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HomeMy WebLinkAboutIT17-565 - Original - Prime Team Partners, Inc. - Business Analyst - 11/06/2017 .� Records pemei � Document CANf1'� ! /III„r,I CONTRACT COVER SHEET I67v 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 City Clerk's Office. Vendor Name: Prime Team Partners, Inc. Vendor Number: 1641644 JD Edwards Number Contract Number: T � r '5 � This is assigned by City Clerk's Office Project Name: Consultant Services - Business Analyst Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ❑ Contract ❑ Other: Contract Effective Date: 11/06/2017 Termination Date: 12/22/2017 Contract Renewal Notice (Days): 30 Number of days required notice for termination or renewal or amendment Contract Manager: John Filicetti Department: Information Technology Contract Amount: $20.000 Approval Authority: ® Department Director ❑ Mayor ❑ City Council Detail: (i.e. address, location, parcel number, tax id, etc.): As of: 08/27/14 0 0 0 y o 0 O O O O U o 6 0 0 O O 0 o O O Q N N O O F � � ° m w m G N m L C f/1 E O o .. ._..._._.._._..._......_ 1< 0 0 m IL0 Q U o U o o O m A L C h O o O V : N M K N N N 0) r to a) � U m , W O v ma) C NN C O co C Z ',. ... . J f 0 C m 0 O a o E C1 .�+ m E Q 'c 3k G m 0 � 2 � cu c -a v v 'ac Eon E c O O O > a` � v� a 3 0 d v m a) E L m o m u O J Q. 4 T W N V d a+ L Cl) 4Y C i tl C j N N o LE Y ° ° M co :EOB p 4/ m O m co m v3 TmC0mm y " N 00 G c = a 0mu) G a o LAW (D a `om o ° 0c0 00 ° w (NO y m jyM m N L U J > j m Q fn (q L O N � C C U G• > U O m b C C C U U 0 U C � N CC) 0 0 0) a � N(_'n N -0 a) � O a. m L o ° U m i m m 0 C a m m m d a: � E — A C � Uc° ( v bJ (�L , Y aO E d0w m _ Lm ao)(n = UI J N Q CONSULTANT SERVICES AGREEMENT between the City of Kent and Prime Team Partners, Inc. THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Prime Team Partners, Inc. organized under the laws of the State of Washington, located and doing business at 100 W. Harrison St., Suite 450, Seattle, WA 98199, (206) 281-5552 (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: Perform all business analyst services necessary to assist the City's Information Technology Department in any of the active projects. Consultant shall provide high quality, customer focused services. Specifically, Consultant's duties include without limitation the following: • Identify, coordinate, document, and plan necessary business analysis activities related to identified projects; • Establish best practices for staff to utilize with a focus on open and transparent communication and socialization; • Lead City staff in developing and adopting processes through coaching, mentoring, partnering, and hands- on training; • Collaborate with City staff to deliver current and future state process by applying Lean methodologies. • Lead the following activities as they relate to conversion process within the City Clerk's Office: Lean process documentation, agile leadership, research analysis, business process analysis, usability testing, process improvement/Lean facilitation, functional/non-functional business requirements analysis and management, organizational change management, implementation coordination, usability analysis, testing, training, user acceptance coordination and post implementation support. • Analyze and document the current state business processes and workflows associated with the City Clerk's Office. • Facilitate and create documentation as it relates to the assigned projects: o Context diagrams, value stream maps, business process flows, solution requirements specifications, use cases, user stories, prototypes, recommendation document, charter development, data source to target map, design documentation, user acceptance criteria, user acceptance test plan, and vendor demonstration scenarios. • Recommend to the Director of Information Technology and PMO Manager how to best solve the business needs of the related Service Areas including options, risks, and impact to systems and business processes. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. The City has budgeted $20,000, toward the Consultant's services. Work under this contract shall continue until those funds are depleted.. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $20,000, for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and EEO COMPLIANCE DOCUMENTS - 1 executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be $90.00 per hour, with the total hours performed under this Agreement not to exceed 222 hours, unless expressly approved by the City in writing though a properly negotiated and executed contract amendment. B, The Consultant shall submit an invoice to the City once the Consultant has performed all work under this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C, The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or EEO COMPLIANCE DOCUMENTS - 2 suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's duty to defend, indemnify, and hold the City harmless, and Consultant's liability accruing from that obligation shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys'fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Consultant's part. The provisions of this section shall survive the expiration or termination of this Agreement. VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work under this Agreement. X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the Consultant. Consultant shall make such data, documents, and files available to the City upon the City's request. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. The City's use or reuse of any of the documents, data, and files created by Consultant for this project by anyone other than Consultant on any other project shall be without liability or legal exposure to Consultant. XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor with the authority to control and direct the performance and details of the work authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIII. MISCELLANEOUS PROVISIONS. EEO COMPLIANCE DOCUMENTS - 3 A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-LNaiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. WTitten Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignmenk. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Mgglification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. G. Entire Agreemenk. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or farming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public EgLQrA5 Ac . The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. EEO COMPLIANCE DOCUMENTS - 4 K. Counterparts and Signatures by, Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. All acts consistent with the authority of this Agreement and prior to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. CONSULTANT: O ENT: 7 By: B)A (signature) gsigraature Print Name:Brent Stach Print Name: Micha`eLCarrington Its:Director, Business Development Its: City of KenG_IT Dy ctor (title) DATE: 11/ym 7 DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Brent Stach <brent@primeteampartners.com> John F. Filicetti Prime Team Partners, Inc. City of Kent 100 W Harrison St s450 220 Fourth Avenue South Seattle, WA 98199 Kent, WA 98032 (206) 281-5552 (telephone) (253) 856-4660 (telephone) None (facsimile) (253) 856-4700 (facsimile) [In this ncld,yuu mzV enter[he electronic fil (lath whew fhc mnfrac[has been saycdl EEO COMPLIANCE DOCUMENTS - 5 DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: /3a.osLtf ^ . For: Brent Stach Prime Team Partners Title: Director, Business Development _...__._._ Date: 11/3/2D17_..... _ CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 EXHIBIT R INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01. The City shall be named as an Additional Insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. PRIME-1 OP ID: SR CERTIFICATE OF' LIABILITY INSURANCE 1 OA111032017 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Sprague Israel,Giles PHONE - ------------------------------------- PAX 1501 Fourth Avenue,Suite 730 INC.NP,Path fAfcr Nabl. .. Seattle,WA 98101-3225 E'MAIC Pierce Dyer A CA License#0192858 A. ESS ........ INSURERISI AFFORDING COVERAGE NAICp INSURER A:Massachusetfs Bay Ins Co INSURED Prime Team Partners INSURER B:The Han er Insurance Company 22292 100 W Harrison St.,#S450 - Seattle,WA 98119 INSURER c INSURER D INSURER _.. ,>,. ...... INSURER F ... COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES..LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AbBL 5UeiP POLICY Err I P oLICY EXV ...I ILTRR TYPE OFINSURANLE_ POLICY NUMBER MN40DPNYYk �MfdYpIYYYY LIMITS wca wun GENERAL LIABILITY EACH OCCURRENCE b 1,000,00 DAMAGEt"OFENTrO ' A X COMMERCIAL GENERAL LIABILITY X OD2 A40200503 0812512017 08/2512018 PREMISEE (E rmrce) _ �$ 300,00 CLAIMS MADE X j � OCCUR MED FXP Orycre person)... {$ 10100 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE b 2,000,00 GEN L AGGREGATE LIMIT APPLIES PER CPRODUC FS..-COMMOP AGO I $ 2,000,00" 6 PRO. LOC I Stop Gap $ Included :-POLICY AUTOMOBILE LIABILITY COMBIN{Een SIN9LL UMI1 1,000,00 A ANYAUFO X DD2 A40200503 08125/2017 08125/2018I BODILY INJURY(Par Pemoo) $ — ALL OWNED "— SCHEDULED BODILY IDJURY(Par eccldeot) $ AUTOS _ AUrus _ NON-OWNED POi FLNTX'DAMAGE $ X HIRED AUTOS X AUTOS rPEk ACCIDENT) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ' EXCESS LIAR CLAIMS MADEAGGREGATE l$ DED RETENTIONS $ WORKERS COMPENSATION " WC STATU OTH- ANDEMPLOYERS'LIABILITY X rq",y IMITC Fk B MandE IME ANY PROPRIE lNH EXCLUDED' Y I vry H 2A402000 OS 08/25/2017 0812$12018 E L DIvrEASECEA EMPLOYEE' $ 1,000,00( IDENT $ OFFICER/MEM NH)EXCLUDED9 D NIA E ' Dyes describe under pFRCRIPTII)N OF OPERATIONS below E L DISEASE POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADach ACORD 101,Additional Remarks Schedule,if more space is required) The City of Kent is additional insured if required by written contract or agreement, subject to the General & Auto Liability additional insured .provision endorsement attached. Insurance is Primary & Non Contributory CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Kent 220 4th Avenue South Kent,WA 98032-5838 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract, Agreement or Permit Included 1 - _...._ - -- — 2. Addtic-nal Insured- Broad Form Vendors Included 2 3. Alienated Premises Included 3 4.m Broad Form Property Damage - Borrowed Equipment, Customers Included 3 Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) Included 3 6. Personal and Advertising Injury - Broad Form Included 4 ......... _..._. __.......... ., 7. Product Recall Expense Included 4 -------------------- -- Product Recall Expense Each Occurrence Limit $25,000 5 Occurrence —... --..................... Product Recall Expense Aggregate Limit $50,000 5 Aggregate Product Recall Deductible $500 5 8. Unintentional Failure to Disclose Hazards Included 6 9. Unintentional Failure to Notify Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II - (2) Premises you own, rent, lease or LIABILITY: occupy; or 1. Additional Insured by Contract, Agreement or (3) Your maintenance, operation or use of Permit equipment leased to you. The following is added to SECTION II - b. The insurance afforded to such additional LIABILITY, C.Who Is An Insured: insured described above: Additional Insured by Contract, Agreement or (1) Only applies to the extent permitted by Permit law; and a. Any person or organization with whom you (2) Will not be broader than the insurance agreed in a written contract, written which you are required by the contract, agreement or permit to add such person or agreement or permit to provide for such organization as an additional insured on additional insured. your policy is an additional insured only with (3) Applies on a primary basis if that is respect to liability for "Inci injury", required by the written contract, written "property damage", or "personal and agreement or permit. advertising injury" caused, in whale or in 4 Will not be broader than coverage part, by Your acts or omissions, or the acts ( ) or omissions of those acting on your behalf, provided to any other insured. but only with respect to: (5) Does not apply if the "bodily injury", (1) "Your work" for the additional insureds) "property damage" or "personal and designated in the contract, agreement or advertising injury"is otherwise excluded permit; from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices. Inc., with its permission, Page 1 of 6 I,u. H�"��It1C3VG1" Insuranccc Group.. 082 D244121 0901621 c. This provision does not apply: The most we will pay on behalf of the (1) Unless the written contract or written additional insured for a covered claim is the agreement was executed or permit was lesser of the amount of insurance: issued prior to the "bodily injury", 1. Required by the contract, agreement or "property damage", or "personal injury permit described in Paragraph a.; or and advertising injury". 2. Available under the applicable Limits of (2) To any person or organization included Insurance shown in the Declarations. as an insured by another endorsement This endorsement shall not increase the issued by us and made part of this applicable Limits of Insurance shown in the Coverage Part Declarations (3) To any lessor of equipment: e. All other insuring agreements, exclusions, (a) After the equipment lease expires; or and conditions of the policy apply. (b) If the "bodily injury", "property 2. Additional Insured - Broad Form Vendors damage", "personal and advertising The following is added to SECTION II - injury" arises out of sole negligence LIABILITY, C.Who Is An Insured: of the lessor. Additional Insured - Broad Form Vendors (4) To any: a Owners or other interests from whom a. Any person or organization that is a vendor ( ) with whom you agreed in a written contract land has been leased if the or written agreement to include as an "occurrence" takes place or the additional insured under this Coverage Part offense is committed after the lease is an insured, but only with respect to liability forthe land expires, or