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PSA between KC and AtWork!
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09. September
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2026-09-01 10:00 AM - Commissioners' Agenda
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PSA between KC and AtWork!
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Last modified
8/27/2026 12:13:49 PM
Creation date
8/27/2026 12:05:31 PM
Metadata
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Meeting
Date
9/1/2026
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve an Agreement for Services between Kittitas County and AtWork!
Order
31
Placement
Consent Agenda
Row ID
148367
Type
Agreement
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Forth W-9 (Rev. 3-2024) <br />Part II. Certification <br />To estatliish to the withholding agent that you are a U.S. person. or <br />resident a#ien, sign Form W-9. You may be requested to sign by the <br />withholding agent erFn if item t, 4. or 5 below indicates atherbvise. <br />For a joint account. only the person whale TIN is shown in part I <br />should sign (when required). In the case of a disregarded entity. the <br />person identified on line I must sign. Exempt payees, sae ExempI AaYee <br />code, earlier. <br />Signature requirements. Complete the certification as indicated in <br />items 1 through 5 below. <br />1. Interest, dividend, and barter exchange accounts Opened <br />before 1984 and broker accounts considered active during M& <br />You must give your correct TIN. but you do not have to sign the <br />certification. <br />2. Interest, dividend, broker, and barter exchange accounts <br />opened after 11983 and broker accounts considered inactive during <br />f M. You must sign the certification or backup wAholding will apply. If <br />you are subject to backup withholding and you are merely providing <br />your correct TIN to the requester, you must cross out item 2 in Fite <br />certification before signing the farm. <br />3. Real estate transactions. You must sign the certification. You may <br />cross out item 2 of the certification. <br />4. Other payments. You must give your correct TIN. but you do not <br />have to sign the certification unless you have been notified that you <br />have previously given an incorrect 11N. "Other payments" include <br />payments made in the course of the requester's trade or business for <br />rents, royafties. goods (other than bills for merchandise), medical and <br />health care services (including payments to corporations). payments to <br />a nonemployee for services. payments made in settlement of payment <br />card and third -party network transactions. payments to certain fishing <br />boat craw members and fishermen, and gross proceeds paid to <br />attorneys (including payments to corporations). <br />S. Mortgage interest pasd by you, acquisition or abandonment of <br />Secured property. cancellation of debt, qualified tuition program <br />payments (under seetion SM. AB LE accounts (under section 529A), <br />IRA, GoverdeiI ESA, Archer MSA or HSA contributions or <br />distributions, and pension distributions. You must give your correct <br />TiN, but you do nut have to sign the certification. <br />What Name and Number To Give the Requester <br />For this type of account: <br />Give name and SSN of: <br />1. Inds, ideal <br />The individuA <br />2. Two or mart ir4jv duals ijoirm 104ot o <br />The actual owner of the account or. <br />other 1F>Sn an account rruinttineo by <br />if combined funds, the first individual <br />an FFI <br />on the 3ccourt1 <br />3. Two or more US Pem0ns <br />Each holder of the account <br />6oint account maintainad by an FFI) <br />4. CuutodiA account of a minor <br />The minor' <br />I73nftim Gift to MkKx:r Act) <br />5. a. Tkc usual ce.ocable savrngs tnrSt <br />The grantor-trusts-e- <br />(grantor is afro <br />b. So-called trust account that * not <br />The actual owner' <br />a legal or valid tnni ,eider state law <br />c. Sole propd4tomlvp or d!sregarded <br />The ovmers <br />entity owned by an ind-idual <br />r, Grantor trust frying -,TK4r Optional <br />The grantor" <br />Filing method t Sset ReguWiors <br />SeUion 1,671 <br />Kittitas County Agreement for Services (rev. 5/14/25) <br />Page 20 of 21 <br />Page 5 <br />For this type of account <br />Give name and EIN of- <br />S. Disregarded Mtity Nt owned by an <br />The owner <br />indivi&ml <br />9. A valid trust, estate, OF pehsuo-n trust <br />Le:o emit.' <br />10. Corporation or LLC electing corpO,ate <br />The coryoratron <br />status on Form SK2 or Form 2553 <br />11. Associatirn, dub. religion.:. chasiiaL4--. <br />Tfie rrgaramtiOn <br />educational, or othx taxaAempt <br />organi=tian <br />12. Partnership or multi-merniser 1L: <br />The pares^. ershp <br />13. A broke, or registered nominee <br />Tre broker or nominee <br />14. Acwta-ft hith the Department of <br />The public entity <br />Agriculture it the runx of s PuWic <br />entity f%zch as a state or iccel <br />g r.wrviterit. whool ?istrm or on-,on't <br />that receives agricdtural program <br />payments <br />15, Grantor trust filing Form 1041 ar <br />Tile trust <br />wider the Optional Filing A Hind 2. <br />re[luirng Farr+ 1098 tsecP49UL tocs <br />section 1.fs71-41.bi(2Ajlft;ij" <br />'List first and circle the name of the person whose number you furnish. <br />If only one person on a joint account has an SSN. that person's number <br />must be furnished. <br />2Circle the minors narne and furnish t.'te rmnor's SSN. <br />3Yore must shovr your individual name on line 1, and enttr yyo�ur business <br />air06A name. if any, on fine 2. You may use a thar your SSN or EIN ',d <br />you have one). but the IRS r"urages you to use your SSN. <br />' List first and circle the name of the trust. estate. or mansion trust. Mo <br />not furnish the TIN of the personal repma ntattve or trustee unless the <br />leg at entity itself is not designatEd in the account title.) <br />Note: The grantor must also provide a Form W-9 to the trustee of the <br />trust. <br />--For morn information on optorral thing mathods for grantor trusts s?a <br />the Instructions for Form 1041. <br />Note_ If no name rs carded htten more than one name is listed. the <br />number will be com &red to 4e tat of the fir=-t nafn- list. <br />Secure Your Tax Records From Identity Theft <br />Identity thatt accurs when someone uses your personal information. <br />such as your name. SSN. or otter idett6iog infarmation. vrittwut your <br />pecmisslon to commit fraud ar other cremes. An identty thief may use <br />your SSN to get a tab or may file a tax return using your SSN to receive <br />a refund. <br />To reduce your risk <br />• Protect your SSN. <br />• E um your employer is protec509 your SSN. and <br />• Be careful when ctwosing a tax return prvloamr. <br />If your tax records are affected by kkritity theft and VW receive a <br />notice from the IRS. resgoryJ right aaay to the name and phone nwnber <br />printed on the IRS notice or letter. <br />If your tax records are hat currently affected by identity theft but you <br />think you are at risk due to a lest or stolen p'os' or wallet, questionable <br />credit card activity, or a quiestionahJe credit report- contact She IRS <br />Identity Theft Hotline at 2t)u-9N -449D or submd Form W39. <br />For more information. sea Pub- 302" tderttily Theft Information for <br />Taxpayers. <br />
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