176790 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 357977 Page 1 of 1
ONE CIVIC SQUARE ICE MOUNTAIN
CARMEL, INDIANA 46032 P O BOX 856680 CHECK AMOUNT: $26.05
LOUISVILLE KY 40285 -6680 CHECK NUMBER: 176790
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 09HO11925282 26.05 OTHER MAINT SUPPLIES
720806
i► R e 0 E�
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service. icemountain.com
WED- SEP 16 0119252823
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I 15
FR
I- NOV NOV 13
#BWNNWYR WED-DEC 16
#0400001192528234#
CITY OF CARMEL STREET DEPARTME Customer Service. 1- 800 472 -9888
BONNIE CALLAHAN
f 3400 W 131 ST ST Thank you for choosing Ice Mountain Home Office
WESTFIELD IN 46074 -8267 Delivery! We value your business.
Have you gotten your SAVINGS ADVANTAGE? Put two or more cases of Ice Mountain 1/2 Liter in your'My
Regular Order' and pay just $4.99 case -DELIVERED! Call 800 472 -9888 or visit www.icemountain.com to take
advantage of the new, lower prices.
i
ACCOUNT ACTIVITY ay your bill online at: service. icemountain.com or b phone at: 1 -800- 472 -9888. Its free!
Delivery a ress:
PREVIOUS BALANCE 48.90
8/13 532930 PAYMENT -THANK YOU -52.89
7/17 0629711730 6 5 GAL ICE MOUNTAIN DIRK W /HANDLE 20.94
6 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 36.00
6 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -36.00
1 9 OZ PLASTIC UP 50C /SLEEVE 2.99
8/12 0635042674 1 OIL /FUEL SURCHARGE 2.12
H7957636 RENT 3.99
TOTAL 26.05
ACCOUNT SUMMARY PREVIOUS BALANCE a PAYMENT /ADJ ►ISTMF.NT C VITY PAY THIS AMOUNT
to terms on reverse side. I 48.90 52.89 30.04 26.05 �s
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HUP 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.
#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 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 SA MPLE I NVO ICE
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. 123456]890 Your Account Number
You do not have to pay the disputed amount while it is being A 00/00/00 00100100
investigated. During the investigation, we cannot report your account 2
23456
as delinquent or take any action to collect the amount in question. me 00 w
O T 29 Watch here for a
GENERAL INFORMATION NOV 2,
TdE. oK IB p ersonalized account
I. Payments received after the billing (INVOICE) date will appear on Important
II, 11,. �III��III�AIIILL,. IIII,I,1111,..,11111 „11 „IIA,III c w sere: l BOe 4]29888
your next invoice. Past due invoices (not paid within 30 days of news and T1„nEy«•'°< °y"
M°unuln Pr"duc,• message
john Dce and service
billing date) may be assessed a late fee as allowed by law not to offers to Maln s,
ocv, Rate 00000
exceed $20 per month. Additionally, third party collection/attorney
expenses may be assessed at a rate not to exceed 100% of the
unpaid balance or the maximum allowed by law. �Y� a .�+w�^"°ppn 9 Pay electronicalh'
T naN5e Y IDMFOthY „ymuch. TUCM1mPrtl
2. Each returned check is subject to a service charge subject to the
maximum check return charge allowable in our State.
b Y Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity
ACTIVITY. amount has been
since your ACCOUNT ACTIVnV Ma1n 5, Y 51PU
4. Equipment replacement costs will be charged for bottles lost, •DeliveryAddress'. tonnoue. C paid in full to
last invoice 9
stolen, damaged or not returned. avoid late fees
PaY^`ent.iNnkYw Water
5. In accordance with NWNA's Terms and Conditions ("T &C your 08n, )1 46,898 sGan9nw, °la's -moo
]885 6 ce MOU"TainSGal Dep��,
Equipment Lease and/or Service Agreement account may be 1 3 ,]ees,dw4 s '�CeM omamsGalBe,w^ Monthly Oil
9111
subject to minimum monthly purchases and/or early cancellation 09n1 m 3,e26 aes,4ua
1 aen ee Surchar Fuel
fees. (A complete version of the current T &C may be viewed on the 4 97 s,AO Surcharge or Delivery
websitc 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. <u e.1,.T +T. T
6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or y y our a Information
Deliver Fee as described in our T &C. Only one of these fees Payment stub ACCOUNT SUMMARY au.
Y oo� +•••o+owor"r. -0" v PAY BY PAY THIS AMOUNT
will apply to each account. The fee that applies to vour account _mo „a,„�„�„�,w+^�^' ACCOUNT NU MBER
5740
is stated on the front of the invoice. For further information please 1234567890 BIWNGDATE MT. ENCEoSEO
INVOICE NUMBER 00108100
visit the website listed below or contact our customer service 123456]89
center.
7. As a food product, bottled water is subject to the rules and 042aa96307 04262712619 00039 2009 1 Amount due
regulations promulgated by the Federal Food and Drug pnn o«
Administration (FDA). ICE MOUNTAIN wnrE eoPU a,v s 00000
S. Your first invoice indicates the products delivered on your first .a.:, NNE` Submit your
delivery, along with any applicable bottle and account deposits.
0 oe <0 5T0MEP5EBVI <E "T "'800,]z.9686 payment by this
1...III,1,.. „I ,e sm. Pnm n "rem�x+0^Be�e, :e s,e•.
redemption fees, and any dispenser charges. All future Invoices �5w0 P 8T 00..,59 "0P6.9�,.w0n 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 will reflect
two deliveries.
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))
08/14/09 09HO119252823 $26.05
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.
ALLOWED 20
Ice Mountain
IN SUM OF
P. O. Box 856680
Louisville, KY 40285 -6680
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 09HO119252823 42- 389.00 X8"0'^ I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
05 materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, Ay `st 27, 2009
r
Street Commissi
St reet (yi@&�issiorer
Cost distribution ledger classification if
claim paid motor vehicle highway fund