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214686 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 0 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CARMEL, INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $62.19 PO Box 856680 CHECK NUMBER: 214686 LOUISVILLE KY 40285-6680 CHECK DATE: 11/2012012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4239099 13 . 65 02JO121776199 1701 4239099 13 . 65 12J7220327048 2200 4239099 17 . 75 02JO120048525 2201 4238900 17 . 14 02JO117821082 w" service.icemountainwater.com @ @ @ 0 #215 6661 DIXIE HWY,SUITE 4 e c LOUISVILLE KY 40258 10/01/12- 10/31/12 02J0117821082 ADDRESS SERVICE REQUESTED @ H111IHIN1) HIM IIII M11IH N TIHOU- DEEC 13 0117821082 WED- JAN 16 FRI- FEB 15 Customer Service: 1-800-472-9888 CITY OF CARMEL STREET DEPATMENT Did you forget about us? Kindly pay upon receipt. 3400 W 131ST ST Remember,past due accounts are subject to a late fee. CARMEL IN 46074-8267 Your prompt payment is appreciated. For your convenience,pay online:service.icemountainwater.com. If payment has been made,we thank you. °BS':,F+EL°y•E,<GR:xI:N•.--O ei,.,ia.:vF•: s s� ea � elebronsb 1 „axngon cass 0.'T ACQ=U A PAN:..N.,XAe reLady for all;t w ' e SAN P.>ELLEGRINOIDSPARKLING ll f BEVERAGES � PERRIER Call 1 800=472=9888:or"-I g T 12 1 onx9AserUice.ICetYtOUnfalnwateC 5otp, ',Ordt?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 STREET DEPARTMENT,3400 W 131TH ST,CARMEL IN 46074 PREVIOUS BALANCE 17.06 10/15 0798364626 1 9 OZ PLASTIC CUP 50C/SLV 3.29 2 5 GAL ICE MOUNTAIN DIRK W/HANDLE 6.98 2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -12.00 10131 0802144576 1 OIL/FUEL SURCHARGE 2.88 J3433143 RENT 3.99 TOTAL 34.20 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY Jc>,:yp Subject to terms on reverse side. 17.06 — 0.00 + 17.14 O BILLING RIGHTS SUMMARY YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETTER M 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. - Your Account Number You do not have to pay the disputed amount while it is being 00100100-00rop/Do rz3+sera90 investigated.During the investigation,we cannot report your account r ,Z3�sers { as delinquent or take any action to collect the amount in question. ,tin-ar a t Watch here for a GENERAL INFORMATION no-DEC;e ,�,rz,ssa personalized account 1.Payments received after the billing(INVOICE)date will appear on Important 4�•ilt0.t1•dIdJ9 cmt« a^a"" { message your next invoice.Past due invoices(not paid within 30 days of news and as m° 1A4m r„e„kYw„ "as"e billing date)may be assessed a late fee as allowed by law not to offers pi M�^st •M aa+ke• CitY.Stzte 0000 16LW,t�a exceed$20 per month.Additionally,third party collectiontattorney expenses may be assessed at a rate not to exceed 100%of the uy .�ecez4. „F ° a"H Pa electronically 2.Each rebtumed heckeisuub subject aosreerdvicelch a subject to the r� Y 1 1 t w dereq ; maximum check return charge allowable in your State. �' -°� :�;� � �:_.a-_' � Make Sure this 3. All bottle and equipment deposits are shown as CURRENT Activity - " a•"°""'�°""�M� 1 amount has been ACTIVITY. since your nccoutrr"c �r3 n S,� Cm• a pp00° paid In full t0 4. Equipment replacement costs will be charged for bottles lost, last invoice O�Ne^rd°'� mo stolen,damaged or not returned. e• avoid Tate fees 5.In accordance with NWNA's Terms and Conditions("T&C"),your m,eza Sw„�swkn'"'�' - ,._.._• jp10` ` Month Oil Equipment Lease and/or Service Agreement account may be ^, „reasu+" s eseaiaem,• *xjp1 f Monthly subject to minimum month purchases and/or early cancellation p3^' ? '� (�Irk.>I+ �"" f .xe� 1 monthly P Y „ t-0 s.:, •E -v� 'i Surcharge,Fuel 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 ,mra �.—__, ,. Fee(see#6 under Leased Equipment is charged through the end of the billing cycle i "General in which service is discontinued. .° " O = Information) 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or ,,,,.o� ,n..>a , °°- i Delivery Fee as described in your T&C. Only one of these fees Payment stub Account SUMMARY e.. MYTMSAMOUW ; will apply to each account. The fee that applies to your account _"_ ------ xccourrr Wont°EP `ar'r is stated on the front of the invoice.For further information please ' awn+c wrr "'CtOSM i visit the website listed below or contact our customer service 12r,567e90 apjao/0D S center. ' 7. As a food product, bottled water is subject to the rules and 0V20096307 0V2E2732619 000391049 2004 �� 1 Amount due regulations promulgated by the Federal Food and Drug �nOOe Administration(FDA). �MO,arrr�w„y,rra coMav+`' ,x3A V000ao - 8.Your first invoice indicates the products delivered on your first cm. o w. r_,k„ Submit your delivery,along with any applicable bottle and account deposits, ya•yt,6t,W.a rO""'O1AE4 � „�. payment by this redemption fees,and any dispenser charges-All future invoices `'�' smw,.w�rnae _- date will reflect charges for water delivered and dispenser rental,bottle „r„vronrNnoran 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. in Spring Water Company,a Division of Nestl6 Waters North America Inc. Form No.NW 70908/12 ainwateccom �.�-i�.� -�� ''• ,y„ J` °,� � �cct..p�r }� �r�s""`t fif 1�- ��t ,�,�� "�'�� ctl t z , t &W _ s VOUCHER NO. WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF $ P. O. Box 856680 Louisville, KY 40285-6680 $17.14 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 102JO117821082 I 42-389.00j $17.14 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 4 t Thursday, Noember 15, 2012 S., Sheet Comm ssloner 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)) 11/02/12 02JO117821082 $17.14 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 #215 6661 DIXIE HWY,SUITE 4 LOUISVILLE KY 40258 10/01/12- 10/31/12 12J7220327048 I 27W ADDRESS SERVICE REQUESTED ® $ e TUE- DEC 04 7220327048 MON- JAN 07 WED- FEB 06 FRI- MAR 08 CITY OF CARMEL OFFICE OF THE CLERK TREASURER Customer Service: 1-800-472-9888 ANN DAVIS 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 •.�, ;=s;' y °>. ". P through�--2731/12 :enjoy„savings xon c£aseS,OT?:A C.Q..:fiUA_RAi N N..F I rearlor-ali°thtsYOye?ar;s celebrations Now LEGRINO:SPARKLNu�rm-IT BE +P ., 4GES&±PERRIER#C Ili�1 x$00=4729888 0�10 ontasery cerlcemountatnwater:comto-order, today!: d �• _ . =.� » �.:�,;x. ��a�, g,� .": � s ...,;%' ;a9' � � ";� '�� `:,✓µ,�,'"'��..', r�. :�,.„c'`S''r`.%- rte' ~';::�N��:��,;:,,'�. <�',..,s^:, n ':�. — ��e Z .F»w 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 CIVIC SQ, CLERK TREASURER OFFICE,CARMEL IN 46032 PREVIOUS BALANCE 27.14 10/07 553005 PAYMENT-THANK YOU -13.57 10/21 644518 PAYMENT-THANK YOU -13.57 10/04 0796899409 1 5 GAL ICE MOUNTAIN DIRK VV/HANDLE 3.49 1 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00 1 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00 1 9 OZ PLASTIC CUP 50C/SLV 3.29 10/31 0802267963 1 OIL/FUEL SURCHARGE 2.88 J3478960 RENT 3.99 TOTAL 13.65 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 27.14 — 27.14 + 13.65 13.65 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 1-80OA72-9888 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. S You are obligated to pay the parts of your bill that are not in question. ' �rooro° lz3,sb7BS° Your Account Number You do not have