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Home My WebLink About240098 12/09/14 �%'�,q,,f• CITY OF CARMEL, INDIANA VENDOR: 368931 ® } ONE CIVIC SQUARE RANDALL SCOTT HARDEN FINE ART CHECK AMOUNT: $*******400.00* s. _� CARMEL, INDIANA 46032 695 N 10TH ST CHECK NUMBER: 240098 9.y��TON��' NOBLESVILLE IN 46060 CHECK DATE: 12/09/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 854 5023990 AWARD LIST 400.00 OTHER EXPENSES QUICK DRAW WINNERS 1 sT Place-Beth Forst $300 Merit Awards 1St Place-Susan Mauck $100 2nd Place-Donna Shortt $100 3rd Place-David Seward $100 4th Place-Jeffrey Baumgartner $100 to 5 Place-Kathy Blankenheim $100 6th Place-Jeremy Mallov $100 7th Place-Beth Schwier $100 CARMEL ON CANVAS WINNERS BEST OF SHOW-Troy Kilgore $1000 PROFESSIONAL 1st Place-Jeff Klinker $600 t:2"d-P_Iace-Randy Harden__ _ _ _ $400 3rd Place-David Seward $300 4th Place-Bob Meyers $200 Merit Winners Martha Sands $100 Kathy Blankensheim $100 Steven Tanaka $100 Donna Shortt $100 Beth Schwier $100 Steve Haigh $100 Pam Newell $100 \ Susan Mauck $100 _ Wyatt Legrand $100 - Jeffrey Baumgartner $100 NON-PROFESSIONAL 1st Place-Jan Johnson $200 2nd Place-Morika Christensen $100 Merit-Jann Wright $50 TEEN 1sT Place-Faith Dee $100 2nd Place-Nicholas SerVaas $75 3rd Place-Imaan Hassan $50 Form -9 Request for Taxpayer Give Form to the (Rev.August 2013) 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 retum) '? ►J)7 .�L 5 MIT k� '2-p�.N N Business name/disregarded entity name,if different from above CO ° Check appropriate box for federal tax classification: Exemptions(see instructions): c ° ❑Individual/sole proprietor ❑ C Corporation Q S Corporation F] Partnership ❑Trust/estate N CL o Exempt payee code(if any) C ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)Do- Exemption from FATCA reporting a code(if any) a ❑ Other(see instructions)► U E Address(number,street,and apt or suite no.) Requester's name and address(optional) 1 v�ST- City,state,and ZIP code V; l�c;i�-1�1; �4 goo List account number(s)here(optional) ff MITI!! Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line Social security number to avoid backup withholding.For individuals,this is your social security number However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions onn page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN 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. 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),and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject 4o backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not squired to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign Signature of Here U.S.person► '" -- � W— Date► C -3 C> �.Q General Instructions withholding tax on foreign partners'share of effectively connected income,and 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are Section references are to the Internal Revenue Code unless otherwise noted. exempt from the FATCA reporting,is correct. Future developments.The IRS has created a page on IRS.gov for information Note.If you are a U.S.person and a requester gives you a form other than Form about Form W-9;at wwwJrs.gov/w9.Information about any future developments W-9 to request your TIN,you must use the requester's form if it is substantially affecting Form W-9(such as legislation enacted after we release it)will be posted similar to this Form W-9. on that page. Definition of a U.S.person.For federal tax purposes,you are considered a U.S. Purpose of Form person if you are: A person who is required to file an information return with the IRS must obtain your -An individual who is a U.S.citizen or U.S.resident alien, correct taxpayer identification number(TIN)to report,for example,income paid to •A partnership,corporation,company,or association created or organized in the you,payments made to you in settlement of payment card and third party network United States or under the laws of the United States, transactions,real estate transactions,mortgage interest you paid,acquisition or •An estate(other than a foreign estate),or abandonment of secured property,cancellation 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(including a resident alien),to Special rules for partnerships.Partnerships that conduct a trade or business in provide your correct TIN to the person requesting it(the requester)and,when the United States are generally required to pay a withholding tax under section applicable,to: 1446 on any foreign partners'share of effectively connected taxable income from such business.Further,in certain cases where a Form W-9 has not been received, 1.Certify that the TIN you are giving is correct(or you are waiting for a number the rules under section 1446 require a partnership to presume that a partner is a to be issued), foreign person,and pay the section 1446 withholding tax.Therefore,if you are a 2.Certify that you are not subject to backup withholding,or U.S.person that is a partner in a partnership conducting a trade or business in the 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If United States,provide Form W-9 to the partnership to establish your U.S.status applicable,you are also certifying that as a U.S.person,your allocable share of and avoid section 1446 withholding on your share of partnership income. any partnership income from a U.S.trade or business is not subject to the Cat.No.10231X Form W-9(Rev.8-2013) VOUCHER NO. WARRANT NO. ALLOWED 20 Randall Scott Harden Fine Art IN SUM OF$ 895 N. 10th Street Noblesville, IN 46060 $400.00 ON ACCOUNT OF APPROPRIATION FOR Community Relations Gift Fund 854 3 PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT; Board Members $ 854 Award List 400.00 Arts District Festivals 1 hereby certify that the attached invoice(s), or I I I 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/Econo is 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) I 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 I whom, rates per day, number of hours, rate per hour, number of units,price per unit,etc. Payee Purchase Order No. I Terms f Date Due I Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 11/30/14 Award List $400.00 I I I 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