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HomeMy WebLinkAbout310352 04/18/17 ,+�,Gqq*f �;; ;� CITY OF CARMEL, INDIANA VENDOR: 371614 ONE CIVIC SQUARE BIG CAR CHECK AMOUNT: $*****2,500.00* ? ?4; CARMEL, INDIANA 46032 1125 CRUFT ST CHECK NUMBER: 310352 ,,y INDIANAPOLIS IN 46203 CHECK DATE: 04/18/17 ..i.oN ca. DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4239039 106 2,500.00 GENERAL PROGRAM SUPPL $ o Q0 § C 0 CD 0 / g 8 040 3 � < O � �� # K o o E m a 0 E & o e © 2 2 00) 3 E o m . w 0 7 k 7 / / # 0 2 T 2 � \ & k § 2 2 -06 ago 45. # g o ® J [ � X C CD z ® { w \ P E N % k cn o % § 0 CD S ] / D ° - K m f ¢ m M ƒ ƒ E g E E ] CD . q 0 G 0 > ƒ $ 0 » k @ - CD/ \ k 7 ) kk §-CL \k 2 \ (D k \ \ 0 § » ` ® ° § �_ K $ A o / 7 § w | \ 0 Request for Taxpayer Give Form to the ` ;ce- or 2 141 requester.Do not Department ofneTreasury Identification Number and Certification Send to the IRs. 1•1temrl nevt+mue Service 1 Name fits;sl*wn eft your iticome tax return).Names requ,+t.I un lidt+limo:do not leave this line blank !Big Car Media,Inc N { 2 Business name!divegarded entity name,it diffe•unt 1•11)nr above ------ ' 0' a a( 3 Check a;Xngiriate.tx+x hx("Iteral tax ctassVication;check only one of the•-fullt.%woul careen boxes: 4 Exemphorm Icr>dns apply only to O O Indiwduai%sot!pfopiletcf n C Corporation S Carporalinn ' pa•Inorshi 1 Trustre•state certain u•tlit+es.not individuals;see r, I L P = instructions on pagr,3). o ! single•member LLC Exe rptt ivy"code(if any) y p , j._j Limited liability company.Enter the tax classtireslion;C-C corporation,S=S eorpore;iae.,Fl-partnere:hipi► c 2 I Nola.For a single-member LLC that as d�smgataNi vis nuc cnutk LLL:copeck the apprnp taus box in tor,w.a above to, Exemption from FA 1 CA re p orta+g _ % I the tax classification or the lunglr.-rneyrttlCr uvnrp. code!if any) a C (✓ Olhw(see instructions)I- Non-Profit Corporation tkf.l..n>w. k..w"Mvero.aswreuso .E 5 Addfass;numher,lose),and.yrt.o•suite no.} Rewuoster's name and irkloess(np!ionWi 1125 Cruft Street h 8 Cely,stale.and ZIP cede _- rh Indianapolis,IN 46203 7 Lr;account num _.....___ _.._�._ ber(s}here(opUonafj — 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 alien, ole For individuals,this is generally your social security number(sag) However,fora resident alien,sole proprietor,or disregarded entity,sod the Part I Instructions on page?.For ottwr entities,it is your employer identification number(EIN).If you do riot have a number,see Now to get a TIN on page 3. or _ Note.If Ilia account is in more than one name,see the instructions for Ione 1 and the chart on page 4 for Employer Identification number guidelines,on whose nuxrtber to enter. 1 t J37 J21511 ' 5171 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 rite);and 2. 1 am nol subject to backup withholding because:(a)I am exempt front backup withholding,or(b)I have not been notified by the Internal Revenue Service(Ili that I am subject to backup withholding as a result of a failure to report all Interest or dividends,or(cl 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 codes)entered on this form(if any)indicating that I ant exompt from FATCA reporting is correct, certification instructions.You must cross out item 2 above if you have been wAified 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,dem 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contritxitions 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 geuraof HI Date wr L. . so , - i �1 General Instructions •Form 1008(home mortgage interest),IEW-E(student loan interest},1098 T malign) Section rafeeencos aro to the Internal Revenue Code unless otherwise nosed. •Form 1099-C(canaoled debt) Future developments.Information about develc4inients afterttng Corm 67 9(tach •Fam IiYJ9-Afar yursrtiun car au uxfwnment car sutured property) as legislatiur+unacted lift(,we relapse ill is at WWW.as.gov:7W9 Ilse,Form W-9 only it you are a U S.person lnGuding a resident alien),to Purpose of Form provide you correct TIN. An individual or entity(Form W-9 requester who is required to L1e an Infix•ryilr0o t'low du nut rafurn/'arm W-9 to Biu rawuester with a TIN.you might be Bublbct relum with tiro 1135 must obtain your correct taxpayer identification r%,mbef fTINI to backup wrhhard(rrg.See What is harkup withhorrpng7 on rxige 2. which may be your sinal seaxity rwmber(SSN),;ndividuai taxprn•eer k*A11 rcanun Cly r'tgnkill the filled ova form,you: rnxfrtnu(Il w),attoptior tnxpayer xlenlda:alnn ntanbt+r(ATIN),or employer 1.Cettib shat the TIN you are giving Is correct or are waitin for a number identification number(EIfJI,to report on an information return the a^.ouw pad 10 to he Issued). 9 ' 9 { Yo U Voir,or otM am irl reportable on yn Intnrmatron return Fxamplos of information returrn include,but are riot limited to,the follamng. 2 Cenify shat you are not mit>jexa to backup vattvrnldtntl,w •warn t D99-INI(irdaff-M ranted of pouf; 3 Clvirn r;xurnpliurr Iron backup vnlhhokfing of you are a U.S exempt payee.If •Farm 1099-DIV jdWldenda,including l!YJae)hoer storks or niu1r16111.fvtett applicabW you are also certifying that as a U.S.pe•snn,your allocable share CO any partntiWilp Irx:onrrt born a U.S.Itai W business is not subject to the to Fenn 1099-MISC(vanws types of ktcome,p•rzr_s,awartk:,ur press txoceods) withholding tax on foreign partners'shore of effectively coms:;trxl racoma,and •Form 1099-B(sto:x or mutual fund sales and certain other hansacbons by L.Cervfy that FAI CA cone),q rntered on this form(,t any)indicating that you are bfokeral exempt from the FATCA reporting,is co-rect.See V11wr is FATC.Arnpr••fk;%;7 an •Form 1099-S(proceeds from real estate(ransactions) page 2 for further infom+strcm •Fotm t099-K(mecha•)i c3t0 and third party nelN•Urk 1•ansacNiurrg( /—,'T FD V Cat.No 10231X APR 6 2017 frnnW-9(Hev.1220141 FBY... 1 1011 ' BIG 011 It VOK f:, Bill To: Invoice#: 106 Date:4-5-17 Lindsay Labas,CPRP Marketing Director Due Date:4-5-17 Carmel Clay Parks&Recreation Terms:Net 30 Monon Community Center 1235 Central Park Drive East Carmel,IN 46032 Description Discount Quantity Unit Price Total TEDxlndianapoiis Silver Level Sponsorship 1 $2,500 $2,500 Thank you,Lindsayl It's a pleasure to have Carmel Clay Parks&Recreation partner with usl--Diana Please make check payable to Big Car,fiscal agent for TEDxindianapolis Balance Due: : $2,500 ............. . ..... .. ........ .. ........__