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HomeMy WebLinkAbout199391 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 365323 Page 1 of 1 ONE CIVIC SQUARE C P P INDY, LLC CARMEL, INDIANA 46032 5151 N SHADELAND AVE CHECK AMOUNT: $5,200.00 INDIANAPOLIS IN 46226 CHECK NUMBER: 199391 CHECK DATE: 7/2012011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4350100 25758 10075 5,200.00 PAINT BUILDING Coma ro 4 'y 5151 N. Shadeland Ave. Indianapolis, IN 46226 BILL TO Carmel Police Department Invoice Attn: Teresa Anderson DATE INVOICE 3 Civic Square 6/30/2011 10075 Carmel, IN 46032 P.O. NO. TERMS PROJECT 25758 Net 30 CI7B6400500 QUANTITY DESCRIPTION RATE AMOUNT Exterior Painting 5,200.00 5,200.00 The just walks in his integrity; his sons are blessed after him. Proverbs Total 20:7 $5,200.00 Form Request for Taxpayer Give Form to the Department of the T) reasury Identification Number and Certification requester. Do not DepartmentoiT Send to the IRS. Internal Revenue Service Name (as shown on your income tax return) CPP Indy, 1i N Business name /disregarded entity name, if different from above I CertaPro Painters m Check appropriate box for federal tax c classification (required): Individual/sole /l vidual soe ro rietor C Corporation a proprietor p S Corporation Partnership ❑Trust/estate Q c ao Z' Exempt payee 0 ❑J Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P= partnership) C oy C t o ii u E] Other (see instructions) 11i 15 Address (number, street, and apt, or suite no.) Requester's name and address (optional) U o. 5151 N. Shadeland Ave. City, state, and ZIP code a� u) Indianapolis, IN 46226 List account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number avoid backup withholding. For individuals, this is your social security number However, for re Tu resident alien, sole proprietor, or disregarded entity, see the Part I instructions on n 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. 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. 3 5- 2 1 5 1 8 8 5 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. 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 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 U.S. person �(J� Date LU General Instruct Note. If a requester gives you a form other than Form W -9 to request Section references are to the Internal Revenue Code unless otherwise your TIN, you must use the requester's form it it is substantially similar to this Form W -9. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: A person who is required to file an information return with the IRS must An individual who is a U.S. citizen or U.S. resident alien, obtain your correct taxpayer identification number (TIN) to report, for A partnership, corporation, company, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation An estate (other than a foreign estate), or of debt, or contributions you made to an IRA. A domestic trust (as defined in Regulations section 301.7701 -7). Use Form W -9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to: business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. 1. Certify that the TIN you are giving is correct (or you are waiting for a Further, in certain cases where a Form W -9 has not been received, a number to be issued), partnership is required to presume that a partner is a foreign person, 2. Certify that you are not subject to backup withholding, or and pay the withholding tax. Therefore, if you are a U.S. person that is a 3. Claim exemption from backup withholding if you are a U.S. exempt partner in a partnership conducting a trade or business in the United payee. If applicable, you are also certifying that as a U.S. person, your States, provide Form W -9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Form w -9 (Rev. 1 -2011) INDIANA RETAIL TAX EXEMPT PAGE i CERTIFICATE NO. 003120155 002 0 C ,x� sane PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 25756 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. 'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 5Rwmi i CPP Indy, LLC cumal Police Department VENDOR SHIP 3 Civi Square 5951 N. Ohadol2nd Avenua TO Coo IN 4603 India ipolls, IN 4 (397) 571 2 =YUNI PAYMENT TERMS FREIGHT DESCRIPTION UNIT PRICE EXTENSION Account $3-609.00 9 Each paird building $5,200.00 $5,200.00 Oub Total: $5,200.00 p ,A I I AV— a �C' fi .lob 17884001 P `fig Send Invoice To: Car>I'rloi Police Department f Attn: Tomsm Anderson 3 Civic sguam Carmel, IN 42- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. �C`� PAYMENT M,200.00 A!P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.Q. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT �AY FOR THE ABOVE ORDER, 1 C.0-D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL fob SHIPPING LABELS. ioq O F Polica THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE I AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO- 2 5 7 5 8 A. P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 2a IN THE 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_ 2© Signature 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)) 06/30/11 10075 payment for building painting $5,200.00 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 2d Clerk Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 CPP indy, LLC IN SUM OF 5151 N. Shadeland Avenue Indianapolis, IN 46226 $5,200.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVO[CE NO. ACCT /TITLE AMOUNT Board Members 25758 I 10075 43- 501.00 I $5,200.00 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 Thursday, July 14, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund