HomeMy WebLinkAbout170276 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 00351526 Page 1 of 1
ONE CIVIC SQUARE CARMEL CLAY SCHOOLS CHECK AMOUNT: $15,200.00
z CARMEL, INDIANA 46032 5201 E 131ST ST
ATTN ACCT RECEIVABLE CHECK NUMBER: 170276
CARMEL. IN 46033
CHECK DATE: 411/2009
DEPARTMENT ACCOUNT PO.NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
920 4470602 15,200.00 136TH /KEYSTONE R —O —W
a,
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL INDIANA
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
Carmel Clay Schools Purchase Order No.
Attn.: Ron Farrand Terms
5185 East 131 Street, Carmel, IN 46033 Date Due
Invoice Invoice Description
Date number or note attached invoices or bills Amount
PROJECT: 07 -08� Keystone Parkway 136`h Street
PARCEL: 86
COUNTY: Hamilton
1
Compensation for Permanent Right -of -Way Total: 1 $15,200.00
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
1
1 2009 By: Uv
(Signa re) Title
By:
(Signature) Title
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.
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION Board /Council Members
FOR
COST DISTRIBUTION LEDGER CLASSIFICATION
IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND
Acct. Account Title Amount
No.
Form WW Request for Taxpayer Give form to the
(Rev. October 2007) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue service
Name (as shown on your income tax return)
Carmel Clay Schools, an Indiana political subdivision
CL Business name, if different from above
C-
0
o Check appropriate box: Individual /Sole proprietor Corporation Partnership Exempt
r Limited liability company. Enter the tax classification (D =disregarded entity, C= corporation, P =partnership) p
payee
0 2 Other (see instructions) 0
Address (number, street, and apt. or suite no.) Requester's name and address (optional)
a c 5185 East 131 st Street
City, state, and ZIP code
rn Carmel, IN 46033
y List account number(s) here (optional)
FXM 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 Now 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. 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, payment other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instr ns on pa a 4.
Sign Signature of ,Q
Here U.S. person Date III. re ,b
General Instructions RC)ga— rn� IG(-jAe Definition of a U.S. person. For federal t purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless
otherwise noted. 0 An individual who is a U.S. citizen or U.S. resident alien,
A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your correct taxpayer identification number (TIN) a An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701 -7).
abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
_contributions you made to an_ IRA. trade or business in the United States are generally required to
Use Form W -9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W -9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
provide Form W -9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W -9. The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W -9 (Rev. 10 2007)
Form W -9 (Rev. 10 -2007) Page 3
Generally, individuals (including sole proprietors) are not exempt part I. Taxpayer Identification
from backup withholding. Corporations are exempt from backup Number (TIN)
withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should Enter your TIN in the appropriate box. If you are a resident
still complete this form to avoid possible erroneous backup alien and you do not have and are not eligible to get an SSN,
withholding. your TIN is your IRS individual taxpayer identification number
The following payees are exempt from backup withholding: (ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
1. An organization exempt from tax under section 501(a), any If you are a sole proprietor and you have an EIN, you may
IRA, or a custodial account under section 403(b)(7) if the account
satisfies the requirements of section 401(f)(2), enter either your SSN or EIN. However, the IRS prefers that you
use your SSN.
2. The United States or any of its agencies or If you are a single- member LLC that is disregarded as an
instrumentalities, entity separate from its owner (see Limited liability company
3. A state, the District of Columbia, a possession of the United (LLC) on page 2), enter the owner's SSN (or EIN, if the owner
States, or any of their political subdivisions or instrumentalities, has one). Do not enter the disregarded entity's EIN. If the LLC is
4. A foreign government or any of its political subdivisions, classified as a corporation or partnership, enter the entity's EIN.
