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Exhibit C <br />CONTRACTOR FINANCIAL CERTIFICATION FORM <br />Contractor Name: <br />Organization (if different than Contractor): <br />Project: <br />Project Address: <br />Project Contact: <br />Status: <br />❑ Non -Profit <br />❑ Corporation <br />❑ Governmental <br />❑ Individual <br />❑ Other: <br />Please complete and return the attached forms if they have not been submitted to Walla Walla <br />County Department of Community Health in the past 12- months, or if they are out of date: <br />❑ W-9, Request for Taxpayer Identification <br />❑ Last Audited Finance Statements, or <br />❑ Form 990, 990T, 1120, 1040 Schedule C <br />❑ Insurance Certification as required in GT&C Section 18 <br />o Insurance. CONTRACTOR is a member of the Washington Counties Risk Pool. <br />CONTRACTOR shall notify COUNTY forty-five (45) days before cancellation <br />or reduction in CONTRACTOR's insurance coverage. <br />