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Home My WebLink About329775 09/10/18 CITY OF CARMEL, INDIANA VENDOR: 066000 ® ONE CIVIC SQUARE CORRELATED PRODUCTS INC. CHECK AMOUNT: $*******360.00* CARMEL, INDIANA 46032 PO BOX 6457 CHECK NUMBER: 329775 v ETON DEPT 274 CHECK DATE: 09/10/18 INDIANAPOLIS IN 46206 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4236300 011779 360.00 BITUMINOUS MATERIALS VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 066000 CORRELATED PRODUCTS INC. IN SUM OF$ CITY OF CARMEL PO BOX 6457 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service DEPT 274 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. INDIANAPOLIS, IN 46206 Payee $360.00 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 011779 42-363.00 $360.00 1 hereby certify that the attached invoice(s),or 8/29/18 011779 Bituminous $360.00 2201 2201 2201 2201 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Tuesday, September 04,2018 Huffman, Dave Director I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer coRa8LAT Q /NVOICE AD BpiPRODUCTS, INC, Correlated Products 5616 Progress Road Phone 800-428-3266 SalUtipnslris, Indianapolis. IN 46241 Fax Page ' 1/1' Sold To Ship To CARMEL STREET DEPARTMENT CARMEL STREET DEPARTMENT ATT: JIM HOBBS 3400 W. 131ST STREET 3400 W. 131ST STREET CARMEL IN 46074 CARMEL IN 46074 Customer;#. Order Date :: Sales;Qrrier# Buyer:: Customer PIO Shrp Ura:; Salesman-; _ -0-9-03-1-6 0 —-b-9:/-23-/2-0-1.8. 0117_7-9-- --- - - -S COTT -NORTH 2 9 0 0 -- Invorce#:> Invoice Date;" Ship Date Freight Terms : Job Number Terms %011779 08/29/2018 , 08/29/18 PREPAID& ADD 30 ................................................................................................................................................................................................................................................................................................. ................................................................................................................................................................................................................................................................................................ 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Pl. ._ _36..00 ._ .$.36X"0.00_._.._.._ ':'BLACK PAIL _. .__.. ..... . .._............. _._ .... .._. .._... _ ..__... .... _. .. .. . .... ........... ... ......__..-- -- _......._ _ _........ _..._. *****Remit to Address:***** Merchandise 360.00 PO BOX 6457 DEPARTMENT 274 Frei ght 0.00 INDIANAPOLIS, IN 46206 Mi sc Charges 0.00 Sub Total 360.00 Taxable 360.00 Tax (IN)k 25.20. TOTAL $385.20 Customer Copy Pay By 09/28/2018 Writer: SN F � SALES ORDER ADCORRELATED Correlated Products �. '� PAODUCTS� INC, 5616 Progress Road Phone 800.428.3266 z ,` S01uti0nS,lnc, Indianapolis, IN 46241 Fax IIIIIIIIIIII III II 08:56 08/24/18 DJ Page 1/1 fdef # B/ Rel HR/WHSE USER 011779-00-00 01/01 SN S CARMEL STREET DEPARTMENT S CARMEL STREET DEPARTMENT 0 T ATT: JIM HOBBS H T 3400 W. 131ST STREET L 0 3400 W. 131ST STREET I 0 CARMEL IN 46074 D CARMEL IN 46074 P Tel 317-733-2001 Fax ORDER CUSTOMER CUSTOMER P/O TERMS TAX SHIP SALES JOB DATE NUMBER NUMBER CODE CODE VIA PERSON ID/NAME 08/23/18 9903100 30 IN/7.000% SCOTT NORTH SCOTT NORTH I+N# Q-ORD Q-PCK Q-B/O Q-SHP B-LOC PRODUCT DESCRIPTION UOM ***** Special Instructions ***** * Scott will deliver> DO NOT * charge Freight ********************************** 1) 10 10 0 ENDIRRI INSTANT ROAD REPAIR 50LB PL BLACK PAIL TOT: 10 10 0 Received in Good Condition: Ship Date Loc Volume Picked by Weight Pieces Packed by Pallet Pkgs Checked by Ctns X: Lnth Loaded by r; Form ST-105 Indiang Department.of 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 Utltlties, Vehic es, 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 c Purchaser must provide minimum of one ID number below.* a Provide your'lndiana 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 j 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 e'ithdr.-number. State ID Number: State of Issue: i N � c Is this a R✓i blanket purchase exemption request or a C single purchase exemption request? (check one) Description of items to be purchased: ? .< N i I 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. i C Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10.(May not be used for personal hotel rooms and meals.) i Sales of tangible personal property predominately used(greater then 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. c USDOT Number: Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale. 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. 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). F Sales to the United States Federal Government-show age.�tcy 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, i vehicle,watercraft,or aircraft. i i e c I confirm my understanding that �suse, (either negligent or Intent and/or fraudulent use of this certificate may subject both me personally and/or the bus' e�s a tity I represent to t i'imp sit on of tax, interest,and civil and/or criminal penalties. (� ' r Signature of Purchaser: l / 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.