agencies, or instrumentalities, or Note. See the chart on page 4 for further clarification of name
5. An international organization or any of its agencies or and TIN combinations.
instrumentalities. How to get a TIN. If you do not have a TIN, apply for one
Other payees that may be exempt from backup withholding immediately. To apply for an SSN, get Form SS -5, Application
include: for a Social Security Card, from your local Social Security
Administration office or get this form online at www.ssa.gov. You
6. A corporation, may also get this form by calling 1- 800 772 -1213. Use Form
7. A foreign central bank of issue, W -7, Application for IRS Individual Taxpayer Identification
8. A dealer in securities or commodities required to register in Number, to apply for an ITIN, or Farm SS -4, Application for
the United States, the District of Columbia, or a possession of Employer Identification Number, to apply for an EIN. You can
the United States, apply for an EIN online by accessing the IRS website at
www.irs.gov /businesses and clicking on Employer Identification
9. A futures commission merchant registered with the Number (EIN) under Starting a Business. You can get Forms W -7
Commodity Futures Trading Commission, and SS -4 from the IRS by visiting www.irs.gov or by calling
10. A real estate investment trust, 1- 800 -TAX -FORM (1- 800 829 3676).
11. An entity registered at all times during the tax year under If you are asked to complete Form W -9 but do not have a TIN,
the Investment Company Act of 1940, write "Applied For" in the space for the TIN, sign and date the
form, and give it to the requester. For interest and dividend
12. A common trust fund operated by a bank under section payments, and certain payments made with respect to readily
584(a), tradable instruments, generally you will have 60 days to get a
13. A financial institution, TIN and give it to the requester before you are subject to backup
14. A middleman known in the investment community as a withholding on payments. The 60 -day rule does not apply to
nominee or custodian, or other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to
15. A trust exempt from tax under section 664 or described in the requester.
section 4947. Note. Entering "Applied For" means that you have already
The chart below shows types of payments that may be applied for a TIN or that you intend to apply for one soon.
exempt from backup withholding. The chart applies to the Caution: A disregarded domestic entity that has a foreign owner
exempt payees listed above, 1 through 15. must use the appropriate Form W -8.
IF the payment is for THEN the payment is exempt part II. Certification
for...
To establish to the withholding agent that you are a U.S. person,
Interest and dividend payments All exempt payees except or resident alien, sign Form W -9. You may be requested to sign
for 9 by the withholding agent even if items 1, 4, and 5 below indicate
Broker transactions Exempt payees 1 through 13. otherwise.
Also, a person registered under For a joint account, only the person whose TIN is shown in
the Investment Advisers Act of Part I should sign (when required). Exempt payees, see Exempt
1940 who regularly acts as a Payee on page 2.
broker Signature requirements. Complete the certification as indicated
Barter exchange transactions Exempt payees 1 through 5 in 1 through 5 below.
and patronage dividends 1. Interest, dividend, and barter exchange accounts
Payments over $60D required Generally, exempt payees opened before 1984 and broker accounts considered active
to be reported and direct 1 through 7 during 1983. You must give your correct TIN, but you do not
have to sign the certification.
sales over $5,000'
2. Interest, dividend, broker, and barter exchange
zSee Form 1099 -MISC, Miscellaneous Income, and its instructions. accounts opened after 1983 and broker accounts considered
However, the following payments made to a corporation (including gross inactive during 1983. You must sign the certification or backup
proceeds aid to an attorney under section 5045
P P y are d even if the attorney is a withholding will apply. If you are subject to backup withholding
an you are mere) r
corporation) and reportable on Form 1099 -MISC are not exempt from y y providing your correct TIN to the requester,
backup withholding: medical and health care payments, attorneys' fees, and you must cross out item 2 in the certification before signing the
payments for services paid by a federal executive agency. form.
F orm W -9 (Re v. 1 2 00 7) Page 4
3. Real estate transactions. You must sign the certification. Secure Your Tax Records from Identity Theft
You may cross out item 2 of the certification.
Identity theft occurs when someone uses your personal
4. Other payments. You must give your correct TIN, but you information such as your name, social security number (SSN), or
do not have to sign the certification unless you have been other identifying information, without your permission, to commit
notified that you have previously given an incorrect TIN. "Other fraud or other crimes. An identity thief may use your SSN to get
payments" include payments made in the course of the a job or may file a tax return using your SSN to receive a refund.
requester's trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services To reduce your risk:
(including payments to corporations), payments to a Protect your SSN,
nonemployee for services, payments to certain fishing boat crew Ensure your employer is protecting your SSN, and
members and fishermen, and gross proceeds paid to attorneys o Be careful when choosing a tax preparer.
