173295 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 356597 Rage 1 of 1
0 ONE CIVIC SQUARE DEZURIK WATER CONTROLS CHECK AMOUNT: $2,854.00
„o. CARMEL, INDIANA 46032 NW 5520 PO BOX 1450
MINNEAPOLIS MN 55485 -5520 CHECK NUMBER: 173295
CHECK DATE: 6/10/2009
DEPARTME ACCOUNT PO NU MBER INVOICE NU AMO D ESCRIPTION
604 5023990 W08772 55005110 2,854.00 VALVES
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SA RTELLWWes, n c o Ph
F one (320)
ax (320) 259 -2
Water Vanes& 250 Riverside Avenue North, Sartell, Minnesota 56377 -2129 USA
®eZImJRIK Controls STELL a Controls
INVOICE
Customer/ Original/ Page 1
`'Date Ship Date Customer PO No. Agent Ref. No. Invoice No.
05 -20 -2009 05 -19 -2009 051409 -ROB LOVELL 911300 RPI /55005110
SOLD TO 122163 SHIPPED TO
CARMEL UTILITIES V CARMEL WATER DEPT
760 3RD AVE SW U C/O PLANT 5
CARMEL, IN 5484 EAST 126TH STREET
46032 D n CARMEL, IN
1 S -I 46032
W�
DEL.TERMS: Prepaid and Allow TERMS: Net 30 Days
ORDER NO.: 860561 DUE DATE: 06 -19 -2009
Dez (Customer I Quantity) Part Number I Revision I Price (Unit I Amount
ItemlItem I I I I I
I I I I I I I
Reference A 742787
Reference B SEH Project Name
IF PRODUCTS LISTED BELOW REQUIRE MATERIAL SAFETY
DATA SHEETS IN ACCORDANCE WITH OSHA (1910.1200
(B) (5) IV, (C) THEY WILL ACCOMPANY PRODUCT
SHIPMENT.
1 1 2.00 9497450 001 1427.00 ea 2854.00
Sartell Valves Controls BOS, 18, CL, L1, CI,EPDM,EPDM,DI- S4 *AM-250C -HD12
Goods Total USD
2854.00 2854.00
PLEASE REFERENCE OUR INVOICE NO. RPI/55005110 WHEN REMITTING PAYMENT.
REMIT To: DeZURIK COURIER To: DeZURIK WIRE To: DeZURIK
NW 5520 Lockbox NW 5520,C/O Regulus Account Number 4121081996
PO BOX 1450 1350 Energy Lane, Suite 200 ABA #121000248 Wells Fargo Bank
Minneapolis, MN 55485 -5520 Saint Paul, MN -55108 San Francisco, CA
Prescribed by State Board of Accounts City Form 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
356597
DeZURIK WATER CONTROLS Purchase Order No.
NW 5520 Terms
PO BOX 1450 Due Date 6/2/2009
MINNEAPOLIS, MN 55485 -5520
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/2/2009 55005110 $2,854.00
1
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 WARRANT ALLOWED
356597 IN SUM OF
tDeZURIK WATER CONTROLS ���r� U'
NW 5520 2
PO BOX 1450 0 ,a�R1�,�0
MINNEAPOLIS, MN 55485 -5520
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
(ca• 3 �4D 5
Q �1� 55005110 02- 2308 -00 $2,854.00
UU Depreciation
Voucher Total $2,854.00
Cost distribution ledger classification if
claim paid under vehicle highway fund