HomeMy WebLinkAboutAFS between Kittitas County and Kittitas School Dist 26-270
Kittitas County Public Health Public Health
Contract/Agreement Review Form
Today's Date: 07/01/27 Legal Request #: 12559
Fund/Department: 1/10th of Mental Health Tax Agenda Date:
Contract/Agreement Information
Contract/Agreement Agency: Kittitas School District
Contract/Agreement Title: AFS between Kittitas County and Kittitas School District
Begin Date: 07/01/26
Total $ Amount: $82,400.00
Contract/Agreement Summary:
End Date: 06/30/27
Contract/Agreement #: PHMH26-013
The purpose of this Agreement allows the utilization of 1/10th funding to Kittitas School district to
contract with a licensed mental health care provider to provide mental health services to the
students in Kittitas School District.
Kittitas County Prosecutor and Auditor Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office 1OW1/1--
Signature of Auditor's Office-_ �J
Budget Information
Revenue Code(s): 105 - 560.3134000
Expense Code(s): 105 - 560.54101
Agency is not suspended/disbarred Not Checked (reason)
Pass Through Information
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub -Contract Approved Date:
Date
71912.6
Date -,/9/2-6
ADMIN I Version. 0 1 Supersedes. 0 Date Adopted: 12/01/2024 1 Modified By Katie Odiaga Approval By: Chelsey Loeffers
7/7/26, 9:30 AM
SAM.gov
KITTITAS SCHOOL
DISTRICT
Unique Entity ID CAGE/NCAGE
JSX9MFWGBVB7 5QTL1
Physical Address
505 N Pierce ST
Kittitas, Washington
98934-5918, United States
Purpose of Registration
Federal Assistance Awards Only
Version
Current Record
BUSINESS MFORMATION
Doing Business As URL
(blank)
www.ksd403.org
Division Name
Division Number
(blank)
(blank)
Congressional
State/Country of
District
Incorporation
Washington 08
(blank), (blank)
Owner CAGE Legal Business
Name
Immediate (blank)(blank)
Owner
Entity Information
Active Registration
Expiration Date
Jun 1, 2027
Mailing Address
PO Box 599
Kittitas, Washington
98934-0599, United States
Registration Dates
Activation Date
Jun 3, 2026
Submission
Date
Jun 1, 2026
Initial Registration
Date
Oct 5, 2009
Highest Level (blank)(blank)
Owner
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717/26, 9:30 AM SAM.gov
Entity Dates
Entity Start
Date
Sep 1, 1912
Fiscal Year End
Close Date
Aug 31
Executive Compensation
Registrants in the System for Award Management (SAM) respond to the Executive Compensation
questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding
Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is
sent to USAspending.gov for display in association with an eligible award. Maintaining an active
registration in SAM demonstrates the registrant responded to the questions.
SAM SEARCH AUTHOR2AMN
I authorize my entity's non -sensitive information to be displayed in SAM public search results:
Yes
ENTITY TYPES
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Entity Structure U.S. Government
Entity
Entity Type US Local Government
Profit Structure (blank)
Organization (blank)
Factors
Socio-Economic Types
Check the registrant's Reps & Certs, if
present, under FAR 52.212-3 or FAR 52.219-1
to determine if the entity is an SBA -certified
HUBZone small business concern. Additional
small business information may be found in
the SBA's Dynamic Small Business Search if
the entity completed the SBA supplemental
pages during registration.
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SAM.gov
Government Types
U.S. Local Government, School District
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KITTITAS COUNTY
AGREEMENT FOR SERVICES
PHMH26-013
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 Kittitas School District (hereinafter
"Contractor").
The purpose of this Agreement is as follows: 1/10th funding to Kittitas School district to contract with a
licensed mental health care provider to provide mental health services to the students in Kittitas School District.
