239984 12/09/14 0�y���p\ CITY OF CARMEL, INDIANA VENDOR: 368923
ONE CIVIC SQUARE • GRAPHICON INC CHECK AMOUNT: $""""9,901.02•
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CARMEL, INDIANA 46032 8459 CASTLEWOOD DRIVE,STE C CHECK NUMBER: 239984
4M��roN"�°' INDIANAPOLIS IN 46250 CHECK DATE: 12/09/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
854 5023990 11573 9,901.02 OTHER EXPENSES
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Graphicon, Inc. Invoice
� 8459 Castlewood Dr., Suite C
Gr con DATE INVOICE#
Indianapolis, IN 46250
YOUR CREATIVE PROMOTIONS PARTNER Phone 317-579-9090 Fax 317-579-9191 9/15/2014 11573
PROMOTIONAL PRODUCTS
& LOGO APPAREL
BILL TO SHIP TO
City of Carmel Carmel PorchFest
1 Civic Square PO Box 1033
Carmel,Indiana 46032 Carmel,IN 46082
Attn: Sue Finkam
P.O. NUMBER TERMS DUE DATE REP SHIP VIA F.O.B.
Sue Finkam Due on receipt 9/15/2014 9/15/2014 UPS ground Indianapolis
QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
3 240620-Deluxe S... 240620-Deluxe Showstopper Tent NO LOGO 400.00 1,200.00
1 Freight(merchand... Shipping Charges from Factory(FOB MN) 204.18 204.18
4 109014-Table Thr... 109014 Standard 8'Table Throw with 1 Imprint Color 168.00 672.00
w/logo
I Setup Charges Setup Charge 50.00 50.00
1 Rush Charge Rush Charge 60.00 60.00
4 220009-Case 220009 Table Throw Soft Carry Case 27.00 108.00
1 Freight(merchand... Shipping Charges from Factory(FOB MN) 43.98 43.98
4 190763 Sail Banner 190763 Sail Banner 8'with Scissor base&logo 232.00 928.00
1 Setup Charges Setup Charge 50.00 50.00
1 Freight(merchand... Shipping Charges from Factory(FOB MN) 53.26 53.26
3 240084 Tent Wall... 240084 Full Tent Wall 10'full dye sublimation w/Logo 352.00 1,056.00
1 Setup Charges Var... Setup Charges 50.00 50.00
1 Freight(merchand... Shipping Charges from Factory(FOB MN) 38.92 38.92
3 263033 Trek Retra... 263033 Four Seasons Trek Retractor Banner kit w/Logo 452.00 1,356.00
1 Setup Charges Setup Charge 50.00 50.00
1 Freight(merchand... Shipping Charges from Factory(FOB MN) 91.93 91.93
2,500 BI-1075-Lanyard BH075 Polyester 3/4"Lanyard w/logo 0.99 2,475.00
1 Setup Charges Var... Setup Charges 50.00 50.00
1 Freight(merchand... Shipping Charges from Factory(FOB CO) 78.49 78.49
2,500 740-V 4"X 8"Vertical Credential Holder 0.32 800.00
1 Freight(merchand... Shipping Charges from Factory(FOB NJ) 87.50 87.50
200 Non Inventory Item Orange T-Shirt**No Charge Per Tim Sito** 0.00 0.00
Thank you for your business. Total
Page 1
- Graphicon, Inc. Invoice
Gr ht6on 8459 Castlewood Dr., Suite C DATE INVOICE#
Indianapolis, IN 46250
YOUR CREATIVE PROMOTIONS PARTNER Phone 317-579-9090 Fax 317-579-9191 9/15/2014 11573
PROMOTIONAL PRODUCTS
& LOGO APPAREL
BILL TO SHIP TO
City of Carmel Carmel PorchFest
1 Civic Square PO Box 1033
Carmel,Indiana 46032 Carmel,IN 46082
Attn: Sue Finkam
P.O. NUMBER TERMS DUE DATE REP SHIP VIA F.O.B.
