HomeMy WebLinkAbout245680 05/27/15 ��p" CITY OF CARMEL, INDIANA VENDOR: 359662
it ONE CIVIC SQUARE AT&T CHECK AMOUNT: $*********1.42*
f �� CARMEL, INDIANA 46032 PO BOX 5014 CHECK NUMBER: 245680
��'�irud�� CAROL STREAM IL 60197-5014 CHECK DATE: 05/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4344000 140534025-3 1.42 140534025-3
P, 1
Communication Result Report ( May- 27. 2015 9:45AM )
2)
Date/Time: May. 27. 2015 9:37AM
File Page
No. Mode Destination Pg (s) Result Not Sent
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0835 Memory TX 918883543832 P. 2 OK
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Reasonfor error
E. 1) Hang U or line fail E. 2) Busy
E. 3) No answer E. 4) No fats imi 1 e connection
E. 5) Exceeded max. E—mai 1 s i z E. 6) Dest i nat ion does not suDpo rt IP—Fax
CERTIFICATE OF EXEMPTION FROM FEDERAL.EXCISE TAX ON COMMUPBCATIONSERVICES OR
FACILITIES FURMSHM BY AT&T SERVICES AND ITS AFFILIATES
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Oelmemsl Revenue Codeumathe followinggmvtdwe(Cheek the eppmpsigexNon m/pmvidere4ui,od information wimsnnppfitrble)
❑ RnaRn afCommunicetloq$ervicee(Sectim A253(e)Jrll huodertbod Mq no rw w0l he eolleded 6yATAT Servicrs orfua(uliow
on rhggsutorssid eetvia;aodthp<iw81 hetherrspoanbRiryotthevoderstgncd W eolktsom m tan nt mYbe duefrom Its mslamer;
wdrrndt poymaatta ma lmemdRaserwe Service FCC 4991D Adudecbmmeosraoperadngmn(Meekane):
()Cempefitive Loral 9mhavge Carder ()lutenoet Smice Provider ()Other[pleoae specify]
❑J Inetr®entnMyof(beUnlled Surto Ga mmmi(Swdm4293)
@9 $tato/lanl gmerrrmmq or Fulitkol eubdividan thereof[e.g.,school du;tric%towty of m](Section 4253(Q)
❑ Indian tribal gm rnmwt(Section4253(t):Section 78711 Fm exemption on aMal mcmbe.mtdz service 10Ceted On
qualibed Ivdim,]mid;cheek hrse❑wd urtlgda allarafbn lraufiomalDaf op7clat
❑ A public In(ernaU"Orgood d a(Secdon4253(e):Secdox 7701(0X13)
❑ An organlation mated and specJBcally designated ax exempt by on Act ofCongrea;Public Lav No.
❑ Aq—d-goveromenml 0rgonlg11-n,perfimdng the civic fonction Of :paid from
the funds a[ (Name afeeemptwSudwden).(Affedallm Werfrons exeinlforgaafmtran rMuliad)
❑ Anbeaadow,Ministto or oMer Dlpkmotic Rcprcaudolivts oFn torcign go rocat
❑ Can wIarotr—of afordgog--caIPS-98from OFMMob Mfor each arem9fogilob re nn-&srJ
❑ Commoucarrier,talepbonewdldegrepha pang,rodioandtelaldmbmodmstingamtiomnndnetoorke
Section 4253(1 TRC),taxi arld by Section 4251 of the code on WAIS. .'r�tc.exemption on1Y opPiiea m WAIS,"B00"m
"888'smNireused exclusively inlhe conductoftu bmfness as a(rheCK ono):
()Conon currier()Teleph—Company ()Telegraph Company ()Radio as TeWslan Bmadcating Station
❑
Nonprofit Educational OrganimRon(Section 4253Q)�I.I desschools opeceting w an activity ofa church m otbm
religious bow.chis organiation eL3imingexesnylion ions received o detertninadon Inter(m coling)0rowhe IRS
gaallfyisg to be ucmplfsom Incume,Tor undu Se tion 501(a)or Section 501(-x3)./Copy of50I(c)how regrrtreaff
❑ NonpmRl Hospital(Sedan4253(h)).Thu orgeoizatlw claiming ernuption bas received a dotesmios[mn lever(w ruling)from
the UtS qualifying on he exempt from Inscme To under Section 501(x)./COpy of$01(e)IWrequtra 4
❑ Nolongereotilled 10 COX exemptiao,elfectivotbo dam: - - - - -
Plewe listaaoonts(lelophononambers)gnsliRed for exemption.Lf neceasery,Ilcl on separate pag<and almN to eerllfiate. -
140s-3�¢ozs 3
]lee urdssifned ryas to nn8yATATSaviw in saritinewnen the baapfartmr rreeryt+an ioeicaob above chaogum¢ssa sonic the
undrni@scd tori&rdw d¢erampdmcloimedbeBomODle wdu epplic,bklaax aM undcrstrsWsrhgf dalmt erre ofstia oenificge for Ora
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9201).
Sgn° S—zI-15
nurHDRm1DREPResRNrarlvE DATE
[PRINT NAMEf 1— ft'I I `
CONTACT PHONE NUMME.5171 Cu 4�
( &MA CL ADDRESS�<��P ItIL(YYI�i•I Fy
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208 9.Aenices
2089.Aknd Sk•Aonm 1076^Delfes,Tx 75x24299
atel FAX 1-688-354-9852
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DWI113.61-VO2.0
CERTIFICATE OF EXEMPTION FROM FEDERAL EXCISE TAX ON COMMUNICATION SERVICES OR
FACILITIES FURNISHED BY AT&T SERVICES AND ITS AFFILIATES
Name of Purchaser. firm or aaencv Doina Business As
urpq O/F _:bP001ZStNa CSO.-P Yee
Billina Street Address Citv State Zio
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The undersigned represents that he/she is authorized to execute this certificate and hereby claims exemption from taxes imposed by Section 4251 of
the Internal Revenue Code under the following provisions. (Check the appropriate section and provide required information where applicable)
❑ Reseller of Communication Services(Section 4253(e)): It is understood that no tax will be collected by AT&T Services or its affiliates
on charges for said services,and that it will be the responsibility of the undersigned to collect such as tax as may be duefrom its customers,
and remit payment to the Internal Revenue Service. FCC 499 ID Includes businesses operating as a(check one):
( )Competitive Local Exchange Carrier ( )Internet Service Provider ( )Other[please specify]
❑ Instrumentality of the United States Government(Section 4293)
State/local government,or political subdivision thereof [e.g.,school districts,county offices] (Section 4253 (i))
❑ Indian tribal government(Section 4253 (i): Section 7871). For exemption on tribal member's residence service located on
qualified Indian lands,check here❑ and include attestation letter from tribal official.
❑ A public International Organization (Section4253(c): Section 7701(a)(18)
❑ An organization created and specifically designated tax exempt by an Act of Congress.Public Law No.
❑ A quasi-governmental organization,performing the civic function of :paid from
the funds of (Name of exempt organization).[Attestation letterfrom exempt organization required.]
❑ Ambassadors,Ministers or other Diplomatic Representatives of a foreign government
❑ Consular officer of a foreign government[DS--98 from OFM required for each exempt telephone number]
❑ Common carrier,telephone and telegraph company, radio and television broadcasting stations and networks
Section 4253(f),IRC),tax imposed by Section 4251 of the code on WATS. Note: exemption only applies to WATS,"800"or
"888"service used exclusively in the conduct of its business as a(check one):
( )Common carrier ( )Telephone Company ( )Telegraph Company ( )Radio or Television Broadcaling Station
❑ Nonprofit Educational Organization(Section 42530)), includes schools operating as an activity of a church or other
religious body. This organization claiming exemption has received a determination letter(or ruling)fromthe IRS
qualifying to be exempt from Income Tax under Section 501(a)or Section 501(c)(3).[Copy of 501(c)letter required.]
❑ Nonprofit Hospital(Section 4253(h)).This organization claiming exemption has received a determination letter(or ruling)from
the IRS qualifying to be exempt from Income Tax under Section 501(a).[Copy of 501(c)letter required.]
❑ No longer entitled to tax exemption,effective this date:
Please list accounts(telephone numbers)qualified for exemption. If necessary,list on separate page and attach to certificate.
5_-3 ;3 _ -__
The undersigned agrees to notify AT&T Services in writing when the basis for tax exemption indicated above changes or ceases to exit. The
undersigned certifies that the exemption claimed is allowable under applicable laws and understands that fraudulent use of this certificate for the
purpose of securing exemption will subject him/her and all guilty parties to a fine or imprisonment,together with costs of prosecution(IRC Section
7201). , A
Sign here:
AUTHORIZED REPREES,E(N'TATIVE //��„ DATE
[PRINT NAME] �PV � TITL
CONTACT PHONE NUMBER 5rI` E-MAIL ADDRESS
Return completed form via mail or fax to:
AT&T Services
208 S.Akard St.a Room 1040aDallas,TX 75202-4299
aW FAX 1-888-354-3832
Rev.3/04
Bcs 1113.dot-Ver3.0
STATE
STATE Of INDIANA V . _
" ~ " INDIANAPOLIS IN 46204-2253
DEPARTMENT OF REVENUE
INDIANA GOVERNMENT CENTER NORTH
100 N.SENATE AVE
February 22,•2012
CARMEL CITY OF
ONE CIVIC SQUARE
CARMEL, IN 46032
RE: Utility/Telecommunications Exemption
TID#0003120155-001
Date Approved: 2/20/2012
Dear Taxpayer:
Please be advised that this letter is being issued in lieu of the Utility Exemption Certificate(Form
ST-109). All present and future metered utility and/or telecommunications accounts, excluding
sewer charges, billed under the legal entity name of CARMEL CITY OF registered under
Taxpayer Identification Number #0003120155-001 are exempt from the requirement of paying
Indiana Sales Tax only. This blanket exemption letter is an exception to the normal requirement
of providing an ST-109 for each utility account/meter.
Please provide a copy of this blanket exemption to each of your utility/telecommunication
providers.
Should you have any questions, please contact the Indiana Department of Revenue at (317) 232-
2339.
Sincerely,
Y,
Enforcement Div,Refunds/Utilities MS#105
Indiana Department of Revenue
PO Box 935
Indianapolis,IN 46206-0935
(317)232-2339
LE
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CC. I
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11743-003
sr_ BROOKSHIRE GOLF CLUB Page: 1 of 2
at&t 12120 PKWY Bill Cycle Date: 05/04/15-05/15/15
CARMELL IN IN 46 46033-33-3314 Account: 140534025
Visit us online at: www.att.com
U-verse Statement
l rBlll-At AGlancer' ( J ' i.r7
ll _ 11111 �.i�
Previous Balance $69.28CR Texting and driving...
Payment $0.00 it can wait.
Adjustments $0.00 Join the millions who have
already pledged to nottext and
Balance $69.28CR drive.No text is worth a life.
a•
New Charges $70.70
Total Amount Due $1.42
Amount Due in Full by Jun 05,2015
�.t_ .E l�.�a lJ � U T1 A Account Charges {J
:. Se vlee Summlary'' s l7`.' .` � la ;'
Monthly Charges- May 16 thru Jun 15
Service Page Total 1. High Speed Internet Equipment Fee 10.00
A Account Charges 1 $10.70 Other Charges and Credits
® U-verse internet 1 $60.00 Government Fees and Taxes
2. IN State Sales Tax 0.70
Total New Charges $70.70
Total Account Charges 10.70
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AT&T High Speed Internet Max Plus-provides speed and
reliability;and Includes built-in wireless home networking
capability,access to the entire national AT&T Wi-FI
network,11 email accounts,photo storage,AT&T Security
Suite powered by McAfee',pop-up blocker,and parental
controls.
Monthly Charges- May 16 thru Jun 15
1. AT&T U-verse Internet Max Plus(Promotional 60.00
How to Contact Us: Offer)
For Ordering,Billing,or Support:Call 888-288-8339
For Online Billing and Account Support: Total U-verse Internet 60.00
Visit att.com/bill
Information about your bill,please
AutoPay Enrollment
If I enroll in AutoPay,I authorize AT&T to pay my bill monthly
by electronically deducting money from my bank account.I can
cancel authorization by notifying AT&T at www.att.com or by
calling the customer care number listed on my bill.Your
enrollment could take 1-2 billing cycles for AutoPay to take
effect.Continue to submit payment until page one of your Invoice
reflects either AutoPay will Debit Your Bank Account by or
AutoPay will Debit Your Credit Card by.
Bank Account Holder Signature:
Date:
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att.com
BROOKSHIRE GOLF CLUB Page: 1 of 3
12120 BROOKSHIRE PKWY Bill CycLe Date: 04/04/15-.05/03/15
at&t CARMEL IN 46033-3314 Account: 140534025
Visit us online at: www.att.com
U-verse Statement
i
Previous Balance. $312:31 Texting and driving...
Payment - 04/14 $117.31CR I can 1/V I ;
Adjustments $195.000R Join the millions who have
already pledged to nottext and
Balance 50.00 drive,Notextisworth alife.
,New.Charges $69.28CR it can wailt
Balance $69.28CR. " • itcanwa •
ffl
Payment is-Not Required
Payments &:Ad�ustrnents ----------------------------
" Item
Service" Page Total No. Description
1 Credit Card Payment posted 04/14.` '117.31CR
A Account Charges 1 $41.05
2. Account Adjustment 195.000R
® U-verse Internet 2 5110:33CR Total Payments &Adjustments 312.31CR
Total New Charges $69.28CR
. A Account'' Charges _ -
Monthly Charges - May 4 thru May 15
Tech Support 360 .
Questions about charges-listed in this section?Please contact us
at 1 877 888-7360.
