170434 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $12.97
CARMEL, INDIANA 46032 PROCESSING CENTER
PO BOX 856680
CHECK NUMBER: 170434
LOUISVILLE KY 40285 -6680
CHECK DATE: 4/1/2009
&!PARTME NT ACCOUNT PO NU MBER INV OICE NUMBE AMOUNT DESCRIPTION
2201 4238900 09CO11925282 12.97 OTHER MAINT SUPPLIES
�K'
720106
0 02/13/09 3/12/09 09C 19252823
#215 6661 DIXIE HWY, SUITE 4 LOUISVILLE KY 40258
service.icemountain.com P &Amgg
THU- MAR 19 0119252823
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N- MAY 18
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#0400001192528234#
CITY OF CARMEL STREET DEPARTME Customer Service: 1- 800 472 -9888
BONNIE CALLAHAN
3400 W 131ST ST Did you forget about us? Kindly pay upon receipt.
WESTFIELD IN 46074 -8267 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.
Fperd elivery. SAVE on a variety of Ice Mountain products! Take an additional $3,off.on Half Pint, 700mL, 1
Pod, Perrier 1/2 Liter plastic and San Pellegrino Sparkling Fruit beverages. Limit 6 discounted cases
Call 800 472 -9888 or go online TODAY!
ACCOUNT ACTIVITY Pay your bill online at: service.icemountain.com or by phone at: 1-800-472-9888. Its free!
Delivery address: ,2 46032
PREVIOUS BALANCE 38.72
2/22 586484 PAYMENT -THANK YOU -19.19
2/19 0607154580 2 5 GAL ICE MOUNTAIN DRK W /HANDLE 6.98
2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00
2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -12.00
3/12 0611912056 1 OIL /FUEL SURCHARGE, 2.00
C7248371 RENT 3.99
TOTAL 32.50
ACCOUNT Stlfr4MARY PREVIOUS BALANCE a PAYMENT /ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
,S r gubject to terms on reverse side. 38.7? 19.19 12.97 32.50
BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP OS SERVE YOU BETTER
IN CASE OF ERRORS OR QUESTIONS ABourYOUR 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 INFORN1AT ION. 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 AC your first invoice will include a pro -rated fee for the current month, plus the next month's rental.
ICE DioUNTAIN SPRING tvATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash.
P216 If you prefer, you can pay your bill online at service.icemountain.com.
6661 DIXIE HWY- SUITE 4
LOUISVILLE. K)'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. \ve
must hear from you in writing error than thirty (3(1) days after w
SAMPLE I N V ®NC E
sent you you the first bill o which the he m error or proble appeared. You ca n
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.
l'ou are obligated to pay the parts of your bill that are not in question. ,2 34se Your Account Number
)'oil do not have to pay the disputed amount while it is being r oolooloo oolooloo
investigated. During the investigation. we cannot report your account
as delinquent or take any action to collect the amount in question. mR -OCT o4
12345
MO &OCT 29 Watch here for a
wED NOV 11
GENERAL INFORMATION DJ1 DEC personalized account
I. Payments received after the billing (INVOICE) date will appear on Important II 11 111 111.. IIIIIA, nllll.LIIIL,IIIII „II,.II,LIII customs Services BOD .1�u888 messa g e
vour next invoice. past due invoices (not paid within 30 days of news and I x yin 1e MOOmala pr
billing date) may be assessed a late fee as allowed by law not to offers l ii3 sl ana.eMa
exceed $20 per month. Additionally, third party collection /attorney oLy.st.te DDOOD
I..dll,I. ,11,,,11 „1,11 „1,,,1,1,1,1.,1 „11
expenses may be assessed at a rate not to exceed 100% of the
2. Eah un balanc
heck is subject to t o L se b e subject to the r 1 M 9eYa �.m ,aav�^�9^a ^,o�aucn upemin9 Pay electronically
adHenes.oae fiom ouewid
maximum check return charge allowable in your State. 1 wa Make sure this
3. All bottle and equipment deposits are shown as CURRENT Activity.
'flVl'fY. bl amount has been
AC
since your ACCOUNT ACTIVITY c s ale
4. Equipment replacement costs will be charged for bottles lost, 123
last invoice ceI yAeaesa: bA ^DpeMai aa000 paid in full to
s y g
stolen, damaged or not returned. P,e,,e^�ealame Saw avoid late fees
ravme rnan wa,e� soon
5. In accordance with NWNA's Terms and Conditions T &C your oerJl ab,e9a s�anon Naw�al sp ^9 so.on
9111 J17005 5 I[e Mountain Seal Deposit 96
Equipment Lease and/or Service Agreement account may be Jvaas144aa s I�eMnNn,ainsaa,ReL�m „s9 Monthly Oil
0911, 61a444 RentSu«aar9e
subject to minimum monthly purchase., and /or early cancellation J,Ta0
ogt1z J a b M Surcharge, Fuel
fees. (A complete version of the current T &C may be viewed on the o9�IJ '401' s,w Surcharge or Delivery
website listed beloly) Upon service discontinuation, rent for the TOTAL Fee (see #6 under
Leased Payment stub Equipment is charged through the end of the billing cycle PM
"General
in which service is discontinued. "uRUM "ten 577ao
Information
6. You will be chareeLi a monthly Oil Surcharge, Fuel Surcharge or o oo. 9
Dellvery FCC its described III your T&C. Oniv one of thes fees Pa ACCOUNT SUMMARY 99
y T PAY TH,S OUNT
will apply to AY BY each account. The fee that applies to vour account ACCOUNT NUMSER aA,'Y 174o
E
123406 MT.
ENCLOSED
DATE i stated on the front of the invoice. For fitnher 090 SU, infbrntation please 3,ue NO
INVOICE NUMBER I o1�100
visit the website listed below or contact our customer service ,234sb7 I L_
CClCr. 42OD963D� D,262?12619 D003910V9 20D4 18
7. As s product a food roduct, bottled water is s ub j ect to th o
e rules and Amount due
regulations promulgated by the Federal Food and Drug Innn D«
Administration (FDA).
ICE MOUMAN WATE�C�M AN 1 y s tate OODnO
pµd Nnwnm
8. Your first invoice indicates the products delivered on your lust D STDMERSERmcECALLIeIxi+77 -96ae Submit your
delivery, along Evith any applicable bottle and account d.. IIL.,.. IL,.. IL..11 Ia „I,
t deposits, payment by this
I,Al1A,„,.J,1,1,1 „1 „�I�eu�e NOR pm, "meN�Re,,,��;,•.
redemption fees. and any dispenser charges. All future invoices es date
0, ur EoRr aEUU7oMr�v9 ^ur
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. )on 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))
03/14/09 09CO119252823 $12.97
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
VOU)CHER WARRANT NO.
ALLOWED 20
Ice Mountain
IN SUM OF
P. O. Box 856680
Louisville, KY 40285 -6680
$12.97
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 0900119252823 42- 389.00 $12.97 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
Friday, March 27, 2009
ner
Street si
W 1
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund