HomeMy WebLinkAboutCAG2023-494 - Original - Richard C. McDonald & Sarah B. McDonald - S. 218th St./98th Ave S. (from 94th Pl S to S 216th St) - 09/21/2023 FOR CITY OF KENT OFFICIAL USE ONLY
Sup/Mgr:
Agreement Routing Form DirAsst:
• For Approvals,Signatures and Records Management Dir/Dep:
KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover (optional)
WASHINGTON Sheet forms. (Print on pink or cherry colored paper)
Originator: Department:
Cheryl Rolcik-Wilcox Public Works
Date Sent: Date Required:
c 09/19/2023 09/26/2023
QAuthorized to Sign: Date of Council Approval:
Q �✓ Mayor or Designee 7/6/2021
Budget Account Number: Grant? Yes No�✓
Budget? Yes Type N/A
0M
Vendor Name: Category:
Richard C. McDonald and Sarah B. McDonald Contract
Vendor Number: Sub-Category:
Original
0
Project Name: S. 218th St./98th Ave. S. (from 94th PI. S. to S. 216th St.)
1. Project Details:
0 Possession & Use Agreement
c
Ic
Agreement $24,200.00
�
Basis for Selection of Contractor:
E *Memo to Mayor must be attached
i Start Date: Termination Date:
lm
a Local Business? Yes F]No*If meets requirements per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace.
Business License Verification: ❑Yes In-Process F1 Exempt(KCC 5.01.045) FlAuthorized Signer Verified
Notice required prior to disclosure? Contract Number:
Yes ✓❑No CAG2023-494
Comments:
Mayor Ralph - Please sign the attached Possession & Use Agreement (4th
page of this packet). Thx! Cheryl R-W
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a,
a
Date Received:City Attorney: 9/19/23 Date Routed:Mayor's Office 9/20/23 'ty Clerk's Office 9/21/23
adccW22373_7_20 Visit Documents.KentWA.gov to obtain copies of all agreements
rev.20221201
Possession and Use Agreement
KEN-50 S. 218th St./98th Ave. S. from 94th PI. S. to S. 216th St. Project
City of Kent Project Number: 17-3010
Owner: Richard C. McDonald and Sarah B. McDonald
King County Tax Parcel Number: 072205-9055
Address: 21636 98th Avenue S.
This Possession and Use Agreement ("Agreement") is between the City of Kent, a
Washington municipal corporation ("City") and Richard C. McDonald and Sarah B.
McDonald (collectively "the McDonalds").
Background
A. The McDonalds own real property located at 21636 98th Avenue S. (the
"Property").
B. To accommodate the City's S. 218th Street/98th Avenue S. from 94th Place S.
to S. 216th Street Project ("Project"), the City must acquire from the McDonalds the
following property and/or property rights:
450 square feet of right-of-way in fee, as legally described in Attachment A
and depicted in Attachment A-1 to this Agreement (the "Right-of-Way Take"),
and a temporary easement over a 1,223 square foot portion of the property,
as legally described in Attachment B and depicted in Attachment B-1 to this
Agreement (the "Temporary Easement"). The Right-of-Way Take and the
Temporary Easement shall collectively be referred to as the "Acquisition Area".
C. Based on an administrative offer summary prepared by an appraiser
contracted by the City, the City made an offer to the McDonalds for a total amount
of $24,200.00 as follows:
• $8,100.00 (eight thousand one hundred dollars) as total just compensation
for the right-of-way conveyed by Warranty Deed;
• $2,600.00 (two thousand six hundred dollars) as total just compensation
for the Temporary Easement; and
• $13,500.00 (thirteen thousand five hundred dollars) as total just
compensation for the value of improvements that will be displaced during
construction of the Project.
City of Kent/McDonald Possession and Use Agreement
Page 1
D. The parties wish to settle the acquisition of property rights, if possible, but the
McDonalds have requested more time to evaluate the City's offer.
NOW, THEREFORE, the parties agree as follows:
Agreement
1. Payment. The City shall issue payment to the McDonalds in the amount of
$24,200.00 (twenty-four thousand two hundred dollars) (the "Possession Payment").
To facilitate the Possession Payment, the McDonalds shall deliver to the City a
completed "Vendor Information Set-Up Form" in the form attached as Attachment C.
The City will send the Possession Payment to McDonalds no later than 14 days from
receipt of the Vendor Information Set-Up Form.
2. Possession and Use. The McDonalds agree that upon deposit of the Possession
Payment, the City shall have possession and use of the Acquisition Area. The date
upon which the City makes payment to the McDonalds and obtains possession and
use rights shall become the Possession Date.
3. Condemnation Lawsuit.
3.1 If the parties are unable to reach a settlement, the City shall file a
condemnation petition. The City agrees that it will not file a condemnation petition
any sooner than 90 days after the Possession Date.
3.2 Upon the City's filing of a condemnation petition in Superior Court, the
McDonalds agree they will not object to the City entering an "Order Adjudicating
Public Use", as provided by Chapter 8.12 RCW, to be drafted and filed by the City at
the City's expense.
4. Access During Construction. The City will maintain ingress and egress to the
Property for the McDonalds during construction.
5. Landscaping and Fencing.
5.1 The City will remove one tree from the southwest corner of the Property
as depicted in Attachment C and will protect the remaining trees located within the
Temporary Easement Area and on the Property. The City may trim branches on the
protected trees as needed for the Project. The City will remove the existing wood
fence by panels and will provide the preserved panels to the McDonalds. The City will
reinstall new fencing behind the new sidewalk only to the extent the existing fencing
is removed as part of the Project.
5.2 McDonalds have identified trees shown in Attachment D as having the
potential to be damaged during the City's Project. The City agrees to have an arborist
evaluate the trees during construction and make recommendations regarding
necessary preventative measures to maintain the viability of the trees. The City
City of Kent/McDonald Possession and Use Agreement
Page 2
agrees to take such recommended measures. The Parties agree that if the trees are
removed and or damaged, the Parties will evaluate and negotiate what damages may
be due from the City to McDonald for same. McDonalds agree to bring any claim
regarding removed or damaged trees within one year of the City completing
construction within "Acquisition Area".
6. Septic Drain Field and Sewer Stub. The City will not impact the existing septic
drain field during construction of the Project.
7. Date of Valuation. The date of valuation for the determination of just
compensation shall be the effective date of this Agreement.
8. Amendments. This Agreement may only be amended in writing, signed by all
parties.
9. Severability. If any term, covenant, condition, or provision contained in this
Agreement is determined to be invalid, voided or otherwise unenforceable, by any
court of competent jurisdiction, such determination shall in no way affect the validity
or enforceability of any other term, covenant, condition, or provision contained in this
Agreement.
10. Execution in Counterparts. This Agreement may be executed in counterparts
and/or transmitted electronically, and copies so executed or transmitted will be
deemed originals.
11. Entire Agreement. This Agreement, together with all exhibits constitutes the
entire agreement between the parties with respect to the subject matter of this
Agreement. This Agreement is specifically intended by the parties to supersede all
prior agreements whether written or oral.
12. Effective Date. The effective date of this Agreement is the last date signed
below.
CITY OF KENT
By: Dana Ralph By: Richard C McDonald
Title: Mayor Date: f
Date: 09/21/2023
City of Kent/McDonald Possession and Use Agreement
Page 3
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Sarah B. McDon Id
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Attachment List
A and A-1 - Legal Description and depiction of Right-of-Way in Fee
B and B-1 - Legal Description and diction of Temporary Easement
C - Vendor Set-Up Form and W-9
D - Aerial photo depicting trees
City of Kent/McDonald Possession and Use Agreement
Page 4
ATTACHMENT A
TAX LOT 0722059055
RIGHT OF WAY DEDICATION
THE WEST 5 FEET OF PARCEL A DESCRIBED BELOW.
PARCEL A:
THE WEST 200 FEET OF THE SOUTH 340 FEET OF THE NORTHEAST QUARTER OF
THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 7,
TOWNSHIP 22 NORTH, RANGE 5 EAST, WILLAMETTE MERIDIAN, CITY OF KENT, IN
KING COUNTY, WASHINGTON; EXCEPT THE SOUTH 250 FEET THEREOF; AND
EXCEPT THAT PORTION LYING WITHIN 98TH AVENUE SOUTH, CONVEYED TO KING
COUNTY UNDER RECORDING NUMBER 5030891;
CONTAINING 450 SQUARE FEET, MORE OR LESS.
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ATTACHMENT B
TAX LOT 0722059055
TEMPORARY CONSTRUCTION EASEMENT
THE EAST 9.5 FEET OF THE WEST 14.5 FEET, AND THE SOUTH 35.0 FEET OF THE
EAST 10.5 FEET OF THE WEST 25.0 FEET OF PARCEL A DESCRIBED BELOW.
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PARCEL A:
THE WEST 200 FEET OF THE SOUTH 340 FEET OF THE NORTHEAST QUARTER OF
THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 7,
TOWNSHIP 22 NORTH, RANGE 5 EAST, WILLAMETTE MERIDIAN, CITY OF KENT, IN
KING COUNTY, WASHINGTON; EXCEPT THE SOUTH 250 FEET THEREOF, AND
EXCEPT THAT PORTION LYING WITHIN 98TH AVENUE SOUTH, CONVEYED TO KING
COUNTY UNDER RECORDING NUMBER 5030891;
CONTAINING 1,223 SQUARE FEET, MORE OR LESS.
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ATTACHMENT C
[r New Vendor
❑ Reactivate Vendor
s
L KENT Vendor Set-up Form ❑ Address Change
WASHINGTON To be filled out by Vendor ONLY Vendor Number
FINANCE
220 Fourth Avenue South • Kent,WA 98032-5895 • Phone: (253) 856-5235 • Fax: (253)856-6200
+MMVA An incomplete form will create a delay in our payment(s)to you and your payment(s)
could be subject to the IRS required back-upwithholding.
442- ,� .0 - WbOQAt-�3 5 a
Name, as it will ap ear on the k (NO ABk3REVIATIONS) Doing Business As(If different than name on check)
Payment Address Business Address
City State Zip City State Zip
Phone Number Accounts Receivable Contact
•. + check the a ro riate box
❑ Corporation ❑ Government Agency Individual/Sole Proprietor ❑ Non-Profit ❑ Partnership
11[4fiT:R.V*T,T_N This business is
❑ Minority Owned ❑ Women Owned ❑ Both Minority and Women Owned ❑ Neither
Will you provide medical services to the City of Kent? ................................................................Yes No
Will you provide legal services to the City of Kent? ....................................................................Yes No
Will you provide services other than medical or legal to the City of Kent?....................................Yes No
Will you provide parts, supplies or materials to the City of Kent?..................................................Yes No
Do you pay sales tax to the State of Washington?........................................................................Yes No
if exempt from Form 1099 reporting, and check your qualifying exemption reason below:
❑ 1. 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, b or�SSN) a � jys name appears on IRS or Social Security
Administration Records): 13
_A-a 4-0 • /or Y ( C A-Lb
Social Security#: or Federal TIN:
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be
issued to me) and,
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or(b) I have not been
notified by the internal Revenue Service (IRS)that I am subject to backup withholding as a result of a failure to
report all interest qr dividends, or(c)the IRS has notified me that I am no longer subject to backup withholding.
+ r
Signature I. WC 'J) 71�. Date P.
fics2727 Indd+2M4
Form Request for Taxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.irs.gov/FormM for instructions and the latest information.
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
2 Business name/disregarded entity name,if different from above
M 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to
rn following seven boxes. certain entities,not individuals;see
(a instructions on page 3):
a �,/
cp LJ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trustlestate
c single-member LLC Exempt payee code(if any)
,4 5 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
`p Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
c LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any)
another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,asingle-member LLC that
0. o is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Gi ❑ Other(see instructions)► I(Applies to accounts maintained outside the U.S.)
H 5 Address(number,streett,and apt.or suite
no.)See insftr�uctions. Requester's name and address(optional)
U) r— if 2 � T
6 City,state,and ZIP co e
!_ � � �q dt�®3 /
'e C _
7 List account number(s)here(optional)
ff 71 1 Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding.For individuals,this is generally your social security number(SSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN,later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),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 for Part 11,later.
Si n
9 Signature of120
Here U.S.person► ►.�/�u�J (�C.. Date / <
General Instr ctions •Form 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest information about developments o Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9. a Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption a Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10-2018)
Form W-9(Rev.10-2018) Page 2
By signing the filled-out form,you: Example.Article 20 of the U.S.-China income tax treaty allows an
1.Certify that the TIN you are giving is correct(or you are waiting for a exemption from tax for scholarship income received by a Chinese
number to be issued), student temporarily present in the United States.Under U.S.law,this
student will become a resident alien for tax purposes if his or her stay in
2.Certify that you are not subject to backup withholding,or the United States exceeds 5 calendar years.However,paragraph 2 of
3.Claim exemption from backup withholding if you are a U.S.exempt the first Protocol to the U.S.-China treaty(dated April 30,1984)allows
payee.If applicable,you are also certifying that as a U.S.person,your the provisions of Article 20 to continue to apply even after the Chinese
allocable share of any partnership income from a U.S.trade or business student becomes a resident alien of the United States.A Chinese
is not subject to the withholding tax on foreign partners'share of student who qualifies for this exception(under paragraph 2 of the first
effectively connected income,and protocol)and is relying on this exception to claim an exemption from tax
4.Certify that FATCA code(s)entered on this form(if any)indicating on his or her scholarship or fellowship income would attach to Form
that you are exempt from the FATCA reporting,is correct.See What is W-9 a statement that includes the information described above to
FATCA reporting, later,for further information. support that exemption.
Note:If you are a U.S.person and a requester gives you a form other If you are a nonresident alien or a foreign entity,give the requester the
than Form W-9 to request your TIN,you must use the requester's form if appropriate completed Form W-8 or Form 8233.
it is substantially similar to this Form W-9. Backup Withholding
Definition of a U.S.person.For federal tax purposes,you are
considered a U.S.person if you are: What is backup withholding?Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 24/o of such
•An individual who is a U.S.citizen or U.S.resident alien; payments.This is called"backup withholding." Payments that may be
•A partnership,corporation,company,or association created or subject to backup withholding include interest,tax-exempt interest,
organized in the United States or under the laws of the United States; dividends,broker and barter exchange transactions,rents,royalties,
•An estate(other than a foreign estate);or nonemployee pay,payments made in settlement of payment card and
•A domestic trust(as defined in Regulations section 301.7701 7). third party network transactions,and certain payments from fishing boat
operators.Real estate transactions are not subject to backup
Special rules for partnerships.Partnerships that conduct a trade or withholding.
business in the United States are generally required to pay a withholding You will not be subject to backup withholding on payments you
tax under section 1446 on any foreign partners'share of effectively receive if you give the requester your correct TIN,make the proper
connected taxable income from such business.Further,in certain cases certifications,and report all your taxable interest and dividends on your
where a Form W-9 has not been received,the rules under section 1446 tax return.
require a partnership to presume that a partner is a foreign person,and
pay the section 1446 withholding tax.Therefore,if you are a U.S.person Payments you receive will be subject to backup withholding if:
that is a partner in a partnership conducting a trade or business in the 1.You do not furnish your TIN to the requester,
United States,provide Form W-9 to the partnership to establish your 2.You do not certify your TIN when required(see the instructions for
U.S.status and avoid section 1446 withholding on your share of Part II for details),
partnership income.
I 3.The IRS tells the requester that you furnished an incorrect TIN,
n the cases below,the following person must give Form W-9 to the
partnership for purposes of establishing its U.S.status and avoiding 4.The IRS tells you that you are subject to backup withholding
withholding on its allocable share of net income from the partnership because you did not report all your interest and dividends on your tax
conducting a trade or business in the United States. return(for reportable interest and dividends only),or
•In the case of a disregarded entity with a U.S.owner,the U.S.owner 5.You do not certify to the requester that you are not subject to
of the disregarded entity and not the entity; backup withholding under 4 above(for reportable interest and dividend
•In the case of a grantor trust with a U.S.grantor or other U.S.owner, accounts opened after 1983 only).
generally,the U.S.grantor or other U.S.owner of the grantor trust and Certain payees and payments are exempt from backup withholding.
not the trust;and See Exempt payee code, later,and the separate Instructions for the
•In the case of a U.S.trust(other than a grantor trust),the U.S.trust Requester of Form W-9 for more information.
(other than a grantor trust)and not the beneficiaries of the trust. Also see Special rules for partnerships,earlier.
Foreign person.If you are a foreign person or the U.S.branch of a What is FATCA Reporting?
foreign bank that has elected to be treated as a U.S.person,do not use
Form W-9.Instead,use the appropriate Form W-8 or Form 8233(see The Foreign Account Tax Compliance Act(FATCA)requires a
Pub.515,Withholding of Tax on Nonresident Aliens and Foreign participating foreign financial institution to report all United States
Entities). account holders that are specified United States persons.Certain
Nonresident alien who becomes a resident alien.Generally,only a payees are exempt from FATCA reporting.See Exemption from FATCA
nonresident alien individual may use the terms of a tax treaty to reduce reporting code,later,and the Instructions for the Requester of Form
or eliminate U.S.tax on certain types of income.However,most tax W-9 for more information.
treaties contain a provision known as a"saving clause."Exceptions Updating Your Information
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise You must provide updated information to any person to whom you
become a U.S.resident alien for tax purposes. claimed to be an exempt payee if you are no longer an exempt payee
If you are a U.S.resident alien who is relying on an exception and anticipate receiving reportable payments in the future from this
contained in the saving clause of a tax treaty to claim an exemption person.For example,you may need to provide updated information if
from U.S.tax on certain types of income,you must attach a statement you are a C corporation that elects to be an S corporation,or if you no
to Form W-9 that specifies the following five items. longer are tax exempt.In addition,you must furnish a new Form W-9 if
1.The treaty country.Generally,this must be the same treaty under the name or TIN changes for the account;for example,if the grantor of a
which you claimed exemption from tax as a nonresident alien. grantor trust dies.
2.The treaty article addressing the income. Penalties
3.The article number(or location)in the tax treaty that contains the
saving clause and its exceptions. Failure to furnish TIN.If you fail to furnish your correct TIN to a
4.The type and amount of income that qualifies for the exemption requester,you are subject to a penalty of$50 for each such failure
from tax. unless your failure is due to reasonable cause and not to willful neglect.
5.Sufficient facts to justify the exemption from tax under the terms of Civil penalty for false information with respect to withholding.If you
the treaty article. make a false statement with no reasonable basis that results in no
backup withholding,you are subject to a$500 penalty.
Form W-9(Rev.10-2018) Page 3
Criminal penalty for falsifying information.Willfully falsifying IF the entity/person on line 1 is THEN check the box for...
certifications or affirmations may subject you to criminal penalties a(n)...
including fines and/or imprisonment.
Misuse of TINs.If the requester discloses or uses TINs in violation of • Corporation Corporation
federal law,the requester may be subject to civil and criminal penalties. • Individual Individual/sole proprietor or single-
* Sole proprietorship,or member LLC
Specific Instructions • Single-member limited liability
company(LLC)owned by an
Line 1 individual and disregarded for U.S.
You must enter one of the following on this line;do not leave this line federal tax purposes.
blank.The name should match the name on your tax return. • LLC treated as a partnership for Limited liability company and enter
If this Form W-9 is for a joint account(other than an account U.S.federal tax purposes, the appropriate tax classification.
maintained by a foreign financial institution(FFI)),list first,and then . LLC that has filed Form 8832 or (P=Partnership;C=C corporation;
circle,the name of the person or entity whose number you entered in 2553 to be taxed as a corporation, or S=S corporation)
Part I of Form W-9.If you are providing Form W-9 to an FFI to document or
a joint account,each holder of the account that is a U.S.person must e LLC that is disregarded as an
provide a Form W-9. entity separate from its owner but
a. Individual.Generally,enter the name shown on your tax return.If the owner is another LLC that is
you have changed your last name without informing the Social Security not disregarded for U.S.federal tax
Administration(SSA)of the name change,enter your first name,the last purposes.
name as shown on your social security card,and your new last name.
Note:[TIN applicant:Enter your individual name as it was entered on • Partnership Partnership
your Form W-7 application,line 1 a.This should also be the same as the • Trust/estate Trustlestate
name you entered on the Form 1040/1040A/1040EZ you filed with your Line 4, Exemptions
application.
b. Sole proprietor or single-member LLC.Enter your individual If you are exempt from backup withholding and/orcode(s)
that
may apply to
reporting,
name as shown on your 1040/1040A/1040EZ on line 1.You may enter enter in the appropriate space on line 4 any codehat
your business,trade,or"doing business as"(DBA)name on line 2. you.
c. Partnership,LLC that is not a single-member LLC,C Exempt payee code.
corporation,or S corporation.Enter the entity's name as shown on the Generally,individuals(including sole proprietors)are not exempt from
entity's tax return on line 1 and any business,trade,or DBA name on backup withholding.
line 2. • Except as provided below,corporations are exempt from backup
d. Other entities.Enter your name as shown on required U.S.federal withholding for certain payments,including interest and dividends.
tax documents on line 1.This name should match the name shown on the . Corporations are not exempt from backup withholding for payments
charter or other legal document creating the entity.You may enter any made in settlement of payment card or third party network transactions.
business,trade,or DBA name on line 2. • Corporations are not exempt from backup withholding with respect to
e. Disregarded entity.For U.S.federal tax purposes,an entity that is attorneys'fees or gross proceeds paid to attorneys,and corporations
disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect
"disregarded entity." See Regulations section 301.7701-2(c)(2)(iii).Enter to payments reportable on Form 1099-MISC.
the owner's name on line 1.The name of the entity entered on line 1
should never be a disregarded entity.The name on line 1 should be the The following codes identify payees that are exempt from backup
name shown on the income tax return on which the income should be withholding.Enter the appropriate code in the space in line 4.
reported.For example,if a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a),any IRA,or
entity for U.S.federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7)if the account satisfies the
person,the U.S.owner's name is required to be provided on line 1.If requirements of section 401(f)(2)
the direct owner of the entity is also a disregarded entity,enter the first 2—The United States or any of its agencies or instrumentalities
owner that is not disregarded for federal tax purposes.Enter the
or
disregarded entity's name on line 2,"Business name/disregarded entity 3—A state,the District Columbia,a U.S.commonwealth
name."If the owner of the disregarded entity is a foreign person,the possession,or any of their
r political subdivisions or instrumentalities
owner must complete an appropriate Form W-8 instead of a Form W-9. 4—A foreign government or any of its political subdivisions,agencies,
This is the case even if the foreign person has a U.S.TIN. or instrumentalities
Line 2 5—A corporation
If you have a business name,trade name,DBA name,or disregarded 6—A dealer in securities or commodities required to register in the
entity name,you may enter it on line 2. United States,the District of Columbia,or a U.S.commonwealth or
possession
Line 3 7—A futures commission merchant registered with the Commodity
Check the appropriate box on line 3 for the U.S.federal tax Futures Trading Commission
classification of the person whose name is entered on line 1.Check only 8—A real estate investment trust
one box on line 3. 9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Form W-9(Rev.10-2018) Page 4
The following chart shows types of payments that may be exempt M—A tax exempt trust under a section 403(b)plan or section 457(g)
from backup withholding.The chart applies to the exempt payees listed plan
above,1 through 13. Note:You may wish to consult with the financial institution requesting
IF the payment is for... THEN the payment is exempt this form to determine whether the FATCA code and/or exempt payee
for... code should be completed.
Interest and dividend payments All exempt payees except Line 5
for 7 Enter your address(number,street,and apartment or suite number).
Broker transactions Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your information
through 11 and all C corporations. returns.If this address differs from the one the requester already has on
S corporations must not enter an file,write NEW at the top.If a new address is provided,there is still a
exempt payee code because they chance the old address will be used until the payor changes your
are exempt only for sales of address in their records.
noncovered securities acquired Line 6
prior to 2012.
Enter your city,state,and ZIP code.
Barter exchange transactions and Exempt payees 1 through 4
patronage dividends Part I. Taxpayer Identification Number (TIN)
Payments over$600 required to be Generally,exempt payees Enter your TIN in the appropriate box.If you are a resident alien and
reported and direct sales over 1 through 52 you do not have and are not eligible to get an SSN,your TIN is your IRS
$5,0001 individual taxpayer identification number(ITIN).Enter it in the social
security number box.If you do not have an ITIN,see How to get a TIN
Payments made in settlement of Exempt payees 1 through 4 below.
payment card or third party network If you are a sole proprietor and you have an EIN,you may enter either
transactions your SSN or EIN.
1 See Form 1099-MISC,Miscellaneous Income,and its instructions. If you are a single-member LLC that is disregarded as an entity
separate from its owner,enter the owner's SSN(or EIN,if the owner has
2 However,the following payments made to a corporation and one).Do not enter the disregarded entity's EIN.If the LLC is classified as
reportable on Form 1099-MISC are not exempt from backup a corporation or partnership,enter the entity's EIN.
withholding:medical and health care payments,attorneys'fees,gross Note:See What Name and Number To Give the Requester, later,for
proceeds paid to an attorney reportable under section 6045(f),and further clarification of name and TIN combinations.
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code.The following codes identify How apply
get a TIN.If you do not have a TIN,apply for one immediately.
payees that are exempt from reporting under FATCA.These codes C apply for an SSN,get Form SS-5,Application for a Social Security
apply to persons submitting this form for accounts maintained outside Card,from your local SSA office t get this form online at
213.
of the United States by certain foreign financial institutions.Therefore,if Use For W-7 You may also get this form by calling 1 Identification
72 1on
you are only submitting this form for an account you hold in the United Use Form W 7,Application for IRS Individual Taxpayer Identification
States,you may leave this field blank.Consult with the person Number,to apply for an ITIN,or Form SS-4,Application for Employer
Identification Number,to apply for an EIN.You can apply for an EIN
requesting this form if you are uncertain if the financial institution is
subject to these requirements.A requester may indicate that a code is online by accessing the IRS cation eat Number
(EIN)under
and
not required by providing you with a Form W-9 with"Not Applicable"(or clicking . Employer Identification Number(EIN)under Starting a
any similar indication)written or printed on the line for a FATCA Business.Go to SS-4.;Or,you can
to view,download,or print Form
exemption code. W-7 and/or Form SS-4. Or,you can go to www.irs.govlOrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
A—An organization exempt from tax under section 501(a)or any business days.
individual retirement plan as defined in section 7701(a)(37) If you are asked to complete Form W-9 but do not have a TIN,apply
B—The United States or any of its agencies or instrumentalities for a TIN and write"Applied For"in the space for the TIN,sign and date
C—A state,the District of Columbia,a U.S.commonwealth or the form,and give it to the requester.For interest and dividend
possession,or any of their political subdivisions or instrumentalities payments,and certain payments made with respect to readily tradable
D—A corporation the stock of which is regularly traded on one or instruments,generally you will have 60 days to get a TIN and give it to
more established securities markets,as described in Regulations the requester before you are subject to backup withholding on
section 1.1472-1(c)(1)(i) payments.The 60-day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
E—A corporation that is a member of the same expanded affiliated you provide your TIN to the requester.
group as a corporation described in Regulations section 1.1472-1(c)(1)(i) Note:Entering"Applied For"means that you have already applied for a
F—A dealer in securities,commodities,or derivative financial TIN or that you intend to apply for one soon.
instruments(including notional principal contracts,futures,forwards, Caution:A disregarded U.S.entity that has a foreign owner must use
and options)that is registered as such under the laws of the United the appropriate Form W-8.
States or any state
G—A real estate investment trust Part II. Certification
H—A regulated investment company as defined in section 851 or an To establish to the withholding agent that you are a U.S.person,or
entity registered at all times during the tax year under the Investment resident alien,sign Form W-9.You may be requested to sign by the
Company Act of 1940 withholding agent even if item 1,4,or 5 below indicates otherwise.
I—A common trust fund as defined in section 584(a) For a joint account,only the person whose TIN is shown in Part I
J—A bank as defined in section 581 should sign(when required).In the case of a disregarded entity,the
K—A broker person identified on line 1 must sign.Exempt payees,see Exempt payee
L—A trust exempt from tax under section 664 or described in section
code,earlier.
4947(a)(1) Signature requirements.Complete the certification as indicated in
items 1 through 5 below.
Form W-9(Rev.10-2018) Page 5
1.Interest,dividend,and barter exchange accounts opened For this type of account: Give name and EIN of:
before 1984 and broker accounts considered active during 1983. 14.Account with the Department of The public entity
You must give your correct TIN,but you do not have to sign the Agriculture in the name of a public
certification. entity(such as a state or local
2.Interest,dividend,broker,and barter exchange accounts government,school district,or
opened after 1983 and broker accounts considered inactive during prison)that receives agricultural
1983.You must sign the certification or backup withholding will apply.If program payments
you are subject to backup withholding and you are merely providing
your correct TIN to the requester,you must cross out item 2 in the 15.Grantor trust filing under the Form The trust
certification before signing the form. 1041 Filing Method or the Optional
3.Real estate transactions.You must sign the certification.You may Form 1099 Filing Method 2(see
cross out item 2 of the certification. Regulations section 1.671-4(b)(2)(i)(B))
4.Other payments.You must give your correct TIN,but you do not ' List first and circle the name of the person whose number you furnish.
have to sign the certification unless you have been notified that you If only one person on a joint account has an SSN,that person's number
have previously given an incorrect TIN."Other payments"include must be furnished.
payments made in the course of the requester's trade or business for 2 Circle the minor's name and furnish the minor's SSN.
rents,royalties,goods(other than bills for merchandise),medical and
health care services(including payments to corporations),payments to 3 You must show your individual name and you may also enter your
a nonemployee for services,payments made in settlement of payment business or DBA name on the"Business name/disregarded entity"
card and third party network transactions,payments to certain fishing name line.You may use either your SSN or EIN(if you have one),but the
boat crew members and fishermen,and gross proceeds paid to IRS encourages you to use your SSN.
attorneys(including payments to corporations). ^List first and circle the name of the trust,estate,or pension trust.(Do
5.Mortgage interest paid by you,acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the
secured property,cancellation of debt,qualified tuition program legal entity itself is not designated in the account title.)Also see Special
payments(under section 529),ABLE accounts(under section 529A), rules for partnerships,earlier.
