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Home My WebLink About245855 06/03/15 a u!.44gy ! ,°� CITY OF CARMEL, INDIANA VENDOR: 369395 s' ONE CIVIC SQUARE BOB HELBER CHECK AMOUNT: $*****1,450.00* ?Q CARMEL, INDIANA 46032 7033 S 600 w CHECK NUMBER: 245855 �'�£oN"�°' PENDLETON IN 46064 CHECK DATE: 06/03/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4462000 0017 1,450.00 OTHER STRUCTURE IMPRO 130 66c,.,- Z03J S Gadd WORK PERFORMED AT: T0: IiiN/azd ar'. ff DATE YOUR WORK ORDER NO. OUR BID NO. DESCRIPTION OF WORK PERFORMED 6 146Z. Z2 5 r r X-o e A on on rel 6 G�y*2or-�o Z' d ile f re', >- ` - 1052 ef) 1AX74 d tr- Account # Co 20 All Material is guaranteed to be as specified,and the above work was performed in accordance with theswings d specifications pMeoabove work and was completed in a substantial workmanlike manner for the agreed sum of Dollars($ JUN 0 12015 This is a ❑Partial ❑Full invoice due and payable by: tl5 r Month ', v a e s tiFe r in accordance with our ❑Agreement ❑Proposal No. Dated Month Day adams•NG3822 09-11 f. Form W'9 Request for Taxpayer Give Form to the (Rev.December 2014) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. Robert A.Helber t`i 2 Business name/disregarded entity name,if different from above a, Helber Masonry cc 0 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exem tions(codes apply only to o certain entities,not individuals;see ✓❑Individual/sole proprietor or ❑ C Corporation ❑s Corporation ❑ Partnership ❑TrusVestate instructions on page 3): m e single-member LLC Exempt payee code(if any) CL o E]Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► 0 Exemption from FATCA reporting o 2 Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for N the tax classification of the single-member owner. code(if any) IL E E]Other(see instructions)10- (Applies to accounts mslnmined D"de the U.S.) E 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) a o. 7033 S 600 West N 6 City,state,and ZIP code m cnn Pendleton,IN 46064 7 List account numbers)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other :[1R —M78 entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. 3 5 - 1 1 7 9 6 61014 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. I 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 to 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 required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign signature of Here U.S.person► _ Date► General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T (tuition) Section references are to the internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.gov/fw9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099 DN(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014) • i VOUCHER NO. WARRANT NO. ALLOWED 20 Helber Masonry IN SUM OF$ 7033 S 600 West Pendleton, IN 46064 $1,450.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 0017 44-620.00 $1,450.00 1 hereby certify that the attached invoice(s), or 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, June 01, 2015 Director,Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund I Prescribed b State Board of Accounts Y 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)) 05/06/15 0017 Civic Fountain $1,450.00 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 , 20 Clerk-Treasurer