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Home My WebLink About259946 06/24/16 CITY OF CARMEL, INDIANA VENDOR: 369514 ONE CIVIC SQUARE LITANIA SPORTS GROUP INC CHECK AMOUNT: $*******366.51* CARMEL, INDIANA 46032 PC Box 1790 CHECK NUMBER: 259946 ttruw CHAMPAIGN IL 61824-1790 CHECK DATE: 06/24/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1093 4237000 000029026.2 366.51 REPAIR PARTS Voucher No. Warrant No. Allowed 20 Litania Sports Group, Inc. P.O. Box 1790 Champaign, IL 61824-1790 In Sum of$ $ 366.51 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1093 290262 4237000 $ 366.51 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 June 15, 2016 Signature $ 366.51 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Lr EASE:.REIUIIT_T_O,s/ Page No: Pagel -- g nvoice No: 0000290262 LITA�NIA SPORTS�qROUP INC TPS OyBOX,17,90 r , I voice Dat Oe 6/03/20A6 CHAMPAIGN!,1,;6,j_824 1799 FAX'217-36738440438 ---ZECI TV-ED FEIN:71-08883690 INVOICE JUN - 8 2016 Customer No: 800557 Your Order No: 9192 BY: Customer Phone: Our Order No: 060316-199480-1-0000 Bill To: CARMEL CLAY PARKS&RECREATION Ship To: 1411 E 116TH ST MCC-WEST CARMEL IN 46032 ATTN:MIKE KILPATRICK 1235 CENTRAL PARK DRIVE EAST CARMEL IN 46032 Terms: Cash#1: Disc: Shipped: 060316 Cash#2: Disc: Shipped Via: 3-PB-UPS GROUND Net Due Date: 070316 F.O.B.: CHAMPAIGN IL Shipment No: 000288202 Ref: MLF Your Customer Rep Is: DMK Pro No: 1Z6225550304452450 Ordered Shipped Back-ordered Item Unit Price Extd Price Qty QTY Qty Number US DOLLAR US DOLLAR 1 1 0 ELEC00011000 351.51- 351.51 3/4 HP ELEC MOTOR SPEC 34M08W199 FREIGHT 15.00 FREIGHT Return Policy SALES TOTAL: 351.51 SALES TAX: 000' ALL RETURNS MUST BE PRE-AUTHORIZED. In order for Litania FREIGHT: 15.00 Sports Group to accept a return,the shipment must be accompanied by a Return Merchandise Authorization(RMA)number and must be LESS: 0:00 returned within 30 days of the RMA's creation. Cash refunds will not OTHER CHARGES: 0.00 be issued. Unused credits will be cancelled after one year. Please INVOICE-TOTAL:,,v_.�.._.-. , ,,I—x;366:5 refer to the RMA information on our websites for more detailed return ,w information. US-DOL-L-AR '" cc 7JUN �VEDForm WWg .1 2015 R quest for Taxpayer Give Form to the Dev.August2 aT Identificati n Number and Certificationrequester•Do not Departmentofthe Treasury � send to the IRS. Internal Revenue Service Name(as shown on your income tax return) LITANIA SPORTS GROUP,INC. cq Business name/disregarded entity,name,If different from above m rn er a Check appropriate box for fedwal tax classification: 0 Exemptions(see Instructions): ° ❑ proprietor Individual/sole ro p p ❑ C Corporation ✓❑S Corporation El Partnership E]Trust/estate o Exempt payee code Of arty) ❑ Limited liability company-Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► ° Exemption from FATCA reporting c code(if any) a ° ❑ Other(see Instructions)10- Address Address(number,street,and awp or suite no.) Requester's name and address(aptlonaq rc 601 MERCURY DRIVE City,state,and ZIP code CHAMPAIGN,IL 61822 List account number(s)here(optional) Taxpayer Identification Number IN 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(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I Instructions on page 3.For other -[E - 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 Idertdfication number number to enter. M71 - 0 8 8 8 3M69 • Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am wafting for a number to be Issued to me),and 2. 1 am not subject to backup withholding because:(a)1 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.co0e(s).e�tt@d Q�t�s_f —-- (if any)Jndioatinglhall.am.sxempt_from_EATCA_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 pall,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement ORA),and generally,payments other than Interest and dividends,you are not required to sign the certlflcafion,but you must provide your correct TIN.See the instructions on page 3. Sign Signature of � � Here U.S.person► Q �� Date► 9� / �'� General Instructions withholding tax on foreign partners'share of effectively connected Income,end 4.Certify that FATCA coda(s)entered on this form(K any)Indicating that you are Section references are to the Internal Revenue Code unless otherwise noted. Futuro developments.The IRS has created a page on IRS.gov for information exempt from the FATCA reporting,Is correct. about Form W-9,at www.frs.gov/w9.information about any future developments Note.If you are a U.S.person and a requester gives you rr form other than Form effecting Form W-9(such as legislation enacted after we release it)will be posted W-9 to request your TIN,you must use the requester's form.it it Is substantially on that page. similar to this Form W-9. Purpose of Form Definition of a U.S.person.For federal tax purposes,you are considered a U.S. parson 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, abandonmentf Galaredta�osactions,mortgage interest you paid,acquisition or .p n estate(otherthan a foreign estate),or to an IRA Pr pkv'cancefiatlon of debt,or contributions you made •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 partnere'share of effectively connected taxable Income from 1.Certify that the TIN you are giving Is correct(or you are waiting for a number such business.Further,In certain cases where a Forth W-9 has not been received, to be Issued), the rules under section 1446 require a partnership to presume that a partner Is a 2.Certify that you are riot subject to l�ackuP withholding,,or foreign person,and pay the section 1446 withholding tax.Therefore,if you are a 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 Forth W-9(Rev.8-2013) J