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Home My WebLink About259895 06/24/16 �?l'"p • CITY OF CARMEL, INDIANA VENDOR: 370704 ;. ® ONE CIVIC SQUARE CORE LITE INDUSTRIES, LLC CHECK AMOUNT: $*****1,400.00* CARMEL, INDIANA 46032 13354 GREENLEAF LANE CHECK NUMBER: 259895 GRAND HAVEN MI 49417 CHECK DATE: 06/24/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4238000 33250 1,400.00 SMALL TOOLS & MINOR E Voucher No. Warrant No. Core Lite Industries, LLC Allowed 20 13354 Greenleaf Lane Grand Haven, MI 49417 In Sum of$ $ 1,400.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITI-E AMOUNT Board Members Dept# 1096-21 33250 4238000 $ 1,400.00 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 PANS*'UVUA-) Signature $ 1,400.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund RECEIVED DATE:e 15126t166- FeatherBlock MAY 2 7 2016 EFFECTIVE DATE: 05/26/16 FEATHERBLOCK.NET SUPERSEDES: All Others Inotc��3325.0 _ TO: Carmel Clay Parks &Recreation PHONE: 317-573-4021 1411 E 116th Street FAX: Carmel,IN 46032 EMAIL: akostrzewa(cDcannelclavoarks.com ATTN: Audrey Kostrzewa Sales Associate: Bob Brock F.O.B.: Grand Haven,MI PAYMENT TERMS-Check Requisition#9132 PRICES EFFECTIVE: 5/26/2016 -T- 1 PRICES VALID THROUGH: next pt_rice change 't i +" it _.1 ..�,: 1iT y. :..rr _� : _ � a a?; , ,I .:: %, _.46,;TX196._x.8.DiIT $ Hi h DIMENSIONS(in.) Unit Total PART# QTY Weight Weight DESCRIPTION UNIT PRICE Sub-Total HEIGHT WIDTH LENGTH (lbs.) (lbs.) FB-SS489608 1 8 48 48" 120 120 8"x 48"x 96"Stage Module $1,085.00 $1,085.00 with EPS Core 2"radius all comers and anti-skid top deck Shipping Pallet 1 16 52 100 120 120 Wood Shipping-Pallet $175.00 $175.00 UPS Freight- Freight Class 150 1 240 Shipping via UPS Freight Bus. $140.00 $140.00 Sales Tax Info-Out of State _$0.00„e..,_,_ $0.00 f Total: $1,-400:00`— TERMS AND CONDITIONS: ` COfe Ufe Indo LHC - . -UNLESS OTHERWISE SPECIFIED, THE ABOVE PRICES ARE FOR ONE RELEASE OF CONTINUOUS PRODUCTION OF EACH PART. 1335.4 Greenleaf Lane -PRICES FOR RELEASES OTHER THAN QUOTED QUANTITIES ARE SUBJECT TO AN INCREASE IN PRICE AND/OR '�,. � Grand Hav enMI,9917. 'ADDITIONAL SETUP CHARGES. Phone:(616)843-5993 ' Caution:Combustible.materials will ignite If exposed to fire of sufficient heat and intensity. Notice:Core Lite Industries,LLC shall not be liable for incidental and consequential damages directly or indirectly sustained,nor for any loss caused by application of these goods not in accordance with current printed instructions,or for other than the intended use. Core Lite Industries,LLC liability is expressly limited to replacement of defective goods. See FeatherBlock/Core Lite Return Policy and 12-Month Limited Warranty for Details. . i Fon, W-9 Request for Taxpayer Give Form to the (Rev.December Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Intemal Revenue Service 1 Name(as shown on your Income tax retum).Name is required on this line;do not leave this line blank. Core-Lite Industries,LLC Cki 2 Business name/disregarded entity name,if different from above m m m °L3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to r- certain entities,not individuals;see O ❑.IndividuaUsole proprietor or ❑ C Corporation ❑S Corporation ❑✓ Partnership ❑Trust/estate instructions on page 3 a c single-member LLC Exempt payee code(if any) ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,Partnership)► P p Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting' H the tax classification of the single-member owner. code(if any) CL E]Other(see Instructions)0- /Nwaasmaao'u�csm�nrav,edams;deme us) v 6 Address(number,street,and apt.or suite no.) Requester's name and address(optional) v 13354 Greenleaf Lane m 6 City,state,and ZIP code Grand Haven,M149417 7 list account number(s)here(optional) ff-0.61111 Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Soclat security number backup withholding.For individuals,this is generally your social security number{page However,for a ITT] -17 - resident alien,sole proprietor,or disregarded entity,seethe Part I instructions on page 3.For other entities,it is your employer identification number ON).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. M45 -131618101516 6 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 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 QRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.Seethe instructions on page 3. Sign Signature of �� r Here I U.S.person 0,- 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 .Farm 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.lrsgov/fw9. Use Forth W-9 only ii you are a U.S.person(including a resident alien),to Purpose of Form provide yourcarrect'nN. An individual or entity(Form W-9 requester)who is required to file an information Ifyou 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 MN) 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(rrIN),adoption taxpayer Identification number(A-1-IN),or employer 1.Certify that the TIN you are giving is correct(or you are waking 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) S.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 codes)entered on this forth(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)