HomeMy WebLinkAboutFranklin County Emergency Management (FCEM) - Hazard Mitigation Professional Services Contract FY 2018-2020-� FRANKLIN COUNTY
EMERGENCY MANAGEMENT
1011 E. Ainsworth Street
EM
KMXWM Pu" Trow Pasco, WA 99301
E� d (509) 545-3546 Main Line
(509) 545-2139 Fax
TO: Mr. Zabell, City of Pasco — City Manager
FROM: Jordan Hanes — Franklin County Emergency Management
SUBJECT: Professional Services Contract between FCEM & the City of Pasco —
Fire Department
Re: Washington State Contract#: E19-090, FFY 2018
DATE: 05/01/2019
Included with this memo you will find the Professional Services Contract between Franklin County
Emergency Management (FCEM) and the City of Pasco — Fire Department as well as the following
Exhibits:
Exhibit A: Services Provided by the Parties
Exhibit B: Compensation
Exhibit C: Debarment Certification
Exhibit D: 2 CFR Part 200 Subpart F Audit Certification
Exhibit E: FFATA
Exhibit F: W9-2018
Exhibit G: NIMS, and
Exhibit H: State Contract E19-090
The following will need to be completed and/or signed:
Pages 9 & 18 of the Professional Services Contract,
Exhibit C: Debarment Certification,
Exhibit D: 2 CFR Part 200 Subpart F Audit Certification,
Exhibit E: FFATA,
Exhibit F: W9-2018, and
Exhibit G: NIMS.
Please feel free to contact me at (509) 545-3546 if you have any questions or concerns.
PERSONAL SERVICES CONTRACT
TERMS AND CONDITIONS
THIS CONTRACT is made and entered into by and between FRANKLIN COUNTY
EMERGENCY MANAGEMENT, a political subdivision, with its principal offices at 1011
E. Ainsworth Street, Pasco, WA 99301, hereinafter "FCEM", and City of Pasco — Fire
Department, with its principal offices at 525 N. Third Ave., Pasco, Washington 99301,
hereinafter "CONTRACTOR".
In consideration of the mutual benefits and covenants contained herein, the parties
agree as follows:
1. CONTRACT DOCUMENTS
This $10,000.00 Contract consists of the following documents:
a.
b.
C.
d.
e,
f.
9.
h.
Exhibit A: Services Provided by the Parties,
Exhibit B: Compensation,
Exhibit C: Debarment Certification,
Exhibit D: 2 CFR Part 200 Subpart F
Exhibit E: FFATA,
Exhibit F: W9-2018,
Exhibit G: NIMS, and
Exhibit H: State Contract E19-090.
2. DURATION OF CONTRACT
Audit Certification,
The term of this Contract shall begin 1 September 2018, and shall terminate 31
December 2020. The CONTRACTOR shall complete all work by the time(s) specified
herein, or if no such time is otherwise specified, no later than the expiration date.
3. SERVICES PROVIDED
The CONTRACTOR shall perform the following services:
a. A detailed description of the services to be performed by the CONTRACTOR is
set forth in Exhibit "A, Scope of Work", which is attached hereto and incorporated
herein by reference.
b. The CONTRACTOR agrees to provide its own labor and materials. Unless
otherwise provided in this Contract, no material, labor, or facilities will be furnished
by FCEM.
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c. The CONTRACTOR shall complete its work in a timely manner and in accordance
with the schedule and requirements agreed to by the parties and stipulated in
Washington State Contract #: E19-090, FFY 2018 Homeland Security Grant
Program, State Homeland Security Program, CFDA #: 97.067 - 18HSGP. Two
items need to be noted: 1.) At a minimum, 25% of the 2018 SHSP award must be
spent on law enforcement terrorism prevention -activities; 2.) The Contractor will
not be reimbursed for personnel costs in excess of 50% of their portion of the 2018
SHSP award.
d. The CONTRACTOR WILL prepare and present status reports semi-annually and
other information that may be pertinent and necessary, or as may be requested by
FCEM. Reimbursements will be held if not completed.
e. The Contractor shall use the funds to perform tasks as described in the Statement
of Work and Budget portions of this contract.
f. The Contractor shall submit at a maximum -month) and a minimum-cluarterly,
signed and approved, invoice vouchers (State Form A-19) and a Reimbursement
Spreadsheet to FCEM for costs incurred.
g. The Contractor agrees that all exercises must comply with the Homeland Security
Exercise Evaluation Program (HSEEP). Upon completion of the exercise, an After
Action Report and an Improvement Plan must be prepared and submitted to the
FEMA portal within 60 days of completion of the exercise. Reimbursements for
exercise related expenditures cannot be made until this requirement has been met.
h. The Contractor agrees that to receive any federal preparedness funding, all
environmental and Historical Protection (EHP) Program compliance requirements
outlined in applicable guidance must be met. The Contractor is advised that all
projects that involve disturbing earth, communication towers, physical security
enhancements, new construction, renovation, and modifications to buildings and
structures that are 50 years old or older require EHP review. All other projects,
including training and exercise activities, must be evaluated to determine impact.
If impact is identified they must also go through an EHP review.
i. The Contractor agrees that to receive any federal preparedness funding, all
National Incident Management System (NIMS) compliance requirements outlined
in applicable guidance must be met.
j. The Contractor agrees that grant funds may not be used to replace or supplant
existing funding.
k. The Contractor agrees to provide a match of $0 of non-federal origin.
I. The Contractor acknowledges that since this contract involves federal funding, the
period of performance described herein will likely begin prior to the availability of
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appropriated federal funds. The Contractor agrees that it will not hold FCEM, the
State of Washington, or the United States liable for any damages, claim for
reimbursement, or any type of payment whatsoever for services performed under
this contract prior to distribution of appropriated federal funds.
m. The Contractor agrees that if will not hold FCEM, the State of Washington, or the
United States liable for any damages, claim for reimbursement or any type of
payment if federal funds are not appropriated or are not appropriated in a particular
amount.
FCEM shall perform the following services:
In order to assist the CONTRACTOR in fulfilling its duties under this Contract,
FCEM shall provide the following:
a. Relevant information as exists to assist the CONTRACTOR with the
performance of the CONTRACTOR'S services.
b. Coordination with other Counties or other Consultants as necessary for the
performance of the CONTRACTOR'S services.
C. Reimbursement for planning, training, and exercise to be vouchered in a
timely manner.
4. CONTRACT REPRESENTATIVES
Each party to this Contract shall have a contract representative. Each party may
change its representative upon providing written notice to the other party. The parties'
representatives are as follows:
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a. For CONTRACTOR: City of Pasco — Fire Department
Name of Representative: Dave Zabell
Title: City Manager
Mailing Address: 525 N. Third Ave
City, State, and Zip Code: Pasco, WA 99301
Telephone Number: (509) 545-3404
Fax Number: (509) 545-3403
Email Address: zabelld(cr_pasco-wa.us
b. For FCEM: Franklin County Emergency Management
Name of Representative: Sean T. Davis
Title: Director
Mailing Address: 1011 E. Ainsworth Street
City, State, and Zip Code: Pasco, WA 99301
Telephone Number: (509) 545-3546
Fax Number: (509) 545-2139
Email Address: sdavis(o)-co.franklin.wa.us
5. COMPENSATION
For the services performed hereunder, the CONTRACTOR shall be paid as
follows:
a. A detailed description of the compensation to be paid by the FCEM is set
forth in Exhibit B, "Compensation", which is attached hereto and
incorporated herein by reference.
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b. The maximum total amount payable by FCEM to the CONTRACTOR under
this Contract shall not exceed $10,000.00 including sales tax. The
CONTRACTOR shall be paid by reimbursement through the state A-19
process.
C. No payment shall be made for any work performed by the CONTRACTOR,
except for work identified and set forth in this Contract.
d. The CONTRACTOR may, in accordance with Exhibit "B," submit invoices
to FCEM not less than quarterly and not more than once per month during
the progress of the work for partial payment of work completed to date.
Invoices shall cover the time CONTRACTOR performed work for FCEM
during the billing period. FCEM shall pay the CONTRACTOR for services
rendered in the month following the actual delivery of the work and will remit
payment within thirty (30) days from the date of billing.
e. The CONTRACTOR shall not be paid for services rendered under this
Contract unless and until they have been performed in compliance with the
state contract.
f. In the event the CONTRACTOR has failed to perform any substantial
obligation to be performed by the CONTRACTOR under this Contract and
such failure has not been cured within ten (10) days following notice from
FCEM, then FCEM may, in its sole discretion, upon written notice to the
CONTRACTOR, withhold any and all monies due and payable to the
CONTRACTOR, without penalty, until such failure to perform is cured or
otherwise adjudicated. "Substantial" for purposes of this contract means
faithfully fulfilling the terms of this contract with variances only for technical
or minor omissions or defects.
g. Unless otherwise provided in this Contract or any exhibits or attachments
hereto, the CONTRACTOR will not be paid for any billings or invoices
presented for services rendered prior to the execution of this Contract or
after its termination.
6. AMENDMENTS AND CHANGES IN WORK
a. In the event of any errors or omissions by the CONTRACTOR in the
performance of any work required under this Contract, the CONTRACTOR
shall make any and all necessary corrections without additional
compensation. All work submitted by the CONTRACTOR shall be certified
by the CONTRACTOR and checked for errors and omissions. The
CONTRACTOR shall be responsible for the accuracy of the work, even if
the work is accepted by FCEM.
b. No amendment or modification shall be made to this Contract, unless set
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forth in a written Contract Amendment signed by both parties' authorized
representatives and attached to this contract. Work under a Contract
Amendment shall not proceed until the Contract Amendment is duly
executed by the FCEM.
