205200 01/05/2012 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $20.48
ro CARMEL, INDIANA 46032 PROCESSING CENTER
PO BOX 856680 CHECK NUMBER: 205200
LOUISVILLE KY 40285 -6680
CHECK DATE: 1/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 01LO11925282 20.48 OTHER MAINT SUPPLIES
service.icemountainwater.com
oo 215 6661 DIXIE HWY SUITE 4 LOUISVILLE KY 40258 11/13/11 12/12/11 01 L0119252823
0
ADDRESS SERVICE REQUESTED e
THU- JAN 05 0119252823
1 111 I HI H OIL MON- FEB 06
WED- MAR 07
THU- APR 05
CITY OF CARMEL STREET DEPARTMENT Customer Service: 1- 800 472 -9888
BONNIE CALLAHAN Thank you for choosing Ice Mountain Home Office
3400 W 131ST ST Delivery! We value your business.
CARMEL IN 46074 -8267
"lllll l'I'I "III�IIIIIIII "'I'I'I 1 '1' 11 111 "IIIIIII'll "111'1
Whether.used as a. mixer or served on its own PERRIER Sparkling Natural Mineral Water is the perfect
addition to a great part y! Available in Original,. Lemon, Lime, Citron, and Grapefruit. Enjoy $3 off per case. Cali
1- 800472 =9888. Hurry! Offer expires 12/31/11..
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 STREET DEPARTMENT, 3400 W. 131ST ST, CARMEL IN 46032
PREVIOUS BALANCE -20.01
11/22 0751091398 4 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -24.00
4 5 GAL ICE MOUNTAIN DIRK W /HANDLE 13.96
4 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 24.00
2 9 OZ PLASTIC UP 50C /SLEEVE 5.98
12/06 6678285202 4 5 GAL ICE MOUNTAIN DIRK W/HANDLE 13.96
4 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 24.00
4 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -24.00
12/12 0755031762 1 OIL /FUEL SURCHARGE 2.60
L1928603 RENT 3.99
TOTAL 20.48
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
Subject to terms on reverse side. -20.01 0.00 40.49 20.48
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL, OR FOR I 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- 800472 -9888 OR WRITE US AT: your first Invoice will include a pro-rated fee for the current month, plus the next month 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. If you
#216 prefer, you can pay your bill online at service.icemountainwater.com
6661 DIXIE HWY., 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 SAMPLE INVOICE
sheet of paper. We must 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 telephone us, but doing Date range of this invoice
so will not preserve your rights. In your letter, give us the following
information:
Your name, address, telephone and account numbers. 17M567590 The dollar amount of the suspected error. ootooto".
Describe the error and explain if you can, why you believe there is
an error. "R ar a 1234567890
M°w ocT p
Your Account Number
You are obligated to pay the parts of your bill that are not in question.
You do not have to pay the disputed amount while it is being roe oEC
g g g p y n tt:,at nt emanam,4umn,monu,ua,m Cu, o r M e:1 -000. 11.9888
investigated. During the investigation, we cannot repo our account T1 Watch here for a
as delinquent or take any action to collect the amount in question. wzJ n
city We 80080 personalized account
GENERAL INFORMATION Important t..aaa..m.' 1 4 a message
1. Payments received after the billing (INVOICE) date will appear on news and
Po doe n s loot paid within 30 days of on +•�9 w" xt9 <a" vz o" nog
o ,�a,a,m�rdv
ea,•,onw e6P
billing (late) may be assessed a late fee as allowed by law not to a e e ^,oun,
1
exceed $20 per month. Additionally, third party collection /attorney Pay electronically ,:,+a9• -+u'
expenses may be assessed at a rate not to exceed 100% of the
ACCOUHTARMN Pnw'•°�P�"•` G1 oW00
unpaid balance or the maximum allowed by law. '�.M, ionnooe nM z Make sure this
2. Each returned check is subject to a service charge subject to the a 1,Me u1z amount has been
maximum check return charge allowable in your State. Activity
since your e 1 paid in full to
3. All bottle and equipment deposits are shown as CURRENT Tvmsi z �s0.� avoid late fees
ACTIVITY. last invoice 890 rnei z92N•u
4. Equipment replacement costs will be charged for bottles lost, wn ae•^•P' s
stolen, damaged or not returned. Monthly Oil
5. In accordance with N%VNA's Terms and Conditions "T &C" your Surcharge, Fuel
Equipment Lease and/or Service Agreement account may be
subject to minimum monthly purchases and/or early cancellation Your new v9• M". Surcharge or Delivery
ACCOUW SUMMARY
49 Fee (see #6 under
fees. (A complete version of the currem T &C may be viewed on the delivery c
website listed below) Upon service discontinuation, rent for the calendar. pgyDeliveriesKOy a•R "o"1Fk11S°'°"0 "General
Leased Equipment is charged through the end of the billing cycle Information
`D'indicates 1:�
in which service is discontinued. "6
6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or a Scheduled
Delivery Fee as described in your T &C. Only one of these fees delivery
will apply to each account. The fee that applies to your account
is stated on the front of the invoice. For further information please o;, r �•on .o.
visit the website listed below or contact our customer service ;o', mur „n,•
center. Payment stub ""n
p Y 8V P T S AMOUM
7. As a food product, bottled water is subject to the rules and -.P sccOUMNUM6FR s,.o Amount due
p„•,n a 0010010
regulations promulgated by the Federal Food and Drug o,c, 90 B1WNG D.TE Naosco
1NVO�C[ MBEe w'K
Administration (FDA). x sere90
S. Your first invoice indicates the products delivered on your first
delivery, along with any applicable bottle and account deposits, "9zo"9s3ov "9ze2112611 000391"99 z0o9oT"16 Submit your
redemption fees, and any dispenser charges. All future invoices will w o« payment by
reflect charges for water delivered and dispenser rental, bottle �cEMOU„'",m "TE °,..P s1Ma�ns,
o,rsa,e cow" this date
deposits and credits plus charges for any additional products eft CUSTOMEaER9KE UU,a^o-'r +Peaa
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 RvP
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 708 5/08
service. icemountainwater.com
VOUCHER NO. WARRANT NO.
ALLOWED 20
Ice Mountain
IN SUM OF
P. O. Box 856680
Louisville, KY 40285 -6680
$20.48
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
RO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
2201 07 L0119252823 42- 389.00 $20.48 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
Tuesday, January 03, 2012
Street Commiss on�er
!.1
Street CO Title'ssloner
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))
12/14/11 01 LO119252823 $20.48
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
2d
Clerk- Treasurer