HomeMy WebLinkAboutKittitas County & Kittitas School DistKITTITAS COUNTY
AGREEMENT FOR SERVICES
PHMH25.O13
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 Schooldistrict to contract with a
licensed mental health care providerto provide mental health services to the students in Kittitas School District.
The term of this Agreement shall be from July I't,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
COUNW CONTRACTOR
205 West 5th Ave, Suite 108
Ellensburg, WA 98925
Kasey Knutson
Human Services Manager
Kittitas County Public Health Department
Kasev. knutson @co. kittitas.wa. us
509.962.7090
PO Box 599
Kittitas, WA 98934
Tim pr.aino ]oh Yt ?a{le5
Superintendent
Kittitas School district
rim-prai no-@,k3d403.ore j d hn - kt v 50 lcs,t{ d 3' ot
509.955.3L20
This Agreement includes the following, which are attached hereto and hereby incorporated by this
reference:
Attachment "A":
Attachment "B":
Attachment "C":
Attachment "D"
Attachment "E":
Attachment "F":
Kittitas County Agreement for Services (rev.5/14/251
Page 1 of 21
Scope of Work
Compensation
lnsurance Requirements
Reporting
General Terms and Conditions
W-9 (Corrl.ractor 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/L4/25)
Page 2 ol 2L
BOARD OF COUNTY COMMISSIO
Attest:
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Commissioner
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KITTITAS COUNTY
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CONTRACTOR
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ATTACHMENT,,A,,
SCOPE OF WORK
ln addition to providing all material and labor, the Contractor shall perform the following activities
o Social Worker (District Truancy Liaison): The social worker also serves as the district's truancy liaison,
coordinating with families, courts, and community agencies.
o 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.
o 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
o Anti-bullyingand anti-discrimination consultation services
o 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/t4/25l,
Page 3 of 21
AfiACHMENT'8"
COMPENSATION
THE COUNTY WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL
CoNTRACTOR SUBMTTS 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: 582,400.
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. lf 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.
Allfunds must be spent byJune 30,2027, No extension of the funding period will be granted.
Reim bu rsement 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. Al[ invoices must be submitted by the tast day of the month fotlowing the catendar 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.
ln no event shall payments under this agreement total more than 582,400.
Kittitas County Agreement for Services (rev.5lMl25)
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.5h4/25)
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 Vll or better in the most recently published edition of Best's Reports unless otherwise approved
by the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies
must comply with Chapter 48.15 RCW and 284-15 WAC.
At a minimum, Contractor shall maintain and provide proof of the following selected options
Commercial General Liabilitv lnsurance
. Coverage limits not less than:
o $L,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:
o $L,000,000 combined single limit
n Excess or Umbrella Liability
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 Insurance 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 nfficials, 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 $1,000,000 per accident or disease.
Kittitas County Agreement for Services (rev.5/!4/25)
Page 5 of 21
t
I
n Professional Liability / Errors and Omissions Liability
Coverage limits not less than:
o $L,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)
PageT of 2L
I
AfiACHMENT ''D''
REPORTING
Contractor shall provide quarterly progress reports using the template provided. Please submit progress reports
to the clerk at hea lthandhumanservices@co.kittitas.wa.us.
r Quarter 1 (January-March) report due on the last day of April.
r Quarter 2 (AprilJune) report due on the last day of July.
o Quarter 3 (July-September) report due on the last day of October.
r Quarter 4 (October-December) report due on the last day of January.
The report shall include, at a minimum:
r A narrative of project activities during the reporting period, including progress on the activities outlined
in your Scope of Work (Attachment " A").
o A narrative of project successes during the reporting period.
o 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.5/14125)
Page 8 of 21
AfiACHMENT "E'
GENERAL TERMS AND CONDITIONS
L. 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 "8". Where Attachment "8" requires payment(s) by the County, payment shall
be based upon billings, supported unless provided otherwise in Attachment "B", by documentation of units of
work actually performed and amounts earned, including, where appropriate, the total number of hours for the
month and the total dollar payment requested. Unless specifically stated in Attachment "8", the County will not
reimburse Contractor for any costs or expenses incurred by Contractor in performance of this Agreement. Where
required, the County shall, upon receipt of appropriate documentation, compensate Contractor, no more often
than monthly, through the County voucher system, for Contractor's services pursuant to the fee schedule set forth
in Attachment "B". 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
theCountytomakewithholdingforanytaxesotherthanincometaxes(e.g.,Medicare), Allcompensationreceived
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 (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. 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 "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. 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.5l74/25)
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. 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 pe rfo rma nce of the su bcontract,
6. Risht 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
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. 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 andf 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 Countv mav, 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. 5174/25)
Page 10 of 21
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 against any and all claims, damages, losses and expenses, including but not limited to court costs, attorney's
fees and alternative dispute resolution costs, for any personal or bodily injury, sickness, disease or death, for any
damage to or destruction of any property (including the loss of use resulting therefrom), and for any other claims,
damages, losses, and expenses sustained by the County, which (1) are caused in whole or in part by any act or
omission, negligent or otherwise, of Contractor, its employees, agents or volunteers, or Contractor's
subcontractors, their employees, agents or volunteers; or (2) are directly or indirectly arising out of, resulting
from, or otherwise connected with the performance of this Agreement; or (3) are based upon Contractor's or its
subcontractors' use of, presence upon or proximity to the property of the County. This indemnification obligation
of Contractor shall not apply in the limited circumstance where the claim, damage, loss or expense is caused by
the sole negligence of the County. This indemnification obligation of Contractor shall not be limited in any way by
the Washington State lndustrial lnsurance Act, RCW Title 51, or by application of any other workmen's
compensation act, disability benefit act or other employee benefit act, and Contractor hereby expressly waives
any immunity afforded by such acts. The foregoing indemnification obligations of Contractor are a material
inducement to the County to enter into this Agreement, are reflected in Contractor's compensation, and have
been mutually negotiated by the parties.
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.
10. Venue and Choice of Law: ln the event that any litigation should arise concerning this Agreement,
the venue for such action sha ll be in the Superior Court of the State of Washington in and for the Cou nty of Kittitas.
This Agreement shall be governed by the laws of the State of Washington.
1l-. Non-AppropriationolFunds: litheCountydoesnotappropriatesufficientfundingforthisAgreement
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.5/74/25)
Page 11 of 21
tz.t 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.
12.3 This Agreement has been validly executed by an authorized representative of Contractor and
constitutes a valid and legally binding and enforceable obligation of Contractor.
12.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses,
permits and other authorizations from federal, state and local governmental authorities, or from any applicable
industrial or professional certification or licensing bodies, as are necessary for the lawful performance of its
obligations under this Agreement, and will maintain such throughout the term of this Agreement.
12.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of
which will or may materially affect Contractor's ability to perform its obligations under this Agreement. Contractor
is not subject to any order or judgment of any court, tribunal or governmental agency which materially and
adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under
this Agreement,
12.6 Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency.
12J None of the representations or warranties in this Agreement, and none of the documents,
statements, certificates or schedules furnished by Contractor in connection with the performance of the
obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact
or omits or will omit a material fact necessary to make the statements of fact contained therein not misleading.
13. Ownership of ltems Produced: All writings, programs, data, reports, films, recordings, or other
materials prepared by Contractor and/or its consultants or subcontractors, in connection with the performance
of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of
ownership therein, including but not limited to the right to use, copyright, trademark, andfor patent, and the
ability to transfer any or all ownership rights.
t4. Intellectual Propertv 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
notlfied promptly in wrrting 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 County Name and Logo: Contractor m ay 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.5h4/25)
Page L2 of 2t
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.
t7. Confidentialitv: Contractor, its employees, agents and volunteers, and any of Contractor's
subcontractors and their employees, agents and volunteers, shall maintain the confidentiality of all information
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 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,L2 and the rules and
regulations of the Washington State Department of Labor and lndustries. The schedule of prevailing wage rates
for the applicable locality or localities is determined by the lndustrial Statistician of the Department of Labor and
lndustries. lt is Contractor's responsibility to verify the applicable prevailing wage rate. lt is understood that
Contractor is responsible for obtaining and completing all required government forms relating to prevailing wage
and submitting same to the proper authorities. Disputes regarding prevailing wage rates shall be referred for
arbitration to the Director of the Department of Labor and lndustries. The arbitration decision shall be final and
conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.060.
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
Kittitas County Agreement for Services (rev.5/I4l2S)
Page 13 of 21
21.I ln the performance of this Agreement, Contractor will not discriminate against any employee or
applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration
status, sex, sexual orientation, marital status, honorably discharged veteran or military status, orthe presence of
any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a
disability; provided that the prohibition against discrimination because of such disability shall not apply if the
particular disability prevents the proper performance of the particular worker involved. Contractor shall ensure
that applicants are employed, and that employees are treated during employment, without discrimination
because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation,
marital status, honorably discharged veteran or military status, or the presence of any sensory, mental or physical
disability or the use of a trained dog guide or service animal by a person with a disability. Such requirements
apply, without limitation, to the following: employment, promotion, demotion, transfer, recruitment or
recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and programs for
training, including apprenticeships. Contractor shall take such action with respect to this Agreement as may be
required to ensure full compliance with local, state and federal laws prohibiting discrimination in employment.
27.2 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 sha ll include a ppropriate safegua rds aga inst 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, 70, L3, 14,15, 16, 17 , L9,20,22,24, 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 irnplietJ, regardirrg LJre work to be performed hereunder. The partles agree that no other representations,
inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made
between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this
Agreement shall be valid or binding unless in writing and signed by the parties.
26. Severabilitv: lf any term or condition of this Agreement or the application thereof to any person(s)
or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can
be given effect without the invalid term, condition or application. To this end, the terms and conditions of this
Agreement are declared to be severable.
Kittitas County Agreement for Services (rev.5lt4l25)
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 signedwriting.
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.5/7a/251
Page 15 of 21
,",, ull-9
ATTACHMENT "F'
Request for Taxpayer
ldentificatlon Number and Certification
Oo to www.rrs.govlFomwgto?lnstructlons and thd latest intormadon.
Glve form to the
requester. Do not
send to the lRS.
(H6v. Mnrch 2024)
Ooparlmsnt of lho Troasury
lntomal Fovmuo Sotrlco
ldentilicatlon
0 City, slato, and ZIP codo
5 Addrcss (numb€r, sl16t, 6nd apl. or sulto no.). S6e inftruollons.
3b It on lino 36 you checkod "PalinsEhip" or 'Tru3v6slato," or cnockad "LLC" end ontetad "P" s its lu clossification,
Aod you tr€ provldlng thl3 lom to a pMnBrship. lru8t, or oslal€ in which you hava an owmrshlp inltr€s!, chek
lhls box ll you havo nny lorelgn partnero, owne8, or bsnoficlsrlos. Ses instruallons . !
3r Chock lhe approprlald box for lodsral lax clnssrllcation of lh€ entily/indivdusl vhoso namo ls enlered on lina 1. Clrock
only onc ol th6 tollowlng 86v6n boxos.
ff hdlviduau8oloproprlotor I Ccorporatlon f] $corporatlon n P0rtmrshlp ! Trusvostato
f] LLC, Entorihotaxclassllicstlon(C =Cr.orporatlon, S= Scrrporallon, P = Parlndshlp)
Nolcr Chtrk lha "LLC'box abova 8nd, ln iha €nlry 8pnc6, ontor tha approprlate codE (C, S, ot P) lor lh€ tax
clnsBlflcatlon of lho LLC, unlocs ll ls o dlsrogardod anllty. A dierooRrdod onlily should krAtoed chock tho approFrlalo
box lo? tho tu clas8llication ol iG owm/.
