh.com BILLING PERIODINVOICE Refresh. #215 6661 DIXIE HWY,SUITE 4 09/25/15- 10/24/15 05JO125805523 LOUISVILLE KY 40258 AND QUENCH \� UPCOMING DELIVERIES ACCOUNTNUMBER ADDRESS SERVICE REQUESTED II I I II I II II"I IIIII I I I I I I I I II I III WED- NOV04 0125805523 DEC MON- DEC 07 FRI- JAN 08 Access your delivery calendar at TUE- FEB 09 eservice.readyrefresh.com CITY OF CARMEL CITY COURT Customer Service: 1-800474-5282 DIANE APPELGET For your convenience,you can pay your bill online.It's 1 CIVIC SQ fast and easy! CARMEL IN 46032-2584 111111111111 I I I I'I l l l l l l l l'l l l l l'pill 1111111111 11 Stock up for spirited-celebrations Order Perr er Spark.ling Natural Mineral Water today:!Visit: _ _ e5ervice'readyrefresYi com _- = ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800-274-5282 or visit eservice.readyrefresh.com. DATE REFERENCE# QTY DESERIPTIONAMOUNT Delivery address: CITY OF CARMEL,1 CIVIC SQ, CITY COURT,CARMEL IN 46032 PREVIOUS BALANCE .00 10115 0963399217 5 5 GAL ICE MOUNTAIN DRK W/HANDLE 19.95 1 5 GAL ICE MOUNTAIN DIRK W/HANDLE .00 1 9 OZ PLASTIC CUP 50C/SLV 3.29 1 9 OZ PLASTIC CUP50C/SLV .00 1 PLEATED CUP;'DISPENSER,, , '1 (Y-I, } .00 BOTTLE DEPOSIT.;,-6CHARGED, '0 CREDITED 36.00 10/24 0965291651 1 DELIVERY FEE' SALES TAX r _ , d� 1 a ,t d,-. C27 TOTAL r 7 p G tlsr JUST CLIa'K # `s ; + BILLING RIGHTS SUMMARY IN CASE OF ERRORS OR BILI; SE FOR ERRORS OR,QUESTIONS ABOUT YOUR Date range of this invoice INFORMATION, PLEASE ON OUR WEBSITE AAT.. SAMPLE ��VOICE ESERVICE•P-EADYREFP&SH.COM OR WRITE US AT: READYREFRESH BY NESTLE #216 Ready olroolDo 00 ooroD 7234567890 war Your Account Number 6661 DIXIE HVN,SUITE 4 MR.DC« 123456789 LOUISVILLE, Important vvD KY 40258 414 Inld9d IP luted u 4 q P°dllrr'd's news and UE-oK,B Watch here for a If You think our offers Personalized Y bill is D',S.I5Vee eusmml,sBM•, 1x274-szez account an.s�m np message wrong, or if Thank YonkrusigRcaCYRa,reshp a8a g information about a transaction n your bill write us onra "'I'�91PmI Inh Vl i itilhlPl hlhm �au�+.• separate sheet ofpa er.We later than thi7-1�' P must hear from o �� "7 (30)days a We Se you In writing ?e; s^Y > ^�'Y "-�s " "on` �`°�'m''f _ Pay electronically which t fter on Y «N , he error or problem a sent You the first bill on Activity ,, but doing so will not PPeared.You can telephone us, Y ur � Make sure the preserve our ri since o us the 'following Y ghts.In your letter,give AC°aONTACT T p�Y° "A°NlneatosaMnR aerR f n. vro�atltoo-z7 sF�e �3mount h g information: last invoice ll been Delivery Address:khn Dce,123 Main Sl,Gty,Sfate00000 Paid to full to suspected 90oDB999I,r,l1,,3,, a333,b6,1773,e8a9e043G194)444 5S R6D,G�eetmd;i;i�uryANkeaeelPN°RIS avoid late fees B85,M6 FY ,Th kYU• Yourname,address, and account numbers.The dollar 093 3=6= 5XXXmountofthe SIS ected • Describe the error and explain if you can,wh Total J ;, xXXM re is an error. YYou believe the — _ r You are obligated to Payment stub ACCOUNT SUMMARY °P " ` Rr +�2 in question.you pay the parts of your bill that are not �<wn,.w,.•w-•�_�__ °° m�� -- ------------------------------------ do not have to N tlO°3 � � ACGOUNFNUMBER"-MVBY_..-_RAYTNISAMOUNT while it is being pay the disputed amount =N�J890 - g investigated. During the investigation, we INVOICE NUMBER BILLING DATE AMT.ENCLOSE - cannot report your account as delinquentIT346a7890 00100110 y to collect the or take any action _ amount in question. __ 0420096307 94282732619 000391049 00407036 1�J23nM n6, Amount due GENERAL INFORMATION °"6uw 111 1• Past due invoices date)may be asses(not paid nId^4114uh1in4,,P,pywII UIIIuI�IIIIm FORN90M RSERV0 CALL1$1RT 651@ within 30 days of billing sed a late fee as allowed by law not Submit your to exceed$20 per month.Additionally, Payment by collection/attorney expenses may Y third party this date rate not to exceed 100assessed at a %of the unpaid balance or the maximum allowed by law 1' YOUR INVOICE-4 WAYS TO HELP US Each returned check ier Payment is due by th SERVE YOU BETTER 2• s subject to a service charge Please rememb smoothest service. e "pay by" date noted to ensure the subject to the maximum check return charge allowable 2. Remember,if in your State. You are renting e 3 Equipment replacement costs will be charged for month in advance.That means equipment your equipment rental is charged one bottles lost,stolen,damaged or not returned. the current month, your first invoice will include a 3• Kindly plus the next month's rental. pro-rated fee for 4. Register or log-in to eservice.read Y In the amount enclosed,include o manage your account,see the va dyrefresh.com to and do not send cash.If you prefer Y ur account number on your check variety of beverages and Nevereservice hesitate to call You can pay your bill online at: exciting promotions. 