HomeMy WebLinkAboutPCS On Call2026 signed copy(002)Kittitas County Agreement for Services (rev. 5/14/25)
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KITTITAS 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 [ PCS Structural Solutions ]
(hereinafter “Contractor”).
The purpose of this Agreement is as follows: [ On-Call consulting services related to Civil, Structural, and
Construction Engineering Services. The on-call contract will be for three years (3) with an opportunity for one one-
year extension if mutually agreed upon and approval is obtained by the Board of County Commissioners ].
The term of this Agreement shall be from the date of execution through [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
[ 205 W 5th Ave, Suite 105]
[ Ellensburg, WA 98926 ]
[ Charlie Smith]
[ Program Manager ]
[ Auditors Office]
[ Charlie.Smith@Co.kittitas.wa.us ]
[ (509)962-7530]
[ 1250 Pacific Ave, Suite 701]
[ Tacoma, WA 98402 ]
[ Wes Neeley ]
[ Associate Principal ]
[ wneeley@-pcs-structural.com ]
[ (253)383-2797 ]
This Agreement includes the following, which are attached hereto and hereby incorporated by this
reference:
Attachment “A”: Scope of Work
Attachment “B”: Compensation
Attachment “C”: Insurance Requirements
Attachment “D”: General Terms and Conditions
Attachment “E”: W-9 (Contractor must complete and return to the County for payment)
Attachment “F”: Retirement Status Form (Contractor must complete and return to the County
for payment if Contractor is an individual, as opposed to a corporate business
entity)
Kittitas County Agreement for Services (rev. 5/14/25)
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IN WITNESS 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
BOARD OF COUNTY COMMISSIONERS
Chair
Vice-Chair
Commissioner
Date:
Attest:
Clerk of the Board
CONTRACTOR
Signature
Printed Name
Title
Date:
Kittitas County Agreement for Services (rev. 5/14/25)
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ATTACHMENT “A”
SCOPE OF WORK
[ To Provide on Call Engineering and Consulting Services
for Kittitas County ]
Kittitas County Agreement for Services (rev. 5/14/25)
Page 4 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 full compensation 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 Itemized price sheet attached.
Hourly rates are per the firm's fee schedule, effective April 1, 2026, and are subject to adjustment each
October and April. Any adjustment requires written notice and mutual written consent prior to
implementation.
The County provides no guarantee that projects will become available.
Associate Principal, Principal, and Directors ........................................................ $200.00
. .....................................................................................................................................to
. ........................................................................................................................... $250.00
Project Manager/Associate Engineer ................................................................... $160.00
. .....................................................................................................................................to
. ........................................................................................................................... $200.00
Design Engineer/Project Engineer ....................................................................... $130.00
. .....................................................................................................................................to
. ........................................................................................................................... $160.00
CAD/BIM Technician and BIM Directors .............................................................. $130.00
. .....................................................................................................................................to
. ........................................................................................................................... $180.00
Administrative/Clerical............................................................................................ $90.00
. .....................................................................................................................................to
. .......................................................................................................................... $120.00
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 under this 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 VII or better in the most recently published edition of Best’s Reports unless otherwise approved
by the County. If 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 Liability Insurance
▪ Coverage limits not less than:
• $1,000,000 per occurrence, for all covered losses
• $2,000,000 general aggregate
• $1,000,000 products & completed operations aggregate
• $1,000,000 personal and advertising injury, each offense
▪ The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds.
☒ Commercial Automobile Liability Insurance
▪ 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.
▪ Coverage limits not less than:
• $1,000,000 combined single limit
☐ Excess or Umbrella Liability
▪ Contractor shall provide Excess or Umbrella Liability coverage of $5,000,000. This Excess
or Umbrella Liability coverage shall apply, at a minimum, to both the Commercial General
and Automobile Insurance policy coverages. If 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.
▪ The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds.
▪ Coverage shall be “pay on behalf”, with defense costs payable in addition to policy limits.
▪ There shall be no cross liability exclusion precluding coverage for claims or suits by one
insured against another.
☒ Workers’ Compensation & Employer’s Liability
▪ Contractor shall provide Workers Compensation and Employer’s Liability insurance on a
state-approved policy form providing benefits as required by law with employer’s liability
limits no less than $1,000,000 per accident or disease.
☐Professional Liability / Errors and Omissions Liability
▪Coverage limits not less than:
•$1,000,000 each claim
▪Contractor must provide evidence of this coverage on a policy form appropriate to
Contractor’s profession.
☐[ Other insurance coverage as deemed appropriate by either the County Risk Manager or the
assigned Deputy Prosecuting Attorney. Additional insurance 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 Insurance, 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 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
Insurance 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”
GENERAL TERMS 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 otherwise provided
herein. All work performed under this Agreement shall comply with applicable laws and regulations.
2. Accounting and Payment: Compensation to Contractor for services rendered under this Agreement
shall be as set forth in Attachment "B". Where Attachment "B" 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 "B", 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
than monthly, through the County voucher system, for Contractor’s services pursuant to the fee schedule set forth
in Attachment "B". In 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 Internal Revenue Service at the end of the calendar year in accordance with
applicable IRS regulations. It 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. Contractor must pay all other taxes, including but not limited to: business and occupation tax; or taxes based
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 "B", 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 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 with or
evaluation by service recipients under this Agreement. Contractor shall preserve and maintain all records
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
7.1. 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. If any such Change Notice causes an increase or decrease to Contractor’s cost of, or the
time required for, performance of the work, 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; otherwise, 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 prior to 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 If 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. If 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 under this 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.Indemnification
9.1 To the fullest extent permitted by law, Contractor agrees to indemnify, and hold the
County and its departments, elected and appointed officials, employees, and volunteers, harmless from
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 negligent act or omission, 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; 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 Industrial Insurance 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. Notwithstanding the foregoing, Sub-consultant does not waive
immunity under RCW 51.24.035.
9.2 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 In 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 Contractor’s indemnity
obligations to the County.
10. Venue and Choice of Law: In 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-Appropriation of Funds: If the County does not appropriate sufficient funding for this
Agreement 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.
12.Contractor Commitments, Warranties, and Representations: Contractor represents and warrants as
follows:
12.1 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.
12.2 Contractor has the authority to execute this Agreement, to make the representations and
warranties set forth herein, and to perform its obligations hereunder.
12.3 This Agreement has been validly executed by an authorized representative of Contractor and
constitutes a valid and legally binding and enforceable obligation of Contractor.
12.4 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.
12.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of
which will or may materially affect Contractor's ability to perform its obligations under this 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.
12.7 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 Items Produced: The Contractor shall be deemed the author and owner of their
respective instruments of Service, including the Drawings and Specifications, and shall retain all common law,
statutory and other reserved rights, including copyrights, The Contractor grants to the County a nonexclusive
license to use the Architect's Instruments of Service Solely and exclusively for the purpose of evaluating,
constructing, using, maintaining, altering and adding to the Project.
14. Intellectual Property Infringement: 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 for the 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 County Name and Logo: 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. In 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 (4) the arbitrator’s decision or award shall be final and
binding on both parties.
17. Confidentiality: 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
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 resulting from 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.Prevailing Wage: Where labor to 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 Industries. The schedule of prevailing wage rates
for the applicable locality or localities is determined by the Industrial Statistician of the Department of Labor and
Industries. It is Contractor's responsibility to verify the applicable prevailing wage rate. It 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 Industries. The arbitration decision shall be final and
conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.060.
20.Standard of Care: Contractor shall perform its duties hereunder in a manner consistent with that
degree of care and skill ordinarily 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
21.1 In 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, 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; 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, 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. 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
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.
21.2 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.
21.3 If any assignment and/or subcontracting has been authorized by the County, said assignment or
subcontract 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 by the 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, 9, 10, 13, 14, 15, 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. Severability: If 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. Agreement 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, any third parties.
