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HomeMy WebLinkAbout2015 CON Assi Security - Door Security ServicesSHORT FORM SERVICES AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND ASSI SECURITY INCORPORATED THIS AGREEMENT is entered into this 15th day of June, 2015, by and between the CITY OF NATIONAL CITY, a municipal corporation (the "CITY"), and ASSI SECURITY, a CORPORATION (the "CONTRACTOR"). NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set forth herein in accordance with the following terms and conditions: 1. Description of Services. CONTRACTOR shall provide City -Wide on -site door security service and repairs as -needed for our fiscal year ending June 30, 2016, and as directed by Rick Hernandez, the City's Facilities Maintenance Supervisor 2. Length of Agreement. The duration of this agreement is through June 30, 2016. 3. Compensation. The total compensation to CONTRACTOR for providing the services set forth herein shall not exceed an annual total cost of $5,000.00. The compensation for CONTRACTOR'S work shall be based upon and not exceed the rates given in Exhibit "A" (the labor rates) without prior written authorization from CITY. 4. Payment Schedule. CITY will make payment within thirty (30) days of receiving and approving a billing statement for the satisfactorily completed services of CONTRACTOR. 5. Termination. CITY may terminate this Agreement at any time by providing a one (1) day written notice to CONTRACTOR. 6. Independent Contractor. It is agreed that CONTRACTOR is an independent Contractor, and all persons working for or under the direction of CONTRACTOR are CONTRACTOR'S agents, servants and employees, and said persons shall not be deemed agents, servants, or employees of CITY. 7. Insurance. CONTRACTOR shall obtain: A. ❑ If checked, Professional Liability Insurance (errors and omissions) with minimum limits of $1,000,000 per occurrence. B. Automobile insurance covering all bodily injury and property damage incurred during the performance of this Agreement, with a minimum coverage of $1,000,000 combined single limit per accident. Such automobile insurance shall include owned, non -owned, and hired vehicles ("any auto"). C. Commercial general liability insurance, with minimum limits of $1,000,000 per occurrence/$2,000,000 aggregate, covering all bodily injury and property damage arising out of its operations under this Agreement. D. Workers' compensation insurance in an amount sufficient to meet statutory requirements covering all of CONTRACTOR'S employees and employers' liability insurance with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a waiver of subrogation in favor of the City. Said endorsement shall be provided prior to commencement of work under this Agreement. E. The aforesaid policies shall constitute primary insurance as to the CITY, its officers, employees, and volunteers, so that any other policies held by the CITY shall not contribute to any loss under said insurance. Said policies shall provide for thirty (30) days prior written notice to the CITY of cancellation or material change. F. Said policies, except for the professional liability and workers' compensation policies, shall name the CITY and its officers, agents and employees as additional insureds, and separate additional insured endorsements shall be provided. G. If required insurance coverage is provided on a "claims made" rather than "occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years after expiration of the term (and any extensions) of this Agreement. In addition, the "retro" date must be on or before the date of this Agreement. H. Insurance shall be written with only California admitted companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII according to the current Best's Key Rating Guide, or a company equal financial stability that is approved by the City's Risk Manager. In the event coverage is provided by non -admitted "surplus lines" carriers, they must be included on the most recent California List of Eligible Surplus Lines Insurers (LESLI list) and otherwise meet rating requirements. I. This Agreement shall not take effect until certificate(s) or other sufficient proof that these insurance provisions have been complied with, are filed with, and approved by the CITY's Risk Manager. If the CONTRACTOR does not keep all of such insurance policies in full force and effect at all times during the terms of this Agreement, the CITY may elect to treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the Agreement as provided herein. J. All deductibles and self -insured retentions in excess of $10,000 must be disclosed to and approved by the CITY. K. Insurance certificates must specify certificate holder as: City of National City ATTN: Risk Manager 1243 National City Blvd National City, CA 91950-4301 8. Hold Harmless. CONTRACTOR shall defend, indemnify, and hold CITY, its Officers, employees, and agents harmless from any liability for damage or claims of same, including but not limited to personal injury, property damage and death, which may arise from CONTRACTOR, or CONTRACTOR'S subcontractors, agents or employees' operations under this Agreement. CITY shall cooperate reasonably in the defense of any action, and CONTRACTOR shall employ competent counsel, reasonably acceptable to the City Attorney. 9. Acceptability of Work. The City shall, with reasonable diligence, determine the quality or acceptability of the work, the manner of performance, and/or the compensation payable to the CONTRACTOR. 10. Business License. CONTRACTOR must possess or shall obtain business license from National City Finance Department before beginning work. Revised August 2014 2 11. Miscellaneous Provisions. A. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which, together, shall constitute but one and the same instrument. B. Captions. Any captions to, or headings of, the sections or subsections of this Agreement are solely for the convenience of the parties hereto, are not a part of this Agreement, and shall not be used for the interpretation or determination of the validity of this Agreement or any provision hereof. C. No Obligations to Third Parties. Except as otherwise expressly provided herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon, or obligate any of the parties hereto, to any person or entity other than the parties hereto. D. Exhibits and Schedules. The Exhibits and Schedules attached hereto are hereby incorporated herein by this reference for all purposes. E. Amendment to this Agreement. The terms of this Agreement may not be modified or amended except by an instrument in writing executed by each of the parties hereto. F. Waiver. The waiver or failure to enforce any provision of this Agreement shall not operate as a waiver of any future breach of any such provision or any other provision hereof. G. Applicable Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California. The CONTRACTOR shall comply with all laws, including federal, state, and local laws, whether now in force or subsequently enacted. H. Entire Agreement. This Agreement supersedes any prior agreements, negotiations and communications, oral or written, and contains the entire agreement between the parties as to the subject matter hereof. No subsequent agreement, representation, or promise made by either party hereto, or by or to an employee, officer, agent, or representative of any party hereto shall be of any effect unless it is in writing and executed by the party to be bound thereby. I. Successors and Assigns. This Agreement shall be binding upon and shall inure to the benefit of the successors and assigns of the parties hereto. J. Construction. The parties acknowledge and agree that (i) each party is of equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and negotiation of this Agreement, (iii) each such party has consulted with or has had the opportunity to consult with its own, independent counsel and such other professional advisors as such party has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv) any rule or construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in the interpretation of this Agreement, or any portions hereof, or any amendments hereto. IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR on the date and year first above written. Revised August 2014 3 CITY OF NATIONAL CITY By: Leslie Deese, City Manager PROVED ► S TO FO Cudia Gacitua ilva City Attorne CONTACT INFORMATION CITY OF NATIONAL CITY 1243 National City Boulevard National City, CA 91950-4301 Phone: (619)336- 4585 Fax: (619)336-4397 Contact: Rick Hernandez Title: Facilities Supervisor Dep.: Public Works Email: rickh@nationalcityca.gov ASSI SECURITY INCORPORATED (Corporation — signatures of two corporate officers required) (Partnership — one signature) (Sole proprietorship — one signature) By: (Name) M iuna (Print) V i(:e.-1 icP.174 (Title) C (/// �f By: , �1 (Name) - ;U \h)Or (Print) (Title) ASSI SECURITY Complete Address: 1370 Reynolds Ave. STE 201 Irvine, CA. 92614 Phone: (949) 955-0244 Fax: (760) 804-0219 Contact: Sam Colacino Title: President Email: service@assisecurity.com Taxpayer I.D. No.: 330585909 Revised August 2014 4 April 1, 2015 1370 REYNOLOS AVE, SUITE 201 IRVINE, CA 92614 Time and Materials Service Building Access Control and CCTV Systems Business Hours are Sam — 5pm, Monday — Friday. Hourly rates are: $135.00 for the first hour $100.00 for each hour thereafter $150.00 for Programming Hourly rates for any service call outside those hours will be $210.00 per hour, including travel There is a minimum one hour charge for all service calls. Billing begins when the technician arrives on site. There is no charge for travel time during normal business hours. Please don't hesitate to cal! me at (949) 955-0244x127 should you need anything else. Sincerely, Amy Tompkinson Operations Coordinator CERTIFICATE OF LIABILITY INSURANCE OP ID: SC DATE (MMIOD/YYYY) 04/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER GREG LERUM INSURANCE 302 N. EL CAMINO REAL #118 SAN CLEMENTE, CA 92672 Greg Lerum INSURED ASS! Security Inc 1370 Reynolds Ave Suite 201 Irvine, CA 92614 CONTACT NAME: PHONE INC No. Fat>: E-MAIL ADDRESS: PRODUCER CUSTOMER ID # ASSIS 1 INSURENSI AFFORDING COVERAGE INSURER A: Mid Century Insurance Company INSURER B : INC,FAX No): NAIL N INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH INSR TYPE OF INSURANCE LTR OF INSURANCE PERTAIN. POLICIES. ADDL INSR SUBR 1/1/VD I VD LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY NUMBER (MM/DDIYYYY) POLICY EXP IMMJDO/YYYYI GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO Rf=N FED COMMERCIAL GENERAL LIABILITY PREMISES (ga occurrence) ____ CLAIMS -MADE OCCUR MED EXP (Any one person) --. $ PERSONAL & ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG_4 POLICY I_.._ I PRO- i LOC JFCT _, ___ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 A ANY AUTO BODILY INJURY (Per person) $ A X Al L OWNED AUTOS 014960535 05/09/2015 05/09/2016 BODILY INJURY (Per acadenl) $ A X 1SCHEDULEDAUTOS 014960535 05/09/2015 05/09/2016 PROPERTY DAMAGE A X HIRED AUTOS 014960535 05/09/2015 05/09/2016 (PER ACCIDENT) $ A X NON -OWNED AUTOS 014960535 05/09/2015 05/09/2016 $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE 3 EXCESS LIAB CLAIMS -MADE AGGREGATE. $ DEDUCTIBLE $ _ RETENTION 5 $ WORKERS COMPENSATION ! WC STATU- j OTH- J TQRY LIMITS L 1 Ell AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVEE OFFICER'MEMBEREXCLUDED,/ N ! A !Mandatory in NH) C.L. DISEASE - EA EMPLOYEE $ 1 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule,,, if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009109) O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED'S NAME ASSI Security Inc SCHEDULED AUTOS INCLUDE: 1.) 2005 NISSAN FRONTIER VIN: 1N6AD06U45C429129 2.) 2002 FORD F150 SUPER VIN: 1FTRW07332KC89033 3.) 2006 JEEP LIBERTY SP VIN: 1J4GK48K46W239542 4.) 2002 CADILLAC ESCALADE VIN: 1GYEK63N32R260234 5.) 2012 CADILLAC CTS PREUMIUM VIN: 1G6DP5E34C0119707 6.) 2011 BMW ALPINA B7 VIN: WBAKBBC5OBCY64604 7.) 2013 TOYOTA SCION XB VIN: JTLZE4FEXDJ048001 8.) 2013 TOYOTA SCION XB VIN: JTLZE4FE3DJ043917 9.) 2013 TOYOTA SCION XB VIN: JTLZE4FE5DJ048052 10.) 2012 BMW 6501 VIN: WBALZ3C52CDL72915 11.) 2014 BMW 750LI VIN:WBAYE8C57ED134768 12.) 2013 TOYOTA SCION XB VIN: JTLZE4FE1DJ048470 13.) 2014 TOYOTA SCION XB VIN: JTLZE4FE4EJ051896 14.) 2014 LAND ROVER SPORT VIN: SALWG2WF7EA358509 15.) 2014 FORD EDGE VIN: 2FMDK3JC5EBB65579 16.) 2003 JEEP LIBERTY SP VIN: 1J4GK48K53W689924 17.) 2015 CADILLAC SRX LUXURY VIN: 3GYFNBE31FS524487 ASSIS-1 OP ID: SC PAGE 2 Dale 04/27/2015 ACORN CERTIFICATE OF LIABILITY INSURANCE ‘....... DATE(MM/DDIYYYY) 4/10/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Leavitt Southern California Insurance Services #0F13098 1820 E. First Street, Ste 500 Santa Ana CA 92705 CONTACT Sandra. Cox NAME: AfCNNo. Exfl• (714)569-2700 (A/C X No). (714)569-3099 EMAIL sandra-cox@leavitt.cora ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INsuRERA:Associated Industries Insurance 23140 INSURED ASSI Security Inc. 1370 Reynolds Avenue Suite 201 Irvine CA 92614 INSURER B :SCOttsdale Insurance Company 91297 INSURERC: INsuRER o : INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER:2015 GL-XS • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A AODL INSR SUBR. WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDOIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY AES1034496 4/12/2015 4/12/2016 EACH OCCURRENCE s 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) S 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) S Exal X Professional Liability PERSONAL &ADV INJURY $ 1,000,000 $5,000 Deductible GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: —1 7 POLICY X .PIE(? 1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) .5 S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ B X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE XLS0096753 4/12/2015 4/12/2016 EACH OCCURRENCE S 5,000,000 AGGREGATE $ 5,000,000 DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABIL TY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE r-n OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A WC STATU- TORY OMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Mind ACORD 101, Additional Rernarks Schedule, R more space Is required) RE OPERATIONS OF THE NAMED INSURED AS ON FILE WITH THE INSURANCE CARRIER. THE CITY OF NATIONAL CITY, ITS ELECTED OFFICIALS, OFFICERTS, AGENTS AND EMPLOYEES ARE ADDTL INSURED AS RESPECTS GENERAL LIABILITY PER CG2033 07/04 & CG2037 07/04, CERTIFICATE HOLDER CANCELLATION CITY OF NATIONAL CITY 1243 NATIONAL CITY BLVD NATIONAL CITY, CA 91950-4301 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gary Wells/JUBAE� ACORD 25 (2010/05) INS025 fn01000/ n1 ©1988-2010 ACORD CORPORATION- All rights reserved. Tha GRr1Rr1 namo anti Innn arcs roniafo rorl marlrc of ACTOR") POLICY NUMBER: AES1034496 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 1I — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are complet- ed. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying ser- vices, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: AES1034496 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizatlon(s): Location And Description Of Completed Operations All persons or organizations where written contract with the Named Insured requires additional insured completed operations This form does not apply to your work on "residen- tial property". Information required to complete this Schedule, if not shown above, will be shown in the Declarations Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Taxpayer IdentifioatIon Number (TIN) instructions on page 3. Sign Signature of Here U.S. person IP General Instructions Section releiences are to the Internal Revenue COS101.10)5S otherwise noted. Future cleyeluniiienrs. information attain developments affecting vorm W-9 (such as tegistation elected Mier we release i,t) is at www.lis.govi1ie9. Purpose of Form Arimumdimi cr entity (1-orm W-9 requester) who is required to ale an information 'Morn with the 15 must obtain your correct taxpayer identification number (TIN) which (nay be your social security number (SSN), individual taxpayer ident.fication ilirobfff intoption taxpayer identification number (ATIN), Of employer ntenlianiion 0411-111301 (FIN), 10 report on an information return the amount