249466 09/09/15 Sf CITY OF CARMEL, INDIANA VENDOR: 366022
4;
® 1 ONE CIVIC SQUARE XYLEM WATER SOLUTIONS CHECK AMOUNT: $*****2,652.00'
} CARMEL, INDIANA 46032 26717 NETWORK PLACE CHECK NUMBER: 249466
CHICAGO IL 60673-1267 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 3556855010 2,652.00 OTHER EXPENSES
Xylem Water Solutions U .S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 INVOICE YOUR PURCHASE ORDER
Tel.(317)273-4470 Fax:(317)273-4480 S15385
INVOICE NO. FUS NO. DATE SHIPPED DELIVERY NOTE
26717 Network Place 3556855010 A25769 8/20/15 C63562
cI11Ca O, 0L 60673-1267 INVOICE DATE TRN WHS PAYMENT TERMS
9 8/20/15 A3 115 100 o N60 FROM INVOICE
Sold To: Customer No. 201654 Ship To:
Global No. 8027181
CARMEL UTILITIES WTP CARMEL WASTE WATER TREATMENT
9609 HAZEL DELL PKWY ATTN: DUANE JARVIS
9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
INDIANAPOLIS IN 46280
INCO TERMS DELIVERY TERMS ORDER PROCESSED BY
�CA US WH/ Factory PP/Add Order P.,ositio FLYGT-INDIANAPOLIS, IN BRA
SHIP VIA a — ~ORDER TEXT �— CUSTOMER TEXT
FedEx PKG Ground Business LIFT STATIONS Vicki LeFeber
LINE ITEM/DESCRIPTION QUANTITY SHIPPED UNIT PRICE NET PRICE EXTENDED AMOUNT
UM DISCOUNT/CHARGE
Quote# 2015-IND-0450
001 8400000800051 2 1, 257 . 00 1, 257 . 000 2 , 514 . 00
CONTROLLER,MTDPC,DUPLEX + EA
MTDPC, 110VAC
S/N: cl531257
S/N:a1530714
002 140000069983ON 1 119 . 00 138 . 000 138 . 00
SHIPPING AND HANDLING-NO TAX EA
Increase by Set $ Valu 19 . 00
SUB- OTAL OF POS TIONS 2 , 652 . 00
*S & H CHARGED AS LINE ITEM*
TOTAL WEIGHT 9 . )00 LBS
NET MOUNT BEFORI TAXES USD 2 , 652 . 00
DISPATCH INFO: 643665582923
O AER TOTAL USD
2 , 652 . 00
IMPORTANT-This invoice is governed by and subject to Xylem Water Solutions USA,Inc.General Terms and Conditions of Sale. Different terms are hereby rejected unless expressly assented
to in writing. Terms are accessible at http://www.xylemwatersolutions.com/scs/usa/en-us/Pages/General-Terns-and-Condit ions-of-Sale.aspx
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
352772
Xylem Water Solutions USA Inc(GODWIN PUMF Purchase Order No.
26717 Network Place Terms
Chicago, IL 60673-1267 Due Date 9/1/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/1/2015 3556855010 $2,652.00
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
9�j�S --�rn.
Date Officer
VOUCHER # 156198 WARRANT # ALLOWED
352772 IN SUM OF $
Xylem Water Solutions USA Inc (GODW
26717 Network Place
Chicago, IL 60673-1267
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
3556855010 01-7200-03 $2,652.00
Voucher Total $2,652.00
i
Cost distribution ledger classification if
claim paid under vehicle highway fund
I