219871 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 367120 Page 1 of 1
`. ONE CIVIC SQUARE PUBLISHING RESOURCES GROUP INC CHECK AMOUNT: $8,442.00
CARMEL, INDIANA 46032 PO BOX 770307
«o� MEMPHIS TN 38177 CHECK NUMBER: 219871
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4359300 13-1170 8, 442 . 00 ECONOMIC DEVELOPMENT
Published by
Car 1 a 'round abouT Hght Urban Renaissance Publishing
a division of
Publishing
[PEGGrouplinc.
Resources
PO Box 770307
Memphis,TN 38177
Bill To:
Mayor James Brainard By Mayor Jim Brainard
City of Carmel
One Civic Square
Carmel, IN 46032
e-Inv®ice/Statement
_ Invoice Date: 5/2/13 INVOICE#13-1170 _
Project ID: RAR_6_10
Executive Publisher: Bob Towery
Description of Item(s)Contracted: Amount:
1000 Carmel: 'round about right Books-1st Edition $ 8,000.00
Shipping and handling $ 442.00
I
Total Outstanding: $ 8,442.00
Invoice Due Date: Upon Receipt
Remit Payment to:
Questions about this invoice? 4
Call 901-483-1001 P :. o 307
s e
Publishing Resources Group,Inc.Is a Tennessee corporation
i
i Eortn W-9 Request for Taxpayer Give Form to the
(Rev.January
e.nvto1JheTr Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Intemal Revenue Service
Name(as shown on your income tax return)
Publishing Resources Group,Inc
N Business name/disregarded entity name,if different from above
A dba:Urban Renaissance Publishing;dba:American Image Publishing;dba:Books a La Carte
CL
Check appropriate box for federal tax
c
classification(required): ❑ Individuaysoie proprietor ❑ C Corporation El S Corporation El Partnership []Trustlestate
w
ao
i E] Limited liability company.Ester the tax classification(C--C corporation,S=S corporation,P=partnership)10- [Z]Exem t
P payee
a --------------------------=----
i �
I C C
a` ❑ Other(see instructions)►
jAddress(number,street,and apt.or suite no.) Requester's name and address(optional)
u
CL PO Box 770307
CA City,state,and Z1P code
in Memphis,TN 38177-0307
List account number(s)here(optional)
i
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 However,for a
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on n page 3.For other
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
71N on page 3.
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.
M26 — 0 1 3 1 3 1 8 1 5 6 9
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
1 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
II 3. 1 am a U.S.citizen or other U.S.person(defined below).
( Certification Instructions.You must cross out Rem 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 retum.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
instructions on page 4.
Sign Signature of //
Here U.S.person 11- 1. Date►
General 9nstr i Uns 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 Code unless 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.
Use Form W-9 only if you are a U.S.person(including a resident •A domestic trust(as defined in Regulations section 301.7701-7).
alien),to provide your correct TIN 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
1.Certify that the TIN you are giving is correct(or you are waiting fora tax on any foreign partners'share of income from such business.
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 withholding 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.
allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income.
is not subject to the withholding tax on foreign partners'share of
effectively connected income.
Cat.No.10231X Form W-9(Rev.1-2011)
I
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/02/13 13-1170 $8,442.00
1 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
Publishing Resources Group, Inc.
IN SUM OF $
P. O. Box 770307
Memphis, TN 38177
$8,442.00
ON ACCOUNT OF APPROPRIATION FOR
Community Relations
PO#/Dept. INVOICE NO. ACCT#frITLE AMOUNT Board Members
1203 I 13-1170 I 43-593.00 I $8,442.00 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, May 05, 2013
Director, Community Relations/Economic Development
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund