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192819 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 364690 Page 1 of 1 ONE CIVIC SQUARE GLOBAL RISK INNOVATIONS INDIANA 46032 PO BOX 534642 CHECK AMOUNT: $3,500.00 CARMEL ATLANTA GA 30353 -4642 CHECK NUMBER: 192819 CHECK DATE: 12/15/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 24170 29157250 3,500.00 I v4 .3 r I n i 1V %j J V L U I I V IN a Make Cheques payable to: Global Risk Innovations Inc. PO Box 534642 Atlanta, GA 30353 -4642 Federal Tax ID #68- 0680293 Download W9 form for your Accounts Payable Dept. Invoice Registration ID: 29157250 Registration Date: 121912010 Invoice Date: 12/9/2010 Issued By: Global Risk Innovations Inc. 68- 0680293 Event: Loveland -Jan Blue Card Command Train the Trainer Date/Time: Monday, January 24, 2011 8:00 AM Saturday, January 29, 2011 1:00 PM (Eastern Time) Registrants RDegistration Name Company /Organization Type 9157250 Mr.StevenFrye Carmel Fire Department 3 Day Train the Trainer (you are previously Certified Billing Information Steven Frye Carmel Fire Department 2 Civic Square Carmel, IN 46032 United States 317-571-2606 sfrye @carmel.in.gov Fee Summa Fee Quantity Unit Price Amount 3 Day Train the Trainer (you_are previously Certified) Event Fee 1 $3,500.00 $3,500.00 Subtotal $3,500.00 T otal: $3,600.00 Transaction Summa Transaction Type Date Amount Balance T ransaction Amount 12/9/2010 $3,500.0 $3,500.00 Current Balance: $3,500.00 Payment Information Payment Method: Invoice my department Payment Instructions: Refund Information No Refunds after January 1 st, 2011 reg mrrof 6ac WONEWORX Farm rag Request for Taxpayer Give form to the (Rev. October 200n identification dumber and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service Name (as shown on your income tax return) Global Risk Innovations Inc. M Business name, if different from above C 0 o Check appropriate box: El Individual /S ©le proprietor Corporation El Partnership Exempt z`.2 El Limited liability company. Enter the tax classification (O= disregarded entity, C= corporation, P= partnership) I. E] pay ee O E] Other (see instructions) c Address (number, street, and apt, or suite no.) Requester's name and address (optionaq u PQ Box 534642 City, state, and ZIP code rn Atlanta, GA, 303534642 cu List account numberls) here (optional) ME Taxpayer Identification Number IN 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 f 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 ident number number to enter. fib 0680293 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. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the tntemal 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. 1 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 to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment f secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments oth nterest an ends, you are not required to sign the Certification, but you must provide your correct TIN. See the lost do e 4. Sign signature of V Lo 41: OO Here U.S. person Ill Date 111i. General Instructions Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: Section references are to the internal Revenue Code unless a 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) 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 withholdin or partnership conducting a trade or business in the United States, 9' 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 fulekgn partners' ahare of offoctively connected innnme. on its aliconblo chore of net income from the partnership Note. If a requester gives you a farm 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. o The U.S. owner of a disregarded entity and not the entity, Cat. No, 10231X Form W -9 (Rev. 10 2007) VOU NO. WARRANT NO. ALLOWED 20 Global Risk Innovations IN SUM OF P.O. Box 543642 Atlanta, GA 30353 $3,500.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# l Dept. INVOICE NO. ACCT41TITLE AMOUNT Board Members 24170 29157250 43- 570.04 $3,500.00 1 hereby certify that the attached 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 OEC 1.3 2010 1 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State 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 whore, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 29157250 $3,500.00 1 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