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CMAS CONTRACTOR PACKET <br />EXHIBIT T — PAYEE DATA RECORD <br />STATF-NGV}FCFNN <br />PAYEE DATA RECORD <br />(Required in lieu of IRS W -9 when doing business with the State -af California) <br />SPJ. ]L tRLV. 3Yt <br />NOTE: Governmental anoWes, federal, state, and focal (Including srhtic/ disvicts) are not required to submit this form. <br />SECTION 1 must be completed by the requesting stab agency before fawarGrp to the payer - <br />DGS Pttcstearn[ Divisive - CN A.S Unit . PURPOSE Infomtatlon contained in INs form will <br />smtEr,noRess be used by state agencbs to Prepare imiermadon <br />PLEASE 1500 - 5th SOUL, Suite 116 Ratltms (Form 199) and for witNwldng on <br />RETURN a7YWAre5ccoe payments to nonresident payees. Prompt return af <br />TO: Sacntnmro, CA 95814 this fully completed form wig Prevent delays when <br />tea<rw w.esn pmoeasing paymentL <br />(916) 324 -8045 (See Privacy Sbbment on res ji <br />RA�B1"e .4 Bentley Systems, Inc. <br />60lEPKFPiESORi -eNiFA anRQS.IIL.Ur4 NH+E M1..,N..w <br />MWLIG AnflESfi (Wn�W9R„rc P. 6 cb.'M/ee.'1 <br />685 Stockton Drive <br />Exton. PA 19341 <br />7 <br />cEmcwacxO y <br />NOTE State and <br />MEDICAL e.my,amsy, <br />L CORPORATION pfg <br />❑ ❑ <br />kcal gwemmemal <br />PAYEE <br />�. �,,,,s,, ,evpOm, cr PARTNERSHIP <br />entitles. intlt�ng <br />Ettitiy <br />TYPE <br />C EXEMPT CORPORATION(Nanpredr) F� ESTATE OR TRUST <br />schmi dehd'3 an, <br />nct regWed to <br />subma this farm, <br />- <br />ALL OTHER CORPORATIONS ❑ INDI)IWAUSOLEPROPRIETOR <br />SOCULL SECURITY NUMBER RECUIRED FOR INDtVDUAL:SOLE PROPRIETOR BY AUTHORITY OF THE <br />REYENUE AND TAXATION CODE SECTION 18&16 ISee raYH/ae) <br />NOTE Parrment <br />Witl not be <br />PAYEE'S <br />er...d%itlrout <br />TAXPAYER <br />�E.PN.;A.PUxPas aNnnuTm euwet (FFna 300.LLSEtU3n`/ uuNe9t <br />an ammgarryirq <br />I.D. NUMBER <br />tm=M LO, <br />9,5 91 31 fi , 6' 2 3 <br />-!3 • <br />nunber. <br />If aAYEa FNm�v'vPE 4ACZW.^RAPpI ?ARiNEA- IF PAV�3m.IY i�Pea MGYlCAN4(aeLc <br />SNP, STA1E OR �VSr.9(f ^i 1N PeLWC. bC 3lrS� SSUI <br />� <br />deIX.VPRGPRN230x1F3T <br />Nam <br />i An Wste it a <br />CaWlmia Resident - Cuaieed W do buabwe in CA ere permanent lace d <br />1B9d� 1 <br />v <br />d<�mdaA <br />PAYEE <br />Lmowasa in CA <br />rora <br />RESIDENLY <br />�.Nonreeldent(Sae Ravarae) 2 Vmems M mat antacr:aM may ER SNbteC _ � <br />at Wna ddamh, <br />STATUS <br />W State W Wdin <br />b. A tnat is a <br />1 WIWSReF STATe NnN MG FAOYFAANa115e TAY 91•M ➢ATfY�® <br />rbldwt It in oust <br />�� <br />Clb C'4tree 6 d <br />❑ °EQYIC(aS PJIFOP}EO CL�9B CF �nw <br />P$��lSel <br />I hereby certify under penalty of perjury that the information provided on this document <br />is true and correct. Nnry msiderrcy status should charge, f will promptly ififortn you. <br />j <br />CERTIFYING <br />Fu*>•wv:n PAr�aEPP�amArNes e..+e.�e. yPhp <br />1 <br />INGNATURE <br />Roy Ho kinson <br />I Regional Vice President <br />NU"" <br />925/824 -3112 <br />February 2001 71 <br />