178207 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER
CARMEL, INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $93.66
PO BOX 856680
CHECK NUMBER: 178207
LOUISVILLE KY 40285 -6680
CHECK DATE: 10/1412009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 09I011782108 X13.57 OTHER MAINT SUPPLIES
1125 4353099 09I012009535 X20.04 OTHER RENTAL LEASES
1047 4353099 09I012120276 /36.91 OTHER RENTAL LEASES
1205 4239099 09I012177619 X7.06 OTHER MISCELLANOUS
1701 4239099 09I722032704 /16.08 OTHER MISCELLANOUS
0 720806
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0
9/01/09 9/30/09 0910120095351
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258 D
service. icemou ntain.com
TUE- OCT 27 0120095351
III 1M IN 11111111111111111111111111 H 1 1111111111111 M r—, W ED- 25
y T,UE- DEC DEC 29
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CARM CLA PARKS AND REC DEPT
OCT 9 20U� Customer Service: 1 800 472 9888
CARM
AUDREY KOSTRZEWA
1411 E 116TH ST Thank you for choosing Ice Mountain Home Office
CARMEL IN 46032 -3455 Delivery! We value your business.
Did you know our 3 and 5 gallon bottles are refilled on average 35 times before being recycled? Thank you for
helping the environment!
i
ACCOUNT ACTIVITY Pay your bill online at: service. icemountain.com or by phone at: 1 -800- 472 -9888. It's free!
Delivery address: P CARMEL CLAY PARKS AND REC DE, 1427 E 116TH ST, CARMEL IN 46032
PREVIOUS BALANCE 98.89
9/10 680763 PAYMENT -THANK YOU -57.87
9/27 765218 PAYMENT -THANK YOU -41.02
9/28 0640482022 2 5 GAL ICE MOUNTAIN DRK W /HANDLE 7.98
4 9 OZ PLASTIC UP 50C /SLEEVE 11.96
BOTTLE DEPOSIT: 2 CHARGED, 4 CREDITED -12.00
9/30 0642268353 1 OIL /FUEL SURCHARGE 2.12
I8092735 RENT Purchase 9.98
TOTAL Description 20.04
P.O.# PorF
G.L.
Budget
Line Descr
Purchaser Date
Approval Date
ACCOUNT SUMMARY PREVIOUS BALANCE m PAYMENT /ADJUSTMENT CU ENT A TIVITY a PAY THIS AMOUNT
Subject to terms on reverse side.
1 98.89 98.89 20.04 20.04
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BET'T'ER
IN CASE OF ERRORS OR QUESTIONS A 130 I YOUR PILL, 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 I -800- 472 -9888 OR wRH E US AT- your first invoice will include a pro -rated fee for the current month, plus the next month's rental.
ICE 110UNTAIN SPRING RATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash.
6661 DIXIE If you prefer, you can pay your bill online at service.icemountain.com.
6661
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
it transaction on your bill, write us on a separate sheet of paper. We
must hear irons you in writing later than thing (30) days after we SM M P LE 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. p a90
You are obligated to pay the parts of your bill that are not in question. 1z3C Your Account Number
You do not have to pay the disputed amount while it is bein_ •00/00100 00100100
investigated Dining the investigation, we cannot report your account i'
as delinquent or take any action to Collect the amount
nt in question. Tti6 04
sz3ase�esd'
29 Watch here for a
GENERAL INFORMATION WED NDV 21
TAE- DK 16 personalized account
1. Payments received after the billing (INVOICE) date will appear on Important
il,ll,. VIII, VIII., IIIIIIalil ,lllll.••IIIII.IL.II,IAII cuzwmer service: l- 800 -192 -968
message
vour next invoice. Past due invoices (not paid within 30 days of news and m o k ro u mru:; og lceMwr rat ^P•pdo
John Doe 1 and services.
billing date) may be assessed a late fee as allowed by law not to Offers 1 23 y M ra
l le s 00 000
exceed $20 per month. Additionally, third party collection /attorney C
unpa expe balance be
r the maximum u allowed by la
s lowtceeci 10111 of the ah,.,n,,
pNM a B �^a,t§nwlrRS Pay electronically
2. Each returned check Is subject to a service charge subject to the `�u= y rO^5 x;mda�.`=`� +a.'
re allowable in vour State.
maximum check return char aeer
b Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
a^ amount has been
ACTIVITY.
since your ACCOUNT Ac"No" y scaee 00000
4. Equipment replacement costs will be charged for bottles lost. n
U,j. Add' 1 3onnDOe.la3mams«eer o`Y ,1e9 paid in full t0
last invoice 4.9
stolen, damaged or not returned. P,e.IPn s6zlanse 42 4 s avoid late fees
Paymenr'Th "nk YOU SoOg
5. In accordance with NWNA's Terms and Conditions ("T &C"), your 06rn, ae 5' s Ice Mountain
Galmn N oo
9111 SGal Deposit
Equipment Lease and /or Service Agreement account may be e s <.we ..GaleerPm 119, Monthly Oil
0.e
subject to minimum monthly purchases and/or early cancellation 1 3 Su har9e s16 63abn Surcharge, FU¢1
fees. (A complete version of the current T &C may be viewed on the o9n2 I6A^pn9' m szw
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 diSCORUnue(I. u ea.NTaanm ePy' a
Information
6. You will be charged a monthly Oil Surcharge. Fuel Surcharge or PPWIgga 0A99 1199 „•1.�+
Delivery Fee as described in your T &C. Only one of UM^"
these fees Payment Stub nccouNT S Anv
oc. sax. ice. uoxxr.x PAY BV
h' to each account. The fee that applies to our account xa w P AY m�>
will a MOUNT
PP PP Y w ^r nccourrr NUrnaen oolomoo
is stated on the front of the invoice. For further information please a13 Iz3nssre90 BL ,uNe OA,E MT. ENaoseO
INVOICE NUMBER oolm1w
visit the website listed below or contact our customer service l za asoIS9 0
ce a P I 042009630? 04282 ?12619 0003910`19 200`1 18
7. Asa food roduct, bottled water is sub to the rules and Amount due
regulations promulgated by the Federal Food and Drug
Ad Innu oue
ministration (FDA).
ICEMOUNtAINWATENNOMPPNY I 011 r5 $1
are0O�o Submit vour
pMr d N .ae wn
Y. four fist urvolee indicates the products delivered on your first roRC,,,,OMBRSERVICECALL1_800 -9808
delivcrv, along with anv applicable bottle and account deposits. n „sal „I
s payment by this
1.,. ul, ,.,I,ta,l ..l .al „e,ld= g ^P..e„ date
redemption fees. and any dispenser charges. All future Invoices P g0 re x Pewe
will renect charges for water delivered and dispenser rental, bottle Big
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 deIIVCFiCS.
0 2008 Ice Mountain Spring Water Company, a Division of Nestle Waters North America Inc. Form No. NW 709 5/08
1 720806
9/01/09 9/30/09 0910121202766
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service.icemou ntai n.com
MON- OCT 12 0121202766
IIIIIII III' III 1 IIIIIIII 1 IIIIII IIII IIII I ,p a WED- DA 13
4 W 0 00 212027662# OCT 0 9 2009
CITY OF CARMEL PARKS DEPARTMEN Customer Service: 1- 800 472 -9888
MANDY SPADY
1411 E 116TH ST Thank you for choosing Ice Mountain Home Office
CARMEL IN 46032 -3455 Delivery! We value your business.
Back to School Savings on our most popular products! "Great new lower prices on cases of 1/21 Spring water-
plus get $2 off each box of Nestea Tea Sticks or case of San Pellegrino Sparkling Fruit cans you,add to,your
me OnIy�CAIL TODAYI
order. Uml t0
F F
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 PARKS DEPT /MONO, 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
PREVIOUS BALANCE 63.83
9/10 680762 PAYMENT -THANK YOU -36.91
9/27 765219 PAYMENT -THANK YOU -26.92
9/11 0637736653 6 5 GAL ICE MOUNTAIN DRK W/HANDLf 23.94
2 9 OZ PLASTIC UP 50C /SLEEVE Purchase 5
BOTTLE DEPOSIT: 6 CHARGED, ED "ib><iD .00
9/30 0642199707 1 OIL /FUEL SURCHARGE P.O.# P or 2.00
I8164174 RENT G.L. 4.99
TOTAL Bud 36.91
Line Descr
Purchaser Date
Approval Date
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT /ADJUSTMENT CURRENT AC IVITY PAY THIS AMOUNT
�ubject to terns on reverse side. 63.83 63.83 36.91 36.91
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER I
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 WRIT E 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 HWY- SUITE 4
LOUISVILLE. KY 40258 4. Never hesitate to call us with comments, questions, or concerns.
If you think y our 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 error than thirty (30) days after we SAMPLE M ®I 1'f�6� E
sent you the first bill on which the he n error or problem appeared. You ca
telephone us, but doing so will not preserve your rights. In your letter,
give us the following information;
Ybur 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. 123456 Your Account Number
You do not have to pay the di amount while it is being IF oolo°ioo-ooro
f Y F
investigated. During the investigation, we cannot report your account i
723 5 678
as delinquent or take any action to collect the amount in question.
,WON 29 Watch here for a
GENERAL INFORMATION WED No 21
TuEDE <'e personalized account
L Payments received after the billing (INVOICE) date will appear on Important
u.n.,.nt „m., nut ,1 „au6t,tm,,,,ttta „tt „tt,l,ttl a "o.��ne message
your next invoice. Past due invoices (not paid within 30 days of news and Tna "EY °i
billing date) may be assessed a late fee as allowed by law not to offers iz INam st "n
exceed S20 per month. Additionally. third party collection /attorney C"
11,,11 „1,11,6
expenses may be assessed at a rate not to exceed 100% of the
unpaid balance or the aximm u allowed by law. y ",msnw PHVS tO r� a Pa electronicall
R .��TOrtana§oYW du�xYo"'a bD mnefieM+d p i Y Y
m
2. Each returned check is subject to a service charge subject to the
maximum check return charge allowable in your State." Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
amount has been
ACTIVITY.
Since your A cmuNrpawm <;,ystace°o� aid in full to
4. Equipment replacement costs will be charged For bottles lost, D 3�e. Add es4 ,on "o 'vM Sfe1
p
last invoice y a'.11
stolen, damaged or not returned. �''poz 4245 avoid late fees
v
5. ht accordance with NWNA's Terms and Conditions "T &C your °er31 �1 scab "�Nat"'a's "gma'e' -saw
9,11 311884,4 eMO "ta "4�a1 °eDO t Monthly Oil
Equipment Lease and /or Service Agreement account
nt may be 11 �nees4m^ m "taI "seal net"'" n99
°9/11 3118841 -4
subject to minimum monthly purchases and/or early cancellation °912 318z��e„ I F Rent Surcharge, Fuel
fees. (A complete version of the current may be viewed on the °v'2 '�pp49 41. Surcharge or Delivery
wcbsite listed below) Upon service discontinuation, rent for the roTAE Fee (see #6 under
Leased Equipment is charged through the end of the billing cycle "General
in which service is discontinued. 5RN1 DAY,nI,A In forma t ion")
57 4
o
6. You will be charged a m onthly Oil Surcharge. Fuel Surcharge or 9
liver Fee as described in our T &C. Onl} one of these fees Payment Stub AccouNTSUMMABV
De e9"
y y Y ppy THIS AMOUNT
will apple to each account. The fee that applies to your account f�n�e,�au,mmU,a d+^^` ACC OUMNUMeE DAyer S
.o, n. o,�..
e°I0°loo
is stated on the front of the invoice. For further information please j2;g56jg90 INVOIC BauNe DAL e MT.ENCEOSED
E NUMBER 01M.
visit the wcbsite listed below or contact our customer service 12, 0-9
center.
p 1 0420096307 04282712619 000391049 200V 16
Amount due
Z Asa food product. bottled water is sub:ect to the rules and
regulations promulgated by the Federal Food and Drug I "n "ooe
Administration (FDA). ct
23 Ma;n St
ICE MOUNTAIN WATER COMDANY Submit your
a"�+rron of N° al'K
8. Your f invoice indicates the products delivered on y wR our first N, e ew� CUSroMCR 4EnmcE Cnul eoa.lz 9eea
delivery, along with any applicable bottle and account deposits. 51ee payment b this
redemption fees. and any dispenser charges. All future invoices
L uI, L,. t., nl,. n. a. n. I,wd,.,i.laa,.t s ae D,;�tA�,<N•n9.. date Y
will reflect charges for water delivered and dispenser rental, bottle
deposits and credits plus charges Ior any additional products
ordered by you. Deliveries are made every three or four weeks, for
it 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.
0 2008 Ice Mountain Spring Water Company, a Division of Nestle Waters North America Inc. Form No. NW 709 5/06
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
051125 Ice Mountain Terms
P.O. box 856680
Louisville, KY 40285 -6680
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/6/09 0910120095351 Water cooler lease 20.04
10/6/09 0910121202768 Water cooler lease 36.91
Total 56.95
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 No.
051125 Ice Mountain Allowed 20
P.O. box 856680
Louisville, KY 40285 -6680
In Sum of
56.95
I
ON ACCOUNT OF APPROPRIATION FOR
101 General 104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 0910120095351 4353099 20.04 1 hereby certify that the attached invoice(s), or
1047 0910121202768 4353099 36.91 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
9 -Oct 2009
Signature
56.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
9 c
720806
0
9/01/09 9/3 0/09 091012
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service.icemountain.com
THU- OCT 15 0121776199
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII FRI- 13
DEC
WED- DEC 16
#BWNNVVYR TUE- JAN 19
#0400001217761992#
CITY OF CARMEL HUMAN RESOURCES Customer Service: 1- 800 472 -9888
SHELLY LINGELBAUGH
1 CIVIC SQ Thank you for choosing Ice Mountain Home Office
CARMEL IN 46032 -2584 Delivery! We value your business.
6 Back to School Savings on our most popular: products! Great new lower prices on cases of 1/2 L Spring water-
plus get $2 off each pox of Nestea Tea Sticks or case,of San Pellegrino Sparkling Fruit cans you add to your
Sticks
order. Limited Time Only CALL TODAY!
I
ACCOUNT ACTIVITY Pay your bill online at: service.icemountain.com or by phone at: 1 -800- 472 -9888. It's free!
D elivery address:
PREVIOUS BALANCE 26.81
9/27 765217 PAYMENT -THANK YOU -22.57
9/03 IA1074629 SALES TAX -.28
9116 0638529172 1 9 OZ PLASTIC UP 50C /SLEEVE 2.99
BOTTLE DEPOSIT: 0 CHARGED, 1 CREDITED -6.00
9/30 0642301543 1 OIL /FUEL SURCHARGE 2.12
I8072928 RENT 3.9
CAI CC.. 2A ''Y 1
90/9 60Z MN ON w,od .oul eouawV LIVON Sa91eM 911s9N to uo!S!A!a e 'Auedwoo aeleM buudS welunon 901 8002 OO
Sauangap oml
1aapa fpm saaionw asogl 10 S XjoaewixoJdde OS APoX jad sauul Z I
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 I- 800-472-9888 OR WRITE US Al: your first invoice will include a pro -rated fee for the current month, plus the next month's rental.
