170109 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 358337 Page 1 of 1
ONE CIVIC SQUARE SIEMENS WATER TECHNOLOGIES CHECK AMOUNT: $120.00
CARMEL, INDIANA 46032 DEPT CH 14266
PALATINE IL 60055 -4171 CHECK NUMBER: 170109
CHECK DATE: 3/18/2009
DEPARTMENT ACCO P NUMBER INVOICE NUMBER AMOUNT DESC
651 5023990 RJE 5951 120.00 OTHER EXPENSES
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S Water Technologies
Carmel Utilities Invoice
760 3rd Avenue SW
Suite 110 INVOICE NO. RJE -5951
Carmel, IN 46032 DATE 2/20/2009
PROJECT NO. 304084 Carmel, IN
Project Name Carmel, IN
Shipping Address P.O. No. Signed Quote
Carmel Utilities i "ern is 30 ivE T
9609 Hazel Dell Parkway Due Date 3/22/2009
Indianapolis, IN 46280 Ship Date 2/16/2009
Rep NO
Ship Via Best Way
Item Description Class Total
3750 GASKETS 304084 -E1 C... 120.00
Invoice Amount $120.00
Remit Payments to: Siemens Water Technologies
Dept CH 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: 8421.29.0065
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 s.
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
y
SIEMENS WATER TECHNOLOGIES (U.S. FILT Purchase Order No.
DEPT CH 14171 Terms
PALATINE, IL 60055 -4171 Due Date 3/9/2009
Invoice Invoice Description
Date Number. (or note attached invoice(s) or bill(s)) Amount
3/9/2009 RJE 5951 $120.00
j
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 095192 WARRANT ALLOWED
352296 IN SUM OF
SIEMENS WATER TECHNOLOGIES (U
DEPT CH I'Z
PALATINE, IL 60055 -4171
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
RJE 5951 01- 7202 -06 $120.00
'n
Voucher Total $120.00
Cost distribution ledger classification if
claim paid under vehicle highway fund