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Farm
<br />W'9
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. December
<br />Identification Number and Certification
<br />requester. Do not
<br />Department
<br />Treasury
<br />Treasury
<br />send to the IRS.
<br />Internal
<br />v nue
<br />Revenue Service
<br />I Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank.
<br />Michael Baker International, Inc.
<br />2 Business name/disregarded entity name, if different from above
<br />N
<br />m
<br />rs
<br />o-
<br />3 Check appropriate box for federal tax classification; check only one of the fallowing seven boxes:
<br />4 Exemptions (codes apply only to
<br />entities, not individuals; see
<br />ocertaln
<br />❑ IndlvlduaUsole proprietor or ❑J C Corporation ❑ $ Corporation ❑ Partnership ❑ Trust/estate
<br />Instructions an page 3t:
<br />is
<br />;p
<br />single -member LLC
<br />❑ Limited liability company. Enter the tax classification (C -C corporation, S=S corporation, P=padnerstrih
<br />Exempt payee code (If any)
<br />o
<br />'$
<br />Note. For single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
<br />Exemption from FATCA reporting
<br />� H
<br />nember
<br />the tax classification of the single -member owner.
<br />s
<br />code (If any) 5
<br />a C
<br />❑ Other (see instructions) k
<br />(AppBen roacce..n rai etlo lux. um U.S.)
<br />5 Address (number, street, and apt. or suite no.)
<br />Requester's name and address (optional)
<br />U
<br />n
<br />P.O. Box 515714
<br />a City, state, and ZIP code
<br />to
<br />Los Angeles, CA 90051.5195
<br />7 List account number(s) here (Optional)
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I social security number
<br />backup withholding. For individuals, this is generally your social securityInstructions
<br />number (page However, for a m _
<br />resident alien, sole proprietor, or disregarded entity, see the Part I Instructions an page 3. For other
<br />entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
<br />TIN on page 3.
<br />
<br />
<br />
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />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
<br />2, 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b)1 have not been notified by the Internal Revenue
<br />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
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA bodies) entered on this form (If any) Indicating that I am exempt from FATCA. reporting is correct.
<br />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
<br />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
<br />interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
<br />generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />Instructions on page 3.
<br />Sign Signature of
<br />Here I U.S. person 0- ! Dated V JI`LCiI p
<br />General Instructions
<br />Section references are to the Internal Revenue Cade unless otheralse noted.
<br />Future developments, Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) is at www.irs.gov/fw9.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who Is required to He an information
<br />return with the IRE must obtain your correct taxpayer Identification number (TIN)
<br />which may be your social security number ISSN), individual taxpayer identification
<br />number fTIN), adoption taxpayer Identlidatlon number (ATIN), or employer
<br />Identification number(EIN), to report on an information return the amount paid to
<br />you, or other amount reportable on an Information return. Examples of Information
<br />returns Include, but are not limped to, the following:
<br />• Form 1099 -INT (interest earned or paid)
<br />• Farm 1099 -DIV (dividends, including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-8 (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-5 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactlons)-
<br />• Form 1099 (home mortgage interest). 1098-E (student loan interest), 1098-T
<br />(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S. person (Including a resident alien), to
<br />provide your correct TIN.
<br />li do not return Farm W-9 to the requesterwith a TIN, you might be subject
<br />to backup withholding. See What is backup withholding? an page 2.
<br />By signing the filled out form, you:
<br />1. Certify that the TIN you are giving is correct (or you are waiting for a number
<br />to be Issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />9. Claim exemption from baclkup withholding If you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership income from a U.S, trade or business is not subject to the
<br />withholding tax on foreign partners' share of effectively connected Income, and
<br />4, Certify that FATCA consist entered on this form (If any) Indicating that you are
<br />exempt from the FATCA reporting, Is correct, See What is FATCA reporting? on
<br />page 2 for further information.
<br />Cat. No. 10231X Farm W-9 (Rev. 12-20'14)
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