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HomeMy WebLinkAboutPK05-096 - Original - King County Parks and Recreation - East Hill Skate Park - 5/20/05 i I 1 ecords M eme KEN? _wjap WABNINO TON Document i CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed, if you have questions, please contact Mary Simmons, City Clerks Office. Vendor Name: kl✓r4 0Ct4 4r,4 )PA4, --Y Contract Number: f kos' D 7� This Is assigned by Mary Simmons Vendor Number: Project Name: S Wi� Pexf-� - �J Contract Effective Date: Contract Termination Date: 12 IL3 II IOC Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: toeq/� Department: Y Abstract: ADCL7832 07/02 s.t King County Parks and Recreation Division Department of Natural Resources and Parks King Street Center BulkUng KSC-NR-0700 201 South Jackson Street Seattle,WA 98104-3855 206-296-M7 May 25,2005 Perry Brooks, Project Manager Kent Parks&Recreation 220 4th Avenue South Kent,WA 98032 RE: Youth Sports Facility Grant,D34961D, $17,000 Dear Perry, Congratulations again on your grant award for the East Hill Skate Park. This letter serves as an "Authorization to Proceed"with your project. Enclosed is an executed contract. Please keep me informed as the project proceeds and nears completion. Also, any project signage or promotional material should note King County and this program as a financial sponsor. We will provide you with a modest plaque to be placed at the facility when the project is complete. King County Parks is pleased to be partnering with you and trust that this project will serve your community well. I can be reached at 206.263.6267 if you or project members have any questions. All the best, A � Butch Lovelace Program Manager fCng County - Department of Natural Resources and Parks 1, Parks and Recreation Division YOUTH SPORTS FACILITY GRANT CONTRACT—2005 Department/Division: Natural Resources and Parks / Parks Division Agency: Kent Parks and Recreation Project Title: East Hill Skatepark Climbing Wall Contract Amount: $ 17,000 Fund Code: 1638 Contract Period From: January 1,2005 To December 31,2006 Contract Number: D34961D THIS CONTRACT is entered into by KING COUNTY(the"County"), and Kent Parks and Recreation (the "Agency").,whose address is 220 4th Avenue South,Kent,WA 98032-, WHEREAS,King County is the manager of the Youth Sports Facility Grant(YSFG)Program; WHEREAS,the grant recipient is either a public agency or a non-profit organization whose land or facility will provide recreational or athletic opportunities primarily to youth under 21 years of age; WHEREAS, King County has selected the identified agency to be awarded a Youth Sports Facility Grant to assist in capital improvements for increased recreational opportunities; WHEREAS, the grant recipients and/or landowner on whose property will receive these improvements will develop,program,operate,and maintain the facility to address a recreation need in King County; WHEREAS,King County has the authority under KC Ordinance 10454 to enter into agreements for the use of King County funds by public agencies and/or non-profit organizations to provide a service to the public, This form is available in alternate formats for people with disabilities upon request. 1 -kR e NOW THEREFORE, in consideration of payments, covenants,and agreements hereinafter mentioned, to be made and performed by the parties hereto,the paw covenant and do mutually agree as follows: 1. SCOPE OF SERVICES The Agency shall provide services and comply with the requirements set forth hereinafter and in the following attached exhibits,which are incorporated herein by reference: ❑ Scope of Services Attached hereto as Exhibit I ❑ Budget Attached hereto as Exhibit II ❑ Timeline Attached hereto as Exhibit III ❑ Invoice Voucher Attached hereto as Exhibit IV ❑ Design Documents Attached hereto as Exhibit V ❑ Insurance Certificate Attached hereto as Exhibit VI ❑ W-9 Attached hereto as Exhibit VH ❑ Use Agreement Attached hereto as Exhibit VIU ❑ personnel Inventory Report(K.C.C. 12.16) NA ❑ Affidavit of Compliance(Y C.C. 12.16) NA ❑ Assurance of Compliance/Section 504 NA 2. DURATION OF CONTRACT This Contract shall commence on the Ist day of January,2005, and shall terminate on the 31 stst day of December, 2006,unless extended or terminated earlier, pursuant to the terms and conditions of f the Contract. 3. PREMSES ` This grant project is located in. ' Kent,Washington ` r 4. PARTIES All communication,notices,coordination,and other tenets of this agreement shall be managed by: On behalf of King County: Butch Lovelace,YSFG Program Manager King County Department of Natural Resources and Parks 201 South Jackson St,Suite 701 Seattle,WA 98104�3855 Email:butch lovelaceeametrokc.sov Phone:206.263.6267 2 � - On behalf of- Mr.Perry Brooks,Project Mauer_ Kent Parks and Recreation - 220 4th Avenue South Kent, WA 98032- 253-856-5114 pbrooks@ci.kent.wa.us 5. COMPENSATION AND METHOD OF PAYMENT A. The County shall reimburse the agency for satisfactory completion of the services and requirements specified in this Contract after the agency submits an invoice and all accompanying reports as specified in the attached exhibits. The County will initiate authorization for payment after approval of corrected invoices and reports. The County shall make payment to the Agency not more than 30 days after a complete and accurate invoice is received. B. The Agency shall submit its final invoice and all outstanding reports within 15 days of the date this Contract terminates. If the Agency's final invoice and reports are not submitted by the day specified in this subsection,the County will be relieved of all liability for payment to the Agency of the amounts set forth in said invoice or any subsequent invoice. , 6. OPERATING BUDGET When a budget is attached hereto as exhibit II,the Agency shall apply the funds received from the County under this Contract in accordance with said budget. The Agency shall request prior approval from the County for an amendment to this Contract when the cumulative amount of transfers among the budget categories, i.e. Project Tasks, is expected to exceed 10% of the Contract amount. Supporting documents necessary to explain fully the nature and purpose of the amendment must accompany each request for an amendment. 7. COMMUNICATION The Agency shall recognize King County Parks as a fiscal sponsor for the grant project in the following manner: A. Plaque: At the time of project completion or dedication, which ever comes first, the Agency shall install on or near the facility a 4" X 6" plaque provided by the County that notes King County as a fiscal sponsor. B. Events: The Agency shall invite and recognize King County Parks at all events promoting the project during construction,and at the final project dedication. C. Written material: The Agency shall recognize King County Parks as a fiscal sponsor in all ' brochures, banners, posters, and other promotional material. 3 �s g, PUBLIC ACCESS The Agency shall to the ante°t reasonably possible make the project available for use by ma*, . the general public without unreasonable requirements for use. Fees for use of the project shall be no greater than those generally charged by public operators of similar facilities in King County. 9. GREEN BU"ING is committed o promoting and using green buildin g practices in construction King Countystrop encourages Practices that conserve resources, projects.Though not required,King County rgy efficiency,and otherwise consider environmental, use recycled content materials,maximize erieeconomic and social benefits in the design and construction of a building project. ,gym erc'niTNT G SYSTEM 10. INTERNAL CONTROL A. The Agency shall establish and maintain a system of accounting governme at accounting controls internal complies with applicable, generally accepted accounting p p C Chapter and financial reporting standards in accordance with Revised Code of Washington(R V� 40.14. 11. '.'.;AiNTEN NCE OF RF�'O�� A. he Agency shall maintain accounts and records, including personnel, property, financial, by the and programmatic records and other for all�Crontra t may be and mcomplianceed �with this County to ensure proper accounting . Contract. L Period of six ars after nation hereof unless B. These r a ssc to destroy themtis d f footed by the office 6)ofethe Archivist l in accordance with , perm Revised Code of Washington(R.CW)Chapter 40.14. fferent from the Agency C. The Agency shall inform the County C tract, of the aforesaid books,lrecords, ocuments, and address listed on peg m writing of any changes in location within ten other evidence and shall notify the County 8 (10)working days of any such relocation. 12. RIGHT TO INS n reserves the right to review and approve the performance of Agency King County at its discretio with regard to this Contract 13. CO ALL LAWS AND REGULAR The Agency,in cooperation and agreement with the owners of the Premises,shall comply with all applicable laws, ordinances and regulations in using funds provided by the County including, to the extent applicable, those related to "public works," payment of prevailing wages and e specifically agrees to comply and pay all costs competitive bidding of contracts. The Agency spec Y gr and that King associated with achieving such complianverw notice° of demat notice nd foom r King County, any instance. County, does not waive this section by giving d the The Agency shall indemnify and defenor a violation of such laws related o this Agreement. County should it be sued or made the subject of an administrative investigation or hearing 4 s' k�r _ t 14. CORRECTIVE ACTION A. If the County determines veldt a breach of contract has occurred or does not approve of the aforementioned performance; it will give the Agency written notification of unacceptable performance. Agency then agrees to take corrective action within a reasonable period of time,as defined by King County in the aforementioned written notification. B. The County may withhold any payment owed the Agency until the County is satisfied that corrective action has been taken or completed. 15. TERMINATION A. This Contract may be terminated by the County without cause, in whole or in part, prior to the date specified in Section II, by providing the Agency ten (10) days advance written notice of the termination. ' B. If the termination results from acts or omissions of the Agency, including but not limited to misappropriation, nonperformance of required services, or fiscal mismanagement, the Agency shall return to the County immediately any funds, misappropriated or unexpended, which have been paid to the Agency by the County. ' 16. FUTURE SUPPORT The County makes no commitment to support the services contracted for herein and assumes no obligation for future support of the activity contracted herein except as expressly set forth in this Contract. 17. HOLD HARMLESS AND INDEMNIFICATION The Agency agrees to indemnify and hold King County harmless as provided herein. Accordingly, The Agency agrees for itself, its successors, and assigns, to defend indemnify, and hold harmless King County, its appointed and elected officials, and employees from and against liability for all claims, demands,suits,and judgments,including costs of defense thereof for injury to persons,death, or property damage which is caused by, arises out of, or is incidental to any use of or occurrence on the Project that is the subject of this Contract or The Agency's exercise of rights and privileges granted by this Contract,except to the extent of the County's sole negligence. The Agency's obligations under this section shall include: A. The duty to promptly accept tender of defense and provide defense to the County at The Agency's own expense; ;F ti B. Indemnification of claims made by The Agency's employees or agents; and C. Waiver of The Agency's immunity under the industrial insurance provisions of Title 51 RCW. but only to the extent necessary to indemnify King County, which waiver has been mutually negotiated by the parties. In the event it is necessary for the County to incur attorney's fees, legal expenses or other costs to enforce the provisions of this section, all such fees, expenses and costs shall be recoverable from The Agency. 5 In the event it is determined that RCW 4.24.115 applies to this Contract, The Agency agrees to protect, defend, indemnify and v�the County, its officers, officials, employees and agents from any and all claims, demands, suits, penalties, losses damages judgments, or costs of any kind whatsoever for bodily injury to peocros or damage to property(hereinafter"claims"), arising out of or in any way resulting from Tha A.gency's officers,employees,agents and/or subcontractors of all tiers, acts or omissions, pedformanoe of failure to perform the rights and privileges granted under this Contract, to the maximum extent permitted by law or as defined by RCW 4.24.115, now enacted or as hereafter amended. A hold harmless provision to protect King County similar to this provision shall be included in all Contractor or Subcontractor Agreements entered into by Agency in conjunction with this Contract. 18. INSURANCE A. Liability Insurance.' Requirements Notwithstanding any other provision within this Agreement, Grant recipient shall procure and maintain the following Minimum Limits of Insurance for the duration of the term and shall require their contractors to procure and maintain: 1. Commercial General LLaability. (to include Products-Completed Operations) insurance against claims for injuries to persons or damages to property that may arise from or in connection with the Concessionaire's use of the premises at the County Park site. General liability insurance shall be as broad as that provided by Commercial General Liability"occurrence"form CGOOOI (Ed. 11/85). The insurance limits shall be no less than One Million dollars ($1,000,000) combined single limit per occurrence and Two million dollars ($ 2,000,000) in the aggregate for bodily injury and property damage 2. Automobile Liability. Insurance Services form number CA 00 01 (Ed. 1/80) any auto. If the giant includes the use of automobiles,the Limit of Liability shall be no less than Ond Million dollars($ 1,000,000)per occurrence. 3. - Workers Compensationl top Gan. If the recipient or its contractors has employees, parties shall provide Statutory Workers Compensation coverage and Stop Gap Liability for a limit no less than One Million dollars($1,000,000) 4. Professional Liability. If the grant includes the use of Professional Services, a Per Claim/Aggregate Limit of$ 1,000,000.shall be provided. B. If the grant involves the construction of a capitol project or involves the purchase of ' equipment greater than$ 5,000. in value,Grant Recipient shall provides"All Risk"Builders Risk or Property" coverage ,for the full replacement value of the project/property built/purchased. King County shall be listed as a Loss payee. C. King County and its officers,'t fficials, employees and agents shall be covered as additional insured with respect to liability arising out of activities performed by the grant recipient and its contractors. Additional Insured status shall include Products-Completed Operations. D. To the extent of the grant recipient or its contractor's negligence,their insurance respectively shall be primary insurance with respect to the County, its officers, employees and agents. Any insurance or self-insurance maintained by the County, and its officers, officials, 6 z" employees or agents shall not be subjected to contribution in favor of the Grant recipient or its contractors insurance and shall not benefit their in any way. Grant Recipient and Contractors insurance shall apply separately to each insured against whom a claim is made orb Is wsuit is brought,subject to the limits of the insurer's liability. E. Coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except by the reduction of the applicable aggregate limit by claims paid, until after thirty(30)days' prior written notice has been given to and change in coverage accepted by King County. F. The insurance provider must be licensed to do business in the State of Washington and maintain a Best's rating of no less than A VUL The Grant Recipient must provide a Certificate of Insurance and Additional Insured Endorsement to the (Exhibit VII), and upon written request of the County, provide a duplicate of the policy as evidence of insurance protection. Grant recipient shall be responsible for the maintenance of their contractors insurance documentation. G. If the Agency is a Municipal Corporation or an agency of the State of Washington and is self-insured for any of the above insurance requirements, a certification of self-insurance shall be attached hereto and be incorporated by'reference and shall constitute compliance with this section. 19. NONDISCRIMINATION AND EQUAL EMPLOYMENT OPPORTUNITY / A. Nondiscrimination in Emplovment Provision of Services King County Code Chapter 12.16 is incorporated by reference as if fully set forth herein and such requirements apply to this Contract. During the performance of this Contract, neither the Agency nor any party subcontracting under the authority of this Contract shall discriminate or tolerate harassment on the basis of race,color, sex, religion, national origin, marital status, sexual orientation, age, or the presence of any sensory, mental, or physical disability in the employment or application for employment or in the administration or delivery of services or any other benefits under this Contract. B. Nondiscrimination in Subcontracting Practices King County-Code Chapter 12.17 is incorporated by reference as if fully set forth herein and such requirements apply to this Contract. During the solicitation, award and term of this Contract,the Agency shall not create barriers to open and fair opportunities to participate in County contracts or to obtain or compete for contracts and subcontracts as sources of supplies, equipment, construction and services. In considering offers from and doing business with subcontractors and suppliers, the Agency shall not discriminate against any person on the basis of race, color, religion,,sex, age, national origin, marital status, sexual orientation or the presence of any mental or physical disability in an otherwise qualified disabled person. C. Fair EmRlgyment Practices King County Code Chapter 12.18 is incorporated by reference as if fully set forth herein and such requirements apply to this Contract. During the performance of this Contract, neither the Agency nor any party subcontracting under the authority of this Contract shall engage in unfair employment practices. 