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HomeMy WebLinkAbout161529 07/11/2008 CITY OF CARMEL, INDIANA VENDOR: 361436 Page 1 of 1 ONE CIVIC SQUARE QUANTUM GRAPHIX CHECK AMOUNT: $135.25 CARMEL, INDIANA 46032 PO BOX 99876 LOUISVILLE KY 40269 -0876 CHECK NUMBER: 161529 ho CHECK DATE: 7111/2008 DEPARTMENT ACCOUNT PO NUM I NVOICE N UMBER AMOUNT DESCRIPTION 902 4359003 240667 135.25 FESTIVAL /COMMUNITY EV t INA TUM RAAPH1 Please note our new remittance address: PO Box 99876 Louisville, KY 40269 -0876 PRINTING COPY CENTRE 2130 Watterson Trail Louisville, KY 40299 ommo Tel. 502- 493 -5933 Fax 502 493 -8360 email accountingQquontumgraphix.net 07/02/08 240667 Federal Tax ID Number: 61- 1360261 �D .jff E. 240667 Carmel Redevelopement Commission Carmel "Redevelopment 111 W Main St. 111 W Main St. Suite 140 Suite 140 Carmel IN 46032 Carmel IN 46032 Net 30 Amy Mendenhall 08/01/08 o 250 Q3A Rock the District Posters $135.25 I We accept cash, check, VISA, MasterCard, and American Express. Our accounting dept. can be reached at (502) 493 -5933 or toll free (866) Sub Total $135.25 t 493 -5933. www.quantumgraphix.net Sales Tax: 47 Shipping /Handling: $0,00 Please note past due accounts are subject to finance charges. See below for details. Balance Due $144.72 Form 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 ,j Name (as shown on your income tax return) I V CITY OF CARMEL m CL Business name, 4 different from above C 0 Or W a o Individual/ LOCAL GOVT Exempt from backup �t Check appropriate box: Sole Proprietor Corporation Partnership Other b, etor withholding 0 2 w Address (number, street, and apt. or suite no.) Requester's name and address (optional) CL ONE CIVIC SQUARE U o City, state, and ZIP code CARMEL, IN 46032 y List account number here optional o (P 1 N 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 T!N 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. 315+61010101917 2 OTM 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) 1 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 instruction on page 4.) Sign Signature of Here I U.S. person pate Purpose of Form An individual who is a citizen or resident of the United A person who is required to file an information return with the C Rates, 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 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 it 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 Note. If a requester gives you a form other than Form W -9 to purposes of establishing its U.S. status and avoiding request your TIN, you must use the requester's form it it is withholding on its allocable share of net income from the substantially similar to this Form W -9. Partnership conducting a trade or business in the United States is in the following eases: For federal tax purposes, you are considered a person it you a The U.S. owner of a disregarded entity and not the entity, are: Cat. No. 10231X Form W -9 (Rev. 11.2005) Form ST 105 Indiana Deparunent of Revenue State Pom, 49065 R4/ 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 Watercraft or Aireru t. 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 -110L) directly with the Department of Revenue. Nanic of Purchaser CITY OF CARMEL Business Address ONE CIVIC SQUARE Ci CARMEL State IN Zip 46032 Purchaser most provide minimum (if one ID number below.* Provide you Indiana Registered Retail Merchant's Certificate 0031201550 020 c TID and L,OC Number as shown on your CCertificata UD# (10 digits) LOC# 3 digits) If not registered with the Indiana DOR, provide your State Tax ID Number from another State *See instructions on the reverse side if you do not have either number. State ID# State of issue Is this a 0 blanket purchase exemption request or a single purchase exemption request? (check one) Description of items to be purchased Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain) 0 Sales to a retailer, wholesaler, or manufacturer for resale only, Sale of manufacturing machinery, tools, and equipment to be used directly in direct production. Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin #10. (May not be used for personal hotel rooms and mcals.) C3 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 c provide their SS# or PID# in lieu of a State ID# in Section #1. USDOT# a Sales to persons, occupationally engaged as farmers, to be used directly in production of agricultural products for sale. Note: Afarmer not possessing a State Business License# may enter a FlD# or a SS# .in lieu of a State ID# in Section #1. Sales to a contractor for exempt projects (such as public schools, government, or nonprofits). Sales to Indiana Governmental Units (agencies, cities, towns, municipalities, public schools, and state universities). 0 Sales to the United States Federal Government show agency name. Note: A U.S. Government agency should enter its hederal Identification Number (FII) in Section #1 in lieu of a State ID Other explain. I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is in 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. either negligent or i entionul), and /or i4audulent use of this certificate may subject both me personally and/or the business entity T represen 4 e itrt(Sosibon �r ter t, and civil and /or criminal penalties. t� 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. Prescribed by Slate 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 Q 06 4 uvn i x Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) r AIL c, S Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in ac,(Prdance with IC 5- 11- 10 -1.6. 20 r Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Q\,j a MA(Y) I X IN SUM OF L Ky l 35. aS ON ACCOUNT OF APPROPRIATION FOR �U Z. Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 0 o L 00 3 35;5 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 lcxvu �0 0 Si i /I' Y^ /G�i r L W Cost distribution ledger classification if Title claim paid motor vehicle highway fund