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212628 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CARMEL INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $51.17 , PO BOX 856680 «o„ CHECK NUMBER: 212628 LOUISVILLE KY 40285-6680 CHECK DATE: 9/12/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4239099 13 . 57 02H0121776199 2201 4238900 37. 60 OSH0117821082 service.icemountainwater.com #215 6661 DIXIE HWY,SUITE 4 08/01/12-07/31/12 02H0l17821082 n LOUISVILLE KY 40258 ` e ADDRESS SERVICE REQUESTED g ® o MHUNNIM III��II II M111 H N MO SET 14 0117821082 MON- OCT 15 MON- NOV 12 THU- DEC 13 Customer Service: 1-800-472-9888 CITY OF CARMEL STREET DEPATMENT Pay your bill online at:service.icemountainwater.com or 3400 W 131ST ST by phone at: 1-800-472-9888.It's free! CARMEL IN 46074-8267 IIIIIII�IIIIIIIIIIIIII'lll'I111111'llll'l 111"'I"II'lll��l�lllll �.'„ �, si+F' L '-' '.: ,�sY- r. ;`;"` %^,� - .,�: ;r:'.µ-:'�r•'r,- �:x<rs'• v.»:..-:, �� r� ,r,. $ave�novlr4lirough 1:0/31%12fon�cases:o FTRADE'1NINDS�Caris At dust°2 cases foc9.$13 ,you can mivand;match..e� --�'' r .;Kdr.,w.gr„s� � ,�'e`r,�� ,«"' r Mom.- ..: � �'r„�vz�_.. . ,�:..,Z. {{}fr,oiti a,varletyaof refreshingJ1aV,ors".-Offer=includes- casesyof ARIZONi9►Arnold P,a-finer.>' Ca11�=1=800=472,-9888 or {` ':,% .:._ ,`izb'"�,. �.•�:r."'�"'"; z'e+;-a ..F,,r. I�ogxonto.se rvice.icemountainuvat r ^ :y- ex d s S•t_s Jr„ w e .com=toFaddto. o.ur.:-next.:d"elive - Ykz.' __ �� nXva�` z:" F6 '"" deF, ; a" - _ - ::':�u� �ur'°,:,,^-. »��� ,,•, s yr'Y, la-"r".-°.':W_.�.•;,,+.°✓�s ." .,6?' ''-� ,° ""rte`%:v.:srz;'_..,'"rrCd.�' .,..,.,°�f" '>>.°v` '';::rf,"'ya-'...,�r•''�r+'` .'.'c::.a;;�r''. _.,F,s '" ., ""�q �.M,v'-t,^'• NO r'„.•;� i'✓,rf�'"� � �.l,I' re"r'ro .E'n's,�'��r_J�6.s�-'� =,; " YA.a ACCOUNT 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 STREET DEPARTMENT,3400 W 131TH ST,CARMEL IN 46074 PREVIOUS BALANCE 8.43 8/26 331402 PAYMENT-THANK YOU -8.43 8/15 0789428653 3 9 OZ PLASTIC CUP 50C/SLV 9.87 6 5 GAL ICE MOUNTAIN DRK_W/HANDLE 20.94 6 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 36.00 6 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -36.00 8/31 0792913543 1 OIL/FUEL SURCHARGE 2.80 H3114782 RENT 3.99 TOTAL 37.60 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 8.43 — 8.43 + 37.60 = 37.60 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 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 �� a ®� sent you the first bill on which the error or problem appeared.You can �1 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. Iz3as6re90 Your Account Number You do not have to pay the disputed amount while it is being I ooroor0o-00100100 investigated.During the investigation,we cannot report your account 123456789 as delinquent or take any action to collect the amount in question. THR-aT 04 MON-aT 19 Watch here for a GENERAL INFORMATION WED-MD 31 NE-oEC 10 personalized account 1.Payments received after the billing(INVOICE)date will appear on Important ILp,»I11.11Ldltlld»dltlddh.6.�dlttl"K»IWdtl Cusromer Sem<e 1-BOU'II3-900 g your next invoice.Past due invoices(not paid within 30 days of news and ,Hank you for u.l�l<•M°"n,aln pr message billing date)may be assessed a late fee as allowed by law not to offers 1iz M sE ana.er•I<.. exceed$20 per month.Additionally,third party collection/attorney C,S1.1e 0000D 3 I1, expenses may be assessed at a rate not to exceed 100%of the .,,,..»