226014 11/05/2013 CITY OF CARMEL, INDIANA VENDOR: 366022 Page 1 of 1
ONE CIVIC SQUARE XYLEM WATER SOLUTIONS USA INC CHECK AMOUNT: $5,994.00
CARMEL, INDIANA 46032 PO BOX 223724
PITTSBURGH PA 15251-2724 CHECK NUMBER: 226014
CHECK DATE: 1115/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
652 5023990 07758742 5, 994 . 00 OTHER EXPENSES
Xylem Water Solutions U.S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 T l�T O L� YOUR PURCHASE ORDER
Tel.(317)273-4470 Fax:(317)273-4480 111 ii S13723
INVOICE NO. FUS NO. DATE SHIPPED FDELIVERY NOTE
07758742 920622 10/14/13
P.O. BOX 223724 17943
Pittsburgh,PA 15251-2724 INVOICE DATE TRN WHS PAYMENT TERMS
10/14/13 A3 115 NET 60 DAYS
Sold To: Customer No. 1039.7:3 Ship To:
CITY OF CARMEL CARMEL WWTP
ATTN: LISA KEMPER ATTN: BLAINE MALLBER
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
FedEx PKG Ground Business QUOTE #2013-IND-0445,VER2 ED RYAN
QUANTITY SHIPPED UNIT PRICE
TINE ITEM/DESCRIPTION NET PRICE EXTENDED'AMOUNT
UM DISCOUNTJCHARGE'
NS1384 / LIFT STATIONS 02 . 2308 . 00 (CARMEL MULTITR DE
COMPONENTS)
001 8400000800103 3 285 . 00 285 . 000 855 . 00
RELAY, LEVEL CONTROL, ALARM + EA
110VAC
SIN:
002 8400000800004 3 391 . 00 391 . 000 1, 173 . 00
PROBE, FS, 3 SENSORS + EA
1' 4" LONG, 33 ' CABLE
SIN.
003 8400000800048 3 50 . 00 50 . 000 150 . 00
KIT, PROBE MOUNTING, STANDARD EA
004 8400000800051 3 1, 190 . 00 1, 190 . 000 3 , 570 . 00
CONTROLLER, DUPLEX, BASIC, + EA
2 ALARM, 110VAC
SIN:
005 140000069983ON 1 246 . 00 246 . 000 246 . 00
Cont on 2
Xylem Water Solutions U .S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 JAN O C E YOUR PURCHASE ORDER
Tel.(317)273-4470 Fax:(317)273-4480 S13723
INVOICE NO. FUS NO. DATE SHIPPED I DELIVERY NOTE
P.O. BOX 223724 07758742 920622 10/14/131 B17943
Pittsburgh, PA 15251-2724 INVOICE DATE TRN WHS PAYMENT TERMS
10/14/13 A3 115 NET 60 DAYS
Page 2
Sold To: Customer No. 103973 Ship To:
CITY OF CARMEL CARMEL WWTP
ATTN: LISA KEMPER ATTN: BLAINE MALLBER
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
FedEx PKG Ground Business QUOTE #2013-IND-0445,VER2 ED RYAN
QUANTITY SHIPPED UNIT PRICE
LINE ITEM/DESCRIPTION NET PRICE' EXTENDED AMOUNT
UM DISCOUNT/CHARGE
005 140000069983ON
FREIGHT CHARGE-NO TAX EA
SUB-TOTAL OF POSITIONS 5 , 994 . 00
*FREIGHT CHARGED AS LINE ITEM*
TOTAL WEIGHT 26 . 000 LBS
NET AMOUNT BEFORE TAXES USD 5, 994 . 00
DISPATCH INFO: 429794365796
ORDER TOTAL USE)
5 , 994 . 00
VOUCHER # 136688 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
07758742 02-2308-00 $5,994.00
Depreciation
1
I
1
Voucher Total $5,994.00
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 10/29/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/29/201: 07758742 $5,994.00
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