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HomeMy WebLinkAbout304453 10/31/16 a`! �,Af� CITY OF CARMEL, INDIANA VENDOR: 00351753 ® 1 ONE CIVIC SQUARE A.ARNOLD WORLD CLASS RELOCATIOfj iECK AMOUNT: S*******150.00* :.. =q CARMEL, INDIANA 46032 5220 W.76TH STREET CHECK NUMBER: 304453 9M��96r1�O'; INDIANAPOLIS IN 46268 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 202 R4460500 33408 102616 150.00 RIGHT OF WAY VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL r 04-+ie ve-­d0,f- GENERAL FUND IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service GENERAL FUND rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $30/00\1b" 30 00 Cbd` Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Engineering 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 33408 0 44-605.00 $150.00 1 hereby certify that the attached invoice(s),or 10/25/16 0 A.Arnold World Class.RelocaGon P.O.Box $150.00 2200 Encrrmbered 202 2200 202 _=- 56346 Atlanta;GA 30343 bill(s)is(are)true and correct and that the 33408 0 $150.00 1 /25/16 'Superior Moving&Storage Inc P.O.Box fi $150.00 � rrcrrm ere202 d 22 202 -- raw ,dsvlllerlN�91111 � E materials or services itemized thereon for Q�lu C2 1' V• 33r-4 p� by 42,0113 which charge is made were ordered and received except Tuesday, October 25,2016 hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer C�.O. 'S3�og Carmel 2016 Bond Projects 2 O 2- 1ZL41l fo 05 C>a Request for Payment Project Name Carmel Dr.&Rangeline Rd.Roundabout City Project Number 15-12 DES Number,if applicable 1296021 Project Parcel Number 3(001) Owner Name Arby's Hamilton Co.Tax I.D.Number State Tax I.D. Number 29-09-36-000-028.000-018 Payee Name A.Arnold World Class Relocation Payee Address P.O.Box 56346 City Atlanta,GA Zip 30343 PURPOSE OF PAYMENT*' AMOUNT. . Relocation Move Bid Fee 150.00 PAYMENT TOTAL: 150.00 Owner Signature: l GC A VV--..L.e c� SPECIAL INSTRUCTIONS: CITY APPROVAL SIGNATURES Jeremy Kashman,P.E. City Engineer Christine Pauley Clerk Treasurer rev 07121610:40am Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL,INDIANA 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 A. Arnold World Class Relocation Purchase Order No. P.O. Box 56346 Terms Atlanta,GA 30343 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount 9/6/2016 PROJECT: 1296021 Ran eline Rd Carmel $150 . 00 PARCEL 3 (001) Arby' s - Relocation Services : Move Bid Fee Robert Rhodes X One Hundred and Fifty Dollars and 00/100 ITotal 150 . 00 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 except 20 Signature Title 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 IMMI 1111 RELOCATION SERVICES (bid fees, interpreter etc. — up to $499.00) NAME: Arby's CODE: LPA PARCEL: 3(001) REVIEWER: SW Submit Previously when Attached Su miffed available Form# Required Items © NA NA Voucher Original signed claim voucher+ 1 copy ® ❑ NA W-9 Original+ I copy(if not previously submitted) NA NA Invoice Invoice or Bill not to exceed the approved bid fee ❑ [E NA Bid Original bid on company letterhead ❑ NA #27 Bid Specifications signed by the bidder FK] NA NA #8 "PARC"Agent's Report detailing the claim * Delivery Instructions must be noted * R8 does not need to be lengthy,but it must be specific and complete * R8 must be signed by the agent only COMPLIANCE CERTIFICATION I, Joe Gromosky,Boomerang Ventures,LLC, certify that this submittal is made in good faith,that the supporting data is accurate and complete to the best of my knowledge and that this submittal is in accordance with 49 CFR Part 24, PL 91-646 and IC 32-24 and that all applicable rules and regulations of the Federal Highw Administration have been complied with. i azure --Joe Gromosky Boomeranures,LLC Phone: (317)650-5489 Email: joe@gromosky.com Reviewer Comments: Page 24 Relocation Services OWOOT Indiana REVISED 07/2014 MM 0"°°"`r,'Worm REAL ESTATE CODE PCL Formw-9 Request for Taxpayer Give Form to the (Rev Dec tofthe real Identification Number and Certification requester. I not Departmentofthe7reasury send to the IRS. Internal Revenue Service 1 Name(as shown on your Income tax return) Name Is required on this line.do not leave this line blank ARNOLD MOVING COMPANY, LLC 2 Business name/disregarded entity name,if different from above A. ARNOLD WORLD CLASS RELOCATION 3 Check appropriate box for federal tax classification,check only one of the following seven boxes 4 Exemptions(codes apply only to o Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate certain entities,not Individuals,see c ❑ Instructions on page 3) Ingle-member LLC Exempt payee code(if any) Z,;, ®Limited liability company Enter the tax classification(C=C corporation,S=S corporation.P=partnership)- ` xemption from FATCA reporting o Note.For a single-member LLC that is disregarded do not check I.I.C.Ccheck the appropriate box in the line a ove or yf the tax classification of the single-member owner code(if any) ti ` IT]Other see instrucons ► I- V ( ) (ApDlree to eacounh meuitaned ouisMe the U S.) 5 Address(number,street,and apt or suite no Requester's name and address(optional) P.O. Box 56346 N 6 City,state,and ZIP code in Atlanta, GA 30343 7 List account number(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN In the appropriate box.The TIN provided must match the name given on line 1 to avoid Soclal security number backup withholding For individuals,this is generally 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 entities,it Is your employer identification number(EIN) 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 J� –1 11090�1 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(IRA),and generally,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 ISigni Signature of �HU.S.person- �� at'e�► I�VZ .s--//y— 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 -Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at wwwirs.gow" Use Form W-9 only if you are a U S person(including a resident alien),to Purpose of Form provide your correct TIN An individual or entity(Form W-9 requester)who is required to file an information If you do not retum Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) 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(ITIN),adoption taxpayer Identification number(ATIN),or employer Certify that the TIN you are giving is correct(or you are waiting for a number Identification number(EIN).to report on an information return the amount paid to to 1 I 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) 3 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 Wocable 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 code(s)entered on this form(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 Carmel 3 (001) Arby' s Move Bid Fee Invoice ARNOLD MOVING COMPANY PO BOX 56346 INVOICE ATLANTA, GA 30343 (317) 870-5777 Invoice Date: 3/18/2016 Billed to: Arby's c/o Boomerang Ventures, LLC 411 Northfield Dr. #426 Brownsburg, IN 46112 Order Number Type if, ervice 'Date Completed h Terms E n z Project Rangeline Rd SUR6102187 Code LPA Parcel 3(001) 3/17/2016 Upon Receipt £Date frol N r Description otServices Wgt/Qty/Hrs Rate Amount 3/17/2016 Moving quote for: 1 150.00 150.00 Arby's 1224 S Rangeline Road Carmel,IN 46032 _H xRe ept Total}�f paic!'upon c $15000 l u ExtendeC�editkCharge 1 50 v r r 7 rm... Gross if{paid afterl0 clays Mw._, CITY OF CARMEL, INDIANA RIGHT OF WAY AGENT REPORT Name: Arby's Project: Carmel Rangeline Rd Property: 1224 S Rangeline Rd,Cannel,IN 46032 Code: LPA Parcel: 3(001) Mailing: 1155 Perminter Center West,Atlanta,GA 30338 Email Address: idavittna.arbvs.com Telephone# (317)408-1224 Person Contacted Name: A.Arnold World Class Relocation Date: 9/6/2016 Address: POB 56346,Atlanta,GA 30343 Time: 47--k Type of Relocation: Business-Reestablishment Voucher: Professional Move Bid Fee _ Purpose: Joe Gromosky,agent on the above parcel, is submitting documentation for payment of a Professional Move Bid Fee. Mr.Robert Rhodes,from A.Arnold World Class Relocation,prepared a move bid for Arby's in March,2016. Amount/Calculation:Mr.Rhodes has invoiced the City of Cannel,IN $150.00 for the professional move estimate. That is the total for this voucher. Requirement:Mr.Rhodes has submitted the original estimate and the Bid Specification sheet so all requirements for payment of the bid fee have been met. The Displacee elected to use the self move option, and this move has been completed. Closing: Mr. Rhodes was advised that all matters regarding this bid fee are subject to the review and approval of the Relocation section of the City of Carmel, IN. Check Delivery Instructions.- Please nstructions.Please pay the vendor immediately. Mail check to: P.O.Box 56346 Atlanta,GA 30343 13-,r7—k/io� by b�e"I_ i e J.Gromos ,Right of Way Agent (317)563-8043 jg@boomerangventures.com RAAP FORM#8 REVISED 07/2014