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Beaches Go Green2.1 City of Atlantic Beach I Contribution Awards: Cultural Arts and Recreation Programs I � FY2019-2020 Application Guidelines Package For ORGA NIZA TIONS APPLICATION GUIDELINES FOR FY2019-2020 CONTRIBUTION AWARDS Funding Availability: The City Commission has allocated funding for FY2019-2020 to support artistic, recreational, or cultural programs, events or projects which benefit the residents of Atlantic Beach. Applications for contributions are invited from eligible non-profit, 501(c)(3) community organizations, providing extra-curricular/extramural programs, arts, cultural and recreation programs, activities or events that serve Atlantic Beach residents. Only one (1) Contribution application may be submitted per eligible non-profit, 501(c) (3) community service organization, with award request of $100 - $3,000 per applicant. Final Contribution Award amount may be allocated as determined by the Cultural Arts and Recreation Advisory Committee. In the event that the amount awarded is less than the amount requested, applicants must be prepared to submit a revised program budget and description reflecting changes in scale if applicable. Please note relevant code pertaining to contributions: Sec. 2-2. Charitable contributions prohibited. The City shall not contribute City funds to any charitable, non-profit, or other worthy cause. However, the City may contribute City funds or other support to artistic, recreational, or cultural programs, events or projects which benefit the residents of Atlantic Beach, as follows: (1) Requests for contributions to such programs, events or projects shall be submitted to the Cultural Arts and Recreational Advisory Committee. (2) The Cultural Arts and Recreational Advisory Committee will make recommendations on any such requests to the City Commission, who will then make the final decision on funding the request. (3) Any request for contributions which are not artistic, recreational, or cultural in nature shall be submitted directly to the City Commission for consideration. (Ord. No. 95-91-50, § 1, 10-28-91; Ord. No. 05-02-37, § 1, 7-8-02) Editor's note-- Ord. No. 95-91-50, , adopted Oct. 28, 1991, amended the Code by adding (b). For purposes of classification, (b) has been codified as at the discretion of the editor. APPLICATION FORM WITH SCORING AND REVIEW CRITERIA AND GUIDANCE 20 Funding amount requested: $' ,) 00 Dates of event/program start -end Yes/No Conditions A. Fair and justifiable program costs (Program/Event Budget required) /No B. Serves Atlantic Beach residents /No C. Program/event pertains to cultural, arts, recreation Mmo D. Program/event activities completed by September 30, 2020 /No E. Program/event is non-discriminatory /No. F. Is the event free from inherently religious activities? Q00 NOTE: If the Yes/No conditions are not met, the application is not eligible for funding, and will not be processed for review. NOTE: Questions reviewers will consider are listed in italics as a helpful guide for applicants I. Participants (Maximum 35 points) ❑ Location(s) where program/event will take place RtI Q M tech j Sa whe ❑ Total estimated number of participants{ p® ❑ Number and percent of participants who are Atlantic Beach residents #14-0-00 ❑ Total number of hgVrs eeach participant will be directly engaged in program/event—,n y`—E-A.h ❑ Frequency and duration of program/event (e.g. 1 time event for 2 hours, or 1 x/month for 1 hour) ❑ Is the event ope to all residents of Atlantic Beach who may want to participate? ❑ Is the event to occur in Atlantic Beach or to serve primarily Atlantic Beach? NOTE: An important criteria for funding is to ensure that an adequate number of Atlantic Beach residents will benefit from the program/event relative to the amount of funding requested. To address this criteria, a per -person -per -hour cost will be calculated by the reviewers. 2. Need (Maximum 20 points) Briefly describe any community needs or gaps that the program/eventis intended to address. Please state if the program/event targets a population or age group that is currently underserved in Atlantic Beach. NOTE: Reviewers will consider the following questions when assigning points: ❑ Is there a demonstrated need for the program/event? ❑ Is the program/event duplicative of other programs/events in the area? ❑ Is the program/event a response to a need articulated from the community? The Recreation Director will calculate final scores based on both proposal content and presentations. October 14, 2019 City Commission Aoproval: City Commission awards Contributions and appropriates funds at Regular City Commission Meeting October 17, 2019 Applicants notified regarding application outcome October 24, 2019 Contribution Awards Disbursed: All FY2019-2020 Contribution awards released to award recipients FINANCIAL AND OUTCOME REPORTING FOR AWARD RECIPIENTS FY2019-2020 LETTER NOTIFICATION: Upon completion of the program or event, all FY2019-2020 award recipients. will be notified to submit their final reports and copies of receipts. DEADLINE: All FY2019-2020 award recipients must submit copies of paid receipts/invoices and a written report, including number of Atlantic Beach citizens served and program or event outcomes within 30 days of completion of the program or event. If the paid receipts/invoices and written report is not received, the award recipient will be required to immediately reimburse City of Atlantic Beach Contribution funds. General guidelines for reports 1. Report should clearly state how deliverables described in the proposal were met 2. Report should be clear regarding how funding was used to benefit residents of Atlantic Beach. 