208735 05/10/2012 CITY- Or-CARMEL, INDIANA VENDOR: 051125
ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $10.36
CARMEL, INDIANA 46032 PROCESSING CENTER
PO BOX 856680 CHECK NUMBER: 208735
LOUISVILLE KY 40285 -6680 CHECK DATE: 5/1012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4239099 10.36 1207220327048
service. icemountainwater.com
0 Q 215 6661 DIXIE HWY, SUITE 4 04/01/1204/30/12 12D7220327048
LOUISVILLE KY 40258
ADDRESS SERVICE REQUESTED
RI I� I ��I� IBM I I I I I �I M MOD- MAY 07 7220327048
WED- JUN 06
FRI- JUL 06
MON- AUG 06
CITY OF CARMEL OFFICE OF THE CLERK TREASURER Customer Service: 1- 800 472 -9888
ANN DAVIS Did you forget about us? Kindly pay upon receipt.
1 CIVIC SQ Remember, past due accounts are subject to a late fee.
CARMEL IN 46032 -2584 Your prompt payment is appreciated. For your
convenience, pay online: service. icemountainwater.com.
If payment has been made, we thank you.
;RS hingiDrinks- Refreshing Savings For a limited tune, enjoy $:1off'seleccasesof TR DEdUIR1DS 8�,
LEAF Beverages With °prices this'cool; bring on the heat!Log onto service icemountainwater com or 72 004 9888 to�add to o next ofder! Offer ez res °7 1/12._
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ACCOU ACTIVITY For questions or a report on water quality and information, call 1.800- 472 -9888 or visit service.icemountainwater.com.
Delivery address: CITY OF CARMEL, 1 CIVIC SQ, CLERK TREASURER OFFICE, CARMEL IN 46032
PREVIOUS BALANCE 16.90
4/05 0769882903 1 5 GAL ICE MOUNTAIN DIRK W /HANDLE 3.49
1 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00
1 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00
4/30 0774767719 1 OIL /FUEL SURCHARGE 2.88
D2536754 RENT 3.99
TOTAL 27.26
ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
r Subject to terms on reverse side. 16.90 0.00 10.36 27.26
1
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- 800472 -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 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.icemountainwater.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
sent you the first bill on which the error or problem appeared. You can SAMPLE INVOICE
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. ,z34s678 I Your Account Number
You do not have to pay the disputed amount while it is being 00/001DO 001 too l
investigated. During the investigation, we cannot report your account
as delinquent or take any action to collect the amount in question. TM8 a 123+5678
NDN -a z9 k Watch here for a
GENERAL INFORMATION VIED
,vE -DEC ,B personalized account
1. Pay received after the billi INVOICE date will a p p ear on Important dU c,nw�K• x ,.g00.e72-9 888 t
Ym g( PP 14tldtl.I6da keMaununm^�R• j message
your next invoice. Past due invoices (not paid within 30 days of news and Tt,•�EY°"
billing date) may be assessed a late fee as allowed by law not to offers 123M11- St
exceed $20 per month. Additionally, third party collection/attorney C',S`pte O DOW d6„tl 6a 4 6u64d -o
6da,Wd«a6
expenses may be assessed at a rate not to exceed 100% of the
unpaid balance or the maximum allowed by law ta.y„„.^�"„'" "Q` s3 rk Pay electronically
2. Each returned check is subject to a service charge subject to the
maximum check return charge allowable in our State.'`
g Y Make sure this
3. All bottle and equipment de oasts are shown as CURRENT Activit
P amount has been
,zn
ACTIVITY. since your Ac couNrACT 11 ni 1
r6a msR�.crost�tp ppp00 ,1.99 t aid in full to
4. Equipment replacement costs will be charged for bottles lost, last invoice D d "`„Mdress nDOe 1 p
stolen, damaged or not returned. ik avoid late fees
5. In accordance with NWNA's Terms and Conditions "T &C your m/3, m,e9e s 1 c,�woN.vuNisp�� 9w 5000
ui merit Lease and/or Service Agreement account may be s ums
Equip
9 P g y m 31=" s r6wou,,,sc+�xe Monthly Oil
o9n, s ums«+. w Nw,n,, 9•t (';t S Surchar Fuel.
subject to minimum monthly purchases and/or early cancellation 318263m„ rg
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 TDTe,. €t Fee (see #6 under
Leased Equipment is charged through the end of the billing cycle
General
in which service is discontinued.µ „w i
I Information")
6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or 99 Sej
Delivery ee as described in our T &C. Only one of these fees P stub ACCOUNT SuMMABY .,c E «w
rY Y Y Y Tern nAM
will apply [o each account. The fee that applies to our account vAY ev
PP Y PP Y w •°��«u b^ c ACCWNTNUMBER .B
DO
is stated on the front of the invoice. For further information please 123/567890 ENCLOSED nrvoicT
,,;,167890 wwNCDATL
visit the website listed below or contact our customer service 00
center.
7. As a food product, bottled water is subject to the rules and 0 20096307 04262712619 000391 2pp° 1B i Amount due
regulations promulgated by the Federal Food and Drug w�
Administration (FDA). ICEMWNTNN N•� WATE0.CJ,OMM� K ay.s�U000B
Submit your
8. Your first invoice indicates the products delivered on your first -gem
delivery, along with any applicable bottle and account deposits, payment by this
6 dYd.. L, a6, .,J6.n.,11.6a..6.6466d.a date
redemption fees, and any dispenser charges. All future invoices
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 Nestle Waters North America Inc. Form No. NW 709 11/08
4 service. icemountainwater.com
Prescribed by 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.
I Paa l yee
r I r (.0 j L A l Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
ta3
ON ACCOUNT OF APPROPRIATION FOR
I #t D�tia�
i c) Board Members
PO# or D EPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
I D �d bill(s) is (are) true and correct and that the
'10 materials or services itemized thereon for
which charge is made were ordered and
received except
f 20
A r
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund