173371 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER
CARMEL, INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $15.96
PO BOX 856680 CHECK NUMBER: 173371
LOUISVILLE KY 40285 -6680
CHECK DATE: 6/10/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE N A MOUNT DES CRIPTION
1701 4239099 09E722032704 15.96 OTHER MISCELLANOUS
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t w o 720806 e 5/01/09 5/31/09 09E7220327048
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service.icemountain.com
WED- JUN 17 7220327048
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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.
NEW Savings Advantage! Ice Mountain Direct now delivers more savings than ever. Ice Mountain half liter cases
1 for as low as $4.99 /case Yes! As low as $4.99.a case DELIVERED! Call 800- 472 -9888 or visit
1 IceM ou ntainwa t er.com /service to take advantag of our new lower prices
ACCOUNT ACTIVITY Pay your bill online at: service. icemountain.com or by phone at: 1 -800- 472 -9888. Its free!
D LO R r
Delivery address: CITY OF CARMEL OFFICE OF CLERK, 1 CIVIC SQ, CARMEL IN 46032
PREVIOUS BALANCE 18.95
5/24 095355 PAYMENT -THANK YOU -18.95
5/18 0620668541 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00
2 5 GAL ICE MOUNTAIN DRK W /HANDLE 6.98
2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00
1 9 OZ PLASTIC UP 50C /SLEEVE 2.99
5/31 0623726676 1 OIL /FUEL SURCHARGE 2.00
E7532539 RENT 3.99
TOTAL 15.96
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER a
IN CASE OF ERRORS Olt QUESTIONS ABOU r 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 QUALI tY 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 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 WNIFER 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 LIWY.. 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 N
sent you the first bill on which the error or problem appeared. You can SAMPLE INVOICE
telephone us, but doing so will riot 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 ifyou can, why you believe there is
an error.
You are obligated to pay the parts of your bill that are not in question. 1234667890 Your Account Number
You do not have to pay the disputed amount while it is being j 00100100 -00, 0100
investigated. During the investigation. we cannot report your account •t
Ln� 1234567
as delinquent or take any action to collect the amount in question.
M N_aT 79 Watch here for a
GENERAL INFORMATION TUE OEC 21
DE. DEC IR personalized account
I. Payments received after the billine (INVOICE) dare will appear on Important il, rib ,nl „nni, „au•i,au ^,ann,dl „ua,m Nst«ne,'MOr.l- 800 <R -9888 messag
your next invoice. fast due invoices (riot paid within 30 (lays of news and
billing date) may be assessed a late fee as allowed by law not to offers �l i3Mn
aria .e,Mcev
exceed S20 per month. Additionally. third party collection /attorney �,r S.
1111.1,Illt a u.u,rnl 1 1 1 111 1. 1 .1 1 1 esp —ses may be assessed at a rata not to escead 100% of the
unpaid balance or the maximum allowed by law. y i aar« 9m „�iz'vwI x«w K 9 Pay electronically
6 Nra y dCCaWfI
2. Each returned check is subject to a service charge subject to the
aRrsnm
=4
maximum check return charge allowable in your State Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity l m^ amount has been
ACTIVITY since your ACCOUNT ArnwTy e 5� c r su1e 00000
4. Equipment replacement costs will be charged for bottles lost, Delnennmre I n paid In full to
last invoice
stolen, damaged or not returned. Pievi "p, Bala "a <:as avoid late fees
5. In accordance with NWNA'sTemms and Conditions "T &C" your saGallonNm ^alSpuin9'Ma1el so.o
Ill 117.11- S Ice MOUnuinsGal DeDgit 296
Equipment Lease and/or Service Agreement account may be I mses,a4°° s Mwnui psGalaet ,,.9s Monthly Oil
subject to minimum monthly purchases and/or early cancellation os 37 E°e's "'ma`ee Surcharge, Fuel
fees. (A complete version of the current T &C maybe viewed on the ov 'Wa 97 Surcharge or Delivery
website listed below) Upon service discontinuation, rent for the Tout Fee (see #6 under
Leased Equipment is charged through the end of the billing cycle "General
in which service is discontinued. NTaCmITy o °aPTX' y".4
1 n
6. You will be charged a monthly Oil Surcharge. Fuel Surcharge or ,a a a1e I n f orma ti on"
N, f n
Deliver Fee as described in yourT &C. Only One Of these fees P a ym ent stub AccouNTsuMMARV
3 PAY TNIS AMOUNT
ea.�+o�or___°M'" p ACCOUNT NUMBER oo
will appl to each account. The fee that applies to your account 57.40
e ��l „nl+nub.��e �e1u+n pp OOI0
IS stated on the front ofthe invoice. For further information please 1,1116789 0 BILLING DATE MT, ENCLOSED
INVOICE NUMBER oo,.fw
visit the website listed below or contact our customer service 123456789
center.
7. As a food product, bottled water is subject to the rules and 0420096307 04282712619 000391049 00” 1
2 Amount due
regulations promulgated by the Federal Food and Drug Ipa,D: in
Administration (FDA)' c"'S'e. ICE MOUNTAIN MATER COMPANY 131 Ma S[ BeB Submit your
ei rvn,lik wa,mr Nwu amnKa lrc. 00000
S. Your first invoice indicates the products delivered on your first FOR CUSTOMER stwic No., OB 779
y this
delivery. along w ,NNT6a�e=D
with any applicable bottle and account deposits• p ayment h
i... al, I,., t.. t.adl,a„da.l,i,.l,al s,a. P„^"R�us;ae
redemption fees, and any dispenser charges. All future invoices date 6I Nl,l r ,R Ea s" ^vRRm.4.30 "�.,x
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
L,vn.del;vecie> a�
96 91, 96'9 1 96'91 S6 91 apls esJanaJ uo swJel oI 1Defgr>
1NnOWtl swi Avd A11AIlOTd _N321Nnn1 +1N3W1snr0V /1N9WAVd 30NVIVS snOIA3Hd AHvwwns 1Nn000v
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.
nn �M 1 I A^ �j �Pa�yee
�WyvlW Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Y
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
F U
(A)6 UZ1(il r l
5, 9�,
ON ACCOUNT OF APPROPRIATION FOR
C� 31 oAq OkL4 L S�
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Qq 6 j um bill(s) is (are) true and correct and that the
1* materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund