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Home My WebLink About253850 01/26/16 .�Aq " F�� CITY OF CARMEL, INDIANA VENDOR: 370238 j; it ONE CIVIC SQUARE COLDSPRING CHECK AMOUNT: $***"'"446.00' _, ?� CARMEL, INDIANA 46032 PO BOX 71037 CHECK NUMBER: 253850 .yiTON�. CHICAGO IL 60694-1037 CHECK DATE: 01/26/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1206 4350400 912515 446.00 GROUNDS MAINTENANCE COLDSPRING'" Page 1 of 1 Invoice Bill To: Account#: 347372 Invoice#: 912515 CITY OF CARMEL STREET DEPARTMENT Invoice Date: 1/14/2016 3400 WEST 131 ST ST Due Date: 2/13/2016 Payment Terms: N30 WESTFIELD, IN 46074 Net 30 Job#: 1002570 Job Name: CITY OF CARMEL PALADIUM PAVER Job Location : CARMEL, IN Customer Ref Contract Billing Item Description: SCHEDULD.PAYMENT Contract Billing Item Amount: $446.00 Total Complete Less Prior Billed $446.00 1 $0.00 Amount Billed Now: $446.00 Tax Information: Code, Name, City, State,Zip, Country and County V150572081 CITY OF.CARMEL STREET DEPARTMENT WESTFIELD, IN 46074 US HAMILTON Tax Billed Now: $31.22 Thank you for your business Amount Billed Now Subtotal: $446.00 USD *,Tax Subtotal: $31.22 USD When remitting payment to the below address, lease include your Account#and Invoice#. Invoice Total: $477.22 USD PLEASE REMIT TO THIS ADDRESS: ,,,�� Coldspring PO BOX 71037, CHICAGO, IL 60694-1037 Note: To deduct the sales tax, an exemption certificate or resale certificate must be included with payment. 17482 Granite West Road, Cold Spring, MN 56320-4578 T 800-328-7038 P 320-685-3621 F 320-685-5053 W www.coldspringusa.com Form ST-105 Indiana Department of Revenue State Forth 49065 R4/8-05 General Sales Tax Exemption Certificate Indiana registered retail merchants and businesses located outside Indiana may use this certificate.The claimed exemption must be allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors.This exemption certificate can not be issued for the purchase of Utilities Wh'c Watercraft,or A irer_art, Purchaser must be registered with the Department of Revenue or the appropriate taxing authority of the purchaser's state of residence. Sales tax must be charged unless all information in each section is fully completed by the purchaser.Purchasers not able to provide all required information must pay the tax and may file a claim for refund(Form GA-11 OL)directly with the Department of Revenue. Name of Purchaser CITY OF CARMEL 1.4 a Business Address ONE CIVIC SQUARE City CARMEL State IN Zip 46032 int Purchaser must provide minimum of one ID number below.* Provide your Indiana Registered Retail Merchant's Certificate TID and LOC Number as shown on your Certificate............................... 0031201550 — 020 # TID#(10 digits) LOC#(3 digits) - If not registered with the Indiana DOR,provide your State Tax ID Number from another State................................................................ *See instructions on the reverse side if you do not have either number. State ID# State of Issue Is this a ®blanket purchase exemption request or a ❑single purchase exemption request? (check one) a Description of items to be purchased. WPM Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain) ❑ Sales to a retailer,wholesaler,or manufacturer for resale only. 'WE 0 Sale of manufacturing machinery,tools,and equipment to be used directly in direct production. INS❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10. (May not be used for personal hotel rooms and meals.) WN ❑ Sales of tangible personal property predominately used(greater then 50 percent)in providing public transportation-provide USDOT#' A person or corporation who is hauling under someone else's motor carrier authority,or has a contract as a school bus operator,must provide their SS#or FID#in lieu of a State ID#in Section#1. USDOT# � I ❑ Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale. Note:A farmer not possessing a State Business License#may enter a FID#or a SS#in lieu of a State ID#in Section#1. i I ❑ Sales to a contractor for exempt projects(such as-public schools,government,or nonprofits). , I ® Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools,and state universities). ., i ❑ Sales to the United States Federal Government-show agency name. Note:A U.S.Government agency should enter its Federal Identification Number(FID#)in Section#1 in lieu of a State ID#. ❑ Other-explain. i i W II hereby certify under the penalties of pequry that the property purchased by the use of this exemption certificate is to be used for an exempt purpose pursuant to the State Gross Retail Sales Tax Act,Indiana Code 6-2.5,and the item purchased is not a utility,vehicle,watercraft,or aircraft. I aI confirm my understandiFthnt4 se,(either negligent or intentional),and/or fraudulent use of this certificate may subject both me personally and/or the business entity. � to the imposition of xXinl",e ,and civil and/or criminal penalties.Signature of PurchaserDate 1/1/2016 j I Printed Name CHRISTINE S. PAULEY Title CLERK-TREASURER The Indiana Department of Revenue may request verification of registration in another state if you are an out-of-state purchaser. Seller must Iceep this certificate on file to support exempt sales. 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s) or bill(s)) 01/14/16 912515 $446.00 1206 101 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 COLDSPRING PO BOX 71037 IN SUM OF$ CHICAGO, IL 60694-1037 $446.00 ON ACCOUNT OF APPROPRIATION FOR Street Department PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Member 912515 43-504.00 $446.00 1 hereby certify that the attached invoice(s), or 1206 101 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 Thursday, January 21, 2016 , r ; 9 r / Street Corn rrilasioner Cost distribution ledger classification if claim paid motor vehicle highway fund