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Home My WebLink About300096 07/12/16 �%��* CITY OF CARMEL, INDIANA VENDOR: 36,9677 ® ONE CIVIC SQUARE GENESIS FARMS CHECK AMOUNT: $*******156.00* ;�, CARMEL, INDIANA 46032 3501 E CONNER STREET CHECK NUMBER: 300096 9;ETON NOB LESwuE w 46060 CHECK DATE: 07/12/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4239034 2117 156.00 LANDSCAPING SUPPLIES I VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER GENESIS FARMS 3501 E CONNER STREET IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service NOBLESVI LLE, IN 46060 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $156.00 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Street Department Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 2117 42-390.34 $156.00 I hereby certify that the attached invoice(s),or 6/21/16 2117 $156.00 2201 201 2201 201 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 Wednesday,June 29,2016 lja,� Dave Huffman Director 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- Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Genesis Farms, LLC Invoice 3501 E Conner Street Date Invoice# Noblesville, IN 46060 6/21/2016 2117 Bill To Ship To Carmel Street Department Carmel Street Department 3400 W 131 st Street 3400 W 131 st Street Carmel,IN 46074 Carmel,IN 46074 Attn:Steve Zellar i Attn:Steve Zellar I P.O. Number Terms Rep Ship I Via F.O.B. Project I ' 6/21/2016 Quantity Item Code Description Price Each Amount 26 F Fescue Sod price per sq.roll 6.00 156.00T Sales Tax 7.00% 10.92 I I i i Total $166.92 Form ST-105 Indiana Department of Revenue State Form 49065 R418-05 General Sales TaxExemption 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.Yehicles. atercra t,or Aircraft, 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-il OL)directly with the Department of Revenue. = Name of Purchaser CITY OF CARMEL Business Address ONE CIVIC SQUARE City CARMEL State IN Zip 46032 Purchaser must provide minimum of one ID number below.* Provide your Indiana Registered Retail Merchant's Certificate A TID and LOC Number as shown on your Certificate............................... 0031201550 020 4 TIM(10 digits) LOC#(3 digits) If not registered with the Indiana DOR,provide your State Tax x ID Number from another State.................... ............................................ *See instructions on the reverse side if you do not have either number. State I11# State of Issue I N: `oF Is this a ®blanket purchase exemption request or a ❑single purchase exemption request? (check one) !-451 Description of items to be purchased. -- i I W 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. gq ❑ Sale of manufacturing machinery,tools,and equipment to be used directly in direct production. ❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10. (May not be used for personal hotel rooms and meals.) MOE 3E❑ 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 o provide their SS#or FID#in lieu of a State ID#in Section#1. USDOT# 13 Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale. `sem 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. z ❑ Sales to a contractor for exempt projects(such as public schools,government,or nonprofits). ® Sales to Indiana Governmental Units(agencies,cities,towns,r unicipalities,public schools,and state universities). y 0 Sales to the United States Federal Government-show agency name. u3 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 hereby certify under the penalties of perjury that the property purcased 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. ai I confirm my understanding that f se,(either negligent or intentional),and/or fraudulent use of this certificate may subject both me personally 3 and/or the business entity I fpr i o the imposition of x,int a and civil and/or criminal penalties. t!= Signature of Purchaser ' Date. 1/1/2016 i I CHRISTINE S. PAULEY Printed Name 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 keep this certificate on file to support exempt sales.