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HomeMy WebLinkAbout310420 04/18/17 Q CITY OF CARMEL, INDIANA VENDOR: 371629 ONE CIVIC SQUARE SUNSCREEN LABS CHECK AMOUNT: S*****3,340.26* CARMEL, INDIANA 46032 14700 W 66TH PLACE,SUITE N2 CHECK NUMBER: 310420 ARVADA CO 80004 CHECK DATE: 04/18/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1082 4239099 39963 3,340.26 OTHER MISCELLANOUS $ § 0 \ _ > z k 2 q 40 > @ & / k / / a) -4 @ m w . m � 0 co -n 0 $ / / D A 0 © CT f o CO)@ T 4 CDCh / W k q C 2 = E J [ � m 2 $ 2 E \ w C P A w w § k k o k 3 PQ k m ] — S D n m R a m ƒ ƒ Z _ � CD $ E ] 2 m 0 § o 0 CD g \ w > 2 2 0 2 2) @ M.cn E E » / CD k k 2 , 0 k 0 \ m OD w C 9 § & . \ \ \ / o = � |/ o Form W'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 fine;do not leave this line blank. The Erickson Marketing Group,Inc. N 2 Business name/disregarded entity name,if different from above rn Sunscreen Labs 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to certain entities.not individuals;see o ❑Individuatisole proprietor or ❑ C Corporation ✓❑S Corporation ❑ Partnership ❑Trust/estate instructions on page 3): c single-member LLC Exempt payee code if any) 0 ❑limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► p 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 c y the tax classification of the single-member owner. code(if any) •� C OApY•s to accounra edoLKWV&the U.SJ p, Other(see instructions)10- !E 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) 14700 W 66th PI.Suite#2 W 6 City,state,and ZIP code Arvada CO 80004 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 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. 9971M 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 retum.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� J �/It+�/�+• �(�rf Here U.S.person► , Data► 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 •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at wwwJrs.9ov/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 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(EIM,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 2.Certify that you are not subject to backup withholding,or returns Include,but are not limited to,the following: •Form 1089-INT interest earned or paid) 3.Claim exemption from backup withholding it you are a U.S.exempt payee.If applicable,you are also certifying that as a U.S.person,your allocable share of •Form 1099-DN(dividends,including those from stocks or mutual funds) any partnership income from a U.S.trade or business is not subject to the •Form 1099-MSC(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 inf rmation. •Form 1099-K(merchant card and third party network transactions) [r �.E` x `' Cat.No.10231 X APR 0 +4 Z Q 1 7 orrn W-9(Rev.12-2014) ABY. _ _ a R F f-TE MAR 232017 Sunscreen Labs 14700 W. 66th Place, Suite #2 @LABS nvo ce Arvada, CO 80004 SUNSCREEN DATE NUMBER 1-888-356-8899; 303-940-9809 Fax info@rmsunscreen.com 3/22/2017 39963 BILL TO SHIP TO Carmel Clay Park&Rec Carmel Clay Park& Rec Dawn Koepper Linda Acosta 1411 E. 116th St. 1235 Central Park Dr. East Carmel, IN 46032 Carmel, IN 46032 P.O. NUMBER TERMS DUE DATE REP SHIP DATE Shipping F.O.B. ORDER DATE PO#41266. Net 30 4/21/2017 HOU 3/22/2017 Prepay... Ground Arvada 03/20/2017 ITEM CODE DESCRIPTION QUANTITY PRICE EA. AMOUNT 35095 SPRAY Gallon Refill SPF-50 KIDS 26 108.00 2,808.00 Sunscreen (ORM-D, Ground Only) 35075 SPRAY Quart SPF-50 KIDS Sunscreen 22 38.25 841.50 (ORM-D, Ground Only) Subtotal 3,649.50 Spring Stock... Spring Stock Up Sale -15.00% -547.43 Shipping Shipping & Handling 1 238.19 238.19 lZ8X06490377464878 Thank you for your business. INVOICE TOTAL $3,340.26 Title to above merchandise delivered is retained by the seller until paid in full, including freight. Sunscreen Labs payment terms require payment of this invoice by the Due Date. All invoices not paid in full within above terms are subject to a 2% monthly finance charge retroactive to the invoice date. Finance charges apply only to invoices that are not paid within payment terms.