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Home My WebLink About305687 11/28/16 /�'w""'�. CITY OF CARMEL, INDIANA VENDOR: 371310 t\I ONE CIVIC SQUARE TOP NOTCH MASONRY CHECK AMOUNT: $*****2 800.00* ��° CARMEL, INDIANA 46032 997 S.10TH STREET CHECK NUMBER: 305687 M��r`6N.�°. NOBLESVILLE IN 46060 CHECK DATE: 11/28/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4350100 24894 2,800.00 MASONRY WORK STA #41 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) TOP NOTCH MASONRY ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 997 S. 10TH STREET IN SUM OF$ 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. $2,800.00 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire 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 24894 0 43-501.00 $2,800.00 1 hereby certify that the attached invoice(s),or 11/18/16 0 $2,800.00 1120 101 1120 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Friday, November 18,2016 David Haboush Fire Chief I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer CONTRACTORS INVOICE TOP NOTCH MASONRY 997 South 10th Street Noblesville,IN 46060 WORK PERFORMED AT: TO: r L( ate - DATE YOUR WORK ORDER NO. OUR BID NO. �v to ( ca S 3L DESCRIPTIONOF WORK PERFORMED 9 co -�- (; f ®a. L V%A—A p � 1 I GL/ C �j t � All Material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of Dollars ($Z This is a ❑ Partial Cull invoice due and payable by: Month Day Year in accordance with our ❑Agreement Xproposal No. Dated SJ Month Day Year NC3822 CONTRACTORS INVOICE Formw=9 Request for Taxpayer Give Form;to the (Rev.December 2014) Identification Number and Certification requester.:Do not Department of the Treasury 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. r7/ ayti av S ri` N Business na disregarded entity namt,9 different from above 0 I CL 3 CheA appropriate box for federal tax classifica heck only one of the following seven boxes: 4 Exemptions(codes apply only to c certain entities,not individuals;see O '�IndividuaNsole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trustlestate instructions on page 3): W C single-member LLC Exempt payee code(f any) ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► o o � Note.For asingle-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting .the-tax.classfcation of the single-member owner. _ ___ - _ code(if any) - CL ElOther(see instructions)0- (ApOw to�•os nmfnWned outside the U.S.) �c-- 5 Address(number,street,and apt.or suite no.) Requester's name and address(optionao rn m 6 City,state,and ZIP code l// � iVabl ll �_ Kba(o d 7 List account number(s)here(optionao Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid 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 i and the chart on page 4 for Employer identification number guidelines on whose number to enter. Certification Under-penalties-of-perjury;I-certify-that:-- - -- - — ---- -- - -- -r _- --- 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 TRS that you are currently subject to backup withholding because.you have failed ed all interest'and dividends on your tax return.For,real,estate transactions,item 2'does not apply:For mortgage interest paid,acquisition ora an donmentofsecured 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 Here J. U.S.person► Date► r LO 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 e Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)Is at www.1rs.gov/fw9. 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 notetum Foam 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(SSM,individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.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 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) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If -•Form 1099-DIV(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.099,!Vll (variousaypes of income,prizes,awards;or gross proceeds) withholding taxon foreign partners'share of effectively connected income,and ;.. - .: •Form 109.9.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 1099-5(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)