181939 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 363843 Page 1 of 1
C. f ONE CIVIC SQUARE HURD INDIANA LLC
2000 FULLER ROAD CHECK AMOUNT: $66,803.00
CARMEL, INDIANA 46032 WEST DES MOINES IA 50265 CHECK NUMBER: 181939
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
920 4470302 66,803.00 116 /CARMEL DR R -O -W
TH I•I- 27- -20111 10: 11_'1 STF, "I Ii= :TI_IF'EFI= 1I1'IT n�
r54G_10� r t01 F' .01/1
Tammy K. Haney
4i i 'Direct Dal; (317) 684 -5306
Fax: (317) 223 -0306
E t- r E-Mail; THaneyObaselaw.coM
A1TDRNEY` AT LAW
'January 26, 2010
1 "iu UPS Overni, lervice
Skip Teni ancour
American Structure Point Inc:
7260 Shadelarrd Station
Indianapolis IN 46256 -3957
Re; Keystone /116' Street Parcel 32 Merchants Pointe
Dear Skip:
in connection with the above referenced parcel, I have enclosed originals of the following
documents:
1. Warranty Deed;
2. Sales Disclosure Form (which needs to be executed on behalf of the City of Carmel);
3. W -9;
4, Affidavit regarding payment;
5, Partial Release of Mortgage.
By way of background, on November 3, 2009 the City of Carmel made a Uniform Property
Acquisition Offer in the amount of $72,251.00 to Merchants Pointe Associates, LLC to acquire a portion
of its property for public right of way for the Keystone Parkway project. The offer was based on an
appraisal performed by Terzo Bologna. Merchants Pointe Associates LLC was in the process of selling
this property and together with Hurd Indiana, LLC the proposed buyer of the property, entered into a
Right of Entry. Upon acquisition of the property by Hurd Indiana, LLC, Hurd Indiana, LLC rejected the
offer and made a counter offer of $150,000.00. During subsequent negotiations the City agreed to modify
the right of way line and Hurd Indiana, LLC accepted the City's settlement offer in the amount of
$66,303.00.
Please let rile know what else you need from me in order to process payment for this acquisition.
Please let ine know so that I can keep Tim Hogan, the attorney for Third Indiana, LLC, updated as to
when payment is expected. Also, please send me recorded copies of the Partial Release of Mortgage and
the Warranty Deed.
Sincerely,
4
'fanuiry K. HaneY
TK -I:src
111 Monument CCirde, Suite 2700 Indianapolis, Indiana 462041 Main Telephone:: 317 -664 -5000 Main Fax.: 317.684 -5173
www.husel
TOTHL P.
i
JAh1 -27 -201 10: 1 STRIJCTUP,EPDINNT 1 r 543�1 P. i1i 11
K. Haney
T
Di D ial: (317) 6$4 -5308
Fax: (31 223 0308
Tammy
Tt lartieyGhoselaw.cn n
ATTORNEYS AT LAW
January 26, 2010
Via UPS Overni,ehtService
Skip Termancour
American Structure Point Inc.
7260 Shadeland Station
Indianapolis IN 46256 -3957
Re; Keystone /116 Street Parcel 32 'Merchants Pointe
Dear Skip:
In connection with the above- referenced parcel, I have enclosed originals of the following
documents:
1. Warranty Deed;
2. Sales Disclosure Form (which needs to be executed on behalf of the City of Cannel);
3. W 9;
4. Affidavit regarding payment;
5. Partial Release of Mortgage.
By way of background, on November 3, 2009 the City of Cannel made a Uniform Property
Acquisition Offer in the amount of 572,251.00 to Merchants Pointe Associates, LLC to acquire a portion
of its property for public right of way for the Keystone Parkway project. The offer was based on an
appraisal performed by Terzo Bologna, Merchants Pointe Associates LLC was in the process of selling
this property and together with Hurd Indiana, LLC the proposed buyer of the property, entered into a
Right of Entry. Upon acquisition of the property by Hurd Indiana, LLC, Hurd Indiana, LLC rejected the
offer and made a counter offer of $150,000.00. During subsequent negotiations the City agreed to modify
the right of way line and Hurd Indiana, LLC accepted the City's settlement offer in the amount of
$66,503.00.
Please let me know what else you need from me in order to process payment for this acquisition.
Please let me know so that I can keep Tim Hogan, the attorney for Hurd Indiana, LLC, updated as to
when payment is expected. Also, please send me recorded copies of the Partial Release of Mortgage and
the Warranty Deed.
