HomeMy WebLinkAbout32 DISTRICT AGRICULTURAL ASSOCIATION dba OC FAIR AND EVENT CENTERDocuSign Envelope ID: C6479571-74E8-4DCC-8F07-F71 D3249C902
N-2023-126
INSURANCE NOT REQUIRED
WORK MAY PROCEED
CITY CLERK
DATE: MAY 2 2 2023
FAi�&,
_V PCENTER
(Cmakr-Amtfl l
Welcome to the OC Fair & Event Center!
Some items to keep in mind while planning your event...
OC Fair & Event Center is our venue name. Please use this name on all emails, advertising, etc
when referring to our venue.
Rental Agreement and Insurance
The company name on the rental agreement must match the name of the insured on the insurance
certificate covering the event.
Payment
All payments are due one (1) month prior to your set up day.
We only accept checks.
We do not accept cash.
Parking Fee
We charge for parking.on event days. We offer the following for clients, their staff and vendors:
Promoter Parking Passes —As a courtesy, we provide ten (10) promoter parking passes
for distribution to your staff.
For events after January 1, 2024
Our building and grounds rates will go up as will some personnel rates. Please visit our website at
www.ocfair.com
Food & Beverage
Oak View Group dba OVG Hospitality is the OC Fair & Event Center's full service onsite master
concessionaire. OVG Hospitality handles all food and beverage needs at the OC Fair & Event
Center and holds the alcohol license. For your catering needs, please contact OVG Hospitality at
(714) 708-1880.
State Fire Marshal Hourly Rate
$263.00 per hour (subject to periodic change)
Thank you for choosing our venue!
The OC Fair & Event Center Team
OC FAIR & EVENT CENTER LOGO
AND BRAND GUIDELINES
• Refer to logo style guide for correct logo usage.
• Only logo artwork distributed by OC Fair & Event Center (OCFEC) may be used in any
OCFEC-related advertising, signage, decoration, promotion or any other use where
OCFEC property is depicted.
• Any use of the OCFEC artwork for sale or public distribution, including advertising,
must receive written approval from OCFEC prior to publication and/or distribution.
• OCFEC Logos may be downloaded here.
ONLY the following references to the property/organization may be used when
OC Fair & Event Center is referred to in text form within advertising or promotion:
• OC Fair & Event Center
• OC Fair & Event Center — Home of the OC Fair
• OC Fair & Event Center — Costa Mesa, California
Please sign below and return to your OCFEC coordinator
I have read and understand these branding guidelines for the, OC Fair & Event Center.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
FORM F-31 AGREEMENT NO. R-038-23
DATE March 9, 2023
REVIEWED co 3/9/23 FAIRTIME
Cd 3/9/23 JH 3110/23 INTERIM X
APPROVED
RENTAL AGREEMENT
THIS RENTAL AGREEMENT hereinafter, called the Agreement by and between the 32n' District
Agricultural Association dba OC Fair & Event Center, hereinafter called the Association, and Santa Ana
Police Department hereinafter, called the Renter. Association and Renter may be collectively referred to as the
Parties.
WITNESSETH:
1. THAT WHEREAS, The Renter desires to secure from the Association certain rights and privileges and to
obtain permission from the Association to use Association Premises: from
January 1, 2023 — December 31, 2023
2. NOW, THEREFORE, Association hereby grants to the Renter the right to occupy the space(s) described
below for the purpose hereinafter set forth, subject to the terms and conditions of this Agreement:
See Exhibit A
3. Renter shall guarantee the payment of any damage to Association property, removal of all property and the
leaving of the Premises in the same condition in which Renter took possession.
4. The purpose of occupancy shall be limited to, and shall be for no other purpose or purposes whatsoever:
Santa Ana Police Department - Officer Training
5. Renter agrees to pay to Association for the rights. and privileges hereby granted, the amounts and in the manner
set forth below:
$125.00 per day
6. The Association may retain from the deposit any amount necessary to remedy Renter defaults in the payment
of rent, repair of damage to the Premises caused by Renter, or to clean the Premises upon Renter move -out if
not left in the same condition in which Renter took possession. The deposit amount or balance, if any, and an
itemized list of any deductions shall be returned to Renter no later than thirty (30) days.
7. Renter shall abide by the additional terms and conditions indicated in the following Exhibits "A" `B" "C"
"E" "F" and "V" attached to this Agreement and incorporated by these references.
8. Renter acknowledges that the Association's Fairgrounds may be required at any time, with limited advance
notice, for the purpose of responding to an emergency declared by local, state, and/or federal government.
Association shall not be liable for any interference of Renter's use or possession of the Premises or loss to or
expenses incurred by the Renter or its subcontractors or patrons that may result from such emergency use of
the Premises.
9. If as a result of any Act of God, war, epidemic, accident, fire, violent weather or weather related disaster,
strike, lock -out, or other labor controversy, riot, civil disturbance, act of Public enemy, law enactment, rule,
restraint, order, or act of any governmental instrumentality or military authority, failure of technical facilities,
failure, delay or reduction in transportation services, firc,.explosion, or other cause not reasonably within
either Party's control and which renders either party's performance impossible, infeasible, or unsafe ("Force
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
Majeure Event'), then either party may cancel this agreement and neither party shall have any further
liabilities and/or obligations in connection with this agreement.
10. Association shalt have the right to audit and monitor any and all sates as well as access to the Premises.
11. Renter further agrees to indemnify and save harmless Association and the State of California, their officers,
agents, servants and employees, and the Association's sales agency of record (currently Moor + South/Pier
Management, Co., LP, a Delaware Limited Partnership dba Tandem) from any and all claims, causes of action
and suits accruing or resulting from any damages, injury or loss to any person or persons, including all persons
to whom the Renter may be liable under any Workers' Compensation law and Renter himself and from any
loss, damage, cause of action, claims or suits for damages including but not limited to loss of property, goods,
wares or merchandise, caused by, arising out of or in any way connected with the exercise by Renter of the
privileges herein granted.
12. Renter further agrees to not sell, exchange or barter, or permit his employees to sell, exchange or barter, any
licenses or permits issued to Renter or its employees.
13. It is mutually understood and agreed that this contract or the privileges granted herein, or any part thereof,
cannot be assigned or otherwise transferred without the written consent of Association. Subleasing of the
Premises is prohibited.
14. It is mutually understood and agreed that no alteration or variation of the terms of this contract shall be valid,
unless made in writing and signed by the Parties hereto, and that no oral understanding or agreements not
incorporated herein and no alterations or variations of the terms hereof, unless made in writing and signed by
the Parties hereto, shall be binding upon any of the Parties hereto.
15. The Rules and Regulations printed on the next page are made a part of this Agreement as though fully
incorporated herein, and Renter agrees that he has read this Agreement and the said Rules and Regulations
and understands that they shall apply, unless amended by mutual consent in writing of the Parties hereto.
16. In the event Renter fails to comply in any respect with the terms of this Agreement and its Exhibits referred
to herein, all payments under this Agreement shall be deemed earned and non-refundable by Association, and
Association shall have the right to occupy the Premises in any manner deemed for the best interest of
Association.
17. Special Provisions: The Event Sales & Services Policies & Procedures Handbook does hereby
become a part of this Agreement by reference and is on file with the Association. By signing the
Agreement, Renter acknowledges that they have read the Event Sales & Services Policies & Procedures
Handbook and agrees to abide by said Policies and Procedures.
18. This Agreement is not binding upon Association until it has been signed by its authorized representative.
IN WITNESS WHEREOF, the Parties hereto have affixed their signatures on the date shown below. The
signatories represent and warrant that they were duly authorized by their respective governing bodies to execute
this Agreement and the Parties hereby agree to all the terms and conditions set forth in this Agreement.
Santa Ana Police Department 32nd District Agricultural Association
20 Civic Center Plaza 88 Fair Drive
Santa Ana, CA 92701 Costa Mesa, CA 92626
II 05/10/2023 1 12:20:30 PDT
yDater By: �AiMIU Date:
Lr Valentin, Chief of Pol' a Title: Joan Hamill, Chief Business Development Officer
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
ATTEST:
w
Clerk of the council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By.
TAMARA BOGOSIAN
Senior Assistant City Attorney
RECOMMENDED FOR APPROVAL:
CITY OF SANTA ANA
KRISTINE RIDGE
City Manager
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
RULES AND REGULATIONS GOVERNING RENTAL SPACE
1. No Renter will be allowed to open until all the preliminary requirements herein set forth have been
complied with.
2. Renter will conduct his business in a quiet and orderly manner; will deposit all rubbish, slop,
garbage, tin cans, paper, etc. in receptacles provided by the Association within Premises plot for such
purpose, and will keep the area within and surrounding Premises free from all rubbish and debris.
3. All buildings, temporary tents, or enclosures erected by Renter shall have the prior written approval of
Association and the local fire suppression authorities. Renter shall not affix any fixtures to the Premises without
the written preapproval of the Association and if the removal of the fixture may be affected without injury to the
Premises. Upon request, Renter will furnish Association with a list of all sales prices and other charges of any
kind whatsoever to be charged by the Renter. If Renter is a food serving concession and not restricted to specific
items, Renter shall submit menus and prices to Association for approval at least twelve (12) hours in advance of
each day's operation. Upon request, Renter must furnish to Association receipts for license fees, tax deposits,
insurance, etc., prior to event.
4. Renter will conduct the privileges granted in this Agreement according to all the rules and requirements
of applicable state and local health authorities, and without infringement upon the rights and privileges of others;
will not handle or sell any commodities or transact any business whatsoever for which an exclusive privilege is
sold by Association, nor engage in any other business whatsoever upon or within said Premises or Fairgrounds,
except that which is herein expressly stipulated and contracted for; will confine said transactions to the Premises
and privilege provided in the Agreement, and that any and all exclusives granted Renter shall not include the
Carnival and the Carnival Area.
5. Renter will post in a conspicuous manner at the front entrance to the concession, a sign showing the prices
to be charged for all articles offered for sale to the public under the Agreement; the size of said sign, manner and
place of posting to be pre -approved by Association.
6. Association will furnish necessary janitor service for all aisles, streets; roads and areas used by the public,
but Renter must, at his/her own expense, keep the Premises and adjacent areas properly arranged and clean.. All
concessions must be clean, all coverings removed, and the concession ready for business each day at least one
hour before the Fair is open to the public. Receptacles will be provided at several locations to received Renter's
trash, and such trash must not be swept into the aisles or streets or any public areas.
7. All sound -producing devices used by Renter within the Premises must be of such a nature and must be so
operated, as not to cause annoyance or inconvenience to patrons or to other Concessionaires or Exhibitors. The
decision of Association as to the desirability of any such sound producing device shall be final and conclusive.
Sound -amplification equipment may be installed only by first obtaining written permission thereof from
Association.
8. Renter agrees that there will be no games, gambling or any other activities in which money is used as a
prize or premium, and that Renter shall not buy and/or permit "buy backs" for cash, any prizes or premiums given
away to patrons. Only straight merchandising methods shall be used and all methods of operation, demonstration
and sale, shall be subject to the approval of the Association and the local law enforcement officials.
9. Renter is entirely responsible for the Premises and agrees to reimburse Association for any damage to the
real property, equipment, or grounds use in connection with the Premises, reasonable wear and tear expected.
Renter agrees to inspect the conditions of the Premises and of all property it will use on the Premises, including
but not limited to equipment, furniture or other personal property owned by Association, and to be entirely
responsible for the use of the Premises and such property.
10. Association may provide watchman service, which will provide for reasonable protection of the property
of Renters, but Association shall not be responsible for loss or damage to the property of Renter.
DocuSign Envelope ID: CB479571-74E84DCC-8F07-F71D3249C902
11. Each and every article and all boxes, crates, packing material, and debris of whatsoever nature must be
removed from the Premises by Renter, at Renter's own expense, upon expiration or early termination of this
Agreement. It is understood that in the event of Renter's failure to vacate said Premises herein provided, unless
permission in writing is first obtained, Association may and is hereby authorized and made the agent of Renter to
remove all remaining material of any nature whatsoever, at the Renter's risk and expense, and Renter shall
reimburse Association for expenses thus incurred.
12. No Renter will be permitted to sell or dispose of anywhere on the Premises alcoholic beverages as defined
in the Alcoholic Beverage Control Act, unless Association authorizes Renter in writing and unless Renter holds
a lawful license authorizing such sales on the Premises.
13. All safety orders of the Division of Industrial Safety, Department of Industrial Relations, must be strictly
observed,
14. Failure of Association to insist in any one or more instances upon the observance and/or performance of
any of these terms and conditions of this Agreement shall not constitute a waiver of any subsequent breach of any
such rules and regulations.
15. This Agreement shall be subject to termination by either party at any time prior to or during the term
hereof by giving the other party notice in writing at least 30 days prior to the date when such termination shall
become effective. Such termination shall relieve the Association of any further performance of the terms of this
Agreement.
16, "Contractor, by signing this contract, does swear under penalty that no more than one final unappealable
finding of contempt of court by a Federal court has been issued against that contractor within the immediately
preceding two-year period because of the Contractor's failure to comply with an order of the National Labor
Relations Board (Government Code Section 14780.5) (SAM Sec. 12127)."
17. Renter recognizes and understands that this Agreement may create a possessory interest subject to property
taxation and that the Renter may be subject to the payment or property taxes levied on such interest.
18. The Association shall have the privilege of inspecting the Premises covered by this Agreement at any time
or all times. Association shall have the right to retain a key to the Premises and may enter with at least 24-hour
written notice to Renter.
19. The Parties hereto agree that Renter, and any agents and employees of Renter, in the performance of this
Agreement, shall act in an independent capacity and not as officers or employees or agents of Association.
20. Time is of the essence of each and all the provisions of this Agreement, and the provisions of this
Agreement shall extend to and be binding upon and inure to the benefit of the heirs, executors, administrators,
successors, and assigns of the respective parties hereto.
Memo for Fair Management: Hazardous Agreements. If this Agreement provides for a hazardous activity,
the current Form FE-13, Statement Regarding Insurance, must be attached to each copy and incorporated
by reference in Paragraph 11 of page two.
By state law and in the interest of public health, smoking shall not be permitted in or within 20 feet of any
State of California building, including the Santa Ana Pavilion area, OC Promenade area, Centennial Farm,
Kidland carnival area, the Livestock area, Pacific Amphitheatre seating area, and Arena grandstand and
bleacher seating areas. This policy includes the use of electronic cigarettes, vaporizers and oil/wax pens.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3249C902
EXIIIBIT "A"
Event Name: Santa Ana Police Department Officer Training Contract No: R-038-23
Contact Person: Damian Moreno, Officer Phone: (714) 245-8212
Event Dates: O1/01/2023 - 12/31/2023 Hours: 7:00 AM - 4:00 PM
Projected Attendance: 15
LOCATION(S):
2023 Available Parking Lot........................................................................................................................... $125.00 Per Day
RENTER AGREES:
• That this agreement covers all officer training sessions to take place in parking lots at the OC Fair & Event Center
during the 2023 calendar year.
• To contact the Event Sales & Services Department at (714) 708-1545 prior to scheduling any training sessions to ensure
that the location is available.
• To pay $125.00 per parking lot per day for all parking lot usage in 2023, in addition Renter shall compensate for parking
lot usage In 2022. Renter agrees to pay OCFEC for services provided in calendar year 2022 totaling $2,000.00 as
provided in invoice Ws 12377, 12376, 12375, 12112 and 12053, which shall be incorporated by reference. Parties agree
that this amount and invoices reflect all services and outstanding invoices for calendar year 2022 and no other
outstanding amounts are owed by Renter.
• That an OC Fair & Event Center written confirmation approving each date and specific location is required
prior to Renter scheduling a training session. This avoids any miscommunication between Renter's attendees
and the OC Fair & Event Center.
• To provide proof of insurance upon signing this agreement.
• To notify the District (OCFEC) of any accident that takes place during the training. The Safety & Traffic Department
can be reached by phone at (714) 708-1588, 24 hours a day, or they can be located at the Safety & Traffic Office
near Gate 5 off Arlington Drive between the hours of 6:00 AM -12:00 Midnight.
• To reimburse the District (OCFEC) for any out of pocket expenses related to this event/training session.
• That any and all equipment, materials and vehicles will be removed from OCFEC properly after the final day of training
or after each single day session.
• That alcohol brought on grounds by participants, attendees or event personnel is strictly prohibited.
• That loud noises are not allowed on the property at anytime due to the proximity of adjacent residential housing tracks,
City Hall and City services. Such sound violations can be cause for termination of your event/training session and
removal from the premises.
• That damage occurring in the parking lot and/or of OCFEC property will be itemized and invoiced. Payment will be
due prior to any new activity taking place at the OC Fair & Event Center.
• To limit speeds to no more than 40 MPH.
• That parking lot usage will be conducted in a safe manner, with consideration of other activities taking place at the OC
Fair & Event Center. To ensure safety within and around your event, the District (OCFEC) may, at the expense of the
Renter, construct a barrier around the perimeter of the driving portion of the event. Renter will be responsible for all
further necessary precautions in and around the event/training session.
DocuSlgn Envelope ID: CB479571-74E8-4DCC-8F07-F7l D3249C902
It is mutually understood that any additions to this agreement shall be achieved through either a signed amendment or service order, The
OCFEC will make every effort to contain the need to add services and equipment placement, It is agreed, however, that safety and
security additions deemed necessary, as determined by OCFEC management for purpose of protecting all persons on OCFEC property,
are not negotiable and will not be compromised.
CANNABIS EVENTS
OC Fair & Event Center (OCFEC) does not currently book any cannabis -related events. This policy also extends to existing events at
OCFEC. OCFEC does not permit vendors, booths, exhibits, displays, signage, etc from cannabis dispensaries or third -parties that sell
cannabis -related products as part of any event. Event sponsors, vendors and/or exhibitors may not distribute, sell or promote cannabis
products or drug paraphernalia during any event at OCFEC.
EVENT PROGRAM POLICIES AND PROCEDURES
As specified on page 1 of this Rental Agreement, the Event Sales & Services Policies & Procedures Handbook is a part of this
Agreement, and Renter agrees to abide by said Policies and Procedures. The handbook is located on the OC Fair & Event Center
website, and can also be accessed at httos://ocfair•conk/wp-coutenthmloadalQ,i$/`lffg1 . sproce l ry�,BQq_klet2l8v2 f
EXHIBIT V
See Exhibit V for OCFEC COVID-19 Infection Mitigation Protocol and Procedure Guidelines,
OAK VIEW GROUP dba OVG HOSPITALITY
All food and beverage service must be discussed with and approved by OVG Hospitality, the OCFEC Master Concessionaire.
RECYCLING / SB 1383
SB 1383 is a California statute commonly known as the Short -Lived Climate Pollutants: Organic Waste Reductions Law. The statute
requires food generator entities including, but not limited to, large venues, large events, county fairgrounds and state agencies to recycle
their organic waste including, but not limited to, food and green material waste, paper products, biosolids and digestate and in some
cases, to donate edible food. SB 1383 recovery requirements include a 75% reduction in landfilled organic waste and a 20% increase
in recovery of currently disposed edible food by 2025. The OC Fair & Event Center is already actively engaged and fully committed to
meeting SB 1383 guidelines by way of in-house recycling initiatives and measures, but is also critically dependent upon compliance of
all year round show promoters/producers while on property during their event, It is of utmost importance that all operators adhere to
direction provided by OCFEC staff.
SOUND ORDINANCE
Per City Ordinance, loud noise is not allowed during move in and move out between the hours of 9:00 PM to 8:00 AM. Please refer to
Exhibit E. Sound Monitor/Engineer must be on site for sound check and all music performances. All outside (on grounds) amplified
music/sound must end by 10:00 PM on Friday and Saturday, and by 9:00 PM Sunday through Thursday unless otherwise
approved in writing by OCFEC. Bull horns or similar devices are not allowed. Vendors are prohibited from playing any sound
systems (radios, public address systems, portable speakers, etc) that create amplified sound. Any proposed outdoor music/sound
producing entertainment (i.e. - DJ, stage performance, etc) must be discussed with and approved by OCFEC Sound Engineer prior to
the event. Installation of suitable barriers is also required by OCFEC as a sound mitigation measure (see above sound mitigation
terms). Should the Sound Engineer/Sound Monitor or Event Coordinator request that the volume of music, sound or noise be
lowered or turned off, Santa Ana Police Department must comply with request.
STATE FIRE MARSHAL
Event footprint capacity will be determined by State Fire Marshal. Santa Ana Police Department must comply with all California State
Fire Codes. State Fire Marshal may require changes to event layout. If so, Santa Ana Police Department must execute changes within
the specified time frame.
DouiSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3249C902
California Fair Services Authority
INSURANCE REQUIREMENTS
(revised effective January 1, 2023)
I. Evidence of Coverage
The contractor/renter shall provide a signed original evidence of coverage form for the term of the
contract or agreement (hereinafter "contract") protecting the legal liability of the State of California,
the California Fair Services Authority, District Agricultural Associations, County Fairs, Counties
in which County Fairs are located, Lessor/Sublessor if fair site is, leased/subleased, Citrus Fruit
Fairs, California Exposition and State Fair, or Entities (public or non-profit) operating California
designated agricultural fairs, their directors, officers, agents, servants, and employees, from occurrences
related to operations under the contract. This may be provided by:
A. Insurance Certificate - The contractor/renter provides the fair with a signed original certificate
of insurance (the ACORD form is acceptable), lawfully transacted, which sets forth the
following:
1. List as the Additional Insured: "That. the State of California, the California Fair.
Services Authority, the District Agricultural Association, County Fair, the County in
which the County Fair is located, Lessor/ Sublessor if fair site is leased/subleased, Citrus
Fruit Fair, California Exposition and State Fair, or Entities (public or non-profit)
operating California designated agricultural fairs, their directors, officers, agents,
servants, and employees are made additional insured, but only insofar as the operations
under this contract are concerned."
2. Dates: The dates of inception and expiration of the insurance. For individual events,
the specific event dates must be listed, along with all set-up and tear down dates.
3. Coverages:
a. General Liability - Commercial General Liability coverage, on an occurrence
basis, at least as broad as the current Insurance Service Office (ISO) policy form
#CG 00-01. Limits shall not be less than for the limits in the CFSA
Hazardous/Nonhazardous Activities List which includes, but is not limited to, the
following: $5,000,000 per occurrence for Carnival Rides and for Freefall
Attractions (elevated jumps involving airbags); $5,000,000 per occurrence
for the following types of Motorized Events: Automobile races, drifting
exhibitions, burnout contests/competitions, truck rodeos, tractor/truck pulls,
destruction derbies, RV destruction derbies, mud bogs, mud racing, car crunches,
monster truck shows, automobile thrill shows, figure 8 racing, stock car racing,
tuff trucks, boat races, autocross, dirt racing, oval track, sprint cars/410 sprints,
modified, super stock, mini -stock, dwarf cars, micro lights, endure, pro stock.
$3,000,000 per occurrence for the following types of Motorized Events:
motorcycle racing, flat track motorcycle racing, arena -cross, freestyle motocross,
motorcycle thrill shows and stunt teams, ATV, sand drags, go karts, snowmobile
races, quarter midget races, golf cart races, Redneck Roundup (ATVs),
lawnmower races. $3,000,000 per occurrence for Rodeo Events all types with a
paid gate and any Rough Stock Events such as Bull Riding, Bareback, Saddle
Revised Eff. January 1, 2023
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
Page 2
Brone, or Mutton Busting; $2,000,000 per occurrence for the following:
Concerts: 2,000 and more attendees; Extreme Attractions: All Types, including
but not limited to bungee attractions, ejection seats, sky scrapers, Trampoline
Things/quad jumpers, zip line or similar attractions requiring a Cal/OSHA permit
to operate; Fair time Kiddie Carnival Rides: Up to 6 kiddie rides (includes book -
in rides); Interim Carnival Rides; Extreme Attractions; Law Enforcement: All
types, including but not limited to city police, county sheriff, California Highway
Patrol, county probation, California Department of Corrections, state or federal
military. Mutual indemnification in the contract may substitute for coverage with
written approval from CFSA. Mechanical Bulls; Motorized Events: Car jumping
contests/demonstrations of hydraulic modifications to automobiles; Rave Type
Events: Any dance or concert which extends beyond midnight; Rodeo Events: All
Types without a paid gate and with any Rough Stock Events such as Bull Riding,
Bareback, Saddle Brone, or Mutton Busting; Simulators; $1,000,000 per
occurrence for Rodeo Events All Types without any Rough Stock Events but
including barrel racing, penning, and roping; $1,000,000 per occurrence for all
other contracts for which liability insurance (and liquor liability, if applicable) is
required,
The Certificate of Insurance shall list the applicable policy forms, including
endorsements. Any exclusions or coverage limitations, including sub -limits, that
apply to the contractor/renter's activities, or business to be conducted under the
contract or rental agreement/lease, must be listed in the Certificate of Insurance.
If there is a self -insured retention or deductible in the contractor/renter's coverage
equal to or in excess of $.100,000, the self -insured retention/deductible amount
shall be included as part of the Certificate of Insurance. A copy of the
contractor/renter's policy declaration page containing this information as an
attachment/exhibit to the Certificate of Insurance will be acceptable, provided it
contains all the aforementioned information.
b. Automobile L i ability - Commercial Automobile Liability coverage, on a per
accident basis, at least as broad as the current ISO policy form # CA 00-01,
Symbol 41 (Any Auto) with limits of not less than $1,000,000 combined single
limits per accident for contracts involving use of contractor vehicles (autos,
trucks or other licensed vehicles) on fairgrounds,
c. Workers' Compensation - Workers' Compensation coverage shall be maintained
covering contractor/renter's employees, as required by law.
d. Medical Malpractice - Medical Malpractice coverage with limits of not less
than $1,000,000 per occurrence shall be maintained for contracts involving
medical services.
e. Liquor Liability -Liquor Liability coverage with limits of not less than $1,000,000
per occurrence shall be maintained for contracts involving the sale of alcoholic
beverages.
Revised Eff. January 1, 2023
DocuSign Envelope ID: CB479671-74E8-4DCC-8F07-F71 D3249C902
Page 3
4. Cancellation Notice: Notice of cancellation of the listed policy or policies shall be sent
to the Certificate Holder in accordance with policy provisions.
5. Certificate Holder:
• For Individual Events Only - Fair, along with fair's address, is listed as the certificate
holder.
• For Master Insurance Certificates Only - California Fair Services Authority, Attn:
Risk Management, 1776 Tribute Road, Suite 100, Sacramento, CA 95815 is listed as
the certificate holder.
6. Insurance Company: The company providing insurance coverage must be acceptable to
the California Department of Insurance.
7. Insured: The contractor/renter must be specifically listed as the Insured.
OR
B. CFSA Special Events Program - The contractor/renter obtains liability protection through
the California Fair Services Authority (CFSA) Special Events Program, when applicable,
W
C. Master Certificates - A current master certificate of insurance for the contractor/renter has been
approved by and is on file with California Fair Services Authority (CFSA).
•'
D. Self -Insurance - The contractor/renter is self -insured and acceptable evidence of self- insurance
has been approved by California Fair Services Authority (CFSA).
H. General Provisions
1. Maintenance of Coveraee - The contractor/renter agrees that the commercial general liability
(and automobile liability, workers' compensation, medical malpractice and/or liquor liability, if
applicable) insurance coverage herein provided for shall be in effect at all times during the
term of this contract. In the event said insurance coverage expires or is cancelled at any time
or times prior to or during the term of this contract, contractor/renter agrees to provide the
fair, prior to said expiration date, a new certificate of insurance evidencing insurance
coverage as provided for herein for not less than the remainder of the term of the contract, or
for a period of not less than one (1) year. New certificates of insurance are subject to the
approval of California Fair Services Authority, and contractor/renter agrees that no work or
services shall be performed prior to the giving of such approval. In the event the
contractor/renter fails to keep in effect at all times insurance coverage as herein provided, the fair
may, in addition to any other remedies it may have, take any of the following actions: (1) declare
a material breach by contractor/renter and terminate this contract; (2) withhold all payments
due to contractor/renter until notice is received that such insurance coverage is in effect; and
Revised Eff. January 1, 2023
DocuSign Envelope ID: CB479571-74E8-4DCC-8FO7-F71D3249C902
Page 4
(3) obtain such insurance coverage and deduct premiums for same from any sums due or which
become due to contractor/renter under the terms of this contract
2. Primary Coverage - The contractor/renter's insurance coverage shall be primary and any
separate coverage or protection available to the fair or any other additional insured shall be
secondary.
3. Contractor's Responsibility - Nothing herein shall be construed as limiting in any way the
extent to which contractor/renter may be held responsible for damages resulting from
contractor/renter's operations, acts, omissions or negligence. Insurance coverage obtained in
the minimum amounts specified above shall not relieve contractor/renter of liability in excess
of such minimum coverage, nor shall it preclude the fair from taking other actions available
to it under contract documents or by law, including, but not limited to, actions pursuant to
contractor/renter's indemnity obligations. The contractor/renter indemnity obligations shall
survive the expiration, termination or assignment of this contract.
4, Certified Copies of Policies - Upon request by fair, contractor/ranter shall immediately furnish
a complete copy of any policy required hereunder, with said copy certified by the underwriter to
be a true and correct copy of the original policy, Fairtirne Carnival Ride contractors must
submit copies of actual liability insurance policies, certified by an underwriter, to California
Fair Services Authority (CFSA).
III. Participant Waivers
1. For hazardous participant events (see subsection 4, below), the contractor/renter agrees to
obtain a properly executed release and waiver of liability agreement (Form required by
contractor/renter's insurance company or CFSA Release and Waiver Form) from each
participant prior to his/her participation in the events sponsored by contractor/renter.
2. Contractor/renter shall ensure that any party renting space from the contractor/renter with, or
for, hazardous participant events (see subsection 4. below) obtains a properly executed release
and waiver of liability agreement (Form required by contractor/renter's insurance company or
CFSA Release and Waiver Form) from each participant prior to his/her participation in the
events and provides a copy to the contractor/renter.
3. The contractor/renter shall provide copies of all executed release and waiver of liability
agreements required under subsections 1. and 2, above to the Fair at the end of the rental
agreement.
4. Hazardous participant events include, but are not limited to, any event within the following
broad categories: Athletic Team Events; Equestrian -related Events; Extreme Attractions;
Freefall Attractions; Mechanical Bulls; Simulators; Motorized Events; Rodeo Events; and
Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair
Services Authority, Risk Management Department at (916) 921-2213 for further information
and for CFSA Release and Waiver Form.
Revised Eff. January 1, 2023
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3249C902
State of California EXHIBIT "C" Division of Fairs & Expositions
STANDARD CONTRACT TERMS AND CONDITIONS (F-31, RENTAL AGREEMENT)
1. National Labor Relations Board WCC section 10296)
Contractor, by signing this contract, does swear under penalty of perjury that no more than one
final unappealable finding of contempt of court by a Federal Court has been issued against
contractor within the immediately preceding two-year period because of the contractor's failure to
comply with an order of a Federal Court which orders the contractor to comply with an order of
National Labor Relations Board (Public Contract Code Section 10296).
2. Resolution of Contract Disputes (PGG 1az4o.5. IuasI
If, during the performance of this agreement, a dispute arises between contractor and Fair
Management, which cannot be settled by discussion, the contractor shall submit a written
statement regarding the dispute to Fair Management. A decision by Fair Management shall be
made to the Contractor in writing, and shall be final and conclusive. Contractor shall continue to
perform contract requirements without interruption during the dispute period.
3. Non -Discrimination Clause
During the performance of this Agreement, Contractor and its subcontractors shall not deny the
contract's benefits to any person on the basis of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical condition, genetic information, marital
status, sex, gender, gender identity, gender expression, age, sexual orientation, or military and
veteran status, nor shall they discriminate unlawfully against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability,
mental disability, medical condition, genetic information, marital status, sex, gender, gender
identity, gender expression, age, sexual orientation, or military and veteran status. Contractor
shall insure that the evaluation and treatment of employees and applicants for employment are
free of such discrimination. Contractor and subcontractors shall comply with the provisions of the
Fair Employment and Housing Act (Gov. Code §12900 et seq.), the regulations promulgated
thereunder (Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part
1, Division 3, Title 2 of the Government Code (Gov. Code §§11135-11139.5), and the regulations
or standards adopted by the awarding state agency to implement such article. Contractor shall
permit access by representatives of the Department of Fair Employment and Housing and the
awarding state agency upon reasonable notice at any time during. the normal business hours, but
in no case less than 24 hours' notice, to such of its books, records, accounts, and all other
sources of information and its facilities as said Department or Agency shall require to ascertain
compliance with this clause. Contractor and its subcontractors shall give written notice of their
obligations under this clause to labor organizations with which they have a collective bargaining
or other agreement. (See Cal. Code Regs., tit. 2, §11106.)
Contractor shall include the nondiscrimination and compliance provisions of this clause in all
subcontracts to perform work under the Agreement.
4. Amendment (GC 11010.5)
Contract modification, when allowable, may be made by formal amendment only.
6. Assldnment
This Agreement is not assignable by the Contractor, either in whole or in part, without the
consent of the State in the form of a formal written amendment.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3249C902
6. Termination
The State reserves the right to terminate any contract, at any time, upon order of the Board of
Directors by giving the contractor notice in writing at least 30 days prior to the date when such
termination shall become effective. Such termination shall relieve the fair of any further
payments, obligations, and/or performances required in the terms of the contract.
Contractor may submit a written request to terminate this agreement only if the State should
substantially fail to perform its responsibilities as provided herein.
However, the agreement can be immediately terminated for cause. The term "for cause" shall
mean that the Contractor fails to meet the terms, conditions, and/or responsibilities of the
contract. In this instance, the contract termination shall be effective as of, the date indicated on
the State's notification to the Contractor.
This agreement may be suspended or cancelled without notice, at the option of the Contractor, if
the Contractor or State's premises or equipment are destroyed by fire or other catastrophe, or so
substantially damaged that it is impractical to continue service, or in the event the Contractor is
unable to render service as a result of any action by any governmental authority.
SCTC, F-31 (revised 10/01)
7. Governin_a Law
This contract is governed by and shall be interpreted in accordance with the laws of the State of
California.
8. Conflict of Interest (PCC 10410, 10411,10420)
Contractor needs to be aware of the following provisions regarding current or former state
employees. If Contractor has any questions on the status of any person rendering services or
involved with the Agreement, the awarding agency must be contacted immediately for
clarification.
Current State Employees (PCC 10410):
1) No officer or employee shall engage in any employment, activity or enterprise from which the
officer or employee receives compensation or has a financial interest and which is sponsored
or funded by any state agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
2) No officer or employee shall contract on his or her own behalf as an independent contractor
with any state agency to provide goods or services.
Former State Employees (PCC 10411):
1) For the two-year period from the date he or she left state employment, no former state officer
or employee may enter into a contract in which he or she engaged in any of the negotiations,
transactions, planning, arrangements or any part of the decision -making process relevant to
the contract while employed in any capacity by any state agency.
2) For the twelve-month period from the date he or she left state employment, no former state
officer or employee may enter into a contract with any state agency if he or she was employed
by that state agency in a policy -making position in the same general subject area as the
proposed contract within the 12-month period prior to his or her leaving state service. If
DocuSign Envelope ID: CB479571-74E84DCC-8F07-F71D3249C902
Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (PCC 10420).
9. Contractor Name Change
An amendment is required to change the Contractor's name as listed on this Agreement. Upon
receipt of legal documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval of said
amendment.
10. Air or Water Pollution Violation (WC 13301)
Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not
subject to review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of
the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3)
finally determined to be in violation of provisions of federal law relating to air or water pollution.
State of California Division of Fairs & Exposition SCTC, F-31 (revised 12/19)
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3249C902
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
1r FAIR,�.
`EVVNTCENTER
Exhibit F - Assembly Bill 1499
If you haven't already heard, the California Legislature enacted Assembly Bill 1499 (AB 1499).
The bill became effective July 1, 2018 and requires retailers (commercial exhibitors/vendors,
merchants, concessionaires, etc) who make sales of tangible personal property at a California
state -designated fairground to separately report the sales amount on their Sales and Use Tax
Return. The OC Fair & Event Center (OCFEC) is a California state -designated fairground.
When you operate at the OCFEC as well as at other state -designated fairgrounds, on -
premises sales that you and/or your vendors generate are to be reported separately for each
specific fairground.
Please note that AB 1499 does not impact current state and local sales tax charged In Orange
County or in other California locales. It does, however, direct the California Department of
Tax and Fee Administration (CDTFA) to reallocate 3/4 of 1% of the total amount of reported
gross receipts and to appropriate these monles to the Fair and Exposition Fund for specified
fairground operational and infrastructure needs projects. This funding contributes to
upgraded fairground facilities that will help event producers and vendors grow their
businesses.
Below are links to helpful Information on how this may affect you and your vendors.
Please take the time to read through the Information and pass along to all of your vendors
who will be on OC Fair and Event Center property for your upcoming event.
If you or your vendors have any questions, please contact the California Department of Tax
and Fee Administration's customer service line at 1-800-400-7115. Representatives are
available Monday - Friday (except state holidays), from 8:00 a,m. to 5:00 p.m. (Pacific time).
California Department of Tax and Fee Administration
httf)://www.cdtfa.ca.gov/lndu5try/gtAte-faircir<)urwds htm
California Legislative Information
Westerns Fairs Association
https //www westernfairs org/plmembers/subsidlaries/cfa/ab1499
Thank you for being a valued part of the OCFEC's Year Round Event Program and ensuring
that all of your participating retailers are aware of and In compliance with AB 1499. We look
forward to your upcoming events.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3249C902
EXHIBIT V
COVID-19 INFECTION MITIGATION PROTOCOL & PROCEDURE GUIDELINES
Scope. As a result of the worldwide COVID-19 pandemic, the 32°a District agricultural
Association (OCFEC) implemented numerous essential protocols and procedures to protect
OCFEC staff, renters, event promoter/producer employees, exhibitors, vendors, contractors,
subcontractors, volunteers and members of the public. These protocols and procedures do not
supersede or replace any existing orders issued by local governments, the State of California or
the Federal Government. The protocol and procedure guidelines (COVID-19 Guidelines) apply
equally to all organizations and persons doing business on OCFEC property, both public and
private, and all event types, commercial, trade or other, hosted at the OCFEC.
2, Sick, elderly and vulnerable persons. Anyone who feels sick should remain at home. In
addition, high -risk persons who are over 65 years of age, or anyone with chronic illness or
underlying medical conditions, should continue to follow recommendations to stay at home and
limit public interaction.
3. Physical Distancing in the Workplace. Physical distancing of a minimum of six (6) feet
should be maintained between customer -facing employees and the general public, and — to the
extent practical — between employees in the field or at employee workstations. Where isolation
of employees in the field or at employee workstations is impractical, face coverings must be
worn without exception.
4. Handwashing, Personal Protective Equipment, and Testing. Renters, event promoters,
event producers, exhibitors, vendors, and their respective contractors, subcontractors and
volunteers (collectively, "Business Partners") conducting business at the OCFEC must require
all customer -facing employees to either wash their hands or use hand sanitizer every thirty
minutes, or wear disposable gloves which are to be changed as frequently as specified by
guidelines established for each applicable job assignment, Face coverings must be provided to
all employees.
Before starting a shift, all OCFEC employees and all Business Partner employees, must have
their temperatures taken and documented, and individual(s) will not be permitted to remain at
work if the temperature reading exceeds 100A degrees (0) Fahrenheit. Affected individual(s)
may only return to work after registering and documenting their temperature reading below
100,4° Fahrenheit for seventy-two (72) consecutive hours.
All OCFEC event attendees, before entering OCFEC premises, must have their temperatures
taken and documented. Any OCFEC event attendee with a temperature reading above 100.4°
Fahrenheit will not be permitted to attend the event and will be required to immediately leave
the OCFEC premises. Paid admission/parking fee refunds will be subject to processing
schedule.
All competitive professional and amateur sports participants, including youth sports
participants, must be tested for COVID-19 at least one (1) week before the date of the
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71 D3240C902
scheduled competition, and will not be permitted to compete if the intended participant tests
positive for COVID-19. If the intended participant tests positive for COVID-19, he/she will not
be allowed to participate in any activities at the OCFEC until after (i) receiving a negative
result on a subsequent COVID-19 test and (ii) satisfying the specified 14-day (or otherwise
governmentally specified) COVID-19 quarantine period.
OCFEC Business Partners should make every effort to limit physical touch points at their
respective places of business, including at the OCFEC. All OCFEC event promoters must
significantly increase frequency of sanitation and disinfection measures at all workstations and
equipment that come into contact with OCFEC employees and the general public. All OCFEC
Business Partners must assess and identify the frequency of necessary sanitation and
disinfection practices, and will review and agree upon a sanitation and disinfection schedule
with the OCFEC.
Face coverings and disposable -gloves must be worn by all OCFEC Business Partner customer -
facing employees. All OCFEC event attendees and visitors must wear appropriate face
coverings. Physical barriers, if available, are preferred but not required as the general public
will make the personal decision of whether to attend an event at the OCFEC and/or patronize
an OCFEC Business Partner. For the benefit of the public, OCFEC employees and Business
Partner employees, handwashing or hand sanitizing should be done as soon as possible
following the handling of materials that come in contact with the general public.
5. Event Attendance Limitations. Attendance at all OCFEC events, including all move -in and
move -out activities, must be limited at any given time, to no more than the current maximum
attendance levels permitted by all applicable local and state orders or laws.
OCFEC Business Partners must establish and actively enforce measures to monitor and ensure
attendance limitation compliance. If an OFCEC Business Partner fails to comply with event
attendance limitations, the OCFEC in its sole and absolute discretion may cancel the event
without notice and refer the matter to local law enforcement.
6. OCFEC Business Partner Compliance. OCFEC Business Partners shall make every effort to
assure compliance with COVED-19 related mitigation requirements. If an OCFEC Business
Partner fails to comply with these COVID-19 Guidelines, the OCFEC in its sole and absolute
discretion may close non -compliant event spaces, exhibitor spaces or other such rental spaces,
or may cancel the event without notice and refer the matter to local law enforcement,
7. Covid-19 Release and Waiver of Liability. As consideration for being permitted to conduct
event activities at the OCFEC, OCFEC Business Partners must acknowledge and agree to all
COVID-19 Pandemic and related governmental orders, directives and guidelines, and forever
release the 32nd District Agricultural Association, the State, California Fair Services Authority
("CFSA"), the County, the Lessor, and any fair affiliated organization, along with their
respective directors, officers, employees, volunteers, agents, contractors, and representatives
(collectively "Releasees") from any and all liabilities, causes of action, lawsuits, claims,
demands, or damages of any kind whatsoever that OCFEC Business Partner, OCFEC Business
Partner's employees, contractors, subcontractors, exhibitors, vendors, assignees, heirs,
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
distributees, guardians, next of kin, spouse and legal representatives now have, or may have in
the future, for injury, death, or property damage, related to (i) OCFEC Business Partner's
participation in these activities, (ii) the negligence or other acts of any Releasee, whether
directly connected to these activities or not, and however caused, or (iii) the condition of the
premises where these activities occur, whether or not the OCFEC Business Partner is then
participating in the activities.
8. Event Organization Protocols. Each OCFEC Business Partner must submit event
organization -specific COVID-19 related infection mitigation protocols and procedures for
OCFEC review and approval no later thirty (30) days before the event's scheduled move -in
date. The OCFEC reserves the right to reject any protocols and procedures that are in conflict
with, or are less stringent than, the COVID-19 Guidelines. If the OCFEC rejects the OCFEC
Business Partner's COVID-19 related infection mitigation protocols and procedures, the
OCFEC Business Partner must resubmit revised infection mitigation protocols and procedures
for review no less than fifteen (15) days before the event's scheduled move -in date. If OCFEC
Business Partner fails to submit the COVID-19 related infection mitigation protocols and
procedures on time, the OCFEC in its sole and absolute discretion may terminate the agreement
and cancel the event without notice.
Further Action as Necessary. The OCFEC reserves the right to modify these COVID-19
Guidelines as circumstances warrant. Specifically, the OCFEC recognizes that additional
restrictions not reflected in these guidelines may be necessary to address the health and safety
of certain populations depending upon their age or underlying health concerns, or otherwise to
address medical issues as they arise.
I HAVE CAREFULLY READ THIS AGREEMENT EXHIBIT AND FULLY UNDERSTAND ITS
CONTENTS. I AM AWARE THAT THIS IS A CONTRACTUAL AGREEMENT BETWEEN MYSELF
AND THE 32ND DISTRICT AGRICULTURAL ASSOCIATION, THE STATE, CFSA, THE COUNTY,
AND THE LESSOR, AND SIGN IT OF MY OWN FREE WILL.
Executed on , /0 20-
OCFEC BUSINESS PARTNER
Signature
Address
Address
DocuSign Envelope ID: C8479571-74E8-4DCC-8F07-F71 D3249C902
'Arm
9
Request for Taxpayer
Give Farr„ to the
Form to er
Identification Number and Certification
requester. Do not
(Rev. October heTr
De mil Rev rue Treasury
Internal Revon'enue service
► Go to www,lrs. ov/FormW9 for Instructions and the latest information.
9
Send to the IRS.
1 Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank.
2 Business nameldisregamed entity name, If different from above
m
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 to
certain entitles, not Individuate; sea
following seven boxes,
Instfuctlons on page 3):
n
a
❑ Indviduat/sole proprietor or ❑ C Corporation El Corporation El Partnership ElTmst/estats
ai o
single -member LLC Exempt payee code (if any)
❑ Limited llablllty, company. Enter the tax classification(C=C corporation. S=S coryorell(n, P=Partnership)►
`p
Note: Check the appropriate box In the line obove for the tax cieeeiflat lion of the eingle-member owner. Do not check Exemption from FATCA reporting
19
LLC If the LLC Is clossirled as a single -member LLC that Is disregarded from the owner unless the owner of the LLC Is code (if any)
Ic
another LLC that le not disregarded from the owner for U.S. federal tax purposes, Otherwise, a single -member LLC that
n-
Is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
❑ Other(89el ft lona)► (Appparto aow,afa meAxeNetl outside ko e8.)
N
a Address (number, street and apt. or suite no.) Sea instructions. Requester'sl(sdrms 'mladdress (optional)
ro
e City, state, end ZIP code
r List account number(A) hem (optional)
ffM
Taxpayer Identif cation Number(TIN)
Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avold
Saslal
aecurky
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 instructions for Pan I, later. For other
W
__ .,,e_- a ,...,..�,. e...w,..,e. umnaMnenn numlrar frim If vnu do nrd have a number. see How to oet a
anE , ,, ,a a..... ,,,,,v,.x... ......................._...__. ,_.. ,... , -- --
TIN, later. -
Note: If the account Is In more than one name, seethe Instructions for line 1. Also see What Name and
Number To Give the Requesterfor guidelines on whose number to enter.
1. The number shown on this form Is my correct taxpayer Identl8callon 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 Intemal 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 subjeelto backup withholding because
you have failed to report all interest and dividends on yourtax 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 lhan Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign signatureof
Here I U.S. person► _ _ Date ►
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 and Its Instructions, such as legislation enacted
after they were published, go to www,lrs.gov/Form I0-
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
ISSN), 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 fallowing.
• Form 1099-INT (Interest earned or paid)
• Form 1099-DIV (dividends, Including those from stocks or mutual
funds)
• Form 1099-MISO (vadoustypes of Income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-5 (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage Interest),1008-E (student loan Interest),
1098-T (tulgon)
• Form 1090-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.
ff you do not return Form W-9 to the requesterwith a TIN, you might
be subject to backup withholding, See What Is backup withholding,
later.
Cat. No. 10231X Form W9 (Rev. 10-2e111)
DocuSign Envelope ID: CB479571-74E84DCC-8F07-F71 D3249C902
Forth W-9 (Rev. 10-2018)
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. Cerny 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. Cerny 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, later, for further Information.
Note: If you are a U.S. person and a requester gives you a forth other
than Form W-9 to request your TIN, you must use the requesters form If
It is substantially similar to this Form W-9.
Definition of a U.S. person. Forfedeml 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 assodation 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 301.7701-4
Special rules for partnerships. Partnerships that conduct a trade or
business in the United Stales 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 shareof
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
withholdlhg on Its allocableshare of net Income from the partnership
conducting a trade or business In the United Stales.
• In the,case of a disregarded entity whh 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 (otherthan a grantor trust), the U.S. trust
(otherthan 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 Forth 8233 (see
Pub, 616, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien Individual may use the terms of a tax treaty to reduce
or eliminato 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 allen for tax purposes.
If you area U.S, resident alien who is relyingg 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 Farm W-9 that specifies the following five Items.
1. The treaty country. Generally, this must be the some 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 lax 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 faces to justly 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 lax for scholarship Income received by a Chinese
student temporarily present In the United States. Under U.B. law, this
student will become a resident allen 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 allen of the United States. A Chinese
student who quallfes 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 24% of such
payments. This Is called "backup withholding" Payments that maybe
subject to backup wlthhoiding Include Interest, tax-exempt Interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made 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 resolve will he subject to backup withholding If:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Instructions for
Part II for details),
3, The IRS tells the requester that you fumished 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 Wthholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign Mendel 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, later, 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. It you fall 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
backup withholding, you are subject to a $500 penalty.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
Form W-9 (Rev. 10-2018) Page 3
Criminal penally for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
Including fines andlor 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 (other than an account
maintained by a foreign financial Institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered In
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that Is a U.S. person must
provide a 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 la. This should also be the same as the
name you entered on the Form 1040/1040AI1040EZ 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-mombor 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 DSA name on
line 2.
d. Otherentlties. Enteryour 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 online 2.
A. 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 Regulatlons section 301,7701-2(c)(2)(111). 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 Farm W-8 Instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN,
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter It an line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name Is entered on line 1. Check only
one box on line 3.
IF the entitylperson on line 1 Is
THEN check the box for...
a(n)...
• Corporation
Corporation
• Individual
Indivlduallsole proprietor or single-
• Sole proprietorship, or
member LLC
• Single -member limited liability
company (LLC) owned by an
Individual and disregarded for U.S.
federal tax purposes.
• LLC treated as a partnership for
Limited liability company and enter
U.S. federal tax purposes,
the appropriate tax classification.
• LLC that has filed Form 8832 or
(P=Partnership; C= C corporation;
2553 to be taxed as a corporation,
or S= S corporation)
or
• LLC that is disregarded as an
entity separate from Its owner but
the owner is another LLC that Is
not disregarded for U.S. federal lax
purposes,
• Partnership
Partnership
• Trust/estate
Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code($) 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 601(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 instmmenlallties
3—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—Aforelgn government or any of Its political subdivisions, agencies,
or Instrumentalities
8—A corporatlon
8—A dealer in securities or commodities required to register In the
United Stales, 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 reglstered 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 884(a)
11--AManclal institution
12—A middleman known In the Investment community as a nominee or
custodian
13—A trust exempt from tax under section 884 or described In section
4947
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
Form W-9 (Rev. 10.2018)
The following chart shows types of payments that may be exemppt
from backup withholding. The chart applies to the exempt payees listed
above,/ 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 an
exempt 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
1 through 52
$5,000r
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
r See Form 1099-MISC, Miscellaneous Income, and Its instructions.
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
Slates, you may leavethis field blank. Consult with the person
requesting thig'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 indicatlon).wrllten or printed on the line for a FATCA
exemption code. -
A —An organization exempt from tax under section 601(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)(1)
E—Acorporation that is a member of the same expanded affiliated
group as a corporation described In Regulations section 1,1472-1(0)(1)(1)
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 lax 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 6
Enter your address (number, street, and apartment or suite number),
This Is where therequester of this Form.W-9 will mall your Information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address Is provided, there is still a
chance the old address will be used until the payer changes your
address In their records.
Line 6
Enteryour 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). Enterlt 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.
If you are a single -member LLC that Is disregarded as an entity,
separate from Its owner, 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 What Name and Number To Give the Requester, later, 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 Farm SS-6, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also gat 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 88-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at wwwlrs.govreua/nesses and . -
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to wwwdrs.gov/Forms to view, download, or print Form
W-7 and/or Form SS-4. Or, you can go to www.lrs.gowOrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
business days.
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 apace 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,
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 Item 1, 4, or 6 below Indicates otherwise.
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.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902
Form W-9 (Rev. 10.2018)
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 cedlficatlon 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 trada or business for
rants, royalties, goods (other than bills for merchandlae), medical and
health care services (Including payments to corporations), payments to
a nonemployso for services, payments made In settlement of payment
card and third party network transactions, payments to certain fishing
boat crew mambers and fishermen, and gross proceeds paid to
attorneys (Including payments to corporations),
6. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 629), ABLE accounts (undersectfon 629A),
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 mare individuals fioint The actual owner of the account or, if
account) other than an account combined funds, the first Individual on
maintained by an FFI the account'
3. Two or more U.S. persons
Each holder of the account
Qolnt account maintained by an FFI)
4. Custodial account of a minor
The mine?
(Uniform Gift to Minoru Act)
6. a. The usual revocable savings trust
The grantor-trustea�
(grantor Is also trustee)
b. Swcalled trust account that Is not
The actual owner'
a legal or valid trust under state law
6. Sole proprietorship or disregarded
The owners
entity owned by an Individual
7. Grantor trust thing under Optional The grantor -
Form 1099 Ring Method 1 (see
Regulations section 1.671-4(b)(2)Q)
(A))
For this type of account: I Give name and EIN of:
6. Disregarded angry not owned by an Theowner
Individual
9. A valid trust, estate, or pension trust Legal entky4
10. Corporation or LLC electing Thecurporetion
corporate status on Form 6832 or
Form 2853
11. Association, club, rellglous, Theorganlzation
charitable, educational, or other tax-
exempt organization -
12,Parmerehlpormull-member LLC Thepartnerehlp
13. A broker or registered nominee The broker or nominee
Page 5
Agriculture In the name or a public
entity, (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trustfiling under the Form Thelrust
1041 Fling Method or the Options!
Form 1099 Flling Method 2 (see
Regulations aectlon 1.671.4(b)f2)(II(9))
' List first and circle the name of the person whose number you furnish.
If only one person on ajoint account has an SSN, that person's number
must he furnished.
2 Circle the minor's name and furnish the minor's SSN.
a You must show your Individual name and you may also enter our
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.
4 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
Is al entity Itself is not designated In the account title.) Also see Special
rules for partnerships, earlier.
'Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: If no name Is circled when more then 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 88N 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 Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic 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 TAB by
calling the TASloll-free case Intake line at 1-877.777-4778 or TTYrrDD
1.800.829-4059.
Protect yourselffrom auspicious smalls or phlshing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business smalls 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. ,
1
DocuSign Envelope ID: CB479671-74E84DCC-8F07-F7l D3249C902
Form W-9 (Rev.10-2018)
The IRS does not Initiate contacts with taxpayers via emalls, Also, the
IRS does not request personal detailed Information through small 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 small claiming to be from the IRS,
forward this message to phlshing@irs,gov. You may also report misuse
of the IRS name, logo, or other IRS properly to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484, You can
forward suspicious smalls to the Federal Trade Commission at
spam@uce,gov or report them at www1o.gov/compla/nt. You can
contact the FTC at wv,w.Rc.govlldthek or 877-IDTHEFT (877-438-4338).
If you have been the victim of Identity theft, see www,ldentityThaft.gov
and Pub. 6027,
Visit wwwJrs,govlldsnt@yTheft 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 provide 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.
DocuSign Envelope ID: CB479571-74E8-4DCC-8F07-F71D3249C902