191240 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
h i ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $49.15
CARMEL, INDIANA 46032 PROCESSING CENTER
PO BOX 856680 CHECK NUMBER: 191240
LOUISVILLE KY 40285 -6680
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
920 4239099 001012220610 25.22 0010122206105
2200 4239099 0120048525 23.93 OTHER MISCELLANOUS
wo sery ice.icemountainwater.com 215 6661 DIXIE HWY, SUITE 4 09/01/10 09/30/10 0010122206105
LOUISVILLE KY 40258
ADDRESS SERVICE REQUESTED
�IO��[�DDIDI��I 1 ID�I III DI MID DID MO OCT 15 0122206105
MON- NOV 15
THU- DEC 16
CITY OF CARMEL ENGINEERING /1ST AVE Customer Service: 1- 800 472 -9888
KATIE NEVILLE Did you forget about us? Kindly pay upon receipt.
1 CIVIC SQ Remember, past due accounts are subject to a late fee.
CARMEL IN 46032 -2584 Your prompt payment is appreciated. For your
IIIIIIlI lllil�'�il'11111'P 1�' 1 '��I1�1'���I�'� "11 11 convenience, pay online: icemountainwater.com /service.
If payment has been made, we thank you.
s� "te
�IOFfl1 AVAILABLEFiomemade goodness in a bottler 'I'00 °lo UrganicSweet LeafmTea trr:Orlgtnal Sweet Tea:a
and�Lemonacie,�96o� glass °bot 12 per case 'Call 8U0- 472.9888 or�visit vi it cvm for
off�speclal� Of€r exptres 10/31/10
df
ACCOUNT ACTIVITY Pay your bill online at: service.icemountainwater.com or by phone at:1- 800-472 -9888. It's free!
Delivery address: CITY OF CARMEL ENGINEERING, 130 15T AVE SW, CARMEL IN 46032
PREVIOUS BALANCE 48.68
9113 566765 PAYMENT -THANK YOU -19.97
9116 0689833325 2 5 GAL ICE MOUNTAIN DIRK W /HANDLE 6.98
2 9 OZ PLASTIC UP 50C /SLEEVE 5.98
1 .5 L NATURAL SPRING WATER ICE MTN 5.99
BOTTLE DEPOSIT: 2 CHARGED, 2 CREDITED .00
9/30 0693156051 1 OIL /FUEL SURCHARGE 2.28
19736609 RENT 3.99
TOTAL 53.93
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 WATER QUALITY AND INFORMATION, PLEASE
CALL 1-800- 47 2 -9SS8 OR WRITE US AT 2. Remember, if you are renting equipment, your equipment rental is charged one month in advance. That means
47
your first invoice will include apro -rated fee for the current month, plus the next month's rental.
ICE MOUNTAIN SPRING RATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash.
6216
6661 DIXIE 11WY., SUITE 4 If you prefer, you can pay your bill online at service.icemountain.com.
LOUISV ILLE, 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, wrile us on a separate sheet of paper. We
must hear from you in writing he later than thirty (30) days after we SA MPL E I NVOICE
sent you the first 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. tz3456ra9O Your Account Number
You do not have to pay the disputed amount while it is being oolooroo aoloeloe
investigated. During the investigation, we cannot report your account I 56759
as delinquent or take any action to collect the amount in question. n a .ca w
µorv°cr Watch here for a
wE°-Nd✓ V+
GENERAL INFORMATION r °E -DEC 9 personalized account
I. Payments received after the billing INVOICE date will appear on Important Y i PP I tt p, q„, Itt. uu,lut 6M,lnl,Ltuu�dnU.,u,dtadll cfsr °m 9 1° P.o'eb message
your next invoice. Past due invoices (not paid within 30 days of news and mmkv«•
billing date) may be assessed a late fee as allowed by law not to offers �ixim a ead tea...
exceed S20 per month. Additionally, third party collection/attorney '1 Y 511e At
t, lt !d
1.2A t,.d t1L, 11 11 1411 A
expenses may be assessed at a rate not to exceed 100% of the
unpaid balance or the maximum allowed by law. -t+-= =""°""fit n aw re'"sf Pay electronically
2, Each returned check is subject to a service charge subject to the,'
y`.
maximum check return charge allowable in your State. `'x`y Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
k w y amount has been
ACTIVITY. since your nccoudrnawTM paid in full to
P g last invoice cer ery nae.c :s i n oe rz3 m s urv,s +a
4. E quipment re replacement costs will be charged for bnttics lost,
stolen, damaged or not returned. p,e may +mom avoid late fees
5. In accordance with N WNA's Terms and Conditions "T &C" our "a� w
Y Darn 5 io °N +ios�:ia�,4 -sow
n; 3 uaes..w
Equipment Lease and/or Service Agreement account may be yr,eas,+4<a s ',`�¢Mo ",amsc =�9.�u ,,e9 Monthly Oil
09n+ 5neasu.w r„�iw•maee
subject to minimum monthly purchases and for early cancellation Surcharge, Fuel
fees. (A complete version of the current T &C may be viewed on the ovnx 0 9 s,a° Surcharge or Delivery
website listed below) Upon service discontinuation, rent for the rm "r Fee (see #6 under
Leased Equipment is charged through the end of the billing cycle "General
in which service is discontinued. e "57IG
6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or "ur.r° ":,9+ M n Information
Delivery Fee as described in your T &C. Only one of these fees Payment stub nccour+r suMmAaY Fw u s nmoutn
eec 9Y var rn
will apply to each account. The fee that applies to your account fe „7„-;„-,a.cm^•^° ACC oura*+ MR p0
123 MT.
is stated on the front of the invoice. For further information please icp NUmSEn e;EUr+c Darr
visit the website listed below or contact our customer service oolo°ru4
center.
P a,2U096307 04262712619 000391049 20a4 SE
7. Asa food pr oduct, bottled water is subject to the rules and Amount due
regulations promulgated by the Federal Food and Drug n„oce
Administration (FDA). ;amouNrmN wnrEnrcanr n, y ,sia e
S. Your first invoice indicates the products delivered on your first ""k"4W sE Submit your
on rusroMEa avKr w�i saa.rx.9eee
delivery, along with any applicable bottle and account deposits, l�6o „u.luba�a p ayment by this
b. au .wa.ss..du..lu.d on °��a�a�.
redemption fees, and any dispenser charges. All future invoices dot Nu "uoa.nu1ie°OnX`"`
will reflect charges for water delivered and dispenser rental, bottle s
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.
rresu"ueu uy oldie ouniu ui nuWu"r8 miry run" cu i �nev. yaa�
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
Ice Mountain Direct Purchase Order No. NA
PO Box 856680 Terms
Louisville, KY 40258 -6680 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/05/10 00101 22206105 Keystone Reconstruction Project $25.22
Miscellaneous
Project 07 -08
s
Total $25.22
1 hereby certify that the attached invoice(s), or bills(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER N0. WARRANT NO.
Ice Mountain Direct ALLOWED 20
PO Box 856680 IN THE SUM OF
Louisville, KY 40258 -6680
25.22
ON ACCOUNT OF APPROPRIATION FOR
Ice Mountain Direct
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
DEPT.#
NA 0010122206105 4239099 $25.22
NA I hereby certify that the attched 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
25 -Oct 2010
Total 25.22 Signature
Cost distribution ledger classification if City Engineer________
claim paid motor vehicle highway fund Title
service.icemountainwater.com ®B 8`
215 6661 DIXIE HWY, SUITE 4
LOUISVILLE KY 40258 pg/01/10 09/30/10 0010120048525
0
ADDRESS SERVICE REQUESTED
�ID���OIdII HEM III DI I00�0 DID MON- OCT 25 0120048525
TUE- NOV 23
MON- DEC 27
CITY OF CARMEL DEPT OF ENGINEERING Customer Service: 1- 800 7472 -9888
LISA SCOTT OR JUDY STOHLER
Did you forget about us? Kindly pay upon receipt.
1 CIVIC SQ Remember, past due accounts are subject to a late fee.
CARMEL IN 46032 -2584 Your prompt payment is appreciated. For your
II' 11 1111111111111411111111111'lll' convenience, pay online: icemountainwater.comiservice.
If payment has been made, we thank you.
W10VN AV ►1t BLE Homemade- goodness I nca b0t 1e; '100% Organic Sweet Leaf Tea in yrlginal Sweet Tea
arid Lemonade, 160 glass bottles, 92 pelt case a SCafl`8.00 -472 9888 _or vlsltservlce Icemountalnwater.com for
our $2 o4fi�special!w`Offer eupire$ 10131f1'0.
ACCOUNT ACTIVITY Pay your bill online at: service.icemountainwater.com or by phone at:1- 800 -472 -9888. It's free!
Delivery address: CITY OF CARMEL, 1 CIVIC SQ, CITY ENGINEERING DEPT, CARMEL IN 46032
PREVIOUS BALANCE 51.35
9113 566766 PAYMENT -THANK YOU -27.42
9/24 0691331300 4 5 GAL ICE MOUNTAIN DIRK WIHANDLE 13.96
4 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00
4 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00
2 9 OZ PLASTIC UP 50C /SLEEVE.. 5.98
9130 19746888 RENT 3.99
TOTAL 47.86
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT 1 ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
Subject to terms on reverse side. 51.35 27.42 23.93 47.86
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 RATER CO. 3, Kindly fill in the amount enclosed, include your account number on your check, and do not send cash.
6661 DIXIE WWY., SUITE 4 If you prefer, you can pay your bill online at service.icemountain.com.
6[i61
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 later than thirty (30) days after we SA MPLE INVOICE
sent you the first bill on which the he 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.
123ase7 Your Account Number
You do not have to pay the disputed amount while it is being 1 o J00[0o. ooroulPo
investigated. During the investigation, we cannot report your account
as delinquent or take any action to collect the amount in question. MR Da saseres
Mon Watch here for a
GENERAL INFORMATION 11 DEC ruE personalized account
1. Payments received after the billing (INVOICE) date will appear on Important
tG�:, ttu „tnmtl „nndduL „dnu,ti ilddn c +�me1s °ryjeijgpD4'��$ge
your next invoice. Past due invoices (no( paid within 30 days of news and monk rn "`M °P, message
billing date m be assessed a late fee as allowed b law not to 423
g Y Y offers Ix3M +1 ^s
exceed $20 per month. Additionally, third party collection/attorney I zaa�Id g ft ,dtsI tat t etUA
expenses may be assessed at a rate not to exceed 100 of the
unpaid balance or the maximum allowed law f. rates v"'''ineckrd `Pn1pR�
p y ro aal sa a wEam^ m9 Pay electronically
2. Each returned check is subject to a service charge subject to the
maximum check return charge allowable in your State. .;s'r .ran Make Sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
ACTIVITY since your ACCOU ACrnV amount has been
4. Equipment replacement costs will be charged for bottles lost, D yAda,e ^n ^Dme'zamal^sE,ee.e Y s ,coaoao "s' paid in full to
last invoice
stolen, damaged or not returned. SE S avoid late fees
prymentThank Ynu 5000
5. In accordance with NWNA's Terms and Conditions "T &C your oaAa+ ,a,ana S seaiw�u "'sw' "y wa�
],�eas,ww I Md,A,a ^soaloeco•
Equipment Lease and/or Service Agreement account may be 3 „Eas,a+^ s IoM ^�n,a; psciR�w Month Oil
o91,t ],re55 5 n n5urcf'a�9e
subject to minimum monthly purchases and/or early cancellation oYnP Surcharge Fuel
fees. (A complete version of the currentT &C maybe viewed on the Surcharge or Delivery
websitc listed below) Upon service discontinuation, rent for the o P Fee (sec #6 under
Leased Equipment is charged through the end of the billing cycle "General
in which service is discontinued. sa
w exENr.cmm zn0
^T °q.M ,r.o +M uo
6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or Information
,,,e,,
Delivery Fee as described in your T &C. Only one of these fees Payment stub AccouNrsuMA+A➢Y
pqY HY PAY THIS AMOD
will apply to each account. The fee that applies to your account "_N�w;„,am.�w.ln`,p".^•^' ACCOU1JrNUmecR si4o
aoroo
is stated on the front of the invoice. For further information please e's9a anu c DArE Mr. ENCLOSED
INVOICE NIIMOER ,00100
visit the websitc listed below or contact our customer service ,z3ass7eao
center. 9 PDP391P 2pp4 1L
7. As a food product, bottled water is sub Vs282r126L
act to the rules and Amount due
regulations promulgated by the Federal Food and Drug I ^nn D«
Administration (FDA). icE ouNOV WA"RCOMPA" 123
d p^npm....•Irc- Ca oa000 Submit your
8. Your first invoice indicates the products delivered on your first OaCUSTOMkwSEPVICEV ,�C�'aa�' °'�98a'
delivery, along with any applicable bottle and account deposits, payment by this
1. d➢, 3Wd ➢L.dl. «dL.dl..L ➢.L,LLI.Ld date
redemption fees, and any dispenser charges. All future invoices o9rpEE .ulomnsn,aPaA� „ea ^'v °`T'
will reflect charges for water delivered and dispenser rental, bottle
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 Nestle Waters North America Inc. Form No. NW 709 11108
service. ice mountain. com S
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
r 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
Ice Mountain
Purchase Order No.
OX
Terms
Louisville, KY 40285 -6680
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoices) or bill(s))
10/05/10 001 Rent and Servie Sept $23.93
ccnt
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Ice Mn ntain IN SUM OF
P.O. Box 856680
Louisville, KY 40285 -6680
$23.93
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
n a 001 ENG 4239099 materials or services itemized thereon for
A cnt 0120048525 which charge is made were ordered and
received except
0 2S 20
1
Signature
Cost distribution ledger classification if —Title
claim paid motor vehicle highway fund