304117 10/10/16 CITY OF CARMEL, INDIANA VENDOR: 369794
CHECKAMOUNT: S'•'""'"'57.32•
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ONE CIVIC SQUARE READY REFRESH BY NESTLECARMEL, INDIANA 46032 PO BOX 856660 CHECK NUMBER: 304117
LOUISVILLE KY 40285-6680 CHECK DATE: 10/10/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
506 4239099 OGIO12580552 57.32 OTHER MISCELLANOUS
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
READY REFRESH BY NESTLE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 856680 IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
LOUISVILLE, KY 40285-6680 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$57.32 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel City Court Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT - Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0610125805523 42-390.99 $57.32 1 hereby certify that the attached invoice(s),or 10/4/16 0610125805523 Water and cups $57.32
1301 506 1301 506
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were..ord red and
recei� t
Tuesday, October 04,2016
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
F-pad y eservice.readyrefresh.com BILLING PERIOD •
Refresh #215 6661 DIXIE HWY,SUITE 4 08/25/16-09/24/16 0610125805523
LOUISVILLE KY 40258
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ADDRESS SERVICE REQUESTED UPCOMING DELIVERIES ACCOUNT
FRI- OCT 07 0125805523
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THU- DEC 08 Access your.delivery calendar
TUE- JAN 10 at eservice.readyrefresh.com
CITY OF CARMEL CITY COURT Customer Service: 1-800-274-5282
DIANE APPELGET YOUR ACCOUNT IS PAST DUE and is subject to
1 CIVIC SQ additional late fees.Water delivery service may be
CARMEL IN 46032-2584 interrupted. Please make your payment today. For your
IIIIII��III'lll�llllll"I'1'll'�11���111�1111�'1'�I"III�'1��1�11 convenience,you can pay your bill online.If payment has
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DATE REFERENCE# QTY DESCRIPTION AMOUNT
Delivery address: CITY OF CARMEL,1 CIVIC SQ, CITY COURT,CARMEL IN 46032
PREVIOUS BALANCE 38.32
9/08 1012955405 5 5 GAL ICE MOUNTAIN DIRK W/HANDLE 19.95
2 9 OZ PLASTIC CUP 50C/SLV 6.58
BOTTLE DEPOSIT: 5 CHARGED, 4 CREDITED 6.00
9/17 1016108894 1 LATE FEE t 15.00
9/24 1017169234 1 DELIVERY FEE�:�` i i ? l '� 3.95
11147110 RENT 4.99
SALES TAX! .85
TOTAL , ,t �`. - _ 95.64
3
ny
167
,Z3 i
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENTC(IihENT ACTIV TY PAY THIS AMOUNT
Subject to terms on reverse side. 38.32 — 0.00 -}- 57.32 = 95.64
----------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- --------------------------------------------------------------
Detach this stub and return with your payment
ACCOUNT NUMBER PAY BY PAY THIS AMOUNT
P.O. Box 856680 0125805523 10/16/16 95.64
Louisville, KY 40285-6680
INVOICE NUMBER BILLING DATE AMT. ENCLOSED
0610125805523 09/26/16
407201258055238 0005732 00095640 5
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a Division of Nestle Waters North America Inc. CITY OF CARMEL CITY COURT
P.O. Box 856680 DIANE APPELGET
Louisville, KY 40285-6680 1 CIVIC SQ
CARMEL IN 46032-2584
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PAY BY PAY TNKo MOUNT
ACCOUNT NUMGEB °010°100
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You are obli ated to a the arts of our bill that are not CE 67890
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in question. You do not have to pay the disputed amount
while it is being investigated. During the investigation,we 0420096307 04282712619 000391049 Amount
Amount due
cannot report your account as delinquent or take any action — ”
123 Main St
to collect the amount in question. = a"$.,.°°°00
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