I Othor{geo hrstructlons)
Part I
d
oooo
6
aEg.e
OEE!
ae
'$
I
odth
Botoro
Enler your TIN in the appropriate box, The TIN provlded must match the ,1ame given on litre 1 to avoid
backup wilhholding. For indlviduals, this is genorally your soclal socurlty number {SSN). However, for a
rosldont allon, sole proprletor, or dlsrogardod ontity, se6 lhe lnstructlons for Part l, later. For olh6r
ontitles, it is your amploy€r identilicalion number (ElN). lf you do nol have a numb€r, geo How to 96t a
ni/, later.
Notrt lf the account is in more than one name. seo lhe lnstructions for llne 1. See aleo What Name and
Number To Qlva thd Rdqueslor for grtidelinos on whoso number lo 6nlor,
For rolaled to lho of Form 900 of b6low.
t Namo ol ontity/lndlvidual. An oniry is roquired. {For a sle proprietor or disregarded cnlity, onlor lho owncr's Dame on llne 1, and entor tho busin€svdlsregildcd
mtity's name on ling 2,)
2 Buslnosg ndmo/dbrogordod ontily namo, il dilloront trom 8bovo.
4 Exomptions (codos 6pdy sly lo
cortaln enlllles, not lndivlduRls:
se€ lnslnlclbns on page 3):
Exompt paym cods (il f,ny)
Exomptlon from Fo'elgn Account Tax
Complianco Act (fnTCA) raporlll0
codo (il sy)
(Applies lo occounls mainteinad
dlsldo tto Uritad Slates.)
Rrquestor'e ntmo snd Addross (optlonsr)
7 [.i6] sccounl number(8] hsro (oplima0
or
Under penaltlas ol perjury, I cerlity thRt:
I . Tho numbot shown on this {orm is my corroct tnxpnyer idonllficatlon numbor (or I am waltlng for a numbor lo bs issued lo me); and
2. I sm not subjoct to backup wtthholding b€causo (n) I f,m oxdmpt from backup wlthholdlng, or (b) I havo nol boon nollfied by lho lntomnl Rovonuo
Sorvico (lRS) thai I om sublect to backup wlthholdlng as a result ol a lallure lo report Fll lnlerost or dlvldends, or (c) th6 IRS has notilled mo that I am
ro loflgsr subjoct lo backup wlthholdlng; and
3. I am a U.S. citizen or oth€r U.S. person (definod below); and
4. Tho FATCA code(s) enlored on this form 0f any) lndlcatlng lhal I am exompt from FATCA roporllng is corroct.
Ccnmcailon ln8lruc,tlone, You must cross oul ilom 2 abov6 lf you havo boen nollllod by tho IRS that you aro currenlly subJc\ct to backup wllhholdlng
b€causs you havo fallod to r€port all int6r6st and dividsnds on your tax r6tum. For roal estate lransaclions, item 2 doos not apply. For mortgags interesl paid,
acquisition or abandonment ol secursd property, canc€llsllon of debt, oontributions to an lndividual retiroment anangemet1l (lBA), and, generally, payments
othor than int€rest and ar€ not lo tho but must corroct TlN. Se€ lhe instructldls for Part ll lator
Sign gl0nstuF ol
Here U.S. pcrlon Dale
General lnstructions
Section reler€nc€s ere to lho lntemal R€venue Code unl€ss oth€rwise
notcd.
Fulurr dov6lopmontt. For th6 letost lntormation aboul dovolopmonl$
relaled to Form W-9 and its instructions, such as leglslallon enacted
aftsrlhey were published, go to w|w.irs.govlFormW9,
What's New
Lins 3a has been modilied to clarily how a distegardod €nlity complotes
lhis lino. An LLC that is a disrsgarded €ntity should chock lhe
approprlatc box for ths lax classlflcatlon of its owner. Othorwlso, lt
should ch6ck lhe "LLC" box and enter ile appropriat6 lax classificatlon.
Now llno 3b has be€n added to lhis form. A flow-lhrough ontily is
r€qulred to compl€to this line to lndicate that il has direct or indir€ct
loreign panrrers, ownerc, or b€neticiaries when it provides the Form W-9
to anolhor flow-through ontlty in whlch t has an ownorship int€rost. lhls
chongo ls int6ndod to provido a llow{hrough onlily with informalion
r€garding th6 status ot its lndir€cl fo,oign partnors, ownors, or
bonencisries, so that it can gatisty any applicab16 roporting
roquirem€nts. For example, a partn€rship that has any indir€ct tor€ign
parlners may be requlrod to complete Schedules K-2 and K-3. See ths
Partnorshlp lnstructions tor Sohodulo3 K-2 and K-3 (Form 1065).
Purpose of Form
An lndlvldual or sntlty (Form W-9
inlonnatlon r6tum wilh the IRS ls
roquester) who ls roqulred to lllo an
givlng you this lorm becauso lhey
Part ll
Cel. No. 10231X
Kittitas County Agreement for Services (rev. 5h4/25)
Page 16 of 21
rorm W-9 {nov. 3-aozn)
Form W-9 {Hev. 3-2024)Pqe2
must obtain your corrcct taxpay€( id€ntification number (nN), which
may be your social security number {SSN), individml taxpayer
identificalion numb€r (fnN), adoption taxpay€r identification number
(ATIN), or employer identification number (ElN), to report on an
information retum the amowt paid to you. or other arnount reportable
on an information relum. Examples of infonnation r€tums include, hn
are not limited to, the following"
r Form '1099-lNT {interest eamed or paid).
o Form 1099-DlV (dMdends, including those from stocks or mutual
tunds).
. Form 1099-MISC (various types of incomg pdzes, awards, or gross
pmceeds).
r Form 1099-NEG (nonemployee compensation).
