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Home My WebLink AboutJPD Ice & Water Machine City of Jeffersonville Government Contract Coversheet Please note: All information MUST be completely filled out and submitted to Clerk's Office within 48 hrs of execution. Date Submitted to Clerk: 3/18/2026 Department: Police Vendor Name: Bottleless Nation Sign Date: 3/18/2026 Ending Date: 3/18/2031 Amount of Original Contract: $119.00 per month billed quarterly Is this an amendment or change order to original contract? Yes or No Amended Contract Amount: Purpose: Rental of filtered ice and water machine. For Clerk's Office to fill out Date uploaded to Gateway: BOTTLELESS NATION CUSTOMER SATISFACTION GUARANTEE This warranty covers all water and ice purification systems serviced by Bottleless Nation per the attached rental agreement. Bottleless Nation will provide all service and support for the system(s) during the entire rental period, including the following items: • All Service Calls • All Parts • All Labor (including travel) • All Required Filter Changes Our Preventative Maintenance Program will strictly follow manufacturer guidelines for system sanitization intervals. If repairs cannot be made, Bottleless Nation will replace the equipment with another model of equal or greater capabilities at no additional cost to the customer. In the event that the customer becomes aware that the equipment does not meet minimum performance standards, customer agrees to notify Bottleless Nation in writing within ten (10) business days of first knowledge of unsatisfactory performance. Bottleless Nation shall have five (5) business days to correct the specified problem. In the event the specified problem is not corrected, as provided herein, the customer shall be issued a check from Bottleless Nation equal to the amount of one month's rental payment per non-performing system. Preventative Maintenance pricing is subject to an annual increase to adjust for inflation. Customer agrees to prov':e normal care for the unit(s). Damage to the water purification unit(s) outside of no m• w-ar and ear and/or attempts to move the unit(s) or to alter their performance m i y oif, the war •nty. Customer B Representative_ - Signature: �� Signatur 0 - Wadi Erw+y Print Name: -k . Print Nae: Title: c\A‘..\0' Date: Date: "3 \ '-' Reference ft: Items Not Included: • Water Only Preventative Program - $129.00 each • Water/Ice Preventative Program - $199.00 each • Industrial Ice Bi-Annual Preventative Program - $250.00 each • Equipment Relocation - $195.00 each • CO2 Exchange,Other - $119.00 • CO2 Exchange, KUPA - $195.00 BOTTLELESS NATION BOTTLELESS NATION '/402 E 90th St DELIVERY AND ACCEPTANCE AGREEMENT Indianapolis, IN 46256 [866) 621 6910 Customer Name: V f n Customer and Distributor certify that all E ment described in the Rental Agreement has been delivered and properly installed according to the Rental Agreement. Customer acknowledges that the Equipment is in good condition and is performing satisfactorily. The Customer hereby accepts the equipment unconditionally and irrevocably, in accordance with the Rental Agreement, and understands that invoicing will commence upon receipt of this Certificate, which confirms execution by the Customer. Distributor acknowledges its obligation to provide maintenance services in accordance with any maintenance agreement separately entered into between Distributor and Customer. CUSTOMER AUTHORIZED SIGNATURE NAME (PRINTED) 711I E DAii _ 7yei 1 j, 4 (%�, ly\\�, cot\ Branch Manager _DISTRIBUTOR UTH RIZED SIGNATURE NAME (PRINTED) IITI E DA/i Model Serial Number <�. n��`LL t) ,w)) Statement of Assurance Distributor is committed to providing you with quality equipment, quality service and quality drinking water. If for an y reason you are not satisfied with the performance of your equipment or the level of service provided,please contact us directly for prompt assistance. REFERENCE NUMBER(INTERNAL USE) E SEE ATTACHED EQUIPMENT SCHEDULE, IF APPLICABLE BOTTLELESS NATION 7402 E 90th St RENTAL AGREEMENT Indianap866,)121 6910 CUSTOMER INFORMATION • Company Full Legal Name: IIi► axci, 11., c cb Contact:Lov_r tl 1 )1,c 0�-'(, Phone : Ext: Equipment Location Address: 4, 11 cl E_ 1 N _ t City, State, Zip: �ltz. . � �� Lam\ b � l 3c') Email: Ck.CA irypc— r\ e Q.-eieC.NLA-Na. 11ti1 AIN #. lr,C't1Ch~ RENTAL MONTHLY BILLING SPECIAL TERM PAYMENT FREQUENCY INSTRUCTIONS El ANNUALLY 60 mo. I $ I )-1•• lir QUARTERLY PLUS TAXES 0 MONTHLY ACCUNT EQUIPMENT SCHEDULE SET UP FEES Water Installation Fee $200/Unit Ice&Water Installation Fee $250/Unit = Industrial Ice Installation Fee $350/Unit = -- SEE ATTACHED EQUIPMENT SCHEDULE, IF APPLICABLE. Total= AGREED AND ACCEPTED BY: CUSTOMER DISTRIBUT(,1i (Yr G- AUTHORIZED SIGNATURE AUTHORIZED SIG TU E AftRIh---.13k\00k }) ' ��T NANTED NAME PRINTED Branch Manager TITLE TIME i DATE DATE Customer acknowledges having read and understood oil of the terms of this Rental Agreement,including page 2 hereof. and agrees to be bound by all of the terms herein upon execution of this Rental Agreement. ► BOTTLELESS water: NATION """"""F4 TPANSACIION NUMBFG(INirPNAi USFI BOTTLELESS NATION onebn .com CUSTOMER PAYMENT AUTHORIZATION • pur'=watery)0rtners ✓Oak Pi Hv Thank you for choosing your Pure Water System Please tell us how you prefer to pay your invoices BOTTLE LE SS NATION Customer Name: C � �tLStf1NI 1 �1 0 QL) 1 j�1 :,�('Lt i �x [�, Ei New ElRenewal n Rewrite Efi Dealer Buyout Payables Department Information: Payables Contact Name: A m Kin ci (1 Pi a.:0(-5pn Billing Address: ?v- I t • 10ill 3f ; Jeeersc Iv I le s IN 41 1 30 Email: O 0, i Cker Son @Jef ersUV VI I le oG(inc jL V Phone: 'el " U 1 '" .)�) Ext: J Tax Exempt: EYes (PI EASE PROVIDE FORM) No Vendor Form: Yes (PLEASE PROVIDE FORM) Er No Payment Method: 0 Auto Pay I Recurring ACH or E Check(Preferred Method) PWP will contact you for banking information. Check I s3.00processing fee will apply [f ACH Payments i Direct Deposit to Pure Water Partners.Banking info will be sent to the email provided. 12 Credit Card/Debit Card I Processing fees will apply Invoicing Preference: f�' Email for Invoices: 0C't1C�'�{ VTt,-) '1 @iefcelso tr ju)1 vd1c9din . 1/ II Payment Inquiry Email: Invoice Capture/Portal: Ei Yes El No (PORTAL NAME OR INVOICECAPTUPE EMAIL ADDRESS) Is a PO # required on Invoices? 0 Yes ® No Po # Trans Number: Account Pep: 123 South Third Avenue,Suite 28 • Sandpoint,ID 83864 •208.255.2525 •customerservice@purewaterpartners corn