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Home My WebLink About217648 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 366989 Page 1 of 1 ONE CIVIC SQUARE GRM MGMT SERVICES OF IN CHECK AMOUNT: $110.70 +< CARMEL, INDIANA 46032 PO BOX 28404 NEW YORK NY 10087 CHECK NUMBER: 217648 CHECK DATE: 2/26/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 502 4341999 753982 110 . 70 OTHER PROFESSIONAL FE INVOICE invoice# M53982 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ..-Account. .::: 2039 2002 S. East Street Indianapolis, IN 46225 i vn3 c'e-Da ..::.* 01-31-2013 Pa (317) 686-5754 :;..::: :; 1 Fax: (317) 686-5759 it:tQ`Addrss ". Attn: ACCOUNTS PAYABLE CITY OF CARMEL, CITY COURT ONE CIVIC SQUARE SECOND FLOOR CARMEL, IN 46032 Ea en. :.;::Teriris B ar i'?a Ge BncY ' : : Nizz_ �r:? ate: ri P-01nb ;> > >::::;: Net :15.. xDa..y..s i 01-01-2013 01-31-2013 02-15-2013 ::;:% i gg S ageBill i isi ... 2>i *** Do not combine this invoice with office360 invoices. Please note new remit to address for GRM payments below. Questions regarding billing should be directed to Amy at 317-686-5754 ext 114. Thank You. Storage Fees 72 .20 Services Performed 38.50 Merchandise Purchased Sales Tax 0.00 Total Amount Due $110.70 ........ . !I��li!lI�I��1111l�I !1I��1[ff�l I�I�i Ilfll�I1�1111�1111I 111 ��i i�!��i��it ll1ll I ll I I �I!IEI I��I Form W-9 Request for Taxpayer Give Form to the Department r 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) GRM INFORMATION MANAGEMENT SERVICES OF INDIANA LLC C\i Business name/disregarded entity name,if different from above m Check appropriate box for federal tax c o classification(required): ❑ Individual/sole rietor ro C Corporation� c p p' ❑ p ❑ S Corporation ❑ Partnership ❑Trust/estate .�o ❑Exempt payee 3 ❑ Limited liability company Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► C o ------------------------------ c y • c ri o ❑ Other(see instructions)► Address(number,street,and apt or suite no.) Requester's name and address(optional) C 5 Lo�2 City,state,and ZIP code 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 to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a' FM resident-alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other m entities,it is your employer identification number(EIN).If you do not have a number,see Now 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 rEmployer Identification number number to enter. IRM FN - 1 5 8 8 4 8 8 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)f 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 bele,,v). 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 into 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 t• Date► L L��d . Genera! Instru jcttons Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue C,-id-- mess otherwise 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 TIC!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,vithholding 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. allocabie share of any partnership income from a U S trade or business stat;:s and avoid withholding on your share of partnership income is not subject to the withholding tax on foreign partners'share of effectively connected income. I��I I�I��1111111111 I��{ III 111111 fll(9I IN Gat No.10231X Form W-9(Rev.i-2311) Scan `�' 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 CCR 11 —Li Fd k mk-f 1 D N l�(� I kj Purchase Order No. Po o2 � y o Terms t'(A A( l 0- Date Due Invoice Invoice Description Amount Date Number (or note attached invoice s) or bill(s)) Total 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 VOUCHER NO. WARRANT NO. ALLOWED 20 N1 �H—r S?t2J -TXl b IN SUM OF $ toi $ Irl� •� y ON ACCOUNT OF APPROPRIATION FOR P1 Ro r6IL" ) Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or y199 / 7� 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 20 0"t Cost distribution ledger classification if itle claim paid motor vehicle highway fund