30. Consultant shall have no responsibility for job-site safety, which shall remain exclusively the
responsibility of the Contractor, and no authority to stop work. Consultant shall have no responsibility for the
discovery, presence, handling, removal or disposal of, or exposure of persons to, hazardous materials or toxic
substances in any form at the Project site.
2 Business.name/disrngardedl 011tM1:y name. if diffBrRr1t frorn above.
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4 Exomplior,s (codGSapply only to
certain entities, not in-dYvidl1ais;
see lnstroctkms on page 3):
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Compliance Act (FATCA) roporting
code (if any)
CL O
(Ap{)li�s to,'?'C:COJ.Jflts maintri!_in�cJ
outside the United States.)
Requester's name Mel address (optionaQ a,
<J)
I
5 Adcl,es, (numbe , street, Md apt. or uite no.). See instructions.
Taxpayer Identification Number (TIN)
3a Check the appropriate box lor federaltax classilication of the en�ryfindlvidoal whosen e is entered on line 1. Check
only one of trn, fQ!lowlng seven boxes. □lndividlual/sore propriotor □G corporatior1 □S corporation □P.artoorship □Trust/estate
classification of the LLC, unless it is adiwegarded entity. A disregard entity should instead check the 8J)proprlate
,or
ATTACHMENT “E”
Form W•9
(Rev. March 2024)
D<,partmont of the Trnasury
lrritemal R@venue ServiC8
!Request for Taxpayer
Identification Number and Certification
Go to www.irs.gov/FormW9 for instructions and the latest info·rmat'ion.
Give form to the
requester. Do not
send to the IRS.
-
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprieto:r, or disregarded entity, see the instructions for Pa.rt I, later. For other
entlties, it is your employer identification number (EIN). If you do not have a nutnber, see How to get a
TIN, later.
Note: If the account is i11more·than one name, see the instructions for limi 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enler.
Certification
Under penalties of perjury, I certiify that:
[Il]-ITJ-1I I I I
I Em1>loyer'identification numi>er
1.The number shown on this form is my correct taxpayer identification number (or I am wa1ting for a number to be issued to me); and
.2. I am not sub,ject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not beer, notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividend's, or (o) the IRS has notified me that I am
no longer subject to backup withholding; at1d
3. I am a U.S. citizen or other U.S. person (deNned below); and
4.The FATCA code(s) entered on this form QI any) indicating that I am exempt from FATCA reporting is correct.
Certification ins1ructiions. You rnust cross out itern 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report ali interest and dividends on your tax return. For reai estate transactions, item 2 does not apply. For mort91age interest paid,
acquisition or abandonmen,t of secured property, cancellation of debt. contributions to an individual retirement arrangeme11t (IRA), and, generally, payments
-other than interest and dividends, you are not requirnd to sign the certification, but you must provide your correct TIN. Soothe instructions for Part II, later.
Sign I Signatur<> of
Here , U1.S,,porson Dal ..
General Instructions
Section refererices are to the Internal Revenue Code unless otherwise
no•ted.
Future developments. For the latest information about d'eve'lopments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9,
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 Its owner. Otherwise, it
should check the "LLC'" box and enter its appropriate tax classification.
New line 3b has been addedl to this form. A flow-through entity is
required to complete this Ii e to indicate that it has direcl or indirect
foreign partners, owners, or beneflcia�ies when rt provides the Form W-9
to another tlow-thrm,gh e 11ily in which it has an ownersh,ip interest. This
chang,e;s intended to provide a flow-through entity with information
regarding the status of its i direct lor,eign partners, owners, or·
beneficiaries, so lhat it can satisfy any applicable reporting
requirements.. For example, a partnership that has any indirect foreign
partners 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 Is required to file an
information rett1m with lhe IRS is giving you this form because they
Cat. No. 10231X Form W-9 (Rev. 3-2024)
FormW-9 (Rev. 3-2024) Page2
must obtain your oorrect taxpayer identrificatrion rmmber {TIN), which
may be your social security number (SSN), individual taxpayer
identification number (ITIN), adoptrion taxpayer ide111tilication number
(ATIN), or employer identifioation number l�IN), to report 0111 an
information re:tum the amount paid to you, or other amount reportable
on an information return. Examples of information returns include, but
are not limited to, the following.
