101854 XYLEM WATER SOLUTIONS USA, INC INDIANA RETAIL TAX EXEMPT Page 1
f9.
II itCilt37 ot Carmel
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101854
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING LIP ,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL=1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO: VENDOR NO. DESCRIPTION . \r7
8/912018 372689
XYLEM WATER SOLUTIONS USA, INC Human Resources
VENDOR 26717 NETWORK PLACE SHIP 1 Civic Square
TO::. Carmel,:IN 46032- . .
CHICAGO, IL 60673--1267
PURCHASE ID BLANKET CONTRACT
PAYMENT TERMS;' , FREIGHT
28379
QUANTITY .: : UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1208 Fund: 101 General Fund
Account:. 43-509.00
1 Each . . Other Contracted Services : $1,560.60 $1,560.60
Sub Total
. .. :$1,560.60017
. :
es4,t
4
, .°'Mill
at
Send Invoice To: 1,®rt"
Human Resources
1:Civic SquareI Ata
,"":
Carmel,IN 46032=
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT. : . I : PROJECT .: I .PROJECT ACCOUNT . :. AMOUNT.
PAYMENT $1,560.60
•NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
*SHIP PREPAID. AFFIDAVIT ATTACHED.::I HEREBY CERTIFY THAT THERE IS AN UNOBUGATED BALANCE IN
•C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
`PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
James Crider
TITLE .:. Administration
CONTROL NO. :101854 CLERK-TREASURER