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HomeMy WebLinkAboutRepublic ITSAGREEMENT 0" THIS AGREEMENT is made and entered into on theme day of 2011 by and between the TOWN OF LOS ALTOS HILLS (hereinafter referred to as "TOWN") and Republic ITS (hereinafter referred to as "CONTRACTOR"). In consideration of their mutual covenants, the parties hereto agree as follows: CONTRACTOR. Shall provide or furnish the following specified services and/or materials: Perform level foundation and reset traffic signal pole at the northeast corner of El Monte Road & St. Nicholas School 2. EXHIBITS, The following attached exhibits are hereby incorporated into and made a part of this Agreement: Proposal from CONTRACTOR dated January 10, 2011 3. TERMS, The services and/or materials furnished under this Agreement shall commence i b ( and shall be completed by -!I d- 4�s 1 unless terminated pursuant to Section 5(f), 4. COMPENSATION, For the full performance of this Agreement, a. TOWN shall pay CONTRACTOR an amount not to exceed Three thousand eight hundred dollars and zero cents ($3,800.00) within thirty (30) days following receipt of invoice and completion/delivery of services/goods as detailed in Sections 1, 2, and 3 of this Agreement and only upon satisfactory delivery/completion of goods/services in a manner consistent with professional/industry standards for the area in which CONTRACTOR operates. TOWN is not responsible for paying for any work done by CONTRACTOR or any subcontractor above and beyond the not to exceed amount, b. Town shall not reimburse for any of CONTRACTOR's costs or expenses to deliver any services/goods. Town shall not be responsible for any interest or late charges on any payments from Town to CONTRACTOR. c. CONTRACTOR is responsible for monitoring its own forces/employees/agents/ subcontractors to ensure delivery of goods/services within the terms of this Agreement. TOWN will not accept or compensate CONTRACTOR for incomplete goods/services. Town of Los Altos Flllls Page I of 4 Short form Updated 412allo 5. GENERAL TERMS AND CONDITIONS, a. HOLD HARMLESS. CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of personal injury (including death) and property damage of any nature, caused by or arising out of the performance of CONTRACTOR under this Agreement. With regard to CONTRACTOR'S work product, CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of any nature to the extent caused by the negligent performance of CONTRACTOR under this Agreement. b. INSURANCE. CONTRACTOR shall file with the TOWN a certificate of insurance before commencing any services under this Agreement as follows-, WORKERS COMPENSATION INSURANCE: Minimum statutory limits. COMMERCIAL GENERAL LIABILITY AND PROPERTY DAMAGE INSURANCE: General Liability and Property Damage Combined, $1,000,000.00 per occurrence including comprehensive form, personal injury, broad form personal damage, contractual and premises/operation, all on an occurrence basis. If an aggregate limit exists, it shall apply separately or be no less than two (2) times the occurrence limit iii, AUTOMOBILE INSURANCE: $ 1,000,000.00 per occurrence. iv. ERRORS AND OMISSIONS INSURANCE. $1,000,000.00 aggregate, v, NOTICE OF CANCELLATION.The City requires 30 days written notice of cancellation. Additionally, the notice statement on the certificate should not include the wording "endeavor to" or "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives," vi. CERTIFICATE OF INSURANCE., Prior to commencement of services, evidence of insurance coverage must be shown by a properly executed certificate of insurance and it shall name "The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers" as additional insureds. vii. To prevent delay and ensure compliance with this Agreement, the insurance certificates and endorsements must be submitted to: Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 Town of Los Altos Hills Page 2 of 4 Short form Updated 4123110 a. NON-DISCRIMINATION. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, age, ancestry, religion or sex of such person. d, INTEREST OF CONTRACTOR. It is understood and agreed that this Agreement is not a contract of employment and does not create an employer- employee relationship between the TOWN and CONTRACTOR,. At all times CONTRACTOR shall be an independent contractor and CONTRACTOR is not authorized to bind the TOWN to any contracts or other obligations without the express written consent of the TOWN. In executing this Agreement, CONTRACTOR certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of TOWN. e. CHANGES. This Agreement shall not be assigned or. transferred without advance written consent of the TOWN, No changes or variations of any kind are authorized without the written consent of the City Manager. This Agreement may only be amended by a written instrument signed by both parties. f. TERMINATION. This Agreement may be terminated by TOWN upon seven (7) days written notice to CONTRACTOR. Monies owed for work satisfactorily completed shall be paid to CONTRACTOR within 14 days of termination. g. RECORDS,. All reports, data, maps, models, charts, studies, surveys, calculations, photographs, memoranda, plans, Studies, specifications, records, files, or any other documents or materials, in electronic or any other form, that are prepared or obtained pursuant to this Agreement and that relate to the matters covered hereunder shall be the property of the TOWN. CONTRACTOR hereby agrees to deliver those documents to the TOWN at any time upon demand of the TOWN. It is understood and agreed that the documents and other materials, including but not limited to those described above, prepared pursuant to this Agreement are prepared specifically for the TOWN and are not necessarily suitable for .any future or other use.. Failure by CONTRACTOR to deliver these documents to the TOWN within a reasonable time period or as specified by the TOWN shall be a material breach of this Agreement. TOWN and CONTRACTOR agree that until final approval by TOWN, all data, plans, specifications, reports and other documents are preliminary drafts not kept by the TOWN in the ordinary course of business and will not be disclosed to third parties without prior written consent of both parties. All work products submitted to the TOWN pursuant to this Agreement shall be deemed a "work for hire." Upon submission of any work for hire pursuant to this Agreement, and acceptance by the TOWN as complete, non-exclusive title to copyright of said work for hire shall transfer to the TOWN. The compensation recited in Section 4 shall be deemed to be sufficient consideration for said transfer of copyright. CONTRACTOR retains the right to use any project records, documents and materials for marketing of their professional services. Town of Los Altos Hills Page 3 of 4 Short form Updated 4123110 h. ENTIRE AGREEMENT. This Agreement represents the entire agreement between the Parties. Any ambiguities or disputed terms between this Agreement and any attached Exhibits shall be interpreted according to the language in this Agreement and not the Exhibits. 6, INVOICING. Send all invoices to the contract coordinator at the address below. This Agreement shall become effective upon its approval and execution by TOWN. In witness whereof, the parties have executed this Agreement the day and year first written above. CONTRACT COORDINATOR and representative for TOWN: CONTRACTOR., Richard Chiu Public Works Director Town of Los Altos Hills By: 26379 Fremont Road Et u Cre Date Los Altos Hills, CA 94022 mes A Print name, Title ll TOWN OF LOS ALTOS HILLS By: o- �o� I Cahill, City Manager Date Town of Los Altos Hills Page 4 of 4 Shod form Updated 4/23110 January 10, 2011 ,John Chau Town of Los Altos Hills 26379 Fremont Rd. Los Altos Hills, CA 94027 Job Name: EL MONTE RD & NICHOLAS SCHOOL - LEVEL FOUNDATION & RESET POLE Job Location: EL MONTE RD & NICHOLAS SCHOOL --NORM CAST CORNER Dear Mr. Chau: During our monthly maintenance of your traffic signals on December 20, 2010, we found the traffic signal pole at the Northeast corner of Cl Monte Rd. & NichoIas School leaning. We recommend realigning this pole to level position. It appears the foundation is still intact and tine pole can be reset by adjusting the existing anchor bolts per Caltrans specifications. We offer to perform the following services based on our standard terms and conditions: Close part of the west bound lane of Voorhees Dr, and the east bound lane of El Monte Rd. Remove any traffic signal wiring connected to the pole. Lift the existing traffic signal pole, Modify the existing anchor bolts such that the pole will be level, Reset the existing pole as needed. Ensure pole is level. Grout pole foundation. Reinstall necessary wiring.. Check to make sure that the traffic signal pole is operational. TOTAL. LABOR, MATERIALS & EQUIPMENT... $ 3,800,00 *Note: Quote is assuming foundation is intact. There will be an additional $2,000 for removing and replacing the old foundation if necessary. 1"his offer, shall expire 90 days from Ute date hereof and may be withdrawn by us at any time prior, thereto with or without notice This offer supersedes any prior offers, commitment or orders, contains all terms, conditions and %varrantics and when accepted, constitutes the entire contxact between the parties The resulting contract shall not be modified except by formal written amendment. This offer shall be accepted by delivery to us of a copy of this offer duly signed by you in the space provided. rhe foregoing offer is hereby accepted this day of , 2011. CITY OF LOS ALTOS REPUBLIC ITS 2 Owen Villar Title: Project Coordinator (415) 884-3000 - (4 15) 884-4800 - 371 Bel Marin Kcys Blvd • Suite 200 - Novaro, CA 94949 Boston • DaIIns • 1-1ouston • Los Angeles - N1iarni - 1)hiIade11)hia Phoenix - Sacramento Snn Diego San Francisco • San Jose i Republic Y k ITS E Intelligent Transportation f. Services January 10, 2011 ,John Chau Town of Los Altos Hills 26379 Fremont Rd. Los Altos Hills, CA 94027 Job Name: EL MONTE RD & NICHOLAS SCHOOL - LEVEL FOUNDATION & RESET POLE Job Location: EL MONTE RD & NICHOLAS SCHOOL --NORM CAST CORNER Dear Mr. Chau: During our monthly maintenance of your traffic signals on December 20, 2010, we found the traffic signal pole at the Northeast corner of Cl Monte Rd. & NichoIas School leaning. We recommend realigning this pole to level position. It appears the foundation is still intact and tine pole can be reset by adjusting the existing anchor bolts per Caltrans specifications. We offer to perform the following services based on our standard terms and conditions: Close part of the west bound lane of Voorhees Dr, and the east bound lane of El Monte Rd. Remove any traffic signal wiring connected to the pole. Lift the existing traffic signal pole, Modify the existing anchor bolts such that the pole will be level, Reset the existing pole as needed. Ensure pole is level. Grout pole foundation. Reinstall necessary wiring.. Check to make sure that the traffic signal pole is operational. TOTAL. LABOR, MATERIALS & EQUIPMENT... $ 3,800,00 *Note: Quote is assuming foundation is intact. There will be an additional $2,000 for removing and replacing the old foundation if necessary. 