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168524 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $19.19 CARMEL, INDIANA 46032 PROCESSING CENTER o `a PO BOX 856680 CHECK NUMBER: 168524 LOUISVILLE KY 40285 -6680 CHECK DATE: 2/4/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION 2201 4238900 09AO11925282 19.19 OTHER MAINT SUPPLIES r I 0 720106 >M, 0 12/13/08 1/12/09 09AO119252823 #215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258 service. icemountain.com TUE- JAN 20 0119252823 III IMNIINNICIMIM�II0IMINMIIHIii THU- FEB 19 THU- MAR 19 #BWNNWYR FRI- APR 17 #0400001192528234# CITY OF CARMEL STREET DEPARTME Customer Service: 1- 800 472 -9888 BONNIE CALLAHAN 3400 W 131ST ST Thank you for choosing Ice Mountain Home Office WESTFIELD IN 't 46074 -8267 Delivery! We value your business. ,Enjoy special savings! Save $3 /case on 700mL Sport Top Bottles: Also, add a little flavor to your delivery, save $2/boX on Nestea Flavored Tea Sticks. Limit offer to 6 of each per delivery expires 2/27/09. More' info. go to service. icemountainwater :com or call 800- 472 9888: ACCOUNT ACTIVITY Pay your bill online at: service. icemountain.com or by phone at: 1- 800 472 -9888. Its free! Delivery address: CITY OF CARMEL STREET DEPA TME, 2 CIVIC SQ, CARMEL IN 46032 PREVIOUS BALANCE 3.99 12/15 0597615400 2 5 GAL ICE MOUNTAIN DRK W /HANDLE 6.98 2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00 2 9 OZ PLASTIC UP 50C /SLEEVE 5.98 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -12.00 1/12 0602761181 1 OIL /FUEL SURCHARGE 2.24 A6959737 RENT 3.99 TOTAL 23.18 ACCOUNT SUNIMARY I PREVIOUS BALANCE m PAYMENT /ADJUSTMENT CURRENT ACTIVITY m PAY THIS AMOUNT lect to terms on reverse side. 3.99 .00 19.19 23.18 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 WATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. #216 if you prefer, you can pay your bill online at service.icemountain.com. 6661 DIXIE IiWY., SUITE 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 no later than thirty (30) days after we SAM I NVOIC E 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 pans of your bill that are not in question. tz3 4561a9 0 Your Account Number You do not have to pay the disputed amount while it is being oE/00100- 00100100 investigated. During the investigation, we cannot report your account as delinquent or take any action to collect the amount in question. TeR oa 2345678 MC'. OC T 29 Watch here for a uOV 21 GENERAL INFORMATION WED D111B roE. oEC le p ersonalized account I. Payments received after the billing (INVOICE) date will appear on Important IIAI„ all„ 111.. IIIiI, I, IIII ,1.1116�.IIIIIal.11,1,111 Cusmmer 1- eoa -�7z -9888 your next invoice. Past due invoices (not paid within 30 days of news and ya,,,o, message billing date) may be assessed a late fee as allowed by law not to offers l ie WMSt state o�° exceed S20 per month. Additionally, third party collection /attorney ctv, I IOa.,,l „al II II„dl .1 il, I 1 111 .1 „II expenses may be assessed at a rate not to exceed 100% of the unpaid 2. Each returned hetheits maximum allowed se by e subject to the Pay electronically l° e<NVeaes.adcG maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity ACTIVITY. amount has been since your ACCOUNT AerVITY 4. Equipment replacement costs will be charged for bottles lost, oe9veryAddres ^DOe,123Wl� S eet.C"xS`a`e n99 paid in full to last invoice stolen, damaged or not returned. P uusBalance 345 avoid late fees Payment- ThankYOU 5000 S. In accordance with NWNA's Terms and Conditions "T &C your oee, a6ia9e sGauo ^a =`M1�alsa "yw "e1 9111 3178051 5 MOUnIa;n SGal DepOSe 396 Equipment Lease and /or Service Agreement account may be 3vees 38811— s t eMOU ^seaiRewm 11 Monthly Oil FuelSu�cM subject to minimum monthly purchases and/or early cancellation oena 310 63aen n «t Surcharge, Fuel fees. (A complete version of the current T &C may be viewed on the o9n2 5740 Surcharge or Delivery website listed below) Upon service discontinuation, rent for the TOTAL Fee (see #6 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. „.ACrmn A s °ao I f ......t.0 cu u 6. You will be charged a monthly Oil Surcharge, Fuel Surcharge of Y Y Y u 9 n ormation Deliver Fee as described in our T &C. Only one of these fees Pay stub accouNT suMMAnY <99^ PAY A..U will apply to each account. The fee that applies to your account nw>*-^` PAY BY ACCOUNTNUMBER o dd is stated on the front of the invoice. For further information please 12345616'° IWo10E BE BILLING o010o100 OAT P MT. ENCLOSED NUMR visit the website listed below or contact our customer service 1234567 center. 7. As a food product. bottled water is subject to the rules and 0420046307 042e2712619 000391049 200° 16 Amount due regulations promulgated by the Federal Food and Drug Idh�— Administration (FDA). icE MOUNTAIN wnreB CO PnNr Cry Sias 0000D S. Your first invoice indicates the products delivered on your first S your delivery, along with any applicable bottle and account deposits, pay ment w6cunoMEe se6vicE CALL `p1r a ment by this 1,..IIL1.,.I,. ILL... .11,...11�.ALd,ll „I ,,,I,I,IA�.I l e o ^ea«u sin.. P1mt Al co-.^9<s o ^R<. date redemption fees. and any dispenser charges. All future invoices 4PE FR 4 Ay sy ^v ^krow' 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. C 2008 Ice Mountain Spring Water Company, a Division of Nestl6 Waters North America Inc. Form No. NW 709 5/08 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)) 01/13/09 09AO119252823 $19.19 1 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 N O. ALLOWED 20 Ice Mountain IN SUM OF P. O. Box 856680 Louisville, KY 40285 -6680 $19.19 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 09AO119252823 42 389.00 $19.19 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 Thursday, J nuary 29, 2009 Stre Co ss�nn oner Title Cost distribution ledger classification if claim paid motor vehicle highway fund