206856 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 365022 Page 1 of 1
ONE CIVIC SQUARE XYLEM WATER SOLUTIONS
CHECK AMOUNT: $2,628.30
CARMEL, INDIANA 46032 PO BOX 223724
PITTSBURGH PA 15251
CHECK NUMBER: 206856
CHECK DATE: 2/2812012
DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 07672426 2,628.30 OTHER EXPENSES
Xylem Water Solutions U.S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 YOUR PURCHASE ORDER
TeL(317)273 -4470 Fax:(317 )273 -4480 VERBAL JOE FAUCET
INVOICE NO. FUS NO. DATE SHIPPED rE)EL NOTE
07672426 828547 2/07/12
P.O. BOX 223724 3783
A
Pittsburgh, PA 15251 -2724 INVOICE DATE TRN WHS PYMENT TERMS
2/07/12 C1 123 NET 60 DAYS
Sold To: Customer Na: 10397 >3 Ship To:
CITY OF CARMEL CITY OF CARMEL INDIANA
ATTN: LISA KEMPER
760 THIRD AVE SW 9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
CARMEL IN 46032
ORDER LEAD TIME F.O.B /FREIGHT ORDER PROCESSED BY
1 week or less ex WWW or port No Freight Charge INDIANAPOLIS,IN BRANCH
SHIP VIA ORDER TEXT_. CUSTOMER TEXT
Branch Delivery RP##2370 3102.181- 1089008 SILVIA STOIANOVA
QUANTITY SHIPPED UNIT PRICE
LINE ITEM /DESCRIPTION NET PRICE' EXTENDED A.MOUNT
.:.UM: DISCOUNT /CHARGE'
REPAIR OF FLYGT PUMP MODEL 3102
001 0000006018906 1
KIT,REPAIR BASIC+ NI EA
3102.090,180
TOT PRICE/GROUP 001 001 535.50
002 0000006930219 1
IMPELLER,N SH CODE 256 CI EA
TOT PRICE/GROUP 002 002 1,255.80
003 1400000699973 8 97.00 97.000 776.00
LABOR,SERVICE -ININ EA
004 1400000699833 1 34.00 34.000 34.00
ENVIRONMENTAL FEE 0 -10HP EA
005 1400000699800 1 27.00 27.000 27.00
MAT'L..LUDES,SOLVENTS-SMALLPTJMP EA
NET AMOUNT BEFORE TAXES USD 2,628.30
ORDER TOTAL USD
2,628.30
VOUCHER 116835 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
07672426 01- 7202 -06 $1,852.30
07672426 01- 7362 -06 $776.00
Voucher Total $2,628.30
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 PUMP Purchase Order No.
PO box 223724 Terms
Pittsburgh, PA 15251 -2724 Due Date 2/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/20/2012 07672426 $2,628.30
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 icer