1. U-verse App Premium Pkg 30.00
Other Charges and Credits
Plan Changes
Added 04/15
2. High Speed Internet Equipment Fee 6.33
This plan is$10.00 per month. You added this plan
How to Contact Us on 04/15. You are charged at the new plan rate
For Ordering, Billing, or Support: Call 888=288-8339 from 04/15- 05/03.
For Online Billing and Account Support:
Visit att.com/bill
® For Important.Information about your bill, please
see the News You Can Use-section (Page 2).-
Return bottom portion with your check in the enclosed envelope. AT&T u-verse(sM)serviceg provmed by AT&T Indiana.
Applicatlon Services are provided by AT&T Corp.Pa meatsmaY take 7 days o post.
UN Printed on RocYciabla Paper
BROOKSHIRE GOLF CLUB, Page: 2 of 3
12120 BROOKSHIRE PKWY Bill Cycle Date: 04/04/15,-05/03/15
CARMEL IN 46033-3314 Account: 140534025
at&t
Visit us online at: wWw.att.com
Other Charges and Credits Continued
�CCOUnt. Ct1argeS ,=.Continued Removed 05/15 .
5. AT&T U-verse_Internet Max Pius(Promotional 24.00
.Other Charges and Credits - Continued Offer)
Removed 05/15 This plan with promotional offer(s)is $60.00 per
3. High Speed Internet Equipment Fee 4.00 i month. Removing this plan 05/15 resulted in plan
This plan is $10.00 per month. Removing this plan charges from 05/04 _05/15.
on 05/15 resulted in plan charges from 05/04 = Total Plan Changes 110.33CR
05/15.
:Total Plan Changes 10.33 'Total Other Charges & Credits 110.33CR
Government Fees and Taxes Total U-verse Internet 110.33CR
4. IN State Sales-Tax 0.72
.Total Other Charges & Credits
Important Information
Total Account Charges 41.05
LATE'PAYMENT_FEE
A Late Payment Charge of $9.00 will be assessed if payment is
not received or e date.
. ceive on before the du ate
U-verse:-Internet
HOW TO READ YOUR BILL .
Other Charges and Credits See a sample bill online at www.att:com/uversecentral in the
Plan Changes Support section,tune to U-verse TV channel 411 to view the
Added 03/05 then Removed 03/17 Billing video, or refer to your AT&T U-verse Feature Guide.
1. AT&T U-verse Internet Elite 44.00 ENROLL IN AT&T U-VERSE PAPERLESS BILLING
This plan is $110.00 per month. You.added this • Make secure online payments 24x7
plan on 03/05. You are charged at the new plan •View and print copiesof your bills
rate from 03/05 - 03/16.
Added 03/05 then Removed 04/04 "Add automatic payments for more convenience
Log in to AT&T Online Account Management
This
2. U-verse Internet Elite 106.33CR https://www.att.com/ugreen and select Bill & Payments, then
This plan is 5110.00 per month. You added this sign up for Paperless Billing.
plan on 03/05. You are charged at the new plan
rate from 03/05 - 04/01 - ELECTRONIC CHECK.CONVERSION
Removed 04/04 Paying by check authorizes AT&T to use the information from
3: AT&T U-verse Internet Elite - 110.000R your check to make a one-time electronic fund transfer from
This plan is $110.00 per month. You removed this your account. Funds may be withdrawn from your account as
plan on 04/04. You received a credit for the days soon as your payment is received. If we cannot process the
you did not use this plan 04/04 05/03. transaction electronically, you authorize AT&T to present
Added 04/15 an image copy of your check for payment.Your original check
4. .AT&T U-verse.Internet Max Plus(Promotional 38.00 will be destroyed once processed. if your check is returned
Offer) unpaid you agree to pay such fees as identified in the terms
This plan with promotional offer(s)is.$60.00 per and'conditions of your AT&T Service Agreement, up to $30.
month. You added this plan on 04/15. You are
charged at the new plan rate from 04/15 - 05/03. Returned checks may be presented electronically. If you want
to save time and stamps,sign up for.AutoPay at
att.com/stoppaper using your checking account. It's
easy,secure, and convenient!
®2012 AT&T Intellectual Property.All rights reserved.
3187.017:160698.01.020000000 NNNNNNNN 33563.33563
VOUCHER NO. WARRANT NO.
ALLOWED 20
AT T
IN SUM OF$
P.O. Box 5014
Carol Stream, IL 60197-5014
$1.42
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
'PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 140534025 I 43-440.00 I $1.42 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
Friday, May 22, 2015
Director, Brooks re Golf Club
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))
05/15/15 140534025 Internet $1.42
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
120
Clerk-Treasurer