HomeMy WebLinkAbout078-R-1810/02/2018
10/03/2018
78-R-18
A RESOLUTION
Authorizing the City Manager to Enter Into a Lease Agreement
with the United States Postal Service for Parking in the City Parking
Garage Located at 1800 Maple Avenue
WHEREAS, the City of Evanston ("City") owns a parking garage located at
1800 Maple Avenue; and
WHEREAS, the City currently leases 77 parking spaces to the United
States Postal Service ("USPS") at 1800 Maple Avenue and the lease will expire on
October 31, 2018; and
WHEREAS, the USPS wishes to continue leasing 54 parking spaces
through October 31, 2020; and
WHEREAS, the City Council of the City of Evanston has determined that
the best interests of the City would be served by the continued leasing of said parking
to, and executing of leases with, the USPS; and
WHEREAS, pursuant to Section 1-17-4-1 of the Evanston City Code of 2012,
as amended, the City Council may authorize by resolution leases of parking,
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF EVANSTON, COOK COUNTY, ILLINOIS THAT:
SECTION 1: The City Manager is hereby authorized and directed to sign,
and the City Clerk hereby authorized and directed to attest on behalf of the City, a lease
between the City and the USPS for parking in the City Parking Garage, 1800 Maple
Avenue, attached hereto as Exhibit A and incorporated herein by reference.
SECTION 2: The City Manager is hereby authorized and directed to
negotiate any additional terms and conditions of said leases as he may determine to be
in the best interests of the City.
SECTION 3: This Resolution shall be in full force and effect from and
after its adoption.
Attes
Devon Reid, City Clerk
Adopted: -19(2A�o'ec
, 2018
Stephen . Hage y, r
Approved to form:
Michelle L. Masoncup, Corpo fation Counsel
-2-
EXHIBIT A
USPS Lease Agreement for parking in the
City Parking Garage -1800 Maple Avenue
-3-
i F t
Ground Lease
EVANSTON - CITY PARKING GARAGE (162622-003)
1800 Maple Street, EVANSTON, IL 60201-9998
UNITED STATES
POSTAL SERVICE.
Facility Name/Location
EVANSTON - CITY PARKING GARAGE (162622-003)
1800 Maple Street, EVANSTON, IL 60201-9998
Ground Lease
County: Cook
Lease: QL0000531534
This Lease made and entered into by and between CITY OF EVANSTON hereinafter called the Landlord, and the
United States Postal Service, hereinafter called the Postal Service:
In consideration of the mutual promises set forth and for other good and valuable consideration, the sufficiency of which
is hereby acknowledged, the parties covenant and agree as follows:
1. The Landlord hereby leases to the Postal Service and the Postal Service leases from the Landlord the following
premises, hereinafter legally described in paragraph 7, in accordance with the terms and conditions described herein
and contained in the 'General Conditions to USPS Ground Lease,' attached hereto and made a part hereof:
54 DEDICATED USPS PARKING SPACES FOR POSTAL VEHICLES (44 SPACES ON THE 1ST FLOOR & 10
SPACES ON THE 5TH FLOOR PARKING GARAGE)
Total Site Area: 16,200.00 Sq. Ft. (300/sgft per space)
2. RENTAL: The Postal Service will pay the Landlord an annual rental of: $71,280.00 (Seventy One Thousand Two
Hundred Eighty and 00/100 Dollars) payable in equal installments at the end of each calendar month. Rent for a part
of a month will be prorated.
Rent checks shall be payable to:
CITY OF EVANSTON
ATTN: JILL VELAN
PARKING MANAGER
2100 RIDGE AVE
EVANSTON, IL 60201-2798
3. TO HAVE AND TO HOLD the said premises with their appurtenances for the following term:
FIXED TERM: The term becomes effective November 01, 2018 with an expiration date of October 31, 2020, for a total
of 2 Years.
February 2004 1
UNITED STATES
POSTAL SERVICE_
4.
RENEWAL OPTIONS: None
5. TERMINATION:
None, except as specified elsewhere in this Lease.