. Form 1099-8 {stock or mutual fund sales and certain other
transactions by brokers).
o Fom 1099-5 (proceeds fiom real estate transac{ions).
. Form 1099-K (rnerchant card and third-party n€twork transactions).
o Form lo98 (home mortgage inlerest), 1098-E (student ban interest),
and 1098-T (tuition).
e Form 1099-C (canceled debt),
r Form 1099-4 (acquisition or abandonmsnt of s€cured property).
Use Form W-9 only if you are a U.S. person fincluding a resid€nt
alien), to provide your conect TlN.
Caution: It you don't retum Fonn W-g to th€ requester with a TlN, you
might be aubiect to backup withholding. Seo What is backup
withholding,lalar,
By eigning the filled-out form, you:
1. Certify that lhe TIN you are giving is conect (or you arc waiting for a
number lo be iszued);
2. Cortit that you are not subiect to backup withholding; or
3. Claim exemption from backup withholding il you are a U.S. exempl
payee; and
4. Certily to your non-foreign status for pxrrpooes of wilhholding under
chapter 3 or 4 of rhe Code frf applicablel; and
5. Certify that FATCA code{s) entered on this form Sf any) indicaring
that you are €xempt lmm the FATCA reporting b conect. See What ls
FATCA Rqorting, later, for further iniormation.
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 lhe requeste/s fotrn if
it is subotantially similar to this Form W-9.
Definhion of a U.S. person. Forlederal tax purposes. you ar€
considered a U.S. person if yo.l are:
. An individual who is a U.S. citizen or U.S. resllent alien;
. A partn€r€hip, corporation, compeny. or associadon created or
organized in the United States or underthe laws ol the United States;
. An e8tat6 (other than a foreign eslate); or
. A domestic trust {as defined in Regulalions section3Al.7701-n.
Establiehing U.S. ctatus for purposee of chapter 3 and chapter 4
withholding, Paymenls made to forsign p€rson8, including certain
distributions, allocations of incoms, or trangfsra of salea procaeds, may
be aubiect to withholding under chapter 3 or chapter 4 of the Code
(s€clions 1441-1474r. Under those rulss, if a Form W-9 or other
certification of non-foreign statue has not been roceived, a withholding
agont, tranotereo, or parlnership (payorf generally applies pr€sumption
rulss that may require the payor lo withhold applicable lax from the
recipient, own€r, fansferor, or paflner (payee). See Pub. 515,
Withholding of Tax on Nonreaident Aiene arrl Forcign Fntilier
The following persona must provide Form W-9 to the payor for
purposee of establishing its non-foreign status.
r ln the case of a disregarded entity with a U.S. on'ner, the U.S. ownar
of the dbregarded entity and not lhe disregarded entity.
. ln the case of a grantor trust with a U.S. grantor or oiher U.S. owner,
generally, lhe U.S. grantor or other U.S. owner ol lhe grantor trust and
not the grantor trust.
r ln the case of a U.S. lrust {other than a grantor trust}, the U.S. trust
and not the b€neficiaries ol the bust.
See Pub. 515 for mor€ inlormation on pr,oviding a Forrn W-9 or a
certification of non-ioreign stat$ lo avcid withholding.
Kittitas County Agreement for Services (rev.5l74/25)
PageLT of2L
Foreign person. lf 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 1.1a41-1{b)(2xiv) or other applicaHe section for
chapter 3 or 4 purposes), do nol use Form W-9. lnstead, use the
appropriate Form W-8 or Form 823it (see Pub. 51 5). lf you are a
qualilied foreign pension fund under Regulations section 1 .897{)-1 (d), or
a partnerslrip that is wholly owned by qualified loreign pension funds,
that i9 treated as a non-foreign p€rson for purposes of section 1 445
withholding, do not us€ Fonn W-9. lnstead, use Form W-8D(P (or other
certification of non-foreign status).
Nonresident alien rrrho becomes a resident alien. Generally, only a
nonresirJent alien individual may us€ the terms ol a tax treaty to reduce
or eliminate U.S. tax on certain types ol income. However, most tax
lrealies contain a provision known as a saving clause. Exceptions
specified in the saving clausa may permit an exemption fiom tax to
continue for certain tlpes ol ircome even after lhe payee has otherwise
become a U.S. resident alien for tax purposes.
lf you are a U.S. resident albn who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a stalemsnt
to Form W-9 that specifi€s th€ following five items.
1. Ths treaty couniry. Generally, this must be the same treaty urder
which you claimed exemption from tax as a nonresidenl align.
2, The treaty article addressing the income.
3. The articl€ number (or location) in the lax treaty that contains the
saving clauae and ito exceptions.
4. The type and amount of incom€ that qualifles for the €xemption
from tax.
5. Sufficient facls to iustify the sxemption from tax under the terms ol
lhe treaty article.
Exampte. Anicle 2o of the U.S.-China income tax treaty allows an
exemption fom tax for scholarship income received by a Chinese
student tomporarily present in the United States. Under U.S. law, this
student will become a residenl alien for tax purposes if lheir stay in the
United States exceeds 5 calendar years. However, paragraph 2 of the
first Prolocol to the U.S.-China rreaty (dared April 30, 1984) allows the
provisions of Arrticle 20 to conlinue to apply ev€n after the Chinese
student becomes a resident alien of the United Slates, A Chinese
student who qualifies lor this exception (und€r pardgraph 2 ol th€ tirst
Potocol) and is relying on this exception to claim an exemption from lax
on lheir scholarship orlellowship income woarld attach to Form W-9 a
statement thal includes lhe in{ormation described above to suppod that
exemption.
lf llou are a nonresident alien or a foreQn entity, give lhs roquester the
appropriate completed Form W-8 or Form 823{1.
Backup Withholding
What is backup withholding? Persons making certain payrnents to you
must und6r certain conditions withhold and pay to the IRS 24% of such
payrnenls. This is call€d 'backup whhholding." Payments that may be
subiect to backup withholding include, but are not limited to, intore€t,
tax-€xempt interest, dividende, broker and barter exchange
transac{ions, rents, royalties, nonemployee pay, payments made in
settlement of payment card and third-party n€twork traneactions, and
certain payments from fiehing boat operators. Real eetate transactions
are not s{rbiec{ to backup withholding.
You will not be subject to backup withholding on payments you receive
if you give the roquester your con€cr TlN, make the proper cerlifications,
and report all your taxabls interest and dividends on your tax r€tum.
Paynrents you receive will be subject to backup withholding if:
1. You do not fumioh your TIN to tho roquostot;
2. You do not certify your TIN when required (see lhe inslructions for
Part ll for details);
3. The IRS tells the requester that you fumishad an inconect TIN;
4. the IRS tells you tfial you are su$ect to backup withholding
because yor dki not report all your interest and dividends on your lax
r€tum for reportable interest and dividends only); or
5. You do not ceniry to the rsquest€r that you aro not subjecl to
backup withholding, as described in item il under '9y stgni;ng tlte filled-
oul form" above fior reportable inlerest and dividend accounts opened
after 1983 only).
Form W-9 {Rev.3-2@4)Page 3
Gertain payees and paymsnts aro exempt trom backup withholding.
See Exempt payee code, later, and the ssparate lnstruclions for the
Requester of Form W-9 for more information.
See also Fstab/ishlng U.S. status forpurpses of chaplat S and
c hapter 4 w ithhddi ng, ea4ix.
What ls FATCA Reporting?
The Foreign Account Tax Compliance Act {FATCA} requires a
padicipaling foreign financial inslitrtion to report all U.S. account
holddrs that are specified U.S. p€rsons. Cerlain pa.yees are exempt from
FATCA reporting. See Fxemption lrun FATCA repfting coda,later, and
the lnstructions for the Requester of Form W-9 for more information.
Updating Your lnformation
You must provide updated inbmation to any p€rson lo whom you
chimed to be an exempt payea if yor are no longer an exempt payee
and anlicipate receiving reportaHe payments in the hnwe frun lhis
person. For example, you may need to provftle updated information if
you are a C corporation fiar el€cts lo be an S corporation, or if yotr are
no longertax exempt. ln addilion, 1ou must lumish a nertr Form W-9 if
the name or TIN charqes for lhe accornt" ior exarnple, if the grantor ol a
grantortrust dies.
Penalties
Failure to fumish TlN. lf you fuil to fumistr yurr correct TIN to a
requesler, 1lou are su$ect lo a penahy ol $5o lor each such fiailure
unless your failure is due to reasonable cause and not to willful neglect.
Givil penalty for lalse inlormation wilh respcct to withholding. lf you
make a false statement with no reasonable basis tfiat results in no
backup wilhholding, you are subject to a $500 penalty.
Criminal penalty for laleifying information. Willfully falsifying
certifications or atfrmations may subject you to criminal penalti€s
including fi nes and/or imprisonment
Misuse of TlNs, lf the requester disclosss or useo TlNs in violation of
federal law, th6 r€quest€r may be subiect to civil and criminal penalties.
Specific lnstructions
Line I
You must €nier one of the following on this line; do nol leavs this lins
blank. The name should match the name on yourlax relum.
lf lhis Form W-9 is for a loint account (oth€r than an account
maintained by a foreign financial institution {FFl)), list first, and then
circle, the name of th€ person or entity whose number you entered in
Part I of Form W-9. lf you ars providing Form W-9 to an FFI to documsnt
a joint account, each holder of the account that is a U.S. person must
provide a Fom W-9.
. lndividual. Generally, enter the name shown on your tax retum. lf you
have changed pur last name without informing lhe Social Security
Administration (SSA) ol the name change, enter your first neme, lhe last
name as shown on lour social security card, and your new last narne.
Note lor ITIN applicant Enter your individual name as it was enter€d
on your Form W-7 applicaiion. line 1a This should also be the same as
lha name you entered on the Form l0ilo you filed with your applicalion.
o Sole proprietor. Enier your individual name es shown on yow Fonn
1 040 on line 1 . Enter your business, trade, or "doing businees as" (DBA)
name on line 2.
r Partnership, C corporation, S corporation, or LLG, other than a
disregarded entity, Enter the entity's narne as shown on the enli$'s tsx
rafum on linc 1 and any burinert, trede, or DBA narno on lino 2,
. Other entities. Enter your name as shown on required U.S. federal tax
documents on line l. This name should match the name shown on the
charler or other legal document creating th€ entity. Enler any businees,
trade, or DBA name on line 2.
. Digregarded entity, ln general, a businece entity thai has a single
owner, including an LLC, and is not a corporalion, ie disregarded as an
entity separate from iis owner (a dieregarded entity), See Regulations
section 301.7701-2(c)(21. A disregarded entity ahould check the
appropriate box for the tax claseification of ite owner, Enter the owne/s
name on line 1. Ths name of the owner entercd on line 1 should never
be a disregarded entity. The name on line 1 should be the name shown
on the income tax rstum on which lhe income should be reported. For
Kittitas County Agreement for Services (rev.5/Ial25)
Page 18 of 21
example, if a foreign LLC that is treated as a diwegarded entity for U.S.
lederal lax 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. lf the direct owner of
tho enlity is also a disregarded entity, entr the first owner that is not
disregarded for lederal tax purposes. Enter the disregarded entity's
name on line 2. lf the owner of the disregarded enlity is a foreign person,
lhe owner must complete an appropriate Form W-8 instead of a Form
W-9. Thie is the case even if the foreign person has a U.S. TlN.
Llne 2
lf 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 nama is entercd on line 1. Check only
one box on line 3a.
