Loading...
309888 04/04/17 W��'`� CITY OF CARMEL, INDIANA VENDOR: 371598 .� �' ONE CIVIC SQUARE CERVIS TECHNOLOGIES CHECK AMOUNT: $*****2,500.00` ? CARMEL, INDIANA 46032 PO BOX 64181 CHECK NUMBER: 309888 +N�. ,�e` COLORADO SPRINGS CO 80962 CHECK DATE: 04/04/17 �SON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4355200 18341 833.33 SUBSCRIPTIONS 1091 4355200 18341 833.34 SUBSCRIPTIONS 1125 4355200 18341 833.33 SUBSCRIPTIONS f 0 2 CDn c a2 0 / $a © e 10 > f o o E S o q ■ 0 obcD 2 ) m E o92 3 \ k k k \ @ � k o w } \ 2 -0 / \ / % # # # o m f / 2 0 ƒ & k k k j m $ 2 7 R / # g O P o C § / ƒ R R R® C 2 $ O a { w to \ k E n / q 00 OD / n c m Q k j 0 k k S S § \ 2 K ¥ R a f w � e CD CD \ E E § A CD 2 ° cn 0 S \ CD \ 7 0 ' E 2 / CDK « 8 ƒ . J 7 . 2\ 2 $ \ S 2 { / 0 CD / CD -4 C » � k CD J - \ �_ \ 0 / k CD k § | � _ \ 2 SEC 2 2016 Form W9 Request for Taxpayer j Give Form to the (Rev.December 2014) requester.Do not Identification Number and Certification i Department of the Treasury -- - _s4nd 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. VOLSTAR,INC. N 2 Business name/disregarded entity name,if different from above Q, CERVIS TECHNOLOGIES m a 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to c O ❑Individual/sole proprietor or ❑ C Corporation ./ S corporation certain entities,not individuals;see p ❑ p ❑ Partnership ❑Trust/estate y instructions on page 3): m c single-member LLC Q C ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exempt payee code(if any) `p 2 Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting y the tax classification of the single-member owner. code(if any) c a ❑Other(see instructions)10, 44pplies to accounts maintained outside the US) 5 Address(number,street,and apt.or suite no.) Requester's name and address(optionaQ CL P.O.BOX 64181 6 City,state,and ZIP code u) COLORADO SPRINGS,CO 80962 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 Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,fora -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 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. [4F6] - 5 1 6 1 5 1 9 1 2 2 9 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 Here U.S.person 10, Date► NOVEMBER 1,2016 General Instruct ns •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 www.irs.gov/fwg. 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 return 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 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 4 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 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) CERVIS Technologies Invoice P.O. Box 64181 Colorado Springs, CO 80962 - Date Invoice# 12/20/2016 18341 Bill To: Carmel Clay Parks & Recreation Due Date 1411 E 116th Street 1/20/2017 Carmel, IN 46032 _-- _ Item � � Amount ��� Account Set-Up ..... 100.00 Data Import 200.00 Software Training - 5 hours 400.00 Premier Edition -Annual Plan 1,800.00 l E E� Et{ 3 EEf 3 Payments/Credits $0.00 I Balance Due $2,500.00 f 1 www.cervistech.com 888-549-3601 billing@cervistech.com