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219770 05/07/2013
CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 •1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $70.50 CARMEL, INDIANA 46032 PROCESSING CENTER PO BOX 856680 CHECK NUMBER: 219770 LOUISVILLE KY 40285-6680 CHECK DATE: 517/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 70 . 50 03DO119252823 service.icemountainwater.com ififfilily ' A D 10401glaialgam 4 #215 6661 DIXIE HWY,SUITE 4 i LOUISVILLE KY 40258 03/13/13-04/12/13 03D0119252823 ADDRESS SERVICE REQUESTED RNALe® B e D JIUN 087 0119252823 FRI TUE- JUL 09 WED- AUG 07 CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-472-9888 BONNIE CALLAHAN Pay your bill online at:service.icemountainwater.com or 3400 W 131 ST ST CARMEL IN 46074-8267 by phone at: 1-800-472-9888.It's free! Enjoyµ=$1 off;cases 96e'source:nafuralrspring water.:resource has naturaf.electrolyte's,fortaste;and comes'inti a 50%recycled 6ottle�:Visitrservice icemountamwater.com-or Ca11�1-800-472-9888 to ad'd to;your next orderlR' Offerexpires-5/31/13 -;� � ;i.�$ - .,.z:�•> _"?,P-�= ^,g8 ..r sc`.+1e~ � l, ` __ zx . 4.4' -,+k��.i:a. ,gip.._ may¢.»'.. «,�✓}.4 Ste' q '�.J !YS m 'i ..>b,». �•T' =.2..'wa--. _:.fi x°Y.'-Y'.: x}'2ac" -�^f> �.. !.$Yip ix f* ,^..7 t ;p-"_ J E L" .b,.; . 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.131ST ST,CARMEL IN 46032 PREVIOUS BALANCE 31.06 4/02 516765 PAYMENT-THANK YOU -31.06 4/09 0824118103 11 5 GAL ICE MOUNTAIN DIRK W/HANDLE 38.39 11 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 66.00 4 9 OZ PLASTIC CUP 50C/SLV 13.16 9 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -54.00 4/12 0826379646 1 OIL/FUEL SURCHARGE 2.96 D4418936 RENT 3.99 TOTAL 70.50 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT I ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 31.06 — 31.06 + 70.50 = •V 70 5 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 1-800-072-9888 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. 1234567890 Your Account Number You do not have to pay the disputed amount while it is being mooioo-00/00/00 investigated.During the investigation,we cannot report your account t 123456789 as delinquent or take any action to collect the amount in question. MON-0 79 Watch here for a tyro-NOL GENERAL INFORMATION UE-DEC 1a personalized account Important n,n., aL,tnuL na,LmL.,.ain^n,.naan CmLd Sema 1-BW-•72-999- 1.Payments received after the billing(INVOICE)date will appear on P message your next invoice.Past due invoices(not paid within 30 days of news and m.nE yo„lu"a^9'ee Mau^v,^P'^a"m billing date)may be assessed a late fee as allowed by law not to offers �i z3, exceed S20 per month.Additionally,third party collection/attorney °tY's`d1P L„Jaa.+t.n1...ai....a.,a1.Ln.I LMa.a.n expenses may be assessed at a rate t exceed 100 unpaid balance or the maximum allowed by law. %of the may__._. 4a^% y w«^s '' Pa electronically 2.Each returned check is subject to a service charge subject to the J g J �ve,4x.a.de7(Na�4g"•a< maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity ' - �^°a"°"`z;'-_'-• -rat _ ACTIVITY. AMU - °" °, amount has been since your ACCOU4TAeTMTY paid in full to 4. Equipment replacement costs will be charged for bottles lost, last im�oice DebveryAddrett-b1nDO<'173Ma�nSt�eeLCiry.Ra,e00DOB xxxx avoid late fees stolen,damaged or not returned. P,nm ae wix 5.In accordance with NWNA's Terms and Conditions("T&C"),your v61 oe73, 8� s PaymentThanL you s cano^NM4�ai sP^^9waa, wx ,,, 317805,444a < 5oa�oew", , Monthly Oil Equipment Lease and/or Service Agreement account maybe ,„ n7,es4440 s ke MUUnu,n s Ga1"mm^ x„xx o9n, 3,7ses,4a+a E„eiwawroe subject to minimum monthly purchases and/or early cancellation x,,13 31 Surcharge,Fuel fees.(A complete version of the current T&C may be viewed on the o9" "r'10e9 xsx. Surcharge or Delivery website listed below)Upon service discontinuation,rent for the rolAL Fee(see 96 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or y,a,9wANr --axxx" ` °" _ Information") Delivery ee as described in our T&C. Only one of these fees Payment stub ACCOUNT SUMMARY .e.>a..W ry Y Y J PAY no,AMWNT _ —— PAY By will apply to each account. The fee that applies to your account __ � „,----�w,^�" ACCOUW NUMBER � rw is stated on the front of the invoice.For further information please 1334567890 5,LUNL DAIS MT.ENCLOSED visit the website listed below or contact our customer service 3C 5678 BER 00t00t00 u34smB9B center. 18 7.As a food product, bottled water is subject to the rules and 0420096307 042,2712619 000391044 2oov Amount due regulations promulgated by the Federal Food and Drug Administration(FDA). icE MouNTUr+wATEB C°MPrP" �M1y sni<s`ooDOo M�� Submit your 8.Your first invoice indicates the products delivered on your first •o"�d wBC„noMLBSEwKLL^LL`'t0°'71�9B' delivery,along with any applicable bottle and account deposits, payment by this I..dlW.d.nM.JL.dL..l1.6n.J..664LJ�n �v„^,7+n�N^^9•* s rademption fees.and any dispenser charges.All future invoices 0P Sea NnoP4r 3g,,,,o a,�,••4 o^ea.•^•�• date will reflect charges for water delivered and dispenser rental,bottle s'o" 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. service.icemountainwater.com mer Form No.NW 709 08/12 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)) 04/23/13 03DO119252823 $70.50 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. ALLOWED 20 Ice Mountain IN SUM OF $ P. O. Box 856680 Louisville, KY 40285-6680 $70.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE F71TOUNT Board Members 2201 103DO119252823 I 42-389.001 $70.50 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 Ploy, May 03, 2013 Street Com i ioner Street Commissioner Cost distribution ledger classification if claim paid motor vehicle highway fund