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Fully Executed Agreement
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05. May
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2026-05-19 10:00 AM - Commissioners' Agenda
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Fully Executed Agreement
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Last modified
6/25/2026 12:27:26 PM
Creation date
6/25/2026 12:27:11 PM
Metadata
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Template:
Meeting
Date
5/19/2026
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Item
Request to Approve an Agreement for Services between Kittitas County and Comprehensive Healthcare
Order
5
Placement
Consent Agenda
Row ID
144485
Type
Agreement
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Pase 6Fom W-9 (Rev. 3'2024) <br />Victims of icJentity theft urho are exp€riencing.€conomic.harm or a <br />systemic problem, br are seeking help in resolving tax problefis that <br />hive not been resolved lhrough normal channels' may be eligible for <br />Taxpayer Advocate Service [AS) assistance. You can reachlAs-by- <br />calling'lhe TAS toll-free case inlake line at 877 -777-4778 or TTYITDD <br />800-829"4059. <br />Protect yourself {rorn ouspicious etnails or phishillg schenres. <br />Phishing-is the creation and use of email and websites designed to <br />mimic legitimate businegs emails and urebsites. The nrosl common act <br />is sendin-q an email to a user falsely claiming to be an esrablished <br />legitimatdenterpriss in an atlemplio scam ihe user into sunendering <br />private informalion that will be used for identity theft. <br />llre IRS does not initiate contacts with taxpayers via omails. Also, the <br />IRS does not requesl personal deraile'd infonnation lhrough email or ask <br />taxDar/€rs for the PIN numbers, passwords' or similar secret access <br />infdrniation for their credit card,'bank. or other tinancial accounls <br />lf you receive an unsolicited email claiming to be from the IRS' <br />torvrard this m€ssag€ to pfubhring4irs.gov' You may also repod misuse <br />of the IRS narne. logo, or other IRS propetty to the Treasury lnspector <br />General for Tax Adr;linislration flGTA) at 800-366-4484. You can <br />forward suspicious emails to the Federai Trade Commission at <br />slam@uce.gov or report them at rryww.ltc'govlcompla!nt. You can <br />contact the-FTC al vtwl. ftc.govl idtheft or 877 JDTHEFT (877-438-4338)' <br />lf you have been the viclim of identity thefl, see www ldentilyTheft'gov <br />and Pub. 5027. <br />Go to rvwrv.lrs.govltdentityTheft to leam more about identity theft and <br />how to reduce your risk. <br />Privacy Act Notice <br />Section 6109 of the lntemal Revenue Code requires you lo provide your <br />oonect TIN to persons (including federal agencies) who- are required to <br />file information retumg with the IRS to report interest, dividends, or <br />iertiin other income paid to you; mortgdge interest you paid; the <br />acquisition or abandonment 6f secured property; the-^c-ancellation of <br />dedt; or contributions you made to an lRA. Archer MSA, or HSA. The <br />oerson collectino this form uses the information on the form to fils <br />iniormation retuins with the lRS. reporting lhe above information' <br />Boutine uses of this infoffiation include giving it to the Departmant of <br />Justice for civil and criminal liligation and to Cities, states, the District of <br />Columbia, and U.S. comrnonweahlrs and tenitories for use in <br />administerinq their laws. The inlornration may also be disclosed to olher <br />io*tri"J un"a"t a treaty. to federal and statsagenc*)s to enforce civil <br />and criminal lawe . or to federal law eniorcement and intellignce <br />agencies lo combat terrorism' You must provide your TIN whether or not <br />v6u are reouir€d to fite I tax retum. Under seclion 3406, payors must <br />ienerany wittrtrold a percentage of taxable interest. divkl-ends. and <br />dertain 6ther payments to a payee who does not. give a- TlN.to the payor' <br />Cerlain penaliiei nray also alply for providing false or fraudulent <br />information. <br />Kittitas County Agreement for Services (rev. 5/74/251 <br />Page 2l of 22
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