176435 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 358337 Page 1 of 1
ONE CIVIC SQUARE SIEMENS WATER TECHNOLOGY CORP
CARMEL, INDIANA 46032 CONVENTIONAL PRODUCTS CHECK AMOUNT: $790.00
DEPT CD 14241
o CHECK NUMBER: 176435
PALATINE IL 60055 -4241
CHECK DATE: 8/1912009
DEPART ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023'990 S11770 RJE6146 790.00 MEDIA, NOZZLE
4
r$
SIEMENS Water Technologies
1 Carmel Wastewater Utilities Invoke
760 3rd Avenue SW
Suite 110 INVOICE NO. RJE -6146
Carmel, IN 46032 DATE 8/10/2009
PROJECT NO. 304142 Carmel, IN
Project Name Carmel, IN
Shipping Address P.O. No. S11770
Carmel Utilities Terms "3u
9609 Hazel Dell Parkway Due Date 9/9/2009
Indianapolis, IN 46280 Ship Date 8/10/2009
Rep NO
Ship Via Best Way
Item Description Class Total
3750 SHIPMENT OF PACKING MEDIA, NOZZLE SHIPPING 304142 -E1 C... 790.00
Invoice Amount $790.00
Remit Payments to: Siemens Water Technologies
Dept 14266
Palatine, IL 60055 -4266
If you have any questions please contact Zenaida Edwards. Thank you!
Siemens Water Technologies 12316 World Trade Drive, Suite 100 Phone: (858) 487 -2200
San Diego, CA 92128
USA Fax: (858) 487 -5600
ECCN: EAR99 NLR; Country of origin: USA; Commodity Code: 8421.39.8030
DOMESTIC These commodities are sold for domestic consumption. Any export of these commodities must be made in compliance with applicable U.S. laws.
EXPORT These commodities, technology or software (items) were exported from the United States in accordance with the Export Administration Regulations.
Diversion contrary to U.S. law is prohibited. These items are not to be used, directly or indirectly, in prohibited nuclear, chemical /biological or missile weapons
activities.
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
352296
SIEMENS WATER TECHNOLOGIES (U.S. FILT Purchase Order No.
DEPT CH 14171 Terms
PALATINE, IL 60055 -4171 Due Date 8/14/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/14/2009 RJE6146 $790.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 096247 WARRANT ALLOWED
352296 IN SUM OF
SIEMENS WATER TECHNOLOGIES (U
DEPT CH 14171
PALATINE, IL 60055 -4171
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
RJE6146 01- 7202 -06 $790.00
C
O
11
a.
N�
Voucher Total $790.00
Cost distribution ledger classification if
claim paid under vehicle highway fund