Ground Lease
6. OTHER PROVISIONS: The following additional provisions, modifications, riders, layouts, and/or forms were agreed
upon prior to execution and made a part hereof:
Landlord shall be responsible for maintenance of the demised premises.
7. LEGAL DESCRIPTION:
MAPLE AVENUE PARKING GARAGE LOCATED AT 1800 MAPLE AVENUE, EVANSTON, IL 60201, COOK
COUNTY.
February 2004 2
�+ UNITEDSTATES
POSTAL SERVICE
EXECUTED BY LANDLORD this
day of
GOVERNMENTAL ENTITY
Ground Lease
By executing this Lease, Landlord certifies that Landlord is not a USPS employee or contract employee (or an immediate family member of either), or
a business organization substantially owned or controlled by a USPS employee or contract employee (or an immediate family member of either).
Name of Governmental Entity: City of Evanston
Name & Title: City Manager Name & Title:
Name & Title: Name & Title:
Landlord's Address: CITY MANAGER 2100 RIDGE AVE
EVANSTON, IL 60201-2790
Landlord's Telephone Number(s):
Federal Tax Identification No.: XX-XXX5870
Witness Witness
a. Where the Landlord is a governmental entity or other municipal entity, the Lease must be accompanied by documentary evidence affirming the
authority of the signatory(ies) to execute the Lease to bind the governmental entity or municipal entity for which he (or they) purports to act.
b. Any notice to Landlord provided under this Lease or under any law or regulation must be in writing and submitted to Landlord at the address
specified above, or at an address that Landlord has otherwise appropriately directed in writing. Any notice to the Postal Service provided under
this Lease or under any law or regulation must be in writing and submitted to "Contracting Officer, U.S. Postal Service" at the address specified
below, or at an address that the Postal Service has otherwise directed in writing.
Date
Paul Frye
Contracting Officer
ACCEPTANCE BY THE POSTAL SERVICE
Signature of Contracting Officer
FACILITIES REAL ESTATE PO BOX 27497, GREENSBORO, NC 27498-1103
Address of Contracting Officer
Signature Page Grdlease Gvt. Entity (April 2009) 3
UNITEDST13TES General Conditions to USPS Ground Lease
POSTAL SERVICE
1. CHOICE OF LAW
This Lease shall be governed by federal law.
2. RECORDING
Not Required
3. MORTGAGEE'S AGREEMENT
If there is now or will be a mortgage on the property which is or will be recorded prior to the recording of the Lease, the Landlord must notify the
contracting officer of the facts concerning such mortgage and, unless in his sole discretion the contracting officer waives the requirement, the Landlord
must fumish a Mortgagee's Agreement, which will consent to this Lease and shall provide that, in the event of foreclosure, mortgagee, successors,
and assigns shall cause such foreclosures to be subject to the Lease.
4. ASSIGNMENTS
a. The terms and provisions of this Lease and the conditions herein are binding on the Landlord and the Postal Service, and all heirs, executors,
administrators, successors, and assigns.
b. If this contract provides for payments aggregating $10,000 or more, claims for monies due or to become due from the Postal Service under it may
be assigned to a bank, trust company, or other financing institution, including any federal lending agency, and may thereafter be further assigned and
reassigned to any such institution. Any assignment or reassignment must cover all amounts payable and must not be made to more than one party,
except that assignment or reassignment may be made to one party as agent or trustee for two or more parties participating in financing this contract.
No assignment or reassignment will be recognized as valid and binding upon the Postal Service unless a written notice of the assignment or
reassignment, together with a true copy of the instrument of assignment, is filed with:
1. the contracting officer; and
2. the surety or sureties upon any bond
c. Assignment of this contract or any interest in this contract other than in accordance with the provisions of this clause will be grounds for termination
of the contract for default at the option of the Postal Service.
d. Nothing contained herein shall be construed so as to prohibit transfer of ownership of the demised premises, provided that:
1. such transfer is subject to this Lease agreement;
2. both the original Landlord and the successor Landlord execute the standard Certificate of Transfer of Title to Leased Property and Lease
Assignment and Assumption form to be provided by the USPS Contracting Officer.
