199143 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 353755 Page 1 of 1
ONE CIVIC SQUARE PATTERSON PUMP
CARMEL, INDIANA 46032 PO BOX 101049 CHECK AMOUNT: $6,250.48
ATLANTA GA 30392 CHECK NUMBER: 199143
CHECK DATE: 7/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 122225 6,250.48 MATERIALS SUPPLIES
PATTERSON PUMP COMPANY Invoice Number: 122225
2129 AYERSVILLE RD Page: I of I
P.O. Box 790 Date: 5/11/2011
-fl- H i TOCCOA, GEORGIA 30577
PHONE 7061886 -2101 FAX 706 1886.0023 Salesperson: H.E. DANBY CO., INC.
A SUDSIOIARYOF THE GORMAN- RUPPCO. Regular Invoice
Tax ID is 58- 1810950
56223 3
B CITY OF CARMEL S CITY OF CARMEL
I 3450 W. 131 st STREET Fl 5484 E 126th St
L WESTFIELD IN 46074 1 Carmel IN 46033 -9289
L USA 1' USA
T T
0 O
Tag For:
Oriltr Purchasc0'rdet Ptckagcs Yrepftd ,.N Weiglf Ship ViaTems
0000102868 W09493 BEST WAY NET 30 DAYS
LmelRclQty f3raered „Q,ty Shtppcd Back Order UnttP,r'fee Fxtf nle� Price
1 1.00 1.00 0.00 6,172.00000 6,172.00
Cl:
Item: 21002502
Description: ROTOR FOR C046997 5X3 MAC 316SS IMP
U /M: EA
Date Shipped: 05/10/2011
C046997
Final Destination: Carmel, IN USA
SalefResale for use at Final Destination only. Export to any other destination will vold the product
warranty, damage the relationship with the manufacturer and may be contrary to U. S. law. s
Exportation of the product from the United States must be in accordance with U. S. law and diversion v S21C5QTitOUnt'?: 6,172.00
of shipment contrary to U. S. law is prohibited. Misc Charges 0.00
Remit T0: THIS IS TO CERTIFY THAT THE IF THIS SALE IS SUBJECT Freight 78.48
Patterson Pump ERCHANDISE LISTED ON THIS INVOICE TO A SALES OR USE TAX IN Sales Tax 0.00
p HAS BEEN PRODUCED IN ACCORDANCE YOUR STATE, PLEASE PAY
P.O. Box 101049 WITH THE FAIR LABOR STANDARDS ACT AS THE TAX DIRECT TO THE
Atlanta, GA 30392 AMENDED. STATE. Prepaid Amount 0.00
THIS ORDER IS SUBJECT TO OUR STANDARD TERMS AND CONDITIONS. a FO tal 6,250.48
ORIGINAL INVOICE
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
353755
PATTERSON PUMP Purchase Order No.
PO BOX 101049 Terms
ATLANTA, GA 30392 Due Date 6/27/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/27/2011 122225 $6,250.48
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
Date Officer
VOUCHER 111596 WARRANT ALLOWED
353755 IN SUM OF
PATTERSON PUMP
PO BOX 101049 WATER
ATLANTA, GA 30392 OPERATIONS
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
122225 01- 6200 -04 $6,172.00
122225 01- 6200 -04 $78.48
Voucher Total $6,250.48
Cost distribution ledger classification if
claim paid under vehicle highway fund