HomeMy Public PortalAboutC-21-127 - GARTH GARCIA BALASICO ( FIL-AM SPA) CITY OF CARSON —INTERNAL CONTRACT ROUTING SLIP
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FROM:JOSETINGSON EXT.310-830-9991 DEPT:_CS/REC ATTORNEY ASSIGNED:N/A
DOCUMENT TYPE:SERVICE AGREEMENT,NON-COUNCIL APPROVALDATE:N/A ITEM NO:N/A
VENDOR NAME:GARTH BALASICO SERVICES/PRODUCT:ENTERTAINMENT
TERM OF CONTRACT:9/29/2021 tHrouch 10/3/2021 AMOUNT OF CONTRACT:$200.00
SINGLE-SIDED DOCUMENT?[XIYES PAGE COUNT:18
PRE-APPROVAL/PRE-CITY SIGNATURES CHECKLIST
ASSISTING STAFF ACTION REQUIRED COMPLETION (INITIALS)
DIRECTOR Confirm approval to proceed.eG /s J
G7
CONTRACT OFFICER Confirm funds are budgeted and/or available.
CONTRACT OFFICER Preparation of specifications.
PURCHASING Advertise bids,compliance with bid requirements;including posting on City’s website
*RFP/RFQ must include form contract.Wh
PURCHASING OR Evaluate bids/proposals and determine recommended bidder(s).CONTRACT OFFICER .MI
CONTRACT OFFICER Complete contract negotiations/finalize contract (including attachn City
&CITY ATTORNEY Attorney’s Office.
CONTRACT OFFICER Present appropriate contract form to the recommended vendo
*Verify correct agencytitles/corps.are listed.(ie:City Council-Mayor vs.CRA-Chairman}WY
CONTRACT OFFICER Verify compliance with business license requirements,obtain 3.original signatures of ~
vendor,and request W-9 (once received,submit w-9.to purchasing).
*Signatures must be notarized for every original*Ai‘by
CONTRACTOFFICER Verify corporate status,state of Incorporation and Principles.&RISK MANAGEMENT ye M/A
CONTRACT OFFICER Request insurance documents for approval with Risk Management for all contracts.
Verify approval of insurance requirements'with Risk Management.
*Communication through e-mail is preferred..Please provide the written agreement,certificate of iV’4
insurance as weil as all endorsement forms.
CONTRACT OFFICER Provide W-9 to Purchasi genda Thursday if contract is on the upcoming agenda.
*Non-Council items:pro’-9 to,Purchasing on date submitted to City Clerk’s Office.
PURCHASING OR Present Departme mmendation to legislative body to award/approve contract,if MA
CONTRACT OFFICER applicable.
POST-APPROVAL/POST-VENDOR SIGNATURES.CHECKLIST
»insurance (Initialed by Risk Management),*Certificate of Insurance with
ttached to be processed;even on amendments*
CONTRACT OFFICER
CONTRACT OFFICER ble bond requirements and forms.*Public Works contracts MUST attach —
jond has been executed by an admitted surety insurer*Kh
CONTRACT OFFIGER nit 2 complete original sets with this routing slip to the City Clerk’s Office for further
sing.
any special services needed,including ail prior Contracts,Amendments or Awards.4‘/h,
CITY CLERK Verify approval/routing slip completion;obtain signatures:City Attorney,City official,andCityClerk.ALA
CITY CLERK Provides electronic copy and 1 original of executed contract to Contract Officer,City Clerk’s
Office retains 1 original and enters into Laserfiche ATA
PUBLIC WORKS Tyler Entry and Release for City Clerk approval LSA
CITY CLERK Tyler approval;email staff upon completion 77
CONTRACT OFFICER Create a requisition in Tyler for Purchasing to issue a Purchase Order.
&PURCHASING *Vendor is not to proceed with work until the Purchase Orderis approved.@
CONTRACTOFFICER Provide Notice to Proceed to vendor.“74,
CONTRACT OFFICER Tickler contract expiration and insurance expiration MA
FINANCE Process contract purchase order and provide copies to department.M/A
CONTRACT OFFICER Process progress payments.
CONTRACT OFFICER Process contract completion forms.
*Notice of Completion to City Clerk’s Office fA
CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING:|
(-]Route for City Attorney>Mayor or Chair WITHOUT NOTARY>Clerk
[]Route for City Attorney>City Manager WITHOUT NOTARY>Clerk
C]Route for City Attorney>Mayor or Chair WITH NOTARY>Clerk
C]Route for City Attorney>City Manager WITH NOTARY>Clerk
dZ]Other:Dput in Blac
SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS:
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Checklist
Before submitting your application packet make sure each of the belowindicateditemshavebeenattachedorcompleted.(FOR COMMUNITY SERVICES OFFICE USE ONLY)
/
_
Service Provider Application Agreement
~Invoice for Future Event Date’
s/s Business License (ifapplicable)
t/A ProofofInsurance/Certificate of Insurance
Waiver,Release,Hold Harmless,Agreement Not to
Sue,Indemnification,and Photo Release
Current Copy of W-9 Form(if not on file already)
“The date of the Eventshall be listed on the Invaice for Future Event Date {IFED).If the Service Provider Application is
approved,then the IFEO will be processed as an invoice for services rendered for the Event,No payment will be made
until the conclusion of the Event,at earliest.
§32227 5 CEFN AS OF 1-22-2020
“a
e
AAA /2
(Date)
Garth Gara Palasven_
(Company)
(Company Address)
(City,State ZIP)
Insurance Requirements
Dear Gartia Garevs Balasico
(Enter Provider's Name}
Please be advised pursuant to your desire to work with the City of Carson,you are required to
submit the following:
¥Compliant Certificates of Liability Insurance (to be maintained for the duration ofservices
against claims which mayarise from or in connection with the services).evidencing the
coverage(s)as indicated below.
Certificates of insurance,as well as additional insured and waiver of subrogation
endorsements tn favor af the City,must be submitted in their entirety before any services
are provided or the event takes place.Failure to submit such required forms shall be cause
for City of Carson to reject or terminate any service provider application agreement.
The City of Carson reserves the right to modify these requirements based on the nature of the
risk.prior events,insurance coverage,or other special requirements.
MINIMUM SCOPE AND LIMIT OF INSURANCE
General Liabiline daswrauce,Coverage stall be at least ax broad as Insurance Services Fornt
CG OO GF covering CGL an an “occurrence”husiy,including property demure,bodily dpury
and persanal &advertising injury with Hutty no fess then $1,000,000 per occurrence ated
$2,000,000 ageregute.
eldditional Insured Status,
the Ci of Carson,and fis elected and appointed officials,eitployees,voliaitert’s and agents,are
ta he cavered as acddithmal insureds with respect ta lability arising ou of tieir work or
operations performed at or un behalf of the City-spemsared event dictueing arctertats,parts,or
equipment furnished in connection with the event
932227 5 CEN AS OF 1-22-2020
City of Carson
Community Services Department
Service Provider Application Agreement
Checkone (staff use):
[|Carson Levent Center|
|
Human Services Recreation [‘Transportation
Filipino American History Month Carson Event Center 10/02/21EvenEventLocation:Event Date
Name of Service Provider:GARTH GARCIA BALASICO
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited habilitycompany,specify here):
INDIVIDUAL
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,
or other,specify here):
Business Entity State of Incorporation (if applicable):
ENTERTAINMENT
GARTH GARCIA pone #424,362-5872
Emer,Contact:MARS BENITEZ Phone#:(213)309-3048
Billing Address;220 WILSHIRE BLVD SUITE 208
Type of Service:
Contact Person:
Number Street
LOS ANGELES,CA 90010
City Sane Z1P
Proofof Insurance (check one)?lves [VNo
IF ne.would vou Jike to purchase special event insurance through the City (check one)?[Ives Ao
,f ‘
Special Instructions /Notes:City of Carson uoil\erence WSuPance |
532227.5 CEN AS OF 1-22-2020
t
a
t
If Service Provider wishes to request anyspecial accommodation needed to facilitate provision of theservices.please identifyit here or contact the staff member referenced on Page |of this application:
Total Service Fee $200 .00
NOTE:If service provider is unable to provide the services as proposed or requested or the City
of Carson cancels the service for any reason.the associated fees will not be paid.
fromatnder of page intentionally left blank]
5322275 CEN AS OF 1-22-2020
Further Terms of Service Provider Application Agreement:
The undersigned signatory of Service Provider (Service Provider being the above-referenced person
ar entity secking to provide services at the above-referenced event.including all its officers.agents,
employees and volunteers)hereby represents and warrants that be or she is duly authorized by
Service Provider to execute and deliver this application on behalf of Service Provider.and that by so
executing this application.and in consideration for the City’s review of this application.Service
Provider is bound bythese terms.
Service Provider understands and agrees to comply with the City’s “Service Provider Rules &
Regulations.”which are set forth belowand incorporated herein bythis reference.
Service Provider agrees to indemnify and release City in connection with its proposed services in
accordance with the “Waiver.Release.Hold Harmless,Agreement Not to Sue,Indemnification.and
Photo Release”submitted concurrently herewith,
Service Provider agrees to maintain all required insurance coverages and comply with all associated
insurance requirements as set forth on the above “Insurance Requirements”page.which is
incorporated herein by reference.Service Provider agrees that all required policies shall contain.or
be endorsed to contain,an agreement by Service Provider to waive all rights of subrogation and
contribuuon against the City.its elected or appointed officers.officials.employees and avents.for all
losses and liabtlities paid under the terms of any policy which arise from the activities ar operations
of.or the services performed by.Service Provider.regardless of any prior,concurrent.or subsequent
non-active negligence by the City.
In the event there is more than one person or entity named in this Service Provider Application
Agreement as the Service Provider.then all obligations.liabilities.covenants and conditions
hereunder shall be joint and several,
This Service Provider Application Agreement.unless and until accepted.approved.and executed by
the City Manager or designee,is only an application for provision of services to City.and does not
constitute an approval or authorization for Service Provider to perform or provide any service to City.
Neither Service Provider nar any of its agents or employees shall be deemed agents or employees of
the City.nor a member of a joint enterprise with the City.Neither Service Provider nar anyofits
agents or employees shall at any time or in any manner represent that Service Provider or any ofits
agents or employees are agents or employees of City,or that it is a member of a joint enterprise with
City.Subject to the requirements of this Service Provider Application Agreement.neither the City
nor any of its employees shall have any control over the manner.mode or means by which Service
Provider,its agents or employees.perform the services set forth herein.
In the event that part of this Agreement is declared invalid or unenforceable by a valid judgment or
deeree of a court of competent jurisdiction.such invalidity or unenforceability shall not atfeet any of
$32227.5 CEN AS OF 1-22-2020
the remaining portions of this Agreement which ure hereby declared as severable and shall beinterpretedtocarryouttheintentofthepartieshereunder.
Service Provider acknowledyes that the City of Carson's consideration of Service Provider'sapplicationtoprovidetheabove-referenced services is an the express condition that Service Providerrepresentsandwarrantsthatitisandwillbeincompliancewithallapplicablerestrictionsontheuseofintellectualproperty.including copyright laws,in connection with the services prepased to beprovided,Service Provider shall indemnify.defend,and hold harmless the City against any penalties,
claims,or liabilities arising from or in connection with Service Provider’s noncompliance with same.
The undersigned.on behalf of Service Provider.agrees that Service Provider seeks and is willing to
provide the above-referenced service(s)on the date and time of the above-referenced event.
This Service Provider Application Agreement has been executed on the dates written below,
APPLICATION SUBMISSION (wet signature required;no electronic signatures):
SERVICE PROVIDER:Gack)Garein Pala vice
(|\Wig 2\Pent co
(Signature of Service Broyider’s Authorized Representative}
Coe CRT(Printed Name of Service Provider's Authorized Representative)
tspace below this ne for City use only)
AS OF 1-22-2020
Service Provider Rules &Regulations
I,SERVICE PROVIDER APPLICATION:Upon acceptance.approval,and execution of aserviceproviderapplicationbytheCityofCarson(“City”).these rules and provisions shallbecomebindingandapartoftheServiceProviderApplicationAgreementbetweentheapplicant(being the entity providing a service to City as specified in the service provider application).including its officers,employees.agents and volunteers (‘Provider’).on the one hand.and theCity.on the other hand.Any additions and amendmentsthereto that may be established or putintoeffectbytheCity.and provided in writing to the Provider.shall also become binding and apartoftheServiceProviderApplicationAgreement..
&2.PAYMENT/CANCELLATION:Uf the Provider is unable to perform or cannot provide the
services as requested.or the City cancels the service for any reason.the associated fees for
service will not be paid.
3.CANCELLATION:No refunds will be given unless the subject event is cancelled by the
City’s Community Services Department.Applications may be denied or events cancelled in
favor of City programs.
4+,PROPERTY LOSS OR DAMAGES:The City is not responsible for any damage to.loss or
theft of the Provider's property.or that of Provider's agents.employees or invitees.
8.CHARACTER OF ENTERTAINMENT:The Provider shall observe,obey and comply with
all applicable local.state and federal laws,and all applicable policies,rules,regulations and
terms and conditions governing use of City facilities.The Provider will forfeit all rents or other
fees paid if ejected from premises for violations of same.Ejection shall not release Provider
fram any obligations for the payment of rents or other fees not yet paid under such permit or
additionally incurred.‘The policy of the City is to serve the public in the best possible manner,
The Provider shall at all times cooperate to this end.
The policies.rules.regulations and conditions governing use of City facilities are subject to
change without notice to Provider unless the change affects a permit alreadyissued to Provider.
Provider shall be solely responsible for the orderly conduct of all persons using the premises by
its invitation.either expressed or implied,during all times covered by the Service Provider
Application Agreement.The City reserves the right to eject or cause to be ejected from the
premises any person or persons due to unlawful conduct.
6.RESPONSIBILITY:The Provider shall provide all material,equipment,and personnel
necessary for provision of the service described in this agreement.
7.MOVE-TIN/MOVE-OUT:Move-in to the event area will be set for each venue.Unless
otherwise stated.Provider will be required to keep its area fully set up and manned until the
event is officially over.Please note that these times are subject to change.
8.SAFETY:Standing on chairs.tables or other rental equipment is prohibited.This equipment is
not engineered to support your weight.The City of Carson.its employees.agents,or officers will
not be responsible for injuries or falls caused by the improper use of furniture.Please assist in
our efforts to provide a SAFE WORKING ENVIRONMENT.
532227.5 CEN AS OF 1-22-2020
9,VOLUME/LIGHT CONTROL:The City reserves the right to regulate the volume or intensit\of any and all noise or light generating mechanisms (including,but not limited to.loudspeakers.radios,television sets,musical instruments.entertainers.or blinking or flashing lights)in thereasonablejudgmentoftheCity.
10,FLAMMABLE MATERIALS —All decorations,props and electrical equipment must befireprooforoffireretardantmaterials,must meet City requirements andare subject to removal.Candles and other open flame devices will not be permitted except as authorized on this
agreement:subject to Fire Department regulations.
11.COPYRIGHT INFORMATION:Provider is responsible for licensing fees as required by
law.Provider may be sybject to legal action for the use.display or sale of any item using any
copyrighted and/or trademarked name or logo which has not been specifically authorized under
license from the trademark holder.
12.PERMITS AND LICENSE:Provider shall procure at its own cost and expense all the
requiredlicenses and permits applicable to Provider's use or activity .
13.OBLIGATION FOR CLEANLINESS:Provider agrees that the facility and any other
surrounding City properly (including parking lots)used by the Provider must be left in a clean
and orderly condition (equal to or better than the condition existing prior to the event),If
additional maintenance is required,other than the normal cleaning process.the Provider will be
charged additional fees based on the cost of such maintenance.
l4.DISPUTES:All paints not covered by the Service Provider Rules &Regulationsare subject
to the decision of the appropriate City representative.
18.FLOOR MANAGEMENT:The Citv will appoint a Floor Manager who is authorized to
enforce these rules and regulations.
16.SPACE ASSIGNMENT;Event space is assigned to providers at the sole discretion of the
City.Concerns regarding competitive or specific types ofproviders should be communicated to
the City atthe time of application.
17.RULE CHANGES:The City reserves the right to make reasonable changes to the foregoing
rules,event hours and move-in/move-out arrangements at any time without notice to Provider,
unless the change affects a permit already issued to Provider.
532227.8 CPN AS OF 1-22-2026
Waiver,Release,Hold Harmless,Agreement Not te Sue,ludeninification,and Photo Release
[,GARTH GARCIA BALASICO (“individual”)fon behalf of
Gary Core:ra Balasiare)“UService Provider”).and as a bona fide avent of Service Provider
duly authorized to execute this Waiver.Release,Mold Harmless,Agreement Not to Sue and Indemnification
agreement (“Agreement’)on behalf of Service Provider](individual and Service Provider hereinafiercollectivelyreferredtoas“Signatory.”and the term “Signatory”includes Service Provider's officers.afficiats.employees,agents and volunteers),seek acceptance by the City of Carson of an application to provide services
invat Flipine American History Month=(Event’")on October2,2021 (“Date”).
Signatory understands that accidents and injuries can arise out of the Event:knowing therisks.nevertheless.
and in consideration of the acceptance of an application to provide a service at the Event on the Date.
Signatory hereby waives,releases and discharges any and all claims for damages for death.personal injury,or
property damage which Signatory may have.or which hereafter accrue to Signatory.against the City of
Carson,its elected and appointed officers,officials,employees.agents and volunteers (collectively “City”).
and from and against any and all lability arising out of or connected in any waywith Signatory’s participation
in or presence at the Event,even though that lability mayarise out of negligence or carelessness on the part of
City.It is further understood and agreed that this Agreement is to be binding on Signatory's heirs and assigns.
Signatory hereby granis City the right to photograph or video-record Signatory during of in connection with
the Event.and fo use Signatory’s photographed or video-recorded likeness.and any image.silhouette.or
reproduction of the voice or appearance of Signatory taken during or i connectian with the Event
(“Likeness”).for any purpose.including publicity and promotion of City and its events,and creatian or
production of materials in any form for such purpose.with no claim of entitlement to any license fee or royalty
ofany kind from City.Signatory hereby waives any right to the intellectual property of Signatory’s Likeness.
The rights granted by Signatory hereunder shall not expire.
Signatory further agrees to indemnify,defend and hold harmless City froms and against any andall claims.
liabilities.losses,diumaues.expenses.and costs (including without limitation costs and fees of litigation)of
every nature (including,but not limited to.property damage,bodily injury.or death),whether imposed by law
or otherwise,sustained or alleged to be sustained by any person or entity (whether they be members ofthe
public visiting the Event.employees of the City.other service providers at the Event,or otherwise).occurring
at,arising from,or connected with Signatory’s preparation or performance ofservices at the Event.Signatary’s
actions.inactions.or use of facilities at the Event,or any equipment,machineryor items displayed or used by
the Signatory at or for the Event,except for such claim,Hability.loss,damage.expense.or cost which was
caused bythe sole negligerice or willful misconduct ofthe City.
Bysigning below,|acknowledge and represent that I have read and understand the above,and that [
voluntarily agree to i{s terms.
Signed:oN\\
NAME:GARTHGARCIA BALASICO
ORGANIZATION:Garis Gare,Pealasico
Date:9/14/2021
32227,5 CEN AS OF 1-22-2020
GARTH GARCIA
3325 WILSHIRE BLVD,SUITE 208
LOS ANGELES,CA 90010
INVOICE
BILL TO:
COMMUNITY SERVICES DEPARTMENT
CITY OF CARSON ,CA
INVOICE #>001
INVOICE DATE
OCTOBER 2,2021
EVENT NAME DATE OF PROVIDER TYPE OF SERVICE SERVICE
SERVICE CHARGE
($)FAHM 2021 10/2/2021 GARTH GARCIA ENTERTAINMENT (1-2 SONGS)299,00
TOTAL S$200.00
PAYMENT DETAILS:
Zelle:424-362-5872
Check:To be issued under
"Garth Garcia Balasico"
Venmo:@Garth-Garcia
THANK YOU FOR YOUR
BUSINESS!
rom W=9
(Rev.October 2018)
Department ofthe TreasuryInternalRevenueService
Request for Taxpayer
Identification Number and Certification
»Go to www.irs.gov/FormW9for instructions and the latest information.
Give Form to the
requester.Do not
send to the IRS.
GARTH GARCIA BALASICO
2 Business name/disregarded entity name,if different from above
1 Name (as shown on your incometax return).Name is required on this fine;do not leave this line blank.
following seven boxes.
Individual/sole proprietor or CO C Corporation
single-member LLG
Pr
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,
[7]Other(see instructions)>
oO S Corporation
C]Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Partnership)»
Note:Check the appropriate box in the line abovefor the tax classification of the single-member owner.Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
is disregarded fram the owner should check the appropriate box for the tax classification of its owner.
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
certain entities,not individuals;see
instructions on page 3):
O Partnership C]Trust/estate
Exempt payee code (if any}
cade(if any}
(Applies to accounts maintained outside the U.S.) 5 Address (number,street,and apt.or suite no.)See instructions.
3325 WILSHIRE BLVD,SUITE 208S
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Requester's name and address (optional)
§City,state,and ZIP code
LOS ANGELES,CA 90010 7 List account number(s)here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid
backup withholding.For individuals,this is generally your social security number (SSN).However,fora
resident alien,sole proprietor,or disregarded entity,see the instructions for Part |,later.For other 8)4;7)-}O!11)-|5;7/0/16
entities,itis your employer identification number(EIN).If you do not have a number,see How to get a
TIN,later.
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and
Number To Give the Requester for guidelines on whose numberto enter.
Social security number |
or
|Employer identification number |
Ge Certification
Under penalties of perjury,|certify that:
1.The number shown on this form is my correct taxpayer identification number (or |am waiting for a number to be issued to me);and
2.|am not subject to backup withholding because:(a)|am exempt from backup withholding,or (b)|have not been notified by the Internal Revenue
Service (IRS)that |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 |am
no longer subject to backup withholding;and
3.]ama U.S.citizen or other U.S.person (defined below);and
4.The FATCA code(s)entered on this form (if any)indicating that |am exempt from FATCAreporting is correct.
Certification instructions.You must cross out item 2 aboveif 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 estale 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 {l,later.
Sign Signature ofHereU.S,person > wae
General Instructions (J)
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments.For the latest information about developments
related to Form W-9 andits instructions,such as legislation enacted
after they were published,go to www.irs.gov/FormWS9.
Purpose of Form
An individual or entity (Form W-9 requester)who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number(TIN) which may be your social security number
(SSN),individual taxpayer identification number (ITIN),adoption
taxpayer identification number (ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other
amount reportable on an information return.Examplesof information
returns include,but are not limited to,the following.
*Form 1099-INT(interest earned or paid)
Date »afve|21
*Form 1099-DiV (dividends,including those from stocks or mutual
funds)
*Form 1099-MISC (various types of income,prizes,awards,or gross
proceeds)
*Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
*Form 1099-S (proceeds from real estate transactions)
*Form 1099-K (merchant card andthird party network transactions)
*Form 1098 (home mortgage interest),1098-E (student foan interest),1098-T (tuition)
*Form 1098-C (canceled debt)
*Form 1099-A (acquisition or abandonment of secured property}
Use Form W-9 only if you are a U.S.person (including a resident
alien),to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN,you might
be subject to backup withholding.See Whatis backup withholding,
later.
Cat.No.10231X Form W-9 (Rev.10-2018)