Line 3b
Check this box if you are a partnership (ncluding an LLC classified as a
partnership for U.S, federal tax purposes), trust, or estate that has any
toreign partners! ownerc, or beneficiaries, and you are providing thio
form to a partnerehip, trust, or 6tale, in which you have an ownership
interest. You must check lhe box on line 3b if you receive a Form W-8
(or documentary evidence) from any partner, owner, or beneficiary
establishing foreign siatus or if you receive a Form lA/-9 from any
partner, owner, or beneficiary that has checked the box on line 3b.
Note: A parlnerehip lhat provides a Form W-9 and checks box 3b may
be reguired to complele Schedules K-2 and K-3 (Form 1065). For more
information, see the Partnership lnstructions for Schedules K-2 and K-3
(Form 1065).
ll you are required lo complete line 3b but fail to do so, you may not
receive lhe information nec€ssary to file a conecl information retum whh
the IRS or fumish a conect payee stat€m€nt to your partner8 or
beneficiaries. See, for example, s€ctions 6698, 6722, and 6724 lot
penahies that may apply.
Line 4 Exemptions
lf you are €xempt ftom backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any cods{s) that may apply to
you.
Exempt payee code.
. Generally, individuals (including sole proprietorB) are not exempt {rom
backup withholding.
r Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dMdends.
o Corporations are not exempt from backup wilhholding for payments
made in eettlem€nt ol payrnent card or third-party network transactions.
o Corporations are not ex€mpt trom backup withholding with respect to
attomeys'{eee or gross proceeds paid to attomeys, and corporations
thal provide medical or heallh care seruiceg are not €x€mpt with respect
to paym€nts r€portable on Form 1099-M|SC.
The lollowing codes identify payees lhat are exempt lrom backup
withholding. Enter the appropriate code in tfie space on line 4.
1 -An organization exempl {rom tax under section 501{a), any lRA, or
a custodial account under section 403(bX7) if lhe account eatisfies lhe
requirements of s€ction 401ff|{2).
TruBYestato.o Trust/estate
Partnership.r Partnership
Umiled liability company and
enter the appropriale tax
classification:
P = Partnership,
C=Ccorporation,or
S = S corporation.
. LLC classified as a partnership
for U.S. lederal tar purposes ot
. LLC lhat has filed Form 8832 or
2553 el€cting to be laxed as a
corporation
lndMdual/sole proprielor.o lndividual or
. Sole proprietorship
Gonomtion.o Gorporation
THEN check the box forlF the entityfindividual on line 1
is a{n} ...
Form W-9 {Rev. }.2024)Pase 4
2-The United States or any of its ageflcies d inslrumentalities.
3-A siate,lhe District of Columbia. a U.S. comrnonweatlh orlenitory,
or any of thdr political subdivisions o. irstrumenlalifieo.
4-A foreign govemment or any of its political subdivisions, agencies.
or insbumentalifies.
5-A corporation.
6-A dealer in securilies or commodilies requircd to register in the
United States, the Dishict of Columtria or a U.S. commonweallh or
teritory.
7-A tutures commission merchant registered wilh the Commodity
Futures Trading Commiseion.
8-A real $tate inveslm€nt bust.
9-An entity registered at all times during the tax year under the
lnvoslm€nt Company Act of 19lt().
10-A common fuot fund operated by a bank under section 584(a).
I 1 -A linancial institution as defined under soction 581.
12-A middleman known in the investment cornmunity as a nominee or
custodian.
'13-A trust exempt from tax under seclion 664 or d€€cribed in section
4947.
The {ollowing chart shows types of paymenls lhat may be exempt
from backup withholding. The chart applies to the exempt pay€€€ listed
above,'l throush 13.
lF tlre payrnent is lor .THEN the pafnent is exempt
for, . .
o lnterest and dividend payments All exompt pa!,ees excepl
for7
. Broker transactions 4and6
F-A dealer in securities, commodities, or dedvative financial
inslruments flncluding notional principal conlracts, fiiures, foni'/ards,
and opticns) that is register€d as such under the laws of the United
States or any stats.
G-A real estate investment trust
H-A regulated inv€ttnent cornparry as defined in s€ction 851 or an
entity r€gistsr€d at all times during th6 tax year under ths lnvestrnent
Company Act ol 1940.
l-A common trust lund as delined in section 584(a).
J-A bank as defined in s€ction 581.
K-A broker.
L-A lrust exempt from tar und€r section 664 or described in saotion
aeaz{a)(1).
M-A tax-exempt trust under a section ao3(b) plan or section 457(9)
plan.
l{ote: You may wish to consult with the financial inetitution requeeting
this form lo determine wh€th€r the FATCA code andlor exempt payee
code should be completed.
Line 5
Enter yorr address {number, street, and apartment or suite ntrmber).
This is where the requester of this Form W-9 will mail your infrcrmation
refums. lf this addrees diffss from the one the requesler already has on
lile, enter'NEW at th€ top. lf a new address is provided, there is still a
charrce the old address will be used until the payor changes your
address in thdr recods.
Llne 6
Enter your city. state, and ZP code.
Part l. Taxpayer ldentification Number fflNl
Enter your TIN in tlre appropriate box. ll lpu are a resident alien and
you do nol have, and are not eligible to g€t, an SSN, your TIN is your
IRS fflN. Entcr it in the entry space for the Social security number. lf you
do not have an fflN, see How lo gela IIAI below.
lf you are a sole proprietor and pu have an ElN, you may enier either
your SSN or ElN.
lf you are a singls-member LLC that is dbregarded as an entity
separate trom its owner, snter lhe owner'e SSN (or ElN, if the owner has
one). l{ the LLC is classified as a corporalion or partnership, enter lhe
entity'a ElN.
Note: See What Name and Number To Give the Requestar,later, for
further clarification of name and TIN combinations.