7 t i Cr _r D. Compliance with Laws an¢Be�¢ulations The Agency shall comply fully with all applicable federal, state and local laws, ordinances, executive orders and,regulations that prohibit discrimination. These laws include, but are not limited to, RCW Chaptee°49.60, Titles VI and VII of the Civil Rights Act of 1964, the Americans with Disabilities Act,and the Restoration Act of 1987. E. Sanctions for Violations Any violation of the mandatory requirements of the provisions of this Section shall be a material breach of contract for which the Agency may be subject to damages, withholding payment and any other sanctions provided for by the Contract and by applicable law. F. Reporting 1. The Agency entering into a contract or agreement with'King County valued at$25,000 or more shall submit with this Contract a total Personnel Inventory Report providing P employment data for minorities,females,and persons with disabilities. Subject to the provisions of KCC Chapter 12.16.060,the Agency's Personnel Inventory Report shall be effective for two years after the date on which the report was submitted. 2. The Agency entering into a contract with King County valued at more than$25,000, or contracts which in the aggregate have a value to the Agency of more than $25,000 should submit an Affidavit of Compliance in the form provided by the County, demonstrating commitment to comply with the provisions of KCC Chapter 12.16 in accordance with paragraph A of this Section XV. 20. SECTION 504 AND AMERICANS WITH DISABILITIES ACT The Agency shall complete a 504/ADA Self-Evaluation Questionnaire for all programs and services offered by the Agency,(mcluding any services not subject to this Contract) and shall evaluate its services,program&and:employment practices for compliance with Section 504 of the Rehabilitation Act of 1973, as aman l("504") and the Americans with Disabilities Act of 1990 ("ADA"). The Agency shall complete a 5041ADA Assurance of Compliance, and corrective action plan as needed for structural,programmatic, and/or service changes necessary at each of its premises within the State of Washington to comply with 504 and the ADA, and it is attached as an exhibit to this Contract and incorporated herein by reference. 21. CONFLICT OF INTEREST KCC Chapter 3.04 is incorporated by reference as if fully set forth hence,and the Agency agrees to abide by all conditions of said chapter. Failure by the Agency to comply with any requirement of said KCC Chapter shall be a material breach of contract. 22. POLITICAL ACTIVITY PROHIBITED None of the funds, materials, property, or services provided directly or indirectly under this Contract shall be used for any partisan political activity or to further the election or defeat of any candidate for public office. 8 23. EQUIPMENT PURCHASE,UAUMNANCE,AND OWNERSHIP A. The Agency shall be,responsible for all such property, including the proper care and maintenance of the equipment ,- B. The Agency shall establish aad maintain inventory records and transaction documents (purchase requisitions, packing slips, invoices, receipts) of equipment purchased with Contract funds. 2'4. NOTICES Whenever this Contract provides for notice to be provided by one(1) party to another, such notice shall be: A. In writing;and B. Directed to the person specked in Section IV of this Contract. Any time within which a party must take some action shall be computed from the date that the notice is received by said party. 25. ASSIGNMENT The Agency shall not assign any portion of rights and obligations under this Contract or transfer or assign any claim arising pursuant to this Contract without the written consent of the County. Said consent must be sought in writing by the Agency not less than fifteen(15)days prior to the date of any proposed assignment. • 26. CONTRACT AMENDMENTS Either party may request changes to this Contract. Proposed changes that are mutually agreed upon shall be incorporated by written amendments to this Contract. M1 9 ,��.-RC3 27. ENTIRECON7Rl.C"ffW orator the complete expression of the terms hereto and any Parties - The parties agree that this Contract;din not incorporated herein are excluded. Both ormance of the provisions of this contract. Waiver written representations or understan cent default. Waiver or breach of recognize that time is of the essence in the p of any subseq of any default shall not be deep 1 no be deem d to be a waiver of any other or subsequent breach any provision of the Contract attached to the original Contract. not be the Co tr to a modification of the terms of the Contract unless stated to be such and shall rev by the County,Which shall be through written app AGENCY KING COUNTY 7 FOR Si .i g County Exeou e NAME(Please type or pri t),Title Date e — � { Date , ' 10 King County ' �' '`�= ` Exhibit I Department of Natural Resources and Parks Parks and Recreation Division eysy ;Yogi spurts Facility Grant Scope of Services Please detail the scope of work to be performed under this contract as described in the YSFG application. You may use and expand upon the application text. Please be thorough in your description of both the entire project and how the YSFG grant will assist you in your project. The scope of work for this contract portion of the project is to purchase age appropriate children's climbing boulders and the safety surface underneath those structures. The boulders range in height from two feet tall to four feet tall and are manufactured by the same company that is supplying the larger climbing pinnacle and boulder. In 1996, The City of Kent City Council directed staff to build three skateparks for each geographic area of the City. To date, two of the three have been built while the final one on the East hill of Kent, where 80% of the Cities population resides remains to be built. In 2001, the City purchased two acres for the development of this skatepark. Staff begun working with a youth skatepark advisory board to determine what was needed as far as the size, design and other amenities that the site could accommodate. Consequently, the master plan in 2002 reflected those needs and had a 38,000 sq ft skate/BMX park, parking for 49 cars, a climbing boulder and monolith and a picnic/restroom building. Adjacent to the proposed site is a senior assisted living facility that at the time when staff approached them with the master plan, fully endorsed the plan and were excited to see it be bultt.so their residents could enjoy the activities close to their homes. In 2002, staff received an IAC Local Parks grant for the development of the skatepark in the amount of$465,000._ In 2003, management changed at the senior center and the skatepark was seen as a detriment and boycotted its very existence. Staff met with the management and residents to try and alleviate.their concerns and in the span of a year and a half, have created a master plan that is acceptable to the management of the center, citizens and to the CitY. In the effort of cooperation to make the most of the plan, the senior assisted living center donated an acre of land that was incorporated into the re-designed master plan. The re-designed master plan has the same amenities that the previous one had, but now incorporates multi-generational amenities such as areas for gardening, age appt'opriate play equipment, walking trails, a gazebo to watch the climbers, open lawn area, lawn bowling and Bocce ball court. This grant request is to help in funding the acquisition of the additional climbing boulders that are designed for children ages five and up. The City's match will be the installation of the climbing boulders as well the installation of the safety surface underneath all of the climbing structures. l `3Lz � I 77 NRN }Yf Y ,. - Lu j(�... loll i < W CD j ' a � a a F <� � sa -y w f j w h vOi Is �4 d1 J IF in pp 3f s � Lil O cli . �� � � � �� E 11111111111111111111{ p - a 94 j � .."uiS�iw+ ��..� � • Lev.... .:. .....rnv:N ®King County n: Exhibit ui Department of Natural Resources and Parks Parks and Recreation Division Yout Sports Facility Grant Timeline Please provide a schedule of tasks. You may use the application timeline unless it has developed since June. If so,please provide an updated timeline. Below is an example. Tasks (Year One): 2004 Quarter 1 Quarter 2 Quarter 3 Quarter 4 example Jan. - March April -June Jul - Sept. Oct - Dec. YSFG Contracting Complete February 5 Complete Design March 1 Construction Documents April 15 Apply for Permits April 20 Receive Permits July 14 Notice to Proceed August 15 50% Complete October 1 Project Complete November 10 YSFG Billing December 10 Y Tasks (Year Two): 2005 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Jan. -March April -June Jul - Se t Oct. - Dec. w ; W- � s tw ®y7 ON U <�d a 6 � a � f9 4 r I I 3 ¢ w,y• 1 ki j 3 i € Poo re ` F9i"ryttl' b a N s e , N ocm k le rn �- Z � �1 1 � ' I .•, I s o :110 w - - �.. � ,R Id4 1f �l ,.• - I I 13 I- _— ye• d ly{ 11� • 4 Q a —4,�I 'R'N __ +—�•:�T.� Y Y-�IY OAP A -`1 `o-'Ame-. v -."__ � �•�1 � '4-dA e.L : K WA Insurance Authority�: ' , , Y 0. Box 88030 ta,. RECEIVED FEB a , 'liticwila, WA 98138 03-Feb-05 � �Ap� Cert#: 3917 4UMANIJESOCRCES Phone 206-575-6046 King County Parks&Recreation rryOF KENT Attn: Butch Loveless Fax, 206-575-7426 ` KSC-NR-0700,201 S. Jackson St. Seattle,WA 98104-3856 RE: City of Kent Youth Sports Facility Program Grant for East Hill Community Skate Park climbing wall. Evidence of Coverage The above captioned entity is a member of the Washington Cities Insurance Authority (WCIA), which is a self insured pool of over 111 municipal corporations in the State of Washington. WCIA has at least$1 million per occurrence combined single limit of liability coverage in its self insured layer that