ICE MOUNTAIN SPRING `VXFER 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 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 from you in writing no later than thirty (30) days after we SAMPLE 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 vour bill that are not in question. 23 456] 890 Your Account Number
You do not have to a the di amount while it is bei 00100 /00.00toulo0
p ay P
investigated. During the investigation, we cannot report your account i
123456
as delinquent or take any action to collect the amount in question. Tex -aT o'
MoH al �9 Watch here for a
WE6HW
GENERAL INFORMATION personalized account
1. Payments received after ,R fter the billing (INVOICE) date will appear on Important message
11.11,,, III .,III,�IIIII,L��IIII,I,IIII,� „11111 „II „11,1,111 evawne, Servire l 800.4]2 9x2 g
your next Invoice. Past due Invoices (not paid within 30 days of news and manx lo "9 "`M° °0 +201 p,�
billing date) may be assessed a late fee as allowed by law not to Offers I izs Maip s,
cayslace 00000
exceed S20 per month. Additionally. third party collection /attorney II..II
I.IIIJ. I III 11 111 I 1111..1.
expenses may be assessed at a rate not to exceed 100% of the
2. Each returned che r the im axin urn a a ed y l aw.
char e subject to the Pay electronically
maximum check return charge allowable in your State. Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity $MCC "tea y "'a
ACTIVITY. amount has been
yo ACCOUNT ACTIVITYv e Main Street C„y, 5,a,e 0000
Y n.gs
paid in full to
4. Equipment replacement costs will be charged for bottles lost, oec"en naalw�' °nnoo 11 v
last invoice 245 m avoid late fees
stolen. damaged or not returned. v s
5. In accordance with NWNA's Terms and Conditions "T &C your oeal nslese seal Ha 1so""e 5001
311ee514444 5 M main S Gal oePOS�+
Equipment Lease and /or Service Agreement account may be O v I 3nxxsla444 s 'ire MO�ntamsGai Ret "1n n »v Monthly Oil
Surcharge, Fuel
subject to minimm 04
u monthly purchases and /or early cancellation 19 r e 6 can
fees. (A complete version of the current T &C may be viewed on the o 166ppr19] a n. Surcharge or Deliver}'
website listed below) Upon service discontinuation, rent for the ToTAE Fee (see #6 under
Leased Equipment is charged through the end of the billing cycle
AMa "General
in which service is discontinued.
6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or uA 4 Information”)
ACCOUNT SUMMARY
Delivery Fee as described Ill vour T &C. Only one of these fees Payment stub _Eo. ��F UOU ppY THIS AMOUNT
pAY BY
will apply to each account oseo
The Fee that applies to your account ACCOUNT NUMSER IOOJW n.4o
is stated on the front of the invoice. For further information please 123156j89D xaur+c oATE MT. ENa
INVOICE NUn+REx oorooloo
visit the website listed below or contact our customer service 123as6]s90
center.
p 1261
0420096301 U42E279 ODU391049 2004 1
Z As a food roduct, bottled water IS s ub je ct to the rules and Amount due
regulations promulgated by the Federal Food and Drug Ivnn oee
Administration (FDA). ICE MOUNTAIN 00000
WATERCOM pNY 123 Main S,
„,.o^o1N., oty,slate Submit your
8. Your first invoice indicates the products delivered on your first t lo x cus TUMER :ExvicE <pu 1 eoo. <n vase
delivery. along with any applicable bottle and account deposits payment
a payment by this
t L.. L, nI al,,..u,.al,.l.n,.l,.a,6 1a,a.a1 ,Ps,6. ❑P .ny0h, u „Re�.,,
e „d
redemption fees, and any dispenser charges. All future Invoices date
will reflect charges for water deliTered and dispenser rental. bottle 51GN "FYORFe EA 1 deposit, and credit, plus charges I- any additional products
ordered by vnu. Deliveries are made every three or four weeks. for
a`..
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
M Payee
1 A_3 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
v o�1o�z1 t 2.
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. I I WARRANT NO.
ALLOWED 20
v
IN SUM OF
(w c)
ON ACCOUNT OF APPROPRIATION FOR
C, r-\
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1Z��5 eYi�o� 79 390 flit.=3� bill(s) is (are) true and correct and that the
7o(, materials or services itemized thereon for
which charge is made were ordered and
received except
20
f
Sign ul_e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1
�1 D 720806
9/01/09 9/30/09 0917220327048
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258 D
service. icemountain.com
THU- OCT 15 7220327048
III 111111111111 IN II II 1 1118 WED- DEC 1 3
WED- DEC 16
#BWNNWYR TUE- JAN 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 Delivery! We value your business.
Back to School Savings on our most popular products! Great new lower prices on cases of 1/2 L Spring water--
plus get $2 off each box, of Nestea Tea Sticks or case of San Pellegrino Sparkling Fruit cans you add to your
order. Lim Time, Only-CALL TODAY! a
I
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 OFFICE OF CLERK, 1 CIVIC SO, CARMEL IN 46032
PREVIOUS BALANCE 19.07
9/27 765216 PAYMENT -THANK YOU -19.07
9/16 0638529347 2 5 GAL ICE MOUNTAIN DRK W /HANDLE 6.98
2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00
1 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00
1 9 OZ PLASTIC UP 50C /SLEEVE 2.99
9/30 0642176598 1 OIL /FUEL SURCHARGE 2.12
I8104291 RENT 3.99
TOTAL 16.08
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT /ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
$t,�ubiect to germs on reverse side. 19.07 19.07 16.08 16.08
BILLING RIGHTS SUMMARY r
YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER
IN CASE OF ERRORS OR QUES"I IONS 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 QUAL11 Y AND INFORMATION, PLEASE 2. Remember, if you are renting equipment, your equipment rental is charged one month in advance. That means
CALL I 800 -472 -9888 OR WRfFE US AF your first invoice will include a pro -rated fee for the current month, plus the next month's rental.
ICE N9oUMl'AIN SPRING WATER CO. 3. Kindlv fill in the amount enclosed, include your account number on your check, and do not send cash.
X216 If you prefer, you can pay your bill online at service.icemountain.com.
6661 DIXIE I IN Y., SUITI 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 from you in writing he later than thirty (30) days after we SAMPLE INVOICE
sent you the first bill on which the error or problem appeared 1'ou can
telephone us. but doing so will not preserve your rights. In your letter.
give its 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.
1'ou are ohligated to pay the parts of your bill that are not in question. 1234567890 Your Account Number
)'on do not have to pay the disputed amount while it is being
00100 /00 -001001
investigated. During the investigation, we cannot report your account r
123456
as delinquent or take any action to collect the amount in question. i "a T Q9
MoH.CCT 79 Watch here for a
GENERAL INFORMATION TUE DEC 21
,D "1 1B personalized account
I. Pavmcnts received after the billing (INVOICE) date will appear on Important ILII,, Itt„ t11. dIIlla „Inl.l,otl,,,,ppt.,Il „Ild,ta c� "me z. me 800- 42z.9aaa
mesa e
your next invoice. Past title invoices (not paid within 30 days of news and
billing date) may be assessed a late fee as allowed by law not to offers 1 121Ma^ S
exceed $20 per month. Additionally, third party collection /attorney o, 000"
L ma a nl,,,, at ....n. .n d u.d ,.,i,i,t.t,.t.,n
expenses may be assessed at a rate not to exceed 100% of the
aid balance or the maximum allowed by lass v y e a s ^MwS
un rxe w p Pay electronically
2 r T ice v xmn Youun ducr m ufi.mu<h ,Pprel
Each returned cheek is subject to a sett -ice charge subject to the
maximum txnnn check return charge allowable you
r State. at Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity amount has been
ACTIVITY. since our ACCOUNT ACTIVITY 13M see,. �,,YS,a,eow00-
4. Equipm last invoic ent replacement costs will be charged for bottles lost. Y e Aaa,ea.. w ^°Oe• ,1.99 paid in full t0
"9Y
stolen, damaged or not returned. e., ^�.Baianie 4>-41 avoid late fees
PaymentiNnk VOU Water 5o 00.
5. In accordance with NWNA's Terms and Conditions "T &C vour oB 3' .,1. lea "nNavw
Tvae5a 4 M ^�n,am seal oews�� x96
Equipment m
Lease and /or Service Agreement account may be o 9 eesa «M ^en,ain5ca�ae,�'^ 1119 Monthly Oil
09!1, I805
subject to min um m
imonthly purchases and /or early cancellation 3 „z een 1 Gue1 5u,c6a,9e
hem s Surcharge, Fuel
fees. (A complete version of the current T &C may be viewed on the o9 „1 p0d01 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 "General
in which service is discontinued
5 Information
6. lou will be charged a monthly Oil Surcharge. Fuel Surcharge or 9
Fee as described 111 our T &C. Only one of these fees P stub ACCOUm SUMMARY
Delivei 99
7 Y Y .,�,.o�
PAY BY PAY THIS AMOUN
%rill apply to each account. The fee that applies to your accourn N u e� ,hum "r�'P'r ACCOUNT NUMBER 5740
ooloo
is stated on the front of the invoice. For further information please j234$6j890 BIWNO DATE MT ENnosrO
INVOICE NUMBE0. WIWIW
visit the website listed below or contact our customer service T2"'6'm
center. 1E
7. As a food product. bottled water is subject to the rules and 0420096307 09282712619 0003910 9 2009 Amount due
regulations promulgated by the Federal Food and Drug —Z
Administration (FDA). ICE oU"T' "wATE,",a c,Sl s Submit your
.w AE
8. Yom first Invoice Indicates the products delivered on your first
deliverv, along with anv applicable bottle an(] account deposits.
oB oMEB :EB I<E<A -899 p ayment by this
L. t,.6Ia,60 ^nB re,,.�a. P "m.�r<N"9 ^�n B... S,B=
I cdcniption fees, and any dispenser charges. All future Invoices date
P E ^B F0.fF
will reflect charges for water delivered and dispenser rental, bottle
deposits and C1Cdits' plus charges for anv additional products
ordered by vou. Deliveries arc made ever\ three or four weeks, for
a total of 16 -17 deliveries per year 1'ou will only receive invoices
12 tithes 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 5/08
S
Prescribed by State Board of%Sccount-" 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))
.08
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
ON ACCOUNT OF APPROPRIATION FOR
C7R
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
t Q 7 OJT 1(,,O 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
f
oee 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
D 720806
69
9/01/09 9/30/09 0910117821082 i
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service.icemou ntain.com
MON- NOV 09 0117821082
IIII I II III III lil III AI II IIII II THU- DEC 10
TUE- JAN 12
THU- FEB 11
#BWNNWYR
#0400001178210823# Customer Service: 1 800 472 9888
CITY OF CARMEL STREET DEPATMEN
3400 W 131ST ST Thank you for choosing Ice Mountain Home Office
WESTFIELD IN 46074 -8267 Delivery! We value your business.
Back to School Savings on our most popular products! Great new lower prices on cases of 1/2 L Spring water
i plus get $2 off each box of Nestea Tea Sticks or case of'San Pellegrino Sparkling Fruit cans you:add to your
orde Limited Time Only -CAL TODAY!
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, 3400 W 131TH ST, WESTFIELD IN 46074
PREVIOUS BALANCE 38.03
9/27 765215 PAYMENT -THANK YOU -38.03
9/10 0637330200 1 9 OZ PLASTIC UP 50C /SLEEVE 2.99
3 5 GAL ICE MOUNTAIN DRK W /HANDLE 10.47
3 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 18.00
4 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -24.00
9/30 0642096218 1 OIL /FUEL SURCHARGE 2.12
I8067974 RENT 3.99
TOTAL 13.57
A CCOUNT SUMMARY
PREVIOUS GALA
aubject to terms on reverse side. 38.03
BILLING RIGHTS SUMMARY
YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR 1311.1.. 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 INFORMANON. 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 wRI I E Us AI: 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.
