HomeMy Public PortalAboutC-21-133 - SPA - ALVIN CATACUTAN - FIL-AM HIST. MO. EVENT
CITY OF CARSON —INTERNAL CONTRACT ROUTING SLIP
All fields are required to be completely filled out.If not applicable,enter N/A.
FROM:JOSE EMMANUEL TINGSON
DOCUMENT TYPE:SERVICE PROVIDER
DEPT:RECREATION ATTORNEY ASSIGNED:N/A
ITEM NO:N/A
EXT.224
N/A APPROVAL DATE:N/A
VENDOR NAME:PANAMA KALI SERVICES/PRODUCT:PERFORMER
TERM OF CONTRACT:9/29/2021 tHroucu 10/3/2021 AMOUNT OF CONTRACT:N/A
SINGLE-SIDED DOCUMENT?XIYES PAGE COUNT {>
PRE-APPROVAL/PRE-CITY SIGNATURES CHECKLIST
ASSISTING STAFF ACTION REQUIRED COMPLETION {INITIALS}
DIRECTOR Confirm approval to proceed.
CONTRACT OFFICER Confirm funds are budgeted and/or available.
erp WX@ CONTRACT OFFICER Preparation of specifications.
This includes coordinating with Risk Management on the Insurance/Bond requirements.
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PURCHASING Advertise bids,compliance with bid requirements;including posting on City”s website.
*RFP/RFQ mustinclude form contract.VIA PURCHASING OR
CONTRACT OFFICER
Evaluate bids/proposals and determine recommended bidder(s).wf
CONTRACT OFFICER
&CITY ATTORNEY
Complete contract negotiations/finalize contract (including attachments)with City
Attorney’s Office.
CONTRACT OFFICER Present appropriate contract form to the recommended vendor.
*Verify correct agency titles/corps.are listed.(ie:City.Council-Mayor vs.CRA-Chairman)
vA
@
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*M/A
CONTRACTOFFICER
&RISK MANAGEMENT
Verify corporate status,state of Incorporation and Principles.NLA
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
insurance as well as all endorsementforms.
CONTRACT OFFICER Provide W-9 to Purchasing on Agenda Thursday if contract is on the upcoming agenda.
*Non-Council items:provide W-9 to Purchasing on date submitted to City Clerk’s Office.
@@
PURCHASING OR
CONTRACT OFFICER
Present Department’s recommendation to legislative body to award/approve contract,if
applicable.Wi
POST-APPROVAL/POST-VENDOR SIGNATURES CHECKLIST
CONTRACT OFFICER Collectand assemble.insurance (initialed by Risk Management),*Certificate of Insurance with
endorsement must be attached to be processed;even on amendments*wo
CONTRACTOFFICER Collect and assemble bond requirements and forms.*Public Works contracts MUSTattach
verification the bond has been executed by an admitted surety insurer*VA
CONTRACT OFFICER Transmit 2 complete original sets with this routing slip to the City Clerk’s Office for further
processing.
**Note any special services needed,including all prior Contracts,Amendments or Awards.
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MA
CITY CLERK Verify approval/routing slip completion;obtain signatures:City Attorney,City official,and
City Clerk.WIA
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 VA
PUBLIC WORKS Tyler Entry and Release for City Clerk approval aA
CITY CLERK Tyler approval;email staff upon completion WwJA
CONTRACT OFFICER
&PURCHASING
Create a requisition in Tyler for Purchasing to issue a Purchase Order.
*Vendor is not to proceed with work until the Purchase Order is approved.
CONTRACT OFFICER Provide Notice to Proceed to vendor.
CONTRACT OFFICER Tickler contract expiration and insurance expiration VIA
FINANCE Process contract purchase order and provide copies to department.v JA
CONTRACT OFFICER Process progress payments.&
CONTRACT OFFICER Process contract completion forms.
*Notice of Completion to City Clerk’s Office Vv,IA
CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING:
LJ Route for City Attorney>Mayor or Chair WITHOUT NOTARY?>Clerk
C)Route for City Attorney>City Manager WITHOUT NOTARY>Clerk
(1)Route for City Attorney>Mayor or Chair WITH NOTARY>Clerk
L]Route for City Attorney>City Manager WITH NOTARY>Clerk
Gd Other:Thynt om They
SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS:
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Checklist
Before submitting your application packet make sure eachof the below
indicated items have been attached or completed.
(FOR COMMUNITY SERVICES OFFICE USE ONLY)
x Service Provider Application Agreement
x Invoice for Future Event Date!
N/A Business License (if applicable)
N/A Proof of Insurance/Certificate of Insurance
x Waiver,Release,Hold Harmless,Agreement Not to
Sue,Indemnification,and Photo Release
x Current Copy of W-9 Form(if not on file already)
"The date of the Event shall be listed on the Invoice for Future Event Date (IFED).If the Service Provider Application is
approved,then the IFED 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.
532227.5 CFN AS OF 1-22-2020
G
o
(Date)
(Company)
(Company Address)
(City,State ZIP)
Insurance Requirements
Dear Alvin Catacutan
(Enter Provider’s Name)
Please be advised pursuant to your desire to work with the City of Carson,youare required to
submit the following:
¥Compliant Certificates of Liability Insurance (to be maintained for the duration of services
against claims which mayarise fromor 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 in favor of the City,must be submitted in their entirety before any services
are providedor the event takes place.Failure to submit such required forms shall be cause
for City of Carsonto 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 Liability Insurance:Coverage shall be at least as broad as Insurance Services Form
CG 00 GJ covering CGL on an “occurrence”basis,including property damage,bodily injury
and personal &advertising injury with limits no less than $1,000,000 per occurrence and
$2,000,000 aggregate.
Additional Insured Status
The City of Carson,and its elected and appointedofficials,employees,volunteers and agents,are
to be covered as additional insureds with respect to liability arising out of their work or
operations performed at or on behalf of the City-sponsored event including materials,parts,or
equipment furnished in connection withthe event.
532227.5 CFN AS OF 1-22-2020
City of Carson
Community Services DepartmentServiceProviderApplication Agreement
Check one (staffuse):
[|Carson Event Center||HumanServices |WlV]Recreation [|Transportation
Filipino American History Month Carson Event Center 10/02/21Event:Event Location:~~”Event Date:___
Name of Service Provider:VAano.af,Li,L~A C >
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liabilitycompany,specifyhere):
LLC
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,or other,specify here):
eBusinessEntityStateofIncorporation(if applicable):OV KAA
Type of Service:__[V/urbied ALAS QOnerstration"
ContactPerson:doen,CF Kphone #:(25 266-7 SOC |
Emer.Contact:Rages!GBukar pPhone #:(310)YO7-~9/202.
Billing Address:Ye)6 Holloe (orrer Kd.2S@
Proof ofInsurance (check one)?[les
If no,would youlike to purchase special event insurance throughthe City (cheek one)?[Wes
Special Instructions /Notes:CHYop ChePSE Wi Pee WDE IMSGEAUE .
532227.5 CFN AS OF 1-22-2020
If Service Provider wishes to request any special accommod ation needed to facilitate provision oftheservices,please identify it here or contact the staff memberreferenced on Page |ofthis application:
Total Service Fee OO .a&?
NOTE:If service provideris unable to provide the services as proposed orrequestedorthe CityofCarsoncancelstheserviceforanyreason,the associated fees will not be paid.
[remainderofpage intentionallyleft blank]
532227.5 CFN
AS OF 1-22-2020
Further Terms of Service Provider Application Agreement:
The undersigned signatory of Service Provider (Service Provider being the above-referenced personorentityseekingtoprovideservicesattheabove-referenced event,including all its officers,agents,employees and volunteers)hereby represents and warrants that he or she is duly authorized byServiceProvidertoexecuteanddeliverthisapplicationonbehalfofServiceProvider,and that by soexecutingthisapplication,and in consideration for the City’s review of this application,ServiceProviderisboundbytheseterms.
Service Provider understands and agrees to comply with the City’s “Service Provider Rules &Regulations,”which are set forth below and incorporated herein bythis reference.
Service Provider agrees to indemnify and release City in connection withits proposed services inaccordancewiththe“Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,andPhotoRelease”submitted concurrently herewith.
Service Provider agrees to maintain all required insurance coverages and comply with all associatedinsurancerequirementsassetforthontheabove“Insurance Requirements”page,which isincorporatedhereinbyreference.Service Provider agrees that all required policies shall contain,orbeendorsedtocontain,an agreement by Service Provider to waive all rights of subrogation andcontributionagainsttheCity,its elected or appointed officers,officials,employees and agents,foralllossesandliabilitiespaidunderthetermsofanypolicywhicharisefromtheactivitiesoroperationsof,or the services performed by,Service Provider,regardless of anyprior,concurrent,or subsequentnon-active negligence by the City.
In the event there is more than one person or entity named in this Service Provider ApplicationAgreementastheServiceProvider,then all obligations,liabilities.covenants and conditionshereundershallbejointandseveral.
This Service Provider Application Agreement,unless and until accepted,approved,and executed bytheCityManagerordesignee,is only an application for provision of services to City,and does notconstituteanapprovalorauthorizationforServiceProvidertoperformorprovideanyservicetoCity.
Neither Service Provider nor any ofits agents or employees shall be deemed agents or employees oftheCity,nor a memberof a joint enterprise with the City.Neither Service Provider nor anyof itsagentsoremployeesshallatanytimeorinanymannerrepresentthatServiceProvideroranyofitsagentsoremployeesareagentsoremployeesofCity,orthat it is a member ofa joint enterprise withCity.Subject to the requirements of this Service Provider Application Agreement,neither the Citynoranyofitsemployeesshallhaveanycontroloverthemanner,mode or means by which ServiceProvider,its agents or employees,performthe services set forth herein.
In the event that part ofthis Agreement is declared invalid or unenforceable by a valid judgment ordecreeofacourtofcompetentjurisdiction,such invalidity or unenforceability shall not affect any of
532227.5 CEN
AS OF 1-22-2020
the remaining portions of this Agreement which are hereby declared as severable and shall beinterpretedtocarryouttheintentofthepartieshereunder.
Service Provider acknowledges that the City of Carson’s consideration of Service Provider’sapplicationtoprovidetheabove-referenced services is on the express condition that Service Providerrepresentsandwarrantsthatitisandwillbeincompliancewithallapplicablerestrictionsontheuseofintellectualproperty,including copyright Jaws,in connection with the Services proposed to beprovided.Service Providershall 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 toprovidetheabove-referenced service(s)on the date and time of the above-referenced event.
This Service Provider Application Agreement has beenexecuted onthe dates written below.
APPLICATION SUBMISSION (wet signature required;no electronic signatures):
SERVICE PROVIDER:Vocnera dkhi ))Cr
2eS Seat /L_202-|¢Z
f SffSienatare of Service Provider's Authorized Representative)“(Date)/(aT
—filucn Cotaete
-(Printed Name ofService Provider’s Authorized Representative)
(Space below this fine for City use only)
APPLICATION APPROVAL:
CITY OF CARSO
(Signature of City Manager o Designee}(Date)~
532227.5 CFN AS OF 1-22-2020
Service Provider Rules &Regulations
1.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.Anyadditions and amendments thereto that maybe established or putintoeffectbytheCity,and provided in writing to the Provider,shall also become binding and apartoftheServiceProviderApplicationAgreement.
2,PAYMENT/CANCELLATION:If the Provider is unable to perform or cannot provide theservicesasrequested,or the City cancels the service for any‘reason,the associated fees forservicewillnotbepaid.
3.CANCELLATION:No refunds will be given unless the subject event is cancelled by theCity’s Community Services Department.Applications may be denied or events cancelled infavorofCityprograms.
4.PROPERTY LOSS OR DAMAGES:The City is not responsible for any damage to,loss ortheftoftheProvider's property,or that of Provider’s agents,employees orinvitees.
5.CHARACTER OF ENTERTAINMENT:The Provider shall observe,obey and comply withallapplicablelocal,state and federal laws,and all applicable policies,rules,regulations andtermsandconditionsgoverninguseofCityfacilities.The Provider will forfeit all rents or otherfeespaidifejectedfrompremisesforviolationsofsame.Ejection shall not release Providerfromanyobligationsforthepaymentofrentsorotherfeesnotyetpaidundersuchpermitoradditionallyincurred.The policy of the City is to serve the public in the best possible manner.The Providershall at all times cooperate to this end.
The policies,rules,regulations and conditions governing use of City facilities are subject tochangewithoutnoticetoProviderunlessthechangeaffectsapermitalreadyissuedtoProvider.
Providershall be solely responsible for the orderly conduct of all persons using the premises byitsinvitation,either expressed or implied,during all times covered by the Service ProviderApplicationAgreement.The City reserves the right to eject or cause to be ejected from thepremisesanypersonorpersonsduetounlawfulconduct.
6.RESPONSIBILITY:The Provider shall provide all material,equipment,and personnelnecessaryforprovisionoftheservicedescribedinthisagreement.
7.MOVE-IN/MOVE-OUT:Move-in to the event area will be set for each venue.Unlessotherwisestated,Provider will be required to keep its area fully set up and manned until theeventisofficiallyover.Please note that these times are subject to change.
8.SAFETY:Standing on chairs,tables or other rental equipment is prohibited.This equipment isnotengineeredtosupportyourweight.The City of Carson,its employees,agents,or officers willnotberesponsibleforinjuriesorfallscausedbytheimproperuseoffurniture.Please assist inoureffortstoprovideaSAFEWORKINGENVIRONMENT.
532227.5 CFN AS OF 1-22-2020
9.VOLUME/LIGHT CONTROL:The City reserves the right to regulate the volume or intensityofanyandallnoiseorlightgeneratingmechanisms(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 and are subject to removal.Candles and other open flame devices will not be permitted except as authorized on thisagreement;subject to Fire Department regulations.
11.COPYRIGHT INFORMATION:Provider is responsible for licensing fees as required bylaw.Provider may be subject to legal action for the use,display or sale of any item using anycopyrightedand/or trademarked name or logo which has not been specifically authorized underlicensefromthetrademarkholder.
12.PERMITS AND LICENSE:Providershall procure at its own cost and expense all therequiredlicensesandpermitsapplicabletoProvider’s use or activity.
13.OBLIGATION FOR CLEANLINESS:
|
Provider agrees that the facility and any othersurroundingCityproperty(including parking lots)used by the Provider must be left in a cleanandorderlycondition(equal to or better than the condition existing prior to the event).Ifadditionalmaintenanceisrequired,other than the normal cleaning process,the Provider will bechargedadditionalfeesbasedonthecostofsuchmaintenance.
14.DISPUTES:All points not covered by the Service Provider Rules &Regulationsare subjecttothedecisionoftheappropriateCityrepresentative.
15.FLOOR MANAGEMENT:The City will appoint a Floor Manager who is authorized toenforcetheserulesandregulations.
16.SPACE ASSIGNMENT:Event space is assigned to providers at the sole discretion of theCity.Concerns regarding competitive or specific types of providers should be communicated totheCityatthetimeofapplication.
17.RULE CHANGES:The City reserves the right to make reasonable changes to the foregoingrules,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.
532227.5 CFN
AS OF 1-22-2020
Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release
1Atuin (obec oo (“individual”)fon behalf ofDerren
gy.
Kal,LL (“Service Provider”),and as a bona fide agent of Service ProvidereydulyauthorizedtoexecutethisWaiver,Release,Hold Harmless,Agreement Not to Sue and Indemnificationagreement(“Agreement”)on behalf of Service Provider](individual and Service Provider hereinaftercollectivelyreferredtoas“Signatory,”and the term “Signatory”includes Service Provider’s officers,officials,employces,agents and volunteers),seek acceptance by the City of Carson of anapplication to provide servicesin/at Filipino American History Month (“Event”)on October 2,2021 (“Date”).
Signatory understands that accidents and injuries can arise out of the Event:knowing the risks,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,orpropertydamagewhichSignatorymayhave,or which hereafter accrue to Signatory.against the City ofCarson,its clected and appointed officers,officials,employees,agents and volunteers (collectively “City”),and fromand against any and ail liability arising out of or connected in any way with Signatory’s participationinorpresenceattheEvent,even thoughthatliability may arise out of negligence or carelessness on the part ofCity.It is further understood and agreed that this Agreement is to be binding on Signatory’s heirs and assigns.
Signatory hereby grants City the right to photograph or video-record Signatory during or in connection withtheEvent,and to use Signatory’s photographed or video-recorded likeness,and any image,silhouette,orreproductionofthevoiceorappearanceofSignatorytakenduringorinconnectionwiththeEvent(“Likeness”),for any purpose,including publicity and promotion of City and its events,and creation orproductionofmaterialsinanyformforsuchpurpose,with no claim ofentitlement to any license fee orroyaltyofanykindfromCity.Signatory herebywaives 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 from and against any and all claims,liabilities.losses,damages,expenses,and costs (including without limitation costs and fees of litigation)ofeverynature(including.but not limited to,property damage,bodily injury,or death),whether imposed bylaworotherwise,sustained or alleged to be sustained by any person orentity (whether they be members ofthepublicvisitingtheEvent,employees of the City,other service providers at the Event,or otherwise),occurringat,arising from,or connected with Signatory’s preparationor performanceofservices at the Event,Signatory’sactions,inactions,or use offacilities at the Event,or any equipment,machinery or items displayed or used bytheSignatoryatorfortheEvent,except for such claim,liability,loss,damage,expense,or cost which wascausedbythesolenegligenceorwillfulmisconductoftheCity.
By signing below,I acknowledge and represent that [|have read and understand the above,and that Ivoluntarilyagreetoitsterms,
Signed:_
CAME:Aluin (odyKaan.euORGANIZATION:Vea.tabi /Le
Date:S61 °/b #2224
532227.5 CFN AS OF 1-22-2020
October 2,2021
Jonathan Nery
City of Carson /Community Services Dept.
inery@carsonca.gov
310-816-9381
18601 S Main Street
Carson,CA 90248INVOICE
Pamana Kali:
Philippine Martial Arts
and Culture
October 2,2021 ’Martial Arts :$200.00
4403 Torrance Blvd Demonstration;FAHM :
Torrance,CA USA
310-866-7300
info@pamanakali.com
Total $200.00
Please make checks payable to:Pamana Kali LLC
100221
Form W-9
(Rev.October 2018)
Departmentof the Treasury
Internal Revenue Service
Alvin Catacutan
2 Business name/disregarded entity name,if different from above
Request for Taxpayer
Identification Number and Certification
»Go to www.irs.gov/FormW9for instructions and the latest information.
1+Name (as shown on your income tax return).Nameis required on this line;do not jeave this line blank.
Give Form to the
requester.Do not
send to the IRS.
Powara Kali LLC
following seven boxes.
andfriduavsote proprietor or
single-member LLC
C)C Corporation
Pr
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.
C]Other (see instructions)>
Cl S Corporation
C]Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Partnership)»
Note:Check the appropriate boxin the line above for the tax classification of the single-member owner.Do not check Exemption from FATCA reporting
LLC if the LLCis classified as a single-member LLCthatis disregarded from the owner unless the ownerof 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 from 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 tocertainentities,not individuals;see
instructions on page 3):
C]Partnership CI Trust/estate
Exempt payee cade (if any}
code (if any)
(Applies to accaunts maintained outsida the U.S.) §Address (number,street,and apt.or suite no.)See instructions.
48/16 Hollow Corner
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Unit 26-6 Requester’s name and address (optional)
6 City,state,and ZIP code
Culver City CK $0280 7 List account number(s)here (optional) TaxpayerIdentification 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,for a
resident alien,sole proprietor,or disregarded entity,see the instructions for Part |,later.For other -~
entities,it is your ermployer 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 number to enter.
|Social security number
or
|Employer identification number |
G3)-lo Fi YISTE SIS
ee |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 numberto be issued to me);and
2.1 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 lam
no longer subject to backup withholding;and
3.lama 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 fromm FATCAreporting 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 havefailed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For morigage 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 Il,later.
Sign Signature of
Here U.S.person >
General Instructions
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/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester)who is requiredto 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.Examples of information
returns include,but are not limited to,the following.
*Form 1099-INT (interest earned or paid)
SS cur 00/24 [202/
*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 and third party network transactions)
*Form 1098 (home mortgage interest),1098-E (student loan interest),
1098-T (tuition)
*Form 1099-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 What is backup withholding,
later.
Cat.No.10231X Form W-9 (Rev.10-2018)