The term of this Agreement shall be from July V, 2026, through June 30th, 2027, 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 West 5th Ave, Suite 108 PO Box 599
Ellensburg, WA 98926 Kittitas, WA 98934
Kasey Knutson Tim Praino
Human Services Manager Superintendent
Kittitas County Public Health Department Kittitas School district
Kasev.knutson@co.kittitas.wa.us Tim_praino@ksd403.org
509.962.7090 509.955,3120
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": Reporting
Attachment "E": General Terms and Conditions
Attachment "F": W-9 (Contractor must complete and return to the County for payment)
Kittitas County Agreement for Services (rev. 5/14/25)
Page 1 of 21
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
Kittitas County Agreement for Services (rev. 5/14/25)
Page 2 of 21
CONTRACTOR
at
Printed Name
Tit
Date:
ATTACHMENT "A"
SCOPE OF WORK
In addition to providing all material and labor, the Contractor shall perform the following activities:
• Social Worker (District Truancy Liaison): The social worker also serves as the district's truancy liaison,
coordinating with families, courts, and community agencies.
• Behavior Specialist at Kittitas Elementary and Secondary School: This position will provide data -informed
intervention, crisis prevention, progress monitoring, and coordination with counseling and community
partners.
• Employee Assistance Program: The Employee Assistance Program (EAP) provides confidential, short-term
counseling and support services to employees and their eligible family members at no cost. The program
is designed to help individuals address personal or work -related challenges that may impact well-being,
performance, or relationships.
■ Comprehensive Health Care Services
■ Anti -bullying and anti -discrimination consultation services
• Contract with a licensed mental health care provider to provide mental health services for the students in
Kittitas School District as described in the Kittitas School District proposal.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 3 of 21
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 invoice: $82,400.
Allowable direct expenses include, but are not limited to, salaries, wages, benefits, direct client services,
promotion, outreach activities, necessary supplies, professional development and training, travel, equipment, and
subcontracts. Purchases of clothing, incentives, video games and related items are not allowed. Food and gift card
purchases require prior approval by Kittitas County. All expenses must be necessary and directly related to the
scope of work as outlined in Exhibit A. Contractor will refer to their approved budget document submitted through
the funding request process for line -item expenses. Any changes or updates to the budget must be approved by
Kittitas County through the appointed contract manager in advance of the expenditure, in writing.
Any uses of these funds outside of the listed allowable uses must be approved by Kittitas County in advance of the
expenditure, in writing.
All funding is based on local tax and fee revenue. If local economic conditions result in insufficient funds to
compensate at the stated levels, the County reserves the right to renegotiate funding amounts to remain within
available revenue balances. The County will notify the Contractor immediately if financial forecasting or actuals
indicate such a circumstance.
All funds must be spent by June 30, 2027. No extension of the funding period will be granted.
Reimbursement Procedures
A. The Contractor shall submit invoices for services due once a month, which shall be emailed to Katie
Odiaga, Kittitas County Public Health Department, at katie.odiaga@co.kittitas.wa.us.
B. All invoices must be submitted bythe last day of the month following the calendar month in which
services were delivered.
C. The Contactor must provide adequate backup documentation to support costs in each invoice. This
includes a general ledger from the financial accounting system detailing transactions and expenditure
dates for allowable activities within the period of performance. Payroll expenses must show employee
names, hourly rate, number of hours, total pay, and project code. Benefits can be one line item but
should include project code. Non -payroll expenses must include a copy of the receipt or payment
invoice. Payments to subcontractors must be listed as a specific line item per subcontractor.
D. All invoices must include invoice date and an invoice number.
E. All invoices must also be accompanied by an updated Contractor Spending Form, as provided by Kittitas
County, to ensure that billing record keeping matches County records.
F. Failure to submit required monthly deliverable reports as outlined in Exhibit A: Scope of Work may
result in delayed reimbursement payments or denial of invoices.
G. Kittitas County is not liable for services provided unless the invoice is received on time or prior
arrangements are agreed to in writing signed by the County.
In no event shall payments under this agreement total more than $82,400.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 4 of 21
Contractor will refer to their approved documents submitted through the funding request process for the
1/10th of 1% Mental Health and Chemical Dependency Tax Grant. Any changes or updates made to the activities
or budget listed in those documents must be approved by Kittitas County through the appointed contract
manager in advance, in writing.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 5 of 21
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:
C Commercial General Liability Insurance
Coverage limits not less than:
$1,000,000 per occurrence, for all covered losses
e $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.
ix] 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 Liabi
• 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.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 6 of 21
❑ Professional Uabiiit Errors and Omissions UabiIit
■ 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.
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 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 and/or 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 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.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 7 of 21
ATTACHMENT "D"
REPORTING
Contractor shall provide quarterly progress reports using the template provided. Please submit progress reports
to the clerk at 'healthandhumanservices@co.kittitas.wa.us.
■ Quarter 1 (January -March) report due -on the last day of April.
Quarter 2 (April -June) report due on the last day of July.
■ Quarter 3 (July -September) report due on the last day of October.
Quarter 4 (October -December) report due on the last day of January.
The report shall include, at a minimum:
■ A narrative of project activities during the reporting period, including progress on the activities outlined
in your Scope of Work (Attachment "A").
■ A narrative of project successes during the reporting period.
■ A narrative of project challenges during the reporting period.
The County retains the right to request clarification or additional information of the applicant as needed to assess
project progress and/or appropriate use of funds.
Failure to submit the required reports may result in delayed reimbursement payments, denial of invoices, or
contract termination.
Contracts, reporting, and invoicing documentation is subject to public disclosure. Please refrain from using
individual names in these documents. These documents may be posted to the Kittitas County Public Department's
Website at any time to provide transparency in the use of tax funding.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 8 of 21
ATTACHMENT "E"
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 Pa ment: 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: and Subcontracting: No portion of this Agreement may be assigned
or subcontracted to any other individual, firm or entity without the express and prior written approval of the
County. The Contractor may only subcontract work contemplated under this agreement if it obtains the prior
written approval of the County. If the County approves subcontracting, the Contractor shall maintain written
procedures related to subcontracting, as well as copies of all subcontracts and records related to subcontracts.
For cause, the County in writing may require the Contractor to amend its subcontracting procedures as they relate
to this agreement, prohibit the Contractor from subcontracting with a particular person or entity, or require the
Contractor to rescind or amend a subcontract. Every subcontract shall bind the Subcontractor to follow all
applicable terms of this agreement. The Contractor is responsible to the County if the Subcontractor fails to
Kittitas County Agreement for Services (rev. 5/14/25)
Page 9 of 21
comply with any applicable term or condition of this agreement. The Contractor shall appropriately monitor the
activities of the Subcontractor to assure fiscal conditions of this agreement. In no event shall the existence of a
subcontract operate to release or reduce the liability of the Contractor to the County for any breach in the
performance of the Subcontractor's duties.
Every subcontract shall include a term that County is not liable for claims or damages arising from a
Subcontractor's performance of the subcontract.
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
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
Kittitas County Agreement for Services (rev. 5/14/25)
Page 10 of 21
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. Indemnification
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
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 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.
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-Appropriationof 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:
Kittitas County Agreement for Services (rev. 5/14/25)
Page 11 of 21
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 abilityto 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: 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 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
Kittitas County Agreement for Services (rev. 5/14/25)
Page 12 of 21
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
Kittitas County Agreement for Services (rev. 5/14/25)
Page 13 of 21
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, 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
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. Severabilit : 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.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 14 of 21
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.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 15 of 21
ATTACHMENT "Frr
Ferro W-9
Request for Taxpayer
Give form to the
(Rev. March 2024)
Identification Number and Certification
requester. Do not
Department ofthe Treasury
Go to www.)ra.gov/FormW9 for instructions and the latest Information.
send to the IRS.
Internal Revenue Service
Before you begin, For gu4dance
related to the purpose of Form W-9, see Purpose ofFurrrt, below.
1 Name of entity/Indivldua]. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on 11ne 1, and enter the businessidlsregarded
entity's name on line 2.)
2 Business name/diaregardod entity name, K different from above.
3a Check the appropriate box for federal tax classificalion of the entily/ndividual whose name Is entered on line 1. Check
4 Exemptions (codes apply only to
a
only one of the following seven boxes.
certain entities, not individuals:
2.
❑ IndlviduaVsola proprietor ❑ C corporation ❑ S corporation ❑ Partnership ❑ Trust/ostato
see instructions on page 3):
C
❑ LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . .
Exempt payee code (It any)
Nola: Check the "LLC" bax above and, In the unify space, renter the hppropriatH rode (C. S, or P) for the lnx
elAmIrIcatlen o! tho LLC, un km 11 is a disregarded entity. A disregarded ontity should Inslead chink I h a aopwrx al-
Exemption from Foreign Account Tax
o
box for the tax classification of its owner.
Compliance Act (FATCA) ropod Ing
❑ Other (see Instructions)
cotle (il any)
CE
a
3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification,
fAnrdim to accounts maintained
and you are providing this torn to to WnwaNp. trust. or saute rn whlcri you have an ewnersnlp interest, check
❑
outside the United States.)
this box tl you have eny foreign partners. owners, or benefldwiea. Sege PnSt"acilarrs
5 Address (number, street, and apt. or suite no.). See Instructions.
Requester's name
and address (optional)
e City, state, and ZIP code
7 List account number(s) here (opt onal)
giEM
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
I aocwl securny numovr nn
_ m -
resident alien, sole proprietor, or disregarded entity, see the Instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
or
TIN, later.
Employer Identification number
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
FU
FT
Number To Give the Requester for guidelines on whose number to enter.
-
Under penalties of perjury, I certify that:
1. The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been 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 dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
The FAT( -,A code(s) entered on this form (f any) Indicating that I am exempt from FATCA reporting Is correct.
Certification Instructions. You must cross out hem 2 above If you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all Interest and dividends on your tax return. For real Wale transactions, Item 2 does nol apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrartgement (IRA), and, generally, payments
other than Interest and dividends, you are not mquirod to sign the ou tification, but you musi provide your correct TIN. Soo the instructions for Part 11, later,
Sign I signature of
Here u.s. person Data
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest Information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/ForrnW9.
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 box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and eri:er its appropriate tax classification.
Cat. No. 10231x
Kittitas County Agreement for Services (rev. 5/14/25)
Page 16 of 21
New line 3b has been added to this forth. A flow -through entity is
required to complete this line to Indicate that it has direct or Indirect
foreign partners, owners, or beneficiaries when it provides the Forth W-9
to another !Tow -through entity in which rt has an ownership interest. This
change Is intended to provide a flow -through entity with information
regarding the status of its Indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
partrcrs may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Forth 1065).
Purpose of Form
An Individual or entity (Form W-9 requester) who is required to file an
information return with the IRS Is giving you this form because they
Form W-9 (Rev. 3-2024)
Form W-9 (Rev. 3-2024)
Page 2
must obtain your correct taxpayer identification number MN). which
may be your social security number (SSN), individual taxpayer
identification number (ITiN), adoption taxpayer identification number
(ATIN), or employer identification number (EIN), to report on an
information return 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 1099-INT (interest earned or paid).
• Form 1099-DIV (dividends, including those from stocks or mutual
funds).
• Form 1099-MfSC (various types of income, prizes. awards, or gross
proceeds).
• Form 1099-NEC (nonempioyee compensation).
• Form 1099-8 (stock or mutual fund sales and certain other
transactions by brokers).
• Form 1099S (proceeds from real estate transactions).
• Form 1099-K (merchant card and third -party network �arrsattions).
• 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 properlyl.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
Caution: If you don't return Form W-9 to the requester with a TIN, you
might be subject to backup withholding. See What is backup
withholding, later,
By signing the filled -out form, you:
1. Certify that the TIN you are giving is corr?ct (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
chapter 3 or 4 of the Code (if applicable); and
5. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from 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 other
than Form W-9 to request your TiN, you must use the requester's forrn 4
it is substantially similar to this Form W-9.
Definition of a U.S. person. 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 the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Establishing U.S. status for purposes of chapter 3 and chapter 4
withholding. Payments mada to foreign persons, including certain
distributions, allocations cf income, or transfers of sales proceeds. may
be subject to withholding under chapter 3 or chapter 4 of the Code
(sections 1441-1474). Under those rules, if a Form W-9 or other
certification of non -foreign status has not been received, a withholding
agent, transferee. or partnership (payorj generally applies presumption
rules that may require the payor to withhold applicable tax from the
recipient. owner, transferor, of partner (payee). See Pub. 515.
Withholding of Tax on Nonresident Aliens and Foreign Entities.
The following persons must provide Form W-9 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
of the disregarded entity and not the disregarded entity.
• In the vase of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner 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
Ind not the beneficiaries of the trust.
See Pub. 515 for more inforrnation on providing a Form W-9 or a
certification of non -foreign status to avoid withholding.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 17 of 21
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person (under
Regulations section 1.1441-1(b)(2)[rv) or other applicable section for
chapter 3 or 4 purposes), do not use Form W-9. Instead, use the
appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a
qualified foreign pension fund under Regulations section 1.897(I)-1(d), or
a partnership that is wholly owned by qualified foreign pension funds,
that is treated as a non -foreign person for purposes of section 1445
withholding, do not use Form W-9. Instead, use Form W-SEXP (or other
certification of non -foreign status).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, nmost tax
treaties contain a provision known as a saving clause. Exceptions
specified in the saving clause may permit an exemption from tax to
continue 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 exception
contained in the saving clause of a tax treaty to claim are exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The 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 treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S, law, this
student will become a resident alien for tax purposes if their stay in the
United States exceeds 5 calendar years. However, paragraph 2 of the
first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the
provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
Protocol) and is relying on this exception to claim an exemption from tax
on their scholarship or fellowship income would attach to Form W-9 a
statement that includes the information described above to support that
exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Forth W-8 or Farm 9233_
Backup Withholding
What is backup withholding? Persons making certain payments to 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, dividends, broker and barter exchange
transactions, rents, foyallies. nonemployee pay, payments made in
settlement of payment card and third -party network Iransactions, and
certain payments from fishing boat operators. Real estate transactions
are not subject to backup withholding.
You will not be subject to backup withholding on payments you receive
0 you give the requester your correct TIN, make the proper certifications.
and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TiN when required (see the instructions for
Part II for details);
3. The IRS tells the requester that you furnished an incorrect TIN;
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only); or
5. You do not certify to the requester that you are not subject to
backup withholding. as described in item 4 under "By sigrarrg the frfled-
our form" above (for reportable interest and dividend accounts opened
after 1983 only).
Form W-9 (Ray. 3-2024)
Page 3
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 Esfab6shing 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. account
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 to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the 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 grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to famish your correctT(N to a
requester, you are subject to a penalty of S50 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 that results in no
backup withholding, you are subject to a S500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment
Misuse of TINs. If the requester discloses or uses TINS in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific 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 (FFI)), list first, and then
circle. the 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 account, each holder of the account that is a U.S. person must
provide a Form W-9.
• Individual. Generally, enter the name shown on your tax return. If you
have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note for ITIN applicant: Enter your individual name as it was entered
on your Form W-7 application. line la. This should also be the same as
the name you entered on the Form 1040 you filed with your application.
• Sole proprietor. Enter your individual name as shown on your Forth
1040 on line 1. Enter your business, trade. or "doing business W (DBA)
name on line 2.
• Partnership, C corporation, S corporation, or LLC, other than a
disregarded entity. Enter the entity's name as shown on the entity's tax
return on line t and any business. trade, or DBA name on line 2.
• Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the 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 its owner (a disregarded entity). See Regulations
section 301.7701-2(cX2). A disregarded entity should check the
appropriate box for the tax classification of its owner. Enter the owner's
name on line 1. The name of the owner entered on line 1 should never
be a disregarded entity. The name on fine 1 should be the name shown
on the income tax return on which the income should be reported. For
Kittitas County Agreement for Services (rev. 5/14/25)
Page 18 of 21
example, if a foreign LLC that is treated as a disregarded entity far U.S.
federal tax purposes has a single owner that is a U.S. person, the U.S.
owner's name is required to be provided on line 1. If the direct owner of
the entity is also a disregarded entity, enter the first owner that is not
disregarded for federal tax purposes. Enter the disregarded entity's
name an line 2. If the owner of the disregarded entity is a foreign person,
the 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 it on line 2.
Line 3a
Check the appropriate box on line 3a for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3a.
IF the entityrindividual online 1 1
THEN check the box for .. .
is a(n) ...
• Corporation
Corporation.
• Individual or
Individual/sole proprietor.
• Sole proprietorship
■ LLC classified as a parfiership
Limited liability company and
for U.S. federal tax purposes or
enter the appropriate tax
• LLC that has filed Form 8832 or
classification:
2553 electing to be taxed as a
P = Partnership,
corporation
C = C corporation, or
S = S corporation.
• Partnership
Partnership.
• Trustiestate
Trustlestate.
Line 3b
Check this box if you are a partnership (including an LLC classified as a
partnership for U.S. federal tax purposes), trust, or estate that has any
foreign partners. owners, or beneficiaries, and you are providing this
form to a partnership, trust. or estate, in which you have an ownership
interest. You must check the box on line 3b if you receive a Form W-8
(or documentary evidence) from any partner, owner, or beneficiary
establishing foreign status or if you receive a Form W-9 from any
partner, owner, or beneficiary that has checked the box on line 3b.
Nate: A partnership that provides a Form W9 and checks box 3b may
be required to complete Schedules K-2 and K-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 to do so, you may not
receive the information necessary to file a correct information return with
the IRS or fumish 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 from backup withholding and/or FATCA reporting,
enter in the appropriate space on line s 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 backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third -party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys' fees or grass proceeds paid to attomeys. and corporations
Ihat provide medical or health care services are not exempt with respect
to payments reportable on Forth 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space on line 4.
t —An organization exempt from tax under section 501(a), any IRA, or
a custodial account under section 403(b)(7) it the account satisfies the
requirements of section 401(f)(2).
Form W-9 IRey. 3-2024)
Page 4
2—The United States or any of its agencies or instrumentalities.
3—A state. the District of Cckrmbia, 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 — A dealer 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 Commission.
8—A real estate investment trust.
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940.
10—A common trust fund operated by a bank under section 584(a).
11—A financial institution as defined under section 581.
12—A middleman known in the investment community as a nominee or
custodian.
13—A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the 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.
• Sroker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
• Barter exchange transactions
Exempt payees 1 through 4.
and patronage dividends
• Payments over $600 required to
Generally, exempt payees
be reported and direct sales over
1 through 5.2
55.000'
• Payments made in settlement of
Exempt payees 1 through 4.
payment card or third -party
network transactions
r See Form 1099-MISC, Miscellaneous Information, and its instructions.
a However, the following payments made to a corporation and
reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys' fees, gross
proceeds pad to an attomey reportable under s-ection 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this 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
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code 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 organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(aX37).
E—The United States or any of 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 1.1472-1(c)(1)(r).
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)n.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 19 of 21
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state.
G—A real estate investment trust
H—A regulated irrvestment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940.
I —A common trust fund as defined in section 584(a).
J—A bank as defined in section 581.
K—A broker.
L—A trust exempt from tax under section 664 or described in section
4947(a)(1).
M—A tax-exempt trust under a section 403(b) plan or section 457(g)
plan.
Note: You may wish to consult with the financial institution requesting
this form to determine %vhether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number. street, and apartment or suite number}.
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, enter 'NEW' at the top. if a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. II you are a resident alien and
you do not have. and are not eligible to get, an SSN. your TIN is your
IRS MK Enter it in the entry space for the Social security number. If you
do not have an IT1N, see How to get a TIN below.
If you are a sole proprietor and you have an PIN, you may enter either
your SSN or PIN.
If you are a single -member LLC that is disregarded as an entity
separate from its owner, enter the owner's SSN (or PiN. if the owner has
one). If the LLC is classified as a corporation or partnership. enter the
entity's PIN.
Note: See What Name and Number 7a Give the Requester, later. for
further clarification of name and TIN combinations.
How to get a TIN. If you do not hava 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.SSAgov. You may also get this form by calling 800-772-1213. Use
Form W-7, Application for IRS individual Taxpayer Identifical ion
Number, to apply for an TTIN, or Form SS-4, Application for Employer
Identification Number, to apply for an PIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/EfN. Go to
wwwJmgov1Fvrms to view, download, or print Form W-7 and/or Form
SS-4, Or, you can go to www.irs.gov/0i-derFomis to place an order and
have Form W-7 and/or Form SS-4 mailed to you within 15 business
days.
If you are asked to complete Form W-9 but do not have a TiN, apply
for a TiN and enter "Applied For" in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, you will generally have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to athe r 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 Estab6shrng U.S.
staters for purposes of chapter and chapter withholding, earlier, far
when you may instead be subject to withholding under chapter 3 or 4 of
the Code.
Caution: A disc ecarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Form W-9 (Rev. 3-2024)
Page 5
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if Rem 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicates 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 to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive 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
certification before signing the form
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previous) y given an incorrect TIN. 'Other payments" include
payments made in the course of 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 services, payments made in settlement of payment
card and third -party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds 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 section 529). ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA 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 indwidua[s (;oint account)
The actual owner of the account or,
other than an account maintained by
if combined funds, the fast inclis:dual
an FFI
on the account'
3. Two or more U.S. persons
Each holder of the account
Ooint account maintained by an FRI
4. Custodial account of a minor
The menor2
(Uniform Gift to Minors Act)
S. a. The usual revocable savings trust
The grantor -trustee
(grantor is also trustee)
b. So-called trust account that is not
The actual owner'
a legal or valid trust under state law
b. Sole proprietorship or disregarded
The owners
entity owned by an individual
7. Grantor trust filing under Optional
The grantor'
Filing Method 1 (see Regulations
section 1.671-*X2XiWA)r'
Kittitas County Agreement for Services (rev. 5/14/25)
Page 20 of 21
For this type of account: I 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. Corporal ion or LLC electing corporate
The corporation
status on Form 8832 or Form 2553
11. Association, dub, religious, charitable,
The organization
educational, or other tax-exempt
organization
12. Partnership or mufti -member LLC
The partnership
13. A broker or registered nominee
The broker or nominee
14, Account with the Depnrtment of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school dr,trict. or prison)
that receives agricultural program
payments
is-,(' ranto? trust filing Form 1041 or
The trust
under the Optional Fling Method 2,
requiring Form 10" (see Regulatirms
section 1.571-4(b)(2)€i )r
' List first and circle the name of the person whose number you fumish.
If only one person on a joint account has an SSN, that person's number
must be fumished.
2Circle the minors name and furnish the minors SSN.
'You must show your individual name on line 1, and enter your business
or Df3A name, if any, on line 2. You may use either your SSN or EIN (4
you have one), but the IRS encourages you to use your SSN.
'List first and circle the name of the trust, estate, or pension trust. (Do
not fumish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.)
'Note: The grantor must also provide a Form W-9 to the trustee of the
trust.
"For more information on optional filing 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 Theft
Identity theft occurs when someone uses your personal information,
such as your name, SSN, or other identifying information, without your
permission to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your $SN to 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.
It your tax records are affected by identity theft and you recOie a
notice from the IRS. respond right away to the name and phone number
printed on the IRS notice 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)
Page 6
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll -free case intake line at 877-777-4778 or TTYITDO
800-829-4059.
Protect yourself from suspicious emails or phishing 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 to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank. or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (rIGTA) at SM-3664484. You can
forward suspicious emails to the Federal Trade Commission at
spamVuce.gov or report them at www.Rc.govicompJainr. You can
contact the FTC at www.fte.govlidthQR or 877-IDTHEFT (ST7-438-4336).
If you have been the victim oT identity theft. see www,ldendtyTheft.gar
and Pub. 5027.
Go to www.irs.gov/ldenfiryTheft to learn more about identity theft and
how to reduce your risk.
Kittitas County Agreement for Services (rev. 5/14/25)
Page 21 of 21
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS 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. Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths 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 must provide your TIN whether or not
you are required to file a tax return, Under section 3406. payors must
generally withhold a percentage of taxable interest, dividends, and
certain other payments to a payee who does not give a Tiff to the payor.
Certain penalties may also apply for providing false or fraudulent
information.