9216 If you 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 sheet of paper. We
must hear you in writing later than thirty (30) days after we SAMPLE INVOICE
sent you the e 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 infonnation:
four 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. 123as67a9 Your Account Number
You do not have to a the di amount while it Is being oolooloo oolooloo
P "Y P g
investigated During the Investigation, we cannot report your account
1
as delinquent or take any action to collect the amount in question. mR oa 123456789(
MoN -oa 79 Watch here for a
GENERAL INFORMATION WE6NOV
TAE- oEC IR personalized account
I. Payments received after the billing (INVOICE) date will appear on Important
message
161I,�,IIL, 111„ IIIIII,,. IIII .I,IIII..,IIIII.,ILAI,1,111 clnome[semce: l gp04J198s
your next invoice. Past due invoices (not paid within 30 days of news and 'oo- 1 ul^r usl
Mnunla11 y,1aua'
1121 Doe d1 a
billing date) may be assessed a late fee as allowed by law not to Offers +23 Man s[
o1v,s[a[e 00000
exceed 520 per month. Additionally, third party collection/attorney L.. 1161.. d.. u1,. „dL,u,dJ1d,,,1,I,L1
expenses may be assessed at a rate not to exceed 100% of the
unpaid balance or the maximum allowed by law. Pay electronically
r mala re .w 15.rw.Ulcnxxioduazaml mvsh.mlcnml
2. Each returned check is subject to a service charge subject to the �I
maximum check return charge allowable in your State. a-- y Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
amount has been
ACTIVITY. since your ACCOUN R1wry 11100 paid in full to
4. Equipment replacement costs will be charged for bottles lost. oe1 vAda,.e l3n DOe'1z3 Mall s«ee[e[v sa[e
last invoice 1 ,yalalce avoid late fees
stolen, damaged or not returned. eel
Ivwmell.rna ^xmo son
5. In accordance with NWNA's Terms and Conditions "T &C). your ye r31 m1e9R sGauol Nalu�al sl sl y wale[ s0oo
9 /II 3178851.4x4 ice Mountain seal oe1e 196
Equipment Lease and/or Service Aereennent account may be 0 111 317"51- s ae MlomslsGal Revl 1199 Monthly Oil
19,11 5 Fuel su�cFarye
s 31-514aa4
ubject to minimum monthly purchases and/or early cancellation Surcharge, Fuel
0 12 ;15gM97
ices. (A complete version of the current T &C may be viewed on the 19 5740 Surcharge or Delivery
website listed below) Upon service discontinuation, rent for the rorAE Fee (see #6 under
Leased Equipment is charged through the end of the billing evele "General
in which service is discontinued. c 1.um
I nformation")
6. You will be charged a monthly Oil Surcharge. Duel Surcharge or 9
Delivery Fee as described in your T &C Only one of these fees Pa stub nccouNT so Ac' Y .1 PAY THIS AMOUNT
will apply to each account. The fee that applies t0 War account �CCOUNt N0MBE0. PAY 3Y 5 qo
y01o0100
is stated on the front ofth ease
P e invoice. For further information l Iz3rseJa I MT. EN<EOSED
RIMING GATE
visit the websiie listed below or INVOICE NUM3E contact our customer service ooiooi
1z3 <�e >e
Cent P 000391049 2004 18
7. As food p bottled water is sub 04262112619 ect to the rules and _Amount due
regulations promulgated by the Federal Food and Drug 1111ooe
Ad m inisimtion (FDA)- 123Mams[ L
ICE MOUNTAIN WATER COMRANY Su vonr
,a„, °l U• +,li wares NOnn rm lM CI[Y, Sta[e 100
S. Your first invoice indicates the products delivered on your first EoRCOSr1MER5�vIGECA+c, -3� <7J -9833
delivery, along +vith any applicable bottle and account deposits, It 9 1 R, „e5 a ment by this
��a” e,
..a6,lal,d,.,Id.1,1,.1,.n S�ae. P v
redemption fees. and any dispenser charge,. All future invoices 1�9AC. "eeae P date
will reflect charges for water delivered and dispenser rental. bottle slG11P1 R1 [A
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
�w 1 1NH1 Add A1IAI13V 1N32mno 1N31IIIIJ1Siiw,
a, a Form No. NW 709 5/08
c r e
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))
10/06/09 0910117821082 $13.57
P�
i Q
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
a
IN SUM OF
P. O. Box 856680
Louisville, KY 40285 -6680
$13.57
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Member
2201 0910117821082 42- 389.00 $13.57 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the �f
materials or services itemized thereon for TM
which charge is made were ordered and
received except I c
Friday, October 09, 2009 7
1 01 ix 9 Street Commissian
Street Cmenissioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund