BRYAN INDEPENDENT SCHOOL DISTRICT ITB #3653 – Network Cabling & Materials 101 NORTH TEXAS AVENUE BRYAN, TX 77803
The undersigned agrees to all terms and conditions contained in the Invitation to Bid. Company:
_______________________________________________________
Name:
_______________________________________________________
Signature:
_______________________________________________________
Address:
_______________________________________________________
City, State, Zip Code:
________________________________________________
Telephone:
_______________________________________________________
Fax:
_______________________________________________________
E-Mail:
_______________________________________________________
Date:
_______________________________________________________
SECTION 1 – GENERAL/BID SUBMISSION 1.1
Bryan Independent School District (BISD) is soliciting sealed bids from vendors to provide a job order contract for network cabling and materials for various school facilities, on an as needed basis, for the period of July 22, 2014 – July 21, 2015, with three (3) options to renew if agreed upon by both parties.
1.2
Vendors shall submit one original and one copy (Total 2) of the completed bid to the Bryan ISD Business Services Office. All bids must be sealed and marked “ITB #3653 – Network Cabling & Materials” on the outside of the envelope. Bids must be received in the Business Services Office, 101 North Texas Avenue, Bryan, TX 77803, by 1:00 PM on July 8, 2014. Late bids will be marked “LATE” along with the time received and will not be considered in the evaluation of the bid. Bids will be opened and read aloud in Room 208 at the same location at 2:00 PM.
1.3
Tabulation and evaluation of the bids will be made subsequent to bid opening. No award will be made at the bid opening.
1.4
Each bid must include an executed “Felony Conviction Notification.”
1.5
Each bid must include a completed Conflict of Interest Questionnaire, in accordance with Chapter 176 of the Texas Local Government Code, effective January 1, 2006.
1.6
Each bid must include a completed Proposer Information form. See Attachment 1.
1.7 1.8
Each bid must include a signed certificate that vendor has not been debarred from receiving federal funds. Employees with a past criminal record shall not be assigned to work on the campuses of Bryan ISD as part of this contract.
1.9
Questions concerning this bid can be directed to Melissa Martin, Purchasing & Document Coordinator,
[email protected], or (979) 209-1048 or Rob Hayes, Director of Technical Support,
[email protected], or (979) 209-1172.
SECTION 2 – TERMS AND CONDITIONS 2.1
Bryan ISD reserves the right to reject any/all bids.
2.2
Bryan ISD may request additional information and to waive any/all formalities.
2.3
Award criteria are based on the most advantageous combination of factors to ensure quality network cabling and materials for the district facilities. The following criteria will be considered in the evaluation and determination of lowest evaluated price: Total project cost Reputation of the vendor and the offered products Quality of the offered products Vendor’s past relationship with the district Extent to which the products meet the district’s needs Total long-term cost to acquire and maintain the products Impact on the ability of the district to comply with HUB laws Customer preference
2.4
Local/municipal inspections and approvals, including site preparation, shall be provided or performed by the awarded contractor. Excessive site preparation will be approved on a “cost-plus” basis for specific projects.
2.5
The vendor shall save and keep harmless and indemnify Bryan ISD against any and all liability, claims and costs of whatsoever kind and nature for injury to or death of any person or persons and for loss or damage to any property occurring in connection with or in any incident to or arising out of occupancy, use, service, operations or performance of work in connection with this contract, resulting in whole or in part from the negligent acts or omissions of the vendor.
2.6
The vendor shall not assign or sub-contract this agreement, its obligations or right hereunder to any party, company, partnership, incorporation or person without the prior written specific consent of Bryan ISD.
2.7
In order to receive payment for services furnished to Bryan ISD, invoices for each completed service must be submitted to the Bryan ISD Business Office and must properly reference the purchase order that acknowledges the contract for services. All invoices must clearly indicate the originating purchase order number, a complete description of services furnished, the project name, the date of issuance, and all applicable prompt payment discount terms.
2.8
Bryan ISD makes payments on a net 30-day basis. Bryan ISD is not liable for services provided without a purchase order.
2.9
The vendor shall provide evidence of a successful history of working with planning and zoning entities, including an understanding of local code requirements for Brazos County and the City of Bryan.
2.10
Bryan ISD shall have the right to terminate for default all or any part of its ITB if Bidder breaches any of the terms hereof or if the Bidder become insolvent or files any petition in bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Bryan ISD may have in law or equity, specifically including, but not limited to, the right to sue for damages or demand specific performance. Bryan ISD additionally has the right to terminate this ITB without cause by delivery to the Bidder of a “Notice of Termination” specifying the extent to which performance hereunder is terminated and the date upon which such termination becomes effective.
2.11
Bryan ISD reserves the right to terminate this contract at any point of its duration should noncompliance with the terms and conditions become a factor. Should Bryan ISD become dissatisfied with the service supplied under this labor contract, the contractor will be so informed and will be given ten (10) working days in which to make any necessary corrections in order to comply with the quality standards of Bryan ISD. Bryan ISD reserves the right to terminate this labor contract if dissatisfied with the contractor’s efforts to comply with the prescribed quality standards and/or terms and conditions.
2.12
The contractor will furnish all materials required for any jobs scope unless specified otherwise. Bryan ISD reserves the right to purchase the materials for a given project. Bryan ISD will not be responsible for the security of any tools or materials left unattended at a job site by the contractor.
2.13
Bryan ISD reserves the right to issue multiple awards to ensure sufficient availability of qualified cabling personnel within the time frames requested. The vendor deemed by Bryan ISD to be the most responsible bidder will be the primary source of supply and will be contacted first. The next most responsible bidder(s) may be awarded the contract as secondary or third sources of supply to be used if the primary source is unable to furnish the necessary cabling labor and materials in the time frame requested.
2.14
Bryan ISD reserves the right to request a replacement if the technician chosen does not satisfactory perform duties as required.
SECTION 3 - WORKER’S COMPENSATION COVERAGE 3.1
The successful bidder must present a certificate of insurance with a minimum coverage of $100,000 each person and $300,000 each accident, bodily injury liability; $50,000 each accident and $100,000 aggregate property damage liability.
3.2
If proposer’s company does not provide Worker’s Compensation, a letter explaining alternate benefits should be included with the proposal.
SECTION 4 – INSURANCE 4.1
The Contractor, before starting work for the school district, must furnish the District with a Certificate of Insurance or other acceptable evidences from a reputable insurance company or companies licensed to write insurance in the State of Texas, showing that the Contractor is covered by the insurance as follows: General Public Liability Insurance with limits for bodily injury of not less than 100,000/$300,000 and for property damage of not less than $100,000. The policy shall be on the Comprehensive General Liability form and shall include coverage for acts of contractors. Automobile Public Liability Insurance with limits for bodily injury liability of not less than $100,000/$300,000 and for property damage of not less than $100,000 on all self-propelled vehicles used in connection with the contract, whether owner, non-owner, or hired. Umbrella Excess Liability not less than $1,000,000. Statutory Worker’s Compensation and Employer’s Liability Insurance – In the event any work is sublet, the Contractor shall require the subcontractor similarly to provide the same coverage and shall himself acquire evidence of such coverage on behalf of the subcontractor.
4.2
The Certificates of Insurance furnished to the District shall contain a provision that coverage under such policies shall not be canceled or materially changed until at least thirty (30) days prior written notice has been given to the District. Bryan ISD shall be named as the co-insured.
SECTION 5 – PREVAILING WAGES 5.1
The District has adopted a schedule of minimum wage rates for employees used in the construction of these projects.
5.2
Payment greater than prevailing wage rate as listed within Bryan ISD Board Policy is not prohibited per Texas Government Code, Chapter 2258, Prevailing Wage Rates, Subchapter A. General Provisions.
SECTION 6 – PRICING SCHEDULE 6.1
Electronics Technician – Straight Time Hourly Wage __________________________
6.2
Electronics Supervisor – Straight Time Hourly Wage __________________________
6.3
Electronics Technician – Overtime Hourly Wage __________________________
6.4
Electronics Supervisor – Overtime Hourly Wage __________________________
6.5
Electronics Technician – Holidays Hourly Wage __________________________
6.6
Electronics Supervisor – Holidays Hourly Wage __________________________
6.7
Percentage- Mark-Up on Materials
__________________________%
6.8
Trip Charge
__________________________per mile
If the contractor’s hourly rate includes the trip charge, that fact must be noted on this price sheet. In this case, then a breakdown of the person’s actual hourly rate and the amount allocated to the trip charge must be given. Also, the time at which the hourly rate charges start must be noted on this price sheet. For example, does the time start when the Contractor leaves their place of business or when they arrive on site? Contractor will be required to quote to Bryan ISD the materials and labor for each project. Bryan ISD reserves the right to purchase the materials for the project if prices cannot be agreed upon by both parties. Straight time is defined as hours from 8:00 am to 4:30 pm Monday through Friday. Overtime is defined as hours after 4:40 pm Monday through Friday and all day, Saturday and Sunday. Holidays are defined as: January 1, Easter, Labor Day, July 4, Thanksgiving Day, Memorial Day, December 24 & 25.
ATTACHMENT 1 – PROPOSER INFORMATION
1.
How many years has your company been in business? __________________
2.a
Give the name of the person(s) who would be assigned major responsibility for the contract with Bryan ISD. _________________________________________________
2.b
Describe briefly the training and experience of the company staff who will be assigned to the BISD account. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________
3.a
Reference #1: similar project completed within the last 12 months District Name ___________________________________________________ Contact Person __________________________________________________ Daytime Phone Number __________________________________________ E-Mail Address __________________________________________________ Description of service provided ______________________________________ ________________________________________________________________ ________________________________________________________________
3.b
Reference #2: similar project completed with the last 2 years District Name ___________________________________________________ Contact Person __________________________________________________ Daytime Phone Number ____________________________________________ E-Mail Address ___________________________________________________ Description of service provided ______________________________________ ________________________________________________________________ ________________________________________________________________
3.c
Reference #3: similar project completed at least 3 years ago District Name ___________________________________________________ Contact Person __________________________________________________ Daytime Phone Number ___________________________________________ E-Mail Address ___________________________________________________ Description of service provided ______________________________________ ________________________________________________________________ ________________________________________________________________
4.
My company provides worker’s compensation for its employees. YES ____________
5.
My company will provide all necessary liability insurance certifications prior to project initiation. YES ____________
6.
NO ___________
NO ___________
My company meets or exceeds the wage rate tables adopted by Bryan ISD. YES ____________
NO ___________
PREVAILING WAGE RATES Wage Schedules: Civil / Heavy Construction Trades 1. Payment greater than the prevailing wage rate as listed within this document not prohibited per Texas Government Code, Chapter 2258, Prevailing Wage Rates, Sub-Chapter A. General 2. Building construction wage rates shall be paid to all workers except those workers engaged in site work and construction beyond five feet of buildings. 3. Not less than the following hourly rates shall be paid for the various classifications of work required by this project. Workers in classifications where rates are not identified shall be paid not less than the general prevailing rate of "laborer" for the various classifications of work therein listed. 4. The hourly rate for legal holiday and overtime work shall not be less than one and one-half (1 & 1/2) times the base hourly rate. 5. The rates are journeyman rates. Helpers may be used on the project and may be compensated at a rate determined mutually by the worker and employer, commensurate with the experience and skill of the worker but not at a rate less than 60% of the journeyman's wage as shown. Apprentices (enrolled in a federally certified apprentice program) may be used at the percentage rates of the journeyman scale stipulated in their apprenticeship agreement. At no time shall a journeyman supervise more than two (2) apprentices or helpers. All apprentices or helpers shall be under the direct supervision of a journeyman working as a crew. The lowest allowable rate shall be the rate for laborers, no exceptions. 6. Welders shall receive the rate prescribed for the craft performing the operation to which the welding is incidental. 7. Workers in classifications where rates are not identified shall be paid not less than the general prevailing rate of "laborer" for the various classifications of work therein listed. The hourly rate for legal holiday and overtime work shall not be less that one and one-half (1 & 1/2) times the base hourly rate. Welder shall receive the rate prescribed for the craft performing the operation to which the welding is incidental. Compliance with Prevailing Wage Rate Statutes The Bryan Independent School District (the “District”) reserves the right to request and obtain financial statements from contractors and subcontractors listing the actual wage rates paid for each job classification of worker, laborer or mechanic under the contract with the District. The District shall retain any amounts due under the contract pending a final determination of any violation or failure to provide financial information. A contractor or subcontractor who fails to pay the specified rates as required shall pay to the District $60 for each worker, laborer, or mechanic employed for each calendar day or part of a calendar day the worker is paid less then the wage rates specified in the contract.
