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Home My WebLink AboutJPD Rental of Filtered Ice & Water Machine (BPW approved 3/18/26) 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: I BOTTLELESS NATION CUSTOMER SATISFACTION GUARANTEE This warranty covers all water and ice purification systems serviced by Bottleless Notion 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 Preventotiv Maintenance Program will strictly follow manufacturer guidelines fur system sanitization intervals. II 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 ploy' e normal care tar 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 y of the war nty. Customer BN Representative Signature: U �— Signature.: _ r' t` Print Name: \k' Print Natne: Title: Mc.yor Date: Date: 3 -\ . Reference #: Items Not included • Water Only Preventative Program - $129.00 each • Water/Ice Preventative Program - $19900 each • Industrial Ice Br Annual Preventative Nog urn - $25000 eacr • Equipment Relocation - $195.00 each • CO2 Exchange,Other $119.00 • CO2 Exchange. KUPA- $195.00 BOTTLELESS NATION BOTTLELESS NATION 1402 a 90th St 4625 DELIVERY AND ACCEPTANCE AGREEMENT rndianapolis,A66)IN?1 6910 Customer Name: I t • ' Customer and Distributor certify that all E.iLApment 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 unconditionai;y and irrevocooly, 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. CUSt our fl AiIIHURL"'LI SI( NAIrIRI NAME (PRINTED) • r. riAr, Branch Manager a !ilk 4 CQ tti:1\141\t\l"'IbtO Cp/srRlf8UrOR UTH FWED SIGNATURE NAME (PRIN'E D' 117J i Model Serial Number 4( `j i\t)1, 4 3 — — - — Statement of Assurance Distributor is comr,vtted to providing you with quality equipment, quality service and quality drinking water. If for any reason you are not satisfied with the performance of your equipment or the level of service prrwlded,please contact us directly for prompt assistance. El SEE ATTACHED EQUIPMENT SCHEDULE, IF APPLICABLE REFERENCE NUMBER INTERNAI U5E1 BOTTLELESS NATION 7402 E 90th St RENTAL AGREEMENT Indianapolis. CUSTOMER !NI OPMATION Company Full Legal Name: 1 Lit t .]ITh \\- 1- Ali L. S .is i A) i �� - Contact:<<rtys i(r �J1 ci Phone Ext: Equipment Location Address: (9?di 1et �'1~, City, State, Zip: WL,L;64:3\v ��.Ls J> � l�13C') Email ( t��14z� L cycwt11� illttls�tifiN #. 35` IbNINb-1 RENTAL MONTHLY BILLING SPF. TERM PAYMENT FREQUENL't INSTRUL 1 IOti • ANNUALLY 60 mo $ I I elEit QUARTERLY PLUS TAxES El MONTHLY ISQUIPMI-NI '.t tit.Utlt I ACCOUNT aET if{' FFF,, Water Installation Fee S200/Unit Ice&Water Installation Fe., 1250/Una • Industrial Ice Installation Fe S3SO/Unit SEE ATTACHED EQUIPMENT SCHEDULE. IF APPLICABLE Total AGREED AND ACCEPTED B'I -11 CUSTOM. DIST IBUTOR 4 Hin,Wi t U ;,tt,t+AII,Rt AJTHORIIfl+ Sio Tt; t 1 /Ke /floo 2 e- III( ( 1) .4N1 NAME PRINTED NAAf• 04.Nitr Cttok, Branch Manager TOIL T;TLI °Alt OArF Customer ocknowtedges having read and understood all 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 t BOTTLELESS water NATION -YAWSA[TtON MIM/StN 1INtFQNA� usEt BOTTLELESS NATION onebn corn CUSTOMER PAYMENT AUTHORIZATION ♦ I-urcwoterr nwnkyou to ctic s,.;y.„i(l ine Wire,System Reuse WI us louwyuu wrier W puyyuu uwu.crs BOTTLE LE SS NATION Customer Name: \ Lli 1' �Z �� LAI II i L� 1ct akcim Qvvi-, New 0 Renewal Rewrite � efi n Dealer Buyout Payables Department Inforrrration, Payables Contact Name: Ann 0,0 CI e!1 Utc.ersun Billing Address ` I r I 4'' ' ,TefeeYSt)hVI l le ) IN 41130 Email: a ck I C krr son e j e-14- rsvvl Vl Ile palls o ✓ Phone. t : _ L. } L - )001 .) Ext: lax Exempt: 'Yes IPt FASE PROVIDE FOI?M; 0 No Vendor Form: 0 Yes (PLEASE PROVIDE 1-011M! [Er No Payment Method: Auto Pay I Recurring ACH or E Check(Preferred M.•thudi r='A'P w,I;co'uu.-t you for bonkrng information 0 Check I 5300 processing will uppy [r ACH Payments I Direct Depos.t to Pure Water Partners.Banking'ran wit hr.Sete to rho ema.t prrw.iJ"+I Credit Ca rd/Debit Caid I Processing fees will apply Invoicing Preference. f� /� (� Email for Invoices: '\ son '(� je4f irso h v I lCY(iin.J J II Payment Inquiry Email _______ --- Invoice Capture/Pot tal. n Yes � No (pnprAL NAM( OR INVOICI CAPTURE EMAIL ADDRESS) Is a PC.) required on Invoices? � Yes ® NO i((MS Number: Account Rep. 123 South IhndAvenue Sude 28•Soncipo,nt.ID 83864 • 208 255 2525 •custornerserv,ce puiewaterpnrtnersConr