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Home My WebLink About250921 10/22/15 u L4H " `� - CITY OF CARMEL, INDIANA VENDOR: 369977 ® `i', ONE CIVIC SQUARE EWING'S, LLC CHECK AMOUNT: $*****1,510.00' CARMEL, INDIANA 46032 1838 E INVERNESS CIRCLE CHECK NUMBER: 250921 '°%�croN�� COLUMBIA CITY IN 46725 CHECK DATE: 10/22/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4230100 33177 101215F 755.00 SAFETY PLANNER 1110 4230200 33177 101215F 755.00 SAFETY PLANNER Sold To: Ship To: Please Remit To: Carmel Police Department Same Ewing's, LLC Attn: Teresa Anderson 3 Civic Square 1838 E. Inverness Cir Carmel, IN 46032 Columbia City,1N 46725 260-244-4406 Order Date: 10/2/2015 By: ITeresa Anderson INVOICE Phone: 317-571-2523 E-Mail: tanderson@carmel.in.gov Shipped Purchase Order No. Invoice No. Invoice Date Due Date 10/12/2015 33177 101215F 10/12/2015 11/11/2015 Item No. Product Description Ordered Shipped Price TOTAL PSW16 Public Safety Weekly-Work Diary 200 Total 50 $10.00 $500.00 PSW16 Public Safety Weekly-Work Diary 150 $5.50 $825.00 Lined Sheets 3000 3000 $0,05 $150.00 Item Color: Blue limp. Color: B. Gold Wire: 7/16"Black 1st CP Rear: 15 Lined Sheets: Sub-Total: $1,475.00 Imprint: Same as used for 2015. Shipping: $35.00 Sales Tax: TOTAL $1,510.00 Thank you 0 Carmel Police Department Attn:Teresa Anderson 3 Civic Square Carmel, IN 46032 s-nl m Request for Taxpayer Give Form to the iliay.December 201 n1 Identification Number and Certification requester.Go not t)eparhrent of the Treasury send to the IRS. lnte,nal Revenue Service 1 Name(as shown on your income tax return).Narne is required on this fine:do not leave this line blank. EWINGS, LLC 2 Business name disregarded entity name,if different from above c 3 Check appropriate box for federal tax classification:check only one of the following seven bores: 4 Exemptions(codes apply only to certain entities,not individuals,see ° ❑Individual/,ole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ T ustlestate instructions on page 3): u c single member LLC Exempt payee code(if any) fl p - �✓]Limited Irahility company tater the tax classification(C=C corporation,S=S corporation,P=partnership) P V r, r Exemption from FATCA reporting Note.For a single member LLC that is disregarded,do not check LLC:check the approp,iate box in Me lin< abo,,e for N the tax classification of the single-member owner. code(if any) c ❑Other(see instructions)1, 5 Address(number,stet. Requester's name and address(optional et,and apt.or suite no-) q ) 1838 E. INVERNESS CIRCLE � B City.state,and Z!P code n+ COLUMBIA CITY, IN 46725 7 List account number(s)here(optional) __—T_axpayer Identifk+cation Number(TIN) Fnter 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 d entity,see social security number(page However,for a -m - resident alien,sole proprietor.or disregarded entity,see the Part 1 instructions on page 3.For other ( entities,it is your employer identification number(EIN). If you do not have a number,see Now 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 I Employer identification number guidelines an whose number to enter. 4R -1 4 1 8 1 9 1 3 2 9 1 8 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 nc longer subject to backup withholding;and 3. 1 am a U.S.citizen or other U.S.person(defined below):and '1.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 tailed 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 gone,ratly,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 j Signature of Here U.S.person► ,f:� t' '� �, Date® �--.✓ f '� General Instructions - •Form 1098(home mortgage interest); 1098..E(student 4nan interest),_iD98 T - (tuition) S t-,tron 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/hv9. Use Form IN-9 only it you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. A,,individual or entity(I City ® /�° Carme INDIANA RETAIL TAX EXEMPT PAGE ,Jlr CERTIFICATE NO.003120155 002 0 yy v :,'�,< t ' PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 33977 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION �Ol9� z i�ag°g Cumol Pollco Dopadmont VENDOR SHIP 3 CIVIC squm IM E. InVGMGSG CIrCIG TO Camel, IN Columbia City, IN 46M (317)679 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account an 9 Each Public SaW Planner $9,590.00 $9,590.00 Sub Total: $4,590.00 Send Invoice To: Cumol Pollco Dopatmont Attn: PO Young 3 CIVIC Squama CaI r�ol, 16V 41032= PLEASE INVOICE IN DUPLICATE DEPARTMENTNACCOUNT PROJECT PROJECT ACCOUNT AMOUNT C�nelPoolic� ept. Q3 PAYMENT $' ,pry • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. k` NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CER�IFVjTH,A/THERE IS AN UNOBLIGATED BALANCE IN THIS APPROpR�IOIWSUF/�O PAY FOR THE ABOVE ORDER. •SHIP REPAID. /`///// fjf(JJ •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. . PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY ! ;�a g SHIPPING LABELS. !b IoB of pollee •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL No- 33177 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO_ WARRANT NO,--__-._-_-_.._. ALLOWED 20 r IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR ; Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I 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 20 .............. Signature -.._............................................................................................................... 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)) 10/12/15 101215F planners $755.00 10/12/15 101215F planners $755.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Ewing's IN SUM OF $ 1838 E. Inverness Circle Columbia City, IN 46725 $1,510.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 33177 101215F 42-302.00 $755.00 I hereby certify that the attached invoices), or bill(s) is (are)true and correct and that the 33177 101215F 42-301.00 $755.00 materials or services itemized thereon for which charge is made were ordered and received except Friday, O ober 16, 2015 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund