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Home My WebLink About202760 10/11/2011 CITY OF CARMEL, INDIANA VENDOR: 00352689 Page 1 of 1 ONE CIVIC SQUARE SILLY SAFARI SHOWS, INC CHECK AMOUNT: $5,000.00 CARMEL, INDIANA 46032 JUNGLEJOHN 12106 SOUTHEASTERN AVE CHECK NUMBER: 202760 INDIANAPOLIS IN 46259 CHECK DATE: 10/11/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1160 4359003 5437 12894 5,000.00 PETTING ZOO /XMAS ON S Silly Safari Shows, Inc. 12106 Southeastern Avenue Indianapolis, IN 46259 317.662.9003 FAX 662.9005 www.sillysafaris.com CONTACT INFORMATION City of Carmel Holida on the Square The leader in conservation education Meg Associates, LLC event urcr� +zer Livr ANIMAL SHOWS Meg Gates Osborne hlrP�l 9875 Lakewood Drive East Indianapolis, IN 46280 DATE INVOICE OFFICIAL USE ONLY: 9/21/2011 12894 PHONE 317 -590 -7522 Program Confirmation Additional Comments PROGRAM DATE TIME AUDIENCE Special Repeat Performance Reindeer Appearance 11/1912011 4:30 6:30PM Family Wehe4le' ee l 6974 FAX) 571 -2278 Meg's cell) ,590 Include W -9 Cert of Ins REFERRED BY Carmel RULES! PROGRAM DESCRIPTION QTY RATE AMOUNT Reindeer Show Silly Safaris' Reindeer Reserve: Two Elves with LIVE REINDEER for Two 1 1500.00 1,500.00 Hours! Animal Show' Sami Costumed Reindeer Herder wl Other Animals from the North Pole. 2 300.00 600.00 Consulting Sam! Costumed Reindeer Herder for storytelling alongside petting area. 2 300.00 600.00 Consulting Supply Two Elves Juggling in Holiday Fashion. 2 500.00 1,000.00 Consulting Supply One Magician Elf Strolling and Performing 1 500.00 500.00 Consulting Supply Three Elves Twisting Balloons for Corwds 3 350.00 1,050.00 Discount We're giving you a discount! In order to qualify for discount, payment 250.00 250.00 must be made on the day of show or before. THANKS FOR HAVING US BACK! DL°ECTIONS To YOU— GEC �3 t gUO3 5 �3 1) Please return this form AND include directions to your location above..: 2) Silly; Safaris, reserves the fight to reassign'performers as necessa 3) Please circle your choice PAYMENT !INCLUDED INtt L PA p.A 0 F VAN T Signature date Please Make Payable To SILLY SAFARIS ®tai: $5,000.00 Form W -9 Request for Taxpayer Give form to the (Rev. December 2000) Identification Number and Certification re Do not Department of the Treasury send to the IRS. Internal Revenue Service Name (See Specific Instructions on page 2.) a Business name, if different(from above. (See Specific Instructions or? page 2.) A O Check appropriate box: Individual /Sole proprietor Corporation Partnership Other a w Address (number, street, and apt. or suite no.) Requester's name and address (optional) M a' 12iiD Lo ntro a City, state, and ZIP code Taxpayer Ide$tification Number (TIN) List account number(s) here (optional) Enter your TIN in the appropriate box. For individuals, this is your social security number Social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 2. For other entities, it is o For-U:S.- Payees-Exempt- From employer identification number (EIN). If you do not Backup Withholding (See the have a number, see How to get a TIN on page 2. Employer identification number instructions on page 2.) Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose 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 l 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 generally, payments other than interest and dividends, you are not required 'o sign the Certification, but you must provide your correct TIN. (See the ins uctions on page 2.) Sign Signature of Here U.S. person [late j What is backup withholding? Persons making 5. You do not certify to the requester that you P u rpose of Form certain payments to you must withhold and pay are not subject to backup withholding under 4 A person who is required to file an information to the IRS 31 %9 of such payments under certain above (for reportable interest and dividend return with the IRS must get your correct conditions. This is called "backup withholding." accounts opened after 1983 only). taxpayer identification number (TIN) to report, for Payments that may be subject to backup exempt Certain payees and a men[s are example, income paid to you, real estate withholding include interest, dividends, broker F y p y F transactions, mortgage interest you aid, from backup withholding. See the Part 11 y F and barter exchange transactions, rents, acquisition or abandonment of secured property, royalties, nonemployee pay, and certain instructions and the separate Instructions for cancellation of debt, or contributions you made payments from fishing boat operators. Real the Requester of Form W -9. to an IRA. estate transactions are not subject to backup Penalties Use Form W -9 only if you are a U.S. person withholding. (including a resident alien), to give your correct if you gihTIN, Failure to furnish TIN. If you fail to furnish your ve [e requester your correct TIN to the person requesting it (the requester) correct TIN to a requester, you are subject to a make the proper certifications, and report all penalty f $50 for each such failure unless our and, when applicable, to: your taxable interest and dividends on your tax ilure�is due to reasonable cause and not to 1. Certify the TIN you are giving is correct (or return, payments you receive will not be subject willful neglect. you are waiting for a number to be issued), to backup withholding. Payments you receive will be subject to backup withholding if: Civil penalty for false information with respect 2. Certify you are not subject to backup to withholding. If you make a false statement withholding, or 1. You do not furnish your TIN to the with no reasonable basis that results in no 3. Claim exemption from backup withholding if requester, or backup withholding, you are subject to a $500 you are a U.S. exempt payee. 2. You do not certify your TIN when required penalty. If you are a foreign person, use the (see the Part III instructions on page 2 for Criminal penalty for falsifying information. appropriate Form W -8. See Pub. 515, details), or Willfully falsifying certifications or affirmations Withholding of Tax on Nonresident Aliens and 3. The IRS tells the requester that you may subject you to criminal penalties including Foreign Corporations. furnished an incorrect TIN, or fines and/or imprisonment. Note: Ifa requestergives you a farm other than 4. The IRS tells you that you are subject to Misuse of TINS. if the requester discloses or Form W -9 to request your TIN, you must use the backup withholding because you did not report uses TINS in violation of Federal law, the requester form if it is substantially similar to this all your interest and dividends on your tax return requester may be subject to civil and criminal Form W -9. (for reportable interest and dividends only), or penalties. Cat. No. 10231X Form W -9 (Rev. 12 -2000) VOUCHER NO. WARRANT N ALLOWED 20 Silly Safari Shows, Inc. IN SUM OF 12104 Southeastern Avenue Indianapolis, IN 46259 $5,000.00 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office )O# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 5437 12894 43- 590.03 $5,000.00 1 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 Sunday, October 09, 2011 Mayo Title Cost distribution ledger classification if claim paid motor vehicle highway fund 3 rescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 4n invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by rohom, 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)) 09121/11 12894 $5,000.00 P1e c No �n H h hereby certify that the attached invoice(s), or bill(s), is (are) true and correct anu )rdance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer