327698 07/20/18 1°�"44gg1
�•/ F. CITY OF CARMEL, INDIANA VENDOR: 372445
ONE CIVIC SQUARE BRIGHT HOUSE NETWORKS
CHECK AMOUNT: $********83.88*
?� CARMEL, INDIANA 46032 P.O.BOX 790450 CHECK NUMBER: 327698
.y,�roN_�. ST.LOUIS MO 63179.0450 CHECK DATE: 07/20/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4350900 005001371102 83.88 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 372445
BRIGHT HOUSE NETWORKS IN SUM OF$ CITY OF.CARMEL
P.O. BOX 790450 An invoice or 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.
ST. LOUIS, MO 63179-0450
Payee
$83.88
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Street Department Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
001377102070718 43-509.00 $83.88 1 hereby certify that the attached invoice(s),or 7/7/18 00137710207071 $83.88
2201 2201 2201 2201
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday,July 18,2018
Huffman, Dave
Director
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Spectrumo.
ENTERPRISE
July 7,2018
Invoice Number: 001377102070718
Account Number: 0050013771-02
Security Code: 3704
Service At: 3400 W 131 ST ST
CARMEL, IN 46074-8267 SPECTRUM ENTERPRISE NEWS
Contact Us
Visit us at brighthouse.com/business
Or,call us at 1-866-477-1386
throughSurnmary "rvices from 07103118 08/02/18
followingdetails on ag
Previous Balance 0.00
Payments Received 0.00
Remaining Balance $0.00
Spectrum Enterprise TV 76.89
Partial Month Charges 6.99
Taxes, Fees and Charges 5.87
Current Charges $89.75
Total Due by 07/11/18 $89.75
�r Y
Welcome to Spectrum Enterprise!
This bill reflects install and service charges from the date of
install through your current billing period. If you made a
payment at time of install, this bill may not reflect that payment
but your next bill will.
............................................._._ ------------------- ._......------------------------------
Spectrum►
Page 3 of 4 July 7,2018 ENTERPRISE
CARMEL STIR DEPARTMENT Contact Us
Invoice Number: 001377102070718 Visit us at brighthouse.com/business
Account Number: 0050013771-02 Or,call us at 1-866-477-1386
Security Code: 3704 7835 1210 NO RP 07 07072018 NNNNNY 01 000041 0001
Complaint Procedures-You have 60 days from the billing date to
register a complaint if you disagree with your charges.
i
,: ':i`',
Form ST-105 Indiana Department.df Revenue
State Form 49065 General Sales Tax Exemption Certificate
(R5/.6-17)
Indiana registered retail merchants and businesses located outside Indiana may use this certificate. The claimed exemption must be
allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors.This exemption certificate
can not be issued for the purchase of Utilities, Vehicles, Watercraft,or Aircraft, Purchaser must be registered with the Department
of Revenue or the appropriate taxing authority of the purchaser's state of residence.
Sales tax must be charged unless all information in each section is fully completed by the purchaser.Purchasers not able to provide
all required information must pay the tax and may file a claim for refund(Form GA-110L)directly with the Department of Revenue.A valid
certificate also serves as an exemption certificate for(1)county innkeeper's tax and(2)local food and beverage tax.
Name of Purchaser: CITY OF CARMEL
Business Address: ONE CIVIC SQUARE City: CARMEL State: INDIANA ZIP Code: 46032
c `
Purchaser must provide minimum of one ID number below.`
C
g Provide your1ndiana Registered Retail Merchant's Certificate TID and LOC Number as shown on your Certificate.
c TID Number(10 digits): 0031201550 -LOC Number(3 digits): 020
0
if not registered with the Indiana DOR,provide your State Tax ID Number from another State
"See Instructions on the reverse side If you do not have efther-number.
State ID Number: State of Issue: i
i
N
e Is this a 014blanket•purchase exemption request or a single purchase exemption request? (check one)
NDescription of items to be purchased:
Purchaser must indicate the type of exemption being claimed for this purchase.(check one or explain)
Sales to a retailer,wholesaler,or manufacturer for resale only.
Sale of manufacturing machinery,tools,and equipment to be used directly in direct production.
C Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10.(May not be used for
i
personal hotel rooms and meals.)
Sales of tangible personal property predominately used(greaterthen 50 percent)in providing public transportation-provide
USDOT Number.A person or corporation who is hauling under someone else's motor carrier authority,or has a contract as a
school bus operator,must provide their SSN or FID Number in lieu of a State ID Number in Section 1.
M i
c USDOT Number:
m Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale.
N Note:A farmer not possessing a State Business License Number may enter a FID Number or a SSN in lieu of a State ID
Number in Section 1.
i
Sales to a contractor for exempt projects(such as public schools,government,or nonprofits).
Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools, and state universities).
Sales to the United States Federal Government-show agency name.
Note:A U.S. Government agency should enter its Federal Identification Number(FID)in Section 1 in lieu of a State ID
Number.
Other-explain. j
I hereby certify under the penalties of perjury that the property, purchased by the use of this exemption certificate is to be used for
an exempt purpose pursuant to the State Gross Retail Sales Tax Qct; Indiana Code 6-2.5,and the item purchased is not a utility,
vehicle,watercraft,or aircraft.
e
e I confine my understanding that ysuse, (either negligent or intentionaq and/or fraudulent use of this certificate may subject both
� me personally and/or the bus' e� tity I represent to t p imp•sit on of tax, interest,and civil and/or criminal penalties.
0)
Signature of Purchaser: r Date: 1/4/2018
Printed Name: CHRISTINE S. PAULEY ` Title: CLERK-TREASURER
The Indiana Department of Revenue may request verification of registration in another state if you are an out-of-state purchaser.
Seller must keep this certificate on file to support exempt sales.