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223975 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CARMEL, INDIANA 46032 PROCESSING CENTER CHECK AMOUNT: $17.10 oa PO BOX 856680 CHECK NUMBER: 223975 LOUISVILLE KY 40285-6680 CHECK DATE: 9/10/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4239099 13H722032704 17 . 10 13H7220327048 service.icemountainwater.com #215 6661 DIXIE HWY,SUITE 4 08/01/13-08/31/13 13H7220327048 G LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED 111 N I I ��I� I����'I I I I I E N N MON- NOV 07 7220327048 MON- NOV 04 THU- DEC 05 TUE- JAN 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 CARMEL IN 46032-2584 by phone at: 1-800-472-9888.It's free! Illllilll��lill�l���ll�lll�rllllllllnlllllll�llllllllnl�l�l�n IM sssarr rr.. », e, FT ? AsvF �; sr _;nx x, r»u.,-sax� R , :`", � ora;liiriitedaimenly "buytwo1gallonbottles ofTfadewindsstowbrewetlxlcedTea";antlgsave20%a! Youcan �k .sY ,�x, ,�x . , R . ^ ,r:'rs� ' ,� ,�„; � x also buy onw:', gallon bottl for onlyf,$4:99�1 Ayallablem Sweet;f,Green,-.Diet Gteen,..Lemon/Tea;FlaVOrs`Call 1=SUW472 888'�twaddAwyour next order!�Offer expires 10/31%13 ' '.141- r ^';,:A�t"y � 'C,'."j.:.�. �',.,-0., °`•;.«' �' '> �'w�.:�s.:. .1r''a'"8':3-,<"' "f'>' '✓' �,:;J, ""!'II:>r�! 'd.t' aY,.2.a "3" ...�'°a�"+✓C4 .;,� �" r �<." 1s�»4...... I'�a= ^<'�,..,;,'.,{; Cdr,"^', �'`,ti._ �`".��:r �'`'>�.r�°" .CrdF1>".;c`� 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 17.10 8/23 325004 PAYMENT-THANK YOU -17.10 8/07 0841857659 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 8/31 0846915098 1 OIL/FUEL SURCHARGE 2.84 H5068588 RENT 3.99 TOTAL 17.10 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT 2 Subject to terms on reverse side. 17.10 — 17.10 17.10 = 17.10 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 l-soo-a7z-vese OR WRITE u5 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. IMgt .. 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 00r00r00- 00100100 tz3456r890 Your Account Number investigated.During the investigation,we cannot report your account as delinquent or take any action to collect the amount in question. mR-ocr a 23456789 MDH-oa 39 Watch here for a GENERAL INFORMATION D WEU NOV 3+ DT- EC+B personalized account I.Payments received after the billing(INVOICE)date will appear on Important q,q.nt11„gbd1111,1,„tItlJJgbn,lttq„N�J1JJq c^s+a++er nmm prodaeue message your next invoice.Past due invoices(not paid within 30 days of news and TBanxya'^r"'In91C< billing date)may be assessed a late fee as allowed by law not to offers iii Mce sI exceed$20 per month.Additionally,third party collection/attorney C",51_ 00000 expenses may be assessed at a rate balance or the maximum allowedtbolawceed 100%of the -- Pa electronically P Y Y Y 2.Each returned check is subject to a service charge subject to the x.. r maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity �'°'t` ”"` "' r''"a� M„m,,,,,..,<..�°�•+P^°^en"°°"'"'°""' ACTIVITY. since your ACCOUNT ACTIVITY P amount has been 4. Equipment replacement costs will be charged for bottles lost, °cel„eryAddr essa�oh^DOe'r3Ma�°s"ee`c�n s'a`p00°°° xxxx paid in full to last invoice stolen,damaged or not returned. Pernou+Bala xxXZ avoid late fees Payment"Twnk You xx XX 5.In accordance with NWNA's Terms and Conditions("T&C"),your oe1+ +898 sGalbnNaruralsPn�w"" ax /11 31,88510444 �,eMwntam5Gal Depo'+rt Equipment Lease and/or Service Agreement account may be 3„BesI44++ s k<MWnramsGaleerurn xxxx Monthly Oil subject to minimum monthly purchases and/or early cancellation os"' 3° 514°'4 , w='wv`nar9a xrru Surcharge,Fuel 09/13 '1836380++ fees.(A complete version of the current T&C may be viewed on the ov,2 66 0 97 R<nr Surcharge or Delivery website listed below)Upon service discontinuation,rent for the rOTAE - Fee(see#6 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. _ M"e*�'TM = "Y' xzz:M Information") 6.You will be charged a monthly Oil Surcharge,Fuel Surcharge or Delivery Fee as described in your T&C. Only one of these fees Payment stub ACCOUNT _ ____-- y pAY THIS AMOUNT will apply to each account. The fee that applies to our account ___-_ PAY BY PP Y PP Y _ ro" a m u w w menr ACCOUNT NUMBER W E CLOSED is stated on the front of the invoice.For further information lease °°•°°""A'� 133456789° ppj0°/0° P I BRLE visit the website listed below or contact our customer service NV 123456,890 OICE NUMBER o0loolmoroor0o center. 7. As a food product, bottled water is subject to the rules and 0420096307 04262712619 GOU391049 2004 la Amount due regulations promulgated by the Federal Food and Drug ph^1e Administration(FDA). Ie �NNe�N w"TE,.am,AmPMw^° Submit your 123 s+ales°°0°0 8.Your first invoice indicates the products delivered on your first R " delivery,along with any applicable bottle and account deposits, wee°s.oMBRSEmACEr-"""e a ment by this date LJG,b.J„gb„Jb.,JL.dl.bq.,b„66{.bJ.9 ❑vn^ redemption fees,and any dispenser charges.All future invoices FpeF�rP10o,AY�s�9n4Pe<,,,,,<,o„Ber<^es�d< , will reflect charges for water delivered and dispenser rental,bottle ❑s�GH 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 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. P/jayee ,,/1 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) M _ U 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. �Q m ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR �� � V��� Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or C)Cq bill(s) is (are) true and correct and that the `70Lk materials or services itemized thereon for which charge is made were ordered and received except 20 Signatur Title Cost distribution ledger classification if claim paid motor vehicle highway fund