5. APPLICABLE CODES AND ORDINANCES
The Landlord, as part of the rental consideration, agrees to comply with all codes and ordinances applicable to the ownership and operation of the
parcel on which the premises are situated and to obtain all necessary permits and related items at no cost to the Postal Service. When the Postal
Service or one of its contractors (other than the Landlord) is performing work at the premises, the Postal Service will be responsible for obtaining all
necessary and applicable permits, related items, and associated costs.
6. SUBLEASE
The Postal Service may sublet all or any part of the premises or assign this lease but shall not be relieved from any obligation under this lease by
reason of any subletting or assignment.
7. ALTERATIONS
The Postal Service shall have the right to make alterations, attach fixtures and erect additions, structures or signs in or upon the premises hereby
leased (provided such alterations, additions, structures, or signs shall not be detrimental to or inconsistent with the rights granted to other tenants on
the property on which said premises are located); which fixtures, additions or structures so placed in, upon or attached to the said premises shall be
and remain the property of the Postal Service and may be removed or otherwise disposed of by the Postal Service.
8. CLAIMS AND DISPUTES
a. This contract is subject to the Contract Disputes Act of 1978 (41 U.S.C. 601-613) ("the Act").
b. Except as provided in the Act, all disputes arising under or relating to this contract must be resolved under this clause.
c. "Claim," as used in this clause, means a written demand or written assertion by one of the contracting parties seeking, as a matter of right, the
payment of money in a sum certain, the adjustment or interpretation of contract terms, or other relief arising under or relating to this contract.
However, a written demand or written assertion by the Landlord seeking the payment of money exceeding $100,000 is not a claim under the Act until
certified as required by subparagraph d below. A voucher, invoice, or other routine request for payment that is not in dispute when submitted is not a
groundgc (Oct 2009) cc-1
UNITEDSTATES General Conditions to USPS Ground Lease
POSTAL SERVICE
claim under the Act. The submission may be converted to a claim under the Act by complying with the submission and certification requirements of
this clause, if it is disputed either as to liability or amount or is not acted upon in a reasonable time.
d. A claim by the Landlord must be made in writing and submitted to the contracting officer for a written decision. A claim by the Postal Service
against the Landlord is subject to a written decision by the contracting officer. For Landlord claims exceeding $100,000, the Landlord must submit
with the claim the following certification:
"I certify that the claim is made in good faith, that the supporting data are accurate and complete to the best of my knowiedge and belief, that
the amount requested accurately reflects the contract adjustment for which the Landlord believes the Postal Service is liable, and that I am
duly authorized to certify the claim on behalf of the Landlord."
The certification may be executed by any person duly authorized to bind the Landlord with respect to the claim
e. For Landlord claims of $100,000 or less, the contracting officer must, if requested in writing by the Landlord, render a decision within 60 days of the
request. For Landlord -certified claims over $100,000, the contracting officer must, within 60 days, decide the claim or notify the Landlord of the date
by which the decision will be made.
f. The contracting officer's decision is final unless the Landlord appeals or files a suit as provided in the Act.
g. When a claim is submitted by or against a Landlord, the parties by mutual consent may agree to use an alternative dispute resolution (ADR)
process to assist in resolving the claim. A certification as described in subparagraph d of this clause must be provided for any claim, regardless of
dollar amount, before ADR is used.
h. The Postal Service will pay interest on the amount found due and unpaid from
1. the date the contracting officer receives the claim (properly certified if required); or
2. the date payment otherwise would be due, if that date is later, until the date of payment.
i. Simple interest on claims will be paid at a rate determined in accordance with the Act.
j. The Landlord must proceed diligently with performance of this contract, pending final resolution of any request for relief, claim, appeal, or action
arising under the contract, and comply with any decision of the contracting officer.
9. HAZARDOUS/TOXIC CONDITIONS CLAUSE
"Asbestos containing building material" (ACBM) means any material containing more than 1 % asbestos as determined by using i the method specified
in 40 CFR Part 763, Subpart E, Appendix E. "Friable asbestos material" means any ACBM that when dry, can be crumbled, pulverized �* reduced to
powder by hand pressure.
The Landlord must identify and disclose the presence, location and quantity of all ACBM or presumed asbestos containing material (PACM) which
includes all thermal system insulation, sprayed on and troweled on surfacing materials, and asphalt and vinyl flooring material unless such material
has been tested and identified as non-ACBM. The Landlord agrees to disclose any information concerning the presence of lead -based paint, radon
above 4 pCi/L, and lead piping or solder in drinking water systems in the building, to the Postal Service.
Sites cannot have any contaminated soil or water above applicable federal, state or local action levels or undisclosed underground storage tanks.
Unless due to the act or negligence of the Postal Service, if contaminated soil, water, underground storage tanks or piping or friable asbestos material
or any other hazardous/toxic materials or subbstandes as defined by applicable Local, State or Federal law are subsequently identified on the
premises, the Landlord agrees to remove such materials or substances upon notification by the U. S. Postal Service at Landlord's sole cost and
expense in accordance with EPA and/or State guidelines. If ACBM is subsequently found which reasonably should have been determined, identified,
or known to the Landlord, the Landlord agrees to conduct, at Landlord's sole expense, an asbestos survey pursuant to the standards of the Asbestos
Hazard Emergency Response Act (AHERA), establish an Operations and Maintenance (O&M) plan for asbestos management, and provide the survey
report and plan to the Postal Service. If the Landlord fails to remove any friabie asbestos or hazardous/toxic materials or substances, or fails to
complete an AHERA asbestos survey and O&M plan, the Postal Service has the right to accomplish the work and deduct the cost plus administrative
costs, from future rent payments or recover these costs from Landlord by other means, or may, at its sole option, cancel this Lease. In addition, the
Postal Service may proportionally abate the rent for any period the premises, or any part thereof, are determined by the Postal Service to have been
rendered unavailable to it by reason of such condition.
The Landlord hereby indemnifies and holds harmless the Postal Service and its officers, agents, representatives, and employees from all claims, loss,
damage, actions, causes of action, expense, fees and/or liability resulting from, brought for, or on account of any violation of this clause.
The remainder of this clause applies if this Lease is for premises not previously occupied by the Postal Service.
By execution of this Lease the Landlord certifies:
a. the property and improvements are free of all contamination from petroleum products or any hazardous/toxic or unhealthy materials or
substances, including friable asbestos materials, as defined by applicable State or Federal law;
groundgc (Oct 2009) cc-2
LINITEDSTATES General Conditions to USPS Ground Lease
POSTAL SERVICE
b. there are no undisclosed underground storage tanks or associated piping, ACBM, radon, lead -based paint, or lead piping or solder in drinking
water systems, on the property; and
c. it has not received, nor is it aware of, any notification or other communication from any governmental or regulatory entity concerning any
environmental condition, or violation or potential violation of any local, state, or federal environmental statute or regulation, existing at or adjacent to
the property.
10. FACILITIES NONDISCRIMINATION
a. By executing this Lease, the Landlord certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of
its establishments, and that it does not and will not permit its employees to perform services at any location under its control where segregated
facilities are maintained.
b. The Landlord will insert this clause in all contracts or purchase orders under this Lease unless exempted by Secretary of Labor rules, regulations,
or orders issued under Executive Order 11246.
11. CLAUSES REQUIRED TO IMPLEMENT POLICIES, STATUTES, OR EXECUTIVE ORDERS
The following clauses are incorporated in this Lease by reference. The text of incorporated terms may be found in the Postal Service's Supplying
Principles and Practices, accessible at www.usr)s.com/publications.
Clause 1-1, Privacy Protection (July 2007)
Clause 1-5, Gratuities or Gifts (March 2006)
Clause 1-6, Contingent Fees (March 2006)
Clause 4-2, Contract Terms and Conditions Required to Implement Policies, Statues or Executive Orders (July 2009)
Clause 9-3, Davis -Bacon Act (March 2006)'
Clause 9-7, Equal Opportunity (March 2006)2
Clause 9-13, Affirmative Action for Handicapped Workers (March 2006)3
Clause 9-14, Affirmative Action for Disabled Veterans and Veterans of the Vietnam Era (March 2006)"
Clause B-25, Advertising of Contract Awards (March 2006)
Note: For purposes of applying the above standard clauses to this Lease, the terms "supplier," "contractor," and "lessor" are synonymous with
"Landlord," and the term "contract" is synonymous with "Lease."
' For premises with net interior space in excess of 6,500 SF and involving construction work over $2,000.
2 For leases aggregating payments of $10,000 or more.
3 For leases aggregating payments of $10,000 or more.
For leases aggregating payments of $25,000 or more.
groundgc (Oct 2009) cc-3
Facility Name: EVANSTON-CITY PARKING GARAGE
Fin/Sub No: 162622-003
Address: 1800 Maple Street
City, ST, ZIP: EVANSTON, IL 60201-9998
Real Estate Conflict of Interest Certification
To avoid actual or apparent conflicts of interest, the United States Postal Service ("Postal Service")
requires the following certification from you as a potential Landlord/Supplier/Contractor to the Postal
Service. Please check all that apply in item A below. Further, please understand that the Postal Service
will be relying on the accuracy of the statements made by you in this certification in determining whether
to proceed with any possible transaction with you.
I, hereby certify to the Postal Service as follows:
[PRINT: name of potential Land lord/Supplier/Contractorl
A. (Check all that apply) I am:
(i) A Postal Service employee;
(ii) The spouse of a Postal Service employee;
(iii) A family member of a Postal Service employee; (Relationship)
(iv) An individual residing in the same household as a Postal Service employee;
(v) I am one of the individuals listed in (i) through (iv) above AND a controlling shareholder
or owner of a business organization leasing space or intending to lease space to the Postal
Service; OR
(vi) None of the above.
B. (Complete as applicable)
i. I have the following job with the Postal Service(Tit/e)
(Location)
ii. My Spouse who works for the Postal Service holds the following job:
(Title) (Location)
iii. My family member who works for the Postal Service holds the following job:
(Title) (Location)
iv. My household member who works for the Postal Service holds the following job:
(Title) (Location)
C. If you have checked "none of the above" and during the lease term or any renewal term, you do
fall into any of the categories listed in A (i) through (v) above, you shall notify the Postal Service
Contracting Officer in writing within 30 days of the date you fall into any of the such categories
and shall include an explanation of which of the above categories now applies.
D. The person signing this certification has full power of authority to bind the potential Landlord/
Supplier/Contractor named above.
Executed this - . day of 20_ by
BY:
BY:
Title:
[Insert Signature]
[PRINT: name of entity or person]
[Insert title]
[INTERNAL USE ONLY. • TM / RES: 1) If A(vi) 'none of the above' is selected, stop, file form with the lease. 2) If
other items are selected, submit form to Ethics. helv(a us,ps.pov. File form and Ethics determination with the lease.]
Effective March 1, 2014 Appendix A_Conflict of Interest Certification
Form W-9 Reauest for Taxnaver Give Form to the
(Rev. December entoft20Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
1 Name (as shown on your inoorne tax return). Name is required: on this line, do not leave this sine btank.
N
2 Business name/disregarded entity name, if different from above
a)
rn
m
°
3 Cheek appropriate box for fedcarai tax classkicatien, cheek only one of the foliawino seven boxes:
4 Exemptions (codes apply only to
c
❑ Individual/sole proprietor or ❑ C corporation
p ❑ S Corporation ❑ Partnership ❑ Trust/estate
certain entities, not individuals; see
instructions on page 3):
w
d e
Z C
single -member LLC
Limited liability company. Enter the tax classification C=C corporation, S=S corporation, P= artnershi ►
Exempt payee code (if any)
`o i
Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
Exemption from FATCA reporting
H
the tax classification of the single -member owner.
code (if any)
a`
❑ Other (see instructions) Do -(Applies
to accouits maintained outside the U.S.)
i8
Address (number street, and apt. orstilte no Requester's name
and address (optional)
u
d
15
a
N
6 City, state, and ZIP Code
7 List account number(s) here (optional)
■&AU Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the 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. or
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I Employer identification number
guidelines on whose number to enter. m
1 -� I I
JIM Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are got required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
Sign Signature of
Here U.S. person ► ,pate ►
General Instructions
Section references are to the Internal Revenue Code un!'ess otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs.gov/fw9.
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. Examples of information
returns include, but are not limited to, the following:
• Form 1099-INT (interest earned or paid)
• 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 TAN, you might be subject
to backup withholding. See What is backup withholding? on page 2.
By signing the filled -out form, you:
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
withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
page 2 for further information.
Cat. No. 10231 X Form W-9 (Rev. 12-2014)
Form W-9 (Rev. 12-2014)
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.
In the cases below, the following person must give Form W-9 to the partnership
for purposes of establishing its U.S. status and avoiding withholding on its
allocable share of net income from the partnership conducting a trade or business
in the United States:
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the
disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally,
the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a
grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank
that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use
the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a non-resident
alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties contain a provision known as
a "saving clause." Exceptions specified in the saving clause may permit an
exemption from tax to continue for certain types of income even after the payee
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certain types
of income, you must attach a statement to Form W-9 tha: specifies the following
five items:
1. The treaty country. Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty
article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption
from tax for scholarship income received by a Chinese student temporarily present
in the United States. Under U.S. law, this student will become a resident alien for
tax purposes if his or her stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30,
1984) allows the provisions of Article 20 to continue to apply even after the
Chinese student becomes a resident alien of the United States. A Chinese student
who qualifies for this exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax on his or her scholarship
or fellowship income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you must
under certain conditions withhold and pay to the IRS 280/0 of such payments. This
is called "backup withholding." Payments that may be subject to backup
withholding include interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, payments mace in
settlement of payment card and third party network transactions, and certain
payments from fishing boat operators. Real estate transactions are not subject to
backup withholding.
You will not be subject to backup withholding on payments you receive if you
give the requester your correct TIN, make the proper certifications, and report all
your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
Page 2
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did
not report all your interest and dividends on your tax return (for reportable interest
and dividends only), or
5. You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts opened
after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt
payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more information.
Also see Special rules for partnerships above.
What is FATCA reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
financial institution to report all United States account holders that are specified
United States persons. Certain payees are exempt from FATCA reporting. See
Exemption from FATCA reporting code on page 3 and the Instructions for the
Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be
an exempt payee if you are no longer an exempt payee and anticipate receiving
reportable payments in the future from this person. For example, you may need to
provide updated information if you are a C corporation that elects to be an S
corporation, or if you no longer are tax exempt. In addition, you must furnish a new
Form W-9 if the name or TIN changes for the account; for example, if the grantor
of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are
subject to a penalty of $50 for each such failure unless your failure is due to
reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a
false statement with no reasonable basis that results in no oackup withholding,
you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or
affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of TINs. If the requester discloses or uses TINS in violation of federal law,
the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The
name should match the name on your tax return.
If this Form W-9 is for a joint account, list first, and then circle, the name of the
person or entity whose number you entered in Part I of Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If you have
changed your last name without informing the Social Security Administration (SSA)
of the name change, enter your first name, the last name as shown on your social
security card, and your new last name.
Note. ITIN applicant: Enter your individual name as it was entered on your Form
W-7 application, line 1a. This should also be the same as the name you entered on
the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single -member LLC. Enter your individual name as
shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade,
or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line 1
and any business, trade, or DBA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the name shown on the charter or
other legal document creating the entity. You may enter any business, trade, or
DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a "disregarded
entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on
line 1. The name of the entity entered on line 1 should never be a disregarded
entity. The name on line 1 should be the name shown on the income tax return on
which the income should be reported. For example, if a foreign LLC that is treated
as a disregarded entity for U.S. federal tax purposes has a single owner that is a
U.S. person, the U.S. owner's name is required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first owner that is
not disregarded for federal tax purposes. Enter the disregarded entity's name on
line 2, "Business name/disregarded entity name." If the owner of the disregarded
entity is a foreign person, the owner must complete an appropriate Form W-8
instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.
2. You do not certify your TIN when required (see the Part II instructions on page
3 for details),
Form W-9 (Rev. 12-2014)
Line 2
If you have a business name, trade name, IDEA name, or disregarded entity name,
you may enter it on line 2.
Line 3
Check the appropriate box in line 3 for the U.S. federal tax classification of the
person whose name is entered on line 1. Check only one box in line 3.
Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a
partnership for U.S. federal tax purposes, check the "Limited Liability Company"
box and enter "P" in the space provided. If the LLC has filed Form 8832 or 2553 to
be taxed as a corporation, check the "Limited Liability Company" box and in the
space provided enter "C" for C corporation or "S" for S corporation. If it is a
single -member LLC that is a disregarded entity, do not check the "Limited Liability
Company" box; instead check the first box in line 3 "Individual/sole proprietor or
single -member LLC."
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, ente, in the
appropriate space in line 4 any code(s) that may apply to you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup
withholding.
• Except as provided below, corporations are exempt from backup withholding
for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments made in
settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to attorneys'
fees or gross proceeds paid to attorneys, and corporations that provide medical or
health care services are not exempt with respect to payments reportable on Form
1099-MISC.
The following codes identify payees that are exempt from backup withholding.
Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the requirements
of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies, or
instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United
States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures
Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment
Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section L947
The following chart shows types of payments that,maWge exempt from backup
withholding. The chart applies to the exempt payees listea above, 1 through 13.
IF the payment is for ... THEN the payment is exempt for ...
Interest and dividend payments All exempt payees except
for 7
Broker transactions Exempt payees 1 through 4 and 6
through 11 and all C corporations. S
corporations must not enter anexempt
payee code because they are exempt
only for sales of noncovered securities
acquired prior to 2012.
Barter exchange transactions and Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be Generally, exempt payees
reported and direct sales over $5,0001 1 through 52
Payments made in settlement of Exempt payees 1 through 4
payment card or third party network
transactions
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
Page 3
2 However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney reportable under
section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees
that are exempt from reporting under FATCA. These codes apply to persons
submitting this form for accounts maintained outside of the United States by
certain foreign financial institutions. Therefore, if you are only submitting this form
for an account you hold in the United States, you may leave this field blank.
Consult with the person requesting this form if you are uncertain if the financial
institution is subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or any
similar indication) written or printed on the line for a FATCA exemption code.
A —An organization exempt from tax under section 501(a) or any individual
retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more
established securities markets, as described in Regulations section
1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a
corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity
registered at all times during the tax year under the Investment Company Act of
1940
I —A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note. You may wish to consult with the financial institution, requesting this form to
determine whether the FATCA code and/or exempt payee code should be
completed.
Line 5
Enter your address (number, street, and apartment or suite number). This is where
the requester of this Form W-9 will mail your information returns.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not
have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
identification number (ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN
or EIN. However, the IRS prefers that you use your SSN.
If you are a single -member LLC that is disregarded as an entity separate from its
owner (see Limited Liability Company (LLC) on this page), enter the owner's SSN
(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC
is classified as a corporation or partnership, enter the entity's EIN.