3. Describe what was accomplished in general and pertaining to AB specifically, 4. Description of the steps taken to reach out to AB residents to participate or attend the program 5. Report how many from AB attended/participated (number and percent of total participants is preferred) 6. Include feedback received from participants, especially highlight any from Ali. 7. Include evaluation results 8. Submit the paid receipts showing how the money from COAB was used Note: All Contribution Award recipients' final reports will be submitted before the Recreation Director for approval of expenditures. If determination is made that funds were expended inappropriately, the Recreation Director will direct award recipients to reimburse the City of Atlantic Beach. Funding amount requested: 3,000 Date of event/program: 2019 — 2020 Location: Atlantic Beach & Greater Jacksonville Area Total estimated number of participants: 8,000 Number / Percent of AB residents: 2,000 / 25% Total number of hours: 5 years Frequency and duration of program: Weekly Is the event open to all residents of Atlantic Beach who may want to participate? Yes Is the event to occur in Atlantic Beach or to serve primarily AB? Yes 2. There is a strong need for education in COAB in regards to waste and pollution. Wasteful & thoughtless practices are occurring consistently throughout the community. There are no organizations like BGG, supported by residence of COAB as well as the city itself. All residents of AB will benefit from PSA / education programs. 3.1 BGG mission is to bring education and awareness around the waste we produce and how it effects the environment — particularly single -use plastic effecting our beach and oceans. We engage the community through beach and town clean-ups, movies that matter, educational PSAs through print, digital and physical signage. BGG also aims to green -up local merchants and events in the area with our partnership. 3.2 BGG will educate the community through talking to local merchants and offering solutions to wasteful practices. We engage the community by hosting and supporting local events that are suitable for all ages. We are filling an environmental educational gap that our community is missing. 3.3 BGG has strong presence on social media with over 34K followers on Facebook and 3K on Instagram. We plan to expand our educational messaging through print and digital media. 4. BGG will project the same PSAs through multiple channels including COAB bill inserts, community newsletters, city, BGG and community social media pages. Our goal is to add PSA TV presence in the future. S. providing ongoing education for city residents has shown to improve living conditions, positive community relations and increase environmental awareness. COAB has not completed an education program like this in the past but you can see the results of education at www.citymb.infojdepartments/environmental-sustainability 6. BGG takes pride in offering free education to the community to reach people ofall ranges. 7. Pushing out education to the community is difficult to evaluate however by seeing incorporated changes in private lives and businesses we will gauge success. The print media is part of a multi -platform campaign including print social media, community events, educational presentations, high school clubs, and utilizing COAB community newsletters and bill inserts. As a community we will look for improvements in recycling contamination rates, as well as single -use plastic consumption rates in homes and businesses. 8. This is not a for-profit initiatives. BGG will rely on donations from other community partners to help fund our educational messages. CHES GO GREEN 1 P b Q Q . Tiburron - PVHS newsper (7 issues) 300 laches Leader Porte Vedra Leader 52 fssuesj 8,500 VOW ma zfne 112 fssuesr 8,500 Social Media Pcr t Busts 5,000 TOTAL PSA M SES 22,300 Bracenerht Bracelets 211 - - T-shirts for sale 15,000 11,485 Hats 2,000 2,893 Knit 200 350 Stickers 2,500 2,895 sic 2,500 1,584 Eco Promotions 2,253 Stainless Steel Water Bottle 497 nendis 100 n sandwich bags 216 - notebooks, -nils, lunch totes 614 1mm 0000001 0000002 BGG Public Service Announcement (PSA)Budget PSA's in Beaches leader/ Ponte Vedra Leader Quantity Cost each Total 2 col um X 6" ad (3.4168" X 6"1 color environmental education PSA 52 162.50/wk 8,450 Total 8450 Beaches Go Green will provide weekly educational content to appear in Beaches Leader52/yr with a subscription base of 8000 beach residents. 1/3 of the ads will be co -branded with the City of Atlantic Beach in an effort to support community education. Other 2/3 of ads will be co -branded with other local co-sponsors. All ads will impact all local beach communities. Topics Include but aro not limited to: Recycling Right, cigarette butt littering, Public drain pollution, Balloon releases as litter, Flow long it takes to breakdown, 4Rs - refuse, reduce, reuse, recycle, etc. INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: MAR 09, 2019 BEACHES GO GREEN '.INC C/0 SMITH GAMBRELL & FILSSELL LLP KATHERINE F R0141: 50 N LAURA ST 33TE 2800 JACKSONVILLE, FI_ 32202 Dear Applicant: DEPARTMENT OF THE TREASURY Epp.l.oyer Identification Number: 83-1,5600170 DLN: 17053240:36:3028, Contact Peraon: LISA M JAHIVKE ID# 17278 Contact: Telr7phone Number,: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b)(1)(A)(vi) Form 990/99I•EZ/990-N Required: Yes Effective Date of Exemption: August: 08, 2018 Contribu•t.ioi Deductibility: Yes Addendum Ap3lies: 140 We're plea:,ed "'o 'tell ycu we determineo you're axempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions -%heY makE to you under IRC ;eci:i.on 170. You're also qualified to receive tax deductitle bequests, devises, tran3fers or gifi:s under Section 2055, 2106, or 2522. This ].etaer could )eLp resolve questions