HomeMy WebLinkAboutKittitas County & Peers RisingKITTITAS COUNTY
AGREEMENT FOR SERVICES
PHMH26-010
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 Peers Rising (hereinafter
"Contractof ).
The purpose of this Agreement is as follows: Utilize the 2026 One-Time Opioid Abatement Strategies
funding to provide barrier reduction support for individuals impacted by opioid use disorder, including
transportation, basic needs, and reentry assistance.
The term of this Agreement shall be July L, 2026, through June 30,2027, 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
This Agreement includes the following, which are attached hereto and hereby incorporated by this
reference:
Kittitas County Public Health
507 N Nanum Street Ste 102
Ellensburg, WA 98926
Kasey Knutson
Human Services Manager
Human Services
Kasey.kn utson @co. kittitas.wa. us
509-962-7515
Attachment "A":
Attachment "8":
Attachment "C":
Attachment "D":
Attachment "E":
Kittitas County Agreement for Services (rev.5/L4/25)
Page 1 of 19
Peers Rising
110 W 6th Ave PMB 118
Ellensburg, WA 98926
BrandiAmundson, CPC
Executive Director
bra nd i @ peersrisingwa.org
509-312-8041
Scope of Work
Compensation
lnsurance Requirements
General Terms and Conditions
W-9 (Contractor must complete and return to the County for payment)
lN 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 Agreement for Services (rev.5/t4/25l,
Page 2 of 19
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY
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ATTACHMENT'A'
SCOPE OF WORK
r Provide Recovery Support Specialist
. Equipment and Supplies
o Transportation support to access treatment, court, and recovery service
o One time stabilization for housing/utility tied to treatment engagement and recovery.
o Recovery basic needs
. May include hygiene, clothing, one-time prepaid cell, assistance with accessing personal
cluculrrents.
o Temporary pet placement to remove barriers to treatment
o Contractor will refer to their approved proposal documents submitted through the funding request
process for additional scope of work detail.
. Any service provider offering transportation must ensure that drivers hold valid driver's licenses and
have a background screening completed to include a driving abstract in order to safely perform the
services.
Kittitas County Agreement for Services (rev.5/74125)
Page 3 of 19
ATTACHMENT "8"
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: 5 94,202.90. 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
experrdil.ure, irr writing.
Unless otherwise provided herein, Contractor shall be solely responsible for Contractor's travel and
related expenses.
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 funds must be spent by June 30, 2027. No extension of the funding period will be granted
Reimbursement Procedu res
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. Att invoices must be submitted by the tast day of the month fottowing the catendar month in which
services were detivered.
C. The Contractor 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.
ln no event shall payments under this agreement total more than 594,202.90
Kittitas County Agreement for Services (rev. 5lt4/25\
Page 4 of 19
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 Vll or better in the most recently published edition of Best's Reports unless otherwise approved
by the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies
must comply wlth Chapter 48.15 RCW and 284-15 WAC.
At a minimum, Contractor shall maintain and provide proof of the following selected options
X Commercial General Liability lnsurance
Coverage limits not less than:
o $1,000,000 per occurrence, for all covered losses
o $2,000,000 general aggregate
o $L,000,000 products & completed operations aggregate
o $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 Liabilitv lnsurance
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 Liabilitv
. Contractor shall provide Excess or Umbrella Liability coverage of 55,000,000. This Excess
or Umbrella Liability coverage shall apply, at a minimum, to both the Commercial General
and Automobile lnsurance policy coverages. lf used to meet limit requirements, coverage
must be at least as broad as specified for underlying coverages, and must cover those
insured in the underlying policies.
. This requirement may alternatively be satisfied through Contractor's primary Commercial
General and Automobile Liability coverage, or any combination thereof.
. 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 & Emplover's Liabilitv
. 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 51,000,000 per accident or disease.
Kittitas Cou nty Agreement for Services (rev. 5/14/25)
Page 5 of 19
Professional Liabilitv / Errors and Omissions Liabilitv. Coverage limits not less than:
r $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 lnsurance, with endorsement where required above,
as evidence that policies providing insurance required by this Agreement are in full force and effect. Contractor's
insurance policies required above must apply on a primary non-contributing basis in relation to any other
insurance or self-insurance available to the County.
Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any
material alteration or non-renewal, of any of the above-required insurance coverages.
Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools,
machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's agents, employees,
suppliers or contractors, as well as to any temporary structures, scaffolding 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 lnsurance with all
required endorsements, properly completed and in the amounts required, and (2) where requested by the County,
a copy of the required insurance policies, including all required endorsements.
Kittitas County Agreement for Services (rev. 5/74/25)
Page 5 of 19
ATTACHMENT "D"
GENERAL TERMS AND CONDITIONS
t. 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 Pavment: 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 "8", the County will not
reimburse Contractor for any costs or expenses incurred by Contractor in performance of this Agreement. Where
required, the County shall, upon receipt of appropriate documentation, compensate Contractor, no more often
than monthly, through the County voucher system, for Contractor's services pursuant to the fee schedule set forth
in Attachment "8". ln the event Contractor fails to perform any of its obligations under this Agreement within the
time specified herein, then the County may withhold all monies due and payable to Contractor until such failure
to perform is cured or otherwise adjudicated. The County will not process payment for services rendered under
this Agreement until Contractor submits a completed W-9 (See Attachment "E").
3. Taxes: Contractor understands and acknowledges that the County will not withhold Federal or State
income taxes from payments made to Contractor. Where required by State or Federal law, Contractor authorizes
the County to make withholding for any taxes other than income taxes (e.g., Medicare). All compensation received
by Contractor will be reported to the lnternal Revenue Service at the end of the calendar year in accordance with
applicable IRS regulations. lt is the responsibility of Contractor to make its necessary estimated tax payments
throughout the year, if any, and Contractor is solely liable for any tax obligation arising from Contractor's
performance of this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired hereunder as required by
law. Contractor must pay all other taxes, including but not limited to: business and occupation tax; or taxes based
on (L) Contractor's gross or net income, or (2) personal propertyto which the County does not hold title. The
County is exempt from federal excise tax.
4. lndependent Contractor: Contractor's services shall be furnished by Contractor as an independent
contractor, and nothing stated herein shall be construed to create a relationship of employer-employee or a
guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement
is specified in Attachment "8", and that Contractor is not entitled to any County benefits, including but not limited
to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights or
privileges afforded to Kittitas County employees.
5. Assignment and Subcontracting: 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. lf 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.5lIa/25)
Page 7 of 19
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. ln 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
Su bcontracto r's perfo rma nce of the su bco ntract.
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 underthis Agreement. Contractor shall preserve and maintain all records
relatlng to this Agreement for six (6) years after terminatron or exprratron of the Agreement, and upon request
shall make them available for review by any Federal or State auditor, the County, and/or any persons authorized
by the County.
7. Modification
7.L. This Agreement may be amended by mutual agreement of the parties. Any such amendment
shall be in writing and signed by both parties.
7.2 The County may unilaterally amend this Agreement at any time by written notice ("Change
Notice") to Contractor, to modify the work to be performed under this Agreement, within the general scope of
the Agreement. Such changes may include, but are not limited to, changes in the exact scope of work to be
performed (including modification, substitution, addition, or deletion of required tasks) and changes to the
schedule of performance. lf any such Change Notice causes an increase or decrease to Contractor's cost of, or the
time required for, performance of the 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 lf Contractor defaults by failing to perform any of its obligations under this Agreement, or
becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes an assignment
for the benefit of creditors, the County may, by written notice to Contractor, terminate the Agreement, and at
the County's option, obtain performance of the work elsewhere. lf the Agreement is terminated under this
paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all of its
obligations hereunder have been fully performed, and any extra cost or damage to the County shall be deducted
Kittitas County Agreement for Services (rev.5lMl25)
Page 8 of 19
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. lndemnification
9.1 To the fullest extent permitted by law, Contractor agrees to indemnify, defend and hold the
County and its departments, elected and appointed officials, employees, agents and volunteers, harmless from
and agalnst 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 ol resulting
from, or otherwise connected with the performance of this Agreement; or (3) are based upon Contractor's or its
subcontractors' use of, presence upon or proximity to the property of the County. This indemnification obligation
of Contractor shall not apply in the limited circumstance where the claim, damage, loss or expense is caused by
the sole negligence of the County. This indemnification obligation of Contractor shall not be limited in any way by
the Washington State lndustrial 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 ln the event Contractor enters into subcontracts to the extent allowed under this Agreement,
each such subcontractor shall indemnify the County on a basis equal to or exceeding Contractor's indemnity
obligations to the County.
l-0. Venue and Choice of Law: ln the event that any litigation should arise concerning this Agreement,
the venue for such action shall be in the Superior Court of the State of Washington in and for the County of Kittitas.
This Agreement shall be governed by the laws of the State of Washington.
l-l-. Non-Appropriation of Funds: lf 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
endofthelastfiscal periodforwhichsufficientfundingwasappropriated. Nopenaltyorexpenseshallaccrueto
the County in the event this provision applies.
12. Contractor Commitments, Warranties, and Representations
follows:
Kittitas County Agreement for Services (rev.5lt4l25)
Page 9 of 19
Contractor represents and warrants as
1.2.7 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.
I2.2 Contractor has the authority to execute this Agreement, to make the representations and
warranties set forth herein, and to perform its obligations hereunder.
72.3 This Agreement has been validly executed by an authorized representative of Contractor and
constitutes a valid and legally binding and enforceable obligation of Contractor.
L2.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses,
permits and other authorizations from federal, state and local governmental authorities, or from any applicable
industrial or professional certification or licensing bodies, as are necessary for the lawful perfornrance 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.
1,2.6 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,
I2.7 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.
L3. Ownership of ltems Produced: All writings, programs, data, reports, films, recordings, or other
materials prepared by Contractor and/or its consultants or subcontractors, in connection with the performance
of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of
ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the
ability to transfer any or all ownership rights.
L4. lntellectual Propertv lnfrinsement: Contractor will defend and indemnify the County from any
claimed action, cause or demand brought against the County, to the extent such action is based on the claim that
information and/or materials supplied by Contractor infringe any intellectual property rights of any third
party(ies). Contractor will pay all costs and damages attributable to any such claims finally awarded against the
County in any action. Such defense and payments are conditioned upon the following: (1) Contractor shall be
notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right
hereunder, at its option and expense, to obtain 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.
1"5. Use of Countv 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.
t6. 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 10 of 19
by a dispute board ("Dispute Board") in the following manner: Each party shall appoint one member to the Dispute
Board, the members so appointed shall jointly appoint an additional member to the Dispute Board, and the
Dispute Board will evaluate the facts, Agreement terms, and all applicable statutes and rules, and make a
determination as to the proper resolution of the dispute. Such determination shall be final and binding on both
parties. The cost of resolution will be borne as allocated by the Dispute Board. Alternatively, if agreed to in writing
by both parties, the parties may forego the option of establishing a Dispute Board to adjudicate the dispute, and
instead pursue arbitration, jointly selecting an arbitrator acceptable to both parties. ln the event the parties
choose to pursue arbitration, the parties agree that: (1) the fees and expenses of the arbitrator shall be shared
equally by both parties to this Agreement, (2) each party shall bear its own costs and attorney fees, (3) arbitration
shall be conducted according to the commercial arbitration procedures of the American Arbitration Association,
and (4) the arbitrator's decision or award shall be final and binding on both parties.
L7. Cunfidentialitv: Corrtractor, its employees, agents and volunteers, and any of Conffactor'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 1of this Agreement.