Sue Finkam Due on receipt 9/15/2014 9/15/2014 UPS ground Indianapolis
QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
88 Non Inventory Item Orange T-Shirt with 1 Color,2 Locations 4.52 397.76
Indiana Sales Tax 7.00% 0.00
-k�-854 (34Fc,l'a
a,+5
Thank you for your business. A Finance charge of 1.5%per month(18%APR)will be Total $9,901.02
assessed on unpaid balances beyond established terms.
Page 2
Form 18Y-.7 Request for Taxpayer Give Form to the
(Rev.JanuaryDepartment
he Tr Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name(as shown on-your income tax return)
C; ra h;co n Tnc.
C\i Business nam /disregarded entity name,If different from above
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Q Check appropriate box for federal tax
C
O classification(required): ❑ Individual/sole proprietor ❑ C Corporation Corporation ❑ Partnership ❑ Trust/estate
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L v ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnA � )► ❑Exempt payee
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Ci �___ _______________________________
please Not,
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Other(see Instructions) Neiress.'
Address(number,sttand tosute no,) ::a
quester's name and address(optional)
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m City,state, d ZIP code
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=_ nu;nbaFVA-hGro-(optiona#--
WOrell
(optiona#-- -- —_ _ ---- -- - --- -- —
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box:The TIN,providedmust match the name given on the"Name"line Social security number
re avoid backup withholding.For,i sreg rde this is your social security number n page
However,fora _m -
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a FM
T!N on page 3.
Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number
number to enter. M35 19 191013 1aP3
Certification
Under penalties of perjury,I'certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and
2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding,and
3. 1 am a U.S.citizen or other U.S.person(defined below).
Certification instructions.You must cross out item 2 above if ave been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and'dividen p r return.For real estate transactions,item 2 does not apply.For mortgage
interest paid,acquisition or abandonment of secured c ation of debt,contributions to an individual retirement arrangement(IRA),and
generally,payments other than inter It and ividen ,y no equired to sign the certification,but you must provide your correct TIN.See the
Instructions on page 4.
Sign Signature of / 7 J,
Here U.S.person 110-
Date® l/
General Instructions Note.If a requester-gives you a form other than Form W-9 to request
your TIN,you must use the requester's form if it is substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W-9.
noted. Definition of a U.S.person.For federal tax purposes,you are
Purpose of Form considered a U.S.person if you are:
A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien,
obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or
example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States,
you paid,acquisition or abandonment of secured property,cancellation .An estate(other than a foreign estate),or
of debt,or contributions you made to an IRA.
•A domestic trust(as defined in Regulations section 301.7701-7).
Use Form W-9 only if you are a U.S.person Qncluding a resident Special rules for partnerships.Partnerships that conduct a trade or
alien),to provide your correct TIN to the person requesting it(the business in the United States are generally required to pay a withholding
requester)and,when applicable,to: tax on any foreign partners'share of income from such business.
1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a
number to be issued), partnership is required to presume that a partner is a foreign person,
2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a
3.Claim exemption from backup withholding if you are a U,S.exempt partner in a partnership conducting a trade or business in the United
payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S.
allocable share of any partnership income from-a U.S.trade or business status and avoid withholding on your share of partnership income.
Is not subject to the withholding tax on foreign partners'share of
effectively connected income.
Cat.No.10231X Form W-9(Rev.i-2011)
VOUCHER NO. WARRANT NO.
ALLOWED 20
Graphicon, Inc.
IN SUM OF$
8459 Castlewood Drive, Suite C
Indianapolis, IN 46250
$9,901.02
ON ACCOUNT OF APPROPRIATION FOR
Community Relations Gift Fund 854
PO#/Dept. INVOICE NO. ACCTwrITLE AMOUNT _ Board Members
854 I 11573 I Arts District Festivals I $9,901.02 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, December 08,2014
Director,Community Relations/Economi Development
Title
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units,price per unit,etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
09/15/14 11573 $9,901.02
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
20
Clerk-Treasurer