• Form i099-INT �111terest eamed or paid}.
• Form 1099-DIV (dividends, including those from stocks or mutual
funds).
• Form 1099-MISC (various types of income, prizes, awards, or gross
prooeeds),.
• Form i099-NEC (111onemployee oompensation).
• Form 1099-B (stock or mutual fu111d sales and certain other
transactions by brokers).
• Form 1099-S (proceeds from real estate transactions).
• Form 1099-K (merchant card and third-party network tra111sactions).
• 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 property].
Use !'orm W-9 only if you are a U.S. perso111 �ncluding a resident
alien),, to provide your correct TIN.
Cautio111: If you don't return Form W-9 to the requester with a TllNI, you
might be subject to baokup withholding. See What is backup
withholding, later.
By signing the filled-out form, you:
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;,and
4. Certify to your non-foreign status for purposes of withholding under
chaptter 3 or 4 of the Code Cd applicable); and
5. Certify that FATCA code(s) entered on this form �f any) indicating
that you are exempt irom the FATCA reporting is correct. See What Is
FATCA Reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form otrher
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.
De�i111ition of a U.S. perso111. For federal tax purposes, you are
considered a U.S.. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in ti,e United States or under the laws of the U111ited States;,
• An estate (other tha11a1foreign estate),; or
• A domestic trust (as defined in Regulations section 301.7701-7),.
Establishi111g U.S. statl!ls for purposes of chapter 3 and chapter 4
withholdi111g. Payments made to foreign persons, including certain
di&tributions, allocations of income, or transfers of sales prooeeds, may
be subject to withholdi111g under chapter 3 or chapter 4 of the Code
(sections i441-1474). Under those rules, if a Form W-9 or other
certifioatio11011non-foreign status has not been received, a withholding
agent, transferee, or partnership (payo�generally applies presumptio111
rules that may require the payor to withhold applioable tax from the
recipient, owner, tra111sferor, or partner (payee). See Pub. 515,
Withholding ol Tax 0111 No111resident Aliens and Foreig111 Entrities.
The following persons must provide Form W09 to the payor for
purposes of establishing its non-foreign status.
• In the case,of a disregarded entity with a U.S. owner, the U.S. owner
01the disregarded entity and nol ti.e disregarded entity.
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. ow111er of the grantor trust and
not the grantor trust.
• In 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
certifioatio111 01non-foreign status to avoid withholding.
Foreign person. If 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 1.1441-1(b)[2)(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). If you are a
qualified foreign pensio11f1und u111der Regulations section 1.897(1)-1,(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 sectio1111445
withholdi111g, do nol use Form W-9. Instead, use Form W-8EXP (or other
oertificatio11o1f non-foreign status).
Nonresident aHen who becomes a resident alie111. Ge111erally,.only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. lax on certain types of income. However, most tax
treaties contain a provision known as a saving clause. �xceptions
specilied in the saving clause may permrtan exemption from tax to
oonti111ue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an excep1ion
contained i111 the,savi111g clause of a tax treaty to claim an exemption
from U.S. tax 0111 certain types of inoome, you must attach a stateme111t
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 from 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 exemptio111
from tax.
5. Sufficient facts to justify the exemptio11f1rom tax under the terms of
the treaty article.
Example. Article 20 01the U.S.-Chi111a income tax treaty allows an
exemption from tax for scholarship income received by a Chi111ese
stude111t temporarily present in trhe Unit,ed States. Under U.S. law, this
stude111t will become a resident alien for tax purposes if their stay i111 the
United Stat.es exceeds 5 calendar years. However, paragraph 2 of the
first Protocol to the U.S.•-China treat,y(dated April 30, 1984) allows the
provisions 01Article 20 to continue to apply even after the Chinese
stude111t becomes a resident alien of the United States. A Chinese
stude111t who qualilies for this exoeption (under paragraph 2 of lhe first
Protocol) and is relying on this exception to claim an exemption from tax
on their scholarstiip or fellowship income would attach to Form W-9 a
statement that includes !tie information described above to support that
exemption.
If you are a no111resident alien or a foreign entity, give the requester the
appropriate completed 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
subject to backup withholding include, but are not limited to, interest,
tax-exempt interest, divide111ds, broker and barter exchange
transactions, rents, royalties, nonemployee pay, payments made in
settlement01paymentr 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 payments you receive
if you give the requester your correct TIN, make the proper oertifications,
and �eport all your taxable interest and dividends on your tax return.
Payments you receive will be subject lio backup withholding if:
1. You do not furnish your TIN to the requester;
2. You do not certify your TIN when required (see lhe instrLJOtions for
Part II for details);
3. The IRS tells !tie requester that you furnished an,incorrectlllN;
4. The IRS tells you that you are subject to backup withholding
because you did 111ot report all your interest and dividends on your tax
retum (for reportable interest and divide111ds only); or
5. You do not certify to lhe requester lhat you are not subject 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 W·9 (elev. 3-2024) Page3
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
See also �stablishing U.S. status for purposes of chapter 3 and
chapter 4 withholding, earlier.
What Is 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 Instructions for the Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information lo any person to whom you
claimed lo be an exempt payee if 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. In 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 TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If 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 TINs. If tlle requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Speciific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If 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 person or entity whose number you entered in
Part I of form W-9. If you are providing Form W-9 to an FFI to document
a joint aocount, each holder of the account Iha! is a U.S. person must
provide a Forrn W-9.
• Individual.Generally, enter the name shown on your tax return. If you
have changed your last name witllout informing the Social Security
Administration (SSA] of the name change, enter your 1iirst name, the last
name as shown on your social security card, and your new las! name.
Note for ITIN 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 Form
1040 on line 1. bnler your business, trade, or "doing business as" (OBA)
name on line 2.
• Partnership., C corporation, S oorporatfon, or LLC., other than,a
dlisregarded entity. Enter the entily's name as shown on the entity's lax
relum on line 1 and any business, trade, or DBA name on line 2.
• Other entities. Enter your name as stiown on required U.S. federal tax
documents on line 1. This name should match tlle name shown on the
charter or other legal document creating the entity. Enter any business,
trade,,.or DBA name on line 2.
• Disregarded entity. In 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(c)(2). A disregarded enlily should check the
appropriate box ior the tax classification of 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
example, if a foreign LLC that is treated as a disregarded entity for U.S.
federal tax purposes has a single owner Iha! is a U.S. person, the U.S.
owner's name is required to be provided on line 1. If lh.e direct owner of
the entity is also a disregarded entity, enter the first owner tllat is not
disregarded for federal tax purposes. Enter the,disregarded entity's
name on line 2. If lh,e owner of the disregarded enlity is a foreign person,
lt1e 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. TIN.
Line 2
If 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 for the,U.S. lederal tax
classification 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 �ncluding an LLC classified as a
partnership for U.S. federal tax purposes), lrust, or estale that has any
foreign partners, owners, or beneficiaries, and you are providing this
form to a partnership, trust, or eslaile, in which you have an,ownership
interest. You must check the,box on line,3b if you receive a Form W-8
(or dooumenlary evidence] from any partner, owner, or beneficiary
establishing foreign status or if you receive a Forrn W-9 from any
partner, owner, or beneficiary !hat has checked lhe box on line 3b.
Note: A partnership Iha! provides a Forrn W09 and checks box 3b may
be required to complete Schedules K-2 and i<-3 (Form 1065). For more
information,.see the Partnership Instructions for Schedules K-2 and K-3
(Form 1065).
If you are required to complete line 3b but fail lo do so, you may not
receive the information necessary to file a oorreci information relum with
lt1e IRS or furnish a correct payee statement to your partners or
beneficiaries. See, for example, sections 6698, 6722, and 6724 for
penalties that may apply.
Line 4 Exemptions
If 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 not exempt from
backup withholding.
• Except as provided below, corporations are,exempt from baokup
withholding for certain payments, including interest 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 oorporations
that provide medical or health care services are not exempt witll respect
to payments reportable on Form 1099-MISC.
The following codes identify payees thal are exempt from backup
withholding. Enter the appropriate code in the space on line,4.
1- An organization exempt from tax under section 501(a), any IRA, or
a custodial account under section 403(b)(7) if !he account satisfies the
requirements o.f section 401(f)(2).
IF the entitylindiividual on line 1
isa[n) ...
THEN check the box for,...
• Corporation Corporation.
Individual or .• Sole proprietorship
Individual/sole proprietor.
LLC classified as a partnership .f o r U.S..federal tax purposes or
LLC that has filed Forrn 8832 or
2553 electing to be taxed as a
corporation
Limited liability company and
enter the appropriate tax
classification:
P = Partnership,
C = C corporation, or
S = S corporation.
• Partnership Partnership.
• Trust/estate Trusl/eslate.
Form W·9 (elev. 3-2024) Page 4!
2- The United States or any of its agencies or instrumentalities.
3-A state, the District of Columbia, a U.S. commonwealth or territory,
or any of their political subdivisions or instrumentalities.
4-A foreign government or any of its political subdivisions, agencies,
or instrumentalities.
5 -A corporation.
6-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
Futures Trading C-Ommission.
8-A real estate investment trust.
9- An entity register,ed at all times during the tax year under the
Investment Company Ac! of 1940.
10- Acommon trust fund operated by a bank under section 5B4(a).
11-A financial institution as defined under section 531.
12-A middleman known in U1e investment community as a nominee or
custcxlian.
13-A trust e,cempt from tax under section 664 or described in section
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.
IF the payment is for .... THEN the payment is exempt
for ...
• Interest and dividend payments All exempt payees except
for 7.
• Broker transactions Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations mus! not enter an
exempt payee code because they
are exempt only for sales ol
noncovered securities acquired
prior to 2012.
• Barter exchange transactions
and patronage dividends
Exempt payees 1 through 4.
• Payments over $600 required to
be reported and direct sales over
$5,ooo'
Generally, exempt payees
1 through 5_2
• Payments made in settlement of
payment card or lhird-party
network transactions
Exempt payees 1 through 4.
1 See Form 1099-MISC, 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
withholding; medical and health care payments, attorneys' fees, gross
proceeds paid to an,attorney reportable under seciion 604!5(�,, 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 person
requesting this form if you are uncertain if the financial institution is
subject lo these requirements. A requester may indicate that a ccxle is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar indication) entered on the line for a FATCA exemption code.
A-An organizati on exempt from tax under section 501(a),or any
individual retirement plan as defined in section 7701(a)(37].
B- The Uniled States or any ol its agencies or instrumentalities.
C-A state, the District of Columbia, a U.S. commonwealth or
territory, or any of their political subdivisions or instrumentalities.
D-A corporation the stock of which is regularly traded on one·or
more established securities markets, as described in Regulations
section 1.147.2-1(c)(1)(i),.
IE-A corporation that is a member o.fthe same expanded affiliated
group as a corporation desoribed in Regulations section 1.14!72-1(c)(1)(i).
F-A dealer in securities, commcxlities, or derivative financial
instruments �ncluding notional principal conlracts, futures, forwaids,
and options) that is registered as such under !he 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 all times during the tax year under the Investment
Company Act of i 940.
I-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
4947(a)(1).
M-A lax-exempt trusl under a section 403(b) plan,or section 4!57(g}
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).
This is where the requester of this Form W-9 willmail your information
returns. If this address differs from the one the requester already has on
file, enter "NEW" al the top. If 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 I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have, and are not eligible to get, an SSN, your TIN is your
IRS ITIN. Enter it in the entry space for lhe Social security number..It you
do not have an ITIN, see /-low to get a TIN below.
If you are a sole proprietor and you have an IEIN, you may enter either
your SSN or !:::IN..
If you are a single-member LLC that is disregarded as an entity
separate from its owner, enter the owner''s SSN (orEIN, if the owner has
one}. If the LLC is ciassified as a corporation or partnership, enler the
entity's IEIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. tfyou do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from 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 Individual Taxpayer Identification
Number, to apply for an,ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an IEIN
online by accessing the IRS website at www.irs.gov/EIN. Go lo
www.irs.gov/Forms lo view, download, or print Form W-7 and/or Form
SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and
have Form W-7 an.d/or Form SS-4 mailed lo you within 15 business
days.
If you are asked to complete Fonm W-9 but do no! have a TIN, apply
for a TIN and enter "Applied For" in the space for the TIINI, sign and date
the form, and give it to !he 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
the requester before you are subject to backup withholding on
paymenls. The 60cday rule does no! apply to other types of payments.
You 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 or that you intend to apply for one soon. See also Establish/rig U.S.
status for purposes of chapter 3 arid chapter 4 withho/dirig, earlier, for
when you may instead be subject lo withholding under chapter 3 or 4 of
the Code.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-3.
Form W-9 (Flev. 3-2024) Page5
Part IL 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 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
shouId sign (when required). In !he case·01a disregarded entity, lhe
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier,
Signature requirements. Complete !he certification as indicated in
items 1 through 5 below.
1. . Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have lo sign the
cerlifiication.
2. . Interest, dividend, broker, and barter exchange accounts
openedlafter 1983 and broker accounts considered inactiive during
1983. You must sign the certification or backup withholding will apply. If
you are subject 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 transactions. You must sign lhe certification. You may
cross oul item 2 of the certification.
4. . -Other payments. You mus! give your correct TIN, 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 �ncluding payments to corporations), payments to
a nonemployee for services,.payments made in settlement of payment
card and third-party network transactions, payments lo certain fishing
boat crew members and fishermen, and gross prooeeds paid to
attorneys (including payments to corporations).
5. . Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under sect1ion 529), ABLE accounts (under section,529A),
IRA, Coverdell ESA, Archer MSA or HS.A contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account: Give name and SSN of:
1. Individual The individual
2. Two or more individuals ij;oim account)
other than an account maintained by
an FR
The actual owner of the account or,
if combined funds, the fast individual!
on the accoun11
3. Two or more U.S. persons
noinl account maintained by an RR)
E,,_dl, holder ol the account
4. Custodial account of a minor
(U"iform Gift lo Minors Act)
The minor2
5, a, The usual revocabl'e savings trust
(grantor is also trustee)
The grantor-trustee
b, So-called lrust account that is not
a legal or valid trust under state law
The actual owner1
6, Sole proprietorship or disregarded
entity owned by an individual
The owner"
7, Granlor trust filing under Optional
Filing Method 1 (see Flegulations
section l671-4{b)l2)(i)[A))~
The grantor•
For this type of account: Give name and EIN of:
8. Disregarded entity not owned by an The owner
individual
9. A valid trust, estate, or pension trust Legal entity•
10. CDrporation Dr LLC electing corporate The corporation
status on Form 8832 or Form 2553
11. Associ:otion, dub, religious, charfable, The organizmion
educational, or other tax-exem,pt
Drganizalion
12. Partnership or multi-memberlLC The partnership
13. A broker or registered nominee The broker-or nominee
14. Acoount with the Oeparlmenl of The publ'ic entity
Agriculture in the name of a public
entity (such as a state or local
government, school districi1 or prison)
that receives agriculitu ral program
payments
15. Granlortruslliling1form 1041 or The trust
under the Optional Filing Method 2,
requiring,Form 1099 (see Regulations
section 1.67,41jb){2)(i)(B))*'
1 List first and circle !he name of the person whose number you rumish.
If only one person on a joint 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 enter your business
or OBA name, if any,.on line .2. You may use either your SSN or EIN �f
you have one), but the IRS encourages you to use your SSN.
• List first and circle !he name of lhe trust, estate, or pension trust. jDo
nol furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.)
• Note: The gran,tor must also provide a Form W-9 to the trustee of the
trust.
.. For more information on optional fiiling methods for grantor trusts, see
the Instructions for Form 1041.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity lheft
Identity !heft occurs when someone uses your personal information,
such as your name, SSN, or other identifying information, without your
permission to commit fraud or0th.er crimes. An identity thief may use
your SSN to get a job or may file a tax retum using your SSN lo receive
a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax return preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right. away to the name and phone number
printed on the IRS nolice or letter..
If your tax records are not currently affected 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 report, contact the IRS
Identity Theft.Hotline at 800-908-4490 or submit form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Form W-9'(Rev. 3-2024) Page6
Victims of identity thefl who are eKperiencing eGOnomic 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 toll-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 em ail lo a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user inlo surrendering
private information that will be used for idenlity theft.
The IRS does not initiate contacts with la,cpayers via emails. Also, the
IRS does nol request personal detailed information through email or ask
ta,cpayers for the PINInumbers, passwords, or similar secret access
information for their credit card, bank, or otherfinancial accounts.
Ii you receive an unsolicited email claiming to be from the IIRS,
forward !his message to phishing@irs.gov. You may also report misuse
of lhe IIRS name, logo, or other IRS property to th.e Treasury Inspector
General for Tax Administration (TIGTA) at 800c3'66-4!484!. You can
forward suspicious emails to !he federal Trade Commission at
spam@uce.gov or report them at www.ftc..gov/compfaint. You can
contact the FTC al wwwftc.govlidtheft or 877-IDTH�IFT (877-4!38-4338).
Ii you have been th.e victim of identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Go lo www.irs.gov/ldenti!yTheffto learn more about idenlity theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons �ncluding federal agencies} who are requir,ed to
file information returns with the IIRS to report interest, dividends, or
certain other 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 IRA, An;her MSA, or HSA. The
person collecting this form LJSes the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information 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 your TIN whether or not
you are required to file a tax return. Under seotion 3406, payors must
generally withhold a percentage 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 providing false or fraudulent
information.
ATTACHMENT “F”
RETIREMENT STATUS 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? Yes No
Did you retire before age 65 using the 2008 early retirement factors (ERF)? Yes No
Will you be receiving direct compensation for these services? Yes No
Will you be receiving indirect compensation for these services? Yes No
CONTRACTOR (Full name of contractor as in DRS filings-Please Print):
Signature: Last Four Digits of Social Security No.
Date:
SECTION 1: COUNTY 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
If yes, which system and plan?
Teachers’ Retirement System (TRS) Plan 1 Plan 2 __ Plan 3
School Employees’ Retirement System (SERS) Plan 2 __ Plan 3
Public Employees’ Retirement Systems (PERS) Plan 1 Plan 2 __ Plan 3
Public Safety Employees’ Retirement System (PSERS) ___________ Plan 2
Law Enforcement Officers’ & Fire Fighters’ Retirement System (LEOFF) Plan 1 ___ Plan 2
Washington State Patrol Retirement System (WSPRS) Plan 1 ___ Plan 2
Judicial Retirement System (JRS)
2.Is Contractor a retiree of a Washington State Retirement System?Yes No
3.Did Contractor retire before age 65 using the 2008 ERF?Yes No
I have verified the information above using MRV or by contacting DRS.
COUNTY REPRESENTATIVE (Please Print):
Signature: Date:
COUNTY RETAINS THIS FORM