Sincerely,
Tarruny K. Han
TKH:src
111 Monument Circl Suite 2700 I Indianapolis, Indiana 46204 Main Telephone: 317 684 -5000 I Main r'ax: 317.684 5173
www.baselaw.Curn
TOTAL P. a1
Form W Request for Taxpayer Give form to the
(Rev. October 2007) identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal avenue Service
Name (as shown on your income tax return)
HURD INDIANA, L.L.C.
o Business name. if different front above
0
T o Check appropriate box: Individual /Sole proprietor Corporation Partnership Exempt
Limited liability company. Enter the tax classification (D =disregarded entity, C= corporation, P= partnership) F- p
payee
o Other (see instructions) P
Address (number,' street, and apt. or suite no.) Requester's name and address (optional)
a u 2000 FULLER ROAD
City, state, and ZIP code
ctt
rn WEST DES MOINES, IOWA 50265
List account number(s) here (optional)
0)
Pa t' 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 your social security number (SSN). However, for a 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 chart on page 4 for guidelines on whose Employer identification number
number to enter. 26 3979298
Par t• I 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. I am not subject to backup withholding because: (a) 1 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. I am a U.S. citizen or other U.S. person (defined below).
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 1• ••rt all interest and dividends on your tax re n. For real estate transactions, item 2 does not apply.
For mortgage interest paid, sition or .•andonment of s cured property, can ation of debt, contributions to an individual retirement
arrangernent (IRA), and g. erally, pay is oth- han i -r-st and dividends, •u are not required to sign the Certification, but you must
provide your correct TIN. See the in 'uctions .n.pag: 4.
Sign Signature of
Here u.s_ person I> Date
General instructions Definition of a U.S. person. For federal tax purposes, you are
Section references are to the Internal Revenue Code unless considered a U.S. person if you are:
o An individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your correct taxpayer identification number (TIN) 0 An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate e A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301,7701 -7),
abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA. trade or business in the United States are generally required to
Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
provide Form W -9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W-9. 0 The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W -9 (Rev. 10 -2007)
I V 4
AFFIDAVIT
STATE OF IOWA
ss:
COUNTY OF POLK
The undersigned, Richard W. Hurd, being first duly sworn on oath, does depose and state as
follows:
I. I am the sole Member and the sole Manager of Hurd Indiana, LLC.
2. Hurd Indiana, LLC owns certain real estate legally described as Lot 4 in
Merchants' Pointe Subdivision, Carmel, Hamilton County, Indiana (the
"Property
3. The City of Carmel is acquiring a certain portion of the Property described on
Exhibits A and 13 attached hereto (the "Condemned Parcel through a
condemnation proceeding in connection with the Keystone Parkway Project.
4. The City of Carmel has agreed to pay Hurd Indiana, LLC to sum of $66,803.00
as compensation for acquisition of the Condemned Parcel and other damages
arising out of the condemnation proceeding (the "Condemnation Payment
4. I am personally familiar with the lease(s) relating to the Property.
5. No tenant or other third party has any right in or to the Condemnation
Payment.
6. The above is true and correct to the best of my knowledge and belief
Dated this In day January, 2010.
i
1Iiardw:Htti
Signed and sworn to before me by Richard W. 1 -curd on this ir'1 day of January, 2010.
„s L,,, SARA MURPHY 111 t
s° r:, r Commission Number 748920 By: a ilk,
,?.1 My Commission Expires Notary Public ii
September 14, 2010
Pr es ed by Stale Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Hurd Indiana, LLC Purchase Order No. NA
2000 Fuller Road Terms
West Des Moines IA 50265 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/26/10 NA 07 -08 Keystone Parkway
116th Street Just Compensation Land Cost $66,803.00
Parcel 32
Total $66,803.00
I hereby certify that the attached invoice(s), or bills(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
lir-
VOUCHER NO. WARRANT NO.
Hurd Indiana, LLC ALLOWED 20
2000 Fuller Road IN THE SUM OF
West Des Moines IA 50265
66,803.00
ON ACCOUNT OF APPROPRIATION FOR
Hurd Indiana, LLC
PO# or INVOICE NO. ACCT /TITLE AMOUNT Board Members
DEPT.#
NA NA 4470302 $66,803.00
I hereby certify that the attched invoice(s), or
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
Q 1 11‘
February 1, 20 10
$66,803.00 Signature
Cost distribution ledger classification if City Engineer
claim paid motor vehicle highway fund Title