1"his offer, shall expire 90 days from Ute date hereof and may be withdrawn by us at any time prior, thereto with or without notice This offer supersedes any prior offers, commitment or orders, contains all terms, conditions and %varrantics and when accepted, constitutes the entire contxact between the parties The resulting contract shall not be modified except by formal written amendment. This offer shall be accepted by delivery to us of a copy of this offer duly signed by you in the space provided. rhe foregoing offer is hereby accepted this day of , 2011. CITY OF LOS ALTOS REPUBLIC ITS 2 Owen Villar Title: Project Coordinator (415) 884-3000 - (4 15) 884-4800 - 371 Bel Marin Kcys Blvd • Suite 200 - Novaro, CA 94949 Boston • DaIIns • 1-1ouston • Los Angeles - N1iarni - 1)hiIade11)hia Phoenix - Sacramento Snn Diego San Francisco • San Jose '1"axpayar ldentificatian Numtaer (TiN) Enter your. TiN in the appropriate box The TiN provided must match the name given on Une t to avoid social security number backup withholding For individuals, this Is your social security number (SSN) However, for a resident i aliensole proprietor, or disregarded entfty, see the Dart I instructions on page 3 For other entitles, it is your employer Identification number (EIN) It you do not have a number. see How to get a 77N on page 3 or Nate. It the account Is In more than one name. see the chart on page 4 for guidelines on whose Employer identification number number to enter Under penalties of perjury. I certify that: I 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 f am hot subjeot to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internai 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 Instructlons. 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 srycured 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 Cerlification, but you must provide your correct TIN See the Instructions on page 4 $I9n signature of Here I U.S. person A hate 01 - General General Instructions Section references are to the Internal Revenue Code unless otherwise noted Purpose of Form A person who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property. cancellation of debt, or contributions you made to an IRA 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 requester) and. when applicable. to: 1 Certify that the TIN you are giving Is correct (or you are waiting for a number to be Issued). 2 Certify that you are not subject to backup withholding. or 3 Claim exemption from backup withholding if you are a U S exempt payee If applicable, you are also certifying that as a U S person, your 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 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 to this Form W-9 g y y Cat No 10231X Form W-9 (Rev 10.2007) Dotinitlon of a U.S. person. For federal tax purposes. you are considered a U 6 person if you are: m An individual who is a U S citizen or U S resident alien, + A partnership. corporation, company, or association created or organized in the United States or under tite laws of the United States, An estate (other than a foreign estate). or 6 A domestic trust (as defined in Regulations section 301 7701-7) Special rules for partnerships. Partnerships that conduct a trade or business In the United States are generally required to pay a withholding 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 partnership Is required to presume that a partner Is a foreign person, and pay the withholding tax Therefore, if you are a U 5 person that Is a partner in a partnership conducting a trade or business in the United Slates. provide Form W-9 to the partnership to establish your U S status and avoid withholding on your share of partnership Income The person who gives Form W-9 to the partnership for purposes of establishing fts U 5 status and avoiding withholding on Its allocable share of net Income from the partnership conducting a trade or business In the United States is in the following cases; e The U S owner of a disre arded emit and not the entit FormW-9 Request for Taxpayer Calve form: to the (Rev October 2007) Identification Number and Certification requester. Do not Departmnt of the Tmbwry send to the iRS. lruernal Rovenuo solwce Name (or shorm an your income tax return) N m M Business name. if different from above a a m Chock appropriate box: ❑ Individual/Solo proprietor ❑ Corporation ❑ Partnership Exempt ❑ Limited liability company Enter the tax classification (0--disregnrded entity, C_corporation, P=parmorshlp) M ...,.... ❑ o 2 ❑ Other Me instruclione) P payee Address (number. street. and apt or suite no.) Requester's no and address (opbonaq a V- Town of Los Altus Hills City. state. and ZIP coda 15 26379 Fremont Road rn Los Altos Hills, CA 94022 List account number(s) here (optional) '1"axpayar ldentificatian Numtaer (TiN) Enter your. TiN in the appropriate box The TiN provided must match the name given on Une t to avoid social security number backup withholding For individuals, this Is your social security number (SSN) However, for a resident i aliensole proprietor, or disregarded entfty, see the Dart I instructions on page 3 For other entitles, it is your employer Identification number (EIN) It you do not have a number. see How to get a 77N on page 3 or Nate. It the account Is In more than one name. see the chart on page 4 for guidelines on whose Employer identification number number to enter Under penalties of perjury. I certify that: I 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 f am hot subjeot to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internai 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 Instructlons. 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 srycured 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 Cerlification, but you must provide your correct TIN See the Instructions on page 4 $I9n signature of Here I U.S. person A hate 01 - General General Instructions Section references are to the Internal Revenue Code unless otherwise noted Purpose of Form A person who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property. cancellation of debt, or contributions you made to an IRA 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 requester) and. when applicable. to: 1 Certify that the TIN you are giving Is correct (or you are waiting for a number to be Issued). 2 Certify that you are not subject to backup withholding. or 3 Claim exemption from backup withholding if you are a U S exempt payee If applicable, you are also certifying that as a U S person, your 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 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 to this Form W-9 g y y Cat No 10231X Form W-9 (Rev 10.2007) Dotinitlon of a U.S. person. For federal tax purposes. you are considered a U 6 person if you are: m An individual who is a U S citizen or U S resident alien, + A partnership. corporation, company, or association created or organized in the United States or under tite laws of the United States, An estate (other than a foreign estate). or 6 A domestic trust (as defined in Regulations section 301 7701-7) Special rules for partnerships. Partnerships that conduct a trade or business In the United States are generally required to pay a withholding 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 partnership Is required to presume that a partner Is a foreign person, and pay the withholding tax Therefore, if you are a U 5 person that Is a partner in a partnership conducting a trade or business in the United Slates. provide Form W-9 to the partnership to establish your U S status and avoid withholding on your share of partnership Income The person who gives Form W-9 to the partnership for purposes of establishing fts U 5 status and avoiding withholding on Its allocable share of net Income from the partnership conducting a trade or business In the United States is in the following cases; e The U S owner of a disre arded emit and not the entit ?ar Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals, this is your social security number (SSN). However, for a resident ( �� alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (GIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on P,age 4 for guidelines on whose number rErn-ployerldentiftntion number to enter. 1 -8-�- 12 17 16 17 12 1 ` 1 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I ant 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 withholdings 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. person (including a U.S. resident alien). 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 arrangernent (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (Se�jba_`structions on page 4.) Sign I Signature of a Here u.s.. person P. _ Date P, 01/ lq/l A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report.. for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions }Jou made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to tine person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. 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 to this Form W-9. For federal tax purposes you are considered a person if you are: an individual who is a citizen or resident of the United States, a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, or any estate (other than a foreign estate) or trust. See Regulation section 301.7701-6(a) for additional information. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S, tax on certain types of income, you must attach a statement that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. Cat. No. 10231X Form W- (Rev, 10-2.004) Form for Taxpayer Give form to the (Rev. October 2004) u� �c Identification r Certification requester. Do not Deportment of the Treasury send to the ifs. Internal Revenue semice N Name(as reported on your income tax return) M co g(CS, p C REPUBLIC INTELLIGENT TRANSPORTATIONSERVICES, . Business name, if different from alcove c 0 o 15 Individual/ Check appropriate box: ElSoleproprietor ® Corporation ❑ Partnership ❑ Other � ------------------ Exempt from backup 1:1v✓ithholding ® m Address (number, street, and apt. or suite no.) Requester's name and address (optional) (L u 371 BEL MIA. IN KEYS BLVD., SUITE 200 City; state, and ZIP code NO *tl ATO, 5.sX'A 94949-5699 List account number(s) here (optional) cv c� ?ar Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals, this is your social security number (SSN). However, for a resident ( �� alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (GIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on P,age 4 for guidelines on whose number rErn-ployerldentiftntion number to enter. 1 -8-�- 12 17 16 17 12 1 ` 1 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I ant 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 withholdings 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. person (including a U.S. resident alien). 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 arrangernent (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (Se�jba_`structions on page 4.) Sign I Signature of a Here u.s.. person P. _ Date P, 01/ lq/l A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report.. for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions }Jou made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to tine person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. 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 to this Form W-9. For federal tax purposes you are considered a person if you are: an individual who is a citizen or resident of the United States, a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, or any estate (other than a foreign estate) or trust. See Regulation section 301.7701-6(a) for additional information. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S, tax on certain types of income, you must attach a statement that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. Cat. No. 10231X Form W- (Rev, 10-2.004)