HomeMy Public PortalAboutC-21-144 - CHARMAINE CLAMOR - LARRY ITLIONG - SPA
CITY OF CARSON—INTERNAL C
All fields are required to be completely filled out,lf not applicable,enter N/A.
NTRACTROUTINGSLIP
FROM:JOSE EMMANUEL TINGSON
DOCUMENT TYPE:SERVICE PROVIDER
EXT.224 DEPT:_CS/RECREATION ATTORNEY ASSIGNED:N/A
N/A APPROVAL DATE:N/A ITEM NO:N/A
VENDOR NAME:CHARMAINE CLAMOR SERVICES/PRODUCT:ENTERTAINER
TERM OF CONTRACT:10/21/2021 tHroucn 10/24/2021 AMOUNT OF CONTRACT:N/A
SINGLE-SIDED DOCUMENT?[XIYES
"ASSISTING STAFF
PAGE COUNT:
"ACTIONREQUIRED
DIRECTOR Confirm approval to proceed,
CONTRACT OFFICER Confirm funds are budgeted and/or availabie.
CONTRACT OFFICER Preparation of specifications.
This includes coordinating with Risk Management on the Insurance/Bond requireme
PURCHASING Advertise bids,compliance with bid requirements;including posting on Cit 's website N/A
*RFP/RFQ must include form contract.
PURCHASING OR Evaluate bids/proposals and determine recommended bidder(s).N/A
CONTRACT OFFICER .
CONTRACT OFFICER Complete contract negotiations/finalize contract(including attach N/A
&CITY ATTORNEY
Attorney's Office.
CONTRACT OFFICER
Present appropriate contract form to the recommended v nd
*Verify correct agencytitles/corps.are listed.(ie:City.Council-or vs.CRA-Chairman)
CONTRACT OFFICER
Verify compliance with business license requirements,.btain’3.original signatures of
vendor,and request W-9 (oncereceived,submitw-9.tc purchasing).
*Signatures must be notarized for every original*"y
CONTRACT OFFICER
&RISK MANAGEMENT
Verify corporate status,state of incorporation andd Principles.
CONTRACTOFFICER
Request insurance documents for approval:ith Risk Management for ail contracts.
Verify approval of insurance requiremen hRisk Management.
*Communication through e-mail is preferred:.Please provide the written agreement,certificate of
insurance as well as all endorsementforms.
®
CONTRACTOFFICER
Provide W-9 to Purchasi genda‘Thursday if contract is on the upcoming agenda.
*Non-Council items:pro ¥-9 to.Purchasing on date submittedto City Clerk’s Office.SS
PURCHASING OR
CONTRACT OFFICER
CONTRACT OFFICER
Present Department:mendation to legislative body to award/approvecontract,if
applicable.
SPPROVAL/POSTVENDORSIGNATURES CHECKLIST _oo
N/A
CONTRACT OFFICER ble bond requirements and forms.*Public Works contracts MUSTattach N/A
nd has been executed by an admitted surety insurer*
CONTRACT OFFIGER mit 2 complete original sets with this routing slip to the City Clerk’s Office for further N/A
ocessing
Note any special services needed,includingall prior Contracts,Amendments or Awards.
CITY CLERK Verify approval/routing slip completion;obtain signatures:City Attorney,City official,and N/A
City Clerk.
CITY CLERK Provides electronic copy and 1 original of executed contract to Contract Officer,City Clerk's N/A
Office retains 1 original and enters into Laserfiche
PUBLIC WORKS Tyler Entry and Release for City Clerk approval N/A
CITY CLERK Tyler approval;email staff upon completion N/A
CONTRACT OFFICER Create a requisition in Tyler for Purchasing to issue a Purchase Order.YW
&PURCHASING *Vendor is not to proceed with work until the Purchase Order is approved.
CONTRACT OFFICER Provide Notice to Proceed to vendor.N/A
CONTRACT OFFICER Tickler contract expiration and insurance expiration N/A
FINANCE Process contract purchase order and provide copies to department.N/A
CONTRACT OFFICER Process progress payments.(00
Lo
CONTRACT OFFICER Process contract completion forms.=N/A *Notice of Completion to City Clerk’s Office
CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING:
CJ Route for City Attorney>Mayor or Chair WITHOUT NOTARY>Clerk
CL)Route for City Attorney>City Manager WITHOUT NOTARY>Clerk
(_]Route for City Attorney>Mayor or Chair WITH NOTARY>Clerk
(]Route for City Attorney>City Manager WITH NOTARY>Clerk
J Other:INPUT IN TYLER
SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS:
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Checklist
Before submitting your application packet make sure each of 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 onfile already)
*The date of the Event shall be listed on the invoice for Future Event Date (IFED).If the Service Provider Application isapproved,then the IFED will be processed as an invoice for services rendered for the Event.No payment will be madeuntiltheconclusionoftheEvent,at earliest.
532227.5 CFN AS OF 1-22-2020
(Date)
(Company)
(Company Address)
(City,State ZIP)
Insurance Requirements
Dear Charmaine Clamor
(Enter Provider’s Name)
Please be advised pursuant to your desire to work with the City of Carson,you are requiredtosubmitthefollowing:
~Compliant Certificates of Liability Insurance (to be maintained for the duration of servicesagainstclaimswhichmayarisefromorinconnectionwiththeservices),evidencing thecoverage(s)as indicated below.
Certificates of insurance,as well as additional insured and waiver of subrogationendorsementsinfavoroftheCity,must be submitted in their entirety before any servicesareprovidedortheeventtakesplace.Failure to submit such required formsshall be causeforCityofCarsontorejectorterminateanyserviceproviderapplicationagreement.
The City of Carson reservesthe right to modify these requirements based on the nature of therisk,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 FormCG00O01coveringCGLon an “occurrence”basis,including property damage,bodily injuryandpersonal&advertising injury with limits no less than $1,000,000 per occurrence and$2,000,000 aggregate.
Additional Insured Status
The City of Carson,andits elected and appointedofficials,employees,volunteers and agents,aretobecoveredasadditionalinsuredswithrespecttoliabilityarisingoutoftheirworkoroperationsperformedatoronbehalfoftheCity-sponsored event including materials,parts,orequipmentfurnishedinconnectionwiththeevent.
532227.5 CFN AS OF 1-22-2020
City of Carson
Community Services DepartmentServiceProviderApplication Agreement
Check one (staff use):
[|Carson Event Center|_
|
Human Services Recreation [J Transportation
Event:L2""Y Itliong Event Location:Veterans Park Event Date:2/23/21
Nameof Service Provider:Charmaine Clamor
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liabilitycompany,specify here):
sole proprietor
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,or other,specify here):
Business Entity State of Incorporation(if applicable):
Type of Service:Performing Arts
Contact Person:Charmaine Clamor Phone #:()818-625-9872
Emer.Contact:Michael Konik Phone #:(_)323-850-0585 home323-3
Billing Address:1613 N.Vista St.
Number Street
Los Angele,CA 90046
City State ZIP
Proof of Insurance (check one)?[lyes
[v
tno
Ifno,would you like to purchase special event insurance through the City (check one)?
[
Wes 0
i :ity of Carson will provide insurance.Special Instructions /Notes:City
of
Cars pro Cc
532227.5 CFN AS OF 1-22-2020
If Service Provider wishes to request any special accommodation needed to facilitate provision oftheservices,please identify it here or contact the staff memberreferenced on Page |of this application:
Total Service Fee $300.00
NOTE:If service provider is unable to provide the services as proposed or requested or the CityofCarsoncancelstheserviceforanyreason,the associated fees will not be paid.
[remainder ofpage intentionally left blank]
532227.5 CFN AS
O
F
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,includingall 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 by this reference.
Service Provider agrees to indemnify and release City in connection with its 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 nights of subrogation andcontributionagainsttheCity,its elected or appointed officers,officials,employees and agents,for alllossesandliabilitiespaidunderthetermsofanypolicywhicharisefromtheactivitiesoroperationsof,or the services performed by,Service Provider,regardless of any prior,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 anyof its agents or employees shall be deemed agents or employees oftheCity,nor a member of a joint enterprise with the City.Neither Service Provider nor any of itsagentsoremployeesshallatanytimeorinanymannerrepresentthatServiceProvideroranyofitsagentsoremployeesareagentsoremployeesofCity,or that it is a memberof a 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,perform the services set forth herein.
In the event that part of this Agreementis declared invalid or unenforceable by a valid judgmentor.decree of a court of competentjurisdiction,such invalidity or unenforceability shall not affect any of
532227.5 CFN AS OF 1-22-2020
7
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-referencedservicesis on the express condition that Service Providerrepresentsandwarrantsthatitisandwillbeincompliancewithallapplicablerestrictionsontheuseofintellectualproperty,including copyright laws,in connection with the services proposed 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 andis willing toprovidetheabove-referenced service(s)on the date and time of the above-referenced event.
This Service Provider Application Agreementhas been executed on the dates written below.
APPLICATION SUBMISSION (wetsignature required;no electronic signatures):
SERVICE PROVIDER:c[.mead «{tne MPTf+
Clannn cfm,mer 10-15-21
(Signature of Service Provider’s Authorized Representative)(Date)
Charmaine Clamor
(Printed Name of Service Provider's Authorized Representative)
(Space belowthis line for City use only)
APPLICATION APPROVAL:
CITY OF CARS ./0[20f%{a (Signature of City Manager or 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),includingits officers,employees,agents and volunteers (“Provider”),on the one hand,and theCity,on the other hand.Any additions and amendments thereto that may be 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 damageto,loss ortheftoftheProvider’s property,or that of Provider’s agents,employeesor invitees.
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 Providershallat 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 equipmentis prohibited.This equipmentisnotengineeredtosupportyourweight.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 reservesthe right to regulate the volumeor 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:Provider shall 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 beleft in a cleanandorderlycondition(equal to or better than the condition existing prior to the event).Ifadditionalmaintenanceisrequired,other than the normal cleaning process,the Providerwill 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
10
Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release
Charmaine Clamor ,(“individual”)[on behalf ofCharmaineClamor(“Service Provider”),and as a bona fide agent of Service ProviderdulyauthorizedtoexecutethisWaiver,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,employees,agents and volunteers),seek acceptance by the City of Carson ofan application to provide servicesin/at Larry Itliong Day Celebration (“Event”)on October 23,2021 (“Date”),
Signatory understandsthat accidents and injuries can arise out of the Event;knowingthe 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 elected and appointed officers,officials,employees,agents and volunteers (collectively “City”),and from and against any and all liability arising out of or connected in any way with Signatory’s participationinorpresenceattheEvent,even though thatliability 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 or royaltyofanykindfromCity.Signatory hereby waives anyrightto the intellectual property of Signatory’s Likeness.The rights granted by Signatory hereundershall not expire.
Signatory further agrees to indemnify,defend and hold harmless City from and against any andall claims,liabilities,losses,damages,expenses,and costs (including withoutlimitation costs and fees of litigation)ofeverynature(including,but not limited to,property damage,bodily injury,or death),whether imposed by laworotherwise,sustained oralleged to be sustained by any person or entity (whether they be members of thepublicvisitingtheEvent,employees of the City,other service providers at the Event,or otherwise),occurringat,arising from,or connected with Signatory’s preparation or performanceof servicesat the Event,Signatory’sactions,inactions,or use of facilities 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 I have read and understand the above,and that Ivoluntarilyagreetoitsterms.
Signed:Cfo mae cfu,mPr
NAME:Charmaine Clamor
ORGANIZATION:
Date:10-1 5-21
532227.5 CFN AS OF 1-22-2020
CHARMAINE CLAMOR
INVOICE
818-625-9872
Charmainesings@icloud.com
1613 N.Vista St.
Los Angeles,CA
Date:10/23/21
ProjectTitle:Larry Itliong
Lo
Performance
Sincerely yours,
Charmaine Clamor
300
rom W-9
(Rev.October 2018)
Departmentof the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
»Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester.Do not
send to the IRS.
Charmaine Clamor
1 Name {as shown on your income tax retum).Name is required on this lina;do not leavethis line blank.
2 Business name/disregarded entity name,if different from above
following seven boxes,
[v]Individuat/sole proprietor or C]C Corparation
single-member LLC
Pr
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[]Other(see instructions)>
O 8 Corporation
a Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Partnership)»
Note:Check the appropriate box in the line above for the tax classification of the single-member owner.Do not check Exemption from FATCA reportingLLCiftheLLCisclassifiedasasingle-member LLC thatis disregarded from the ownerunless the ownerof the LLC isanotherLLCthatisnotdisregardedfromtheownerforU.S.federal tax purposes,Otherwise,a single-member LLG thatIsdisregardedfromtheownershouldchecktheappropriateboxforthetaxclassificationofitsowner.
3 Check appropriate box for federal tax classification of the Person whose nameis entered on line 1.Check only one of the
|
4 Exemptions (cades apply only to
certain entities,not individuals;see
instructions on page 3):
Cc Partnership Cr Trust/estate
Exempt payee code(if any)
code (if any)
(Applies to accounts maintained outside the U.S) 5 Address (number,street,and apt.or suite na.)See instructions.
1613 N.Vista St.
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3.
Requester’s name and address (optional)
6 City,state,and ZIP code
Los Angeles,CA 90046 7 List account number(s)here (optional)
Gna Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoidbackupwithholding.For individuals,this is generally your social security number (SSN).However,for aresidentalien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other 61175)-(17)4]-15/2]1]8entities,it is your employer identification number (EIN).If you do not have a number,see How to get aTIN,later.
Note:If the accountis in more than one name,see the instructions for line 1.Also see What Name andNumberToGivetheRequesterforguidelinesonwhosenumbertoenter.
Social security number |
or
Employer identification number
Part ll 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);and2.1 am not subject to backup withholding because:(a)|am exempt from backup withholding,or (b)|have not been notified by the Internal RevenueService(IRS)that |am subject to backup withholding as a result of a failure to report all interest or dividends,or (c)the [RS has notified me that !amnolongersubjecttobackupwithholding;and
3.|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 |am exempt from 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 becauseyouhavefailedtoreportallinterestanddividendsonyourtaxretum.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonmentof secured property,cancellation of debt,contribution:other than interest and dividends,you are not required to sign the certification,
s to an individual retirement arrangement(IRA),and generally,paymentsbutyoumustprovideyourcorrectTIN.See the instructions for Part i,later.
Sign Signature ofHereU.S.person > Cf ama fewer apr ate»10-15-2021
General Instructions
Section references are to the Internal Revenue Code unless otherwisenoted.
Future developments.For the latest information about developmentsrelatedtoFormW-9 and its instructions,such as legislation enactedaftertheywerepublished,go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester)who is required tofife aninformationreturnwiththeIRSmustobtainyourcorrecttaxpayeridentificationnurnber(TIN)which may be your social security number(SSN),individual taxpayeridentification number (ITIN),adoptiontaxpayeridentificationnumber(ATIN),or employer identification number(EIN),to report on an information return the amount paid to you,or otheramountreportableonaninformationreturn.Examplesof informationretumsinclude,but are notlimited to,the following.
Form 1099-INT(interest earned or paid)
*Form 1099-DIV (dividends,including those from stocks or mutualfunds)
*Form 1099-MISC (various types of income,prizes,awards,or grossproceeds)
*Form 1099-B (stock or mutual fund sales and certain othertransactionsbybrokers)
*Form 1099-S (proceeds from real estate transactions)
¢Form 1099-K (merchantcard 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 abandonmentof secured property}
Use Form W-9 onlyif you are a U.S.person {including a residentalien),to provide your correct TIN,
if you da not return Farm W-9 to the requester with a TIN,you mightbesubjecttobackupwithholding.See Whatis backup withholding,later.
Cat.No.10231X Form W-9 (Rav.10-2018)