212423 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 366022 Page 1 of 1
ONE CIVIC SQUARE XYLEM WATER SOLUTIONS
\i CHECK AMOUNT: $5,130.80
CARMEL, INDIANA 46032 PO BOX 223724
PITTSBURGH PA 15251 CHECK NUMBER: 212423
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 07698374 4, 826 . 80 OTHER EXPENSES
651 5023990 07698776 304 . 00 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 I N V O I C `E S13192
INVOICE NO. FUS NO. DATE SHIPPED I DELIVERY NOTE
P.O. BOX 223724 07698776 859002 8/13/12 A27187
Pittsburgh,PA 15251-2724 INVOICE DATE TRN FWHS PAYMENT TERMS
8/13/12 A3 11 15 NET 60 DAYS
Sold To: Customer No. 103973 Ship To:
CITY OF CARMEL CITY OF CARMEL INDIANA
760 THIRD AVE SW 9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
CARMEL IN 46032
[NCO TERMS DELIVERY TERMS ORDER PROCESSED BY
CA US WH/Factory - _ PP/Add Order Positio FLYGT-INDIANAPOLIS,IN BRA
SHIP VIA ORDER TEXT CUSTOMER TEXT
FedEx PKG Ground Busin GREG STARK
QUANTITY SHIPPED UNIT PENCE
LINE ITEM/DESCRIPTION NET PRICE EXTENDEDAMOUNT
�M DISCOUNT/CHARGE.
001 0000000942102 40 7 . 60 7 . 600 304 . 00
CABLE, SUBCAB AWG 14/7 19MM FT
SUB-TOTAL OF POSITIONS USD 304 . 00
*FREIGHT CHARGED AS LINE ITEM*
TOTAL WEIGHT 16 . 000 LBS
NET AMOUNT BEFORE TAXES USD 304 . 00
DISPATCH INFO: 759028740037390
ORDER TOTAL USD
304 . 00
'd-0) 00
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 I N V I �. ;E S13192
INVOICE NO. FUS NO. DATE SHIPPED DELIVERY NOTE
P.O. BOX 223724 07698374 859002 8/09/12 A26939
• Pittsburgh, PA 15251-2724 INVOICE DATE TRN WHS PAYMENT TERMS
8/09/12 A3 I 115 NET 60 DAYS
Sold To: Customer No. ..10 3 9 73 Ship To:
CITY OF CARMEL CITY OF CARMEL INDIANA
R
760 THIRD AVE SW 9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
CARMEL IN 46032
INCO TERMS DELIVERY TERMS ORDER PROCESSED BY
CA US WH/ Factory PP/Add Order Positio FLYGT-INDIANAPOLIS, IN BRA
SHIP VIA ORDER TEXT CUSTOMER TEXT
UPS-Ground GREG STARK
QUANTITY SHIPPED UNIT PRICE
LINE ITEM/DESCRIPTION NET PRICE EXTENDED:AMOUNT
UM DISCOUNT%CHARGE
001 0000000841794 1 12 . 00 12 . 000 12 . 00
GROMMET, NBR 21ID 350D 26L EA
002 0000000824061 2 2 . 90 2 . 900 5 . 80
WASHER, SS 24 . 5MM ID 35MM OD EA
003 140000069983ON 1 14 . 00 14 . 000 14 . 00
FREIGHT CHARGE-NO TAX EA
004 0000006018932 1 4 , 632 . 00 4 , 632 . 000 4 , 632 . 00
KIT,REPAIR BASIC 3170/3201 NI EA
005 0000000827034 1 23 . 00 23 . 000 23 . 00
PLUG,M30 STEEL EA
006 140000069983ON 1 140 . 00 140 . 000 140 . 00-
FREIGHT CHARGE-NO TAX EA
SUB-TOTAL OF POSITIONS USD 4 , 826 . 80
*FREIGHT CHARGED AS LINE ITEM*
TOTAL WEIGHT 22 . 000 LBS
Cont on 2
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 INVOICE S13192
INVOICE NO. FUS NO. DATE SHIPPED I DELIVERY NOTE
P.O. BOX 223724
07698374 859002 8/09/12 A26939
Pittsburgh,PA 15251-2724 INVOICE DATE TRN WHS PAYMENT TERMS
8/09/12 A3 115 NET 60 DAYS
Page 2
Sold To: Customer:No 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
INCO TERMS DELIVERY TERMS ORDER PROCESSED BY
CA US WH/Factory PP/Add Order Positio FLYGT-INDIANAPOLIS,IN _BRA
SHIP VIA ORDER TEXT CUSTOMER TEXT
UPS-Ground GREG STARK
_... _ _.. _ _ _._ _.._ _.... .. _......_...__.
__ _ __ __... _ _..._ __.,.. .............._
QUANTITY SHIPPED UNIT PRICE
LINE ITEM/DESCRIPTION NET PRICE EXTENDED:.AMOUNT 111,UM DISCOUNT%CHARGE:
NET AMOIUNT BEFORE TAXES USD 4 , 826 . 80
DIS ATCH INFO: 1Z4F398X0342821515
ORDER TOTAL USD
4 , 826 . 80
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 PUMF Purchase Order No.
PO box 223724 Terms
Pittsburgh, PA 15251-2724 Due Date 8/21/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)). Amount
8/21/2012 07698374 $4,826.80
hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC 5-111.0-1.6
Date Officer
VOUCHER # 125525 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
07698374 01-7202-06 $4,826.80
0-7�8677(6 or, ��o�, o� . 301,00
Voucher Total 1$ - 0
Cost distribution ledger classification if
claim paid under vehicle highway fund