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Home My WebLink About22A - SPEC - HVAC CHILLER AND WATER PUMPREQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: OCTOBER 4, 2016 TITLE CONTRACT AWARD TO JF ELECTRIC TO INSTALL ENERGY - EFFICIENT LIGHTING AND HVAC CHILLED WATER PUMP AND EXECUTE AGREEMENT FOR ON -BILL FINANCING LOAN (SPEC. NO. 16 -099) (STRATEGIC PLAN NO. 4, 3D AND 6, 2A) ■Nx0Z03 IT, 1151:4L,f67:47Teff00 CLERK OF COUNCIL USE ONLY: APPROVED ❑ As Recommended ❑ As Amended ❑ Ordinance on 1" Reading ❑ Ordinance on 2nd Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER 1. Authorize a one -time purchase and payment of purchase order to JF Electric to provide and install advanced energy efficient lighting and a heating, ventilation and air conditioning (HVAC) chilled water pump with variable speed drive at the Main Library in an amount not to exceed $186,538, which includes $7,150 contingency, subject to non - substantive changes approved by the City Manager and City Attorney. 2. Authorize the City Manager and Clerk of the Council to execute an agreement with Southern California Edison (SCE) to provide a $152,649 no- interest On -Bill Financing loan and $33,889 in incentives to fund Spec. No. 16 -099 subject to non - substantive changes approved by the City Manager and City Attorney. DISCUSSION As part of the City's ongoing efforts to identify potential cost - saving energy projects across City facilities, the Finance Department Building Maintenance Division commissioned energy audits for the City's library system (Main Library, Newhope Library, and McFadden Learning Center), Corporate Yard, and Police Administration. The energy audits were completed at no cost to the City by The Energy Network, a non - profit program funded by California utility ratepayers through the California Public Utilities Commission. Based on the energy audit findings, Building Maintenance staff applied for and secured approved funding from SCE to retrofit City library buildings with advanced energy - efficient lighting and 22A -1 Contract Award to Install LED Lights and HVAC Chilled Water Pump and Agreement for On -Bill Financing Loan October 4, 2016 Page 2 HVAC equipment. Funding applications for the Corporate Yard and Police Administration are currently being reviewed by SCE. At this juncture, staff requests Council approve the implementation of the Main Library project as the first of three library retrofit projects. The other two retrofit projects with approved SCE funding are for Newhope Library and McFadden Learning Center, which will be presented to Council on November 15, 2016. The Main Library project consists of a lighting component (replace fluorescent lights with energy - efficient light- emitting diode [LED] lights) and a mechanical component (install new chilled water pump with variable speed drive in the HVAC system). Project benefits include an annual reduction of 164,767 kWh in energy usage, annual utility bill savings of $20,431 and annual greenhouse gas reduction equivalent to taking 291 cars off the road as tabulated below. Total project cost is $186,538 including a $7,150 contingency. Payback period is 8.5 years. As tabulated above, project cost will be fully funded by SCE using cash incentives of $33,889 and a zero interest On -Bill Financing (OBF) loan of $152,649 for a total of $186,538. An innovative feature of the recommended actions is the City will have no upfront costs as the awarded contractor will finance the cost of the project. SCE will then pay contractor directly with the cash incentives and OBF loan proceeds that SCE has approved for the project. As a result of the OBF loan, the Main Library's new electricity bill will be different as it will have a lower Amount Due based on the energy reduction from the project, and a new separate line -item to show the OBF loan repayment amount. This latter amount will reflect kWh saved from the project multiplied by the relevant billing rate. Once the OBF loan is paid in full, SCE will discontinue the OBF loan repayment line -item, and the reduced energy usage due to the project should result in smaller bills. (Cash incentives are grants and not repaid.) Staff requests Council approval of the foregoing project and funding process. SCE Notice of cash incentives and OBF loan amount approved for the project is attached (Exhibit 1). The Notice soliciting bids was advertised on August 16, 2016 on the City's online bid management and publication system. A summary of the bids received is as follows: 22A -2 EstiinaYed Estimated Estimated Estimated PR OJECT Aringal kWh ; bnnusl Utihr Bill Annuah ' SCE Gash Estimated CbIIAPQNENTS� ' SA�(IN(3S SAUIN�3 CAR off Incenfaves OBF -the R at1,', , Lighting 139,720 $17,325 236 $33,590 $134,824 Mechanical 25,047 $3,106 55 $299 $17,825 V u 11, b $3 _ Total project cost is $186,538 including a $7,150 contingency. Payback period is 8.5 years. As tabulated above, project cost will be fully funded by SCE using cash incentives of $33,889 and a zero interest On -Bill Financing (OBF) loan of $152,649 for a total of $186,538. An innovative feature of the recommended actions is the City will have no upfront costs as the awarded contractor will finance the cost of the project. SCE will then pay contractor directly with the cash incentives and OBF loan proceeds that SCE has approved for the project. As a result of the OBF loan, the Main Library's new electricity bill will be different as it will have a lower Amount Due based on the energy reduction from the project, and a new separate line -item to show the OBF loan repayment amount. This latter amount will reflect kWh saved from the project multiplied by the relevant billing rate. Once the OBF loan is paid in full, SCE will discontinue the OBF loan repayment line -item, and the reduced energy usage due to the project should result in smaller bills. (Cash incentives are grants and not repaid.) Staff requests Council approval of the foregoing project and funding process. SCE Notice of cash incentives and OBF loan amount approved for the project is attached (Exhibit 1). The Notice soliciting bids was advertised on August 16, 2016 on the City's online bid management and publication system. A summary of the bids received is as follows: 22A -2 Contract Award to Install LED Lights and HVAC Chilled Water Pump and Agreement for On -Bill Financing Loan October 4, 2016 Page 3 31 Vendors were notified 0 Santa Ana vendors notified 26 Vendors downloaded the solicitation 3 Bids received 0 Bids received from Santa Ana vendor(s) Bids were received on September 7, 2016 and were opened and evaluated (Exhibit 2). The bid received from JF Electric is responsive to the specifications and meets the City's requirements. STRATEGIC PLAN ALIGNMENT Approval of this item supports City efforts to meet Strategic Plan Goal #4 — City Financial Stability, Objective 3 (achieve a structurally balanced budget) Strategy D (Explore innovative revenue and cost recovery strategies) and Goal #6 Community Facilities & Infrastructure: Objective 2 (Address deferred maintenance on City buildings and equipment) Strategy A (Prepare a Deferred Maintenance Plan that assesses safety, adequacy, and liability implications, and estimates repair costs to be programmed in the responsible agency's future budget). ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the recommended actions are exempt from further review. A Notice of Exemption will be filed for this project. FISCAL IMPACT Cash incentives and loan proceeds received through the SCE On -Bill Financing Program will be deposited into the Finance and Management Services Agency (FMSA) SCE Programs and Grants revenue account (16210002- 57384) and appropriated into the FMSA SCE Building Maintenance Projects account (16210100- 62300). Funds for the loan repayments in the amount of $152,649 will be included in the following fiscal years' budget in the Building Maintenance Utilities Account 07310100 - 62000. Main Library Retrofit Fiscal Year Account Amount 2016 -17 16210100 -62300 $152,649 Loan Repayment Fiscal Year Account Amount 2016 -17 07310100 -62000 $ 8,113 2017 -18 07310100 -62000 $18,067 2018 -19 07310100 -62000 $18,067 22A -3 Contract Award to Install LED Lights and HVAC Chilled Water Pump and Agreement for On -Bill Financing Loan October 4, 2016 Page 4 2019 -20 07310100 -62000 $18,067 2020 -21 07310100 -62000 $18,067 2021 -22 07310100 -62000 $18,067 2022 -23 07310100 -62000 $18,067 2023 -24 07310100 -62000 $18,067 2024 -25 07310100 -62000 $18,067 APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez Executive Director (� Finance and Management Services Agency W N /ds /sp EXHIBITS: 1. SCE Incentive and OBF Loan Documents 2. Abstract of Bids 22A -4 miSOUTHERN CCALIFORNIA NII E®IJ ®I An EMON INTRRNATIONAL0 Company January 21, 2016 Project Number: 353 -15- 0500765634 Project: Customized Solutions Approach Authorized Agent: Rebecca Hausheer The Energy Coalition 47 Discovery, Suite 250 Irvine, CA 9261.8 E -mail: Businesslncentives @sce.com I Fax: 626- 633 -3243 Customer Information: John Aguilar City of Santa Ana 20 Civic Center Pl., M -11 Santa Ana, CA 92701 Questions ?: 800- 736 -4777 SEND ALL DOCUMENTS TO: Business Incentives Southern California Edison P.O. Box 800 Rosemead, CA 91770 -0800 RE: NOTICE OF CUSTOMIZED SOLUTIONS CONTRACT AND INCENTIVE APPROVAL Dear Rebecca Hausheer and John Aguilar: Thank you for submitting your Energy Management Solutions Incentive Application ( "Application ") for the Customized Solutions Program ( "Program "). Your Application for incentives for the Project(s) described in your application has been reviewed and approved. Funds reserved are based on SCE approved savings estimate set forth below; however, the actual incentive payments will be made based on verified and actual savings' amounts: SCE Finai Approved Savings and Incentive SOLUTIONS DESCRIPTION Code Estimate kWh 'kW $`Incentive Amount ' Interior LED fixture replacement (utilizing approved luminaries) LT -17492 135,684.0 18.92 $ 32 010.06 Day lighting controls LT -90853 4,255.0 0.54 $ 995.83 Total Approved Savingslincentive Estimates 139,939.0 19.46 $ 33,005.89 PRP Bonus $ (683.80) Total Estimated Incentive $ 33,689.69 10% Measurement and Verification Adder (if applicable) If you do not concur with the energy savings and incentive amounts shown above, you have 30 days from the date of this letter to notify SCE, so that we can attempt to resolve your concern(s). If you do not notify us of any concerns within 30 days of this letter, the savings /incentive estimates set forth above will be deemed correct. If you agree with the estimates, you may proceed to purchase and install the above solution code(s) at any time. This Project Approval incorporates by reference the Application, including the Applicant Agreement regarding Program Terms and Conditions. EXHIBIT 1 Checkout www.sce.coml To see,(fyptlq=plify for the Comprehensive Bonus. After your project is completely installed, operational, and meets all requirements of the Program, which is described in detail in the Customized Statewide Procedures Manual for Business and at www.sce.com/customized—solutions: • Complete, sign and submit the enclosed 2013 -14 Customized Solutions Installation Report. • Submit final invoices and/or documentation to support project cost, clearly detailing all costs associated with the project (equipment, labor, tax, etc.). • Submit complete engineering calculations to demonstrate energy savings and documentation, if applicable (including archival diskette, CD, etc.). • Submit schematic drawings and /or manufacturer specification sheets, if applicable. • Operating Report, if measurement and verification is required. • Submit Pump Curve (if applicable) NOTE: As a reminder, the deadline for the project to be completely installed and operational is one year from the date of this Project Approval letter. Please submit the completed Installation Report within 30 days after installation and prior to the one year deadline. Upon SCE review and approval of your completed hzstallation Report and supporting cost documentation, you will be notified in writing. Thereafter, SCE will process the incentive check or SCE utility bill credit, as applicable. If SCE is unable to approve your incentives based on the information provided, SCE may require you to submit other documents related to the Project, Project site, solutions, energy savings, or any other documents it requires, in its sole discretion, to make a decision on your Application. If you have any questions, please contact your SCE Account Representative. You may also call us at (800) 736- 4777 Monday through Friday, from 8:00 a.m. to 5:00 p.m., or send an e -mail to 13usinessliieentives@sce.com. Please have your project number available for reference when you call and include it in any e -mail correspondence. Business Incentives Team Southern California Edison Checkout www.sce.coml To see if ou qua I fyfor the Comprehensive Bonus. 2jA -6 Ra IIm 10: 666.r,.p.6pp6«Y6,[ 11MI 22A -7 J F °a�rso affou mmlD(,) �e lLE.... IDEN RI m, II Le In III.. IM ... till [ Dill Ell tlllb na [emmen Itlhtiv.Itlln a.4lp ylutleell utlno �.lF.D., are I E111=11I 1. 1141.9 urc rvplaaement I.16Iai.ry api- ..ED w II 6eluWn[atlo rnlptlen m r 1 FF IE.$aill .D w[ wore. n NA xo[ x/n wm P, It LED m.a ppill pr.mep.rm.enm..EDE I.pu*. ., [aan•r.aea rmimm.a....om..w.Y .P . ~nom Fill P— .a.p..a .., IWFEE p., I. other m Fit.ml .rc tl n•rc 6n•pp ma LE nl mem.a.war 1— Lt eo< rLL, I.amn F- re.YI„ ,, amwP n.p,a.1 mmNE D1. Ill LED FM.rIl MI, Fit 1111. DE .a. ala.,l am..a wmm.. e a p,ewlal'r `m .ua lIt FEEL cen.e ED It LEDil 11 DI I Ell pama.[6am.va El 11 - -1 i El e4w :am a nm•..meLmr FEE rI wn wn nano.. wa mlm. pa.l.rc .r, o.re Mn OD • o r.tar M4v.+bme It,P atlIINIFa[maV au111N F,IF IM1ep batl SM1lNn[elmplaVedaetXhwwemrtrlW N.ImtlSANns+haee i""tlmpo au I'm I'll ult'll, III 111111d 11 IF Evil p.m• D . . . . . . Fill lIW Ei Fill em.11eJ m 111 U[ oe many[[[ MpM ELI U PeaX E.L."D 11MI 22A -7 J F °a�rso affou Energy Management Solutions Incentives Application for Business Customers 2013 - 2014 Customized Installation Resort DIRECTIONS: After your project is installed and operational, input the project installation commencement and completion dates in the fields provided. Review the information from your Application Approval Letter. If nothing has changed, and the information in Sections 5 and 6 is correct, complete and sign Section 7 on page 2 of this Installation Report (IR) Form and submit both pages to SCE at one of the addresses below. If Business incentives Fo,overniq F_tdeNvew_ Fax: 626-633-3243 Southern California Edison 6010 N. Irvvindaie Ave. E- mail: 3usinessInrenijves @sce. com P.O. Box 800 Irwindale. CA 91702 C,ue,tions? Call 300- 736 ,777 Rosemead, CA 91770 -0800 UPN #: 353 -15- 0500765634 SAM 3- 000 - 8761 -23 Project Name: Santa Ana Library LT & MC Customer Name: City of Santa Ana Customer's Authorized Agent: The Energy Coalition Installation Commencement Date: Installation Completion Date: Line # Solution Code Solution Description Description of Existing Equipment 1 LT -17492 Interior LED fixture replacement(utilizing approved Il lminariael 2 LT -90853 Day lighting controls 3 4 5 Note: If submitting more than 5 Solutions complete and attach the Customized Solution page from the Multiple Site/Solution Worksheet at w scexomfsolutions. ' On -Peak Energy savings Total Project Cost is) $168,413.64 Calculated Solution # Baseline Usage (kWh) Installed Usage (kWh) Energy Savings (kWh) Incentive Rate ($IkWh) Energy Incentive ($) 1 208,664.2 29.10 135,684.0 $ 02 $ 10,854.72 Calculated Energy Savings Totals 139,939.0 2 17,018.0 12,7630 4,255.0 $ 0.08 $ 340.40 3 — -- Calculated Savings Incentives 'Inslwks Pmlesf Gm Atllushenl tll AppllsaMi 33,589,69 4 5 $ - 5 ' On -Peak Demand. Reduction On -Peak Demand Reduction (kW) 19.46 Calculated Solution # from above Baseline On -Peak Demand (KW) Installed On -Peak Demand (KW) On -Peak Demand Reduction (KW) "- Peak Demand Reduction Incentive ($) SA# 3- 000 - 8761 -23 UPN # 353 -15- 0500765634 NOTE: For projects requiring Ml attach any required baseline or post - installation measurements and analysis, as specified in your approved MV plan. 1 29.10 10.18 18.92 $ 2,838,00 2 2.16 1.62 0.54 $ 81.00 3 $ 4 $ 5 $ - Line# Solution Code Solution Description Description of Existing Equipment 1 2 3 4 5 Note: If submitting more than 5 Solutions complete and attach the Customized Solution page of the Multiple Site/Solution Worksheet at w sceeomisolutions. 2ZA 8 Energy Savings Calculated Solution # Baseline Usage (kWh) Installed Usage (kWh) Energy Savings (kWh) Incentive Rate ($ /kWh) Energy. Incentive ($) 1 2 2 4 3 5 4 5 On -Peak Demand Reduction Calculated Baseline Solution On -Peak # from above Demand (KW) Installed On -Peak Demand (KW) On -Peak Demand Reduction (KW) Peak Demand Reduction Incentive ($) 1 2 3 4 5 Calculated Energy Savings Totals Calculated Savings Incentives On -Peak Demand Reduction (kW) SA# 3- 000 - 8761 -23 UPN# 353 -15- 0500765634 NOTE: For projects requiring M &V, attach any required baseline or post- instartatlon measurements and analysis, as specified in Your approved M &V plan. ;k appropriate boxes: No changes to the proposed solutions have been made since the Project Application Review and Approval and the Authorized agent verifies that the Application approved savings calculations are correct. O Due to changes to the proposed measures, appropriate adjustments in the savings calculations have been made. For measures with changes made during installation, use this section, and Sections 5 & 6 on page 2, to calculate the revised installed energy usage, 0 energy savings, peak demand reduction, and incentives. Attach the appropriate calculation backup: the output from the Estimation Software, Calculate Energy Savings Total or the calculation sheets that document the engineering calculations. )Attach the following supporting documentation with this Installation Report, or email it to the SCE RCx program manager: rted savings calculations, where applicable. as of invoices for implementation, as proof of the Customer's implementation costs. Training Completion Form, including the training agenda, training materials, list of attendees, and measure persistence the RCx Program Guidelines for more information on these items. 1. HVAC Permit (if required). If a permit is required for any HVAC Installation /replacement, I have provided the permit number below. (If no permit Is required, leave this section blank.) Permit# Agency 2. Contractor Certification. If a contractor was used for any HVAC installation/replacement, this section must be completed by the contractor. By checking this box, I certify I am a licensed contractor and have followed applicable permitting requirements and, if required, that the HVAC ❑ permit information above is correct. Signature of Contractor- Name ' p ease prm Date I, the Customer or Authorized Agent below, certify that (1) the Energy Efficiency Solutions have been completely installed, functionally tested and proven capable of operating and being maintained to perform in conformity with their design Intent, and (ii) that a licensed contractor was used, where applicable, and all applicable permitting requirements for this installation were followed. The Installation date of operation of the Energy Efficiency Solutions and any required monitoring data collection per approved M &V plan, are also certified. Signature Name please print Title Date 22a —9 Customized Solutions Installation Report Instructions Project # Mail to: Business Incentives Southern California Edison P.O. Box 800 Rosemead, CA 91770 -0800 1. INDICATE PAYMENT INFORMATION Please confirm address for the incentive payment. Company: Attention: (Name to be printed on check, use only if required) Address: City: State: Zip: Print Name: Title: Authorizing Date: 2. UTILITY BILL CREDIT OPTION You have the option to credit the incentive to your service account. Incentive can only be applied to the service accountlutility bill of host customer. 3. W9 ft CA590 FORMS Please sign and return the W9 & CA590. QUESTIONS? Please call (800) 736 -4777 or e-mail Businesslncentives @sce.com 5OUTHFRN akI IFORNIA EDISON '1s 1iUT5f]M IN %1'.- RhAtl[]NA4" L'vnilonm P.O. Box 800 22A -10 Rosemead, CA 91770 YEAR ® CALIFORNIA FORM 2014 Withholding Exemption Certificate 590 The payee completes this form and submits it to the withholding agent. Withholding Agent (Type or print) Name Payee Name ❑ SSN or ITIN ❑ FEIN ❑ CA Carp no, ❑ CA Soy file no, Address (apt. /ste., room, PO Box, or PMB no.) City (If you have a foreign address, see instructions.) State ZIP Code Exemption Reason Check only one reason box below that applies to the payee. By checking the appropriate box below, the Payee certifies the reason for the exemption from the California income tax withholding requirements on payment(s) made to the entity or individual. ❑ Individuals — Certification of Residency: I am a resident of California and I reside at the address shown above. If I become a nonresident at any time, I will promptly notify the withholding agent. See instructions for General Information D, Definitions. ❑ Corporations: The corporation has a permanent place of business in California at the address shown above or is qualified through the California Secretary of State (SOS) to do business in California. The corporation will file a California tax return. If this corporation ceases to have a permanent place of business in California or ceases to do any of the above, I will promptly notify the withholding agent. See instructions for General Information D, Definitions. ❑ Partnerships or limited liability companies (LLCs): The partnership or LLC has a permanent place of business in California at the address shown above or is registered with the California SOS, and is subject to the laws of California. The partnership or LLC will file a California tax return. If the partnership or LLC ceases to do any of the above, I will promptly inform the withholding agent. For withholding purposes, a limited liability partnership (LLP) is treated like any other partnership. ❑ Tax - Exempt Entities: The entity is exempt from tax under California Revenue and Taxation Code (R &TC) Section 23701 (insert letter) or Internal Revenue Code Section 501(c) _ (insert number). If this entity ceases to be exempt from tax, I will promptly notify the withholding agent. Individuals cannot be tax - exempt entities. ❑ Insurance Companies, Individual Retirement Arrangements (IRAs), or Qualified Pension /Profit Sharing Plans: The entity is an insurance company, IRA, or a federally qualified pension or profit- sharing plan. ❑ California Trusts: At least one trustee and one noncontingent beneficiary of the above -named trust is a California resident. The trust will file a California fiduciary tax return. If the trustee or noncontingent beneficiary becomes a nonresident at any time, I will promptly notify the withholding agent. ❑ Estates — Certification of Residency of Deceased Person: I am the executor of the above -named person's estate or trust. The decedent was a California resident at the time of death. The estate will file a California fiduciary tax return. ❑ Nonmilitary Spouse of a Military Servicemember: I am a nonmilitary spouse of a military servicemember and I meet the Military Spouse Residency Relief Act (MSRRA) requirements. See instructions for General Information E, MSRRA. CERTIFICATE OF PAYEE: Payee must complete and sign below. Under penalties of perjury, I hereby certify that the information provided in this document is, to the best of my knowledge, true and correct. If conditions change, I will promptly notify the withholding agent. Payee's name and title (type or print) Telephone ( ) Payee's signature ► Date For Privacy Notice, get FT61731 ENG /$P, 7061143 Form 590 C2 2013 22A -11 Instructions for Form 590 Withholding Exemption Certificate References in these instructions are to the California Revenue and Taxation Code (R &TC) General Information • Payments to nonresidents for royalties from D Definitions Registered Domestic Partners (RDP) — For natural resources with activities in California. Nonresident includes all of the following: purposes of California income tax, references •Distributions of California source income to g' to a spouse, husband, or wife also refer to a Registered Domestic Partner (POP) unless otherwise specified. For more information on RDPs, get FTB Pub. 737, Tax Information for Registered Domestic Partners. A Purpose Use Form 590, Withholding Exemption Certificate, to certify an exemption from nonresident withholding. Form 590 does not apply to payments of backup withholding. For information on California backup withholding, go to ftb.ca.gov and search for backup withholding. Form 590 does not apply to payments for wages to employees. Wage withholding is administered by the California Employment Development Department (EDD). For more information, go to edd.ca.gov or call 888.745.3886. Do not use Form 590 to certify an exemption from withholding if you are a Seller of California real estate. Sellers of California real estate use Form 593 -C, Real Estate Withholding Certificate, to claim an exemption from real estate withholding. The following are excluded from withholding and completing this form: • The United States and any of its agencies or instrumentalities. • A state, a possession of the United States, the District of Columbia, or any of its political subdivisions or instrumentalities. • A foreign government or any of its political subdivisions, agencies, or instrumentalities. B Income Subject to Withholding California Revenue and Taxation Code (R &TC) Section 18662 requires withholding of income or franchise tax on payments of California source income made to nonresidents of California. Withholding is required on the following, but is not limited to: • Payments to nonresidents for services rendered in California. • Distributions of California source income made to domestic nonresident S corporation shareholders, partners, and members and allocations of California source income made to foreign partners and members. • Payments to nonresidents for rents if the payments are made in the course of the withholding agent's business. nonresident beneficiaries from an estate or trust. • Endorsement payments received for services performed in California. • Prizes and winnings received by nonresidents for contests in California. However, withholding is optional if the total payments of California source income are $1,500 or less during the calendar year. For more information on withholding get FTB Pub. 1017, Resident and Nonresident Withholding Guidelines. To get a withholding publication, see Additional Information. C Who Certifies this Form Form 590 is certified by the payee. California residents or entities exempt from the withholding requirement should complete Form 590 and submit it to the withholding agent. The withholding agent is then relieved of the withholding requirements if the agent relies in good faith on a completed and signed Form 590 unless notified by the Franchise Tax Board (FTB) that the form should not be relied upon. An incomplete certificate is invalid and the withholding agent should not accept it. If the withholding agent receives an incomplete certificate, the withholding agent is required to withhold tax on payments made to the payee until a valid certificate is received. In lieu of a completed certificate on the preprinted form, the withholding agent may accept as a substitute certificate a letter from the payee explaining why the payee is not subject to withholding. The letter must contain all the information required on the certificate in similar language, including the under penalty of perjury statement and the payee's taxpayer identification number. The withholding agent must retain a copy of the certificate or substitute for at least four years after the last payment to which the certificate applies, and provide it upon request to the FTB. For example, if an entertainer (or the entertainer's business entity) is paid for a performance, the entertainer's information must be provided. Do not submit the entertainer's agent or promoter information. The grantor of a grantor trust shall be treated as the payee for withholding purposes. Therefore, if the payee is a grantor trust and one or more of the grantors is a nonresident, withholding is required. If all of the grantors on the trust are residents, no withholding is required. Resident grantors can check the box on Form 590 labeled "Individuals — Certification of Residency." 22A -12 Individuals who are not residents of California. Corporations not qualified through the California Secretary of State (CA SOS) to do business in California or having no permanent place of business in California. Partnerships or limited liability companies (LLCs) with no permanent place of business in California. Any trust without a resident grantor, beneficiary, or trustee, or estates where the decedent was not a California resident. Foreign refers to non -U.S. For more information about determining resident status, get FTB Pub. 1031, Guidelines for Determining Resident Status. Military servicemembers have special rules for residency. For more information, get FTB Pub. 1032, Tax Information for Military Personnel. Permanent Place of Business: A corporation has a permanent place of business in California if it is organized and existing under the laws of California or if it is a foreign corporation qualified to transact Intrastate business by the CA SOS. A corporation that has not qualified to transact intrastate business (e.g., a corporation engaged exclusively in interstate commerce) will be considered as having a permanent place of business in California only if it maintains a permanent office in California that is permanently staffed by its employees. E Military Spouse Residency Relief Act (MSRRA) Generally, for tax purposes you are considered to maintain your existing residence or domicile. If a military servicemember and nonmilitary spouse have the same state of domicile, the MSRRA provides: • A spouse shall not be deemed to have lost a residence or domicile in any state solely by reason of being absent to be with the servicemember serving in compliance with military orders. • A spouse shall not be deemed to have acquired a residence or domicile in any other state solely by reason of being there to be with the servicemember serving in compliance with military orders. Domicile is defined as the one place: • Where you maintain a true, fixed, and permanent home. • To which you intend to return whenever you are absent, Form 590 Instructions 2013 Page 1 A military servicemember's nonmilitary spouse is considered a nonresident for tax purposes if the servicemember and spouse have the same domicile outside of California and the spouse is in California solely to be with the servicemember who is serving in compliance with Permanent Change of Station orders. California may require nonmilitary spouses of military servicemembers to provide proof that they meet the criteria for California personal income tax exemption as set forth in the MSRRA. Income of a military servicemember's nonmilitary spouse for services performed in California is not California source income subject to state tax if the spouse is in California to be with the servicemember serving in compliance with military orders, and the servicemember and spouse have the same domicile in a state other than California. For additional information or assistance in determining whether the applicant meets the MSRRA requirements, get FTB Pub. 1032. Specific Instructions Payee Instructions Enter the withholding agent's name. Enter the payee's information, including the taxpayer identification number (TIN) and check the appropriate TIN box. You must provide an acceptable TIN as requested on this form. The following are acceptable TINs: social security number (SSN); individual taxpayer identification number (TIN); federal employer identification number (FEIN); California corporation number (CA Corp no.); or CA SOS file number. Private Mail Box (PMB) — Include the PMB in the address field. Write "PMB" first, then the box number. Example: 111 Main Street PMB 123. Foreign Address — Enter the information in the following order: City, Country, Province/ Region, and Postal Code. Follow the country's practice for entering the postal code. Do not abbreviate the country's name. Check the box that reflects the reason why the payee is exempt from the California income tax withholding requirement. Withholding Agent Instructions Keep Form 590 for your records. Do not send this form to the FTB unless it has been specifically requested. For more information, contact Withholding Services and Compliance, see Additional Information. Page 2 Form 590 Instructions 2013 The payee must notify the withholding agent if any of the following situations occur: • The individual payee becomes a nonresident. • The corporation ceases to have a permanent place of business in California or ceases to be qualified to do business in California. • The partnership ceases to have a permanent place of business in California. • The LLC ceases to have a permanent place of business in California. • The tax - exempt entity loses its tax- exempt status. If any of these situations occur, then withholding may be required. For more information, get Form 592, Resident and Nonresident Withholding Statement, Form 592 -B, Resident and Nonresident Withholding Tax Statement, and Form 592 -V, Payment Voucher for Resident and Nonresident Withholding. Additional Information For additional information or to speak to a representative regarding this form, call the Withholding Services and Compliance telephone service at: Telephone: 888.792.4900 916.845.4900 Fax: 916.845.9512 OR write to: WITHHOLDING SERVICES AND COMPLIANCE MS F182 FRANCHISE TAX BOARD PO BOX 942867 SACRAMENTO CA 94267 -0651 You can download, view, and print California tax forms and publications at ftb.ca.gov. OR to get forms by mail write to: TAX FORMS REQUEST UNIT FRANCHISE TAX BOARD PO BOX 307 RANCHO CORDOVA CA 95741 -0307 For all other questions unrelated to withholding or to access the TTY/TDD numbers, see the information below. Internet and Telephone Assistance Website: ftb.ca.gov Telephone: 800.852.5711 from within the United States 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments Asistencia Por Internet y Teldfono Sitio web: ftb.ca.gov Telefono: 800.852.5711 dentro de los Estados Unidos 916.845.6500 fuera de los Estados Unidos TTY/TDD: 800.822.6268 personas con discapacidades auditivas y del habla 22A -13 Form w-9 Request for Taxpayer - m -� Give Form to the (Rev. December 2014) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. N 2 Business name /disregarded entity name, if different from above m m °- 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to ° ❑ Individual /sole proprietor or ❑ C Corporation 718 Corporation ❑ Partnership ❑ Trust /estate certain entities, not individuals; see instructions pagefa m c ° o single-member LLC Limited liability company. Enter the tax classification C =C corporation, S =S corporation, P= artnershi Ii. ❑ y p y ( p p P) a Exempt payee code (if any) 0 2 Note. For a single- member LLC that Is disregarded, do not check LLC; check the appropriate box in the line she for Exemption from FATCA reporting c the tax classification of the single- member owner. code (if any) d5 ° E] Other (see instructions) ► lappres roaccounrs memrarncd oanree the U.S,) 5 Address (number, street, and apt. or suite no.) Requester's name and address (optional) ° a m 8 City, state, and ZIP code m rn 7 List account numbers) here (optional) Ni Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number ( However, for a resident alien, sole proprietor, or disregarded entity, see the Pan page I instructions on page 3. For other - m -� entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I Employer Identification number guidelines on whose number to enter. F7_1 F—F-77F penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Jlgn Signature of Here I U.S. person 0- Date Iii General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W -9 (such as legislation enacted after we release it) is at www.Irs.gov /fw9. Purpose of Form An Indlvldual or entity (Form W -9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), Individual taxpayer Identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return, Examples of information returns include, but are not limited to, the following: • Form 1099 -INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099 -MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099 -B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099 -5 (proceeds from real estate transactions) • Form 1099 -K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098 -E (student loan interest), 1098 -T (tuition) • Form 1099 -0 (canceled debt) • Form 1099 -A (acquisition or abandonment of secured property) Use Form W -9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Farm W -9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business Is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (ii any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Cat. No. 10231X 22A -14 Form W-9 (Rev. 12 -2014) Form W-9 (Rev. 12 -2014) Note. If you are a U.S. person and a requester gives you a form other than Form W -9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W -9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien; • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; • An estate (other than a foreign estate); or • A domestic trust (as defined In Regulations section 301.7701 -7). Special rules for partnerships. Partnerships that conduct a trade or business In the United States are generally required to pay a withholding tax under section 1446 on any foreign partners' share of effectively connected taxable income from such business. Further, in certain cases where a Form W -9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, If you are a U.S. person that is a partner in a partnership conducting a trade or business In the United States, provide Form W -9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. In the cases below, the following person must give Form W -9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business In the United States: • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; • In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and • In the case of a US. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W -9. Instead, use the appropriate Form W -8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of Income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a. U.S, resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of Income, you must attach a statement to Form W -9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S. -China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present In the United States. Under U.S. law, this student will become a resident alien for tax purposes If his or her stay In the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S. -China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W -9 a statement that includes the Information described above to support that exemption. If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W -8 or Form 8233. Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax - exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments 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 receive will be 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 Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an Incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable Interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W -9 for more information. Also see Special rules for partnerships above. What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W -9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W -9 If the name or TIN changes for the account; for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure Is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying Information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and /or imprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. If this Form W -9 Is for a joint account, list first, and then circle, the name of the person or entity whose number you entered In Part I of Form W -9. a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note. ITIN applicant: Enter your Individual name as It was entered on your Form W -7 application, line 1 a. This should also be the same as the name you entered on the Form 1040/1040A/I 040EZ you filed with your application. b. Sole proprietor or single- member I.L.C. Enter your individual name as shown on your 1040/1040All 040EZ on line 1. You may enter your business, trade, or "doing business as" (DBA) name on line 2. c. Partnership, LLC that is not a single- member LLC, C Corporation, or S Corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2. d. Other amities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2. e. Disregarded entity. For U.S. federal tax purposes, an entity that Is disregarded as an entity separate from its owner is treated as a "disregarded entity." See Regulations section 301.7701- 2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the Income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that Is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, "Business name /disregarded entity name." If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W -8 instead of a Form W -9. This is the case even If the foreign person has a U.S. TIN. 22A -15 Form W-9 (Rev. 12 -2014) Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2. Line 3 Check the appropriate box in line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box in line 3. Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the "Limited Liability Company" box and enter "P" in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation, checkthe "Limited Liability Company" box and in the space provided enter "C" for C corporation or "S" for S corporation. If it is a single- member LLC that is a disregarded entity, do not check the "Limited Liability Company" box; instead check the first box in line 3 "Individual /sole proprietor or single - member LLC." Line 4, Exemptions If you are exempt from backup withholding and /or FATCA reporting, enter in the appropriate space in line 4 any code(s) that may apply to you. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt from backup withholding. Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099 -MISC. The following codes Identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1 —An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 401 if the account satisfies the requirements of section 401(f)(2) 2 —The United States or any of its agencies or instrumentalities 3 —A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4 —A foreign government or any of its political subdivisions, agencies, or Instrumentalities 5 —A corporation 6 —A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7 —A futures commission merchant registered with the Commodity Futures Trading Commission 8 —A real estate investment trust 9 —An entity registered at all times during the tax year under the Investment Company Act of 1940 10 —A common trust fund operated by a bank under section 584(a) 11 —A financial institution 12 —A middleman known in the Investment community as a nominee or custodian 13 —A trust exempt from tax under section 664 or described in section 4947 The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. IF the payment Is for... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 7 Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter 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 $5,000' 1 through 5' Payments made in settlement of Exempt payees 1 through 4 payment card or third party network transactions 1 See Form 1091 Miscellaneous Income, and Its instructions. '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 601 and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution Is subject to these requirements. A requester may Indicate that a code is not required by providing you with a Form W -9 with "Not Applicable" (or any similar indication) written or printed on the line for a FATCA exemption code. A —An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B —The United States or any of its agencies or instrumentalities C —A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D —A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1 (c)(1)(1) E —A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1 (c)(1)(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 tax year under the Investment Company Act of 1940 I —A common trust fund as defined in section 584(a) J —A bank as defined in section 581 K —A broker L —A trust exempt from tax under section 664 or described in section 491 M —A tax exempt trust under a section 403(b) plan or section 457(g) plan Note. You may wish to consult with the financial Institution requesting this form to determine whether the FATCA code and /or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W -9 will mail your information returns. Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN Is your IRS individual taxpayer Identification number (ITIN). Enter It in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single- member LLC that Is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on this page), enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS -5, Application for a Social Security Card, from your local SSA office or get this form online at www.ssa.gov. You may also get this form by calling 1 -800- 772 -1213. Use Form W -7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.lrs.gov /businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W -7 and SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM (1- 800 -829- 3676). If you are asked to complete Form W -9 but do not have a TIN, apply for a TIN and write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60 -day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For" means that you have already applied for a TIN or that you Intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W -8. 22A -16 Form W -9 (Rev. 12 -2014) Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W -9. You may be requested to sign by the withholding agent even If Items 1, 4, or 5 below Indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required), In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered Inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an Incorrect TIN. "Other payments" Include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third parry network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or NSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual The individual 2. Two or more individuals (Joint The actual owner of the account or, account) if combined funds, the first individual on the account' 3. Custodian account of a minor The minor' (Uniform Gift to Minors Act) 4. a. The usual revocable savings The grantor- trustee' trust (grantor Is also trustee) b. So- called trust account that is The actual owner not a legal or valid trust under state law 5. Sole proprietorship or disregarded The owner' entity owned by an individual 6. Grantor trust filing under Optional The grantor" Form 1099 Filing Method 1 (see Regulations section 1.671- 4(b)(2)(1) (A)) For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an The owner Individual 8. A valid trust, estate, or pension trust Legal entity' 9. Corporation or LLC electing The corporation corporate status on Form 8832 or Form 2553 10. Association, club, religious, The organization charitable, educational, or other tax - exempt organization 11. Partnership or multi- member LLC The partnership 12. A broker or registered nominee The broker or nominee 13. Account with the Department of The public entity Agriculture in the name of e public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671- 4(b)(2)(i) (B)) List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 'Glade the minor's name and furnish the minor's SSN. Page 4 You must show your individual name and you may also enter your business or DBA name on the "Business name /disregarded entity" name line. You may use either your SSN or EIN (If you have one), but the IRS encourages you to use your SSN. List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity Itself is not designated In the account title.) Also see Special rules for partnerships on page 2. 'Note. Grantor also must provide a Form W -g to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An Identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questlonable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1- 800- 908 -4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAB by calling the TAB toll -free case Intake line at 1- 877 - 777 -4778 or TTY7TDD 1- 800 -829 -4059. Protect yourself from suspicious emails or phishing schemes. Finishing 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. The IRS does not initiate contacts with taxpayers via emalls. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access Information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing®irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1 -800- 366 -4484. You can forward suspicious emails to the Federal Trade Commission at: spam @uce.gov or contact them at www.ffc.gov /idtheft or 1- 877 -IDTH EFT (1- 877 - 438 - 4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (Including federal agencies) who are required to file information returns with the IRS to report Interest, dividends, or certain other Income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file Information returns with the IRS, reporting the above information. Routine uses of this information include giving It to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use In administering their laws. The Information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must 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. 22A -17 4UY. 1111 Yth [:1LlftlltV9.1 SFN0 rO: Southern California Edison, Business Incentives Er 1`i % 't P.O. Box 800, Rosemead, CA 91770.0800 D I S O N E -mail: Businesslncentives @sce.com I Fax: 626 -633 -3243 +,enrsrra�>..vrrrre.unar.er t',m,po1, Questions? 800-7364777 Date: August 10, 2016 Customer Information: Authorized Agent Information: John Aguilar Rebecca Hausheer City of Santa Ana The Energy Coalition 20 Civic Center PI. M -11 47 Discovery Ste. 250 Santa Ana, CA 92701 Irvine, CA 92618 RE: NOTICE OF ON -BILL FINANCING (OBF) APPLICATION APPROVAL AND FUNDING RESERVATION Project Number: 353 -15. 0500765634 Dear John Aguilar and Rebecca Hausheer: Your On -Bill Financing Application has been reviewed and approved, and funding for your On -Bill Financing Loan has been reserved. At this point the estimated OBF Loan funding reservation for your project of $152.648.95 has been established. Terms and Conditions of Loan Reservation: 1. The reserved amount has been calculated based on the results of the review and approval of your Energy Efficiency Project Application, and according to the provisions and methodology of the OBF Loan Term Calculation [LTC]. Since the loan reservation amount is based on an approved project proposal, it is an estimate of what the actual loan amount may be. 1a. An OBF Loan Term Calculation [LTC] is attached. 2. The actual loan amount will be calculated based on the results of the review and approval of your Energy Efficiency Project Installation Report, and according to the provisions and methodology of the OBF Loan Term Calculation [LTC]. Therefore, the actual amount of the OBF Loan may differ from the reserved amount presented above. 2a. The actual amount of the OBF loan may be less than the reserved amount presented above. 2b. The actual amount of the OBF loan shall not exceed the reserved amount presented above. 3. The expiration of the loan reservation shall be consistent with that of the project incentive. Next Steps: • You submit the completed Installation Report [IR] to SCE, and SCE will review it. • SCE will calculate the actual final loan amount, based on the results of the IR approval, and the LTC provisions. • SCE will issue 2 copies of the OBF Loan Agreement to you. • You will sign, and have notarized, the Agreements and return to SCE. • SCE will counter -sign the Agreements. • SCE will provide you with 1 copy of the fully- executed Loan Agreement and will process the loan proceeds. If you have any questions, please contact your SCE Account Representative. You may also call us at (800) 736 -4777 Monday through Friday, from 8:00 a.m. to 5:00 p.m., or send an e-mail to bus! nessincentives @sce.com. Please have your Project Number available for reference when you call, or include it in your e-mail. Sincerely, Delia Williams Program Manager- On Bill Financing Southern California Edison Company. Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning SCE is the Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580. 22A -18 On -Bill Financing Program - Preliminary Loan Term Calculation (LTC1) Completion Date /Time: 12/2312015 8:01 AM Project Number: 353 -15- 0500765634 Service Account: 3 -000- 8761 -23 Customer Number: 1 -0- 000 -7130 Customer Account Number: 2 -24- 020 -8303 OBF Application Receipt Date: 9/412015 Project Type(s) : Customized and Deemed Market Segment: Government and Institutions $ Business Name: SANTA ANA, CITY OF B.2. Estimated Annual Dollar($) Savings Reference Name: PRP -SANTA ANA LIBRARY LT & MC Address: 690 W CIVIC CENTER D City, CA Zip: SANTA ANA, CA 92701 PROJECT ECONOMIC SUMMARY ACTUAL TERMS WILL BE CALCULATED BASED ON FINAL REVIEW AND VERIFICATION OF THE PROJECT INSTALLATION REPORT LTC1 Reserved Amount is $152,648.95 First month payment is $585.37 101 subsequent monthly payments $1,505.58 EXPLANATION A. AVERAGE ELECTRIC BILLING RATE -- past 12 months (Cents /kWh) $ 0.12678 Based on Billing History 186,538.64 B. ENERGY EFFICIENCY PROJECT SAVINGS $ B.I. Estimated Annual Kilowatt Hour Savings (kWh) 142,508.4 From Approved Project Application B.2. Estimated Annual Dollar($) Savings $ 18,066.96 Estimated Annual kWh Savings x Average Rate = $ savings (B.1 x A) B.3. Estimated Monthly Dollar($) Savings $ 1,505.58 Estimated Monthly $ Savings (B.2 / 12) C. COSTS C.I. Estimated Total Project Cost $ 186,538.64 C.2. Excess Project Cost $ C.3. Estimated Total Rebate /Incentive $ 33,889.69 C.4. Other $ C.5. Estimated Potential Loan Amount (Gross Amount) $ 152,648.95 C.6. LTC1 Reserved Amount C.7. LTC2 Reserved Amount D. LOAN D.I. Gross Amount for Potential Financing $ 152,648.95 D.2. Monthly Loan Repayment Amount $1,505.58 D.3. Actual loan term (Months) 102 DA. Actual loan term (Years) 8.5 E. LOAN LIMIT TESTS E.I. Market Segment Amount of Loan Test (Min /Max Loan Amount) E,1.1. Market Segment Minimum Loan Amount $ 5,000 E,1.2. Market Segment Maximum Loan Amount $ 250,000 E.1.3. Within Market Segment Limit? Y E.2. Customer Loan Limit Test (Previous Loans for this Service Account) E,2.1. Service Account Loan Amount Limit $ 250,000 From Approved Project Application Based on 20% Basic Lighting Cap Rule From Approved Project Application (C.1) - (C.2) - (C.3) - (C.4) From LTC1 calculation following Approved Project Application LTC2 Loan Amount per policy cannot be greater than LTC1 amount Lesser of (C.5) or (C.6) or (E.1.2) or (E.2.3) or other roles apply (B.3) Time required to repay loan in months (subject to exception analysis below) Time required to repay loan in years: (D, 3) /12 Minimum Loan Amount per Service Account or Bundle Com, Ind, Ag = $100,000, G &I = $250,000 Is D.1 within loan amount limits Y /N? (E.1.2) or $1 M for G &I Facility E,2.2, Previous Loans Reserved for this Service Account $ Total of previous OBF loans + reservations E.2.3. Estimated Amount Eligible for Loans $ 250,000.00 (E.2.1) - (E.2.2), If < 0, then 0. E.2.4. Within Available Amount? Y Is D.1.<E.2.3. Y /N? E.3. Length of Loan Test E.3.1. Loan Length Limit (months) 120 CIA (lighting) = 36, CIA (non- lighting) = 60, G &I = 120 months E.3.2. Within Loan Length Limit? Y Is D.3 within limit Y /N? E.4. Expected Useful Life (EUL)* Loan Length Limit Test E.A.I. Applicable Measure FILL (months) 144 ELL in months of measure with greatest kWh contribution E.4.2. Within ELL Loan Length Limit? Y Is D.3 within limit Y /N? E.S. EXCEPTION ANALYSIS (If any E1 thru E.4. yields a "No") Exception Analysis Loan Minimum Requirement Test Does the loan amount from Exception Analysis meet the $5K loan minimum requirement? YES E.5.1. First Payment Amount $ 585.37 E.5.2. Subsequent Monthly Loan Repayment Amount $ 1,505.58 Based on minimum loan requirement of $6K and supplemental E.5.3. Subsequent Monthly Payments 101 Exception Analysis, this amount qualifies for an estimated OBF E.5.4. Net Amount for Financing $ 152,648.95 loan. -Expected Ueeful Lire (EUL) '. Eaton measure to eri to perform sarlsherodly fora period af time . An EULror sear oner9y efficiency measure Is assigned by the Callfous Energy Oommission (CEC) LTC ID: 9673 22A -19 22A -20 ABSTRACT OF BIDS ENERGY - EFFICIENT LIGHTING AND HVAC CHILLED WATER PUMP (16 -099) Bidder JF Electric Gerhard Electric Location Hesperia Laguna Hills Total $175,480.00 $207,401.09 EXHIBIT 2 22A -21 Western Air Conditioning Co., Inc. Rancho Cucamonga $453,144.00 22A -22 CITY OF SANTA ANA DAVID CAVAZOS City Manager APPROVED AS TO FORM ATTEST Sonia R. Carvalho, City Attorney By: JO M. FUNK Assistant City Attorney FOR APPROVAL FRANCISCO GUTIERREZ Executive Director Finance and Management Services Agency 22A -23 Additional Page for City Signatures SCE On -Bill Financing Agreement Main Library Lighting Retrofit MARIA D. BUIZAR Clerk of the Council 22A -24