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217194 02/13/2013
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CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CARMEL, INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $17.14 PO BOX 856680 CHECK NUMBER: 217194 LOUISVILLE KY 40285680 CHECK DATE: 2/13/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4239099 13A722032704 17 . 14 13A7220327048 service.icemountainwater.com ®® 0215 6661 DDUE HWY,SUITE 4 01/01/13-01/31/13 13A7220327048 LOUISVILLE KY 40258 MUMIGILY H 9 Lou Pi 9 11 LVA a 1.4 1 e ADDRESS SERVICE REQUESTED I I I�I�� ��I� I� �� BI I I 0(�I I I FRI- MAR 08 7220327048 TUE- APR 09 WED- MAY 08 FRI- JUN 07 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 freel CARMEL IN 46032-2584 Al- I���IIII'IIIIIIIIII��1111"'llih��l�l��l'I"��I��'ll�lll'lll�lll Be at�o�it aonno�lro41 t`w o '$1 ®fq c is ofour ICE MO�R4'P 1ll�S ¢kiln�_ b Ifs as VAD ass-dais df,diiP MM"bet4M 9Z�'t�mzhr�i4"66iM, *CG.iCeM0Uh4�ieoe�,, xom=oP Caili 1 19 . 4 i =mod to bur 30193 - ACCOUNT ACTIVITY For questions or a report on water qu ali ty and information,call 1-800-472-9888 or visit service.icemr, -ntainwater.com. ® niging Delivery address: CITY OF CARMEL,I CIVIC SQ, CLERK TREASURER OFFICE,CARMEL IN 46032 PREVIOUS BALANCE 17.18 1128 162394 PAYMENT-THANK YOU -17.18 1/07 0810246694 2 5 GAL ICE MOUNTAIN DIRK W/HANDLE 6.98 2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00 1 9 OZ PLASTIC CUP 50C/SLV 3.29 2 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00 1/31 0816068472 1 OIL/FUEL SURCHARGE 2.88 A3952841 RENT 3.99 TOTAL 17.14 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 17.18 — 17.18 ¢ 17.14 = 17.14 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. 6661 DIXIE HWY.,SUITE 4 If you prefer,you can pay your bill online at service.icemountainwater.com 6661 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 later than thirty(30)days after we SAMPLE INVOICE sent you the first bill on which the he error or problem appeared.You can an 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 00/00,00-00100100 Y. 1x34s67B90 YourAecountNumber investigated.During the investigation,we cannot report your account t ' as delinquent or take any action to collect the amount in question. 1NR-ocr a 23456789 Mq,OCT 24 Watch here for a GENERAL INFORMATIONallo n ruE-oEC,9 personalized account I.Payments received after the billing(INVOICE)dale will appear on Importante,,$oo..,a-9BBa your next invoice.Past due invoices(not paid within 30 days of news and p,iladll6111,dlltldt1166N4^dIIG^R,AIJdtl rn."E� ,,i^9NeMow^ul^a �I message billing date)may be assessed a late fee as allowed by law not to Offers 12 Main St 'n°'•` C5 exceed$20 per month.Additionally,third party collection/attorney ansu,e 00000 expenses may be assessed at a rate I w,sute l6. 0,"d4.d1.4Pp6.Wd,d.tl t exceed 100%of the unpaid balance or the maximum allowed by law. �tw,MA>a•w� �rww,d,e,x}a.a�amt , Pay electronically 2. Each returned check is subject to a service charge subject to the 'v '2"3 < „;,,R.,„w,r . Z maximum check return charge allowable in your State. - Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity „, _ '°°�°_°°� ACTIVITY. N9 ., - amount has been since our ACCOUNT ACrtV1TY aUr 4. Equipment re replacement costs will be charged for bottles lost, y Aea..m ooe,23M,I^s c rs 1e x% ' paid in full to p g last invoice ce' ” stolen,damaged or not returned. neiou,B,�ame %� � avoid late fees 5.In accordance with N WNA's Terms and Conditions("T&C"),your Den, 461.98 M=dsvA^9w,rr Itt 31, 3 IceMwnuin6r++l Equipment Lease and/or Service Agreement account may be 3v9as,w+ s memyy^„�"sc,IR % t Monthly 0i1 O91II 3,raeslw+ s subject to minimum monthly purchases and/or early cancellation Eye's°"""Be �,") -`t. I�',' I Surcharge,Fuel Ovl,2 3 a263ee„ g fees.(A complete version of the current T&C may be viewed on the asl'r '�40"r I - ,+ x""` f Surcharge or Delivery website listed below)Upon service discontinuation,rent for the TWA, - - Fee(see#6 under Leased Equipment is charged through the end of the billing cycle I t "General in which service is discontinued. _ 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or �,a,94,ANE -"; "`"`"``E499EN*!�+^^^'„ xx.n m• Information") Delivery Fee as described in your T&C. Only one of these fees Payment stub ACCOUNT SUMMARY •xxxnYw _ 4 y RAY TUIS AMOUNT RAr er will apply to each account. The fee that applies to your account u•+ew• •---ACCOUNT NUMBER rxla , is stated on the front of the invoice.For further information please „• ,z34s62e90 BA� MT.ENCLOSE° NVOICE NUMBER ,l I 00100I� t visit the website listed below or contact our customer service ,234567-90 `t center. 7. As a food product, bottled water is subject to the rules and 0420096307 04262712619 °00391°49 2°p4 16 Amount due regulations promulgated by the Federal Food and Drug o« Administration(FDA). ICE MOUNraN WATE '�ys.6c S`000°0 8.Your first invoice indicates the products delivered on our first •^ °"""ntlf M""' Submit your p y ,,, ER9ICE CALL 1�900.47i-9989 delivery,along with any applicable bottle and account deposits, a EO9C...0 ERS .4 payment by this d m••diwdf,.,n.►16d..l.ldd,d- ❑„„A^r u�,y,^„9eu,•�•. f date redemption fees,and any dispenser charges.All future invoices 1'm'6'" ,,,,w<w•�0n^Mryes"` 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 S 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 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)) 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 $ ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#(TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or U7�� (��� / (�•/ bill(s) is (are) true and correct and that the p materials or services itemized thereon for which charge is made were ordered and received except 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund