165811 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $10.28
CARMEL, INDIANA 46032 PROCESSING CENTER
PO BOX 856680 CHECK NUMBER: 165811
LOUISVILLE KY 40285 -6680
CHECK DATE: 11/12/2008
DEPARTMENT ACCO PO NU MBER INVOI NUMBER AM DESCRIPTION
1701 4239099 i 10.28 OTHER MISCELLANOUS
720106
D
10/01/08 10/31/08 08J7220327048
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service.icemou n tain.com
I i WED- NOV 12 7220327048
IIII III III I III III III III IIII I IIII II III II MON- DEC 15
TUE- JAN 20
#BWNNWYR THLI- FEB 19
#0400072203270488#
CITY OF CARMEL OFFICE OF THE C Customer Service: 1- 800 472 -9888
ANN DAVIS
1 CIVIC SQ Thank you for choosing Ice Mountain Home Office
CARMEL IN 46032 -2584 Deliveryl We value your business.
It III II IIIII III II III III IIIIIIIIIItIIII II
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For agllmlted tlmeonly you can get 2 or more cases of our onthe -�go 112 LlteriSpring Mottles for. just $6 each L "og��w
onto�sen►lee lcemountalnwa #er com or caE1 800 472 9888 Otter expires November 28, 2008
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ACCOUNT ACTIVITY Pay your bill online at. service. icemounta!n.com or by phone at: 1- 800 472 -9888. It's free!
Delivery address: CITY OF CARMEL OFFICE OF CLERK, 1 CIVIC SQ, CARMEL IN 46032
PREVIOUS BALANCE 10.44
10/24 940110 PAYMENT -THANK YOU -10.44
10/14 0588326751 1 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00
1 5 GAL ICE MOUNTAIN DRK W /HANDLE 3.49
1 5 GALLON, ICE MOUNTAIN BOTTLE DEPOSIT .00
10131 0592157960 1 OIL /FUEL SURCHARGE 2.80
J6527811 RENT 3.99
TOTAL 10.28
C ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT /ADJUSTMENT+ CURRENT ACTIVITY s PAY THIS AMOUNT
Ihinnt to tnrma nn manna chin 10.44 10.44 10.28 10.28
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOB BETTER
IN CASE OP ERRORS OR QUESTIONS ABOUT YOUR BILL, OR FOR 1. Please remember payment is due by the "pay by" date noted to ensure the smoothest i rvice.
A REPORT ON WATER QUALITY AND INFORMATION, PLEASE 2, Remember, if you are renting equipment, your equipment rental is charged one month in advarn*% That means
CALL 1 -800 472 9888 OR WRITE us Ar: 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.
4216 If you prefer, you can pay your bill online at service.icemountain.com,
6661 DIXIE IIWY., SUITE 4
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 ore you in writing error than thirty (30) days after an SAMPLE INVOICE
sent you the e first hill on which the he m error or proble appeared. Yo u can
telephone us, but doing so will not preserve your rigbts. 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 arc obligated to pay the parts of your bill that are not in question. 1,pS6 Your Account Number
You do not have to pay the, disputed amount while it is being r oolooEOa- oolool
investigated. During the investigation, we cannot report your account r
,z3<se7e9
as delinquent or take any action to collect the amount in question. rHR ocre^
Mom O cT 19 Watch here for a
GENERAL INFORMATION WE4 ve 11
at ,R personalized account
i L Pavmcnls received after the belling (INVOICE) date will appear on ire t} ��d11�, 111„ kk1Ad „d91d,11n,,,,a91 „iI „11A,111 as,omel s °'"iCB1tsoo -sTZ -Pea messa e
your next invoice. Past (Inc invoices (not paid within 30 days of news and Ild Tn,nt r ^9 "e "`M°" "ama�r g
billing date) may be assessed a lute fec as allowed by law not to offers iz]Mm "s+
L,In
c"51- wow
exceed S20 per month. Additionally, third party collection /attorney
1...111•L
expenses may be assessed at a rate not io exceed IOD% of the b s„ty y to9Pn o mglRp` Pa electronica
unpaid s ,l a Fach returned check s subject to service charge subject to the Y Y
a^lemr�+,aae. Eras vwU
maximum check return charge allowable in your State. I Make safe this
3. All bottle and equipment deposits are shown as CURRENT Activity m,
amount has been
ACTIVITY. since your ACCOUNTACID7ITM
nda ion Iw z3Nal ^s+ `cr ,i.99
4, Equipment replacement costs will he charged for bottles lost, paid in full to
last invoice �°e'”
stolen, damaged or not returned ^,aal� "�k 50.E avoid late fees
5. In accordance with NWNA's Terms and Conditions "T &C' your oRnl as,e9e sc =�I "SIR °19� °'SP "9w "ef .10. ui menu Lease and/or Service Agreement account nut be 9r„ ,R�es�4a sere I ^SC z�
q P y Monthly Oil
E
cis
subject to minimum monthly purchases undlor early cancellation 091 3 3 Surcharge, Fuel ease„ Re "I
fees. (A complete version of the currcntT &C maybe viewed on the osm s
Surcharge or Delivery
website listed below) Upon service discontinuation, rent for the TO— Fee (see #6 under
Leased Equipment is charged through the end of the billing cycle T s woeNr "General
in which service is discontinued. >R�*mn mao
o +ww r ..MV u.oi g *ME 5z +e Information
6. You wilt be charged a monthly Oil Surcharge, Fuel Surcharge or
11.
Deliver Fee as described m our T &C. Only one of these fees Pa y ment stub ACCWNT SaMMARY 94
Y Y 3
will appiv to each account- The fee that applies to your account m«°�, P-- AeeouNr NUrasrn env er 574
00 oa 90
is stated on the front of the invoice. For further information please 123° enuNwarr MT EN""O
INVOICENVW OOIWIW
visit the website listed below or contact our customer service ,z
center. lE
7. As a food product, bottled water is subject to the rules and oPaoo,63nv o4zsastay.>'9 op63gyp49 aonv Amount due
regulations promulgated by the Federal Food and Drug I'll on o
Administration (FDA). Icr MOUNrA +N wATE�oPnN^ c,'yMiaies'�oo
a �a ew.• e Su your
S. Sour first invoice indicates the products delivered oa your first roRCUnoMER °o9<r�wne
delivery, along with any applicable bottle and account deposits, payment by this
L.. m. L.. xsd. ❑r, ",�M ^g.,a
redemption fees, and any dispenser charges. All future invoices R date
will reflect charges for water dclivcrcd and dispenser rental, bottle R P
deposits and credits plus charges for any additional products
ordered by you. Deliveries are inude 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 5108
Q
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
r
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)) ff
EO.
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
IN SUM OF
pop
uw�miu� �q
ON ACCOUNT OF APPROPRIATION FOR
L oq z j �Q hc-,
Board Members
DEPT INVOICE NO. ACCT /TITLE AMOUNT I 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund