223376 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 366536 Page 1 of 1
ONE CIVIC SQUARE ACROSS THE STREET PRODUCTIONS CHECK AMOUNT: $400.00
CARMEL, INDIANA 46032 19101 STONE RIDGE DR,STE A
+ + SOUTH BEND IN 46637 CHECK NUMBER: 223376
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 12-1459 400 . 00 EXTERNAL INSTRUCT FEE
1
BLUE CAR95
Invoice
Across the Street Productions
19101 Stone Ridge Drive-Suite A Date Invoice#
South Bend, Indiana 46637 8/21/2013 12-1459
Bill To
Carmel Fire Department
Denise Snyder
2 Civic Square
Carmel, IN 46032
P.O. No. Terms Due Date
24479 Net 30 9/20/2013
Quantity Description Rate Amount
1 Hazard Zone Conference 2013; Fuchs 400.00 400.00
Train the Trainer Invoices must be paid 14 days prior to the start of class
Total $400.00
Make Checks Payable to:
Across the Street Productions
Phone (574)273-0962 Toll Free (855) 872-5822 Fax(574)273-3174 Website www.bshifter.com
Form
w-9 Request for Taxpayer Give Form to the
(Rev.December 2011) requester.Do not
Department of the Treasury Identification Number and Certification send to the IRS.
Internal Revenue Service
Name(as shown on your income tax return)
Across the Street Productions, Inc.
N Business name/disregarded entity name,if different from above
Across the Street Productions
o- Check appropriate box for federal tax classification:
C
O El Individual/sole proprietor El Corporation ❑✓ S Corporation ❑ Partnership ❑ Trust/estate
N
CL c
Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exempt payee
❑ Y P Y ( - P - P -P P)
C N
IL ❑ Other(see instructions)0,
w Address(number,street,and apt.or suite no.) Requester's name and address(optional)
v
19101 Stone Ridge Drive-Suite A
d City,state,and ZIP code
South Bend, Indiana 46637
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 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
TIN 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.
F8fl6 - 0 1 8 1 6 7 7 4 7
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,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 Si nature of �� ,�
Here U.S.person► fit/ Date► 08/19/2013
General Instructions 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.
•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 TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade
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 withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United
States,provide Form W-9 to the partnership to establish your U.S.
payee.If applicable,you are also certifying that as a U.S.person,your status and avoid withholding on your share of partnership income.
allocable share of any partnership income from a U.S.trade or business
is not subject to the withholding tax on foreign partners'share of
effectively connected income.
Cat.No.10231X Form W-9(Rev.12-2011)
Snyder, Denise W
From: Blue Card Office Den @bshifter.com]
Sent: Wednesday, August 21, 2013 2:26 PM
To: Snyder, Denise W
Subject: FW: Event Registration
Please find listed below the Event Registration Confirmation for Jeff Fuchs.
Thank you and please do not hesitate to contact me should you need any further information.
Sincerely,
Jennifer Schabbel
Blue Card Office Manager
� Phone (855)872-5822
Fax(574)273-3174
www.bshifter.com
-----Original Message----- �� \
From:traininRadmin @bshifter.com (mailto:traininRadmin @bshifter.com]
Sent:Tuesday,August 20,2013 1:03 PM
To:traininRadmin @bshifter.com
Subject: Event Registration
Bshifter Event Registration Confirmation **************************Event
Info*************************** Event Title: 2013 Brunacini Hazard Zone
Management and Leadership Conference- Notre Dame, IN Date Start: 10/21/2013
Date End: 10/23/2013
CostPerSeat: $400.00
Department: Carmel Fire Department
************************** ******************************
Register Info
Event Registration Transaction Id:15baf433-e4lb-4e5e-85bc-7223c98dcf39
Seats Registered: 1
Discount Applied:
Total Fee:$400.00
Billing PersonName:Jeff Fuchs _
Billing Addressl: 2 Civic Square
Billing Addressl:
Billing City: Carmel
Billing State: Indiana
Billing Zip:46032
Billing Country: USA
Billing Phone:317-571-2600
Billing Email: dsnyder @carmel.in.Rov
Transaction Type: Purchase Order
Billing Reference:24479
PO Reference/Number:24479
Event Registration ID: c90098ff-06fc-45f3-al60-d7c5c222674e
1
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))
12-1459 Fuchs $400.00
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
Across the Street Productions IN SUM OF $
19101 Stone Ridge Drive, Suite A
South Bend, IN 46637
$400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1120 I 12-1459 I 43-570.04 I $400.00 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
AIIG 2 F 2013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund