312789 06/16/17 CITY OF CARMEL, INDIANA VENDOR: 366475
ONE CIVIC SQUARE FACILITIES MANAGEMENT LLC CHECK AMOUNT: $ ....*669.91"
} r° CARMEL, INDIANA 46032 8505 ZIONSVILLE ROAD CHECK NUMBER: 312789
INDIANAPOLIS IN 46268 CHECK DATE: 06/16/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4350000 30197 406.75 EQUIPMENT REPAIRS & M
1095 4350000 30198 263.16 EQUIPMENT REPAIRS & M
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom rates per day, number of hours rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Facilities Management, LLC Terms
8505 Zionsville Road
Indianapolis, IN 46268
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
6/7/17 30197 Service Call on Popcorn Machine 41701 $ 406.75
6/7/17 30198 Service Call on Popcorn Machine 41701 $ 263.16
Total $ 669.91
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_
Clerk-Treasurer
Farm W-9 Request for Taxpayer Give Form to the
CMov.epa Dento(l orIdentification Number and Certification requester.Do not
8 send to the IRS.
1 Name(sa shown on your Income tall return).Name Is required an tMa Ilrw,do not leave tMs One blank.
FACILITIES MANAGEMENT,LLC
bt Teustneea nwWdwegsrded entity none,if different from above
m
3 Oheok appropriate box for federal tat cleesilloatlon:check only one of the fo0owhmg seven boxes: 4 Exemptions(—Jas apply only to
ElIndivldtaNaole proprietor or ❑ o Oarporation (3S Corporation (_1Partnership ❑TmWestate o'page Individuals,ea.
c single-mernber 110 BcemPt Payee ode Of any)
m Umited liability company.Enter the tax classification P-0 oarporatiorb S.•B oorporatlon,P-partnership)► S
`o Nota.Far a elnpb-member 110 that is dleregarded,do not check LLC;check the appropriate fox in the One above for Exemption from FATCA reporting
the tax olaesdbaU.of tta single-member owner, code(i(any)
❑other(see kwbvctions)► 011•a WWA*s.a rr.emru.e.ua,
6 Address Diumber,aaeet;and apt.or aft nos Requesters name and address(optional)
8505 23ONSVILLE ROAD
a City,state,and ZIP code
INDIANAPOLIS,IN 46268
ww_7 Usaccountt numbers)here joptksmQ
Taxpayer
Identification Number N
Etter your TIN In the appropriate box.The TIN provided must match the nerve given on line 1 to avoid sooral seonray number [�
backup w en,sole For tndMproprietor,
or die this is generally enft your social security number(Sag).However,foraresident den,sole proprietor,or disregarded entity,seethe Part 1lnstbvcdons on page 3.For other
enNtleA It Is your employer Ident)flostion number(EIN).If you do not have a number,see How to get a
77N an pme 3. or
Note.If the account In In more than one name,see the Instructions for line 1 and the chart on page 4 for EmpkW idarMoeson rwmber
guldeNnse on whose number to enter.
6 1 - 1,1413 5 1 Mir,
Certification
Under penalties of perjury,I certify that
1. Tho number shown on this form Is my correct taxpayer identification number(or I am waiting for a number be issued to me);and
2. 1 am not subject to backup withholding because:(a)Item exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service QRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notl}led me that i am
no longer"Jed to backup withholding;and
3. 1 am a U.S.olttrmn or other U.S.person(defined below);and
4.The FATCA oode(s)entered on this form(If any)(ndloating that I am exempt from FATCA reporthtg is correct.
Cufficatfon Instructions.You mint orces out Item 2 above N you have been notified by the IRS that you we Currently subject to backup withholding
because you have failed to report all Interest and dividends on your tax return.For real estate trananotiona,Item 2 does not apply.For mortgage
Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retlrement arrangement ORA),and
generally,payments other than( and dividends,you are not required to sign the certification,tart you must provide your oorreot'nN.See the
Instructions on page S.
Sign
Here I u �n* 4 4Z /3
General Ins ons Form 1008(home mortgage Interest),1098-e(stud nt loan Intwoul,1098-T
Section referenow aro to the internal Revenue Oode unless otherwise noted. •Form 1089-C(canceled do"
Future developments.Information about developments effecting Form W-8(such •Form 1099-A
as legislation enacted alter we release 0)Is at www.ksgov1W. (>� a abandomnert of secured property)
Use Form W-9 only If you are a U.S.person(lnotuding it resident atlen),to
Purpose of Form provide your correct TIN.
An IrWWual or entity(Form W-9 requester)who Is required to Ale an Information Nyou do not scrim Fwm W-9 to the requester with a 719 you trA t be se toot
return with the RS must obtain your oorreottaxpayer kientOtasdon ntmbw M to backup withholding.Sas What is backup wfUftktng?on papa 2.
which may be your social security mWn0DD a tax By signing the Aped-out form,you:
number Tn",adoption taxpayer fdsrw t er 4 re 1.OwUly that the 11N you aro giving fe correct(or you awelting for a number
Identification number(EA4),to report on t to be issued),
you,or other amount reportable on an Ink nudlon return.Bcamples of information
returns hdWo,but are riot Imlted to,the Akrw :"`AY 17 zov 2.0ertly that you aro not subject to backup wftimh oknW,or
•Form 1099-Wr(Interest owned or Paid) 3.Claim exemption from backup withholding If you are a U.S.exempt payee.If
•Firm 1090-M(dividends,Including tho e from stocks or mutual funds) applicable,you are also owili ng that as a U.S.person,your WlooWxo share of
arry pert nershlp income Vona U.S.trade or horsiness Is not subject to the
•Form 1�g-MSC M sous types of if Via,err gross proceedo) wittthokRM tax on foreign partners'share of effadively connected income,card
Form I OWS(stook or mutual fund sales oel "SI er'�re'n'--ons by 4.Ow*that FATCA rwde(s)entered on this fomu(H any)Indloaft that you are
brokers) exern from the FATCA repotting,In correct Sae Whet)a FATCA reporting?on
•Form 10995(proceeds from reel estate trmmraotlons) page 2 for furttner Information.
•Form 1098-K(mtrOw t card lend third part,network transactions)
Cud.No.102SIX Form W-9(Rev.12-1014)
Facilities Management, LLC Invoice
8505 ZIONSVILLE ROAD* INDIANAPOLIS, IN*4626 c' '
PHONE: (317)291-0816*FAX: (317)291-0823(fax) Date Number
www.fmcanfixit.com JUN 0 8 2017 6n/17 30197
Billing Address Service Address
CARMEL CLAY PARKS AND REC MONON COMMUNITY CENTER
1411 E. 116TH STREET CARMEL CLAY PARKS, 1195 CENTTAL PARK DI
dkoepper@carmelclayparks.com CARMEL, IN 46032
CARMEL, IN 46032
PO Number: 12855 Terms Due Date
Reference: Work Order 51355 DUE ON RECEII 6/7/2017
Item Quantity Description Unit Price Amount
Labor 3.25 FOOD SERVICE LABOR $87.00 $282.75
Miscellaneous 1.00 SHIPPING&HANDLING 12.72 $12.72
Miscellaneous 1.00 STAR HIGH LIMIT 76.28 $76.28
Miscellaneous 1.00 TRUCK CHARGE 35.00 $35.00
5/19 CHECKED STAR POPCORN MAKER.
FOUND LIMIT TO MIDDLE ELEMENT ON
KETTLE OPENING PREMATURELY AND NOT
PASSING VOLTAGE TO ELEMENT TO HEAT
UP
5/25 FURNISHED AND INSTALLED NEW HIGH
LIMIT SWITCH. CHECKED OPERATIONS.
�0(Q.7J
Sales Tax: $5/4
We gladly accept all credit cards with a 3%surcharge." TOTAL: $ 2.09
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Facilities Management, LLC Invoice
8505 ZIONSVILLE ROAD* INDIANAPOLIS, IN*46268
PHONE: (317)291-0816*FAX: (317)291-0823(fax) JUN 0 8 2017 Date Number
www.fmcanfixit.com 6/7/17 30198
Billing Address S6=dress
CARMEL CLAY PARKS AND REC MONON COMMUNITY CENTER
1411 E. 116TH STREET CARMEL CLAY PARKS, 1195 CENTTAL PARK DI
dkoepper@carmelclayparks.com CARMEL, IN 46032
CARMEL, IN 46032
PO Number: 12855 Terms Due Date
Reference: Work Order 51398 DUE ON RECEII 6/7/2017
Item Quantity Description Unit Price Amount
Labor 1.75 FOOD SERVICE LABOR $87.00 $152.25
Miscellaneous 1.00 SHIPPING&HANDLING 13.72 $13.72
Miscellaneous 2.00 THERMOSTAT 31.10 $62.19
Miscellaneous 1.00 TRUCK CHARGE 35.00 $35.00
6/2 FURNISHED AND INSTALLED 2 STAR
POPCORN POPPER THERMOSTATS.
CHECKED OPERATIONS.
to
Sales Tax: $4.3
"We gladly accept all credit cards with a 3%surcharge." TOTAL: $/7.51
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