213711 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366022 Page 1 of 1
g ONE CIVIC SQUARE XYLEM WATER SOLUTIONS CHECK AMOUNT: $623.60
CARMEL, INDIANA 46032 PO BOX 223724
PITTSBURGH PA 15251 CHECK NUMBER: 213711
CHECK DATE: 101912012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 07705020 623 . 60 MATERIALS & SUPPLIES
Xylem Water Solutions U.S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 �T v ® � C{v YOUR PURCHASE ORDER
Tel.(317)273-4470 Fax:(317)273-4480 INVOICE COOPER
INVOICE NO. FUS NO. DATE SHIPPED DELIVERY NOTE
P.O. BOX 223724 251
07705020 866 9/25/12 A37180
Pittsburgh, PA 15251-2724 INVOICE DATE TRN WHS PAYMENT.TERMS
9/25/12 A3 123 NET 60 DAYS
Sold To: Customer No. 103973 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 No Freight Charge FLYGT-INDIANAPOLIS,IN BRA
-SHIP- A - ORDER TEXT CUSTOMER TEXT
Customer Pick Up WILL CALL GRANT BELLER
QUANTITY SHIPPED UNIT PRICE
LINE ITEM/DESCRIPTION NET PRICE EXTENDED AMOUNT
UM DISCOUNT/CHARGE
001 0000000942104 50 12 . 00 12 . 000 600 . 00
CABLE, SUBCAB AWG 12/7 21MM FT
002 0000000841802 1 19 . 00 19 . 000 19 . 00
GROMMET,NBR 23ID 520D 26L EA
003 0000000824082 1 4 . 60 4 . 600 4 . 60
WASHER, SS 34 . 5MM ID 52MM OD EA
SUB-TOTAL OF POSITIONS USD 623 . 60
** ADD NO FREIGHT CHARGES **
NET AMOUNT BEFORE TAXES USD 623 . 60
ORDER TOTAL USD
623 . 60
VOUCHER # 125845 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
ti
07705020 01-7202-06 $623.60
f
Voucher Total $623.60
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 PUMF Purchase Order No.
PO box 223724 Terms
Pittsburgh, PA 15251-2724 Due Date 10/4/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/4/2012 07705020 $623.60
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