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HomeMy WebLinkAbout193668 01/19/2011 CITY OF CARMEL, INDIANA VENDOR: 362516 Page 1 of 1 0 ONE CIVIC SQUARE BRAD WIESLEY ASSOCIATES CARMEL, INDIANA 46032 PO BOX 3583 CHECK AMOUNT: $5,550.00 BOULDER CO 80307 -3583 CHECK NUMBER: 193668 CHECK DATE: 1/19/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 R4357003 24174 1286 5,550.00 CRYSTAL REPORT SUPPOR Brad Mes, Invoice As�clat�s PO Box 3583 Invoice No. 1286 Boulder, CO 80307 -3583 Invoice Date: January 9, 2011 USA Bill To: Denise Snyder (303) 884-2200 Carmel Fire Department wwww.wiesleyassoc.com Address: 2 Civic Square Carmel, IN 46032 Phone: (317) 571 -2600 E -mail: DSnyder @carm el. in,gov Desc`ription'. r Units Go Per .Unot a, t° Amount Crystal Reports Tr aining 3 Day Fixed Cost Program. 1 ;5;550,00 5,550.00 1 I L OTAL DUE F' �5,55 ©.pO.�,, Make all checks payable to Brad Wiesley Associates Total due in 30 days. Overdue accounts subject to a service charge of 2% per month. Thank you for your business! Form Request for Taxpayer Give form to the (Rev. January 2005) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service N Name (as shown on your income tax return) Brad Wiesley Q. Business name, if different from above o Brad Wiesley Associates dy C Individual/ Exempt from backup Check appropriate box: W1 Sole proprietor Corporation Partnership Other withholding O i c N Address (number, street, and apt. or suite no-) Requester's name and address (optional) a PO Box 3583 U City, state, and ZIP code CL Boulder, CO 80307 -3583 N List account number(s) here (optional) a� m u7 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 {cage 4 for guidelines on whose number Employer identification number to enter. 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 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. 1 am a U.S. person (including a U.S. resident alien). 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 of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign signature of 10/20/2005 Here U.S. person Date Purpose of Form A person who is required to file an information return with the e Any estate (other than a foreign estate) or trust. See IRS, must obtain your correct taxpayer identification number Regulations sections 301.7701 -6(a) and 7(a) for additional (TIN) to report, for example, income paid to you, real estate information. transactions, mortgage interest you paid, acquisition or Foreign person. If you are a foreign person, do not use abandonment of secured property, cancellation of debt, or Form W -9. Instead, use the appropriate Form W -8 (see contributions you made to an IRA. Publication 515, Withholding of Tax on Nonresident Aliens U.S. person. Use Form W -9 only if you are a U.S. person and Foreign Entities). (including a resident alien), to provide your correct TIN to the Nonresident alien who becomes a resident alien. person requesting it (the requester) and, when applicable, to: Generally, only a nonresident alien individual may use the 1. Certify that the TIN you are giving is correct (or you are terms of a tax treaty to reduce or eliminate U.S. tax on waiting for a number to be issued), certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified 2. Certify that you are not subject to backup withholding, in the saving clause may permit an exemption from tax to or continue for certain types of income even after the recipient 3. Claim exemption from backup withholding if you area has otherwise become a U.S. resident alien for tax purposes. U.S. exempt payee. Note. If a requester gives you a form other than Form W -9 to If you are a U.S. resident alien who is relying on an request your TIN, you must use the requester's form if it is exception contained in the saving clause of a tax treaty to substantially similar to this Form W -9, claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W -9 that specifies the For federal tax purposes you are considered a person if you following five items: are: 1. The treaty country. Generally, this must be the same e An individual who is a citizen or resident of the United treaty under which you claimed exemption from tax as a States, nonresident alien. e A partnership, corporation, company, or association 2. The treaty article addressing the income, created or organized in the United States or under the laws 3. The article number (or location) in the tax treaty that of the United States, or contains the saving clause and its exceptions. Cat. No. 10231x Form W -9 (Rev. 1 -2005) VOUCHER NO. WARRANT NO. ALLOWED 20 Brad Wiesley Associates IN SUM OF P.O. Box 3583 Boulder, CO 80307 $5,550.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 24174 1286 43- 570.03 $5,550.00 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 JAN 1 z0i If I -.J 7 V V 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 whom, 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)) 1286 $5,550.00 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 Clerk- Treasurer