may be applicable in the event an incident occurs that is deemed to be attributed to the negligence of the member. WCIA is an Interlocal Agreement among municipalities and liability is completely self funded by the membership. As there is no insurance policy involved and WCIA is not an insurance company,your organization cannot be named as an "additional insured'. Sincerely, Eric B. Larson . Deputy Dirdctor cc: Christopher Hills Joan Broom cletter z Form W-9 equest for Taxpayer Give form to the (Rev.January 2003) Identi�ral#ion Number and Certification requester.Do not De KMNM M we Treasury send to the IRS. hKarrial Reva,tm service N Name m n Busines me,if different from abtrwa 0 pm o IncRYIdualf {{�� ,f/.�H Exempt from backup Check appropriate box. ❑ Sole proprietor ❑Corporation ❑ Partnership,,L'•J other I• .-. -.904 ❑mthholding 02 Address ber��apt suite no.) Requester's name and address(optanal) City.state,and ZIP code _ e tL m Ust account number(s)here(optionall WWM Taxpayer Identification Number IN Enter your TIN in the appropriate box.For hxlividusls,this is your social security number(SSN). social security number However,for a resident alien,sole proprietor,or disregarded errtlty,see the Part i instructions on page 3.For other entidim it Is your employer Identification number(EIN).If you do not have a number, see How to get a TIN on page 3, or Note:9 the account is In more than one name,see the chart on page 4 for guldefines on whose number Employer identification number to enter. 910 RUMM Certification Under penalties of perjury,I y that: 1. The number shown on this form is my correct taxpayer identification number(or I am wafting for a number to be issued to me),and 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that 1 am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup with holding,and 3. 1 am a U.S.person(including a U.S.resident alien). Certification instructions.You must cross out kern 2 above 9 you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return For real estate transactions,item 2 does not apply For mortgage interest paid acquisition or abandonment of secured property,cancellation of debt,coxetributions to an individual retirement arrangement QRA),and generally.payments other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.(See the Instructions on page 4.) Sl(Jt1 signature of Here U.S.person ► Date ► Purpose of Form Nonresident alien who becomes a resident alien. Generally,only a nonresident alien individual may use the A person who is required to file an information return with terms of a tax treaty to reduce or eliminate U.S.tax on the IRS, must obtain your correct taxpayer identification certain types of income. However,most tax treaties contain a number(TIN)to report,for example,income paid to-you,real provision known as a "saving clause."Exceptions specified estate transactions, mortgage interest you paid,acquisition in the saving clause may permit an exemption from tax to or abandonment of secured property,cancellation of debt,or continue for certain types of income even after the recipient contributions you made to an IRA. 11 has otherwise become a U.S.resident alien for tax purposes. r U.S, person.Use Form W-9 only if you are a U.S. person .If you are a U.S.resident alien who is relying on an (including a resident alien),to provide your correct TIN to the exception contained in the saving clause of a tax treaty to person requesting it('the requester)and, when applicable, to: claim an exemption from U.S.tax on certain types of income, 1. Certify that the TIN you are giving is correct(or you are you must attach a statement that species the following five waiting for a number to be issued), items 2. Certify that you are not subject to backup withholding, 1.The treaty country. Generally, this must be the same or I I treaty under which you claimed exemption from tax as a 3. Claim exemption from backup withholding T you are a nonresident alien. U,S.exempt payee. 2.The treaty article addressing the income. _ Note: 11'a requester gives you a form other than Form W-9 S.The article number (or location)in the tax treaty that to request your TIN,you should use the requester'sform. contains the saving clause and its exceptions. However this form must meet the acceptable specifications 4.The type and amount of income that qualifies for the described in Pub. 1167, General Rules and Specifications for exemption from tax. Substitute Tax Forms and Scheilules I _ 5. Sufficient facts to justify the exemption from tax under Foreign person. If you are a foreign person,use the the terms of the treaty article. appropriate Form W-8 (see Pub.516,Withholding of Tax on Nonresident Aftens and Foreign Entities). Cat,No.10231x Form W-9 (Rev.1.2003)