157034 03/05/2008 f CITY OF CARMEL, INDIANA VENDOR: 360929 Page 1 of 1
b ONE CIVIC SQUARE JOHN DECOSTA 11 CHECK AMOUNT: $920.00
y y? CARMEL, INDIANA 46032 PO BOX 4251
CARMEL IN 46082 CHECK NUMBER: 157034
CHECK DATE: 3/5/2008
D EPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT D ESCRIPTION
905 4350600 920.00 CLEANING SERVICES
�OBINVOICE
e g VIL 57
DATE ORDERED ORDER TAKEN BY
TO r PHONE NO. CUSTOMER ORDER
ADDRE S JOB LOCATION
JOB PHONE STARTING DATE
ATTENTION TERMS
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WORK ORDERED BY TOTAL LABOR
DATE ORDERED x
TOTAL MAT.ERIAS
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SU BTOTAL
CUSTOMER APPRO
SIGNATURE TAX
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AUTHORIZED SI AT GRAND TOT
NC2817 JOB INVOICE
5
Form °9 Request for Taxpayer Give form to the
(Rev. November T reasu ry requester. Do not
Identification Number and Certification
Department of the Treasury send to the IRS.
Internal Revenue Service
N N astw
n on your Come tax retur
W S
rn 6
t4
fl Business name, if different from above
v N
a o Individual r�
o Check appropriate box: Sole proprietor Corporation Partnership Other 0 Exem t P from backup
`a L withholding
m Address street, and apt. or suite no.) Requester's name and address (optional)
City, state, and ZIP code
C
W List account number(s) her (optional)
a)
rn
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 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.
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 gener payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN, (S e in tructions on pa
Sign Signature of
Here U.S. person I► c�
Purpose of Form a 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 e 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 s 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. Claim exemption from backup withholding if you are a presume that a partner is a foreign person, and pay the
U.S. exempt payee, withholding tax. Therefore, if you are a U.S. person that is a
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 similar to this Form W -9. States is in the following cases:
For federal tax purposes, you are considered a person if you o The U.S. owner of a disregarded entity and not the entity,
are:
Cat. No. 10231X Form W -9 (Rev. 11 -2005)
u
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))
a �a-o� 90,
Total 9�Z/J, crU
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.
y ALLOWED 20
J v�
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
�OJ CLLA, 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
.2-5 20 D2
i
Sign ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund