The URL can be used to link to this page

Home My WebLink AboutService Supply Ltd. - $3,668Exhibit D Disbursement Instructions Mercantile Bank hereby is instructed to make a disbursement of Loan Proceeds from the Borrower Loan Account to (or for the account of) Borrower in: (a) the amount of the "Total Authorized Disbursement: line in the "Amount of Authorized Disbursement" column below; and (b) accordance with the terms and conditions of the Agreement, the other Loan Documents, and the Disbursement instructions. Purpose of Authorized Disbursement Amount of Authorized Disbursement Service Supply Ltd., Inc. Invoice #18998 $3,668.00 Total Authorized Disbursement $3,668.00 All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Hanover Square Improvements), dated , as of May , 20011, by and between Lender and Village Financial, LLC. Dated: l 2- — 19- ) 2 CITY OF CARMEL REDEVELOPMENT COMMISSkON By Printed Les s Q id 5 II Title EXeCJIVe ulre (4)- Sr'rvice Supply Ltd., Inc. 1524 South Hamilton Road Columbus. OH 43227 Local (614 861 -3681 Ohio: 800 -282 -1900 WV & Indiana: 800- 848 -7556 Fax: (614) 863 -0113 Bill To VILLAGE FINANCIAL, LLC DELORES KROHNE ONE PEDCOR SQUARE 770 3RD AVE. S.W. CARMEL, IN 46032 Invoice Date Invoice # 12/12/2012 18998 Ship To CARMEL STREET DEPARTMENT MATT WORTHLEY 3400 WEST MAIN STREET CARMEL, IN 46032 P.O. No, Terms Payment Due Salesperson Date Shipped Ship Via FOB No Statement Rendered. 20 days 1/1/2013 JG 12/11/2012 DELIV... Item Quantity Shipped Description Price Each Amount 84 -32DM 4 4 32 GALLON RECEPTACLES WITH DOME TOP, COLOR BLACK 917.00 3,668.00 THANK YOU FOR YOUR ORDER. A charge at the rate of 1 1/2 per month, ANNUAL PERCENTAGE RATE 18% may be applied to past due balances. Total $3,668.00 Service S Ipn .5 , 1.d.., 1 524 South Hamilton Road Cohimbus, OH 43227 Ohio 1 -800- 282 -1900 WV -IN 1 -800- 848 -7556 Phone # 614-861 -3681 Fax # 614- 863 -0113 Project TRASH RECEPTACLES W /DOME LID CARMEL REDEVELOPMENT Date Quotation # 9/6/2012 243 Customer CARMEL REDEVELOPMENT MATT WORTHLEY 3400 W. MAIN STREET CARMEL, IN 46032 317 - 571 -2788 Description Qty Unit Price Total 84 -32DM - 32 GALLON TRASH RECEPTACLE WITH DOME TOP LID FREIGHT & HANDLING MATERIAL ONLY DELIVERED 1R Y „ t} L as , ,� , , 3. Ya ><, 917.00 272.00 -- •4;5585.0�0^y-` • 272.00 NO TAXES ARE ?: CI.Ui1)EL IN AFOVE_. KU i1. ADD •_ I ;F ANT:CAPLE . IN] ON A D 1. RE vA!I;.a?+ G WA f3•P,S Nf) i APP? CA.' LE. FOR ..i Aiva f'Y p Total _.....841•837:06•°.,. gg ,_I••t .s t. ,:tit . s L.Y 1 1 JNL. 1S JyICi +11eE ?.k , C? I.,., P, - RAi' F ) FOB:. SHIP POINT Delivery A.R.O.: 6 -8 WEEKS QUOTATION BY - CONNIE TRI.PLETF, SECRETARY Quotation typed by - Connie Triplett Payment Term: NET 20 DAYS PURCHASE ORDER Village Financial, LLC Dolores Krohne One Pedcor Square 770 3rd Ave. SW Carmel, IN 46032 (—ro: pC 1_44. 'sat 444,31., c:)ax.ssvt tt3Z27. •■■■•■■.*011WORNI.61•01 PLEASE SHIP THE POLLOViiiNIG: a4ic-7-FOD 1 RteRiVErt l' N 0 DI!. .;!•-;.91p1-,.,t.s1 it UW-11.-:-.I-. t • • • . . . . . • '1 'I 1 2 SHIP TO: C 41'01 e 341oo 1JJi C.-4 trrt e -P'ep.,1ZTA #47, Li 0 3z DATE REQUIRE): 4 1 i i. • - • 1 I i I 1 • I . 1 ) 1 1 i 1 I i f 1 1 , 1 i 1 i I i t t ti t !t f i i I 1 I i I 1 I i t i t i I I t ; i 1 3 .11401 1—..t....--.,-..1......... -----.....-„,.... ,..-.-„.„......,...,...,-,..„-........_-------,..., , .---------- ..-- = - ...„...._ ..... L 4 : ... • . . • - - 32 Cu, /0A Ti 4M 4L --rop • 3) ei go fArftia ORM 3830 • II•117Q:,..1.1-,;= •• _ • • fitt-qt-t.; LIE trt! Pi.!:•!;:n!vv: • . • „ 4 L ORIGINAL MADE IN Q.S.A. From:Service Supply Ltd. inc. Form Wft..9 t>. Jamey 201 r) Deponent of tfolyssouly Wend atovenun Swan None 614 863 0113 12/18/2012 08:21 #545 P.002/002 • Request for Taxpayer Identification Nurnlbeir and Certification for Yaw Inowne tor *urn) RVICE SUPPLY LTD. INC. IGibe Form to the requester. Da not se na to the IRS. nonitidoregercion entity name. aome chola appropnett Lon for tedwel to dnantaoon Itsvirvoli ❑ trtsktittee Pmeoleter E c Corporation 0 S t:erpomtiOn ❑ Partnership U True 0 Umlted Malty company. We the tax el>mentaitoe , t;-.s oorpondon, Papartrteship) t• ___. ❑ Other One inseedtorm P Address m unbar, street ere apt. at out* n*.) 1524 SOUTH HAMILTON ROAD City. state, end ZIP mate COLUMBUS, OHIO 43227 oat esasust ntrnowtr) lots Option Tw yes Nufnbe'� (I1N Enter your TIN In the oppropriete box. The TIM provided must match the warty gOien an the °Name 6ne to avoid bteckup wltthhottang. For Individuals, this la tour soda see-tatty number 9t3SI4). However. for a resident ellen. sole proprietor, or dleregarded y, hire, it to Identi sea bar t, you do not hum a ra1nnb page 10 gnat a 77■ on page 9. Note. If the account Is In mere titan use creme, see the COM on page 4 tot guidelines nn whose number to enter. Mos Requeele►'aname ad • ,ea Oe 6 2 4 5 9 Under penalties of penury, h certify that 1. The number shown on inks form is my correct taxpayer iden1Jfesti n number (ar 1 tan waft for a number to be issued to me), and 2• t arts rat subjoa to borit4 vAttowtding bersausae I em exempt from beatW w*Ct sitting, or (b) t have not been twilled by Me beanie Ramme r Sandal rut j� • +Jitdroldal' g as a result of a failure to revert of Interest or dividends, or (c) the IRS has twined me that 1 am end no 3. t sum a U.S. citizen er other U.S. person Weaned belev . Certification Instrutillems. You reuse cross out Item 2 above tf you Nava been notified by de IRS that you ere currently aksjal* to backup withnokiing because you have tailed to +apart all Inmost and dividends on your tax Men. For real estate transactions, ins, I 2 does rot PPply. Pot wattage kearoat past, awn or abandonment of secured property, cancellation of debt, oxitnbutions to an Individual retirement arrangement (IRA), end ge+oaily, payments other than interest and dividends. you are not required to alpri the certification, but you mast provide yew► correct Tiff. See the Instructions on potge 4, eleanture Here U.S. General Inert •; s Section references am to ate Internal Revenue Code teases oatem/lee noted !Purpose of Form A parson who t9 required to Me an itlahna ion Ashen yr th the IRS must *tenet your canoe taxpayer reerefileation number (TIN) to report, for example, Income pate to u, mai estate transactions, mortgage Ut�emat you debt. o R� � property, ear heron or Use Form W-9 only If you ere a U.S. person gnaw:Eng a resident ale*, to provide your ccniet TIN to the person requesting It (the requester, and. when vermeil* to t Candy mat the 11N you we giving Is correct for you are waiting for a number to be ts8ueaq, 2. Certify amt you aro net subject to backup withholding, or S. Claim sxempttan from bedatp withholding if you are a U.B. exempt share Mao 9 , you are also coralytng that as a U.S. portion, your partnership Income from na e. bade Wiriness Is nt **eta to wttIthot ert tn share OWN* connected Intone Rate/. December 18, 2012 Note. if a requester giver you a form other than Form W-9 to request y to owlibt, you must use tine requeater'e form If d a aute*a i a ty eM*tar battalion or a Q.B. person. For federal tax purposes. you are cow a U.S. parson 11 you era Ash individual *iv is a U.B. cltrren or US, reskdeni alien, • A partnership, corperatlas, company, or aseodotion excreted or °t mad In eta United States or under ate laws of the United Sta tea, An estate (other than a terelgn tuba), or A domesbe bust (As defused In Regulations seedat 901.77014). ihreoial rules for pertnerships. Partnerships that conduct a bade or winos to the United Stales are generally required to pay a withhavarre tax an any tore+ tweeters' stave or 1neorrle from such busineat. Further, to cattail asses where a Form W4 hoe tiCit bean received, a partnership Is required to presume that a partner Is a Foreign person, mtra pay eta Vietthdidirea tux. therefore, If you Pro a U.S. person that to a Stain, prproalde conducting paste * to h your voted status and et wad withholding on your shahs of pw tnerehlp income, Cat. No. tent x aonrtY .: (Rev. 14011)