HomeMy WebLinkAboutFully ExecutedKIfiITAS COUNTY
AGREEMENT FOR SERVICES
This Agreement for Services (hereinafter "Agreement") is entered into by and between Kittitas County
(hereinafter "County"), a political subdivision of the State of Washington, and I Hultz BHU Engineers inc]
(herei naft er "Contractor").
The purpose of this Agreement is as follows: I To provide on-call consulting services relating to Civil,
Structural, Construction Engineering services, and Electrical Engineering Services.l'
The term of this Agreement shall be from the date of execution through I June 2, 2029 with an option of
a 1-year extension.], unless the Agreement is terminated early or its term is extended as provided herein'
The parties' addresses and points of contact for the administration of this Agreement are as follows:
COUNTY CONTRACTOR
This Agreement includes the following, which are attached hereto and hereby incorporated by this
reference:
[ 205 W sth Ave, STE 105 ]
I Ellensburg, WA 98926 ]
I Charlie Smith ]
I Projects Manager ]
IAuditors Office]
I charlie.smith@co.kittitas.wa.us ]
[(sog) s62-7s30]
Attachment "A":
Attachment "8":
Attachment "C,:
Attachment "D":
Attachment "E":
Attachment "F":
Kittitas County Agreement for Services (rev. 5/L4/25)
Page 1 of 19
[ 1111 Fawcett Ave, Suite 100
ITacoma, WA 98402 ]
I Rick Hultz ]
I President ]
Irickh@hultzbhu.com ]
I2s3-383-32s71
Scope of Work
Compensation
I nsu rance Requirements
General Terms and Conditions
W-9 (Contractor must complete and return to the County for payment)
Retirement Status Form (Contractor must complete and return to the County
for payment f Contractor is an individual, as opposed to a corporate business
entity)
CONTRACTOR
Richard Hultz
Printed Name
President
Title
Date: 5-21-2026
Signature
KITTITAS COUNTY
COMMISSIONERS
atr
Date:
rk of the
t
Co
Attest
t
S[.AL
ry
7
lN WTTNESS WHEREOF, this Agreement has been executed by and on behalf of the parties through their
authorized representatives, effective as of the latest date written below.
Kittitas County Agreement for Services (rev. 5/t4125)
Page 2 of 19
ATTACHMENT'A,,
SCOPE OF WORK
ITo Provide on-call Engineering and consulting services for Kittitas county]
Kittitas County Agreement for Services (rev. 5/L4/251
Page 3 of 19
ATTACHMENT,,B,,
COMPENSATION
THE COUNTY WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL
CoNTRACTOR SUBMITS A COMPLETED W-9 (SEE ATTACHMENT "E").
As fullcompensation for satisfactory performance of the work described in Attachment"A", and within
thirty (30) days of receiving Contractor/s itemized invoice, the County shall pay Contractor the following
amount(s) plus any applicable taxes as detailed in Contractor's attached itemized pricing sheet.
. Hourly rates are per the firm's fee schedule, effective October L,2025, and are subject to annual
adjustment each October. Any adjustment requires written notice and mutual written consent prior to
implementation.
The County provides no guarantee that projects will become available.
Kittitas County Agreement for Services (rev. 5/L4/251
Page 4 of 19
HUl;zHBHU
engineers ino
HOURLY BILLING RATES
Principal
Associate Principal
Senior Engineer ll
Senior Engineer I
Senior Project Manager
Project Engineer ll
Project Engineer I
Project Manager
Senior Designer
Project Designer
CAD Technician
Clerical
REIMBURSABLE RATES
Printing Drawings (Bond, B&W)
Printing L1x17 (Bond, B&W)
Printing 8.5x11 (Bond, B&W)
Mileage
Delivery/Courier
Outsourced & Other Expenses
s 2so.o0
s 22s.oo
s 190.00
518o.oo
s 17s.00
s L60.oo
S 1so.oo
s 1s0.00
s 130.00
s 12o.oo
s 110.00
S as.oo
o.so s/sF
0.38 5/Page
0.28 S/Page
0.725 S/mile
At Cost, Plus 10%
At Cost, Plus 10%
1111 fawcett avenue, suite 100 . tacoma, washington 98402
ph.253.383.3257 . t.253.383.3283 r general@hultzbhu.com
ATTACHMENT "C"
INSURANCE REQUIREMENTS
Contractor shall secure and maintain in effect at all times during performance of work under this
Agreement such insurance as will protect Contractor, its employees, and agents from all claims, losses, harm,
costs, liabilities, damages and expenses arising out of Contractor's performance underthis Agreement, including
but not limited to personal injury (including death) or property damage'
All insurance shall be issued by companies admitted to do business in the State of Washington and have
a rating of A-, Class Vll or better in the most recently published edition of Best's Reports unless otherwise approved
by the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies
must comply with Chapter 48.15 RCW and 284-15 WAC.
At a minimum, Contractor shall maintain and provide proof of the following selected options:
Commercial General Liabilitv lnsurance
r Coverage limits not less than:
. SL,000,000 per occurrence, for all covered losses
o $2,000,000 general aggregate
. S1,000,000 products & completed operations aggregate
. 51,000,000 personaland advertising injury, each offense
r The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds.
X Commercial Automobile Liabilitv lnsurance
r Automobile Liability for owned, non-owned, hired, and leased vehicles, with an MCS 90
endorsement and a CA 9948 endorsement attached if 'pollutants' are to be transported
r Coverage limits not less than:
o $1,000,000 combined single limit
Excess or Umbrella Liabilitv
r Contractor shall provide Excess or Umbrella Liability coverage of 55,000,000. This Excess
or Umbrella Liability coverage shall apply, at a minimum, to both the CommercialGeneral
and Automobile lnsurance policy coverages. lf used to meet limit requirements, coverage
must be at least as broad as specified for underlying coverages, and must cover those
insured in the underlying policies.
. This requirement may alternatively be satisfied through Contractor's primary Commercial
General and Automobile Liability coverage, or any combination thereof.
r The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds.
r Coverage shall be "pay on behalf", with defense costs payable in addition to policy limits'
r There shall be no cross liability exclusion precluding coverage for claims or suits by one
insu red against another.
Workers' Comoensation & Emplover's Liabilitv
r Contractor shall provide Workers Compensation and Employer's Liability insurance on a
state-approved policy form providing benefits as required by law with employerrs liability
limits no less than S1,000,000 per accident or disease'
Kittitas County Agreement for Services (rev. 5/!4/251
Page 5 of 19
Professional Liabilitv / Errors and Omissions Liabilitv
' Coverage limits not less than:
r $1,000,000 each claim
r Contractor must provide evidence of this coverage on a policy form appropriate to
Contractot's profession.
n I Other insurance coverage as deemed appropriate by either the County Risk Manager or
the assigned Deputy Prosecuting Attorney. Additional lnsurance types which the County may
need to require (non-exhaustive list): Cyber, Pollution, Aircraft, Watercraft, Liquor, Crime/
Fidelity, Sexual Abuse & Molestation, Jones Act, Longshoremen/Harborworkers, Marine. ]
Contractor shall furnish to the County a Certificate of lnsurance, with endorsement where
required above, as evidence that policies providing insurance required by this Agreement are in full force
and effect. Contractor's insurance policies required above must apply on a primary non-contributing basis
in relation to any other insurance or self-insurance available to the County.
Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any
material alteration or non-renewal, of any of the above-required insurance coverages.
Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any
tools, machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's
agents, employees, suppliers or contractors, as well as to any temporary structures, scaffolding andlor
protective fences.
Contractor shall have sole responsibility for ensuring the insurance coverage and limits required herein
are also obtained by any subcontractors.
NOTE: Notwithstanding any other provision(s) of this Agreement, no contract shall form under this Agreement
until and unless the following are provided to the County: (1) a copy of the Certificate(s) of lnsurance with all
required endorsements, properly completed and in the amounts required, and (2) where requested by the County,
a copy of the required insurance policies, including all required endorsements.
ATTACHMENT.,D,,
GENERALTERMS AND CONDITIONS
1. Scope of Contractor/s Services: Contractor agrees to provide to the County services as set forth in
Attachment "A". No materials, labor, or facilities will be furnished by the County, unless othenruise provided
herein. All work performed under this Agreement shall comply with applicable laws and regulations.
2. Accounting and Pavment: Compensation to Contractor for services rendered under this Agreement
shall be as set forth in Attachment "B". Where Attachment "8" requires payment(s) by the County, payment shall
be based upon billings, supported unless provided otherwise in Attachment "B", by documentation of units of
work actually performed and amounts earned, including, where appropriate, the total number of hours for the
month and the total dollar payment requested. Unless specifically stated in Attachment "8", the County will not
reimburse Contractor for any costs or expenses incurred by Contractor in performance of this Agreement. Where
required, the County shall, upon receipt of appropriate documentation, compensate Contractor, no more often
tha n month ly, th rough the Cou nty voucher system, for Contractot's services pu rsua nt to the fee sched u le set forth
in Attachment "8". ln the event Contractor fails to perform any of its obligations under this Agreement within the
time specified herein, then the County may withhold all monies due and payable to Contractor until such failure
to perform is cured or otherwise adjudicated. The County will not process payment for services rendered under
this Agreement until Contractor submits a completed W-9 (See Attachment "E").
3. Taxes: Contractor understands and acknowledges that the County will not withhold Federal or State
income taxes from payments made to Contractor. Where required by State or Federal law, Contractor authorizes
the County to make withholding for any taxes other than income taxes (e.g., Medicare). All compensation received
by Contractor will be reported to the lnternal Revenue Service at the end of the calendar year in accordance with
applicable IRS regulations. lt is the responsibility of Contractor to make its necessary estimated tax payments
throughout the year, if any, and Contractor is solely liable for any tax obligation arising from Contractor's
performance of this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired hereunder as required by
law. Contractormustpayallothertaxes,includingbutnotlimitedto:businessandoccupationtax;ortaxesbased
on (1) Contractor/s gross or net income, or (2) personal property to which the County does not hold title' The
County is exempt from federal excise tax.
4. Independent Contractor: Contractor's services shall be furnished by Contractor as an independent
contractor, and nothing stated herein shall be construed to create a relationship of employer-employee or a
guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement
is specified in Attachment "8", and that Contractor is not entitled to any County benefits, including but not limited
to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights or
privileges afforded to Kittitas County employees.
5. Assignment and Subcontracting: This Agreement may not be assigned or subcontracted in whole or
in part without the express prior written approval of the County'
6. Right to Review; Maintenance of Records: This Agreement is subject to review by any Federal or State
auditor. The County or its designee shall have the right to review and monitor the financial and service
components of the work performed under this Agreement by whatever means are deemed expedient by the
County. Such review may occur with or without notice, and may include, without limitation, on-site inspection,
inspection of all records or other materials which the County deems pertinent, and any and all communications
withorevaluationbyservicerecipientsunderthisAgreement. Contractorshall preserveandmaintainall records
Kittitas County Agreement for Services lrev. 5/L4/251
Page 7 of 19
relating to this Agreement for six (6) years after termination or expiration of the Agreement, and upon request
shall make them available for review by any Federal or State auditor, the County, and/or any persons authorized
by the County.
7. Modification
7.L. This Agreement may be amended by mutual agreement of the parties. Any such amendment
shall be in writing and signed by both parties.
7.2 The County may unilaterally amend this Agreement at any time by written notice ("Change
Notice") to Contractor, to modify the work to be performed under this Agreement, within the general scope of
the Agreement. Such changes may include, but are not limited to, changes in the exact scope of work to be
performed (including modification, substitution, addition, or deletion of required tasks) and changes to the
schedule of performance. lf any such Change Notice causes an increase or decrease to Contractor's cost of, or the
time required for, performance of the wor( an equitable adjustment in the compensation to Contractor and/or
in the schedule for the performance of the work shall be made by the County to reflect such an increase or
decrease. Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable adjustment,
Contractor shall proceed in accordance with all Change Notices. Within thirty (30) days after receipt of any Change
Notice which, in Contractor's opinion, lacks an adequate adjustment, Contractor must submit to the County a
written statement requesting a modified adjustment; othenruise, Contractor will forfeit its right to any such
modified adjustment. The County retains the final right to determine adjustments hereunder.
8. Termination
8.1- This Agreement may be terminated at any time by mutual written agreement of the parties'
8.2 The County, by giving written notice, may terminate this Agreement at any time without cause
and without further obligation to Contractor except for payment due for deliverables provided and/or services
performed priorto the effective date of termination. An equitable adjustment in the contracted price for partially
completed tasks will be made by the County, but such adjustment shall not include compensation for loss of
anticipated profit on uncompleted work.
8.3 lf Contractor defaults by failing to perform any of its obligations under this Agreement, or
becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes an assignment
for the benefit of creditors, the County may, by written notice to Contractor, terminate the Agreement, and at
the County's option, obtain performance of the work elsewhere. lf the Agreement is terminated under this
paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all of its
obligations hereunder have been fully performed, and any extra cost or damage to the County shall be deducted
from any money due or coming due to Contractor. Furthermore, in the event of termination underthis paragraph,
Contractor shall bear the costs of any extra expenses incurred by the County in completing the work, and all
damages sustained, or which may be sustained, by the County.
8.4 Termination of this Agreement by any means provided herein shall not excuse any party's
performance of its obligations hereunder through the effective date of termination, except that the County shall
not be obligated to pay for services that have not been performed or deliverables that have not been provided.
9. lndemnification
9.1 To the fullest extent permitted by law, Contractor agrees to indemnify, defend and hold the
County and its departments, elected and appointed officials, employees, agents and volunteers, harmless from
Kittitas County Agreement for Services (rev.5/14/251
Page 8 of 19
and against any and all claims, damages, losses and expenses, including but not limited to court costs, attorney's
fees and alternative dispute resolution costs, for any personal or bodily injury, sickness, disease or death, for any
damage to or destruction of any property (including the loss of use resulting therefrom), and for any other claims,
damages, losses, and expenses sustained by the County, which (1) are caused in whole or in part by any act or
omission, negligent or otherwise, of Contractor, its employees, agents or volunteers, or Contractor's
subcontractors, their employees, agents or volunteers; or (2) are directly or indirectly arising out of, resulting
from, or otherwise connected with the performance of this Agreement; or (3) are based upon Contractor's or its
subcontractors' use of, presence upon or proximity to the property of the County. This indemnification obligation
of Contractor shall not apply in the limited circumstance where the claim, damage, loss or expense is caused by
the sole negligence of the County. This indemnification obligation of Contractor shall not be limited in any way by
the Washington State lndustrial lnsurance Act, RCW Title 51, or by application of any other workmen's
compensation act, disability benefit act or other employee benefit act, and Contractor hereby expressly waives
any immunity afforded by such acts. The foregoing indemnification obligations of Contractor are a material
inducement to the County to enter into this Agreement, are reflected in Contractor's compensation, and have
been mutually negotiated by the parties.
g.2 The County reserves the right, but not the obligation, to participate in the defense of any claim
for damages, losses or expenses, and such participation shall not constitute a waiver of Contractor's indemnity
obligations contained in any section of this Agreement.
9.3 ln the event Contractor enters into subcontracts to the extent allowed under this Agreement,
each such subcontractor shall indemnify the County on a basis equal to or exceeding Contractotrs indemnity
obligations to the County.
10. Venue and Choice of Law: ln the event that any litigation should arise concerning this Agreement,
the venue for such action shall be in the Superior Court of the State of Washington in and for the County of Kittitas.
This Agreement shall be governed by the laws of the State of Washington.
11. Non-Appropriationof Funds:lftheCountydoesnotappropriatesufficientfundingforthisAgreement
for any future fiscal period, the County will not be obligated to make payments for services performed after the
end of the last fiscal period for which sufficient funding was appropriated. No penalty or expense shall accrue to
the County in the event this provision applies.
L2. ContractorCommitments, Warranties. and Representations: Contractor represents and warrants as
follows
L2.l Contractor is duly incorporated, validly existing and in good standing under the laws of the State
of Washington, and has all requisite corporate power and authority to enter into and to perform its obligations
under this Agreement.
!2.2 Contractor has the authority to execute this Agreement, to make the representations and
warranties set forth herein, and to perform its obligations hereunder.
I2.3 This Agreement has been validly executed by an authorized representative of Contractor and
constitutes a valid and legally binding and enforceable obligation of Contractor.
L2.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses,
permits and other authorizations from federal, state and local governmental authorities, or from any applicable
industrial or professional certification or licensing bodies, as are necessary for the lawful performance of its
obligations under this Agreement, and will maintain such throughout the term of this Agreement.
Kittitas County Agreement for Services (rev. 5lt4/25l'
Page 9 of 19
L2.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of
which willor may materially affect Contractor's abilityto perform its obligations underthis Agreement. Contractor
is not subject to any order or judgment of any court, tribunal or governmental agency which materially and
adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under
this Agreement.
12.6 Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency'
L2; None of the representations or warranties in this Agreement, and none of the documents,
statements, certificates or schedules furnished by Contractor in connection with the performance of the
obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact
or omits or will omit a material fact necessary to make the statements of fact contained therein not misleading.
13. Ownership of ltems Produced: All writings, programs, data, reports, films, recordings, or other
materials prepared by Contractor and/or its consultants or subcontractors, in connection with the performance
of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of
ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the
ability to transfer any or all ownership rights.
14. Intellectual Propertv lnfrinsement: Contractor will defend and indemnify the County from any
claimed action, cause or demand brought against the County, to the extent such action is based on the claim that
information and/or materials supplied by Contractor infringe any intellectual property rights of any third
party(ies). Contractor will pay all costs and damages attributable to any such claims finally awarded against the
County in any action. Such defense and payments are conditioned upon the following: (1) Contractor shall be
notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right
hereunder, at its option and expense, to obtain forthe County the right to continue using the information and/or
materials that are the subject of such claim, provided no reduction in performance or loss results to the County'
15. Use of Countv Name and Loso: Contractor may not use the County's name, logo(s), trademark(s), or
other identifying information, or identify the County as a current or former client, on its website or in any
marketing or promotional materials without the prior written consent of the County.
' 16. Disputes: Any dispute between the parties arising under or relating to this Agreement shall be
resolved informally if possible. However, in the event such a dispute cannot be so resolved, it shall be adjudicated
by a dispute board ("Dispute Board") in the following manner: Each party shall appoint one member to the Dispute
Board, the members so appointed shall jointly appoint an additional member to the Dispute Board, and the
Dispute Board will evaluate the facts, Agreement terms, and all applicable statutes and rules, and make a
determination as to the proper resolution of the dispute. Such determination shall be final and binding on both
parties. The cost of resolution will be borne as allocated by the Dispute Board. Alternatively, if agreed to in writing
by both parties, the parties may forego the option of establishing a Dispute Board to adjudicate the dispute, and
instead pursue arbitration, jointly selecting an arbitrator acceptable to both parties. ln the event the parties
choose to pursue arbitration, the parties agree that: (1) the fees and expenses of the arbitrator shall be shared
equally by both parties to this Agreement, (2) each party shall bear its own costs and attorney fees, (3) arbitration
shall be conducted according to the commercial arbitration procedures of the American Arbitration Association,
and (a) the arbitrator's decision or award shall be final and binding on both parties.
!7. Confidentialitv: Contractor, its employees, agents and volunteers, and any of Contractor's
subcontractors and their employees, agents and volunteers, shall maintain the confidentiality of all information
Kittitas County Agreement for Services (rev. 5/t4/251
Page 10 of 19
provided by the County or acquired by Contractor in performance of this Agreement, except upon the prior
written consent of the Kittitas County Prosecuting Attorney or an order entered by a court after having acquired
jurisdiction over the County. Contractor shall immediately provide the County notice of any judicial proceedings
seeking disclosure of such information. Contractor agrees to indemnify, defend and hold harmless the County
and its departments, elected and appointed officials, employees, agents and volunteers from all loss or expense,
including but not limited to settlements, judgments, setoffs, attorneys'fees and costs resultingfrom Contractor's
breach of this provision. Notwithstanding the foregoing, and to the extent that any information obtained by the
Contractor hereunder is required to be shared with others by the explicit terms of the Scope of Work, this
provision shall not be construed as prohibiting such sharing, provided there are no applicable laws or regulations
prohibiting same.
18. Notices: Written notices required or permitted to be provided by one party to the other party under
this Agreement may be provided by personal delivery, legal courier service, or certified mail, postage prepaid and
return receipt requested. Notice may be provided by regular first class mail if simultaneous notice is provided by
email. Notices given by Contractor shall be provided to the County's point of contact listed on page 1 of this
Agreement, at the address there listed, and to the department head of the county department for which services
under this Agreement are rendered. Notices given by the County shall be provided to Contractor at Contractor's
address listed on page 1 of this Agreement.
19. Prevailine Waee: Where laborto be performed under this Agreement is considered "public work" as
defined in RCW 39.04.010, Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics
employed in the performance of work under this Agreement in accordance with RCW 39.12 and the rules and
regulations of the Washington State Department of Labor and lndustries. The schedule of prevailing wage rates
for the applicable locality or localities is determined by the lndustrial Statistician of the Department of Labor and
lndustries. lt is Contractor's responsibility to verify the applicable prevailing wage rate. lt is understood that
Contractor is responsible for obtaining and completing all required government forms relating to prevailing wage
and submitting same to the proper authorities. Disputes regarding prevailing wage rates shall be referred for
arbitration to the Director of the Department of Labor and lndustries. The arbitration decision shall be final and
conclusive and binding on all parties involved in the dispute as provided for in RCW 39.L2.060'
20. Standard of Care: Contractor shall perform its duties hereunder in a manner consistent with that
degree of care and skillordinarily exercised by members of the same profession or industry as Contractor currently
practicing or working under similar circumstances. Contractor shall, without additional compensation, correct any
of its services not meeting such a standard.
21. Nondiscrimination
2l.L ln the performance of this Agreement, Contractor will not discriminate against any employee or
applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration
status, sex, sexual orientation, marital status, honorably discharged veteran or military status, orthe presence of
any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a
disability; provided that the prohibition against discrimination because of such disability shall not apply if the
particular disability prevents the proper performance of the particular worker involved. Contractor shall ensure
that applicants are employed, and that employees are treated during employment, without discrimination
because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation,
marital status, honorably discharged veteran or military status, orthe presence of any sensory, mental or physical
disability or the use of a trained dog guide or service animal by a person with a disability. Such requirements
apply, without limitation, to the following: employment, promotion, demotion, transfer, recruitment or
recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and programs for
Kittitas County Agreement for Services (rev. 5/L4/251
Page 11 of 19
training, including apprenticeships. Contractor shall take such action with respect to this Agreement as may be
required to ensure full compliance with local, state and federal laws prohibiting discrimination in employment.
2L.2 Contractor will not discriminate against any recipient of any services or benefits provided for
under this Agreement on the grounds of age, race, creed, color, national origin, citizenship or immigration status,
sex, sexual orientation, marital status, honorably discharged veteran or military status, or the presence of any
sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a
disability.
2I.3 lf any assignment and/or subcontracting has been authorized by the County, said assignment or
su bcontract shall include appropriate safeguards against discrimination.
22. Waiver: The waiver of any default or breach of this Agreement, or the failure of a party to enforce
any provision hereof or to exercise any right or privilege hereunder, shall not be deemed to waive any prior or
subsequent default or breach, the enforcement of any provision hereof, or the exercise of any right or privilege
hereunder, unless otherwise stated in a writing, signed bythe parties hereto.
23. Headings: The headings of sections and paragraphs of this Agreement are for convenience of
reference only and are not intended to restrict, affect, or be of any weight in the interpretation or construction of
the provisions of such sections or paragraphs.
24. Survival: The provisions of paragraphs 2,3, 4, 6,8, g, lO, !3, 14, L5, 16, 17, 19,20,22,24, and 28 of
these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this
Agreement for any reason.
25. Complete Agreement: This Agreement constitutes the entire agreement between the parties and
supersedes any and all other agreements, understandings, negotiations and discussions, oral or written, express
or implied, regarding the work to be performed hereunder. The parties agree that no other representations,
inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made
between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this
Agreement shall be valid or binding unless in writing and signed by the parties'
26. Severabilitv: lf any term or condition of this Agreement or the application thereof to any person(s)
or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can
be given effect without the invalid term, condition or application. To this end, the terms and conditions of this
Agreement are declared to be severable.
27. Time: Time is of the essence in the performance of this Agreement unless otherwise agreed between
the parties in a signed writing.
28. Construction: This Agreement has been mutually reviewed and negotiated by the parties, and should
not be construed against the drafter.
29. Aereement Not for Benefit of Third Parties: This Agreement is entered into solely for the benefit of
the parties hereto and vests no rights in, nor is it enforceable by, anythird parties.
Kittitas County Agreement for Services (rev. 5/M/25)
Page 12 of 19
ATTACHMENT,.E,,
Form W.9
(Rev. March 2024)
!Request for Taxpayer
ldentification Number and Gertification
Go lo www.lrs.govtFormWgtot instructions and lhe latest info'rmafion.
Give form to the
requester. Do not
send to the IRS.D<,partmont ofthe
lritemal R@venue
Trnasury
SeryiC8
3a Check lhe appropriate box lorfederaltax classili€tion of ihe en ryindlvidoal\ryhosen e is enlered on line 1. Check
only one of tm. fQ!lowhg seven boxes.
fl {ndlvjdluallso.e prcpriotor fl G co.pomtlorl fi s orpomtion I P-artocnhip E TrustJestate
! LLC. Enlerlholru<classifcalioniC= Coorporatlon,s= Ssorporation,P= Partnership)
Note: Check tl\e "LLC. box above a0d, ln lha entry space, enter the appropriate code [C' S, o, P] Jorlha tax
das6ifcationoftheLLC,unlessitisadiweqarded'eniiv.Adisregard en$tyshouldinsteadchecktheSJ)proprlate
box for the lax classificalion ofitg owrlgr-
ln
Sb lf on llne 3a you checked "iPartne6hEp." or "Trusuestate," o. checkedwlLc" and entored .P" as its tax classificatiol'1,
and yOUi me provlding tlris fo to a parlneGhip, trust, or os.tale in which you have an owne6hip lnterost. tlieck
U,ls box i'f you haveany foreign partners, owners, or beneficiades See lnslruciions
no.). See
100
Iile instructions.ofAdcl.es,Mdslreet,(numbe apt.
iteSu1Fawcett
6 city, stale, aml z{P @de
Tacoma WA 98402
t Name,ofentity/lndlvidoal,,Ansntryisrequired,(fofasoreproprietorordisregardedelrilllr.€nterlhemimer'snamoonlinel,andenterlhebusiness/dlsregaded
entitv's name on line 2.i
Hultz BHU Engineers, lnc.
related to lhe of Form
2 Business.name/disrngardedl0lltMl:y name. if difBrRilt kom above,
I Signatur.t ot
ei
0r
o;
CL
c
o
Ll-I4)
4 Exomplor,s {ccdGSapply onlyto
certain enlities, nol !n-dYvidllais:
see lnstroctktris on page 3):
Exempl payee oode (ii any)
tfl;
-.u.h
Exemplionlr.om
ComplianceAct
code (if any)
Foreign AccountTax
(FATGA) roporting
{Apqli..: s to:?c e Je m intti!_illc)
oulside lhe United Slates.)
Requ6siefs name ilrel address (oplionaQ
7 i.Jsl aeounlr>omoori(s)here(optionaij
Enter your TIN in the appropriate box. The ilNl provided must matclh tihe 1 lame givel 1on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However' for a
resident alien, sole proprieto:r, ordisregarded entity, see lhe instructions for Pa.ri l, later. For olher
entlties, it is your employer identification number (ElN). lf you do not have a nutnber, see How to gef a
7/N, later.
Note: tf the account is il lmore.than one name, see the instructions for limi 1. See also Whal Atame and
Number To Givethe Reguesfe/'for guidelines on whose number to enler'
Soclal numb€t
IISII certification
Under penalties of periury, I certiify that:
1. The number shown on thisform is mycotrect taxpayer identif,cation number (or I am walting for a numberto be issued to me); and
2. I am not sub,ject lo backup withholding because (a) I am exempt from backup withholding. or (b) I have not beer, notified by the lnternal Revenue
Service (lRS) that I am sub.lecl to backup withholding as a result of a lailure to report all interest or dividend's, or (o) the IRS has notified me that I am
no longer sub.iect to backup withholding; atld
3. I am a U-S. citizen or other U.S. person {deNned below), and
4. The FATCA code(s) enlered on lhis form Ql any) indicaling that I am exempt from FATCA reporting is conect.
Certification insltuctiions. You must cross out ilem 2 above if you have been notified by the IRS ihat you are cilnently subject to backup withholding
because you have failed lo report ali interest and dividendson yourtd relum. Forreai eslate transactions, ilem 2 does not apply. Formortglage interest paid'
acquisition orabandonmen.t of sedred prope8, cancellation of debt. contributions to an individualretirement anangemellt (lRA), and, generally. payments
-olher lhan interest anat dividen.ls volr aG not reouimd to sion lhe cerlifietion bul voi ' nnrsl orovide vot,r coreci TIN Smlhe inslnrclions lor Parl ll laler.
91-1282644
I Fml>l6var'i.lantilir:lion nl,mDea
Sign
Here Dal ..5-zl-2026
General lnstructions
Section referefices are to lhe lnternal Revenue Code unless othetwise
no.ted.
Future developments. For the latest infolmaiion about d'eve'lopments
related lo Form W-9 and its instructions, such as legislation enacled
after they were published, golo www.irs.gov/Formwg,
What's New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate bo.x for the tax classification of lls owner. Otherwise, il
should check the "LLC"'box and enter its appropriate {ax classificalion.
New line 3b has been addedl to this form. A flow-ihrough entity is
required to complete this Ii e to indjcate that it has direcl orilrdirect
foreign partners, owners, or beneflcia:-ies when rt provides the Form W-9
to anoiher tlow-lhrm,gh e 1 l ily in which it has an ownersh,ip interest. This
chang,e,s intended to provide a tlow-lhrough entiiy with information
regardino lhe status of its i direct lor.eign partners, owners, or
beneficiaries, so lhat lt can satisfy any applicable .eporting
requirements.. For example, a partnership that has any indirect foreign
parlners may be required to complete Schedules K- 2 and K-3, See the
Partnership lnsbructions for Schedules K-2 and K-3,(Form 1065).
Purpose of Form
An indivl:dual ore lily (Form W-9 reque$ler) who ls required to file an
infornration rettl m with lhe IRS is giving you this form because they
cd fb. 10231x
Kittitas County Agreement for Services (rev. 5/L4l25l
Page 13 of 19
Fom W-9 {Rev 3-2024)
Formw-g {Rev. 3-2024}Page2
must obiain your oorrect taxpayer identrificatrion rmmber {TlN}, which
may be your social securiiy number (SSN), individual taxpayer
identification number (lTlN), adoptrion taxpayer ide11 ltilication number
(ATIN), or employer identifioation number lalN), to report 0111 an
information re:tum the amount paid to you, or other amount reportable
on an intormation retum. Examples ol information retums include, but
are not limited to, the following.
. Form i0gSlNT:.j11lterest eamed orpaid).
. Form 1099-DlV (dividends, including those from stocks or mutual
funds).
. Form 1 099-MISC (various types of income, prizes. awatds, or gross
prooeeds),.
. Form i099-NEC (1'llonemployee oompensation).
. Form 1 099-8 (stock or mutual fu 1 1 1 d sales and certain other
transactions by brokers).
. Form 1099-5 (proceeds from real estate transactions).
. Form 1099-K (merchant card and third-party network tralllsactions).
. Form 1098 (home mortgage interest), '1098-E (student loan interest),
and 1098-T (tuition).
. Form 1099-C (canceled debt)..
. Form 1099-A (acquisition or abandonment of secured propertyl.
Use !'orm \^F9 only if you are a U.S. perso111 l..including a resident
alien),, to provide your correct TlN.
Cautiol 1 1: lf you don't return Form W-9 to the requester with a TllNl, you
might be subject to baokup withholding. See Wf,at is backup
withholding,laler.
By signing the filled-out form, you:
1. Certi6/ that the TIN you are giving is correct (or you are waiting fior a
numberto be issued);
2. Certify that you are not subject to backup withholding; or
3. Claim exem ption from backup withholding if you are a U.S - exem pt
payee:,and
4. Certify to your non-foreign status for purposes of withholding under
chaptter 3 or 4 of the Code Gd applicable); and
5. Certify that FATCA code(s) entered on this form i f any) indicating
that you are exempt irom the FATCA reporting is correct. See What ls
FATCA Repofting, later, for further information.
Note: lf you are a U.S. person and a requester gives you a form otrher
than Form W-9 to request your TlN, you must use the requesteis form if
it is substantially similar to this Form W-9.
De-i1 1 l ition of a U.S. persol l 1 . For federal tax purposes, you are
considered a U.S . person if you are:
. An individual who is a U.S. cilizen or U.S. resideni alien;
. A partnership, corpo€tion. company, or association created or
organized in ti.e United States or under the laws of the U 1 1 l ited States:,
. An estate (otherthal lalforeign estate),; or
. A domestic trust (as defined in Regulations section 301.7701-7),.
Establishil 1 1 g U.S. statl lls for purposes of chapter 3 and chapter 4
withholdil llg. Payments made to foreign persons, including certain
di&tributions, allocations of income, or transfers of sales prooeed6, may
be sub.ject to withholdil 1 1g under chapter 3 or chapter 4 of the Code
(sections i441-1474). Under those rules, if a Form W-9 or other
certifioatiol 1 01 1 non-foreign status has not been received, a withholding
agent, transferee, or partnership (payo: -generally applies presumptiol 1 1
rules that may require the payor to withhold applioable tax from the
recipient, owner, tra 1 1 1 sferor, or partner (payee). See Pub. 5 1 5,
Wlhhdding ol Tax 01 1 1 No1 1 1 resident Aliens and Foreigl 1 1 Enkities.
The following persons musl provide Form Wog to the payor for
purposes of establishing its non-foreign status.
. ln the case.of a disregarded entity with a U.S. owner, the U.S. owner
01the disregarded entity and nol ti e disregarded enlity.
. ln the case of a grantor trust with a U.S. grantor or olher U.S. owner,
generally, the U.S. grantor or other U.S. c /v1 1 1er of lhe grantor trust and
not the grantor trust.
. ln the case,of a U.S. trust (other than a grantor trust), the, U.S. trust
and not the beneficiaries of the trust.
See Pub. 515 for more information on providing a Form W-9 or a
cerlifioatiol 1 1 01non-foreign status to avoid withholding.
Kittitas County Agreement for Services (rev. 5l14/25].
Page 14 of 19
Foreign person- lf you are a foreign person or trhe U.S. branch of a
foreign bank lhat has elected to be treated as a U.S. person (under
Regulations section L1441-1(brt2)(iv) or other applicable section for
oha,pter 3 or 4 purposes), do not use Form W-9. lnst,ead, use the
appropriate Form W-8 or Form 8233 (see Pub. 515). lf you are a
qualified foreign pensiol 1f1und u'l 1 lder Regulations section 1.897(1I1 ,(d)' or
a partnership that is wholly owned by qualified foreign pension funds.
that is treat.ed as a non-foreign person for purposes of sectiol 1 1 1445
withholdil 1 1 g, do nol use Form W-9. lnstead, use Form W-8EXP (orother
oertificatiol 1o1f non-foreign status).
Nonresident aHen who becomes a resident aliel 1 1. Gel l l erally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
oreliminate U.S. lax on certain types of income. However, mosttax
treaties contain a provision known as a saving clause. Ixceptions
specilied in the saving clause may permrtan exemption from tax to
oontil 1 I ue for ceriain types of income even after the payee has otherwise
become a U.S. resideni allen fortax purposes.
lf you are a U.S. resident alien who is relying on an exceplion
contained i111 the,savil 1 1g clause of a tax treaty to claim an exemption
from U.S. tax 0111 certain typ€s of inoome, you must attach a statemel 1 1t
to Form W-9 that specifies the,following five items.
1. Th.e treaty country. Generally, this must be the same treaty under
which you claimed exemption trom tax as a nonresident alien'
2. The treaty article addressing the income.
3. The article number (or location) in the tax trreaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies /or the exemptiol 1 1
from tax.
5. Sufficient facis to justify the exemptiol 1f '1rom tax underthe terms of
the treaty article.
Example. Article 20 01the US+i111aincome tax treaty allows an
exemption from tax for scholarship income received by a Oi111e
$L*lllttemporarily present in tl€Unit.ed States- Under U.S.law, this
${.*111twill become a resident alien fortax purposes if their stay i111 the
United Stat.es exceeds 5 calendar years. However, paragraph 2 of the
first Protocol to ihe U.S.'-China treat,y(dated April 30, 1984) allows the
provisions OlArticle 20 to continue to apply even after the Chinese
drdel1lt becomes a resident alien of the United States- A Chinese
sr-*1111who qualilies tor this exoeption (under paragraph 2 of lhe first
Protocol) and is relying on ihis exception to claim an exemption from tax
on their scholarstiip or fellowship income would attach to Form W-9 a
statement that includes ltieinformation described above to support that
exemption.
lfyou are a no'l I lresident alien ora foreign entity. give the requester the
appropriate compleied Form W-8 or Form 8233.
Backup Withholding
What is baclkup withholding? Persons making certain payments tro you
must under certain conditions withhold and pay to the IRS 24% of such
payments. This is called "backup withholding."' Payments that may be
subiect to backup wilhholding include, but are not limited to, interest'
tax-exempt interest, dividel 1 1 ds, broker and barter exchange
transactions, rents, royalties, nonemployee pay, paymenis made in
settlemento't paymentr card and third-party network transaotions, and
certain payments lrom fishing boat operators. Real estate transactions
are no:t subject to backup withholding.
You will not be subject to backup withholding on paymenls you receive
if you give the requester your correct TlN, make the proper oertifications,
and ileport all your taxable interest and dividends on you r tax return.
Payments you receive will be subject lio backup withholding if:
1 . You do noi furnish your TIN to the requester;
2. You do not certify yourTlN when required (see lhe instrlJotions for
Part ll for details);
3. The IRS tells ltie requester that you furnished an,inconectlllN:
4. The IRS tells you that you are subject to backup withholding
because you did 1 1 1ot report all your interest and dividends on yourtax
retum (for reportable interest and dividelllds only); or
5. You do not certify to lhe requester lhat you are not subiect to
backup withholding, as described in item 4 underagy signing the filfed-
out form" above (for reportable interest and dividend accounts opened
after 1983 only).
Form Wg {elev.3-2024i Page3
Certain payees and payments are exemptfrom backup withholding.
See Exempf payeecode, lat€r, and the separale lnstructions for the
Requester of Form W-9 for more information.
See also lsfabllshlng U. S. status for puryoses of chapter 3 and
chapter 4 withholding. earlter.
What ls FATCA Reporting?
The Foreign Account Tax Compliance Act {FATCA) requires a
participating foreign financial institution to report all U.S. aooount
holders that are specified U.S. persons. Certain payees are exempt from
FATCA reporting. See Exemption from FATCA reporting code, later, and
the lnstructions for the Requester of Form W-9 for more information.
Updating Your lnformation
You must provide updated information lo any person to whom you
claimed lo be an exempt payee lf you are no longer an exempt payee
and anticipate receiving reportable payments in tlle future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you are
no longer tax exempt. ln addition, you must furnish a new Form W-9 if
the name or TIN changes for the account, for example, if the granlor of a
grantor trusl dies.
Penalties
Failure lo furnish TlN. li you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless yourfailure is due to reasonable cause and notto willful neglect.
Civil penalty for false information with respect to withholding. lf you
make a false statement with no reasonable basis tllat results in no
backup withholding, you are subject to a $500 penalty.
Criminal penalty tor falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TlNs. lf tlle requester discloses or uses TlNs in violation of
federal law, the requester may be subject to civiland criminal penalties.
Speciific lnstructions
Line 1
You mustenter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
lf this Form W-9 is for a Joint account (other than an account
maintained by a foreign financial institution (FFQ), list first, and then
circle, lhe name of the peason or entity whose number you entered in
Part I of form W-9. lf you are providing Form W-9to an FFlto document
a joint aocount, each holder of the account lhal is a U.S. person must
provide a Forrn W-9.
,lndividual-Generally, enter the name shown on your tax retum. lf you
have changed your last name witlout informing the Social Security
Administration (SSAI of the name change, enter your l iirst name, the last
name as shown on your social security catd, and your new las! name.
Note for lTlN applicant: Enter your individual name as it was entered
on your Form W-7 application, line 1a. This should also be the same as
the name you entered on the Form 104!0 you filed with your application.
. Sole proprietor. Enter your individual name as shown on your Fbrm
1O4O on line 1. bnleryourbusiness, trade. or"doing business as" (OBA)
name on line 2.
. Partnership, C corporation, S oorporatfon, or LLC., otherthan,a
dlisregarded entity. Enter the entily's name as shown on the entiiy's lax
relum on line 1 and any business, trade, or DBA name on line 2
. Other entities. Enteryour name as stiown on required U.S. federal tax
documents on line 1. This name should match tlle name shown on the
charteror other legal document creaiing ihe entity- Enter any business'
trade ,.or DBA name on line 2.
. Disregarded entity. ln general, a business entity that has a single
owner, including an LLC, and is not a corporation, is disregarded as an
entity separate from rts owner (a disregarded entity). See Regulalions
section 301.7701-2(cX2). A disregarded enlily should check the
appropriate box iorthe tax classification ol its owner. Enter the owner's
name on line 1, The name,of the owner entered on line 1 shou'ld never
be a disregarded entity. The name on line 1 should be lhe name shown
on tlle inoome lax return on which the income should be reported. for
Kittitas County Agreement for Services (rev. 5/L4/251
Page 15 of 19
example, if a foreign LLC that is treated as a disregarded entity for U.S.
federal tax purposes has a single owner lha! is a U.S. person, the U S.
ownels name is required to be provided on line 'l- If lh e direct owner of
the enlity is also s disregarded entity, enter the first owner tllat is not
disregarded for federal tax purposes. Enter the,disregarded entity's
name on line 2. lf lh,e oAivner of the disregarded enlity is a foreign percon,
Itl e owner must complete an appropriate Form W-8 instead of a Form
W-9. This is the case even if the foreign person has a U.S TlN.
Line 2
lf you have a business name, trade name, DBA name. or disregarded
entity name, enter ii on line 2.
Line 3a
Check the appropriate box on line 3a forthe.U.S. lederal tax
classilication of the person whose name is entered on line 1. Check only
one box on line 3a.
Line 3b
Check this box if you are a partnership r rncluding an LLC classified as a
partnership for U.S. federal tax purposes), lrust, o. estale that has any
foreign partners, owners, or beneficiaries, and you are providing this
form to a partnership, irust, or eslaile. in which you have an,ownership
interest. You mlrst check the.box on line,3b if you receive a Form W-8
(or dooumenlary evidencel from any partner, owner' or beneflciary
establishing foreign status or if you receive a Forrn W-9 from any
partner, owner, or beneficiary lhat has checked lhe box on llne 3b.
Note: A partnership lha! provides a Forrn \M9 and checks box 3b may
be required to complete Schedules K-2 and i<-3 (Form 1 065). For more
information,.see the Pa.tnership lnstructions for Schedules K-2 and K-3
(Form 1065).
lf you are required to complete line 3b but fail lo do so, you may not
receive the intoamation necessary to lile a oorreci information relum with
It1 e IRS or furnish a correct payee statement to your partners or
beneficiaries. See, for example, sections 6698, 6722, and 6724 fo(
penalties that may aPPIY-
Line 4 Exemptions
lf you are exempt lrom backup wi;lhholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
. Generally, individuals (including sole proprietors) are noi exempt from
backup withholding.
. Except as provided below, corporations are,exempt from baokup
withholding for certain payments, including interesl and dividends.
. Corporations are no! exempt from backup withholding for payments
made in settlement of paymenl card or third-party network lransaooons.
. Corporations are nol exempt from backup withholding with respect to
attorneys' fees or gross proceeds paid to attorneys. and oorporationg
that provide medical or health care services are not exempt witll respect
to payments reportable on Form 1099-M|SC.
The following codes identify payees thal are exempt from backup
withholding. Enter the appropriate code in the space on line.4.
1- An organizaiion exempt from tax under section 501(a)' any IRA' or
a custodial account under section 403(bX7) if !he account satisfies the
requirements o.f section 401 (0(2).
lF the entitylindi:vidualon line 1
isaln) ...
THEN check the box for,...
Corporation Corporation-
r lndividual or
. Sole proprietorship
lndividuallsole proprietor.
LL\/ qas$nQ a5 a pat u lctsl xP
f o r U.S..federal tax purposes or
. LLGtha! hasfiled Forrn 8832 or
2553 electing to be taxed as a
corporation
Limited liability company and
enter the appropriate tax
classification:
P = Partnership,
C=Ccorporation,or
S = S corporation.
Partnership Partnership.
Trusvesiate Truslleslate.
Form W.9 (elev.3-2024)Page 4!
2- The U nited States or any of its agencies or instrumentalities
3-A slate, the District of Columbia, a U.S. commonwealth orterritory,
or any of their polilical subdivisions or instrumentalities.
4-A foreign government or any of its political subdivisions, agencies,
or instrumentalities.
5-A corporation.
G-Adealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
territory.
7-A futures commission merchant registered with the Commodity
Fuiures Trading C-Ommission.
9-A real estate investment trust.
9- An entity register.ed at all times during the tax year underthe
lnvestment CompanyAcl of 1940.
1 o- Acommon trust tund operated by a bank undersection 584(a).
1 1-A financial insiitution as defined under section 531.
12-A middleman known in U1e investment community as a nominee or
custcxlian.
1 &A trust e,cempt from tax under section 664 or described in seclion
4947.
The following chart shows types 01 payments that may be exempt
from backup withholding. The chart applies to th.e exempt payees listed
above, 1 through 13.
lF the payment is for ....THEN the payment is exempt
for...
- lnterest and dividend payments All exempt payees except
fotT
. Brokeriransactions Exempt payees 1 through 4 and 6
through 1 1 and all C corporations.
S corporations mus! not enter an
exempt payee code because they
are exempt only for sales ol
noncovered securities acquired
1o 2012.
. Barter exchange transactions Exempt payees 1 through 4.
and dividends
. Paymentsover$600 requiredto
be reported and direct sales over
$5,ooo'
. Payments made in settlement of
payment card or lhird-party
network transactions
Exempt payees 1 through 4.
l See Form 1099-MlSC, Miscellaneous Information, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 1099-MISC are no! exempt from backup
Wthholding; medical and health care payments, attorneys'fees, gross
proceeds paid to an,attorney reportable under seciion 604!5(i 1., and
payments for services paid by a federal executive agency..
Exemption from FATCA.reporting c ode. The following codes identify
payees that are exempt from reporting under !'ATCA..These codes
apply to persons submitting !his form for accounts maintained outside
of the.United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
Slates, you may leave this field blank. Consult with the per$on
requesting ihis form il you are uncertain if the financial institution is
subject lo these requirements. A reguester may indicate that a ccxle is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar lndication) entered on the line for a FATCA exemption code.
A-An organization exempt from tax under section 501 (a),or any
individual retirement plan as defined in section 7701\a){371.
B- The Uniled States or any ol its agencies or instrumentalities.
C-A state, the Distdct of Columbia, a U.S. commonwealth or
terdtory, or any of their political suMivisions or instrumentalities.
D-A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
sec.ion 1. 1 47.2-1 (cX1 Xi)..
IE-A corporation that is a member o.fthe same expanded affiliated
group as a @rporation desoribed in Regulations section 1.14!72-1(cxl Xi).
Kittitas Cou nty Agreement for Servi ces (r ev. 5 / Ia/ 25l,
Page 16 of 19
F-A dealer in secutities, commcxlities, or derivative financial
instrumenls i jncluding notional principal conlracts, futures, foMaids,
and options) that i$ registered as such under lhe laws of the United
States or any state.
G-A real estate investment trust.
H-A regulated investment company as defined in section 851 or an
entity registered al al, times during the tax year under the lnvestment
Company Act of i 940.
l-A common trustfund as defined in section 584(a).
J-A bank as defined in section 531 .
K-A broker..
L -A trust exempt from tax under section 664 or described in section
49471a)(1t.
M -A lax-exempt trusl under a section 403fb) plan,or seclion 4!57(gl
plan.
Note: You may wish to oonsult with the financial institution requesting
this form to determine whether the FATCA oode andfor exempt payee
code should be completed.
Lines
Enter your address (number, street, and apartment or suite number).
Thls is where the requester ot this Form W-9 willmail your information
returns. lfthis address differs from the one the requester already has on
file, enter "NEW' al the top. lf a new address is provided, lhere is still a
chance the old address will be used until the payer changes your
address in their records.
Une6
Enter your city, state. and ZIP code.
Part l. Taxpayer ldentification Number (TlN)
Enter your TIN in the appropriate box, lf you are a resident alien and
you do not have, and are not eligible to get, an SSN. yourTlN is your
IRS lTlN. Enter it in the entry space for lhe Social security number..lt you
do not have an lTlN. see /-!ow to geta ItlV below.
lf you are a sole proprietor and you have an lElN, you may enter either
your SSN or !:::1N..
lf you are a single-member LLC that is disregarded as an entity
separate from its owner, enterthe ciJvner"s SSN (orElN, if the owner has
one). lf the LLC is ciassified as a corporation or partnership, enler the
entity's lElN-
Note: See t4lhaf /Vame and Number To Give li',e Requester, later' for
further clarification of name and TIN combinations.
How to get a TlN. tfyou do not have a TlN, apply for one immediaiely'
To apply tor an SSN, get Form SS-5, Application for a Social Security
Card, lrom your local SSA office or get this form online at
www.SSA.gov. You may also get lhis form by calling 800'772-1213 Use
Form W-7, Application for IRS lndividual Taxpayer ldentification
Number. to apply for an,lTlN, or Form SS-4. Application for Employer
ldentification Number, to apply for an ElN. You can apply for an lElN
online by accessing the IRS website al www.irs.gov/ElN. Golo
www.irs.gov/Forms lo view, download, or print Form W-7 andlor Form
SS-4. Or. you can go to www.irs.gov/Orde#orms to place an order and
have Form W-7 an.d/or Form SS-4 mailed lo you within 15 business
days.
lf you are asked to complete Fonm W-9 but do no! have a TlN, apply
for a TIN and enter 'Applied Fo/' in the space for ihe TllNl, sign and date
the form, and give it to lhe requester. For interest and dividend
paymenls, and certain paymenls made with respect to readily tradable
instruments, you will generally have 60 days to get a TIN and give ii to
therequesterbefore you aresubject to backup withholding on
paymenls. The 60cday rule does nol apply to othertypes of payments.
Vou will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering "Applied for" means that you have already applied for a
TIN orthat you intend to apply for one soon. See also Establishlrig U.S
status for purposes of chapter 3 atid chapter 4 withho/dkig. earlier' for
when you may instead be subject lo withholding underchapter 3 or4of
the Code.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-3.
Generally, exempt payees
1 through 5-2
Form W-9 (Flev.3-2024i Page5
Part lL Certification
To establish to the withholding agenl that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested lo sign by the
withholding agent even if item l, 4, or 5 below indicates otherwise
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). ln lhe case'o1a disregarded entity, lhe
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier,
Signature requirements. Complete lhe certification as indicated in
itemsl throughsbelow.
1 . lnlerest, dividend, and barter exchange accounts opened
before 1 984 and broker accounts considered ac{ive during 1 983.
You must give your correct TlN, but you do not have lo sign the
cerlifiication.
2 . lnterest, dividend, broker, and bartel exchange accounts
opened,after 1983 and broker accounts considered inactiive during
1983. You must sign the certification or backup withholding will apply lf
you are subiecl to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
cerlifiioation before signing the lorm.
3 . Real estate transac{ions. You must sign lhe certification. You may
cross oul iiem 2 of the certification.
I . -Other payments. You mus! give your correct TlN, but you do not
hav,e to sign the cerlilicalion unless you have been notified that you
have previously given an incorrect TiN. "Other payments" include
payments made in the course o:f the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services : including payments to corporations). payments to
a nonemployee for seNices, payments made in setdement of payment
card and third-party network transactions, payments lo certain fishing
boat crew members and fishermen, and gross prooeeds paid to
attomeys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debl, qualified tuition program
payments (under sectlion 529), ABLEaccounts (under section,529A),
lRA, Coverdell ESA, Archer MSA or HS.A contributions or
distributions, and pension distributions. You must give your correct
TlN, but you do not have to sign the certification.
For this of account:Give name and SSN ot
8. Disregarded entity not omed by an
individual
9- A valid trust, eslale, or pension trust
1 0. CDrporation Dr LLC electing corporate
status on Form 8832 or Fotm 2553
1 1. Associ:otion, dub, religious. charfable,
edu€tional, or othet tax-exem,Pt
Drganizalion
12. Partnership or multi-membedLc
1 3. A broker or regislered nomine€
l4.Acoountwith the Oepadmenl of
Agriillture ifl lhe name of a Public
entity (such as a stale or loml
government, school districi. or prison)
that receives agriculitu ral program
payments
15. Granlortrusllilingiform 1041 or
under the OptionalFiling Malhod 2.
requiring,Form 1 099 (see Regulations
section 1.67,41 jb)t2XiXB)).'
For this of acount:Give name encl FIN of
Tho oMer
Legal slity.
Thesrporation
The organizmion
The parlnsship
The broker-or nmin€
Tho publ ic entiiy
'1. hdividual
2. Twoormore individuals i:oim account)
other than an amunt maintained bY
an FR
3. Two or more U.S. peFons
noinl account maintained by an RR)
4, Custodial account of a minor
(U"iform Gift lo Minors Acti
5. a, The usualrevocabl'e savings trust
{grantor is also trustee)
b, So-called lrust account that is ncd
{ legal or valid trust under state le
6, Sole proprietorship or disregarded
entity owned by an individual
7, Granlor trust filing under Optional
Filing Method 1 (see Flegulations
section 1671 4{bi12Xi)[A))-
Ths individual
The actual owner of the account or,
if combined iunds, the fast individual:
on ihe a€oun1 I
E.-dt, holder ol the amunt
The minorz
The grantor-trustee
The actual ownerl
The ownea'
The grantor,
Thetrust
l List first and circle lhe name of the person whose number you rumlsh.
lf only one person on ajoint aocount has an SSNI, that person's number
must be furnished.
'Circle lhe minor''s name and furnish the minor's SSNI
3You must show your individual name on line 1, and enteryour business
or OBA name, if any,.on line 2. You may use either your SSN or EIN i-lf
you have one), but the IRS encourages you to use your SSN-
List first and circle lhe name of lhe trust, esiate, or pension trust. jDo
nol furnish the TIN of the personal representative or trustee unless the
legal entity itselt is not designated in the account title.)
. Note: The gran,tor must also provide a Form W-9 to lhe trustee of the
trust.
.. For more !nformation on optional fiiling methods for grantor trusts, see
the lnstructions for Form t041.
Note: lt no name is circled when more than one name is Iisted' the
number will be considered !o be that of the first name listed'
Secure Your Tax Records From ldentity lheft
ldentity lheft occurs when someone uses your personal information,
such as your name, SSN, or other identifying information, without your
permission to commit fraud oroth er crimes. An identity thief may use
yourSSN to get a job or may file a tax retum using your SSN lo receive
a refund.
To reduce your risk:
. ProtectyourSSN,
. Ensure your employer is protecting your SSN, and
. Be careful when choosing a tax return pleparer.
lf your tax records are affected by identity theft and you receive a
notice from the lRS, respond right. away to the name and phone number
printed on the IRS nolice or letter..
lf your lax r€cords are not currently atfected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity, or a questionable credit reporl, contact the IRS
ldentity Theft.Hotline al 800-908-4490 or submit form 14039.
For more information, see Pub. 5027. ldentity Theft lnformation for
Taxpayers.
Kittitas County Agreement for Services (rev. 5/L4/251
PageLT of t9
Form w-9'(Rev.3-2024)Paqeo
Victims of identity thefl who are eKperiencing economic harm or a
systemic problem, or ar,e seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advooate Service (TAS) assistance. You can reach TAS by
calling the TAS ioll-free case intake line al 877-777'4778 or TTY/TDD
800-829-4059.
Protect yourself from suspicious emails or ph'ishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites.. The most common act
is sending an email lo a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user inlo surrendedng
private information that will be used for idenlity theft.
The IRS does not initiate contads with la,cpayers via emails. Also, the
IRS does nol request personal detailed information through email or ask
ta,cpayers for lhe PlNinumbers, passwords, or similar secret access
information for their credit card, bank, or otherfinancial accounts
ii you receive an unsolicited email claiming to be from ihe llRS,
forward lhis message to phishing@irs.gov- You may also report misuse
of lhe llRS name, logo, or other IRS property to th.e Treasury Inspector
General forTaxAdministralion (TIGTA) at 800c3'66-4!4841. You can
forward suspicious emails to lhe federal Trade Commission at
spam@uce.govor report them at www.ftc..gov/compfaint. Y ou can
contact the FTC al wvwvftc.govlidthefi or 877-IDTH-|FT (877-4!38-4338).
li you have been th.e viclim of identity theft, see www.ldentityTheft.gov
and Pub. 5027.
Golo www.irs.gov/ldenti!yTheffto leam more about idenlity theft and
ho/v to reduce your risk.
Kittitas County Agreement for Services (rev. 5/t4/251
Page 18 of 19
Privacy Act Notice
Section 61 09 of the lnternal Revenue Code requires you to provide your
correct TIN to persons tncluding federal agenciesl who are requir.ed to
file information returns with the llRS to report interest, dividends, or
certain oiher income paid to you: mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an lRA, An;her MSA, or HSA. The
person collecting this form LJSes the information on the form to file
information returns with ihe lRS, reporting the above information.
Routine uses of this intormation inolude giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. oommonwealths and territories for use in
administering their laws. The information may also be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You mLJSt provid'e yourTlN whether or not
you are required io file a tax return. Under seotion 3406, payors must
generally withhold a percentege of taxable interest, divid'ends, and
certain other payments to a payee who does not give a TIN to the payor.
Certain penalties may also apply for proMding false or fraudulent
intormation.
ATTACHMENT "F,,
RETIREMENTSTATUS FORM
* * All Contractors who are individuals must complete and sign **
SECTION 1: CONTRACTOR COMPLETES THIS SECTION:
Did you retire from one of the State of Washington Retirement Systems?
Did you retire before age 65 using the 2008 early retirement factors (ERF)?
Will you be receiving direct compensation for these services?
Will you be receiving indirect compensation forthese services?
CONTRACTOR (Full name of contractor as in DRS filings-Please Print):-
Signature:LastFourDigitsofSocialSecurity
Date
SECTION 1: COUNW COMPLETES THIS SECTION:
[Use Member Reporting Verification (MRV) to verify the past retirement membership and document below]
1. Has Contractor been a member of a Washington State Retirement System? - Yes
-
No
lf yes, which system and plan?
-
Teachers' Retirement System (TRS)
-
Plan 1
-
Plan 2
-
Plan 3
-
School Employees' Retirement System (SERS)
-
PIan 2
-
Plan 3
- Public Employees' Retirement Systems (PERS)
-
Plan 1
-
Plan 2
-
Plan 3
-
PublicSafetyEmployees'RetirementSystem(PSERS) -
Plan2
_ Law Enforcement Officers' & Fire Fighters' Retirement System (LEOFF)
-
Plan 1
-
Plan 2
_ washington state Patrol Retirement system (wsPRs) _ Plan I
-
Plan2
_ Judicial Retirement System (JRS)
Yes No
Yes _ No
Yes _ No
Yes No
2. ls Contractor a retiree of a Washington State Retirement System?
3. Did Contractor retire before age 65 using the 2008 ERF?
I have verified the information above using MRV or by contacting DRS'
COUNTY REPRESENTATIVE (Please Print)
Signatu D
COUNTY RETAINS THIS FORM
Kittitas County Agreement for Services (rev. 5lL4/251
Page 19 of 19
_Yes _ No
_Yes _ No