180839 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
0 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $55.74
CARMEL, INDIANA 46032 PROCESSING CENTER
PO BOX 856680 CHECK NUMBER: 180839
LOUISVILLE KY 40285 -6680
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
'920 4239099 09KO12220610 33.62 OTHER MISCELLANOUS
2201 4238900 09LO11925282 22.12 OTHER MAINT SUPPLIES
's
service.icemountain.com,
o #215 6661 DIXIE HWY, SUITE 4 0 a
G LOUISVILLE KY 40258 11/13/09 12/12/09 09LO119252823
ADDRESS SERVICE REQUESTED e
TUE- JAN 19 0119252823
III IM11IIINMICIIIIN THU- FEB 18
THU- MAR 18
#BWNNWYR MON- APR 19
#0400001192528234#
CITY OF CARMEL STREET DEPARTME
BONNIE CALLAHAN Customer Service: 1 800 472 9888
3400 W 131ST ST Thank you for choosing Ice Mountain Home 1£ Office
WESTFIELD IN 46074 -8267 Delivery! We value your business.
�I��II��l�ul�ll��lllllllll�ll�ll�llllll�l�llll�llulllllllll��ll
Add sorne.flavor tD.ysr s h olida ys an save some money -toot For a.limite time save $2 on cases off Perrier
Sparking Water and San Pellegrino Sparkling Fruif flavored Beverages!;
ACCOUNT ACTIVITY Pay your bill online at: service. icemountain.com or by phone at: 1- 800 472 -9888. It's free!
Delivery address: CITY OF CARMEL STREET DEPARTME, 2 CIVIC SQ, CARMEL IN 46032
PREVIOUS BALANCE 16.12
12/04 123439 PAYMENT -THANK YOU -16.12
11/13 0647402585 2 5 GAL ICE MOUNTAIN DRK W /HANDLE 6.98
2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00
1 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -6.00
1 9 OZ PLASTIC UP.50C /SLEEVE 2.99
12/12 0652737164 1 OIL /FUEL SURCHARGE 2.16
L8530737 RENT 3.99
TOTAL 22.12
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT /ADJUSTMENT CURRENT ACTIV. PAY THIS AMOUNT
�ubiect to terms on reverse side. 16.12 0 16.12 22.12 22.12
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 NVATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. If you
N216 prefer, you can pay your bill online at service.icemountain.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. ,ilgse]B9
The dollar amount of the suspected error. ootwta' 0o1ppj00
Describe the error and explain if you can, why you believe there is 1234567890
an error. "oN -CC p
You are obligated to pay the parts of your bill that are not in question. Your Account Number
You do not have to pay the disputed amount while it is being
Cuvu,me+ SerwK> 1- 800<]39889
investigated. During the investigation, we cannot report your account 0, 11 dn„ n6. ilala ^•�lll't' it lt °a•m
as delinquent or take any action to collect the amount in question. i °h1[
,,3 T„
Watch here for a
Main Important St
GENERAL INFORMATION p `m' i., n6..,•n.,.ai, n „6n.a,.aaa,ca.:u
message
1. Payments received after the billing (INVOICE) date will appear on news and `i
your next invoice. Past due invoices (not paid within 30 days of offers
billing date) may be assessed a late fee as allowed by law not to adw”
exceed $20 per month. Additionally, third party collection /attorney Pay electronically
expenses may be assessed at a rate not to exceed 100% of the A�COUNrACTM"
unpaid balance or the maximum allowed by law. z3n� s °rys t o 0000B celNery Make sure this
AOC,e35.
2. Each returned check is subject to a service charge subject to the P,e�W +B•b,w• "z °s amount has been
maximum check return charge allowable in your State. Activity
paid in full to
3. All bottle and equipment de oasts are shown as CURRENT since your u, "s"1OeP avoid Tate fees
ACTIVITY. last invoice
8:6380
4. Equipment replacement costs will be charged for bottles lost,
stolen, damaged or not returned. wT "E Monthly Oil
5. In accordance with NWNAs Terns 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 ..8984 •w'"° 99 Surcharge or Delivery
fees. (A complete version of the current T &C may be viewed on the delivery ACCOUNT SUMMARY .mow+ <•.,91^• Fee (see #6 under
,.,.9.9.,•„•9•••
website listed below) Upon service discontinuation, rent for the calendar. "General
`D' indicates my p eu veriesB«W "iN
Leased Equipment is charged through the end of the billing cycle Information
in which service is discontinued.
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 �;nv
will apply to each account. The fee that applies to your account n„ a y 7,;,
w�
is stated on the front of the invoice. For further information please i S.• ~y.
visit the website listed below or contact our customer service �;•o��
center. Payment stub YAY m, �eMouNT
7. As a food product, bottled water is sub to the riles and ACCOUNTNUMBrIt ppYOV Amount due
P J o„xl,w„w.w,.".,..m. w• ooiwtoo
regulations promulgated by the Federal Food and Drug ,z14sB NUMBER ]B90 Blume onTE s Naos[o
INVOKE W.I. Administration (FDA). a3gse]B
S. Your first invoice indicates the products delivered on your first
delivery, along with any applicable bottle and account deposits, 0420096307 o4282712619 000391049 Eao4oio1 Submit your
redemption fees, and any dispenser charges. All future invoices will p y
a ment y
reflect charges for water delivered and dispenser rental, bottle K rno "�uN.„w,, "TE",w`oM K Z3 tm ,5
B000B this date
deposits and credits plus charges for any additional products wB ❑r oNBUBB91«<AN ,.e w]z.9mB
ordered by you. Deliveries arc made every three or four weeks, for t ni t i„ nt.,.. ,n„••n• ^t'll °t ❑TN
a total of 16 -17 deliveries per year. You will only receive invoices,"", we „„,w.o,9. „s9^ °,B.9,.,98onBn•„.
12 times per year, so approximately 5 of those invoices will reflect
two deliveries.
2008 Ice Mountain Spring Water Company, a Division of Nestl6 Waters North America Inc. Form No. NW 808
service. icem., intain.com
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))
12/15/09 09LO119252823 $22.12
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 Mountain
IN SUM OF
P. O. Box 856680
Louisville, KY 40285 -6680
$22.12
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member
2201 09LO119252823 42- 389.00 $22.12 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
Tuesday, Dece'mber 22,2009
Street Commissioner U
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
service. icemountain.com
#215 6661 DIXIE HWY, SUITE 4
0 8 g
LOUISVILLE KY 40258
0
ADDRESS SERVICE REQUESTED 0
WED- DEC 16 0122206105
III If81NIIIINIMf011INMIII IIIMIIHIM TUE- JAN 19
THU- FEB 18
#BWNNWYR THU- MAR 18
#0400001222061057#
CITY- OF_CARM L ENGINEERING /1ST Customer Service: 1- 800 472 -9888
Rf4 NOLAN
1 C IC'SQ Did you forget about us? Kindly pay upon receipt.
CARMEL IN 46032 -2584 Remember, past due accounts are subject to a late
fee. Your prompt payment is appreciated. For your
convenience, pay online:
icemountainwater.com/service. If payment has been
made, we thank you.
you know our 3 and 5 gallon bottles are cleaned and refilled on average 36 t before being turned over to
a recycling company? Each year, we recycle approximately 900,000 of our 3 and 5 gallon bottles, helping to keep
1.6 million Ibs of plastic out of landfills.
ACCOUNT ACTIVITY e.
PREVIOUS BALANCE 54.66
11/20 061178 PAYMENT -THANK YOU -25.57
11/13 0647402965 1 5 GAL ICE MOUNTAIN DRK W /HANDLE 3.49
1 9 OZ PLASTIC UP 50C /SLEEVE 2.99
1 .5 L NATURAL SPRING WATER ICE MTN 5.99
BOTTLE DEPOSIT: 1 CHARGED, 1 CREDITED .00
11/29 0650383839 1 LATE FEE �y� j 7077,7 15.00
11/30 0651065617 1 OIL /FUEL SURCHARGE ra 2.16
K8354619 RENT .99
SALES TAX DEC 2W V
TOTAL 63.20
SP
fl x� ARY EVIOUS SALA NCE PAYNIENT /ADJUSTP. ^.ER.T. rt �a}�7N��
CTIVI ?Y _PAY THIS -AMO NT—
�g 54.66 25.57 ?j 6 0
W o
side.
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- 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 iNIOUNTAIN SPRING ""TER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash.
9216 If you prefer, you can pay your bill online at service.icemountain.com.
6661 DIXIE IIWY., SUITE
LOUISVILLE. KY 40253 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 parts of your bill that are not in question. 1234567890 Your Account Number
You do not have to pay the disputed amount while it is being 00100 too ool ooroo
investigated. During the investigation, we cannot report your account
123 +s67as
as delinquent or take anv action to collect the amount in question. THR ocT
M `O[l 79 Watch here for a
GENERAL INFORMATION WE NDY
TDE -DE personalized account
I. Pavnients received after the billing (INVOICE) date will appear on Important
la•w c ^ma ^u a a 00 P. �e8 message
your next invoice. Past due Invoices (riot paid within 30 days of news and money ^B
a ^a a^rvlas.
billing date) may be assessed a late fee as allowed by law not to offers b iz
a,
state 000BD
exceed $20 per month. Additionally, third party collection /att o",
orney 5 •.I. di...A.,dt.d.ILd.,dddd, 1.11
cxpenvcs may be assessed at a rate not to exceed 100% of the „j..
unpaid balance or the maximum allowed by law t rawaa r a Y« 9 eY^ ^•RrcPm�^ Pay electronically
2. Each returned check Is subject to a service charge subject to the
maximum check return charge allowable in your State. t Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
amount has been
ACTIVITY. since our ACCOUNT ACTIVITY c aooBB
4. Equipment replacement costs will be charged for bottles lost. last invoice ce r e
y y Add JOn gg paid in full to
stolen, damaged or not returned. P er ^,mow <e ^r avoid late fees
Payment TAenh YOU SOOo
5. In accordance with NWNA's Terms and Conditions "T &C your De ll, a61s9a s soon ^nNat^�alsw� "9Wate1 -sI
9111 J17BBSI44^4 Ice Mountain Seal Deposit 1.96
Equipment Lease and /or Service Agreement account may be n, 379n s iCeM ^RntamsealRet ^t^ uv9 Monthly Oil
wets ^,cna�ge
subject to minimum monthly purchases and/or early cancellation °9111 3,7ees, Rent Surcharge, Fuel
fees. (A complete version of the current T &C may be viewed on the 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. RR .<I�P^• °T 's AMSOao
6. You will be charged a monthly Oil Surcharge. Fuel Surcharge of a Information")
Deliver Fee as described in our T &C. Onh• one of' these fees Payment stub ACCOUNT SUMMARY c
Delivery Y our PAY BT PAY THIS AMOUNT
will apph to each account. The fee that applies t V011r aCCOlinl ACCDaNT NUMBER 0o7W7� 57.o is stated on the front of the invoice. For further information please 1234567B90 BIWNGDATE MT, ENCLOSED
INVOICE NUMBER 100100
visit the website listed below or contact our customer service ,234s6
r ncr.
G e food product, bottled water is Subject to the rules and p,20096307 04282712619 000391049 2009 1 Amount due
regulations promulgated by the Federal Food and Drug II
dillinistra(ion(FDA). ICE MOUNTAIN WATER COMPANY CIry SIaw
a ,N� N.,.^" Submit your
fi. 5our first invoice indicates the products delivered on your first wR <UStOME.SERNCEUUI'nuo4T -'e°°
delivery, along with any applicable bottle and account deposits, a payment by this
1,..111 �1.,.1.�111,,..,11 „.11 ,,,11..1.11 „I,.,I,I.I.I..I.II
redemption fees, and anv dispenser charges. All ftuure invoices 5R„OP oREREEw *o „Y,s�, ^t„ReRw��4onRn.�u date
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 wifl reflect
two deliveries.
2008 Ice Mountain Spring Water Company, a Division of Nestle Waters North America Inc.
service. icemountain.com
Prescribed by Stale 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
Ice Mountain Direct Purchase Order No. NA
PO Box 856680 Terms
Louisville, KY 40 -6680 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1 2/04/09 09KO122206105 Keystone Reconstruction Project $33.62
Miscellaneous
Project 07 -08
5.
Total $33.6
I 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 NO. WARRANT NO.
Ice Mountain Direct ALLOWED 20
PO Box 856680 IN THE SUM OF
Louisville, KY 40258 -6680
33.62
ON ACCOUNT OF APPROPRIATION FOR
Ice Mountain Direct
PO# or INVOICE NO. ACCT /TITLE AMOUNT Board Members
DEPT.#
NA 09KO122206105 4239099 $33.62
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
21 -Dec 20 09
Total $3 3.82 Sig ature
Cost distribution ledger classification if Cit En
claim paid motor vehicle highway fund Title