How to got a TlN. lf you do not have a TlN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA oflice or get this form online at
www.SSA.gov. You may also get this form by calling aoo-772-1213.Vsa
Form W-7, Application for IRS lndividual Taxpayer ldentilication
Number, ro apply for an fflN, or Form SS-4, Application for Employer
ldenlification Number, to apply lor an ElN. You can apply for an EIN
online by accessing the IRS website at www.irs.govlFlN. k to
www.its.gavlFonns to view, download, or print Form W-7 and/or Form
SS-4. Or, you can go to wwnirs. pvlOrdartorms to place an order and
have Forn W-7 and/or Form S94 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 Fo/' in the space for the TlN, sign and date
the fiorm, and give it to the requester. For interest and dividend
payments, and certain payments made with rospect to readily tradable
in$trumenb. you will generally havn 6o days lo gcr a TIN anrl give it to
the requester before you are subiect to backup withholding on
payrn€nts. The 6o-day rule does not apdy lo other typ€s ot payments.
You will be sut{ecl io backup withhdding on all such payments until
you provide your TIN to the raquester.
Nole: Entering "Applied Fof means that you have akeady applied for a
TIN or that you intend to appty for one soon. See also Fslabisf,r'ng U-S.
status forpnposes of chaptet 3 and chapter l withholding, earlier, for
when you may instead be subiect to wilhholding under chapter 3 or 4 of
lhe Code"
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
pqy€€s
11 andthrough all C corpomlion*
S corporations must not enter an
exempt pay€€ code because lhey
are exempt only for sales ol
noncovered securities acquired
lo 2012.
r Barter transaclinns Exempt payees ! lhrough 4.
and
r Payments over $600 required to Generally, exempl payees
be reported and direct sales over 1 through 5,2
. Payments made in settlement ol Exsmpt payees 1 through 4.
payment card or third-party
n€twork transaclions
l See Form 1099-M|SC, Miscellaneous lnformation, and its instructions.
2However, the following paym€nta made to a corporalbn and
rsporlable on Form 1099-MISC are nol exempl from backup
withholding: medical and health care paymente, attomeye'fees, 91063
proceeds paid to an attomey reportable under section 8045{fl, and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes ideniify
pay€€s that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by ce,rtain loreign financialinstihdions. There{ore, if
you are only submifting this form for an accouni you hold in the Uru'ted
States, you may leave this field blank. Consult with th€ pocon
requesling this form if 1ou are uncertain il the fnancial instiMion is
sutiiecl to these requircm€nts. A ruqu€st€. may indicate that a code is
not requircd by providing you with a Fqm W-9 wilh 'Not Applicable" (or
uny similar indlcatlon) entered on rhe llne lor a FATCA exempton code.
A-An oryanization exempt ftom tax under section 5O1(a! or any
individual retirement plan as defined in section 7701{af,37).
B-The United States or any ol its agencies or instumentalitieo.
C-A state.lhe f,lislrict ol Columbia, a U.S. commonwealth or
tenitory, or any of lheir political subdivisions or imtrumentalhies.
D-A corporation the stock of which is ragdarly traded on one or
more established securitbs markets, as described in Regulations
section 1.1a72-1(c)(1[).
E-A corporation that is a rnember of the same expanded affiliated
group a6 a corporation described in Regulations section 1.1472-1(cX1[0.
Kittitas County Agreement for Services (rev.5/74/25)
Page 19 of 21
Form W-s (Bev.3-2024)Pagc 5
Part ll. Certilication
To establish to the withholding agent that you are a U.S. per8on, or
resident alien, eign Fom W-9. You may be recpested to sign by the
withhokling ag€flt ev€n if item 1, {, or 5 bdow indicales other',uise.
For a joint account, only the person whose TIN is shown in Part I
should sign {when rcquired). ln the ose of a disregard€d sntity, the
penon identilted on line 1 must sign. Exempt paye€s, see Exempf pape
code, earlier.
Signature requkements. Completc ths cartificarion as indicated in
items 1 through 5 belo,v.
1. Interest, divirfund, and barter axchange accounls opened
belore 1984 and broker accounls considered active during iS3
You must give your correct TlN, h'lt you do not have to sign the
cerlification.
2. Interest, dividend, broker, and bartar erchangp accounts
opened after l98il and broker accounts considered inactive during
l98il. You muet sign the c€rtification or backup withholding will apply. tf
you are subiect to backup withholding and you are merely providing
your conect TIN to the r€quester, you must cross otrt item 2 in lhe
certification before signing the form.
3. Real estate transacliong. You must Bign the certification. You may
cros out item 2 ol the certificEtion.
4. Olhor pryrn€nts, You must give your conect TlN, but you do not
have to sign the certification unlese you have been nolified that you
hava previously given an inconect TlN. 'Other paymentsn include
payments madeln the coune ol the requester's trade or businees lor
renta, royaltiee, goods (other than bills for merchandiae), medical and
health care seruicea (including payrnents to eorporaliofls), payrnents to
a nonemployee for services, payments made in setdemenl of payment
card and third-party network transactions, pay,ments to cedain fishing
boat cr€w members and fshermen, and gross proceeds paid to
attomeys (including payrnente to corporatione).
5. Mortgage interest paid by you, acquisition or abandonmanl of
secured prop€rty, cancellation of debt, qualilied tuition prognam
payrnents (under section 529), ABLE accounls (under section 529A),
IRA Coverdell ESA, Archer MSA or HSA conkibutions or
distributions, and pension distributions. You must give your conect
TlN, but you do rnt have to sign lhe certification.
What Name and Number To Give the Requester
For this ol account:Give name md SSN of!
Ihe individud
For this of accounl:
8. Dbrclardod cntity not owned by an
indivldul
9- A valid trust, estal6, or pemion trust
10. Corporalion or LLG elecling corporate
ststu3 on Fofm 8832 or Form 2553
t1. Associstim, c*.rb, rellians, charitablg
edrcatkrml, or olhsr lax-axsnpt
organizatiln
12, Parhenhip or multi-me*berLLC
13. A brokor or regbtsed nornine
la. Accol'|f with ihe Departrnenl ol
Agricufh.rc h the name ol a public
enlity (susi as a stale or local
govenment, school dbtrict, or pdsonl
that receives agricuitural progranr
payments
15. Granlor truBt lilho Form 1041 or
urder the Optional Filing Method 2,
requiring Form 1009 {soe Reguhlions
secrion 1.671 -4{bX2X}€D"
Give name and EIN or:
Theowr
Legal entity{
The ccporation
The organiaation
The parhership
The broker or nomiree
The public enlity
The minoF
Th6 oranlor-lruBle€!
