The URL can be used to link to this page

Home My WebLink About304772 10/31/16 v`%�4�p � CITY OF CARMEL, INDIANA VENDOR: 371269 ® ; ONE CIVIC SQUARE SUPERIOR MOVING &STORAGE CHECK AMOUNT: $*"""*"*150.00* i. ?�; CARMEL, INDIANA 46032 P.O.Box 169 CHECK NUMBER: 304772 9M��ioN�� CRAWFORDSVILLE IN 47933 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 202 R4460500 33408 102616 150.00 RIGHT OF WAY /OUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ',ITY OF CARMEL n04-+tie v?i-+Gda,e'_ ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 3ENERAL FUND IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service 3ENERAL FUND rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $� .00 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# . Engineerinq 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 44-605.00 ereby certify that the attached invoice(s),or 10/25/16 0 A.Arnold World Class Relocation P.O.Box $150.00 8 "�E rmbered 202 �23 0 202 6 63g Attar t3 '"�-- 33408 0 44-605.00 $150.00 bill(s)is(are)true and correct and that the 10/25/16 0 Superior Moving 1£Storage,Inc.P.O.Box 169 $150.00 2200 E,rcrrmbered 202 materials or services itemized thereon for 2200 1 202 1 Crawfordsville,IN 47933 Red,,Ce P. 0. 33 a4 0` by *3 0 which charge is made were ordered and received except Tuesday, October 25,2016 1 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 .'ost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer 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 Superior Moving & Storage, Inc. Purchase Order No. P.O. Box 169 Terms Crawfordsville, IN 47933 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount 9/6/2016 PROJECT: 1296021 Rangeline Rd Carmel PARCEL 3 (001) Arby' s Relocation Services: Move Bid Fee $150 .00 X 'Lisa Guckes X One-hundred-fifty and no/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 �P.c"5e-5 C _ 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 ❑X NA NA Voucher Original signed claim voucher+ 1 copy 0 ❑ NA W-9 Original+1 copy(if not previously submitted) ® NA NA Invoice Invoice or Bill not to exceed the approved bid fee ❑ ® NA Bid Original bid on company letterhead ❑ ® NA 427 Bid Specifications signed by the bidder ❑X 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 1, 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. � afore Joe Gromosky Boomeranores,LLC Phone: (317)650-5489 Email: joe@gromosky.com Reviewer Comments: Page 24 Relocation Services INDOT 0 Indiana REVISED 07/2014 w4utedal wn?" Formw=9=9 equest for 'taxpayer Give Form to the (Rev.August 2heT Identification Number and Certification requester.Do not Internment of the Treasury send to the IRS. Interna!Revenue Service Name(as shown on your income tax return) C%i Business nameldisregarded entity name,if different from above 00)ro Superior Moving and Storage.Inc. cCheck appropriate box for federal tax classification: Exemptions(see instructions): C ❑Individuallsole proprietor ❑� C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate Exempt payee code(if any) 0 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)D Exemption from FATCA reporting 0 c c code(f any) a ❑ Other(see instructions) Address(number,street,and apt.or suite no.) Requester's name and address(optional) U COL Po Box 169 City,state,and ZIP code W Crawfordsville,IN 47933 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 the"Name"line social security number avoid backup withholding.For individuals,this is your social security number However,for a re -m 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 Now 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 identification number number to enter. 3 5 - 1 1 9 4 1 4 1-1M26 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. Sign Signature of > /t Here U.S.person b � €u •�L� - Date► .r Genera! Instructions withholding tax on foreign partners'share of effectively connected income,and 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are Section references are to the Internal Revenue Code unless otherwise noted. exempt from the FATCA reporting,is correct. Future developments.The IRS has created a page on IRS.gov for information Note.If you are a U.S.person and a requester gives you a form other than Form about Form W-9,at wwvvJrs.gov1w9.Information about any future developments W-9 to request your TIN,you must use the requester's form if it is substantially affecting Form W-9(such as legislation enacted after we release it)will be posted similar to this Form W-9. on that page. Definition of a U.S,person.For federal tax purposes,you are considered a U.S. Purpose of Form person 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 e 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, transactions,real estate transactions,mortgage interest you paid,acquisition or a An estate(other than a foreign estate),or abandonment of secured property,cancellation of debt,or contributions you made to an IRA. •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 partners'share of effectively connected taxable income from such business.Further,in certain cases where a Form N!-9 has not been received, 1.Certify that the TIN you are giving is correct(or you are waiting for a number the rules under section 1446 require a partnership to presume that a partner is a to be issued)' foreign person,and pay the section 1446 withholding tax.Therefore,if you are a 2.Certify that you are not subject to backup withholding,or 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 Form W-9(Rev.8-2013) \..(Ai.LLLL ..,J V V 1 i711JY v 1'1V V Superior Moving& Storage, Inc. Invoice P. O. Box 169 Crawfordsville, IN 47933 Date Invoice# 6/22/2016 9343 Bill To Arby's C/O Boomerang Ventures 411 E Northfield Drive#426 Brownsburg,IN 46112 P.O. No. Terms Project Quantity Description Rate p Amount Arby's relocation bid 150.00 150.00 Project: Rangeline Road Code LPA Parcel 3(001) 0 I i i i I Please remit to above PO Box Number Total $150.00 CITY OF CARMEL, IN BID SPECIFICATIONS Bidder Superior Moving& Storage,Inc. Bidder Phone (765)362-6804 Displacee , Arby's(Joe Davitt-Manager) Project Rangeline Rd Address 1224 S Rangeline Rd.,Carmel,IN 46032 Code LPA Parcel 3 001 Displacee Phone (317)408-1224 DispIacee Email ,jdavittnaarbys.com Bid specifications for moving personal property belonging to the displacee above, located at the address above, as shown in the attached inventory dated 2/8/2016: 1.Follow only those instructions provided by the City of Carmel, IN Right of Way Agent(s) when preparing the bid. 2.I nclude in the bid costs for moving only the personal property items in the attached inventory. 3.Bid must itemize costs associated with disconnects, disassembly,reconnects,reassembly,and resetting. 4.Bid must itemize costs associated with packing loading (at displacement location), and unloading (at replacement location) all personal property. 5.Bid shall be based on mo ving items no more than 50 miles from the present location. 6.Bid must include breakdown of cost components (labor,materials, equipment, etc.) 7.Bid must include full replacement value insurance coverage with no deductible. 8.An y charges for preparing the bid shall be on a separate invoice and shall be submitted with the bid. Invoices submitted later may not be honored. 9.Bid must include the following statement: "Per inventory dated 2/8/2016 as provided by relocation personnel." 10. Other specifications/instructions: Submit bid fee invoice with moveWrdno not bid tables chairs booths or any equipment. Bid to include restaurant inventorV 9940AMous items only, Specifications prepared on 2/8/2016 by Date Joe Gromosky,Right of Way Agent Right of Way Agent's Phone# (371) 650-5489 Email jg@boomerangventures.com Fax: (317) 348-4155 Bidder's Certification: I hereby acknowledge receiving a copy of thesespecifications and the inventory identified above. I have inspected the items on the inventory and WAS I WAS NOT circle one) accompanied by the Right of Way Agent. I understand that my bid will be used to determine the reasonable and necessary cost of relocating the personal property involved. I will be prepared to perform this move as specified for the amount of my bid. I will prepare this bid openly and independently without knowledge of other bids. Any knowledge I have of other bids will be stated on my bid. It is the responsibility of the displacee to select the Professional Mover of their choice. The City of Carmel will be the third party payor up to the amount of the low bid. 6/22/16 Lisa K Guckes Date Lisa Guckes CITY OF CARMEL, INDIANA RIGHT OF WAY AGENT REPORT Name: Arby's Project: Carmel Rangeline Rd Property: 1224 S Rangeline Rd,Carmel,IN 46032 Code: LPA Parcel: 3 001 Mailing: 1155 Perminter Center West,Atlanta,GA 30338 Email Address: 'davitt(a)g bys.com Telephone# (317)408-1224 Person Contacted Name: Superior Moving&Storage,Inc. Date: 9/6/2016 Address: POB 169,Crawfordsville,IN 7933 Time: $/1A 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.Ms.Lisa Guckes,of Superior&Storage,Inc,prepared a bid in June,2016. Amount/Calculation:Ms.Guckes has invoiced the City of Carmel,IN$150.00 for the residential professional move estimate.That is the total for this voucher. Requirement:Ms. Guckes has submitted the original estimate and the Bid Specification sheet so all requirements for payment of the bid fee have been met.The Displacee selected the self move option,and this move has been completed. Closing: Ms.Guckes was advised that all matters related to this bid fee are subject to the review and approval of the Relocation section of Tippecanoe County,W. Check Delivery Instructions Please pay the vendor immediately. by -Lisa 9uckes. J. Gromos ,Right of Way Agent (317)650-5489 jg@boomerangventures.com RAAP FORM#S REVISED 07!2014 Carmel 2016 Bond Projects Z02--P-414 0S0a 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 Superior Moving&Storage,Inc. Payee Address P.O.Box 169 City Crawfordsville,IN Zip 47933 PURPOSE OF,,PAYMENT., AMOUK Relocation Move Bid Fee 150.00 PAYMENT TOTAL: 150.00 Owner Signature: SPECIAL INSTRUCTIONS: CITY APPROVAL SIGN TURES Jeremy Kashman,P.E. i City Engineer Christine Pauley Clerk Treasurer rev 07121610:40am /