paid to you, nr other amount reportable on an information return Examples ot Information returns include, but are not limited io, the following; • Fenn 1099-INT selerest earned or paid) • Form 1099.01V (dividends, including those from steces or mutual funds) • form 1009-MSC (various types of income, prizes, arrazds, or gross proceeds) • Farm 109043 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and Ittrrd party network transactionS) l04//1 W.9 tHev. Oerember 2014) Department of the TrearAlry Internal Pen, enue c-rvicr, Request for Taxpayer Identification Number and Certification Name (as shown on your income lax return). Name is required on this line, do not leave this line blank, ASS! Security, Inc 2 Bus ness narneklisregarded entity name, if different from above re 8 3 Check appropriate box for federal tax classification: Chetany one of the following seven boxes: fl individuatk,oc proprietor or 0 C Corporation D S Corporation 0 Partnership Satgla-rnember (.1,C Ei baited Iir04ity company. Enter tho tax ctassification (CC corporation, $.$ corporation, Ps -partners. hi))) t• Give Form to the requester. Do not send to the IRS. n "frosVestale Note. For a sinemtitiber ti,C that is disregaroctf, do not check LLC; cheek the appropriate box in the hoe above for the tax classification of the single -member owner. 1_1 Other Cseo instructions) k 47, 5 Arkenss (number, sinail, and apt, or suite no.) cg 1370 Reynolds Ave, Suite 201 6 City, slate. and ZIP mar (I) Irvine, CA 92614 7 List account number's) here (oPlional) Enter your T- EN in the appropriate box. The TIN provided must loafer) the name given on line 1 to avoid L sada! socuriknumber .j r_ 1 backup WithhOlding. For individuals. this is generally your social security number (SSN). Tiowever, for a 1 r entities it is your employer ident Meatier' eumber (EIN). If yell do not have a number, see HOW to go! a resident alien, sole proprietor. or disregarded entity, see the Part I instructions on page 3. For other I —1 1 _ i H TIN on page 3. Nolo. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. 4 Exemptions (codes apply only to certain entikes, not eldividuals; see instructiona On page 3): Exempt payee code tif arty) L . Exemption from FATCA reporting code flt any) ewe. riar.reeo maioa ,hrkrl n rsq/e. fra 5/ rittilleSter'S name and address (optiona) Part I Certification or Employer identificat on number -1 0 5 I 8 5 9 0 9 Under penalties of perjury. I certify that: 1. The number shown on this form Is ray correct taxpayer identification number (or I am waiting for a nurnbor to he issued to me); and 2. I am not subject to backup withholding because: (8)1 am exempt from backup withholding, or (b) I have riot been notified by the Internal Revenue Service (IRS) that I arn subject to backup withholOing as a result of a failure to report all Interest or dividends. or (o) the IRS has notified me that I am no longer subject to backup withholding; and 3. I aril a U.S. citizen or other U.S. person (defined below); and A. The FATCA corte(e) 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 tailed to report all interest and dividends un 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 (111A), and generally, payments othor than Interest and eivicleneis, you are not required to sign the certification, but you must provide your correct TIN. See the kJYVkPEi Date P. shi5 • lorrn 10911 thomn mortgage earnest), 1095-E (slocfent loan interest), 1098-T (tuition) • Fortin 1099, e (canceled debt) • Fee, 1099-A Izicriuisaion or abancloornent Ot secured properly) Use FOrn, W-9 only if you are a U S. person (Including a resident airer1), tO provide your correct TIN, tIyii c/o not return Form W-9 to the requester with a TIN, you alight be Subject to bacAup isithhotoring. See What (.9 bachup w4thhohling? on pone 2. Hy signing the lied -out form, you: 1, Curtly that the 1lN you are giving is correct (or you are welting 1010 number to be issued), 2. Certify that you era not subject to backup withholding, or 3. Claim exemption from backup withholding 1 you are a U.9, exempt payee, If applicable, you are also cerhfying 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 withnolding tax on foreign partnersshare of effectively connected income, and 4, Certify that FATCA codels) ordered on this loon ki any) indicating that you are exempt from the FATCA reporting. is COired. Sea What is FAY CA reporhho5 on page 2 for further inlormalion Cat No. 10231X leer W-9 (flee, 12-2014) Form ,11-9 (Ray. 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 roust 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 Unite] States or under the law of the United States; • An estate (other than a foreign estate); or • A domestic trust (as defined in Regulations section 301.7701-7). Speclal rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withhord:ng tax under section 1446 se any foreign partners' share of eflectiveFy connected taxable income from Such business. Further, in certain cases where a Form W-9 has not been received, the nudes under section 1446 require a partnership 10 presume that a partner is a foreign person, and pay the section 1446 withholding lax. Therefore, if you are a 0.