334702 01/18/19 1 ei C�qM
/ CITY OF CARMEL, INDIANA VENDOR: 372969
.,; ,• ONE CIVIC SQUARE HAMMER LIGHTING &GRIP
CHECK AMOUNT: $*******112.20*
CARMEL, INDIANA 46032 7507 CREWS DRIVE CHECK NUMBER: 334702
INDIANAPOLIS IN 46226 CHECK DATE: 01/18119
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1206 4350900 INVO0406 112.20 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
Vendor# 372969 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HAMMER LIGHTING &GRIP IN SUM OF$ CITY OF CARMEL
7507 CREWS DRIVE 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.
INDIANAPOLIS, IN 46226
Payee
$112.20
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
INV-00406 43-509.00 $112.20 1 hereby certify that the attached invoice(s),or 12/3/18 INV-00406 Lighting Rental $112.20
1206 101 Prior Year 1206 101
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,January 08, 2019
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
Invoice
H MMER Invoice Number: I V-00406
lighting&grip
Tarkington Advent Calendar
Hammer Lighting&Grip
7507 Crews Dr
Indianapolis,IN 46226
USA
Phone:317-547-4747
Fax:(317)216-3648
www.hammergrip.ty
Client Venue /Site
City of Carmel
1 Civic Square
Carmel, In 46032
I
Account Manager . Currency Sales Tax Rule Warehouse
Derek Hammer US Dollar Sales Tax Indianapolis
Prepared Date Entered By Due Date Status Customer PO#
12/3/2018 Alyssa Davis 1/4/2019 Exported Tarkington Advent
Calendar 2018
Type Qty.. Description Note Time Rate Unit Rate Ext.Price
Qty.
Rental 2 Source Four Ellipsoidal(HEAD ONLY) 5 Day Rat 18.00 180.00
Rental 2 TVMP Adapter 5 Day Rat. 2.00 20.00
Rental 2 Subrent Equipment 10 degree lenses 5 Day Rat 1 36.00 360.00
Rental 2 Apple Box-Pancake 5 Day Rat 3.00 30.00
Rental 2 Baby Pin to 3/8-16 Threaded Stud 5 Day Rat a 3.00 30.00
Rental 2 Shot Bag-25 lb 5 Day Rat 3.00 30.00
Equipment
Rental 2 Rain Hat-Ellipsoidal 5 Day Rat 10.00 100.00
Eq Apment Total: $100.00
Retail 2 HPL 750 JS115V-750 Watt 3250K 300 Hrs Each 18.90 37.80
Subtotal: $787.80
Sales Tax: $55.15
Delivery and Pickup: $0.00
Total: $842.95
Total Applied Payments: $675.60
Balance Due:
1/2/2019 4:04 PM Page 1 of 1
Form ST 105 Indiana Department of Revenue
State rorm 49065 R4/8-05 General Sales Tax Exemption Certiricate
Indiana registered retail merchants and businesses-located outside Indiana may use this certificate,The claimed exemption rnus he allowed by Indiana
code. Exemption statutes Or other states are not valid for purchases from Indiana vendors.This exemption certificate can not be issued for the
purchase of U'''e. Veliicks, W e r ,or dkffBfr. Purchaser must he registered with the Depurtment or 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 l ile it claim for refund(Form GA-I I OL)directly with the Department of Revenue.
CITY OF CARMEL
Name of Purchaser
2 Business Address ONE CIVIC SQUARE City CARMEL State IN Z p 46032
0
,q Purchaser must'provide minimum of one ID number below.-"
GG _
Provide your Indiana Roistered Retail Merchant's Certificate 0031201550 020
o TID and LOC Number as shown on your Certificate...............................
TIDA 110 digilst LOCH I 3 dia;itsl
�. if not registered with the Indiana DOR.provide yourState Tax
IDNumber from another State................................................................
*See instructions on the reverse side if you du not have either number. State MR State of Issue
N
q Is this a 0 blanket purchase exemption request or a.❑single purchase exemption request? (check one)
0
a
Description of items to be purchased,
Purchaser must indicate the type or 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.
❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Informalion Bulletin#10.
(May not be used for personal hotel rooms and meals,)
❑ Sales of tangible personal property predominately,used(greater then 50 percent)in providing public transportation-provide USDOT#.
to A person or corporation who is hauling under someone else's motorcarrier authority.or has it contract as a school bu .operator,must
provide their SS#or FiD#in lieu of a State 1D#in Section#I. USDO'f#
rT ❑ Sales to persons,occupationally engaged as farmers-,to be used directly in production of agricultural products for s•lc.
Note:A farmer not possessing a Stale Business License#may enter a FID#.or a SS#in lieu of it State ID#in.Seclion 0 1.
❑ Sales to a contractor for exempt project%(such as public schools,government.or nonprofits).
❑ Sales to Indiana Governmental Units(agencies..cities,towns,municipalities,public schools,andalale universities)
❑ Sales the United States Federal Government-show agency name.
Note:A U.S.Government agency should enter its Federal Identification Number(F]D#)in Section#I'in lieu of a St�te IU#.
❑ Other-explain.
1 hereby certil'y 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 Stale Gros%Retail Sales Tax Act,Indian- ,odc 6-2.5,and the item purchased is not it utility,vehicl I.,watercraft,or aircraft:
�. i confirm my understanding t t tn' • (ei/her,nc'XlWnt t,r reu/io a!),a d/or fraudulent use of this certificate may sdbjcct both me personally
°p and/or the business entity epre t the i i sit of i t est.it.; civil and/or criminal penalties. 1'I I2019
W Signature of Purchaser Date
CHRI INE S. PAU CL RK-TREASURER
Tale
Printed Name
The-Indiana Department of Revenue may request verification of registration in-another state if you are an out
of-s ate purchaser.
Seller must Iteep this certificate on rile to support exempt sales.
1