19. Prevailins Wase: Where labor to be performed under this Agreement is considered "public work" as
defined in RCW 39.04.0L0, Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics
employed in the performance of work under this Agreement in accordance with RCW 39.12 and the rules and
regulations of the Washington State Department of Labor and lndustries. The schedule of prevailing wage rates
for the applicable locality or localities is determined by the lndustrial Statistician of the Department of Labor and
lndustries. lt is Contractor's responsibility to verify the applicable prevailing wage rate. lt is understood that
Contractor is responsible for obtaining and completing all required government forms relating to prevailing wage
and submitting same to the proper authorities. Disputes regarding prevailing wage rates shall be referred for
arbitration to the Directorof the Department of Labor and lndustries. The arbitration decision shall be final and
conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.060.
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.
2L. Nondiscrimination
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Page 11 of 19
27.1 ln the performance of this Agreement, Contractor will not discriminate against any employee or
applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration
status, sex, sexual orientation, marital status, honorably discharged veteran or military status, 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, sexualorientation,
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
recruiLrrrerrL advertising, layoff or termlnatlon, rates of pay or other forrns 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 lf 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,I0,13, 1,4, 15, L6,17,19,20,22,24, and 2B of
these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this
Agreement for any reason.
25. Complete Asreement: This Agreement constitutes the entire agreement between the parties and
supersedes any and all other agreements, understandings, negotiations and discussions, oral or written, express
or implied, regarding the work to be performed hereunder. The parties agree that no other representations,
inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made
between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this
Agreement shall be valid or binding unless in writing and signed by the parties.
26. Severabilitv: lf an y 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.5h4l25)
Page 12 of 19
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.5lI4l25)
Page 13 of 19
,.,," llU'9
ATTACHMENT "E"
Request for Taxpayer
ldentification Number and Certification
Go to rvww.rrr.govlFormwglot instructions and the lsle8t lnformatlon'
Glve form to the
requester. Do not
scnd to ihe lRS.
(Hev. MRrch 2024)
Dopartmenl of th6 Tr€asury
lntomal Rovonuo Sorvlco
3a Chsck lho appropriala box for lodoral lax classilication of lhs slily/indivdual vhoae nam€ 13 entersd on line 1. Ch€ck
only ono o, tbo lollowing sovon boxos.
n hdlviduaysolo proprlotor fl c corporatlon f| S corporatlon ! Partnenhlp n TrusVosiato
n LLC. Entor thetaxclassltlcsllon(C = Ccotporatlon, S = Scorfnrallon, P = Partnorshlp)
Nota: Chrck lh€ "LLC' box abovo and, ln the €nlry 3pac6, enler lho approprlale codo (C. S, or P) lor lhs tax
classltlcatlon ot lha LLC, urjloss ll ls n diBreg8rdod ontlly. A disrogardod ontily should lnsl€ad chock the soproprlal€
box for th6 td classilication ot il3 owng/.
n Olher {s6o lnshucllons)
3b It on lins 3o you chocked "Psrtn€rehip" or "Trusvostalo." or chscked "LLC" and €nlsrod "P'as ils ts clsssificatlon,
md you era provldino lhis lorfi lo a psrln€iship, lrust, or €stqto in whlch you havo nn owm€hlp int6r€gl, ch6ck
thls box lf you hava any lorelgn p&dners, own6r3, or bonaflclari€s, soa inolrdcllong , , . n
6 Addrs$B (numba., strotl, and apl. or snlle no.). S€6 loslnrcllons,
6 City, stot6, and ZIP codo
Part I
dooGa
5
oE
9.8;tt!
4o|eIIooa
Belore
Entor your TIN ln the appropriale box. The TIN provlded must match the name given on line 1 to avold
backup withholding. For individuals, this is gsn€rally your soclal securily numb6r (SSN). Howover, for a
r6sldent alion, sole propriotor, or disrogardod onlity, ss6 lhe lnstructlons for Part l, lat€r. For oth€r
entities, it is your employer identlllcatlon number (ElN). lf you do not have a number, 3ee How lo get a
fl/V, later.
Noto: lf tho account is in more than ono namo, seo lh€ instructions for lins 1. Seo also What Name and
Number To Give tho Feguesler for guldolines on whoso numbar lo ontor.
Slenslu.t ol
U,9. plrlon Drt.
For rolatod to lh6 of Form W-9, s6o of Form, b6low.
t Name ol entity/lndlvidusl. n entry ls roquired. (For tr sole proprietor or disrogarded slity, ontor lho owneig nsm on llno 1, snd enter tho business/dbregsrded
sntily's ndms on ling 2.)
2 Eusino8s namo/disrogardod ontity nrmo, it difloronl from obov6.
4 Exomptions (codos apply only to
certain enlhles, not indivlduals:
sea Inslruction3 on page 3):
txomDt oavm codo lil anvl _
Exempllon lrorn Foroiotr Account Tax
Complianco Act {FATCA} roporting
codo (it sy)
(Appllas lo accunls mdinlainad
oulsido the Unlt€d Slatas./
Fequaster'B nam6 and addro$s (optlonaD
7 t.!Bt Accounl numbo(s) hore {optional)
or
Under penaltles ot periury, I certity thai:
'1. Tho number shown on this form is my correct taxpayer identilication number (or I am waiting for a number lo bo issued lo mo)i and
2. I am not sublcct to backup withholding b€cause (a) I am oxompt lrom backup wlthholding, or (b) I havo not been notlfiod by tho lntomal Revenuo
Sorvice (lRS) lhat I am subiecl to backup withholdlng as a result of a tallurc to report all intsrest or dividends, or (c) tho IRS has notilied tno that I am
no longer subiect to backup withholdlng; and
3. I am a U.S. citiz€n or other U.S, person (defined bolowl and
4. Tho FATCA code(s) ontored on thi$ form (if any) lndicallng lhat I am oxempt lrom FATCA roporllng is corr€ct.
Ccdmcdlon lnstructlons. You must cross out item 2 abova lf you havo boen notlliod by tho IRS lhat you aro currently subjecl to backup withholding
becauso you have lailed to roport all lnterest and dividonds on your t$( rolum. For roal $tato transactlons, il€rn 2 doos nol apply. For morlgago intarosl paid,
acqulsltion or f,bandonm€nl ol secur€d propsny, cnncollatlon of dobl, contributions to an indlviduql retirement anengoment (lBA), and, generally. paymonts
olhor and nrg not lo tho but mugt corrscl TlN. Soe lho inslrucllons lor Parl later
Slgn
Here
General lnstructions
Section references ar€ to lhe lntemal Revenuo Code unloss oth€rwlse
noted.
Fulure d6v6lopmont!. For th€ lnl€st lnlormntion sbout dovolopmonls
relatod lo Fonn W-9 and lts lnstructlons, such as leglslation €naoted
atler they were published, go lo wlvw.lrc.govlFormW9,
What's New
Lin€ 3a has been modiflad to clarify how a disregarded €ntity completes
this line. An LLC that is a disregarded enllty should check lho
6ppropriol6 box for th€ tax classiflcation of itg owner. Othoru.,lse, il
should check the "LLC" box and enler ils appropriat€ lax classlticatlon.
Now llno 3b has boon ndded to this form. A flow-lhrough entily is
roqulrod to compl€l€ this llna to lndicate lhat il has diroct or indir€ct
lorelgn partners, ownors, or bon€liciarlos when it providas lhe Fonn W-9
to anothor tlow-through entity in which it has sn ownorshlp intorest. Thls
chnngo is intondGd to provldo a flow-thtough entity with inlormallon
rogarding th6 stotus ot its lndlr6ct loroign partnsrs, ownors, or
b€n€liciaries, so lhat lt can salisfy any appllcabl€ rsporting
roqulroments. For example, a partnership that has any indirect foreign
parlners may bo requlred to complote Schodulos K-2 and K-3. Seo the
Partnorshlp lnstructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An lndlvidual or entlty (Form W-9 roquesto0 who is requlred to flle an
inlormation r6tum wilh th€ IHS ls glving you this lonn b€cau96 thoy
Part ll
Cat. No.'10231X
Kittitas County Agreement for Services (rev.5/t4/25)
Page 14 of 19
rorm W-9 (Rev. g-zoea)
Form W-9 {Rev.3-202t1)Page 2
must obtaln your correct ftD(paye{ identification number FIN). which
may be your social aecurity number (SSN), individual taxpayer
identification number (lTlN), adoption taxpayer identification number
(ATIN), or employer id€ntitication number (ElN), to report on an
information retum the amount paid to you, or olher amount reportable
on an information r€tum. Examples of infomation retums include, but
are not limited to, the following.
o Form 1O99-|NT {intereet eamed or paid).
r Form 1O99-D|V (dividends, including thoge from stocks or mutual
funds).
. Form 1099-MISC (various types of income, prizes, awards, or gross
procaeds).
r Form 1099-NEC (nonemployee compensation).
r Form 1099-8 (stock or mulual fund sales and certain other
transactions by brokers).
. Form 1099-S (proceeds from real estale lransactions).
o Form 1099-K (m€rchant card and third-pafty network transactionsi.
r Form 1098 ffrome mortgags interestl, 1098-E (student loan interest).
and 10s8-T (luition).
. Form 1099-C (cancelad debti.
' Form '1O99-A (acquisition or abandonment o{ secured prop€rty).
Use Form W-9 only if you are a U.S. person flncluding a resident
alien), to provide your conect TlN.
Caution: lf you don't retum Form W-9 to the requester wilh a TlN, you
might be subiect to backup withholding. See Vt/hat rb backup
withholding,laler.
By signing the filled-out form, you:
1. Certily ihat the TIN you are giving is conect (or you are waiting for a
numb€r to be issued);
2. Certily that you are noi sutriect to backup withholding; or
3. Claim exemption from backup withholding il you are a U.S. exempt
payee; and
4. Certity to your non-foreign status for purposss of withholding under
chapter 3 or 4 of the Code (if applicable); and
5. Certify that FATCA code(s) entered on this form (f any) indicating
that you are exempt from the FATCA reporting is conect. See What /s
FATCA Repofting, later, for further information.
Note: lf you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TlN, you must use the requester's form if
it is substantially similar to this Form W-9.
Definition of a U.S. person, For federal lax purposest you are
considered a U.S. person if you are:
r An individual who is a U.S. citizen or U.S. resident alien;
. A partnership, corporation, company, or association creat€d 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 .7701-4.
Establishing U.S, status {or purposes o, chapter 3 and chapter 4
wilhholding. Payments made to for,aign p€rsons, including certain
distributions, allocations of income, or lransfers of sales proceeds, may
be subject to withholding under chapter 3 or chapter 4 of the Code
{s€clions 1441-'!'4741. Under those rules, if a Form W-9 or other
certification of non-foraign stafus has not been received, a withholding
agent, transferee, or partnership (payor) generally applies presumption
rules that may require the payor lo withhold applicaHs tax from the
recipient, owner, transferor, or partner (payee). See Pub. 51 5,
Withholding of Tax on Nonresident Aliens and Foreign Entities.
The following persons must provide Form W-9 to ihe payor for
purposes of establishing its non-foreign status.
. ln lhe case of a disregarded entity with a U.S. owner, lhe U.S. owner
of the disregarded entity and not the disregarded entity.
r ln the case of a grantor trust with a U.S. granlor or olher U.S. owner,
generally, th€ U.S. grantor or other U.S. owner of the grantor lrust and
not the grantor trust.
r ln the case of a U.S. trusi {other than a grantor trust), tha U.S. lrust
and not the beneficiaries of the ttust.
See Pub. 515 for more information on providing a Form W-9 or a
certification of non-foreign siatus to avoid withholding.
Kittitas County Agreement for Services (rev. 5lIa/25)
Page 15 of 19
Foreign person. lf you are a foreign person or the U.S. branch of a
foreign bank that has elected lo be treated as a U.S. person (under
Regulalions section 1.1441-1{b)(2)(iv) or other applicable section for
chapter 3 or 4 purposes), do nol use Form W-9. lnstead, use the
appropriate Form W-8 or Form 8233 (se6 Pub. 5 15). lf you are a
qualilied foreign pension fund under Flegulations section 1 .897(l)-1 (d), or
a parlnership that is wholly owned by qualified foreign pension funds,
thal is treated as a non-foreign person for purposes of section 1 445
withholding, do not use Form W-9. lnstead, use Form W-8EXP (or other
certification ol non-foreign atatus).