IRA,Coverdell ESA,Archer MSA or HSA contributions or "Note:The grantor also must provide a Form W-9 to trustee of trust.
distributions,and pension distributions.You must give your correct Note:If no name is circled when more than one name is listed,the
TIN,but you do not have to sign the certification. number will be considered to be that of the first name listed.
What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft
For this type of account: Give name and SSN of: Identity theft occurs when someone uses your personal information
1.Individual The individual such as your name,SSN,or other identifying information,without your
2.Two or more individuals(joint The actual owner of the account or,if permission,to commit fraud or other crimes.An identity thief may use
account)other than an account combined funds,the first individual on your SSN to get a job or may file a tax return using your SSN to receive
maintained by an FFI the account' a refund.
3.Two or more U.S.persons Each holder of the account To reduce your risk:
Qoint account maintained by an FFI) •Protect your SSN,
4.Custodial account of a minor The minor2 •Ensure your employer is protecting your SSN,and
(Uniform Gift to Minors Act) •Be careful when choosing a tax preparer.
5.a.The usual revocable savings trust The grantor-trustee' If your tax records are affected by identity theft and you receive a
(grantor is also trustee) notice from the IRS,respond right away to the name and phone number
b.So-called trust account that is not The actual owner printed on the IRS notice or letter.
a legal or valid trust under state law
If your tax records are not currently affected by identity theft but you
6.Sole proprietorship or disregarded The owner3 think you are at risk due to a lost or stolen purse or wallet,questionable
entity owned by an individual credit card activity or credit report,contact the IRS Identity Theft Hotline
7.Grantor trust filing under Optional The grantor" at 1-800-908-4490 or submit Form 14039.
Form 1099 Filing Method 1 (see For more information,see Pub.5027,Identity Theft Information for
Regulations section 1.671-4(b)(2)(i) Taxpayers.
(A)) Victims of identity theft who are experiencing economic harm or a
For this type of account: Give name and EIN of: systemic problem,or are seeking help in resolving tax problems that
8.Disregarded entity not owned by an The owner have not been resolved through normal channels,may be eligible for
individual Taxpayer Advocate Service(TAS)assistance.You can reach TAS by
9.A valid trust,estate,or pension trust Legal entity calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
10.Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes.
corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to
Form 2553 mimic legitimate business emails and websites.The most common act
11.Association,club,religious, The organization is sending an email to a user falsely claiming to be an established
charitable,educational,or other tax- legitimate enterprise in an attempt to scam the user into surrendering
exempt organization private information that will be used for identity theft.
12.Partnership or multi-member LLC The partnership
13.A broker or registered nominee The broker or nominee
Form W-9(Rev.10-2018) Page 6
The IRS does not initiate contacts with taxpayers via emails.Also,the privacy Act Notice
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers,passwords,or similar secret access Section IN t of the Internal Revenue Code requires you r provide your
information for their credit card,bank,or other financial accounts. correct TIN i o persons(including federal agencies)who are required to
If you receive an unsolicited email claiming to be from the IRS, file information returns with the IRS or report interest,dividends,or
Y g certain other income paid to you;mortgage interest you paid;the
forward this message to phishing@irs.gov.You may also report misuse acquisition or abandonment of secured property;the cancellation of
of the IRS name,logo,or other IRS property to the Treasury Inspector debt;or contributions you made to an IRA,Archer MSA,or HSA.The
General for Tax Administration(fIGTA)at 1-800-366-4484.You can person collecting this form uses the information on the form to file
forward suspicious emails to the Federal Trade Commission at information returns with the IRS,reporting the above information.
spam@uce.gov or report them at www.ftc.gov/complaint.You can Routine uses of this information include giving it to the Department of
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT(877-438-4338). Justice for civil and criminal litigation and to cities,states,the District of
If you have been the victim of identity theft,see www.ldentityTheft.gov Columbia,and U.S.commonwealths and possessions for use in
and Pub.5027. administering their laws.The information also may be disclosed to other
Visit www.irs.govlldentityTheft to learn more about identity theft and countries under a treaty,to federal and state agencies to enforce civil
how to reduce your risk. and criminal laws,or to federal law enforcement and intelligence
agencies to combat terrorism.You must provide your TIN whether or
not you are required to file a tax return.Under section 3406,payers
must generally withhold a percentage of taxable interest,dividend,and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
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