4. Never hesitate to call us with comments,questions,or concerns. Form ST-105 Indiana Department of Revenue State Foau 49065 RV 8-05 General Sales Tax Exemption Certificate Indiana registered retail merchants and businesses located outside Indiana may use this certificate.The claimed exemption must be allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors.This exemption certificate can not be issued for the purchase of Utilities,Vehicles, Watercraft,or Aircraft, Purchaser must be registered with the Department of Revenue or the appropriate taxing authority of the purchaser's state of residence. Sales tax must be charged unless all information in each section is fully completed by the purchaser.Purchasers not able to provide all required information must pay the tax and may file a claim for refund(Form GA-110L)directly with the Department of Revenue. Name of Purchaser CITY OF CARMEL Business Address ONE CIVIC SQUARE City CARMEL State IN Zip 46032 Purchaser must provide minimum of one ID number below.* r; :y t Provide your Indiana Registered Retail Merchant's Certificate TID and LOC Number as shown on your Certificate............................. 0031201550 — 020 - TID#(10 digits) LOC#(3 digits) If not registered with the Indiana DOR,provide your State Tax IDNumber from another State................................................................ *See instructions on the reverse side if you do not have either number. State 1D# State of Issue Is this a ®blanket purchase exemption request or a ❑single purchase exemption request? (check one) Description of items to be purchased. Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain) ❑ Sales to a retailer,wholesaler,or manufacturer for resale only. ❑ Sale of manufacturing machinery,tools,and equipment to be used directly in direct production. ❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10. (May not be used for personal hotel rooms and meals.) ❑ Sales of tangible personal property predominately used(greater then 50 percent)in providing public transportation-provide USDOT#. A person or corporation who is hauling under someone else's motor carrier authority,or has a contract as a school bus operator,must provide their SS#or FID#in lieu of a State ID#in Section#1. USDOT# ❑ Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale. Note:A farmer not possessing a State Business License#may enter a FID#or a SS#in lieu of a State ID#in Section#1. 0 Sales to a contractor for exempt projects(such as public schools,government,or nonprofits). M Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools,and state universities). ❑ Sales to the United States Federal Government-show agency name. Note:A U.S.Government agency should enter its Federal Identification Number(FID#)in Section#1 in lieu of a State ID#. ❑ Other-explain. I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt purpose pursuant to the State Gross Retail Sales Tax Act,Indiana Code 6-2.5,and the item purchased is not a utility,vehicle,watercraft,or aircraft. I confirm my understanding that misus . either negligent r' entionaO,and/or fraudulent use of this certificate may subje oth me personally and/or the business entity I represent e irttpositio ter ,and civil and/or criminal penalties. f Signature of Purchaser Date �J Printed Name DIANA L CORDRAY Title CLERK-TREAURER The Indiana Department of Revenue may request verification o registration in another state if you are an out-of-state purchaser, Seller must keep this certificate on file to support exempt sales. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.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. P yee Purchase Order No. Terms Date Due Invoice nvoice Description Amount Date Number (or note attached invoice(s) or bill(s)) e Total 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 or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), STO 52 a q,76 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 A 20 ( 4 S ature TiiW Cost distribution ledger classification if claim paid motor vehicle highway fund