-.---- f""'' ',` ^''-, ;,,QescoM9'yr,•�`7�,s;..".. ° "^' «rosM {otl»" w Pa electronically unpaid balance or the maximum allowed by law. �-;rr�"x�; �„n,> : �,,TfraaKaie;�PY°"F=., t�;��;'%::= Y Y 2.Each returned check is subject to a service charge subject to the ;;��,d�;,"'<r,�^10�'"d"'�'''� orsR?a"°u..'"?�""r` ✓' " -`.;'"' J g J maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity '''r_'.'.�.„,�..- "`✓'�F`�'• ^°""°°""`°°"t'� ACTIVITY. since our AccouNTACr1vnY °.< R• """" amount has been P g Y 0,1, ryAddr�a:/ohno»e,113Mmnsveeco,r.5�'a0°°°° ,199 paid in full to 4. Equipment re replacement costs will be charged for bottles lost, .n99 last invoice stolen,damaged or not returned. P,eeioua0alan<e 445 avoid late fees 1 5.In accordance with N WNA's Terms and Conditions "T&C your 5 rmmen`- -SO ( "), 00/31 401890 SGallonN ural5pnng Warer 50 Ill Ice Mountain SGal pepue Equipment Lease and/or Service Agreement account may be /„ 3178851M4a 99 317N514aa4 i CeMoun,alnSGalReam _ „ Monthly Oil subject to minimum monthly purchases and/or early cancellation Z 317MI M F„els"1<na,9='•,` g .j12 „R,6 W„ Re t Surcharge,Fuel fees.(A complete version ofthe currentT&C may be viewed on the o9 1 1n +�"'°°" ,.,: ; _ Surcharge or Delivery website listed below)Upon service discontinuation,rent for the TorAE - Fee(see#6 under Leased Equipment is charged through the end of the billing cycle 11 General in which service is discontinued. e, "rnmr = P"rT"""s°7;o 1 M I +`° `N 7 0 Information") 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or aa,A 99 - MARY 99 Delivery ee as described in our T&C. Only one of these fees Payment stub ACCOUNT"u ° _.4. •»a• ------------ rY Y Y Y - --- PAY THIS AMOUNT will apply to each account. The fee that applies to our account _" ___,g„„ �*- PAY By PPY PP y a - -- ACCOUNT NUMBE0. 00/00/00 5740 is stated on the front of the invoice.For further information please 1z34s67R90 .1u,C DATE MT.ENCLOSED NUM /OOr00 visa INVOICE the website listed below or contact our customer service ,13456789 BER 0 center. 7. As a food product, bottled water is subject to the rules and 0,20°96307 44202712619 4443914A9 2°°" 10 Amount due regulations promulgated by the Federal Food and Drug 1.Hn D- Administration(FDA). IcEMOUNFaNwATERCOMPNV �„'ys[atestowoo Submit your 8.Your first invoice indicates the products delivered on your first •°""°" ryoM1S� FOR CUSTOMER SEMICE CALL I-BOO4R 9808 payment b this delivery,along with any applicable bottle and account deposits, 1_dna d»ab»�d4»•la°a.4a"L.66W,d.a e ❑P n ena,y+p^n�"e,+•S�ae P Y redemption fees,and any dispenser charges.All future invoices NroP"YlSgnupR<9�I,aao�P�e„°5d date will reflect charges for water delivered and dispenser rental,bottle E3 S,G„oPFORFREE” 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 O service.icemountainwater.com INC- VOUCHER NO. WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF $ P. O. Box 856680 Louisville, KY 40285-6680 $37.60 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 2201 I OsH0117821082 I 42-389.001 $37.60 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 f'Friday,/SApte 'ber 07, 20012 ,rY f r� �, �U`t't�v ► .ii Street Commissioner Yr Street GFtle; ,.iss;orier Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 09/04/12 OSH0117821082 $37.60 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 service.icemountainwater.com ;e IT MIA"� A #215 6661 DIXIE HWY,SUITE 4 08/01/12-08/31/12 02HO121776199 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED ® 9 THU- 04 0121776199 NOV THU- NOV 01 TUE- DEC 04 MON- JAN 07 CITY OF CARMEL HUMAN RESOURCES Customer Service: 1-800-472-9888 JIM SPELLBRING Pay your bill online at:service.icemountainwater.com or 1 CIVIC SQ by phone at: 1-800-472-9888.It's free! CARMEL IN 46032-2584 y 'q` ^% �, a9 �: ,r, ,;vrx -✓, 9<*.'ter" `°.. x:rr Sa"venowtxh ounnyh°1073>1'/12`onuses'ofTRADEWINDSCans:At''ustt2n cases`for->$13w°oucan"mlxand`match" ';av '.,,•..w�.t n = h^1':.3t//`�b`.,5,,-'�.`"Y8`S�*ses....oT�.-lx ';',. �,..c:,_,,f. �j..r,,;St4, 2`;'i' °O,,t 'gym,„ ;,< r,��^, x,•,�,�,da.,...:,.:,r,..rx„:���”r , o-Ka<variety.:of#refreshing flavcirs:;OfferrtncluciesEcases of ARIZONA Arnold Palmer Gall 1 8005-4.72-9888 or, • ' ...'°,r` .z. "",;o9a:....':x /` «�>tv:,,''"✓,3�.,; "a.; c,r tr.oaa_.,-a>.f",i ad' �t�o. ].. -;e;t.!.>..'r .,_K"�.�f J.,�,."u."-iy°'^°er. '✓..',x1';9F°,✓« f�,r>»�e?f°e,'-:x n...,w:.�,i✓1l1v.''9-� �>;-, rerr>�4 _ 1icemounainwater m tontoseruic '-'""� ✓ ,,�.'^s`i� ,a.it °�qy>. "',,..: '.� �, r=�°r�r:.�'"'° z ��'��"r, r ^"»w ��,,�F e,'✓�"..,;' ':,?��`�:;°, ..:•4F:°.a>'*s :sd. p�B S:� "" d -�y.w. 'rr,f>»'.;..''Irr>x.-��r ". >`r"tr;.�"a,'4•°�, .°';r,.r,>:. r'`° '.; =`x_: '�`' �' °>q^a.r�,-s`.,=-.°�x":•,9y �!r ra.:�,v,>.,s a` ° :'�'�'i^�'✓•F �y�``dy c�.rt. x,r:!`n. _..>,.>.arff� r.��'x" - i F> S°;vO ,aR- . ..; �;'�:�.,xr.�: •n'�.�,.„s.b.a�,�� �°" ;6r�':»>., ;s,T,a.,�._,.._�����..�',su.,;i"z' '; .":•P"'X°s:,-':''>.:�`-,F., y_x:>;'8,.,r`,�'_�"_'��,.'6_`'�?�L�?.^.�c-.:�..'��'>T�t:��-.-',_:fd,.;._,�',:, 4 ,r,! �,.,� ""^:,r" •�. y yew �,, {'+ -%='"" ."r'��'; �_lzfi;lf�`"«, _>,s�=�«:l';s.. :„3�r�-'td�:__ .i��".Fs',.�` ;'�r;.e�>k�j.; ".�� -;"..;� ?'�p ::>„f��''#';�='a;.t t�dLs"'� `r.�•<s i.- ;F`. .x`:: ,.x> -> •s.>dls,'M .a-r.�`( „» '. 'o'z`x. i<>Ya^sYtt.;_..” .r1:r r.-..".�r. "'?"'rt+"V.'+.` 1,�'»`.s»;r ..•afts."1�'i'"7�;"aa<`r.i .: �rr'<:: r,r:� > ACCOUNT 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 CfVIC SQ, HUMAN RESOURCE DEPT,CARMEL IN 46032 PREVIOUS BALANCE 13.62 8126 331405 PAYMENT-THANK YOU -13.62 8/06 0787816347 1 5 GAL ICE MOUNTAIN DIRK W/HANDLE 3.49 1 9 OZ PLASTIC CUP 50C/SLV 3.29 BOTTLE DEPOSIT: 1 CHARGED, 1 CREDITED .00 8/31 0792963654 1 OIL/FUEL SURCHARGE 2.80 H3119585 RENT 3.99 TOTAL 13.57 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 13.62 — 13.62 + 13.57 = 13.57__ 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 1-800-472-9888 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 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 SAMPLE INVOICE 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. ` 3z3as6�a90 Your Account Number You do not have to pay the disputed amount while it is being I Do/00/oD-00100100 investigated.During the investigation,we cannot report your account as delinquent or take any action to collect the amount in question. mR a,�, 123456789 MON-OCT 29 Watch here for a WED NOV Z, GENERAL INFORMATION nE-DECtB personalized account 1.Payments received after the billing(INVOICE)date will appear on Important 1-eOp.a72-9898 Itn„dtl»nGdaIL6^nll.Wa6»dttp»axlWda C»��^mn$e"". message your next invoice.Pas[due invoices(not paid within 30 days of news and T1�anEY^ufaru�^9heMcu^ui^vim g billing date)may be assessed a late fee as allowed by law not to offers iii Will$1 exceed$20 per month.Additionally,third party collection/attomey orys,ale a�00 ow,stlte - expenses may be assessed at a rate not to exceed 100%of the s.%..,;- "tati ,„,wov<. iH;«um9aTz,: a zFr unpaid balance or the maximum allowed by law. P;rro,n.. tR^N r«;;,� �M,,,B -k ., .,; iry^ j;�� Pay electronically 2.Each returned check is subject to a service charge subject to the a, Bi°�"`' x"'. '' 1 J v"ka,a`?T :tb'°%'.;�' „tl�r=�..� maximum check return charge allowable in your State. T.1,t,.,P.p �" Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity ' '.,.'.'' -- ,a.«.,-�•^••-•"'�"'° °'"""°°" 6, amount has been ACTIVITY. since your ACCOUM ACT IVEIY 123"a 511 e-Ory,St 00000 ,t.99 aid 4. Equipment replacement costs will be charged for bottles lost, oei„�rypaaress'ia+^ p in full to last invoice stolen,damaged or not returned. som avoid late fees payment-TynEVOu 5.In accordance with NWNA's Terms and Conditions("T&C"),your Bem .6,e98 s6aiw^Nagai sc""e'Y"n -soap 3naBStaw s iCaM^ scaiDePO9" '� Monthly Oil Equipment Lease and/or Service Agreement account may be /„ 3vafis114N 5 meMO�^a,n5Ga1Ret +"' wn, 3,2ees,aaw wei w,Cna x' �. }'�`t, ' ' subject to minimum monthly purchases and/or early cancellation Surcharge,Fuel fees.(A complete version of the current T&C maybe viewed on the Re” .- n"0 ;;' _:;: Surcharge or Delivery 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 "General in which service is discontinued. "`""°"� - •..,N�s° ° Information") 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or e.E9wa.MANS , ACCOUNT SUMMARY 1199 Delivery Fee as described in your T&C. Only one of these fees Payment stub ._ _____-- PAY BY PAY 11116 AMOUNT will apply to each account. The fee that applies to your account "-•°°, - „,e�,«•wm••^x'•! ACCOUNT NUMBER s2 ao is stated on the front of the invoice.For further information please INVO °°••°"""N'� 103+,62890 B0LNG DATE MT.ENCLOSED KE NUMBER �I /� visit the website listed below or contact our customer service 1230567890 center. 7. As a food product, bottled water is subject to the rules and 0420096307 04282712619 00°391049 2004 1B Amount due regulations promulgated by the Federal Food and Drug J^n^Doe Administration(FDA). ICE�MOUr=.r ,A E'CCOM'AN',- C,y'De OD, 8.Your first invoice indicates the products delivered on your first '"°R"" uu�ao-o:_9eeB Submit your delivery,along with any applicable bottle and account deposits, w"c"nDMER"RvICE - payment by this t.aa,4. :alN6a,.t.»t,w°bd»a s� redemption fees,and any dispenser charges.All future invoices date mopArs9•ape•9o^"•�"' __-. 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 service.icemountainwater.com VOUCHER NO. WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF $ PO Box 856680 Louisville, KY 40258 $13.57 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 02H0121776199 42-390.99 $13.57 I 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 Monday, ptember 10, 2012 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 09/04/12 02HO121776199 $13.57 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