206504 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366022 Page 1 of 1
ONE CIVIC SQUARE XYLEM WATER SOLUTIONS CHECK AMOUNT: $20,332.44
s CARMEL, INDIANA 46032 PO BOX 223724
c'oH io PITTSBURGH PA 15251 CHECK NUMBER: 206504
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 7671016 20,332.44 OTHER EXPENSES
Xylem Water Solutions U.S.A., Inc.
14125 SOUTH BRIDGE CIRCLE g �T �T g
CHARLOTTE, NC 28273 1 N Y O 1 C E YOUR PURCHASE ORDER
Tel.(704)716 -7600 Fax:(704)716 -7610 S12965
INVOICE NO. FUS NO. DATE SHIPPED DELIVERY NOTE
07671016 828045 1/25/12 961759
P.O. BOX 223724
Pittsburgh,PA 15251 -2724 INVOICE DATE TRN WHS PAYMENT TERMS
1/25/12 A3 115 NET 30 DAYS
Sold To: Customer: No. 10397'3 Ship To:
CITY OF CARMEL CITY OF CARMEL INDIANA
ATTN: LISA KEMPER ATTN: JEFF COOPER
760 THIRD AVE SW 9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
CARMEL IN 46032
ORDER LEAD TIME F.O.B /FREIGHT ORDER PROCESSED BY
Li week or less ex WWW or port PP /Add Actual surcha WEDECQ CHARLOTTE,NC
SHIP VIA ORDER TEXT CUSTOMER TEXT
Shipper choice Ground JULIE
QUANTITY SHIPPED UNIT PRICE
LINE— ITEMlDESCRIPTION NET PRICE EXTENDED AMOUNT
UM .....DISCOUNT/CHARGE.:
001 7600006101276- 150 175.00 135.000 20,250.00
UV LAMP SLR32143 /4PHP.US EA
US VERSION
Reduction by Set Value 40.00
OLD NUMBER: I39898
SUB-TOTAL OF POSITIONS USD 20,250.00
*PLUS ACTUAL FREIGHT CHARGES* 82.44
TOTAL WEIGHT 298.000 LBS
NET AMOUNT BEFORE TAXES USD 20,332.44
DISPATCH INFO: 06216246824
ORDER TOTAL USD
20,332.44
Prescribed by State Board of Accounts City 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.
PO box 223724 Terms
Pittsburgh, PA 15251 -2724 Due Date 2/7/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/7/2012 7671016 $20,332.44
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 116743 WARRANT ALLOWED
352772 IN SUM OF
Xylem Water Solutions USA Inc (GODW
PO box 223724
Pittsburgh, PA 15251 -2724
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
7671016 01- 7202 -06 $20,332.44
Voucher Total $20,332.44
Cost distribution ledger classification if
claim paid under vehicle highway fund