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220653 06/04/2013
w \4F 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: $48.39 PO BOX 856680 CHECK NUMBER: 220653 LOUISVILLE KY 40285-6680 CHECK DATE: 614/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 03EO11925282 48 . 39 03EO119252823 ROM ' ® @ service.icemountainwater.com ' #215 6661 DIXIE HWY,SUITE 4 o LOUISVILLE KY 40258 04/13/13-05/12/13 03E0119252823 ADDRESS SERVICE REQUESTED B FRI- JUN 0N 09 0119252823 H1MENfliffil IfII DIIB I1H SID WED- AUG 07 FRI- SEP 06 CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-472-9888 BONNIE CALLAHAN Did you forget about us? Kindly pay upon receipt. 3400 W 131 ST ST Remember, past due accounts are subject to a late fee. CARMEL IN 46074-8267 Your prompt payment is appreciated. For your IIIIIII'II'�!IIII"III'III'lllllll"��"I�'�II'I'�IIIIIII'I"'III convenience,pay online:service.icemountainwater.com. If payment has been made,we thank you. �a ,1 .. . Refresh your senses,with Nestea! Buy ariy 24casest,o f 1%2Mliter Nesteaa-36ottles for only$$12:9.8!,Available-in saf•=; >°.rz:`-„'�i�5':n-.• r,•-.,. neA,�. ,s..,.�..>.�a''�i'??',�`'�,`.,,.. �..`%�cr=-' :,✓ . variety ofxrefreshengflavors,_:inc!udingnew RaspberryTea!-Vtsstservtce.icerrtountainwater,corre orcall �;" 1.=800-472 9888:to.add"to;:yourfnextorder!jOffer expires 9%30/13; +� f= .,C �,y°d 'te,�,t�` .�`'. �a ✓w.;' � :� .�•p,;z.,-�' s�, n��a�� .r y��. ;�<«,ay-,'.f"; „.;�G exi�" r.,,w;'�"'�,`. - ;2� " ' .::--;1r°��e � ">^..`'^������ ..ar „ l•==3Yd?"'' .°w`'"." `a�°*�. '�° `r. x371` 'd.Jx".° .�i`' ';�. <r;- � � F 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 70.50 5/08 0828480483 10 5 GAL ICE MOUNTAIN DIRK W/HANDLE 34.90 10 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 60.00 2 9 OZ PLASTIC CUP 50C/SLV 6.58 10 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -60.00 5/12 0830781308 1 OIL/FUEL SURCHARGE 2.92 E4579019 RENT 3.99 TOTAL 118.89 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT y Subject to terms on reverse side. 70.50 — 0.00 + 48.39 = 118.89 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 apro-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. #2216 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 oowoloo- 00/00/00 1234567890 investigated.During the investigation,we cannot report your account ' • • • I 2345678 as delinquent or take any action to collect the amount in question. TNR-.0- MON-OCr 29 Watch here for a WED NOV 21 GENERAL INFORMATION uE.Mc 19 personalized account Important n-9BeB I.Payments received after the billing(INVOICE)date will appear on P tl1h6196„dtta"@:ata.W c",t°n`°'s`°""1- message your next invoice.Past due invoices(not paid within 30 days of news and 161Mdt1"ttLalllW°� 1,,,,,%ro„I�mIn9KeM•antu°Rrodi"' billing date)may be assessed a late fee as allowed by law not to offers iz3Mainst - ,,,a,eMee.. exceed S20 per month.Additionally,third party collection/attorney °ry'sLdte o0090 MatdtL.1..666ud"a expenses may be assessed at a rate not to exceed 100%of the ,.-t-°�':<?�'"xu:cr:=•' ,„�q;si;,�:.�� unpaid balance or the maximum allowed by law. I ,'Mu"�'. "'�" ;,bE•�'., Y�+'y°;,°"' ”- Pay electronically 2.Each returned check is subject to a service charge subject to the 6r..:mc^`q< .�u�,n°,mwm.<pm. ='•'n�..r' J a� J z. , o�NtAma><!�`'!"d"rOlv�'"'"•, .s�"rss '� maximum check return charge allowable in your State. w•,"'; r*, 'Jz.,'';'�t.` `N. '^'``' `"' i Make sure this 3. All bottle and equipment de deposits are shown as CURRENT Activity °�a°""" � P �' ^^= `--"` `"' .,•� - , amount has been ACTIVITY. �' � " since your ACCOUNT ACi1Vn1 4. Equipment replacement costs will be charged for bottles lost, •�,K,ynaa�e+8 3°nnDx.123—It""Oty's`ate BOOOO %xx% paid in full to last invoice x% stolen,damaged or not returned. R M°to"" avoid late fees payment-TNankYw %%%% 5.In accordance with NWNA's Terms and Conditions("T&C"),your W3, 46,asB 5 5�ppnNat°,also°°9'"`d1p1 %%x% �„ 31]BBS,44M ReMwmains W�Oepov[ Equipment Lease and/or Service Agreement account maybe �„ 3nees,ua4 s New°nta,nsGa�Rewms Monthly Oil subject to minimum monthly purchases and/or early cancellation wn, 31 E°e's""""� g 31�o4v„ „%%% Surcharge,Fuel fees.(A complete version of the current T&C may be viewed on the 091'2 ' Surcharge or Delivery website listed below)Upon service discontinuation,rent for the ToTAr Fee(see#6 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 ACCOUNT SUMMARY pCCO ,,,,,p„ ,max"„""` 1 M , _ Information") %% Delivery Fee as described in your T&C. Only one of these fees Payment stub „c_."",=e•°� RAY m1s AMOUNT wills 1 to each account. The fee that applies to our account -••--- ----__AccouNrNUMBER vpYBY apply PP Y ""o e wa aim " Bo WIN is stated on the front of the invoice.For further information please 1z34sb2B90 B1wNe oAn T ENCLOSED INVOICE 67B90 w/w/w visit the website listed below or contact our customer service ,2;456)890 center. 7.As a food product, bottled water is subject to the rules and 14200963a7 94262712619 00/393099 2909 1 Amount due regulations promulgated by the Federal Food and Drug innno« Administration(FDA). nE aN was M t '1 ysi t0000B Submit your O S.Your first invoice indicates the products delivered on your firs BCUSTOMERSER,r�cEUEE'_B°°-"29888 ' 6. n,6a"6.61.668.8 B".•n '� s,,e payment by this delivery,along with any applicable bottle and account deposits. °^� date redemption fees,and any dispenser charges.All future invoices will reflect charges for water delivered and dispenser rental,bottle C 4G"""to"1REE>Uro"Ay,s, 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 08112 service.icemountainwater.com VOUCHER NO. WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF $ P. O. Box 856680 Louisville, KY 40285-6680 $48.39 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT Board Members 2201 103EO119252823 I 42-389.001 $48.39 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 A f Y1 16 / . ) Thu M , 2013 N-/%-"vv A.�� A'111Y Stre*rfealnGnissi sinner 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)) 05/15/13 03EO119252823 $48.39 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