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215052 12/04/2012 1 - CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CARMEL, INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $128.24 ?� PO BOX 856680 «„ CHECK NUMBER: 215052 LOUISVILLE KY 40285-6680 CHECK DATE: 1214/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4350900 22 . 67 02JO121202766 1125 4350900 34 . 11 02JO120095351 2201 4238900 71 .46 02KO119252823 service.icemountainwater.com #215 6661 DIXIE HWY,SUITE 4 10/01/12- 10/31/12 02J0120095351 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED ® ® e FRI- 16 0120095351 DEC WED- DEC 19 WED- JAN 23 C._4,117 1D FRI- FEB 22 CARMEL CLAY PARKS AND REC DEPT. NOV 1 3 2012 Customer Service: 1-800-472-9888 AUDREY KOSTRZEWA Pay your bill online at:service.icemountainwater.com or 1411 E 116TH ST By: by phone at: 1-800-472-9888.It's free! CARMEL IN 46032-3455 ,c sTM . ,a . ».>' .,�z".-"-.". .,3M? `t"" `i:�o-xa•N n"�.,L:p"g p., �.x.;_°,'R Be eaiiy for ! rh js�y,.ears eelebratlo s Now through 12/31r/,1a2,:en�oy savings on.cases ofBACQUA PANNI�, S F -"S PELL`EGRINO;SAN PELLEGRINO SPARKLING<FRUIT BEVERAGES 8�PERRIER:Z CaIFTr 800=4729888 d, :r..,WE.s ,�rs'ontservice.ICemountalnwater;:comtoordertotla a y ,� ACCOUNT ACTIVITY For questions or a report on water quality and information,call 1-800-472-9888 or visit service.icemountainwater.com. gm- Omm rMalift g Delivery address: P CARMEL CLAY PARKS AND REC DEPT.,1427 E 116TH ST,CARMEL IN 46032 PREVIOUS BALANCE 63.20 10/07 553003 PAYMENT-THANK YOU -58.59 10/18 0799186309 4 5 GAL ICE MOUNTAIN DIRK W/HANDLE 15.96 1 9 OZ PLASTIC CUP 50C/SLV 3.29 BOTTLE DEPOSIT: 4 CHARGED, 4 CREDITED .00 10/31 0802167437 1 OIL/FUEL SURCHARGE Purchase �fU,yl� VvWuily - ►� �^" 2.88 J3464453 RENT Description 11.98 TOTAL P.O.# P or F 38.72 G.L.# 1125- 1- 13- 4-35b9c� Budget tQ�,O'lOh� ,O,Gt G VCs !"ine D esc Purchaser Date Approval Date ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 63.20 — 58.59 + 34.11 = 38.72 P+.__ BILLING RIGHTS SUMMARY YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETTER IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR HILL,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. 1234567890 ) Your Account Number You do not have to pay the disputed amount while it is being 001o0100-00100100 investigated.During the investigation,we cannot report your account 8 as delinquent or take any action to collect the amount in question. OCT 345678 M, a ,N, T I Watch here for a WED NOOV Zl GENERAL INFORMATION TuE-DEC 16 , 's°°z-986 personalized account L Payments received after the billing(INVOICE)date will appear on Important at�JNl�b.Ila.WSl,:aue �„ � message your next invoice.Past due invoices(not paid within 30 days of news and ��"' rn.,rr«�'«•'"'9"`"E°°"" billing date)may be assessed a late fee as allowed by law not to offers izsr exceed$20 per month.Additionally,third party collection/attorney Gry'SU16 r—M ,a„itAU h.6 UJJ I ex enses may be assessed at a rate unpaid balance or the maximum allowed tby law.exceed 100%of the 11 Pay electronically 2.Each returned check is subject to a service charge subject to the -- �=_ s:�� '- ".�-"• v0i "`;� u "'" -."•-y' i'",�. maximum check return charge allowable in ur State. "mry." ''d ;. .~`"' yO Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity ; � �, ..�•° amount has been ACTIVITY. since your ACCOUM AC711971' yre¢,,Gq.S"m O.W. 4. Equipment replacement costs will be charged for bottles lost, last invoice Aidress. avoid late fees xr-xx paid In full to xxxx stolen,damaged or not returned. �""OY`Th„srm xw0e F 5.In accordance with NWNA%Terms and Conditions("T&C"),your m 3 �'�...a s sww�N•��sv�^9wam -- 1 win I Equipment Lease and/or Service Agreement account may be �„ i;ms,a« s Monthly Oil subject to minimum monthly P urchases and/or early cancellation 0872 n�8�'97 72•,72 ,�,,,�. :f•,_. _"Y`.. 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 rora - t Fee(see#6 under Leased Equipment is charged through the end of the billing cycle ; N i "General in which service is discontinued. aEµn+++, 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or „,x.,w,swA.�T_„,^'8N1, i'M + 7200m�y�,••�,,.. lnformation') Deliver Fee as described in ourT&C. On one of these fees Payment stub pccouNTluMMAa'r •c E .a. -------- Y Y IY Y -- - .,,•,.•......o,• -------- PAY By PAY mss AMOUNT will apply to each account The fee that applies to your account _____--------- „„„•„ ACCOUNT NUMBER , is stated on the front of the invoice.For further information please' u34s6mM stwNC OAIr ENCLOSED visit the website listed below or contact our customer service ,z3s67890 wmolw center. P subject 01262712619 000391019 2001 18 7. As a food product, bottled water is sub�ec[ to the rules and Amount due regulations promulgated by the Federal Food and Drug Administration(FDA). - MOUNraN wAn;°,Me,'AN;,,- cry,- 00000 •0,,,,,,.ew W.* Submit your 8.Your first invoice indicates the products delivered on your firs[ - w,cUr,O,,,EASE.+KEUTT'°°0-"'"9688 payment by this delivery,along with any applicable bottle and account deposits, q,6tabb.t.u,W-a0„ sU, redemption fees,and any dispenser charges,_AII future invoices 6,�L6.+.a1•-�6"'a'" s,q,U,w<w•�°n^""s5ide date sv+wwa�U 00,0,*^ 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 I6-17 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 Nest16 Waters North America Inc. Form No.NW 709 08/12 service.icemountainwater.com 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. You do not have to pay the disputed amount while it is being _01111 111�Wt00j00" 00I00100 123456790 , Your Account Number investigated.During the investigation,we cannot report your account 12345575 s as delinquent or take any action to collect the amount in question. TnR-ocr°' 'oo I Watch here for a GENERAL INFORMATION h° ;a s personalized account Important �0"'"' 1.Payments received after the billing(INVOICE)date will appear on P 41p"tl.dldltl c�'«'+'s""'a'' � message your next invoice.Past due invoices(not paid within 30 days of news and Ott°�"s � +� 3w..,W pm u "1, billing date)may be assessed a late fee as allowed by law not to offers 123 Win It exceed$20 per month.Additionally,third party collection/attorney em•s10te °000° expenses may be assessed at a rate not to exceed 100%of the unpaid balance or the maximum allowed by law. ,r;z,;;'�"° x�n,,;K w+,c a,'",,,s�` t, '`''� • I'ay electronically 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State. l Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity _„`,�' �• '� Y,,,.,Q,a•.,.e..��geyq°"``°'• �� I amount has been ACTIVITY. since your ACCOUNT AC"vm -` "" s„,•,Mss•00000 I aid in full to 4. Equipment replacement costs will be charged for bottles lost, D6 ,Address bMO�.w”. vxxx 1 P last invoice ova avoid late fees stolen,damaged or not returned. SR�F/` � 5.In accordance with NWNA's Terms and Conditions("T&C"),your , .5,e9e" , Monthl Oil Eq uipment Lease and/or Service Agreement account maybe nees,A16' i ! Y oen, wall -v-€t;��»}T Surcharge,Fuel subject to minimum monthly purchases and/or early cancellation an,z n,en3ee„ .f1�3 fees.(A complete version of the current T&C maybe viewed on the �r'z 16`'"0"' i"..- ,�` ,rZ;J ^ 'a-°` Surcharge or Delivery website listed below)Upon service discontinuation,rent for the Twa _---x P° - -- - Leased Equipment is charged through the end of the billing cycle I Fee(see#6 under"General in which service is discontinued. �,,,,,,,,w,mm _ '"YT°', + uxx Information) 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or Delivery ee as described in our T&C. Only one of these fees Pa ment stub AccouNrsuMMAar •c•>a-n' rY Y '] Y - PAY 0Y PAY TXII AMO.M will apply to each account. The fee that applies to your account, _'°'"� ----- ' AccouNr NuM°u' °"'" ' is stated on the front of the invoice.For further information please ,zM+ 78" wwNC ,NypKE NUMBER ) visit the website listed below or contact our customer service ,z3+s w/m/W 5re9. center. 0439 ...391049 2004 15 7. As a food product, bottled water is subject 042523126 to the rules and I Amount due regulations promulgated by the Federal Food and,Drug 1 n0— �. Administration(FDA). ,cEMOUNr WATE,1CoM.,AI„_ our Submit 8.Your first invoice indicates the products delivered on your first '°'°" ,E,.SOwzz-gees Y delivery,along with any applicable bottle and account deposits, . � payment by this redemption fees,and any dispenser charges.All future invoices t" r�,,,,","w•�0n"•"^`5i°` "m �__-._! date will reflect charges for water delivered and dispenser rental,bottle W- 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 service.icemountainwater.com ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 051125 Ice Mountain Terms P.O. Box 856680 Louisville, KY 40285-6680 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 11/2/12 2JO120095351 Drinking water&cooler- Maint $ 34.11 11/2/12 2JO121202766 Drinking water& cooler-MCC $ 22.67 f Total $ 56.78 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 Voucher No. Warrant No. 051125 Ice Mountain Allowed 20 P.O. Box 856680 Louisville, KY 40285-6680 In Sum of$ $ 56.78 ON ACCOUNT OF APPROPRIATION FOR 101 General & 109 - Monon Center I PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1125 2JO120095351 4350900 $ 34.11 1 hereby certify that the attached invoice(s), or 1091 2JO121202766 4350900 $ 22.67 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 29-Nov 2012 Signature $ 56.78 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund 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 1-500.472-9888 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 as 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. z1+s67svo Your Account Number You do not have to pay the disputed amount while it is being 00100100'00100100 investigated.During the investigation,we cannot report your account ' 2345678 as delinquent or take any action to collect the amount in question. rnP —o" MON-OQ 3P Watch here for a GENERAL INFORMATION WE6NOV l personalized account nlE-OEC t6 1.Payments received after the billing INVOICE date will appear on Important la0o-+n96aa Ym g( ) PPe 6A+JgpMtal6L.t116A166.dt1Ra�uJ.la c�w'^efs""`= message your next invoice.Past due invoices(not paid within 30 days of news and mwr«'+°'°'"'9"`"�°"""�P •L5 g billing date)may be assessed a late fee as allowed by law not to offers �� �s, ."a n.a•... cm.s�dtB exceed$20 per month.Additionally,third party collection/attorney 00000 t.aaa•,-It�.dt-„a-a-sa^6-616Lt'a"a expenses may be assessed at a rate not to exceed 100%of the _ -,••>-rs-:""- .��:,:-”'s^�" '•�- '~,•f mr P Y '•�,s :iweiia ;. wO4•.. >,. Y y unpaid balance or the maximum allowed b law. �-�YK-�"�, ro+!a�'""'a- �..,, Pa electronically 2.Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State. g•-:'j ,;•�; R-:+�;.`T�_ •.. � - � Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity ACTIVITY. amount has been since your ACCOUNTACn�nY 123Wla Soe C'ty""e00000 aid in full to 4. Equipment re replacement costs will be charged for bottles lost, wwryMd"5S OOC x x p P last invoice stolen,damaged or not returned. � avoid late fees OU 5.In accordance with NWNA's Terms and Conditions("T&C"),your �3, w,6s6 S M'nwa+E ui ment Lease and/or Service A reement account ma be 3°es,++ ai-FF q P g Y n, 3172 �" s iA"um Monthly Oil s .^ zxxx �" 31�""` �NwAms` Surcharge,Fuel subject to minimum monthly purchases and/or early cancellation 3,6163a9„ g fees.(A complete version of the current T&C may be viewed on the 09'7 '66°97 '' ' r;�;,;" ,}• %� Surcharge or Delivery website listed below)Upon service discontinuation,rent for the rorA, - __ .. - Fee(see#6 under Leased Equipment is charged through the end of the billing cycle I "General in which service is discontinued "" _ .AY,NIAM Information") 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or ,.r" ��" xxxiM , - Deliver Fee as described in our T&C. On one or these fees Payment Stub AccouNT suMMAar °c.�Kx-a _____ Y Y y - -- PAY THIS AMOUNT PAT 8T will apply to each account. The fee that applies to your account _ "-°'°"-•�„ ,�„.�ro.w," M'�-,cccouNTNUMeEB Co >a .wl is stated on the front of the invoice.For further information please >"^ 1734667890 a OWATE ENaosEo ,,,v E NUMBER 00/00/00 visit the website listed below or contact our customer service z 4667890 center, 7. As a food product, bottled water is subject to the rules and 0420096307 04282712619 000393049 200° 1e Amount due regulations promulgated by the Federal Food and Drug 1.,"— Administration(FDA). KE NTNN wXnr C MPS ory s0,+e$1°0°p0 [I Submit your 8.Your first invoice indicates the products delivered on your first C"Y'S YOMUSP EC,,,"'0O+"-Pm6 delivery,along with any applicable bottle and account deposits, .m•-�s yat,-t,tet,6a.a Fog My MMSEW- , payment by this redemption fees,and any dispenser charges.All future invoices Mm" P•o"•a0n""""s"` P""' date s,c"wyonrPO:w,oPAn si9"4P .. 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. VOUCHER NO. WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF $ P. O. Box 856680 Louisville, KY 40285-6680 $71.46 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 102KO119252823 I 42-389.001 $71.46 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 G a Thursday, November 29, 2012 5 Street Commissiti ner lul 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)) 11/14/12 02KO119252823 $71.46 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 5-11-10-1.6 120 Clerk-Treasurer