166829 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00350892 Page 1 of 1
ONE CIVIC SQUARE P P GOLF CAR RENTAL
CARMEL, INDIANA 46032 12218 MANN ROAD CHECK AMOUNT: $319.00
MOORESVILLE IN 46158
CHECK NUMBER: 166829
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D
902 4359003 1660 319.00 FESTIVAL /COMMUNITY EV
IL
0/1 i 1na-C
P &P GOLF CAR RENTAL Invoice No. f G S
7318 E. OLD S. RD. 144
Mooresville, Indiana 46158
Phone(317)831 -4283 r
Fax (317) 834 -1735
Name 4. Y
Fax Phone
Address
Work Phone
Cell Phone `a'� C�
.1
Delivery Date c�- c�i��
QUANTITY DESCRIPTION MOUN
UNIT PRICE AT`
DELIVER ON L
PICKW ON
FUEL SUFI CHARGE
DELIVERY FEE
1�.
SUB TOTAL
V
SALES TAX
TOTAL
AGREEMENT
1 understand that the car will be fully fueled when received and I acknowled ere t,
g receipt of said car in good condition with the execution of my sign this_
agreement I further acknowledge that I shall be responsible for any damages to said car while they are in my possession, including theft.
7. I al so agree to bold P P Golf Car Rental and their owners harmless from any liability for damages or property to third persons resulting from the use of this
equpment while the car are m my possession,
I acknowledge that P P Golf Car Rental will msp cte' the ca_ r for damages afthe: time of pick-up and if damages are assessed to the car, I will reimburse them
forsaiddamages# n! O! nfifteen (15)daysfromrecer�tofasta entfromP& P Golf car Rental asto the total a mount ofdams es.lf
be responsible for attomey fees, court costsan "alfother c t of collection in the event P P Golf Cat Rental must incur said expense en unders
tand that I shall
owed pursuant to this agreement.
p co ect, any monies j
Gusto "mer's Signature Date
Please:.pay from this in�oloe, we do hot send.monthiy statements:_ A late fee Is added if not'paid within 30 tlays:
Mctl'(Zil A- s
Form ST-105 Indiana Department of Revenue
State Fonn 49065 RV 8 -05 General Sales Tax Exemption Certificate
Indiana registered retail merchants and businesses located outside Indiana may use this certificate. The claimed exemption must be allowed by Indiana
code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certificate can not be issued for the
purchase of Utilities Vehicles Watercra or Aircraft. Purchaser must be registered with the Department of Revenue or the appropriate taxing
authority of the purchaser's state of residence.
Sales tax must be charged unless all information in each section is fully completed by the purchaser. Purchasers not able to provide all required
information must pay the tax and may file a claim for refund (Form GA -1I OL) directly with the Department of Revenue.
Name of Purchaser CITY OF CARMEL
ONE CIVIC SQUARE CARMEL IN 46032
Business Address City State Zip
1
r Purchaser mast provide minimum of one ID number below.*
a
at Provide your Indiana Registered Retail Merchant's Certificate
ttc TID and LOC Number as shown on your Certificate N 2t 5 !'550 g 020
TID# (10 digits) LOC# 3 digits)
If not registered with the Indiana DOR, provide your State Tax
Number from another State
*See instructions on the reverse side if you do not have either number. State ID# State of Issue
•ter
Is this a blanket purchase exemption request or a single purchase exemption request? (check one)
1` Description of items to be purchased.
Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain)
Sales to a retailer, wholesaler or manufacturer for resale only.
Sale of manufacturing machinery, tools, and equipment to be used directly in direct production.
'v Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin #10.
(May not be used for personal hotel rooms and meals.)
Sales of tangible personal property predominately used (greater then 50 percent) in providing public transportation provide USDOT
A person or corporation who is hauling under someone else's motor carrier authority, or has a contract as a school bus operator, must
provide their SS# or FID# in lieu of a State ID# in Section #1. USDOT#
i
8 Sales to persons, occupationally engaged as famlers, to be used directly in production of agricultural products for sale.
Note: A farmer not possessing a State Business License# may enter a FID# or a SS# in lieu of a State ID# in Section fl.
C3 Sales to a contractor for exempt projects (such as public schools, government, or nonprofits).
M Sales to Indiana Governmental Units (agencies, cities, towns, municipalities, public schools, and state universities),
4 p Sales to the United States Federal Government show agency name.
Note: A U.S. Government agency should enter its Federal Identification Number (FID in Section 411 in lieu of a State ID
Other explain.
J I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt
purpose pursuant to the State Gross Retail Sales Tax Act, Indiana Code 6 -2.5, and the item purchased is not a utility, vehicle, watercraft, or aircraft.
I confirm my understanding that misuse e. either negligent or itI endonal), and /or fraudulent use of this certificate may subject both me personally
and/or the business entity I represen e irrt[iosition }ter and civil and /or criminal penalties.
Signature of Purchaser Date
Printed Name DIANA L CORDRAY Title CLERK- TREAURER
The Indiana Department of Revenue may request verification o registration in another state if you are an out -of -state purchaser.
Seller must keep this certificate on file to support exempt sales.
J'
Forrn
W-9 Request for Taxpayer Give form to the
(Rev. November 2005) identification plumber and Certification requester. Do not
send to the IRS.
Department of the Treasury
Internal Revenue Service
N Name (as shown on your income tax return)
rn CITY OF CARMEL
m
a Business name, if different from above
c
0
d W
o Individual/ LOCAL GOVT Exempt from backup
v Check appropriate box: Sole proprietor Corporation E] Partnership Other withholding
o m Address (number, street, and apt. or suite no.) Requester's name and address (optional)
CL ONE CIVIC SQUARE
U
City, state, and ZIP code
a CARMEL, IN 46032
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 Line 1 to avoid Social security number
backup withholding. For individuals, this is your social security number (SSN). However, for a resident I I I—L I 1--L]
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 Now to get a TIN on page 3. or
Employer- identrfication number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose}M. -C
number to enter. 0 f0, 39x =7 2
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 Qncluding a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS inat 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 instruction on page 4.)
Sign signature of
Here U.S. person Date
Purpose of Form /;D/An individual who is a citizen or resident of the United
A person who is required to file an information return with the Mates,
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
presume that a partner is a foreign person, and pay the
Claim exemption from backup withholding if you area
3
U.S. ai exempt payee. withholding tax. Therefore, if you are a U.S. person that is a
P Y 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 s The U.S. owner of a disregarded entity and not the entity,
are:
Cat. No. 10231X Form W-9 (Rev. 11 -2005)
Presciibed 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 1
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
44 V
Total a
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
M.JCHER NO. WARRANT NO.
ALLOWED 20
I IN SUM OF
01 d I LiLl
MrJL -e syi I u l 11 j 966
'319 .0C)
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
g0 Z 6 6 O ��3S�vu3 319.vL) 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
C, d 20 �g
ign ur,
7l C�
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund