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Home My WebLink About156980 03/05/2008 CITY OF CARMEL, INDIANA VENDOR: 360920 Page 1 of 1 ONE CIVIC SQUARE FRANK BLANKENSHIP CHECK AMOUNT: $4,600.00 CARMEL, INDIANA 46032 2602 MANSION DRIVE INDIANAPOLIS IN 46222 CHECK NUMBER: 156980 CHECK DATE: 3/5/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 905 4350100 4,600.00 BUILDING REPAIRS MA ;n 1 0) CONTRACTORS INVOICE D all E 2550 Spring Rd .`.;r._' Indianapolis, IN 46222. :9 (317) 25§ -g 186 WORK PERFORMED AT: :q ;A DATE YOUR WORK ORDER NO.; OUR BID NO.:- DESCRIPTI r'1�S ee ro Ck 1 I )n I k,41 ID O)D v e f a o D_ 1 0 All Material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of Dollars This is a Partial Full invoice due and payable by: 3. Month Day Year a in accordance with our Agreement Proposal No. Dated Month Day Year r NC3822 CONTRACTORS INVOICE f Feb 29 08 01:38p paul blockoms 317 -846 -9980 p.1 Form W 9 Request for Taxpayer Give form to the (Rev. November 2005) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service r ni Na (aS Shown O U InCOme t feturn) 0 e h n B ass nom if diflererrr�� from above c o N a e dMd, Exempt from backup Creck appropriate box. Sole proprietor Corporation Partnership Other withholding o Address (number. street, and apt. or suite no. t Requester's name and address (optional) n �t pe r, e— !u Ci�tat end ZIP code m in s; account numbers} here (option IM U) Taxpayer Identification Number (TIN Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it s 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 6nployer identificatlon number number to enter. ff Certification Under penalties of perjury, I certify mat: 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 nc longer subject to backup withholding, and 3. 1 am a U.S- person (including a U.S. resident alen). Certification instructions. You must cross out item 2 above i` 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 Here I U.S. person Date b- a Purpose of F e An individual who is a citizen or resident of the United A person who is required to file an information return with the States, IRS, must obtain your correct taxpayer identification number A partnership, corporation, company, or association (TIN) to report, for example, income paid to you, real estate created or organized in the United States or under the laws transactions, mortgage interest you paid, acquisition or of the United States, or abandonment of secured property, cancellation of debt, or Any estate (other than a foreign estate) or trust. See contributions you made to an IRA. Regulations sections 301.7701 -6(a) and 7(a) for additional U.S. person. Use Form W -9 only if you are a U.S. person information. (Including a resident alien), to provide your correct TIN to the Special rules for partnerships. Partnerships that conduct a person requesting it (the requester) and, when applicable, to: trade or business in the United States are generally required 1. Certify that the TIN you are giving is correct (or you are to pay a withholding tax on any foreign partners' share of waiting for a number to be issued), income from such business. Further, in certain cases where a 2. Certify that you are not subject to backup withholding, or Form W -9 has not been received, a partnership is required to 3 presume that a partner is a foreign person, and pay the Claim exemption from backup withholding if you area withholding tax. Therefore, if you are a U.S. person that is a U.S. exempt payee. partner in a partnership conducting a trade or business in the In 3 above, if applicable, you are also certifying that as a United States, provide Form W -9 to the partnership to U.S. person, your allocable share of any partnership income establish your U.S. status and avoid withholding on your from a U.S. trade or business is not subject to the share of partnership income. withholding tax on foreign partners' share of effectively connected income. The person who gives Form W -9 to the partnership for purposes of establishing its U.S. status and avoiding Note. If a requester gives you a form other than Form W -9 to withholding on its allocable share of net income from the request your TIN, you must use the requester's form if it is partnership conducting a trade or business in the United substantially- siml!ar to this Form W -9. States is in the following cases: For federal tax purposes, you are considered a person if you The U.S. owner of a disregarded entity and not the entity, are: Cat. No. 10231x Form W -9 (Rev. 11 -2005) Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 u�✓ Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total v v, v7D 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 VOUCHER. NO. WARRANT NO. �o ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I 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 a� 20 od ature Title Cost distribution ledger classification if claim paid motor vehicle highway fund