The acfualomorl
Thaownef
The grantod
Kittitas County Agreement for Services (rev.5/74/25)
Page2O of 2l
The trust
t List first and circle the name of the person whose numb€r you fumish.
lf only one peraon on a ioint acr,ount has an SSN, that pereon's number
must befumished.
zCircle the minols name and fumish the minor'g SSN.
3You muet show vour individual name on line 1. and enter vour businees
or DBA name, if airy, on line 2. You may use either your SSlrl or EIN (f
you have one), but the IRS encourages you to use your SSN.
dLiet firet and circle the name of lhe truBt, eslate, or peneion trust. (Do
not fumigh the TIN of the personal representative or truslee unl€ss the
legal entity itself is not designated in the account tille.)
'Note: The grantor must also provide a Form W-9 to the truslee of the
trust.
" For rnore information on optional filing methods for grantor lrusts, se€
the lnstructions for Fom 1O41.
Note: ll no name is circled when more than one name is lisled, the
number will be considered lo be that of lhs first name listed.
Secure Your Tax Records From ldentity Theft
ldentity theft occurs when someone uses your p€rsonal information,
such aB llour name, SSN, or other identi$ing information, without your
permission to commit lraud or other crimss. An identity thief may use
your SSN to get a iob or may lile a tax retum using your SSN to receive
a refund.
To reduce your risk:
r Protect your SSN,
. Ensure your employer i9 protecting pur SSN. and
. Be csreful when choosing a tax retum preparer.
It your tax records are affected by identity lheft and you raceive a
notice from the lRS, respond right away to the name and phone number
pdnted on the IHS notice or lefter.
lf your tax record$ are not cunently affect€d by klentity theft btx you
think you are at rigk due to a lost or stolen purs€ or wallet, qusslionabl€
credit card acliviiy, or a qusslionable credit report, conlact the lFlS
ldentity Theft Hotline at 800-90&4490 or submit Form 14039.
For more information, s€e Pub. 5027, ldentity Theft lnformation for
Taxpayers.
2. Two or rnore individuals 0oint accoun0
olher than an cccount maintained by
an FFI
3. Two or morp U.S. persong
(oint accout maintained by an FE
4. Cuetodial accomt of a miror
(lJnifonn Gift lo Mhors ABt)
5. a. The usual revocable savlngs kust
{grantor b also busloa}
b. So-called trust account thal is not
a lcgal or valirJ trurl uf,der statr law
8. Solo proprietonhip or disregarded
entity own€d by 6n hdividual
7. Grantor trugt filing wrder Optional
filhg Metfiod 1 (ecc Flcgulalions
scction 1.671 -a{bleXiXAD"
The acfual orurer of lhe accurnl or,
il combinod funds, the frrst individual
on tlp accounl:
Each holder olthe rcca:nt
Form W-9 {Hev. 3-2024)Pase 6
Victims of idontity theft wtn are exp€riencit€ r.onomic harm or a
systemic problem, or are s€eking help in resolving tax problsms that
have not been resolved through normal channeb, may be eligible for
Taxpayer Advocate Service fIAS) assbtance. You can reach TAS by
calling the TAS toll-frse case intake line at 877-777-4776 or TfY{fDD
800-829-4059.
Protect yourself from euopicioue emails or phishing schenles.
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 lalsely claiming to be an establish€d
legitimate enterprise in an attempt to Ecam the usar into surrenderirlg
private information that will be used lor identity theft.
The IRS does not initiate contacts with taxpayers via emails. Aso, the
IRS does not requ$t psrsonal detailed infomation through email or ask
taxpayers lor lhe PIN numbers, passwords, or similar secrct access
information for their crsdit card, bank, or other financial accounts.
ll lou receive an unsolicited email claiming to be from lhe lRS,
forward this message tophshing@irs.gpv. You may also report misuse
of the IRS name, logo, or other IRS Foparty to the Treasury lnspector
General for Tax Administration (tlGTA) at 800€6€i-4484. You can
lonivard suspicious emaib to the Federal Trade Commissiofl at
spam@uce.gou or report them at www.f?c.glov/cunplaint. You can
contact the FTC at icww.ftc.grov/rdlhef or 877-IDTHEFT (8774i1&4338).
lf you have been the victim ol identity theft s* www.ldentityTleft.gw
and Pub. 5O27.
Go to wwuirs.govlldentitylheftlo leam more about identity theft and
how to reduce your risk
Kittitas County Agreement for Services (rev.5/M/25)
Page 21 of 21
Privacy Act Notice
Section 6109 of the lntemal Revenue Code requirea you to provide your
conect TIN to persons (ncluding federal agencies) who are required to
file infomation returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgago int€rest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contribdions you made to an lRA, Archer MSA or HSA. The
person collecting this form uses the information on the form to file
informalion retums with the lRS, reporting the above information.
Routine usss of thb information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, lhe District of
Columbia, and U.S. commonweahhs and lenitories for use in
administering their laws. The information may aleo be disclosed to othet
countd€s under a treaty, to federal and state agencies to enforce civil
end criminal laws, orto federal law enforcement and intelligence
agerries to combat tenorism. You must provide your TIN whether or not
you are required to file a tax relum. Under section 3406, payo€ must
generally withhold a percentage of taxable interest, dividends, and
certain other paymerns lo a payee who does not give a TIN lo the papr.
Certain penalties may also apply for providing false or fraudulent
informalion-