for "bodily injury" or "property damage" (b) Managers or lessors of premises if arising out of "your products" which are (i) The "occurrence" takes place or distributed or sold in the regular course of the offense is committed after the vendor's business. you cease to be a tenant in that b. The insurance afforded to such vendor premises, or described above: (ii) The "bodily injury", "property (1) Only applies to the extent permitted by damage", "personal injury" or law, "advertising injury" arises out of (2) Will not be broader than the insurance structural alterations, new which you are required by the contract or construction or demolition agreement to provide for such vendor, operations performed by or on behalf of the manager or lessor (3) Will not be broader than coverage 5 To "bodGVy injury", "property damage" or provided to any other insured, and O , 9 "personal and advertising injury" arising (4) Does not apply if the "bodily injury", out of the rendering of or the failure to "property damage" or "personal and render any professional services. advertising injury" is otherwise excluded lies even if the claims from coverage under this Coverage Part, This exclusion applies including any endorsements thereto against any insured allege negligence or other wrongdoing in the supervision, c. With respect to insurance afforded to such hiring, employment, training or vendors, the following additional exclusions monitoring of others by that insured, if apply: the "occurrence" which caused the The insurance afforded to the vendor does "bodily injury" or "property damage" or not apply to: the offense which caused the "personal and advertising injury" involved the (1) "Bodily injury" or "property damage" for rendering of or failure to render any which the vendor Is obligated to pay professional services by or for you. damages by reasons of the assumption of liability in a contract or agreement. This d. With respect to the insurance afforded to exclusion does not apply to liability for these additional insureds, the following is damages that the insured would have in added to SECTION II - LIABILITY, D. Liability the absence of the contract or and Medical Expense Limits of Insurance: agreement; (2) Any express warranty unauthorized by you; 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 2 of 6 (3) Any physical or chemical change in the The most we will pay on behalf of the vendor product made intentionally by the for a covered claim is the lesser of the vendor; amount of insurance: (4) Repackaging, unless unpacked solely for 1. Required by the contract or agreement the purpose of inspection, described in Paragraph a.; or demonstration, testing, or the 2, Available under the applicable Limits of substitution of parts under instruction Insurance shown in the Declarations, from the manufacturer, and then repackaged in the original container; This endorsement shall not increase the (5) Any failure to make such inspection, applicable Limits of Insurance shown in the adjustments, tests or servicing as the Declarations. vendor has agreed to make or normally 3. Alienated Premises undertakes to make in the usual course SECTION II - LIABILITY, B. Exclusions, 1. of business in connection with the sale Applicable To Business Liability Coverage k. of the product, Damage to Property, paragraph (2) is replaced by (6) Demonstration, installation, servicing or the following: repair operations, except such (2) Premises you sell, give away or abandon, if operations performed at the vendor's the "property damage" arises out of any part premises in connection with the sale of of those premises and occurred from hazards the product, that were known by you, or should have (7) Products which, after distribution or sale reasonably been known by you, at the time by you, have been labeled or relabeled the property was transferred or abandoned. or used as a container, part or 4. Broad Form Property Damage - Borrowed ingredient of any other thing or Equipment,Customers Goods, Use of Elevators substance by or for the vendor; a. The following is added to SECTION II - (8) "Bodily injury" or "property damage" LIABILITY, B. Exclusions, 1. Applicable To arising out of the sole negligence of the Business Liability Coverage, k. Damage to vendor for its own acts or omissions or Property: those of its employees or anyone else Paragraph (4) does not apply to "property acting on its behalf. However, this exclusion does not apply to: damage" to borrowed equipment while at a jobsite and not being used to perform (a) The exceptions contained within the operations. exclusion in subparagraphs (4) or (6) Paragraph 3 , 4 and 6 do not a to above; orO O O apply .'property damage" to "customers goods" (b) Such inspections, adjustments, tests while on your premises nor to the use of or servicing as the vendor has elevators. agreed to make or normally b. For the purposes of this endorsement, the undertakes to make the usual following definition is added to SECTION II - course of business, in connection with the distribution or sale of the LIABILITY, F. Liability and Medical Expenses products. Definitions: (9) "Bodily injury" or "property damage'. 1. "Customers goods" means property of arising out of an "occurrence" that took your customer on your premises for the place before you have signed the purpose of being: contract or agreement with the vendor. a. Worked on; or (10)To any person or organization included b. Used in your manufacturing process. as an Insured by another endorsement c. The insurance afforded under this provision is issued by us and made part of this excess over any other valid and collectible Coverage Part. property insurance (including deductible) (11)Any insured person or organization, available to the insured whether primary, from whom you have acquired such excess, contingent or on any other basis. products, or any ingredient, part or container, entering into, accompanying 5. Incidental Malpractice - Employed Nurses, EMT's or containing such products. and Paramedics d. With respect to the insurance afforded to SECTION II - LIABILITY, C. Who Is An Insured, these vendors, the following is added to paragraph 2.a.(1)(d) does not apply to a nurse, SECTION II - LIABILITY, D. Liability and Medical Expense Limits of Insurance: 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc„ with its permission„ Page 3 of 6 ri�", ;'"� HHca11CAWE�P Insw7nce.(:re�trta.. 0132 D244121 0901621 emergency medical technician or paramedic o. Recall of Products, Work or Impaired employed by you if you are not engaged in the Property is replaced by the following: business or occupation of providing medical, o. Recall of Products, Work or Impaired paramedical, surgical, dental, x-ray or nursing Property services. 6. Personal Injury - Broad Form Damages claimed for any loss, cost or expense incurred by you or others for a. SECTION II - LIABILITY, B. Exclusions, 2. the lass of use, withdrawal, recall, Additional Exclusions Applicable only to inspection, repair, replacement, "Personal and Advertising Injury", paragraph adjustment, removal or disposal of: e. is deleted. (1) "Your product"; b. SECTION II - LIABILITY, F. Liability and (2) "Your work"; or Medical Expenses Definitions, 14. "Personal and advertising injury", paragraph b. is (3) "Impaired property", replaced by the following: If such product, work or property is b. Malicious prosecution or abuse of withdrawn or recalled from the market or process. from use by any person or organization C. The following is added to SECTION II - because of a known or suspected defect, LIABILITY, F. Liability and Medical Expenses deficiency, inadequacy or dangerous Definitions, Definition 14. "Personal and condition in it, but this exclusion does not apply to 'product recall expenses' advertising injury": that you incur for the "covered recall" of "Discrimination" (unless insurance thereof is your product". prohibited by law) that results in injury to the However, the exception to the exclusion feelings or reputation of a natural person, does not apply to "product recall but only if such "discrimination" is: expenses" resulting from: (1) Not done intentionally by or at the (4) Failure of any products to accomplish direction of: their intended purpose; (a) The insured, (5) Breach of warranties of fitness, (b) Any officer of the corporation, quality, durability or performance, director, stockholder, partner or (6) Loss of customer approval, or any member of the insured; and cost incurred to regain customer (2) Not directly or indirectly related to an approval, "employee", not to the employment, (7) Redistribution or replacement of prospective employment or termination "your product" which has been of any person or persons by an insured. recalled by like products or d. For purposes of this endorsement, the substitutes; following definition is added to SECTION II - (g) Caprice or whim of the insured; LIABILITY, F. Liability and Medical Expenses Definitions: (9) A condition likely to cause loss of 1. "Discrimination" means the unlawful which any insured knew or had treatment of individuals based upon race, reason to know at the inception of this insurance; color, ethnic origin, gender, religion, age, or sexual preference. "Discrimination" (10)Asbestos, including loss, damage or does not include the unlawful treatment clean up resulting from asbestos or of individuals based upon developmental, asbestos containing materials, or physical, cognitive, mental, sensory or (11)Recall of "your products" that have emotional impairment or any no known or suspected defect solely combination of these. because a known or suspected e. This coverage does not apply if liability defect in another of "your products' coverage for "personal and advertising has been found injury" is excluded either by the provisions of b. The following is added to SECTION II - the Coverage Form or any endorsement LIABILITY, C. Who Is An Insured, paragraph thereto. 3.b.: 7. Product Recall Expense "Product recall expense" arising out of any a. SECTION II - LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you Applicable To Business Liability Coverage, acquired or formed the organization. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with Its permission.. Page 4 of 6 c. The following is added to SECTION II - of a deductible amount, you shall LIABILITY, D. Liability and Medical Expenses promptly reimburse us for the part of the Limits of Insurance: deductible amount we paid. Product Recall Expense Limits of Insurance The Product Recall Expense Limits of a. The Limits of Insurance shown in the Insurance apply separately to each SUMMARY OF COVERAGES of this consecutive annual period and to any endorsement and the rules stated below remaining period of less than 12 months, fix the most that we will pay under this starting with the beginning of the policy Product Recall Expense Coverage period shown in the Declarations, unless the regardless of the number of: policy period is extended after issuance for an additional period of less than 12 months. (1) Insureds, In that case, the additional period will be (2) "Covered Recalls" initiated, or deemed part of the last preceding period for 3 Number of " our products" the purposes of determining the Limits of ( ) y P Insurance. withdrawn. b. The Product Recall Ex Aggregate d. The following is added to SECTION II - ExpenseLIABILITY, E. Liability and Medical Expense Limit is the most that we will reimburse General Conditions, 2. Duties in the Event of you for the sum of all "product recall Occurrence,Offense,Claim or Suit: expenses" incurred for all "covered recalls" initiated during the policy period. You must see to it that the following are Product Recall Each Occurrence done in the event of an actual or anticipated c. The Pr will pay in the most Each "covered recall" that may result in "product Limit recall expense": connection with any one defect or deficiency. (1) Give us prompt notice of any discovery d. All "product recall expenses" in or notification that "your product" must be withdrawn or recalled. Include connection with substantial) the y same description of 'your product" and the general harmful condition will be reason for the withdrawal or recall, deemed to arise out of the same defect or deficiency and considered one (2) Cease any further release, shipment, "occurrence". consignment or any other method of e. An amount reimbursed for "product distribution of like or similar products y p until it has been determined that all recall expenses" in connection with any such products are free from defects that one "occurrence" will reduce the amount could be a cause of loss under this of the Product Recall Expense Aggregate insurance. Limit available for reimbursement of "product recall expenses" in connection e. For the purposs of this endorsement, the with any other defect or deficiency. following definitions are added to SECTION f. If the Product Recall Expense Aggregate II - LIABILITY, F. Liability and Medical Limit has been reduced by Expenses Definitions: reimbursement of "product recall 1. "Covered recall" means a recall made expenses" to an amount that is less than necessary because you or a government the Product Recall Expense Each body has determined that a known or Occurrence Limit, the remaining suspected defect, deficiency, Aggregate Limit is the most that will be inadequacy, or dangerous condition in available for reimbursement of "product "your product" has resulted or will result recall expenses" in connection with any in "bodily Injury" or "property damage". other defect or deficiency. 2. "Product recall expense(s)" means: g. Product Recall Deductible a. Necessary and reasonable expenses We will only pay for the amount of for: "product recall expenses" which are in (1) Communications, including radio excess of the $500 Product Recall or television announcements or Deductible. The Product Recall printed advertisements including Deductible applies separately to each stationary, envelopes and "covered recall". The limits of insurance postage: will not be reduced by the amount of this deductible. We may, or will if required by law, pay all or any part of any deductible amount, if applicable. Upon notice of our payment 391.1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc„with its permission.. Page 5 of 6 the zk,4 H i jover ]nsurance Group- OB2 D244121 0901621 (2) Shipping the recalled products (1) If the "products - completed operations from any purchaser, distributor or hazard" is excluded from coverage under user to the place or places this Coverage Part including any designated by you; endorsement thereto, or (3) Remuneration paid to your (2) To "product recall expense" arising out of regular "employees" for any of "your products" that are otherwise necessary overtime; excluded from coverage under this (4) Hiring additional persons, other Coverage Part including endorsements than your regular "employees"; thereto. (5) Expenses incurred by"employees" 8. Unintentional Failure to Disclose Hazards including transportation and The following is added to SECTION II - accommodations, LIABILITY, E. Liability and Medical Expenses (6) Expenses to rent additional General Conditions: warehouse or storage space, Representations (7) Disposal of "your product", but We will not disclaim coverage under this only to the extent that specific Coverage Part if you fail to disclose all hazards methods of destruction other than existing as of the inception date of the policy those employed for trash provided such failure is not intentional. discarding or disposal are 9. Unintentional Failure to Notify required to avoid "bodily injury"or "property damage' as a result The following is added to SECTION II - of such disposal, LIABILITY, E. Liability and Medical Expenses General Conditions, 2. Duties in the Event of you incur exc&usively for the purpose Occurrence, Offense, Claim or Suit: of recalling "your product", and Your rights afforded under this Coverage Part b. Your lost profit resulting from such shall not be prejudiced if you fail to give us "covered recall". notice of an "occurrence", offense, claim or "suit", f. This Product Recall Expense Coverage does solely due to your reasonable and documented not apply: belief that the "bodily injury", "property damage" or "personal and advertising Injury" is not covered under this Policy. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc„ with its permission. Page 6 of 6 New Vendor ❑ Reactivate Vendor Vendor Set-up Form ❑ Address Ch'rge %V T To be filled out b Vendor ONLY �- '°"'"'"°'°" Y Vendor Number FINANCE 220 Fourth Avenue South • Kent,WA 98032-5895 • Phone: (253) 856-5235• Fax: (253) 856-6200 An incomplete form will create a delay in our payments)to you and your payment(s) "couldb ctoRS required back-up withholding, C" &4' `'01 LIC.- Name, as it will appear on check (No ASBREVIAT)UN4) Doing Business As (It different than name on check) Payment Address Business Address l W gW IT I< uA t0. 95S l e city /y State Zip City pState Zip ? ry n / Phone Number Accouots Receivable Contact .. M3 check the apipro riete box 63"Corporation ❑ Government Agency ❑Individual/Sole Proprietor ❑ Non-Profit ❑ Partnership . This business is ❑ Minority Owned ❑ Women Owned ❑ Both Minority and Women Owned "either Will you provide medical services to the City of Kent? ................................................................Yes of Will you provide legal services to the City of Kent? ............._...._........,....,................................Yes Will you provide services other than medical or legal to the City of Kent?..................................n5 No Will you provide parts, supplies or materials to the City of Kent?..................................................Yes Do you pay sales tax to the State of Washington?................................ ...._,,.....,..... ................ No • if exem t from Form 1099 reporting, and check your qualifying exemption reason below: ii I. Corporation, except there is no exemption for medical and healthcare payments or payments for legal services ❑ 2. Tax Exempt Charity under 501(a), or IRA ❑ 3. The United States or any of its agencies or instrumentalities ❑ 4. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions ❑ 5. A foreign government or any of its political subdivisions Name (Owner of the Tax Payer Identification Number('EIN or SSN) as name appears on IRS or Social Security Administration Records): .._ t � "" ?Arle ef'r, -d^ vl(- Social Security#: .m. or Federal TIN: d`-29ary Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me) and, 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service(IRS) that I am subject to backup withholding as a result of a failure to report all dnteras ividends, or (c)the,41S has notified me that I am no longer subject to backup withholding, Signature Date *.....-id. _... .. -- n.2m ndd•2104 Fan, "" Request for Taxpayer (live Form to the (Rev.Oacember 2o,1) ident cation Number and Certificatlon fBQOBo the by anRduw u�Twww send to the IRS. Nwngy{.{.g�s""an your tax velum) N euakn—nomefilseregarded entity name,1 dMine I from ebowe Check BWOV ala box for recast tax ales61110000 :.._. ❑(WividuaVaole proprietor ❑ C W3 Capuratbn ❑ Partnership ❑Trust/estate ❑ Lxnited liabillly tympany.Eller the lac rcetbn lC=c corporalbn.s=s capwauon.P�erttnersnip)► ❑Exempt payee n other lees lruawliorie)► Address(number.stmot,sad apt..Orautta no.) Requaeta"s name all addmss(Opuone4 /00 w. 5,44 m City,slate.MW ZIP 0000 119 acmum numbers)harts,(optGuo) ... Taxl3aver Identification Nut riber I Enter your nN in the appropriate box.The TIN prm dad must match the name given on the"Name"line I seem eeaudta ttumbear re avoid backup withholding.For isre arde,the 19 Our social security number n page However,fora _�' resident alien,sole proprietor,w disregarded eMf[y see the Parr I irlsbmctbm on page 3.For other entitles,it is your employer Identification number(E ) t you do not have a number,see How to gar e TIN on page 3. Note.If the account Is in more than one name,see ft chart on page 4 for guidelines on whose EM~Nennaseton.numoe+• number to enter. cortfflo"on Under penalties of perjury,I oergfy that: 1. The number shown on this form Is my correct to cipayer identification number(or I am waiting for a number to be Issued to me),and 2. I am not subject to backup whhhafdtog because (a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service PRS)that I ant subject to backup wf blxi ding as,a result of a Valium to report all Waned or dlvlderxa,or(a)the IRS has notified me that i am no longer subject to Ibackup withholding,and 3. I am a U.S.citizen or other U.S.person(defined w). Certification inetrucltl a You moat cross out ftor 12 above If you have been netsed by the IRS that you are currently subject to backup withholding because you have failed to report all interest and of riciands on your tax return For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of Secure d property,cancellation of debt,contributions to an Individual ref r ment arrangement(IRA),and notionally,payments other than interest and dividen Is,you are not required to aign the cartifi cation,but you must provide your comet 71N.Sae the Insaructkmor an page 4. ,��re} J He a sw pereenurtuare or► woe► W GP' Hamner U.S. le l Note.If a requester gives you a form other than Fonn W-9 to request your TIN,you must use the requester's form it it Is substantially similar Section mus enOm are to the Internal Revenue Cod s unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person h you are: A poison who Is required to fllto as information else with the IRS must a An individual who is a U.S.citizen or U.S.resident after, obtain your correct taxpayer kantlgcafion number N)to report,for a A partnership,corporation,company,or assOdabOn Oraaad or axampre,Income pald to you,real estate transec s,mortgage lntemst organized in the United States or under the laws of the United States. you paid.,amoIsth ern Or abandonment of Secured p operty.Canomfion a An mate(ottror than a foreign estate),or Of dam or contributions you r ,to on IRA, e A domestic trust(as defined in Regulatkxna section 301.7701-7). Use Form W-9 only if you area U.S.person(foci Ing a resident hd ruts,for pasl'rletathips.partnerships that conduct a trade or alien),to provide your correct TIN to the person ling it(the �.,In the United States am generally inquired to pay a withholding requester)and,when applicable,to: tax on any foreign partners'share of Income from such busingga. 1.Certly that the TIN you are giving Is correct lot you are wafting for a Further,In owlen calm where a,Form W-g ohm not been received,a number to be issued), partnership is required to prosume that a partner Is a fixadgn Pewn. 2.Certify that you are not subject to backup with tolding,or and pay the withholding tax.Ttamfore,M you we a U.S,percet that Is a 3.Claim exemption from backup withholding If tr o are a U.S.exempt partner r in a partnership conducting a trade Or business in the United payee.It applicable,you are also oortiykng that m U.S.Person,your SUdM provide Form W-0 to the partnership to asabliah your U.S. allocable share of any partmerahlp Income from a U S.trade or business satus and avoid withholding on your sham of Wr seship Income. is not sub*l to the wbhholtktg ax on'foreign pan rs'share of odecilvey connected Income. Cat,No.10231x rum'W"9 foev.12-2011)