159070 04/30/2008 CITY OF CARMEL, INDIANA VENDOR: 358337 Page 1 of 1
ONE CIVIC SQUARE SIEMENS WATER TECHNOLOGY CORP CHECK AMOUNT: $228.00
CARMEL, INDIANA 46032 CONVENTIONAL PRODUCTS
DEPT CO 14241
CHECK NUMBER: 159070
PALATINE IL 60055 -4241
CHECK DATE: 4/30/2008
DEPARTMENT ACCOUNT P O NUMBER INVOICE NUM AMOUNT DESCRIPTION
601 5023990 20003274 228.00 MATERIALS SUPPLIES
u
I
SIEMENS
INVOICE Original
Delivery Address
Carmel Water Distribution Carmel Water Distribution
3450 W.131st Street Dan Jenkins 317/733 -2854
Westfield IN 3450 W.131st Street
46074 Westfield IN
46074
Customer: 3298 Invoice 20003274 Date: 04 -04 -08
Quantity Unit Item Code Amount Unit Tax Discount Amount
Order Number 331201
Order Date 04 -03 -08
Customer PO WOP3S2319Dan
Dispatch Note: 25664
3.00 ea A0001108C 76.00 ea No 228.00
MANWAY GASKET 14x18 NEO
GASKET MANWAY 14.0 x 18.0
Rubber Gaskets for size 14" x 18" Manway,
1 -1/2" wide x 1/4" thick. Neoprene
Remit to:
Siemens Water Technologies Corp. Dept. CH 14241 Tel: (515) 268 -8400
Conventional Products Palatine, IL 60055 -4241 Fax: (515) 268 -8429
www.siemens.comlwater
SIEMENS
INVOICE Page 2
Customer: 3298 Invoice 20003274 Date: 04 -04 -08
Quantity Unit Item Code Amount Unit Tax Discount Amount
Carry forward: 228.00
Dispatch Note: 25664
For export shipments from the US the following applies:
These commodities, technology or software (items) were exported from the United States in
accordance with the Export Administration Regulations. Diversion contrary to US law is
prohibited. These items are not to be used directly or indirectly in prohibited nuclear
chemical /biological or missle weapons activities.
For domestic shipments the following applies:
These commodities are sold for domestic consumption. Any export of these commodities must
be made in accordance with applicable US laws.
Goods
Total
228.00 228.00
Delivery FOB Shipping Point Frt Alld
Payment 100 Net 30 Days
When remitting, please reference 3298/20003274 Please remit in US Dollars
Remit to:
Siemens Water Technologies Corp. Dept. CH 14241 Tel: (515) 268 -8400
Conventional Products Palatine, IL 60055 -4241 Fax: (515) 268 -8429
www.siemens.com /water
Prescribed by State Board of Accounts City Form No. 201 (Rev 199 5)
ACCOUNTS PAYABLE VOUCHER t
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where f
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
357473
SIEMENS WATER TECHNOLOGIES CORP Purchase Order No.
DEPT CH 14241 Terms
PALATINE, IL 60055 -4241 Due Date 4/22/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/22/2008 20003274 $228.00
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
Date Officer
VOUCHER 081507. WARRANT ALLOWED
357473 IN SUM OF
SIE- MENS WATER TECHNOL S CC
DEPT CH 14241
PALATINE, IL 60055 -4241 Z
qq
0 ,01
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
20003274 01- 6200 -04 $228.00
Voucher Total $228.00
Cost distribution ledger classification if
claim paid under vehicle highway fund