on your exempt status. Please keep it for your records. Organizations exempt order IRC Section 50,1(c)(3) -are further classified as either public charities or private 'Four da•tions . IBJ., determined you're a public charity under :he IRC Section .l.istoij at the top of this letter. IT we indicated at the top of this 10 tier that Voj'r,e required to file Form 990/990-EZ/990•°14, our records show you're requ.irenji to file an annual, information re,:urn (Form 990 or Form 990-EiZ) or eLertronic notice (Form 990-N, the e-Postcardl. If yar, don't file a required ratan or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this .lot•ter that an addendum applies, -the enclosed addendum is ar integral pari: of this letter. For important information about: your responsibilities as a -tax-exempt organization, go to wwv.irs.gov/ch€iri.t.i.es. Enter "4221 -PC" in the search bar to view Publication 4221 -PC, Compl:.ance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, anti disclosure requirements. Letter 947 BEACHES GO GREEN :INC We sent a copy of this letter to your• r,epresentatLve as indicated in your^ power of attorney. Sincerely, Director, Exempt Organizations Ru.lincts ald Agreements Letter 947 r (-o r D0D ,m m o x o Z• Z 9 N K a) K) c) M D = n D = c m r- Z )Z mem �w� D,D �w� rev m 0DO a so c = z O X v m m X 50) m im 10 9 ao 0 0 y 4 Ob 4 co CA) 0 O) Z FCWM W=9 {Rev. October 2018) Departrnenl of r Treasrry Interrkd Revenue Service 1 Name (as shown on your Beaches Go Green Request for Taxpayer Identification Number and Certification ► Go to wwwh gov1FormW9 for instructions and the latest information. velum). Name is required on this line; do name, if 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. ❑ IndividuaVsole proprietor or ❑ C Corporation ❑ 3 Corporation ❑ Partnership ❑ Trust/estate single -member LLC ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P --Partnership) 10 - Note. Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC the is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑✓ Other(seeinstructions)► Nonprofit corporation exempt under IRS Code Section 501(c)(3) 5 Address (numberstreet d Give Form to the requester. Do not send to the IRS. 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (d any) Exemption from FATCA reporting code (f any) 04ppres to acc=ts ma)WW oute,Ffe the US) , an apt. or suite no.) See instructions. Requester's name and address 320 1st St N Suite 701 6 City, state, and ZIP code Jacksonville Beach, FL 32250 7 List account number(s) here (optionail Enter your TIN in the appropriate box The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I; later. For other entities, it is your employer identification number (Elm. If you do not have a number, see How to get a 77N, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. or ©oo©ono®in Under 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 noted 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 oode(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 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 for Part II, later. Sign Signature of Here I U.S. person ► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www irs.gvv/FormW9 Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (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) Date ► • 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 10995 (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-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person (including a resident alien), to provide your correct TIN. !f you do not return Form W-9 to the requester with a 77N, you might be subject to backup withholding. See What is backup withholding, later. Cat No. 10231X Form W-9 (Rev. 10-2018) Form W-9 (Rev. 10-2018) By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. 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 (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information. Note: If you are a U.S. person and a requester gives you a 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). Spacial 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 U.S. 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 Pub. 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 specked 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 terns of the treaty article. Page 2 Examples 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 24% 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 instructions for Part li for details), 3. The IRS tells the requester that you fumished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information. Also see Special rules for partnerships earlier. What is FATCA Reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specked United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this penton. 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. Form W-9 (Rev. 10-2018) 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 (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Foran W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9. a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1 a. This should also be the same as the name you entered on the Form 1040M 040A/1 040EZ you filed with your application. b. Sole proprietor or single -member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or "doing business as" (DBA) name on line 2. c. Partnership, LLC that is not a single -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 entities. 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)(2xii). 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. 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 on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3. Page3 IF the entity/person on line 1 is THEN check the box for ... a(n)... • Corporation Corporation • Individual Individual/sole proprietor or single- • Sole proprietorship, or member LLC • Single -member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes. • LLC treated asfpartnership for Umited liability company and enter U.S. federal tax pes, the appropriate tax classification. • LLC that has film 8832 or (P= Partnership; C= C corporation; 2553 to be taxed orporation, or S= S corporation) or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes. • Partnership Partnership • Trust/estate TrusVestate Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on 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 403(b)(7) if the account satisfies the requirements of section 401(82) 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 Form W-9 (Rev.10-2018) 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 $60D required to be Generally, exempt payees reported and direct sales over 1 through 52 $5,000' Payments made in settlement of Exempt payees 1 through 4 payment card or third party network transactions 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following yments made to a corporation and reportable on Form 109�MISC are not exempt from backup withholding: medical and health care payments, attomeys' fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United 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(cxl)(i) E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(x)(1)0 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(x) J—A bank as defined in section 581 K—A broker L—A trust exempt from tax under section 664 or described in section 4947(a)(l ) Page 4 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. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records. 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. If you are a single -member LLC that is disregarded as an entity separate from its owner, enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, appy for one immediately. To appy 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.SSAgov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to appy for an ITIN, or Form SS -4, Application for Employer Identification Number, to apply for an EIN. You can appy for an EIN online by accessing the IRS website at wwmirs.gov/8usiriesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irsgov/Forms to view, download, or print Form W-7 and/or Form SS -4. Or, you can go to wwmirs.gov/OrderFom►s to place an order and have Form W-7 and/or SS -4 mailed to you within 10 business days. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write "Applied For" in the 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. Part 11. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. Form W-9 (Rev. 10-2018) 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1953 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 party 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), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: 2. Two or more individuals Qoint account) other than an account maintained by an FFI 3. Two or more U.S. persons (joint account maintained by an FFI) 4. Custodial account of a minor (Uniform Gift to Minors Act) 5. a. The usual revocable savings trust (grantor is also trustee) j b. So-called trust account that is not a legal or valid trust under state law 6. Sole proprietorship or disregarded f entity owned by an individual 7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(bx2)() {A)) For this type of account 8. Disregarded entity not owned by an Individual 9. A valid trust, estate, or pension trust 10. Corporation or LLC electing corporate status on Form 8832 or Form 25W 11. Association, club, religious, charitable, educational, or other tax- exempt organization Give name and SSN of: The individual The actual owner of the a000unt or, if combined funds, the first individual on the a000unt' Each holder of the account The minor2 The grantor -trustee' The actual owner' The owner3 The grantor` Give name and EIN of. The Legal ental The corporation The organization 12. Partnership or multi -member LLC The partnership 13. A broker or registered nominee I The broker or nominee Page 5 For this type of account; Ghre name and EIN of. — 14. Account with the Department of The public entity Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program Payments 15. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.6714(b)(2)(i)(8)) ' List first and circle the name of the person whose number you fumish. If only one person on a joint account has an SSN, that person's number must be fumished. 2 Circle the minor's name and furnish the mint's SSN. 3 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 Cd 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, earlier. *Note. The grantor also must provide a Form W-9 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, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Pub. 5027, Identity Theft Information for Taxpayers. Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 14800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails 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. Form W-9 (Rev. 10-2019) The IRS does not initiate contacts with taxpayers via emails. 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@ucegov or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftcgov/idtheft or 877-IDTHEFT (877438-4338). If you have been the victim of identity theft, see www.ldentityTheftgov and Pub. 5027. Visit www3m.gov/Identity7hett to loam more about identity theft and how to reduce your risk. page Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (ncluding federal agencies) who are required to file information retums 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 retum. 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.