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Home My WebLink About306172 CITY OF CARMEL, INDIANA VENDOR: 371349 ROLLFAST, INC CHECK AMOUNT: $****"2,250.00' ONE CIVIC SQUARE 4620 BUCKINGHAM COURT CHECK NUMBER: 306172 CARMEL, INDIANA 46032 CARMEL IN 46033 CHECK DATE: 12/12/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1203 4359300 34263 267 2,250.00 PLAN 3 BIKE RIDES X « k j m3 O k 131 R O g \ \ 2 ® CO n n 0 0 m n m \ O / 2 2 \ 0 f $n O 4 0 3 2 W k > / 7 $ E e � 0 ƒ O ¢ / § § E q f >S j k ® z 2 2 2 / # 2 -nO \ § o ¥ | ƒ - k ( \ k c 0 / k $7 E 2 0 k CL 2 3 3 - CL / } I 2/ , � o n= m . & - 0 o CD xv \ ƒ §m 0 M U k CD k- CL k 7 I \- E C / 0 • ; ( ° C? E ( - 2 B £ / 2 � o # -0 %(D # m § z e § CLƒ C / § ) \ D �� - P \ ( � © RC o 0 0 CD q § q ƒ =L C o � � mCL Z \ « } _ k %k § k c g §0 \ E 2 7° © > 0 0- 0 D §k � 2 7 \ M 6� 2 / $ n 2. 0 E r 0 E ¥ & � / § i \ { C (D / & E } q B k k 2 k 0 8 m 7 ¥ ] ° ` \ k § \ / 2 \ a 0 CD § A i Rollfast INVOICE RF 4620 Buckingham Ct, Carmel, IN 46033 Phone 317-281-8479 INVOICE#267 ROLLFRST matt( rollfaststore.com Date: December 2, 2016 TO Sharon Kibbe SHIP n/a City of Carmel TO Office of the Mayor SHIPPING SHIPPING PAYMENT SALESPERSON JOB METHOD TERMS DELIVERY DATE TERMS DUE DATE n/a n/a n/a n/a n/a Due on receipt QTY DESCRIPTION DISCOUNT LINE TOTAL 1 2016 Planning / advising services for 3 bike rides in 2017 2250.00 TOTAL DISCOUNT SUBTOTAL 2250.00 SALES TAX TOTAL 2250.00 Form W-9 Request for Taxpayer Give Form to the (Rev.January he Tr Identification Number and Certification rend to r.the co not Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax return) Matthew Scott Tanner N Business name/disregarded entity name,H different from above Rolifast Check appropriate bo f> deral tax 0 a classification(required):VIndividual/sole proprietor ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate gc 0 tit Limited liability company.Enter the tax classification C=C c p Payer ❑ y ( corporation,S=S corporation,P=partnership)► Exempt c c IL 5 [:] Other(see instructions)b, Address(number,street,and apt.or suite no.) Requester's name and address(optional► r$ 4620 Buckingham Ct City,state,and ZIP code Carmel,IN 46033 List account number(s)here(optionaQ • Taxpayer Identification Number N) Enter your TIN in the appropriate box.The TIN provided must match the name given on the-Name"line Sociale--fY—b- to avoid backup withholding.For individuals,this is your social security number However,fora _EO _TM resident alien,sole proprietor,or disregarded entity,see the Part I instructions onn 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. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose EmpfoW id'ntlfi;-a' number number to enter. -F < -1 0032y • 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 ORS)that I am subject to backup withholding as a resuft 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). 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 retum.For real estate transactions,item 2 does not apply.For mortgage Interest paid,acquisition or abandon tsecured property,cancellation of debt,contributions to an individual retirement arrangement ORA),and generally,payments other than Inter dividen are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of LA Here U.&person► Date► — 2e:— ZL/ General Instructiom Note.If a requester gives you a form other than Form W-9 to request you TIN,you must use the requester's form it it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation .An estate(other than a foreign estate),or 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 provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waking for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,If you are a U.S.person that is a 3.Gaim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231X Form W-9(Rev.1-2011)