216246 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 366022 Page 1 of 1
ONE CIVIC SQUARE XYLEM WATER SOLUTIONS USA INC
CARMEL, INDIANA 46032 PO BOX 223724 CHECK AMOUNT: $24,998.58
PITTSBURGH PA 15251-2724 CHECK NUMBER: 216246
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
652 5023990 07712540 24, 998 . 58 OTHER EXPENSES
Xylem Water Solutions U.S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 INVOICE YOUR PURCHASE ORDER
Tel.(317)273-4470 Fax:(317)273-4480 S13261
INVOICE NO. FUS NO. DATE SHIPPED I DELIVERY NOTE
P.O. BOX 223724 07712540 866484 � 11/14/121 A48383
Pittsburgh, PA 15251-2724 INVOICE DATE TRN WHS PAYMENT TERMS
11/14/12 A3 088 NET 60 DAYS
Sold To: Customer No. 10 3 9 7 3 Ship To:
CITY OF CARMEL CITY OF CARMEL INDIANA
ATTN: LISA KEMPER REF: PO#513261
760 THIRD AVE SW 9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
CARMEL IN 46032
,NCO TERMS DELIVERY TERMS ORDER PROCESSED BY
CA/FOB US Port/WH/ Factory WILSON(TNT) Order Po FLYGT-INDIANAPOLIS,IN BRA
SHIP VIA Ocean Freight ORDER TEXT CUSTOMER TEXT
WILSON Selects carrier QT#2012-IND-0290 DAVID CHROMIK
QUANTITY SHIPPED UNIT PRICE
LINE ITEM/DESCRIPTION NET PRICE EXTENDED AMOUNT
UM DISCOUNT/CHARGE
001 0031021812964 5 5 , 039 . 00 4 , 898 . 915 24 , 494 . 58
CP435-4 5/460/3 50 ' FLS FV EWR EA
Additional o Discount-Position 2 . 780
S/N: 1270124 DIN A48383
S/N: 1270125 DIN A48383
S/N: 1270126 DIN A48383
S/N: 1270127 DIN A48383
S/N: 1270128 DIN A48383
002 140000069983ON 1 504 . 00 504 . 000 504 . 00
FREIGHT CHARGE-NO TAX EA
SUB-TOTAL OF POSITIONS USD 24 , 998 . 58
*FREIGHT CHARGED AS LINE ITEM*
TOTAL WEIGHT 1, 402 . 500 LBS
NET AMOUNT BEFORE TAXES USD 24 , 998 . 58
TOTAL WEIGHT ON D/N:A48383
DISPATCH INFO: 822003 ORDER TOTAL USD
24 , 998 . 58
VOUCHER # 126278 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
07712540 02-3710-30 $24,998.58
Depreciation
am
Voucher Total $24,998.58
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 PUMP Purchase Order No.
PO box 223724 Terms
Pittsburgh, PA 15251-2724 Due Date 12/6/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/6/2012 07712540 $24,998.58
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC 5-11-10-1.6
Date Officer