to pay the disputed amount while it is being °°t0o100- t investigated.During the investigation,we cannot report your account t 2315678 as delinquent or take any action to collect the amount in question. TMB-ocr a MON 0C1 Watch here for a ,ffl�Mr z, GENERAL INFORMATION ur-°K,e personalized account 1.Payments received after the billing(INVOICE)date will appear on Important p�rmt;,,gp,►IS6:.1119+�•tW'� one sue"""-B0°O2- ..V message your next invoice.Past due invoices(not paid within 30 days of news and mom" 11-1Y"'°'"`b"k`Rw4.mm ° ? billing date)may be assessed a late fee as allowed by law not to offers 123 Mme- exceed$20 per month.Additionally,third party collection/attomey O,ys1a,e expenses may be assessed at a rate not to exceed 100%of the z�.� unpaid balance or the maximum allowed by law. - ;Rwaaa,Br,bPe'�^Y M,womm�A,d4 '"'DCOmtre •• :,, a Pay electronically 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity �:_� �" - -'e.•,+..•...�-�'�^°'°e, amount has been m .`_:.- ACTIVITY. since our ACCOUNrA�nTM` 'I'm y aa•zraN � paid in full to 4. Equipment replacement costs will be charged for bottles lost, cerMrvAeareuinO°`' ,ax+ last invoice stolen,damaged or not returned. „aa - avoid late fees m•�tvw 5.In accordance with N WNA's Terms and Conditions("T&C"),your „ a,7eas,w' s ,aAw4,m�nsrai ' Equipment Lease and/or Service Agreement account maybe �, 31788:,..« s SralRelum rn S �'o Monthly Oil subject to minimum monthly purchases and/or early cancellation �� Y ; nxz 1 Surcharge,Fuel fees. A complete version of the current T&C may be viewed on the xuu ( P Y lr'x, Surcharge or Delivery p i ry website listed below)Upon service discontinuation,rent for the Fee(See#6 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. Informations 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or Delivery ee as described in our T&C. On one of these fees Payment stub ACCOUNT SUMMA" ••-E __--------------- ry Y ty Y -- vAVM cAr mrs AMOUNT t will apply to each account The fee that applies to your account ___ •°�-•�� ,,. , wr^^•' ACCWW MUMBO ux* is stated on the front of the invoice.For further information please � 12MS67890 B wNe aen . W01U BER W/W rNC■osro 1 NUM Wt { visit the websi[e listed below or contact our customer service 1z31w7e90 k center. 18 7.As a food product, bottled water is subject to the rules and 0420096307 04282712619 000391049 2004 1 Amount due regulations promulgated by the Federal Food and Drug ioh„o� l Administration(FDA). i a MougrMN`"An„;°"FA cmu�S,00D00 Submit your 8.Your first invoice indicates the products delivered on your first roxcusroMrxsFmKr7+ delivery,along with any applicable bottle and account deposits, a„t,_ „a payment by this redemption fees,and any dispenser charges.All future invoices 4�' v" `��' 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 08112 service.icemountainwater.com Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) 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. M / `Paayyeee�/1 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) r 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 $ To �b � ON ACCOUNT OF APPROPRIATION FOR 6h& - Board Members PO#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT.# 2 I hereby certify that the attached invoice(s), or J f� 3A �D� ��j. bill(s) is (are) true and correct and that the 70-4 materials or services itemized thereon for which charge is made were ordered and received except 20 Signa re Title Cost distribution ledger classification if claim paid motor vehicle highway fund service.icemountainwater.com 0® 0 ' #215 6661 DIXIE HWY,SUITE 4 � � LOUISVILLE KY 40258 10/01/12- 10/31/12 02J0120048525 ADDRESS SERVICE REQUESTED 'I ' I'I II �I�I (�I III( �I IIII I I� TUN DEC 04 0120048525 MON- JAN 07 WED- FEB 06 FRI- MAR 08 CITY OF CARMEL DEPT OF ENGINEERING Customer Service: 1-800-472-9888 LISA SCOTT OR JUDY STOHLER 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 III'I'II'IIII'��"II�II��'llll'I'IIIII'II'll"IIIII„II,III�IIIII convenience,pay online:service.icemountainwater.com. If payment has been made,we thank you. Bereadyfor.allythisyeas celebrations `Now throughr'12%31112;enjoy avingsroncasesofACQUAPANNA `S PE LEGRINO SAN P,ELLEGRINtO SPARKLING�FRUIT BEYE9RAGES` PaERR1ER. Ca11 ,4 8 004. 2-9888 ar fo ' 'rm';x$,°'0�3.1`�di � `��".,=� '.€ " :onto serviceicemourtainwater:com'to'order°today) =° : X' nMA � a " P e rt .30TM0,,r., ca, ei^'.�.' :.� s�.�;_.'. t b."s° sad. r %- "�..� :> 'c '',� •"-"- sA �"�`,�.�" �.i .,<.r; .��r+3:.�.`.�° a<, d`vs - "s.,:; "d,'Fa'�f_'� � p�'�. �.,.�. c�-�-,:>..✓`�' ,Z''C.�:s ..: ,aa£ ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800-472-9888 or visit service.icemountainwater.com. Wall @11111 Delivery address: CITY OF CARMEL,1 CIVIC SQ, CITY ENGINEERING DEPT,CARMEL IN 46032 PREVIOUS BALANCE 62.82 10/07 553002 PAYMENT-THANK YOU -38.29 10/04 0796899185 3 5 GAL ICE MOUNTAIN DIRK W/HANDLE 10.47 3 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00 1 9 OZ PLASTIC CUP 50C/SLV 3.29 3 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00 10/31 J3447425 RENT 1®'e'1��13144�-7 3.99 TOTAL ^�� ��A42.28 � CEi?/ED tp to N 2'012 CARMEL tiN \ CITY ENGINEER Sever 08ZLZ�a'���b ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 62.82 — 38.29 -F 17.75 = 42.28 BILLING RIGHTS SUMMARY YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETTER IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL,OR FOR I. 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. You do not have to pay the disputed amount while it is being X100100' 00/00100 1234567890 Your Account Number investigated.During the investigation,we cannot report your account 1.t a3�5679 as delinquent or take any action to collect the amount in question. 10 -00 a ma+-ocr z9 Watch here for a GENERAL INFORMATION NE-oEC,e personalized account 1.Payments received after the billing(INVOICE)date will appear on Important L":dRG"tl ,tp c,,, 'S.,_,-"11'72-gee' _1 message your next invoice.Past due invoices(not paid within 30 days of news and 14d"�tl"66,IN6MtI0.1•� TI,NA,W'°'°hg"`"'�""~P���S i billing date)may be assessed a late fee as allowed by law not to offers �iiiN exceed$20 per month.Additionally,third party collection/attorney - °ry's"" ,tuadtMadtl^6^66 "tl, expenses may be assessed at a rate not to exceed 100%of the unpaid balance or the maximum allowed by law. - +art�Aa r« �b5y ;,,�„ymnw; ,._�., - Pay electronically "D C'YOwYa,GPC%ciY .,yi�aa9rz+un �in111rt,, ,. 2.Each returned check is subject to a service charge subject to the - saece>t�"` ,4etei+�Tia w'a"` F;, � •,YA. � maximum check return charge allowable in your State. = ", '-" ... ,._,_ , ' -'• '' ,' Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity `'°'" ;. - a°'•"'°°°"�M „ n � ° amount has been ACTIVITY. since your AccouNrArTn^^' J ,�,x,lRS cm sum oom aid in full to 4. Equipment replacement costs will be charged for bottles lost, last invOiC¢ peln"ryPda '0"x p stolen,damaged or not returned. "`"'�'1�n•«kTW ,I avoid late fees 5.In accordance with N WNA's Terms and Conditions("T&C"),your , ,meae S Wila,wmd slxlm'^'+K' �.—� xzxx I„ 3117=,... 6 keMw^"'"5"I° ` i w Month/ Oil Equipment Lease and/or Service Agreement account maybe �„ 3,rRes,RRa s .Mw"o,"scdRRR� / � }�'_ I y subject to minimum monthly purchases and/or early cancellation 09�" "eas"µ r•asuKNm• ......f'i3' $Sil 3;ex63ee1' '" E_..^. :.--, Surcharge,Fuel fees.(A complete version of the current T&C may be viewed on the 1' tbfii0"r u�- .,, , xx"" Surcharge or Delivery website listed below)Upon service discontinuation,rent for the F¢¢(S¢¢#6 under Leased Equipment is charged through the end of the billing cycle ' in which service is discontinued �.`uM�" mm, _ ,,,,,„„,,. R• j "General 6,You will be charged a monthly Oil Surcharge,Fuel Surcharge or „e,,,o„w..l.� --; - ,U.- Information) ACCOUNT SUMMARY x>LR% t Delivery Fee as described in your T&C. Only one of these fees Payment Stub --- RpY"ll AM UN will apply to each account The fee that applies to your account - "- ,,a,�,;, ,wwa^°"• ACCMM NUMBFR W 00 00 fur ul.rx i is stated on the front of the invoice.For further information please 123 563a9a e1WNG DATE T.ENCLOSE D Y visit the website listed below or contact our customer service IWOICE NUMaER oo/roroo E 12MS6re90 center. 7. As a food product, bottled water is subject to the rules and 00.20096307 00.282712619 00039100.9 2000. 1p Amount due regulations promulgated by the Federal Food and Drug J.h„o� I Administration(FDA). IcE Nral+wplEa oM 1,'ysiaE•S�a°40° ` 8.Your first invoice indicates the products delivered on your first Submit your payment by this SEwICEC'uE'd0e'rr delivery,along with any applicable bottle and account deposits, �®,4..Fw•6�-9 wRcUnoMER ❑ redemption fees,and any dispenser charges.All future invoices t"ttl't'"t�"a6•� e,R.w���^"°^"y5itle _._-_._.._....� date v�+,uv,OR FPFE w,oeRrt sy� �._ 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 08/12 Sr service.icemountainwater.com 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 Ice Mountain Purchase Order No. POB 856680 Terms Louisville, KY 40285-6680 Date Due Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s) Amount 11/2/2012 02J Water Cooler $ 17.75 Total $ 17.75 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. Ice Mountain ALLOWED 20 POB 856680 IN SUM OF $ Louisville, KY 40285-6680 $ 17.75 ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or 0 02J 2200-4239099 $ 17.75 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 11/19/2012 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund service.icemountainwater.com Immilligualm'Lai D al LIM64M W11 #215 6661 DIXIE HWY,SUITE 4 10/01/12- 10/31/12 02JO121776199 -AAjw LOUISVILLE KY 40258 e e ADDRESS SERVICE REQUESTED B TUN DEC 04 0121776199 MON- JAN 07 WED- FEB 06 FRI- MAR 08 CITY OF CARMEL HUMAN RESOURCES Customer Service: 1-800-472-9888 JIM SPELLBRING Did you forget about us? Kindly pay upon receipt. 1 CIVIC SO Remember,past due accounts are subject to a late fee. CARMEL IN 46032-2584 Your prompt payment is appreciated. For your �1�1IIIII��II�I'Ill�l�ll"�II���II'I"'ll'I!I�II�!I�'�'ll'I'lll" convenience,pay online:service.icemountainwater.com. If payment has been made,we thank you. Be ready ft?r all this ye. I C lel rations:­Now through 12/31/12,'en- joy ---savings on cases of ACQUA PANNA S.RELLEGRINO;'SAN.PEELEGRIN0 SPARKLING,FRUIT*B EVE RAG ES~&°PERRIER:6Ca11 1-800-47279888,or-log :� :: "A ,onto service.ICemountalnwatei:corn to-order-today! - _ p w g 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 CIVIC SQ, HUMAN RESOURCE DEPT,CARMEL IN 46032 PREVIOUS BALANCE 17.06 10/04 0796899227 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 10/31 0802192096 1 OIL/FUEL SURCHARGE 2.88' J3438571 RENT 3.99 TOTAL 30.71 D Q a NOV 19 2012 By ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT I reverse side. 17.06 — 0.00 + 13.65 = 30.71 Subject to terms on ,� 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 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. z34s6]B90 Your Account Number You do not have to pay the disputed amount while it is being wrooloo-00100100 investigated.During the investigation,we cannot report your account - 23456]8 as delinquent or take any action to collect the amount in question. aw ­,a NON-«*29 Watch here for a WE6 NOV)+ GENERAL INFORMATION NE-DEC IB personalized account 1.Payments received after the billing INVOICE date will appear on Important Bao 3)]9B8s Y g( ) PPe p,tl..ut.p ^'aa6m4ndua.®:JIJda c"sw^k. �p B message your next invoice.Pas[due invoices(not paid within 30 days of news and n,,,,aY«IIa"+^g"` billing date)may be assessed a late fee as allowed by law not to offers 121 St "d an.sose 00000 exceed$20 per month.Additionally,third party collection/attorney expenses may be assessed at a rate not to exceed 100%of the __.�.--------"'•� r„Y,,,w,ayr raAS unpaid balance or the maximum allowed by law. �---'m.> r»wa«,m, r �u 2 B Pay electronically 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State. Meice Sure this 3. All bottle and equipment deposits are shown as CURRENT Activity --' - _ aa°'•""°°;° ----- ' ACTIVITY. amount has been since your pCCOUNr ACTwT 4. Equipment re replacement costs will be charged for bottles lost, Aaa2ss:bn^0^`•']'""in5i"`ory$11P paid l full to P last invoice ON"""' '�; stolen,damaged or not returned. „ n,e C• avoid late fees 5.In accordance with NWNA's Terms and Conditions("T&C"),your /lt 31)8861•aM dnSGal OeP"L+ Equipment Lease and/or Service Agreement account may be /„ 3ZlMa s ,"10�„�„Ins0a11"s�4" Monthly Oil subject to minimum monthly purchases and/or early cancellation mn+ 1 7 11"" wets°"1"'B` .I Surcharge,Fuel fees. A complete version of the current T&C may be viewed on the +] 16W^•4'' g ( P Y xx'x. Surcharge or Delivery website listed below)Upon service discontinuation,rent for the o u Fee(see#6 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. — "" Information 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or EYI94 " oxx" „ Delivery ee as described in our T&C. Only one of these fees Payment Stub pccouNr SUMMARY x..xx rY Y Y y •�c.eeu e.w _ PAY BY YAY THIS AMOUM will apply to each account. The fee that applies to your account ___° ' ACCOUNT NUMBER >0.><* is stated on the front of the invoice.For further information please ,M 67. ew cwn Mr.ENCLOSED INVOICE N7890 WIDOW visit the website listed below or contact our customer service ,:MS6]B90 center. 7. As a food product, bottled water is subject to the rules and 0420096307 04282732639 0003930`19 2004 18 Amount due regulations promulgated by the Federal Food and Drug 1„^D` Administration(FDA). ICE MM~WATT 123 sa es 00000 aB m Submit your 8.Your first invoice indicates the products delivered on your first • w. uBYlcE UU,aBw):-96ee delivery,along with any applicable bottle and account deposits, ��Lw"11 cOSrDME. , payment by this wtawr° t. redemption fees,and any dispenser charges.All future invoices date❑ „S,q,OPO•w•e^^""`^` 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. Farm No.NW 709 08/12 service.icemountainwater.com VOUCHER NO. WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF $ PO Box 856680 Louisville, KY 40258 $13.65 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 02J0121776199 42-390.99 $13.65 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, November 19, 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)) 11/02/12 02JO121776199 $1165 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