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Home My WebLink About228192 1/15/2014 CITY OF CARMEL, INDIANA VENDOR: 00350333 Page 1 of 1 1 � ONE CIVIC SQUARE INDIANA ASSOCIATION OF CITIES/TOW&ECK AMOUNT: $25,775.00 CARMEL, INDIANA 46032 200 SOUTH MERIDIAN STREET SUITE 34 INDIANAPOLIS IN 46225 CHECK NUMBER: 228192 CHECK DATE: 1/15/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 R4355300 31650 9494 25, 775 . 00 DUES SSj Indiana Association of Cities and Towns 125 W. Market Street Suite 240 • Indianapolis,IN 46204 Phone (317) 237-6200 • Fax (317) 237-6206 •www.citiesandtowns.org ATi Indiana Association of Cities and Towns City of Carmel INVOICE One Civic Square 9494 Carmel, IN 46032 2014 IACT Dues: $25,775.00 - IACT Government Affairs Program Contribution (optional) ❑ $2,000 ❑ $1,500 ❑ $1,000 ❑ $500 ❑ Other$ IACT Foundation Contribution (optional) ❑ $1000 ❑ $500 ❑ $250 ❑ $100 ❑ Other$ IACT Ambassador Program (optional) ❑ $1000 ❑ $500 ❑ $250 ❑ $100 ❑ Other$ Total Remittance: I hereby certify that the foregoing is just and correct,that the amount claimed is legally due after allowing all just credits, and that no part of the same has been paid. W"� v f '//� Matthew C. Greller,IACT Executive Director Please return a copy of this invoice with remittance by January 31,2014 to: Indiana Association of Cities and Towns,125 W.Market Street Suite 240,Indianapolis,IN. 46204 ---------------------------------------- Make checks payable to: Indiana Association of Cities and Towns OR IACT accepts the following credit cards (please compete the following) ❑Master Card ❑Visa ❑Discover Card Card Number: Submitted T® Expiration date: 3-digit security code: JAN �2014 Name on Credit Card: Clerk Treasurer Billing Address of Credit Card: Signature: EM INDIANA ASSOCIATION OF CITIES AND TOWNS Ind anaMolis IN 46204e 240 December 17, 2013 Mayor James Brainard Mayor One Civic Square Carmel, IN 46032 Dear Mayor Brainard, Please find enclosed your community's 2014 dues invoice for membership in the Indiana Association of Cities and Towns (QCT). 2013 has been a huge year for IACT. This year we launched a new website to make connecting with IACT easier and more convenient for you. IACT has conducted 17 cost-effective webinars and nearly 8o in-person workshops to keep Indiana's municipal officials armed Arith the most current information and best practices. Beginning this year,we sent our bi-monthly printed magazine to more than 3,000 readers and hosted over 1,000 attendees at the IACT Annual Conference&Exhibition in Indianapolis. Our staff was cranking on all cylinders this year and we expect next year to be even better. Your opinion matters,please provide your input on IACT programs and services by taking the member survey.Your feedback allows us to implement programming that meets the needs of IACT members. The survey can be found at https://",xv.surxe}7monkey.com/s/IACTMemberSurvey.Thank you to those who have already participated in the survey,we appreciate your input. In 2014 we look forward to continued growth of the IACT Medical Trust. As we begin the New Year,the Trust will be providing stability in volatile health care costs to 20 Indiana communities—small and large. We are thrilled at the growth and success of this service and look forward to sharing it with even more communities in the coming year as the Patient Protection and Affordable Care Act continues to phase into implementation. As always, contact our office to learn more about the Trust. As in year's past,we'll begin 2014 by spending most of our time at the Indiana Statehouse advocating on your behalf. The work we do there is among the most important work we do all year. While our proactive list of agenda items has been set for several months,we are also learning of the any bills that will put our association in a more defensive posture. A confirmed movement to put restrictions on the local use of tax increment financing is an issue IACT is preparing to address. As is, of course,the proposal on the table to eliminate Indiana's personal property tax, a hit of more than $1 billion to local units of government. This effort in particular gives us great pause until we know exactly how the General Assembly proposes to replaces those vital revenues. Please know that your IACT government affairs team is making this initiative a top priority. (317)237-6200 ® Fax:(317)237-6206 www.citiesandtowns.org INDIANA ASSOCIATION OF CITIES AND TOWNS irqr,n Me 1 125 W. t St., IndianaMolise N 46204e 240 Im W 0 Thank you for the ability to serve your community for the past twelve months. It's an honor and privilege to advocate for you and the work you do to improve the lives for those in your community and Hoosiers all around the state. As always, please contact me if there is anything I can do to help you or answer questions about IACT, our work or our team. Sincerely, Trxatthew C. Greller ve Director Enclosure 1@ (317)237-6200 ® Fax:(317)237-6206 www.citiesandtowns.org Form W-9 Request for Taxpayer Give Form to the (Rev.August 2eTr Identification (dumber and Certification sendtoth.Donot Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax return) Indiana Association of Cities and Towns N Business name/disregarded entity name,if different from above d IM ca Check appropriate box for federal tax classification: Exemptions(see Instructions): c ❑Individual/sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership p Trust/estate C Exempt payee code(ri any) ❑ Limited liability company.Enter the tax classification(C-C corporation,S=S corporation,P=partnership)I* Exemption from FATCA reporting e e code(If arty)) a 5 ® Other(see instructions)► unincorporated association Pe Address(number,street,and apt or suite no.) Requester's name and address(optionao U) 125 West Market Street Suite 240 m City,state,and ZIP code m U) Indianapolis, !N 46204 List account numberils)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 �m to avoid backup withholding.For individuals,this is your social security number However,fora _m resident alien,sole proprietor,or disregarded entity,see the Part I instructions onn 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. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer Wontification number number to enter. [T5 - 098 1064 KM 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. lam not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Interna)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),and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. 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 ORA),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 3. Sign Signature of ,J Here U.S.person► Dace► December 17, 2013 General Instructions withholding tax onforeign partners'share of effectively connected,income,and 4.Certify that FATCA codes)entered on this form(f any)indicating that you are Section references are to the Internal Revenue Code unless otherwise noted. exempt from the FATCA reporting,is correct. Future developments.The IRS has created a page on IRS.gov for information Note.If you are a U.S.person and a requester gives you a form other than Form about Form W-9,at wwwJrs.goWw9.Information about arty future developments W-9 to request your TIN,you must use the requester's formif it Is substantialty affecting Form W-9(such as legislation enacted after we release k)will be posted similar to this Form W-9. on that page. Definition of a U.S.person.For federal tax purposes,you are considered a U.S. Purpose of Form person If you are: A person who is required to file an information return with the IRS must obtain your •An individual who is a U.S.citizen or U.S.resident alien, correct taxpayer identification number(TIN)to report,for example,income paid to •A partnership,corporation,company,or association created or organized in the you,payments made to you in settlement of payment card and third party network United States or under the laws of the United States, transactions,real estate transactions,mortgage interest you paid,acquisition or -An estate(other than a foreign estate),or abandonment of secured property,cancellation of debt,or contributions you made to an IRA •A domestic trust(as defined in Regulations section 301.7701-7). Use Fonn W-9 only If you are a U.S.person(including a resident alien),to Special rules for partnerships.Partnerships that conduct a trade or business in provide your correct TIN to the person requesting it One requester)and,when the United States are generally required to pay a withholding tax undersection applicable,to: 1446 on any foreign partners'share of effectively connected taxable income from such business.Further,in certain cases where a Form W-9 has not been received, 1.Certify that the TIN you are giving is correct(or you are waiting for a number the rules under section 1446 require a partnership to presume that a partner is a to be issued), foreign person,and pay the section 1446 withholding tax.Therefore,if you are a 2.Certify that you are not subject to backup withholding,or U.S.person that is a partner in a partnership conducting a trade or business in the 3.Claim exemption from backup withholding If you are a U.S.exempt payee.If United States,provide Form W-9 to the partnership to establish your U.5_status applicable,you are also certifying that as a U.S.person,your allocable share of and avoid section 1446 withholding on your share of partnership Income. arry partnership Incorne from a U.S.trade or business Is not subject to the Cat.No.10231X Formes-9(Rev.8-2013) VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Association of Cities and Towns - IN SUM OF $ 200 South Meridian Street, Suite 340 Indianapolis; IN 46225 $25,775.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members P"O'Year I hereby certify that the attached invoice(s), or 31650 I 9494 I 43-553.00 ( $25,775.00 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and I received except Monday, January 13, 2014 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 12/17/13 9494 $25,775.00 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