McGee, Sandra CIQ 2.28.24PAY TO:
VENDOR #:
NEW VENDOR
VENDOR NAME & REMITTANCE ADDRESS:
DEPARTMENT
INVOICE DATE, NUMBER, AND/OR EXPLANATION ACCT. NO.NET INV. AMT.
TOTAL
Justification for Processing without a PO:
Department Approval Required
X
Supervisor Approval Required <$5,000
X
Director Approval Required >$5,000
Print Approver's Name
Title:
SPECIAL INSTRUCTIONS
Requested By
Print Requestor's Name
FOR PAYMENT TO BE ISSUED
*New Vendor #'s must be set up with Purchasing before sending
CHECK REQUISITIONS MUST BE SUBMITTED TO ACCOUNTS PAYABLE
X
CHECK REQUISITION - VOUCHER
(MUST BE PRINTED ON PINK PAPER)
THE ABOVE HAS BEEN REVIEWED AND RECOMMENDATION FOR BILLING IS MADE BY THE UNDERSIGNED.
Date:
Performer Invoice
INVOICE DATE: 2/16/24
Program: Encounters with Art for the City of Denton
Performer Name Sandra McGee
Performer Address PO Box 368 Keller, TX 76244
Performer Email mcgeeroy@verizon.net
Performer Phone # 817‐808‐1691
Performance Date Number of Performers Artist payout amount
12/7/23 1 $250
TOTAL COST: $250
ADDITIONAL NOTES:
Each event lasted one hour, payment is determined by the number of storytellers sharing the hour.
1 artist (entire hour): $250
2 artists (roughly ½ hour each): $125
3 artists (roughly 1/3 hour each): $100
t 1l
City of Denton Purchasing
901-B Texas St. Denton, TX 76209
Phone: (940) 349-7100 Fax: (940) 349-7302
www.dentonpurchasinq.comflEhI:r01\{
Substitute W-9 Form
The IRS requires all vendors to complete a W-9 Form. The information on this form must be filled out, signed and submitted by a
vendor representative. All information must be completed before a purchase order or payment will be issued.
\
Name as shown on your income tax return:
Tax lD/Social Security #:
Under penalties of pqrjury, I certify that: 1. The number shown on this form is my correct taxtaxpayer identification number (or I
am waiting for a number to be issued to me), and 2. I am nol subject to backup withholding because (a) I am exempt from
backup witholding, or (b) I have not been notifie{ by the lnternal Revenue Service (lRS) that I am subject to backup withholding
as a result of failure to report all interest or dividlnds, or (c) the IRS has notified me that I am no longer subject to backup
withholdinq. and 3. I am a US citizen or other U.S. person-for fededral tax purposes as defined at the bottqm of this page-,
4. I unsdeiCtand that I must disclose any conflict of int'erest in accordance with Section f 76.006 (al) of the Local Governmentl)ode.
Authorized Printed Ge
c
,if I :7,?--\/"'/ rtr
iiailino Address:
Company Name:
Contact Name:
Address:F# Bav 3 e*'
f.1ler'Email: sf1a6 F*, f tlt\ €)tSg-f ; i-"ta). Apf-l ..J -
Website:
Phone Number: {;" Jl - ,yt^i' I {,:il
Fax Number:
Check approoriate box for federal tax classification {required):
lndividual/
51 Sole
Proprietor
r-r PartnershioU
Limited
Liability
Corporation
Other
Please specify:L-]
Exempt
Business Type Real Estate
D Rentaulease (A1) n
Equipment
Rental/Lease (A-9)Royalties (A-2) rLl L-] Medical/Health care (4-6;
tr Corporation
Must designate C or S
I
tr s
Services Only (A-
7l
Merchandise-
n Goods Only (A-7)
Merchandise &
Services (A-7)tr n Legal Firm/Attorney (A-C)
Consultant/Prof
n Fees (A-7)n
Proceeds from
Real Estate
Purchases (S)
Type of Organizalion:n Minority
Owned n Female Owned D Non Profit n HistoricallyUnderutilized
B{siness
*Definition of a U^S. Person-For Federal Tax purposes, Vlu ur" considered a U.S. person if you are: (a) an individual who is a U.S. citizen or
U.S. resident (b) a partnership, corporation, company, or association created or organized in the United States or under the laws of the United
States (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Regulations Section 301.77Aw\.
COD Page 1 9123l24fi
a
t&i, itti ) TY 'U'tt*tr
tr
n
CONFLICT OF INTEREST Q FORM CIQ
mental ebusiness with local
NNAIRE
For or other doi
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined
by Section 1 76"001 (1-a) with a local govemmental entity and the vendor meets requirements under Section 176.006(a) and by City of Denton
Ethics Code, Ordinance 18-757.
By law this questionnaire must be filed with the records administrator of the local govemment entity not later than the 7th business day after the
Oite tfre vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
an offense if the ven{or knowingly violates Section 176.006, Local Government Code. An offense under this section is a
by H.B. 23,84th Leg., Regular SessionThis questionnaire reflects changes made to the law
A vendor commits
misdemeanor.
1
2
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business dayD
after the date on which became aware that the originally filed questionnaire was
Check this box if you an update to a previously filed questionnaire.
or inaccurate.)
@t olfieer about whom the info$mation in this seetlon is being disclosed,
Name of Officer
Describe each employment or other business relationship with the local govenrment officer, or a f'amily member of the officer, as described by Section
176-003(a)(2)(A). Also describe any family relations hip with the local govenment officer. This section. (item 3 including subparts A, B, C & D). must be
completed for each officer rvith rvhom the vendor has an employment or other business relationship as defined hy Section 176.00 1( 1-a), Local Govemment Code.
Attach additional pages to this Form CIQ as necessary.
A. Is the looal government officer named in this section receiving or likely to receive taxable income, cther than investment income, from the vendor?
B. ls the vendor receiving or likely to receive taxable income, other than investment income. frorn or at the direction of the local govemment officer named in
this sectior, AND tlre taxalrle income is not received from the local governmental enlity?
C. Is the {iler olthis questionnaire enrployed by a corporation or other blsiness entity rvith respect to which the local government oificer serves as an officer
or dirsc:tor, or holds an ownership of one percent or more?
D. Describe each employmcnt or bnsiness and family relationship with the local govemment officer nanred in this section.
n No
No
Yes
Yes
Yes No
4 NJ , n"r" no conflict of lnterest to disclose.
!t'2 l.l,r/ -? q
Signature ofvendor doing business gor.cmmcnlal cntiry 7
Name ofvendor who has a business with local govEnmental entity.
a
Dat{
a
Vendor lnformation Not Required for W-9 Form
Remit Address (if different from above)
Company Name:
Contact Narne:
Address:
Email:
Phone Number:
Fax Number:
ACH lnformation-Voluntarv
t
ABA Routing#:
Contact Name:
Bank Account#
Bank Name :
ACH Emall :
ACH Email :
Phone Number;
Fax Number:
q
I (we) authorize the City of Denton to deposit
payments into the checking account listed. The
authority remains in effect until the City of Denton
has received written notification from me of
termination in time to allow reasonable opportunity
to act on it, or until the City of Denton has sent me
written notice of termination of the agreement.
Vendor Signature
Print Name/Title
Date
List Products andlor Services in Bidding:
Stories for storyteling
For lntemal Use Only
n NewVendor
tr VendorChange
n Refund
Requesting Department:
Department Representative (Bfj4lgC-Nglqg)
Purchasing Signature:
Vendor Number
Date:
Date:
COD Page 2 9t23t2011