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 a5Oid section 1448 withholding on your share of partnarahla intoma. In the cases below, the following person roust give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net lecorne 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 n4 a grantor gnat 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 rho case of a U.S. trust (other than a grantor trust). the U.S. truat (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 he treated as a U.S. person, do not use Ferro W-9. Instead, use the appropriate Form W-8 or Form 6233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alion. Generally, only a nonresident stien individual may titre the terms of a lax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known es a "saving cratrse." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain, types of income even alter the payee has otherwise become a' J.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 cram an exemption from U.S. lax on certain types of income. you must attach a statement to Form 4WD that specifies the following live items: 1. The Peaty country, Generally, this must he 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 typo 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 fax treaty allows an exemption from tax fa scholarship income received by a Chinese student temporarily present tit the United Stales. Under U.S. law, this Student will become a resident alien for fax purposes if his or her stay in the Lasted States exceeds 5 calendar years. However, paragraph 2 nl the rust Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 2f) to continue to apply even after the Chinese student becomes a resident alien ail the United States. A Chinese student who qualifies for this exec/saw, (under paragraph 2 of the firstp rotocoli and Is relying on this exception to claim an exemption from tax our his or her scholarship or fellowship income would attach to Farm W-9 a statement that includes the information described above to support that exemption. If you are a nonresidentalien or a foreign entty, give the requeSierthe appropriate completed Form W-8 or Forrn 8233. Backup withholding What is bookrrly withholding? Persons making certain payments 10 you roust under certain conditions withhold and pay to the IRS 2894 of such payments. This is called "backup withholding.' Payments that may be subioct to backup memots:rig include interest. lax -exempt interest, dividends, broker and barter exchange transactions, rents. royalties, nonemp'cyee pay, payments made in settlement of payment card and third party network transactions. and certain payments from fishing boat operators. Rea! estate transaotions are not subject to backup withholding. Youwilt not be subject to backup withholding on payments you receive it you give the requester year correct TIN, make the proper certifications. and report art your taxable interest and dividends on you fax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish you' IN to the requester, 2. You do not certify your TIN when required (see the Part 11 instructions on page 3 for details),. Page 2 3. Tne IRS tells rho requester that you lurnished an incorrect "IN, 4. The IRS tails you that you are subject to backup wahholding because you did not report all your interest and dividends on your tax ratum (for reportable interest. and dividends only'), or 5. You do not certify to the requester that you aro not subject to backup withholding under 4 above (fix reportable interest and dividend accounts opened after 19113 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 Forn, W-9 for more information. Also see Special rules for partnerships above. What is FATCA reporting? The Foreign Amount Tax Compliance Act (FATCA) requires u participating foreign fin enclal institution to report all United Stales 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 Sequester of Form W-9 for more information, Updating Your information You must provide updated nformakon to any person to whom you darned to to 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 provioe updated information if you are a C corporation that elects to bean S corporation, 01 if you no longer are tax exempt. fnaddition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if thegrantcr of a grantor 'trust dies, Penalties Failure to furnish TIN. If you fait to furnish your correct TIN to a requester, you are subjectto a penalty of $50 for each such failure unless your failure la duo 10 reasonable cause and not to willful nagfect. 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 aflirmations may subject you 10 criminal penalties inetu ding fines and/or imptisonruent. Misuse of TINS. If the requester discloses or uses TINS ie violation of federal law the requester may be subject to civil and criminal pens€lies. Specific Instructions Line 1 You must enter one of the following on this lino: dO not leave tits tine blank. The name ehauld match the name on you+ tax return. 11 t111S Form W 0 is fora 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 narna without informing the Social Security Administration (SSA) of the name change. enter your first name, the last name as shown on your Socie) ae Ority card, arid your new last narna. Note, !TIN applicant: Enter your individual name as it was entered or Our Form W-7 application, line la. This should also be the same as the name you entered On the Form 104 011040A/1040E2 you flied w h your application. b. Sole proprietor or single -member U.C. enter your individual name es shown on your 1040f 1040A/10636Z on fine 1, You may enter your business, trade, or "doing business as" (08A) name on fine 2. c. Partnership, LLC that is not a singlo-member LLC, C Corporation, or S Corporation. Enter the entity's name as snows on theontity's tax return on fine 1 and any business, trade, or DRS. name on line 2. d. Other entities, Enter year 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 regal document treading the entity. You may enter any husintl5s, trade, or 013A name on line 2. e. Disregarded entity. For U.S, tederai tax purposes, an entity that is disregarded as an ontitY separate from its owner istreated 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 no line 5 should never b11 a disregarded entity. the name cut line 1 shook] be the name shown do the income tax return on which the income srtould be reported. For example, if a foreign LLC that Is treated as a disregarded entity lOr 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 IOW is not disregarded for festerat tax purposes Enter the disregarded entity's name on line 2, "13usineSa name/disregarded entity name" lithe owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 Instead of a Farm W-9. This is the rase even if the foreign person has a U.S. TIN. Form W-9 (Rev, 12-2014) Line 2 if you have a businessname, trade name, O13A name. or disregarded entity name, you may enter it cn fine 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 eery one box in line 3. Limited Le/betty Company ILLC)" If the name on line 1 is an tic treated as a. partnership for U.S. federal tax purposes, check the "Limited Liability Company' box and enter le" in the space provided. If the LLC has tiled Form 8832 or 2553lo be taxed as iscorporation, check tee "Limited Liebe tyCompany' box ape in the space provided enter "C" for C corporation or "S" far S corporation. 11 it is a single -member LLC that is a disregarded entity, do not check the "Limited Liabltify Company" box; instead check the List boa in One 3 "Individual/sole proprietor or singlemlember LLG." Line 4, Exemptions if you are exempt from backup withholding and7a FATCA reporting, enter in the appropriate space in ens 4 any codafs) that may apply to yeti. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt From, backup withholding. + Exeopl as provided below, corporations are exempt from backup withholding Inr 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 transactione, • Corporations are not exempt from backup withholding with respect toattorneys' fees or gross proceeds paid to attorneys. and corporations that provide med:cat ra health care services are not exempt with respect to payments reportable on Form 1099-MISG. 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 front tax under section 501(a), any iRA, or a custodial account under section 403{b)(7)11 the account satisfies the requirements of section 4010)(2) 2—The United Stales or any of its agencies or instrurnentafilies 3—A slate, the Otslrct of Columbia. a U.S. commonwealth or possession. or any of their political svedivisiona or Instrumentalities 4 —A foreign government or any of its political subdivisions, agencies, re instrumentaliiiee 5 —A corporation 6—A delete in securities or commodities required to register le line Urxted States, the District of Columba, cr a U.S. c0rrnldnwealth orpossesston 7—A futureseommission merchant registered with the Commodity Futures Trading Commission 8 —A real estate inv:Menant trust 9--An entity regrstered at all times during the tax yea- 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 to the investment carnrnunity as a nominee o custodian 13—A trust exempt from tax muter section 664 or described in section 4947 The following chart shows types of payments that may be exempt from backup withhokflrlg, Trte chart applies to the exempt payees fisted atcve, 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 exempl payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. Barter exchange transactions and patronage dividends Exempt payees 1 through 4 Payments over WO required to be reported and direct sales over $5,000' Generally, exempt payees 1 through 52 Payments made in settlement of payment card or third party network transactions Exempt payees 1 through. 4 See Form 1099-MISC, Miscellaneous Income, and its rrlatrpcirone. Page 3 'However, the following payments made to a corporation and reportable on Form 1099-MISG are not exempt from backup withholding: medicaland health care payments, attorneys' fees. gross proceeds paid to an attorney reportableunder section e045(9. and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The foltowing codes ,deraily payees that are exempt kern reporting under FATCA. These codes apply to persons submittng the form for accounts maintained outside of the United Slates by certain foreign teancial institutions. Therefore, if you are only submitting elite 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 restitution re subject to these requirements. A requester may irndcate that a code is not required by providing you with a Form W.9 with "Not Applicable" (or any similar indicaltor,) written or printed on the tine for a FATCA exemption code_ A —An organization exempt from tax under ^,tenon 501(a) or any individual retirement pert ors defined in section 27e1(a)(37) 8—The United States or any of its agencies or inslrumenleetios C—A state, flit District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalibe3 D—A corporation the stock of which is regularly traded on one or mere established securities markets, as described in Regulations section 1.1472-1(01K) E—A corporation that is a member of the same expanded affiliated weep as a corporation described in fieguletrpns section 1.1472-1(c)(1)O F'—A dealer in securities. commodities, or detivativa financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as SOON udder the laws of the United States or any state G—A real estate investment trust H—A regulaled investment company as defined in section 851 or an entity registered at ell limos during the lax year under the Investment Company Act of 1940 I—Acommon trust fund as defined in section 584(3) J—A bank as defined in section 581 K--A broker L—A trust exempt Irom tax under section 864 or described in section 4947(a)(1) NI —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 tour, to determine whether the FATCA code anoror exempt payee code should be completed. Line$ Enter your address (number, streel, and apartment or suite number). This is where the requester of this Form W-9wili mail your information returns. Line 6 Enter year city, state, and ZIP code. Part P. Taxpayer Identification Number (TiN) rotor your TIN In the appropriate box. tf you are a resident aeon and you do not have and are not eligible to get an SSN, your TiN is your IRS individual taxpayer idenlificab0n number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see Now to get a TfN below. If you area sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, rho IRS prefers that you use your SSN, If you are a single -member LLC that is disregarded as an entity separate from its mew (see baited Liability Cowper)), (LLC) on the page), enter the owner's SSN (et EIN, it the owner has one). Do not enter tie disreearderi entity's E1N. lit the LLC is classified as a cerporation or partnership, enter the entity's EIN. Note- See the chart on page 4 for further clarification of neme end TIN combinations, How to get a TINe it you do not have a TIN, apply for One immediately. To apply for an SSN, get Form SS-5, Appication for a Social Security Card, from your weal SSA. office or get tins form online at mesessa.gov. Vol) may also get this form by calling t-800-772.1213. Use Form W-7, Appticatem fur;RS Individual Taxpayer Identification Numhrr, to apply for an tithe or Form SS-4, Application for Employer Identification Number, to apply for en EIN. You errn apply for an EIN Online by accessing the IRS webs ire at www.irs.goa/businesses and cfckin9 01 t Employer Identification Number (FVd) under Starting a Business. You can get Farms W-7 and SS-4 from the IRS by visiting iRS.gov or by carting 1-800-TAX-FORM (1-800-829-3676). ff you are asked to complete Form LN-9 bet do not have a TIN, apply for a TV and write "Applied For" in the space for the TIN, sign an oats the form,and give it to the requester. For interest and dividend payments, errtd certain payments made with respect to readily tradable instruments, generally you veil have 60 daysto get a 11N and give it to the requester before you are subject to backup withholding on payments. The 6O.day rule does not apply to oilier types of payments. You win Lte subject to backup withholding o11 au such payments until you provide your TIN to the requester, Note. Entering'Apptied For" means that you have already applied tor a TIN or that you Intend to apply for one soon. Caution: A disregarded US, entity that has a toretyn owner most use the appropriate Farr W&. Form W-9 (Rev.. 12-2014) Page 4 Part 1I, Certification To establish to the wilhhotdlog agent Thal you are U.S. person, Or residers alien, sign Fern W-9. You may be requested to sign by the withholding agunl c%en t items 1, 4, or 5 below indicate otherwise. Fix a jaiet account, only the person whose TIN is shown in Pert I should sign (when required). In the case of a disregarded entity, the person identified on fine 1 must sign. Exempt payees, sea Exempt payee coda earlier. Signature requirements, Complete the certification as indicated fn 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 Co not have to sign the cerliticaton. 2. Interest, dividend, broker, and barter exchange accounts opened after 1903 end broker accounts considered Inactive during IVOS. You must sign the certification ar backup withholding will apply. If you are subject to backup wiihhc11ding and you are merely providing your cerreat T1N to the requester. you meet cross out item 2 in the certification Orders signing the form. 3. Reel estate transactions. You u:ust sign the certification YOu may Cfb3a out Rem 2 of the certification, 4, Other payments. You must give your correct TIN, but you do not have to sign the cedar cation 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 ar business for rents, royalties, goods (other than arrestor merchandise). medical and health care services (including payments to corporations), payments to a nonernptoyee for services. payments made in seltieme,I of payment card and third party network transactions. paymerts to curtain fishing boat crew members and fishermen, arid gross proceeds paid to attorneys ncladingpayments lecorporations). 5, Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, queliried tuition program payments (under section 529), ifIA, Coverdctl ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You roust give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this typo of account: Give name and SSN of: 1. Individual 2. Two re more individuals (joint account) 3. Custodian account of a minor (Uniform Gift. to Minors Act) 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is riot a legal or valid trust under state law 5. Sole proprietorship or disregarded entity awned by an indiuiduai 6. Grantor trust tiling under Optional ham 1099 Filing Method 1 (see Regudatlons section 1.671-4(0)(2)(i) (A)) The individual The actual owner of the account or, if combined funds, the first ndividual on the account The minor' The grantor -trustee' The actual owner' The owner' The granter For this typo of account Give name and EIS) oh 7. Disregarded entity not owned by an Individual 8. A valid trust, estate, or pension trust 9. Corporation or LLC electing corporate status on Form 8632 or Farm 26533 10. Aslociaden, club, religious. charitable, educational, or other tax- exempt organiratron 11. Partnership or muti-menber 1LC 12. A broker or rel'listered nominee 13. Account with the Department of Agriculture to the name of a. public entity (such as a state or local government, school district, ei' prison) Ihat receives agricu tur al program payments 14. Grantor trust filing under the Form 1041 Filing Method ar the Optional Form 1099 Filing Method 2 (see Regulationssechen 1 6/1-4(b)(2)(i) (t3)) The owner Legal entity' The corporation The organisation Ins partnership The broker or nominee The public entity The (rust 'list fast and circle Me name of the person whose nurnt»r yo-r furnish. If only ore person on ioi1 account has an SSN. that peraoo's number must be furnished. vide the lance's name and furnish the minor's sem 'You must slaw your individual name and you may also enter your business or b8A name on the "Business name:disregarded entity" name line, You may ,rse erfho' your SS!! or I IN tit you have ono), but the IRS encourages you to use your SSN. ' Ost rust a ei:meta the name el Ins trust, estate, or pension trust, (©e not furnish role TINor rho personal represent afro or trustee unless the legal entity its411 is eat designated. Ma asocial titre} Also eas Specie(r. lea for peons s 'ps er, page 2, *Nolo Grantor also muss provide a Form W-9 to trustee of trust. Note. If no name is Circled when more than one name is fisted, the number will be considered to be that of the first name fisted. Secure Your Tax Records from Identity Theft Identity (hell Cecurs when someone uses your personal information such as your name, SSN, or other ident:lying information, withotd your permission, to commit fraud Or Other crimes. An identity thief may use your 0$1.4 to get a job or may life a lax return using your SS hi to receive a rotund. To reduce your risk: Protect your SSN, + testae your employer ,s protecting yrxrr Stiff, 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 des to a iost or stolen purse or wallet, questionable credit card activity or credit report, contact the (F1S Identity Theft Hotline at 1-800-908.4490 or suturnit Form 14039. For more information. see Publreetton 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 he eligible for Taxpayer Advocate Service) (TAS) aSsislanoe. You can reach TAS by calling the TAS toll -tree case intake lino at 1-877-777-4 T 78 or TTY/100 1-800-829-4059, Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and rise of entail and websiles designed to mimic legitimate business emits and websites. The most common act is sending an emelt 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 net initiate contacts with taxpayers via emails. Alas, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or smiler secret access information for their credit card, bank, or other lmanciat accounts. If you receive an unsolicited em&t claiming to be from the IRS, forward this message to phishfnQ9102,9ov. You may also report misuse of the IRS name, logo, or other 01S properly to the Treasury Inspeexor General for Tax Administration (WIN at 1-850.3t36.4484. You can forward suspicious emails to the Federal Trade Commission at: spernetrce.gov or contact them at wtvw rte.govhd:heft or 1.177-IOTHFFT (1.377-438-4338). Visit IRS.gov to learn more &teal identity Ihe11 and how to reduce your risk, Privacy Act Notice Section 6123of too Internal Revenue Code requires you to provide your correct FIN to parsons (including fedrea1 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 IOISA, or I-ISA. The person coll0Cting this *,arm uses the information on the form to file information returns with the IRS, reporting the above information. Routine urns of this information Include giving it in the Department o1 Justice for civil and crimina! Iitrea1On and to cities, states, the restrict of Columbia, and U.S. camntonwa1lhs and possessions for use in administering their laws. The information alto may be disclosed to other covntrioe under a treaty, to federal and state agencies to enforce civil arid criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are requied 10 file a tax. return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, end certain other payments to o payee who does not give a TIN to the payer, Certain penalties may also apply for providing falls or fraudulent information. CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950 619-336-4228 phone / 619-336-4229 fax Michael R. Dalla, CMC - City Clerk November 25, 2015 Mr. Sam Colacino ASSI Security 1370 Reynolds Avenue, Suite 201 Irvine, CA 92614 Dear Mr. Colacino, On June 15th, 2015, an Agreement was entered into between the City of National City and ASSI Security. We are enclosing for your records a fully executed original Agreement. Sincerely, Michael R. Dalla, CMC City Clerk Enclosure