180525 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 356869 Page 1 of 1
E Z ONE CIVIC SQUARE SEEPEX INC
CARMEL, INDIANA 46032 PO BOX 951454 CHECK AMOUNT: $4,905.60
CLEVELAND OH 44193
CHECK NUMBER: 180525
CHECK DATE: 1211612009
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION
651 5023990 S11601 30191732 4,905.60 STATOR
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Q p �f p seepex
5eepex g Inc.
511 Speedway Drive
Enon, Ohio 45323
USA
Phone (937)864 -7150
Invoice Fax (937)864 -7157
BILL TO: www.seepex.com
Carmel WWTP No. 30191732 sales @seepex.net
760 Third Ave SW Date 12/04/2009
CARMEL IN 46032 Delivery Note No. 1062389
USA Delivery Date 12/04/2009
Our Order No. 2232820 Page 1 1
Your P.O. No.
SHIP TO: dated 11/20/2009
Carmel WWTP Your Customer No. 204168
Tag: PO S11907
9609 Hazel Dell Parkway
INDIANAPOLIS IN 46280
USA Terms of delivery
FOB Shipping Point Enon
REMIT TO: Shipping terms:
seepex Inc. by truck YRC
P.O. Box 951454 Weight total(KG)
Cleveland, OH 44193 287.0
USA Tracking No. 643 890075 -1
Item Material Qty. Price p. unit Discount TotaNUSD)
10 STAF0060070OCNTX00 1 EAC 3 3,223.35
stator 60/70 -12 NBR TSE
20 STAF0060035OCNNX00 1 EAC 1,558.38 1,558.38
stator 60/35 -12 NBR
30 STAF00600520ANTX00 1 EAC
stator 60/52 -61- NBR TSE
Items total 4,781.73
Freight /Insurance 123.87
Net value 4,905.60
Final amount (USD) 4,905.60
Terms of payment
within 30 days net
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER t
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
356869
SEEPEX INC Purchase Order No.
PO BOX 951454 Terms
CLEVELAND, OH 44193 Due Date 12/11/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12111/2005 30191732 $4,905.60
I hereby certify that the attached invoice(s), or bills) is (are) true and
correct and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 096940 WARRANT ALLOWED
356869 IN SUM OF
SEEPEX INC
PO BOX 951454
CLEVELAND, OH 44193
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
3
Board members
PO INV ACCT AMOUNT Audit Trail Code
30191732 01- 7202 -06 $4,781.73
30191732 01- 7202 -06 $123.87
Voucher Total $4,905.60
Cost distribution ledger classification if
claim paid under vehicle highway fund