CLASSIFICATION Acoustic Ceiling Installer Asbestos Abatement Worker Carpenter Concrete—Pour and Finish Crane Operator Driver Drywall Installer Electrician—Journeyman Electrician—Apprentice Elevator Mechanic—Journeyman Elevator Mechanic—Apprentice Fire Protection—Controls Fire Protection—Pipefitter Formwork Builder Glazier HVAC—Journeyman HVAC—Apprentice HVAC—Controls Insulator Ironworker Laborer/Helper Mason Equipment Operator—Light Equipment Operator—Heavy Painter Pipefitter—Journeyman Pipefitter—Apprentice Plasterer Plumber—Journeyman Plumber—Apprentice Reinforcing Steel Worker Roofer Stone Mason Terrazzo Installer Tile Setter Waterproofer Welder
RATE 12.75 10.97 12.32 13.01 27.32 12.75 10.77 19.46 11.11 18.78 11.27 13.60 17.21 11.67 14.60 22.47 12.92 16.05 12.62 15.25 10.00 17.43 12.86 15.22 11.57 17.21 10.74 16.07 24.06 15.02 10.16 11.72 15.05 19.55 11.90 11.76
NOTES
Receive rate for classification performing operation.
FELONY CONVICTION NOTIFICATION State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (1), states “a person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.” Subsection (b) states “a school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the contract.” This Notice Is Not Required of a Publicly-Held Corporation. I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge. Vendor’s Name: ________________________________________________________________ Authorized Company Official’s Name (Printed): ________________________________________________________________ A. My firm is a publicly-held corporation, therefore, this reporting requirement is not applicable. Signature of Company Official: ________________________________________________________________ B. My firm is not owned or operated by anyone who has been convicted of a felony: Signature of Company Official: ________________________________________________________________ C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony (describe felony conduct): ______________________________________________________________ The undersigned affirms that they are duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any terms or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this bid. (PLEASE PRINT OR TYPE) COMPANY: __________________________________________________ ADDRESS: __________________________________________________ CITY, STATE, ZIP CODE _______________________________________ TELEPHONE NO. (
) _______________ FAX NO. (
)__________
SIGNATURE: _________________________________________________ Print Name: _____________________________________________ TITLE: ______________________________________________________
FORM
CONFLICT OF INTEREST QUESTIONNAIRE
CIQ
For vendor or other person doing business with local governmental entity OFFICE USE ONLY
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.006(a).
Date Received
By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person commits an offense if the person knowingly violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. 1
Name of person who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3
Name of local government officer with whom filer has employment or business relationship.
Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? Yes
No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? Yes
No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? Yes
No
D. Describe each employment or business relationship with the local government officer named in this section.
4
Signature of person doing business with the governmental entity
Date Adopted 06/29/2007
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants’ responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). (before completing certification, read attached instructions.) (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Organization Name
PR/Award Number or Project Number
Name and Title of Authorized Representative
Signature
Date
Instructions For Suspension/Debarment Certification Statement: 1. By signing and dating the certification statement, the bidder certifies that neither it nor any of its principals (e.g., key employees) has been proposed for debarment, debarred or suspended by a federal agency on the date signed. 2. The prospective bidder shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective bidder learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 3. Federal and State penalties exist for vendors and districts that knowingly enter into contracts with suspended / debarred person.