(including payments to corporations).
5. Mortgage interest aid b Call the !RS at 1- 800 829 -1040 if you think your identity has
p y you, acquisition or been used inappropriately for tax purposes.
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA, Victims of identity theft who are experiencing economic harm
Coverdell ESA, Archer MSA or HSA contributions or or a system problem, or are seeking help in resolving tax
distributions, and pension distributions. You must give your problems that have not been resolved through normal channels,
correct TIN, but you do not have to sign the certification, may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll -free case intake line
What Name and Number To Give the Requester at 1- 877 777 -4778 orTTY/TDD 1 -800- 829 -4059.
Protect yourself from suspicious emails or phishing
For this type of account: Give name and SSN of: schemes. Phishing is the creation and use of email and
1. Individual The individual websites designed to mimic legitimate business emails and
2. Two or more individuals Joint The actual owner of the account or, websites. The most common act is sending an email to a user
account) if combined funds, the first falsely claiming to be an established legitimate enterprise in an
individual on the account' attempt to scam the user into surrendering private information
3. Custodian account of a minor The minor' that will be used for identity theft.
(Uniform Gift to Minors Act) The IRS does not initiate contacts with taxpayers via emails.
4. a. The usual revocable savings The grantor- trustee Also, the IRS does not request personal detailed information
trust (grantor is also trustee) through email or ask taxpayers for the PIN numbers, passwords,
b. So- called trust account that is The actual owner' or similar secret access information for their credit card, bank, or
not a legal or valid trust under other financial accounts.
state law
5. Sole proprietorship or disregarded The owner' If you receive an unsolicited email claiming to be from the IRS,
entity owned by an individual forward this message to phishing@irs.gov. You may also report
misuse of the IRS name, logo, or other IRS personal property to
For this type of account: Give name and EIN of: the Treasury Inspector General for Tax Administration at
6. Disregarded entity not owned by an The owner 1 -800- 366 4484. You can forward suspicious emails to the
individual Federal Trade Commission at: spam@uce.gov or contact them at
7. A valid trust, estate, or pension trust Legal entity www.consumer.gov /idtheft or 1- 877- IDTHEFT(438- 4338).
8. Corporate or LLC electing The corporation
corporate status on Form 8632 Visit the IRS website at www.irs.gov to learn more about
9. Association, club, religious, The organization identity theft and how to reduce your risk.
charitable, educational, or other
tax exempt organization
10. Partnership or multi member LLC The partnership
11. A broker or registered nominee The broker or nominee
12. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
List first and circle the name of the person whose number you furnish. If only one person
on a joint account has an SSN, that person's number must be furnished.
Circle the minor's name and furnish the minor's SSN.
a
You must show your individual name and you may also enter your business or "DBA"
name on the second name line. You may use either your SSN or EIN (if you have one),
but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity itself is not designated in
the account title.) Also see Special rules for partnerships on page 1.
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.
Page 4 PROJECT 07 -08: Keystone Parkway 136 St. PARCEL 86
If you decide to accept the offer of 15.200.00 made by the City of Carmel, sign your name below
and mail this form to the address indicated above. An additional copy of this offer has been
provided for your file.
ACCEPTANCE OF OFFER
I (We), Carmel Clay Schools, an Indiana political subdivision
landowner(s) of the above described property or interest in property, hereby accept the offer of
$15,200.00 made by the City of Carmel on this -"1 day of j—,k Ll�;,{ 2009.
..1
Carmel Clay Schools an Indiana political subdivision
By: i By'.
(Signature) (Signature)
(Printed Name) (Printed Name)
NOTARY'S CERTIFICATE
STATE OF
SS:
COUNTY OF-
Subscribed and sworn to before me this u •S day of 2009.
My Commission Expires:
My County of Residence is: i M1-
(Signature)'
F�r� Lin° r %N
(Printed) NOTARY PUBLIC
I
roa S T ATEN1EN T OF 7—'F- UST COMPENSATiCN �G2
nis Is a wfl :ten staTemsira of. and SlirT7mary eT thie iCr, il':e e9taG!isnmeni c1 'he :?meunt Gellevec tc ihrcucii a vaivaT :en
„955. l 5i �iiC2nSa:iCn i i he 'vrCnaSe Oi i! is �iCnt'J�- 'r'Ja';/ iOr I i'NaV GuFCG52S. i l8 amCUni SBt iCR In Item 'e!o's! IS iiCi ie55
^an he sc estima =.e cr value. In accordance wiih P'-loiic
'_aw L6 as amended, the '-Iniform Act', ona as cociTied In Indiana
aT !C 3 ':brooch this value disfeuards am dec ease cr inc; ease in 'air mar<et vaiue of the orcpe ^y prior ;c the 'ate
Gi 'J2iLauon caused cv the CU liG morovement Tcr wnlcn [he prcce :i is acc;ulred Cther than chvsical Ceterieradcn within re
rIrci C t hoe C. r�r.
.,.i.._ to ,he 'CliOw(r'c
=real ac �curty ?amiitcn
"Nneris; -crm C�z ZL 1s
ne :r_ c= cl Ir re 7. ,;zie iake cr �r r• r'
acres. anC i..- 3C. ,S ;�i ISiI iC iCnt- :T -eVcV
.e ci Cu,.- Tl Cem� e C r. c.:Ces az vT,e 17 .vi '�T all n'siresia In r eai urcceiiv ai iicJ saca,'aia!v i
imemsi is !b-=.ing acquireo SePaTa'tely In `Nncie Or p2;i. excem as may oe eXOiained i n tern, 8 below.
'ni5 aCC'ulSitlCn Is ('Cnec!S are I a. tCtal acouisltion cT th,e rani Orocem
C. 1 r', Carnal aczusiticfi of the real procenv.
Idi2?, EnC7'S ilii2r: u CCmCen5all0r1 flay Cee'.''1 G"eT.er�m:IRed to Ce and the ,Acquiring ��zency�s offerTCr the Purchase cT
this reai orocem/ is as ;cilows:
ai __nv, __��w Imcrcve penis :,a s �iidin�s ?r0
dva 3nca maGeS I. eiCaCi:, F,
value :o e nil es :dues, etcj 5U
c- Cther Camases (Itemize)
Cos: -To -Cure estimates:
so
5
7
emoerar! RAN
Otai Cai 30es
�Cial amount beJaved t o be J Compensation offered Tlor this Accuisition is: n CC
t ne amcurt in :Item 5 abvie may inC',ude ,Cavment for the urc lase of °:"_alrl 'ouidlncs anti Imorovements anG their
anC M:C, Vr -!76MS aj'e iCenZM -=C _S :ClIC'NS:
3 6Un'I tem aC ve ,^ra'J InCII-!Ce Gavmer,•'C:' `h- s a
e �UfChaSc c{C _an% 'li'T'�CrG'!e;" 1.. T„S. ....L•fe...
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3. !tem5 CwrleC �Cv ethers J° ies5ee, ienams, etc.) Inciudec in Item adove are i0er".ZlTled aS TCllcws: N/A
emarxs: NIA
,Q e _c
eviewer.
Sicnatur: c'
Narrle inted: Name Tinted:
V
aTe! w i'
Prescribed by Stale 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
Carmel Clay Schools Purchase Order No. NA
5185 East 131 st Street Terms
Carmel IN 46033 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/23/09 NA 07 -08 Keystone Parkway
136th Street Just Compensation Land Cost
Parcel 86 $15,200.00
Please forward this check to Jeremy Kashman
City of Carmel Engineers Office
Total $15,200.00
I hereby certify that the attached invoice(s), or bills(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.
Carmel Clay Schools ALLOWED 20
6185 East 131st Street IN THE SUM OF
Carmel IN 46033
15,200.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Schools
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
DEPT.#
NA NA 4470602 $15,200.00
1 hereby certify that the attched 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
March 30, 20 08
$15,200.00 Signature
Cost distribution ledger classification if Cit En
claim paid motor vehicle highway fund Title