Nonresident ali€n who becomes a residenl alien, Generally, only a
nonresident alien individual may use the terms of a tax troaty to reduc€
or eliminate U.S. tax on certain types of income. However, most tax
lreaties contain a provision known as a saving clause, Excepiions
specified in the saving clause may p€rmit an exemption from tax to
continue for certain types ol income even after lhe pay€e has otherwise
become a U.S. resident alien fot tax purpos€s.
lf you aro o U.6. rooidont olion who io rolying on on cxooption
contain€d in the saving clause ol a tax treaty to claim an exemption
from U.S. tax on certain types of income, you musl attach a statement
to Form W-9lhat specifies the following live ilems.
1. The treaty country. Generally, rhis must be the same treaty urder
which you claimed exemption from lax as a nonresident alien.
2. The trealy article addressing the income,
3. The article number (or location) in the tax treaty that contains the
saving clause and its €xceptions.
4. The type and amount of income that qualifies for the exemption
from lax.
5. Sufficient facts to iustify lhe exemption from tax under the terms of
lhe Aeaty article.
Example, Article 20 of the U.S.-China income tax teaty allows an
exemption fom tax for schohrship income received by a Chinese
student lemporarily present in the United States. Under U.S. law, this
student will become a residenl ali€n for tax purposes if their stay in tho
Unhed 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 Arlicle 20 to continue to apply even aft€r the Chinese
student becomes a resident alien of lhe United States. A Chinese
student who qualifies for this exception (under paragraph 2 of lhe first
Protocol) and is relying on this exceplion to claim an exemption from tax
on their scholarship oi fellowship income would attach to Form W-9 a
statement that includes the infonnation described abovo to support that
exemption.
lf you are a nonresident alien or a foreign entity, give the r€quester the
appropriate completed Form W-8 or Form 8233.
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
paymenls. This is called "backup withholding." Payrnents thal may be
subject to backup withholding include, but are not limited to. interest,
tax-exempt interest, dividends, broker and barter exchange
transactions, rents, royalties, nonemployee pay, paynents made in
settlemBnt of payment card and third-party network transactions. and
certain payments from fishing boat operators. Real estate transactions
are not s:biect to backup wilhholding.
You will not be subiect to backup withholding on payments you receive
if you give the requester your conect TlN, make the proper certifications,
and report all your taxable interest and dividends on your tax retum.
Payrnents you receive will be subject to backup withholding il:
t. You do not fumish your TIN to the requestefi
2. You do not certify your TIN when required (se€ lhe inslructions for
Parl ll for details):
3. The IRS tells the requesterihat you fumished an inconect TIN;
4. The IRS tells you frat you are subiecl to backup wilhholding
because you did nol report all your interest and dividends on your tax
retum (for reportable interest and dividends only); or
5. You do not certify to the requ$ter that you ar€ not subject to
backup withholding, as described in item 4 under "By signing the filled-
out form" above (for repodable interest and dividend accounts opened
after 1983 only).
Form liV-9 (Rev. 3-20?4)Pase 3
Certain payees and paymans are exempt trom backup withholding.
See Exempt pape code, later, and the s€parate lnstructions for lhe
Requester of Form W-9 for more informalion.
See also Fsta6lishing U.S. status forpurposes otchapterg and
chdptet 4 wilhholding, earlier.
What ls FATGA Reporting?
The Foreign Account Tax Compliance Act {FATGA} requires a
participating fonign financial institution to r€port all U.S. accounl
holders that ar€ specified U.S. penions. Cailain payees are exempt from
FATCA reporting. See kernpfion frun FATCA reporting code, laler, and
the lnstuctions forthe Requester of Form W-9 for more information.
Updating Your lnformation
You must provids updated information to any peraon to whom you
claimed to be an €x€mpt payee il you are no longer an exempt payes
and nnlicipRtq reneiving rePortable payments in the fitlure lrom lhir
person. For example, you may need to provida updated informalion il
you are a C corporation lhat elects to be an S corporation, or il you are
no longer tax exempt. ln addition, you musl lumish a new Form W-9 if
the name or TIN changes for the accounl, for example, if lhe grantor of a
grantor trust dies.
Penalties
Failure to fumish TlN. lf you fail to lumish your corr€ct TIN to a
regu€ster, you are subject to a p€nalty of $50 for each such failure
unless your failure is due lo reasonable cauee and not to willful neglect.
Civil penalty for lalse inlotmation with respect to withholding. lf you
make a false siatemgnt with no reasonable basis thst resuhs in no
backup withholding, 1,ou are subiect to a $5OO penalty.
Griminal penalty lor lalsilying inlormation. Willfully falsifying
certifications or alfimations may subject you to criminal penalties
including fines andlor imprisonment
Misuse of TlNs. ll the requester discloses or uses TlNs in violalion ol
federal law, the;€qu€st$ may be subject to civil and criminal penalties.
Specific lnstructions
Line'l
You must enter one of the following on this line; do not leave this line
blank. The name should match the nam6 on your lax rolum.
lf this Form W-9 is for a joint account (other than an account
maintained by a foreign financial insliMion (FFl)), list firsl, and then
circle, the name ol the person or entity whose number you enlered in
Part I of Form W-9. lf you are providing Form W-9 to an FFI to docurnent
a ioint account, each holder of the account that is a U,S. person must
provide a Form W-9.
. lndividual. Generally, enter the name shown on your tax r€tum. lf you
have changed your last name wilhout informing the Social Security
Adminietration (SSA) of the name change, €nter your first name, ihe laet
name ag shown on your social security card, and your new last name.
Note for lTlN applicant: Enter your individual name as it was entered
on your Form W-7 application, line 1a. This should also be the game as
the name you sntered on the Form 1040 you filed with your application.
. Sole proprietor. Enter your individual name as shown on your Form
'1040 on line 1. Enter your business, trade, or "doing businese as" (DBA)
name on line 2,
. Padnership, G corporation, S corporation. or LLC, other than a
disregarded entity, Enterlhe entity's name as shown on the entity's tax
refum on line 1 and any businees, trede, or DBA name on line 2.
o Other enlities. Enter your name as shown on required U.S. federal tax
documente on line 1. This name should match lhe name shown on the
charter or other legal document creating the entity. Enter any business.
trade, or DBA name on line 2.
. Disregarded entity, ln general, a business enlity that has a single
owner, including an LLC, and is not a corporation, is disregarded as an
entity separale fiom its owner {a disregaded entity}. See Regulations
s€ction 301.7701 -2(c)(2). A disregarded entity should check the
appropriate box for the tax classification of its owner. Enter the owne/s
name on line 1. The name of lhe owner entered on line 1 should never
be a disregarded entity. The name on line 'l slrculd be the name shown
on the income tax rstum on \vhich the income should be reported. For
Kittitas County Agreement for Services (rev.5/74/251
Page 16 of 19
example, il a foreign LLC lhat is treated as a disregarded entity lor U.$.
federal tax prrposes has e single owner that is a U.S. person, the U.S.
ownels name is required to be provided on line 1. lf the direct owner ol
the entity is also a disregaded enlity, entar the first owner that is not
dbregarded for lederal tsx purposes. Enter ths disr€garded entity's
nam€ on line 2. ll ttre owner ol the disregarded entity is a foreign person,
th€ owner must complete an appropriate Form W€ instead of a Form
W-9. This is the cas€ €ven if the foreign person has a U.S. TlN.
Line 2
lf you have a business nsnre, lrade name, DBA name, or dbregarded
entity nam€. enter it on line 2.
Line 3a
Check lhe appropriate box on line 3a for the U.S. federal tax
classification of lhe peraon whose name is enlered on line 1. Check only
one box on line 3a.
Line 3b
Check thb box if you are a partnership (including an LLG classified as a
parhership for U.S. federal tax purposes), trust, o. estats that has any
toreign partners, owners, or beneficiaries, and you are providing this
form to a partn€rstrip, trust, or eslale, in which you have an ownership
interest. Vou mr.st check the box on line 3b il you receive a Form W-8
(or documentary evidence) lrom any partner, owner, or beneliciary
establishing foreign status or if you receive a Form W-9 lrom any
partner, owner, or beneficiary that has checked ihe box on line 3b.
Note: A partnership that provides a Form W-9 and checks box 3b may
be required to complete Schedules K-2 and K-3 (Form 1065). For more
information, see the Partnership lnstructions for Schedules K-2 and K-3
(Form 1065).
lf you are required to complete line 3b but failto do so, you may not
receive the information necessary to file a conect information refum with
the IBS or fumish a conect payee statement to your parlners or
beneficiaries. See, for example, s€ctiona 6698, 6722, and 6724 lor
penalties thal may apply.
Line 4 Exemptions
lf you are exempt from backup withholding and/or FATCA repoding,
eriter in the appropriale space on line a any code(s) that may apply to
you.
Exempt payee code.
o 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.
e Corporations are not exempt from backup withholding for payments
made in setllement of payment card or third-party nelwo* transactions.
. Corporations are not exempl from backup whhholding with resPect to
attomeys'fees or gross proceeds paid to atlomeys, and corporations
that provide medical or health csre services are not exempt with resPect
to paymenb reportable on Form 1O99-MISC.
The following codes identify payees that are exempt lrom backup
wilhholding, Enter the appropriate code in the space on line 4.
1 -An organization exempt ftom tax under seciion 501(a), any lRA, or
a custodial accqrnt under section 403(bX7) if the account satisfies the
requirements ol section 401(QP).
lF the entlty/individual on hne I
is a(nf ...
lllEil check the box lor
o Corporation Corporation.
. lndividual or
o Sole proprietorship
lndividual/sole proprietor.
. LLC classified as a partnership
for U.S. lederal lax purposes or
o LLC that has filed Form 8832 or
2553 €lecting to be taxed as a
corporation
Limited liability company and
enter the appropriate tax
classification:
P = Partnership,
C=Ccorporation,or
S = S corporation.
r Partnership Partnership.
o Trust/estate TrusVestale.
Form W-9 {Rev.3-2024)Page4
2-The United States or any of its agencies or inslrumentalilies.
3-A state, the District ot Columbia, a U.S. commonwealth or territory,
or any of thdr political subdivisions or instlmentalities.
4-A foreign govemmsnt or any of itrs political subdivisions, agencies,
or instrumentalities.
5-A corporation.
6-A dealer in securit'res or commodities required to register in the
United States, the District of Columbria, or a U.S. commonwealth or
tenitory.
7-A futures commission merchant regisie.ed wilh the Comrnodity
Futures Trading Commission.
8-A real estate investment tust.
9-An entity registered at all times during the tax yeat under the
lnveslment Company Act of 1940.
10-A common trust fund operated by a bank under section 584{a}.
I I -A llnanclal ln$drLnlon as d€fln€d under s€crlon 5s1.
12-A middleman known in the investment community as a nominee or
custodian.
13-A trust exempt from tax under section 664 or descdbed in s€ction
4947.
The following chart shows types of payments lhat may be €xempt
from backup withholding. The chart applies to lhe exempt payees listed
above, l through 13.
lF the payment is for. ,THEN the paymenl is exempt
for...
. lnterest and dividend payments All exempt payees excepl
lor 7.
o Broker paye€s 1 through 4 and 6
through 1 1 and all C corporalions.
S corporations must not enter an
exempt paye€ code because lhey
are exempt only for sales of
noncovered securities acquired
lo 20'12.
r Barter exchange transactions Exempt payees 1 through 4.
and dividends
. Payments over $600 required to Generally, exempt payees
be reported and direct sales over 1 through 5.?
$s,ooo'
. Paymeflts made in settlement of Exempt payees 1 through 4.
payment card or third-party
network transactions
l See Form 1099-M|SC, Miscellaneous lnformation, and its instructions.
2However, the following paym€nts made lo a corporalion and
reportable on Form 1099-lvllSc a.e not exempt from backup
withholding: medical and health care paymenls, aftomeys'fees" gross
proceeds pdd to an attomey reportable under section 6045{q, and
payments for services paid by a federal ex€cutiv€ agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt lrom reporting under FATCA. These codes
apply to persons submitting this form for accounb maintained out3ide
ol lhe United States by certain foreign financial institulions. Therefore, if
you are only submitling 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 lhe financial institution is
subject to lhese reguirements. A requester may indicate that a code is
not required by providing you wilh a Form W-9 wilh "Not Applicable" (or
any siririlar indication) enlered on the line lor a FATCA exemption code.
A-An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37).
B-The United States or any of its ag€ncies or instrum€nlalities.
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 gecurhies markets, as dsscribed in Regulations
section 1.1472-1(cX1}{i).
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](i).
Kittitas County Agreement for Services (rev.5/t4/25)
Page 17 of 19
F-A dealer in securities, commodities, or derivative financial
instruments (including notional principal conlracts, futures, forwards,
and options) lhat is registered as such under ihe laws of the United
Statee or any stat€.
G-A real estate investment trust.
H-A regulated inv€stment comparry as defined in section 851 or an
entity r€gbt€red at all times during the tax year under the lnvestment
Company Act of 1940.
l-A common trust fund as defined in s'ection 584(a).
J-A bank as delined in section 581.
K-A broker.
L-A lrust exempt from tax under section 664 or described in section
4ea7{a}{1).
M-A tax-exempt tn:st under a section a03ib) plan or section il57(g)
plan.
iloto: You moy wioh to oonsult with lho financial institution rcqucsting
this form to delerrnine wheth€r 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
rstums. ll this address differs from lhe one the requester already has on
file, enter "NEW at ihe top. lf 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, stat€, and ZIP code.
Part l. Taxpayer ldentification Number (TlNl
Enler your TIN in the appropriate box. lf you are a reeident alien and
you do not have, and are not eligible to get, an SSN, your TIN is your
IRS lTlN. Enter it in the entry space for the Social security number. lf you
do not have an fflN, see How ta get a I/N below.
lf you are a sole proprietor and you have an ElN, you may enter either
your SSN or ElN.
lf you are a single-member LLC that is disregarded as an entity
separate from its owner, enter lhe owner's SSN (or ElN, if lhe owner has
one;. lf the LLC is classilied as a corporalion or partnership, enter the
entity's ElN.
Note: See What Nune and Number To Give the Requester, later, for
further clarification ol name and TIN combinalions.
Flow to get a TlN. lf you do not have a TlN, apply lor one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA offpe or get this form online at
www.SSA.gov. You may also gel this form by calling 800-772-1213. Use
Form W-7, Applicahon for IRS lndividual Taxpayer ldentilication
Number, to apply for an [TlN, or Form SS-4, Application for Employer
ldentifieation Number, to apply for an ElN. You can apply for an EIN
online by accessing the IRS website at www.irs.govlE/N. Go to
www.irs.govlForms to view, download, or print Form W-7 and/or Form
SS-4. Orl you can go to www.irs. govlOdaForms to place an order and
have Form W-7 and/or Form SS-4 mailed to you within 15 business
days.
lf you are asked to complete Form W-9 but do not have a TlN, apply
for a TIN and enter "Applied For" in the space for the TlN, sign and date
the form, and give it to the requester. For interest and dividend
paymente, and certain payments made wilh respsct to readily tradable
inslruments, you will g€nerally have 60 days to get a TIN and give it to
the request€r b€fore you are subiect to backup withholding_ on
paym€nts. The 60-day rule does not apply to other types ol payments.
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering "Applied Fo/' means that you have already applied for a
TIN or that you intend to apply for one soon. See also€stablisfilng U.S.
status for purposes of chaptei 3 and chapter 4 withholding, earlier, for
when you may instead be subject to withholding undor chapter 3 or 4 of
the Code.
Caution: A disregarded U.S. entity that has a foreign owner must use
lhe appropriate Form W-8.
Form W-9 {Rev. 3-2024}Page 5
Part ll. Certification
To establish to the withholding agent lhat 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 item 1, 4, or 5 below indicales othenpise.
For a joint account, only the person whose TIN is shown in Part I
should sign {when required}. ln the case of a disregarded entity, the
person identified on line 'l must sign. Exempt payees, lee Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
itemslthrough5below.
1, lnteresl, dividend, and barter exchange accounlr opened
belore 19&4 and broker accounts considered active during 19S3.
You must give your conect TlN, but you do not hava to sign the
certification.
2. lnterest, dividend, broker, and barter exchange accounts
opened aftet 198i1 and broker accountg considcred inactive dttring
1083. You must sign the certification or backup withholding will apply. lf
you ar€ Bubieci to backup withholding and you are merely providing
your conect TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Reai estate transactions. You must sign the cerlification. You may
crogs out item 2 ol the certifrcation.
4. Olher payments. You must give your conect TlN, but you do nol
have to sign the cerlification unless you have been notified that you
have previously given an inconect TlN. "Orher payrnents" include
paym'ents mad-e in the course of the requester's trade or business lor
rents, royallies, 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 paymenl
card andthiid-party network kansactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attomeys (including payrnents to corporations).
5. Mortgage interest paid by you, acqrrisition or abandonment of
secured property, cancellation of deht, qualified tuition progrll
- _
paymentb (uhdei seclion 5291, ABLE accounts (under seclion 529A),
lRA" Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your conect
TlN, but you do not have to sign the certification.
What Name and Number To Give the
For thig ol account:Give name and SSN of:
1. lndividual
Z.Two or morc individuals (ioinl account)
oiher th6n an account maintained by
an FFI
3. Two or mora U.S. persons
[oint account maintained by an FFI]
4. Cuelodial account ol a mhs
(lJni{orm Gift to MinorsAc{)
5. a. The usual revocable savings bust
tgrdnlor is also truste6)
b. So.called trust account that k nol
a legal or valid kusi under state law
6. Solo proprietorship or disregarded
mtity owned by an individuol
7. Grantor tust fling tmder Optional
Filkrg Method 1 {see Regulations
section 1 .671 -a{b}f2Xi}tAD"
Kittitas County Agreement for Services (rev.5/74/25l,
Page 18 of 19
For this of account:
8. Disregarded enlity not ovmed by an
individual
9- A valid tr6t, estate, or peNion trusl
10. Corporation or LLC electing corporate
staius on Fm 8832 or Form 2553
11- Aesociatim. club, relfuious, charitable,
educa{onsl, or oth6r lax-exempl
orgranization
12. Partnership or mufti-member LLC
'13. A broker or regislered nominee
14. Account with the Oopartmmt ol
Agriculture in the name of a public
enlity (suoh as a state or local
govemmenl, school dislricl, or prison)
lhat receives agdcultural program
paymrnlo
15, Ganror trust tilirg Form 1O4l ot
rmder lhe Optional Filing Method 2,
requiring Fom 1o99 (see Hegulaliong
section 1.671 -4{bH2XiXB}1"
Give name and EIN of:
The orner
Lsgal enlilyl
The ccporation
The organization
The parhership
The brokw or nomhea
The public enlity
The actual owner of tho lccounl or,
if combined funds. the lirgt individual
on lfis accounll
Eacfr holder of the accouni
The minor2
The granlor-trust€er
The actualowrl
Tho owners
The gmtot'
The lrust
i Ust first and circle tha name of the person whose number you fumish.
lf only one person on a loint account has an SSN, ihat person's number
must be fumished.
sCircle the minor's name and fumish the minor's SSN.
sYou must show vour individual name on line 1, and enter vour business
or DBA name. if ahy, on line 2. You may use eilher your SSN or EIN [f
you have one), but the IRS encourages you to use your SSN.
alist lirst and circle ihe name of lhe trust, estale, or p€nsion lrust. (Do
not fumish lhe TIN of the personal representative or trustee unless lhe
legal entity itself is not designated in the account title.)
'Nole: The grantor must also provide a Form W-9 to the trustee of the
trust.
" For more infomation on optional filing methods lor grantor trusts, sea
the lnstructions for Form 1041-
Note: ll no name is circled when more than one name is listed, the
number will be considered to be that of the {irst name listed.
Secure Your Tax Records From ldentity Theft
ldentity theft occurs when someon€ uses your P€rsonal information,
such a's 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 iob or may file a tax r€turn using your SSN to receive
a refund.
To reduce your risk:
e Protect your SSN,
r Ensure your employer is protecting your SSN, and
o Be careful when choosing a tax relum preparer.
ll your tax records are affected by identity theft and you receive a
notiie from the lRS, respond right away to the name and phone number
printed on the IRS notice or letter.
lf your tax records are not cunently affected by idenlity theft but you
thinli you are at risk due to a lost or stolen purse or wallet, questionable
credilcard activity, or a queslionable credit report, contact the IRS
ldentity Theft Hotline at 900-908-449O or submit Form 14039.
For more information. ses Pub. 5027. ldentity Theft lnformation for
Taxpayers.
Form W-9 {Rev. 3-2024}Page 6
Victims of identity theft who are exp€dencing economic harm or a
systemic problem, br are seeking help in resolving tax problems that
h-ave not been resolved through normal channeh, may be eligible for
TaxpayerAdvocate Service OAS) asebtanos. You can reach TAS !V_
calling the TAS toll-lree case intake line 8t 877-777-4778 or TTY/TDD
800-829-4(89.
Protect yoursell lrom srrspicious emails or phishing schernes.
Phishing b the creation and use of emailand websites designed to
mimic legitimata business emails and websites. The most common act
is sending an email to a user fabely claiming to b€ an established
legitimatdenterprise in an attempt to scam ihe user into sunendering
primte infomation that will be used lor identity iheft.
The IRS does not iniliate contacts with taxpayers via emaits. Aso, the
lFlS does not request personal detailed information through email or ask
taxoavers for lhe PIN numberc, passwords, or similar secret accesg
inf<irniation for their credit card,'bank, or other financial accounts.
lf you roooivo on unsolicitcd cmail claiming lo ba frum the lRg,
forwbrd this messags to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS Poperty to the Treasury lnapector
General forTax Administration IrlGTA) at 800-366-448.4. You can
forrlard suspicious emails to the Federal Trade Commisgioo at
spam@uce,gov or report them at www.ftc.govlcomplainl You can
contact the FTC alwww.ftc.govlidtheft or STTJDTHEFT (877-438-43381'
lf you hava been the victim oJ identity theft, s* www'ldentityfheft'gov
and Pub. 5O27.
Go to www.in.govildentityTheft lo leam more about identily theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the lntemal Revenue Code requires 1ou lo provide your
conect TIN to persons (including federal agencies) who are.aquir€d lo
file information retums wilh the IRS to report interest, dividends' or
cerlain other income pqid to you; mortgsg€ interest you Paid; the
acquisition or abandonrYpnt ots€cured property; the cancellalion of
debt; or cont.ibutions you made to an lRA, Archer MSA or HSA. The
oerson collectino this form mes the information on the form to file
Inbrmation retuirs with the lRS, reporting the above information.
Rouline uses ol thb infomalion irrclude giving it to the D€partment of
Justice br civil and criminal litigation and to cilies, states, the District ol
Columbia. and U.S. commonweahhs and lenitories lor use in
administering their laws^ The information may also be disclosed to olher
countri€s unier a treaty, to lederal and statsagenci€s to enforce civil
and criminal laws, or to lederal law enlorcement and intelligence
agerrcies to combat lenorism. You must provide your TIN whether or not
vou oro roquirod to filo o tox rotum. Und* laction 3400, pryors must
lenerally withhold a percentage of taxable interest, dividends, and
iertain other paymenls to a payee who does not give a TIN to the payor.
Certain penalties may also apply for providing false or fraudulent
information.
Kittitas County Agreement for Services (rev.5/I4125)
Page 19 of 19