Residence Certification
In accordance with Article 601g. as adopted by the 1985 Texas Legislature, the following will apply. The pertinent portion of the Act has been extracted and is as follows: Article 601g. State of Political Subdivision Contracts for Construction, Supplies, Services, Bids by Non-Resident Section 1(a) in this Act: 1. “Governmental agency of the state” means an incorporated city or town, a county, a public school district, a special-purpose district or authority, or a district, county, or justice of the peace court. 2. “Nonresident Bidder” means a bidder whose principal place of business is not in this state, but excludes a contractor whose ultimate parent company or majority owner has its principal place of business in this state. 3. “Texas Residential Bidder” means a bidder whose principal place of business is in this state, and includes a contractor whose ultimate parent company or majority owner has its principal place of business in this state. The state or governmental agency of the state may not award a contract for general construction, improvements, services, or public works projects, or purchase of supplies, materials, or equipment to a nonresident bidder unless the nonresident’s bid is lower than the lowest bid submitted by a responsible Texas resident bidder by the same amount that a Texas resident bidder would be required to under bid a nonresident bidder to obtain a comparable contract in the state in which the nonresident’s principal place of business is located.
I certify that as defined in Article 601g, that: Company Name:
____________________________________________ _____ Yes, I am a Texas Residence Bidder _____ No, I am a _____________ Residence Bidder
Printed Name:
____________________________________________
Signature:
____________________________________________
Statement of Non-Collusion and Non-Discrimination
My signature certifies that the accompanying bid: 1. Is not the result of, or affected by an unlawful act of collusion with another person or company engaged in the same line of business or commerce, or any act of fraud punishable under current local, state, and/or federal ordinances, statutes, regulations, and/or policies. Furthermore, I understand that fraud and unlawful collusion are crimes under Federal Law, and can result in fines, prison sentences, and civil damage awards. 2. During the performance of any contracted awarded, the Seller will not discriminate against any employee or applicant for employment because of race, religion, color, sex, or national origin, or handicaps, except where religion, sex, or national origin is a bona fide occupational qualification reasonably necessary to the normal operations of the Seller. The Seller agrees to post in conspicuous places, available to employees and applicants for employment, notice setting forth the provisions of this non-discrimination clause. 3. The Seller, in all solicitations and advertisements for employees placed by, or on behalf of, the Seller, will state that such Seller is an equal opportunity employer. 4. Notices, advertisements, and solicitations placed in accordance with Federal Law, rule, or regulation, shall be deemed sufficient for the purpose of meeting the requirements of this section. 5. The Seller shall include the provisions of the foregoing paragraphs 2, 3, and 4 in every subcontract or purchase order over $10,000.00 so that the provisions will be binding upon each subcontractor or vendor.
I hereby certify that I am authorized to sign as a Representative for the Seller: Name of Seller
_______________________________________
Address:
_______________________________________
City/State/Zip:
_______________________________________
Signature:
_______________________________________
Name (Print):
_______________________________________
Title:
_______________________________________
Date:
_______________________________________
W-9
Form (Rev. August 2013) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification
Give Form to the requester. Do not send to the IRS.
Print or type See Specific Instructions on page 2.
Name (as shown on your income tax return) Business name/disregarded entity name, if different from above
Exemptions (see instructions):
Check appropriate box for federal tax classification: Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/estate Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶ Other (see instructions) ▶ Address (number, street, and apt. or suite no.)
Exemption from FATCA reporting code (if any)
Requester’s name and address (optional)
City, state, and ZIP code List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.
Employer identification number
Part II
–
–
–
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. I 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. I 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 on page 3.
Sign Here
Signature of U.S. person ▶
Date ▶
General Instructions
withholding tax on foreign partners’ share of effectively connected income, and
Section references are to the Internal Revenue Code unless otherwise noted. Future developments. The IRS has created a page on IRS.gov for information about Form W-9, at www.irs.gov/w9. Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page.
Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 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 that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 8-2013)