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS-5, Application for a Social Security Card, from your local
SSA office or get this form online at www.ssa.gov. You may also get this form by
calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN online by
accessing the IRS website at www.irs.gov/businesses and clicking on Employer
Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM
(1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
and write "Applied For" in the space for the TIN, sign and date the form, and give it
to the requester. For interest and dividend payments, and certain payments made
with respect to readily tradable instruments, generally you will have 60 days to get
a TIN and give it to the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you provide your TIN to
the requester.
Note. Entering "Applied For" means that you have already applied for a TIN or that
you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use the
appropriate Form W-8.
Form W-9 (Rev. 12-2014)
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien,
sign Form W-9. You may be requested to sign by the withholding agent even if
items 1, 4, or 5 below indicate otherwise. t
For a joint account, only the person whose TIN is shown in Part I should sign
(when required). In the case of a disregarded entity, the person identified on line 1
must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as indicated in items 1
through 5 below.
1. Interest, dividend, and barter exchange accounts opened before 1984
and broker accounts considered active during 1983. You must give your
correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after
1983 and broker accounts considered inactive during 1983. You must sign the
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out
item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given an
incorrect TIN. "Other payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other than bills for
merchandise), medical and health care services (including payments to
corporations), payments to a nonemployee for services, payments made in
settlement of payment card and third party network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured
property, cancellation of debt, qualified tuition program payments (under
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct TIN, but you
do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account Give name and SSN of:
1. Individual The individual
2. Two or more individuals ljoint
The actual owner of the account or,
account)
if combined funds, the first
individual on the account'
3. Custodian account of a minor
The minor'
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
The grantor -trustee'
trust (grantor is also trustee)
b. So-called trust account that is
The actual owner'
not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
The owner'
entity owned by an individual
6. Grantor trust filing under Optional
The grantor'
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
For this type of account
Give name and EIN of:
7. Disregarded entity not owned by an
The owner
individual
8. A valid trust, estate, or pension trust
Legal entity°
9. Corporation or LLC electing
The corporation
corporate status on Form 8832 or
Form 2553
10. Association, club, religious,
The organization
charitable, educational, or other tax-
exempt organization
11. Partnership or multi -member LLC
The partnership
12. A broker or registered nominee
The broker or nominee
13. Account with the Department of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)
(B))
' List first and circle the name of the person whose number you furnish. If only one parson on a
joint account has an SSN, that person's number must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
Page 4
3 You must show your individual name and you may also enter your business or DBA name on
the "Business name/disregarded entity" name line. You may use either your SSN or EIN (if you
have one), but the IRS encourages you to use your SSN.
' List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 2.
`Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information such as your
name, SSN, or other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get a job or may file a
tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from
the IRS, respond right away to the name and phone number printed on the IRS
notice or letter.
If your tax records are not currently affected by identity theft but you think you
are at risk due to a lost or stolen purse or wallet, questionable credit card activity
or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim
Assistance.
Victims of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have not been resolved
through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
assistance. You can reach TAS by calling the TAS toll -free case intake line at
1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
emails and websites. The most common act is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the user
into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does
not request personal detailed information through email or, ask taxpayers for the
PIN numbers, passwords, or similar secret access information for their credit card,
bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this
message to phishing@irs.gov. You may also report misuse of the IRS name, logo,
or other IRS property to the Treasury Inspector General for Tax Administration
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/idtheft or
1-877-IDTHEFT (1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce your risk
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct
TIN to persons (including federal agencies) who are required to file information
returns with the IRS to report interest, dividends, or certain other income paid to
you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
MSA, or HSA. The person collecting this form uses the information on the form to
file information returns with the IRS, reporting the above information. Routine uses
of this information include giving it to the Department of Justice for civil and
criminal litigation and to cities, states, the District of Columbia, and U.S.
commonwealths and possessions for use in administering their laws. The
information also may be disclosed to other countries under a treaty, to federal and
state agencies to enforce civil and criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism. You must prov'de your TIN whether or
not you are required to file a tax return. Under section 3406, payers must generally
withhold a percentage of taxable interest, dividend, and certain other payments to
a payee who does not give a TIN to the payer. Certain penalties may also apply for
providing false or fraudulent information.