7. HOLD HARMLESS AND INDEMNIFICATION
a. The CONTRACTOR shall hold harmless, indemnify and defend the FCEM,
its officers, officials, employees and agents, from and against any and all
claims, actions, suits, liability, loss, expenses, damages, and judgments of
any nature whatsoever, including reasonable costs and attorneys' fees in
defense thereof, for injury, sickness, disability or death to persons or
damage to property or business, caused by or arising out of the
CONTRACTOR'S acts, errors or omissions in the performance of this
Contract. PROVIDED, that the CONTRACTOR'S obligation hereunder
shall not extend to injury, sickness, death or damage caused by or arising
out of the sole negligence of the FCEM, its officers, officials, employees or
agents.
b. In any and all claims against the FCEM, its officers, officials, employees and
agents by any employee of the CONTRACTOR, subcontractor, anyone
directly or indirectly employed by any of them, or anyone for whose acts any
of them may be liable, the indemnification obligation under this Section shall
not be limited in any way by any limitation on the amount or type of
damages, compensation, or benefits payable by or for the CONTRACTOR
or subcontractor under Workers Compensation acts, disability benefit acts,
or other employee benefit acts, it being clearly agreed and understood by
the parties hereto that the CONTRACTOR expressly waives any immunity
the CONTRACTOR might have had under such laws, including but not
limited to Title 51 of the Revised Code of Washington. By executing this
Contract, the CONTRACTOR acknowledges that the foregoing waiver
has been mutually negotiated by the parties and that the provisions of
this Section shall be incorporated, as relevant, into any contract the
CONTRACTOR makes with any subcontractor or agent performing
work hereunder. CONTRACTOR'S obligations under this Section [7]
shall survive termination and expiration of this Contract.
C. The CONTRACTOR'S obligations hereunder shall include, but are not
limited to, investigating, adjusting and defending all claims alleging loss
from action, error or omission, or breach of any common law, statutory or
other delegated duty by the CONTRACTOR, the CONTRACTOR'S
employees, agents or subcontractors.
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8. INSURANCE
a. Professional Legal Liability: Prior to the start of work under this Contract,
the CONTRACTOR, if he, she or it is a licensed professional, shall maintain
Professional Legal Liability or Professional Errors and Omissions coverage
appropriate to the CONTRACTOR'S profession and shall be written subject
to limits of not less than one million dollars ($1,000,000) per occurrence,
loss or person. If the policy contains a general aggregate or policy limit it
shall be at least two times the incident, loss or person limit.
The coverage shall apply to liability for a professional error, act or omission
arising out of the scope of the CONTRACTOR'S services defined in this
Contract. Coverage shall not exclude bodily injury or property damage.
Coverage shall not exclude hazards related to the work rendered as part of
the Contract or within the scope of the CONTRACTOR'S services as
defined by this Contract including testing, monitoring, measuring
operations, or laboratory analysis where such services are rendered as part
of the Contract. The policy shall state that coverage is claims made, and
state the retroactive date. CONTRACTOR is also required to buy claims
made professional liability insurance for a period of 36 months after
completion of this Contract, which can be satisfied by the continuous
purchase of the above referenced insurance or an extended reporting
period policy. CONTRACTOR shall annually provide FCEM with proof of
all such insurance.
b. Workers Compensation: CONTRACTOR shall comply with all State of
Washington workers compensation statutes and regulations. Prior to the
start of work under this Contract, workers compensation coverage shall be
provided for all employees of CONTRACTOR and employees of any
subcontractor or sub -subcontractor. Coverage shall include bodily injury
(including death) by accident or disease, which arises out of or in connection
with the performance of this Contract. Except as prohibited by law,
CONTRACTOR waives all rights of subrogation against FCEM for recovery
of damages to the extent they are covered by workers compensation,
employers liability, commercial liability or commercial umbrella liability
insurance.
If CONTRACTOR, subcontractor, or sub -subcontractor fails to comply with
all State of Washington workers compensation statutes and regulations and
FCEM incurs fines or is required by law to provide benefits to or obtain
coverage for such employees, CONTRACTOR shall indemnify FCEM
Indemnity shall include all fines, payment of benefits to CONTRACTOR or
subcontractor employees, or their heirs or legal representatives, and the
cost of effecting coverage on behalf of such employees. Any amount owed
to FCEM by CONTRACTOR pursuant to the indemnity agreement may be
deducted from any payments owed by FCEM to CONTRACTOR for
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performance of this Contract.
Certain work or services under this Contract may require insurance
coverage for long shore or harbor workers other than seaman as provided
in the Long Shore and Harbor Workers Compensation Act [33 U.S.C.A.
Section 901 et seq.]. Failure to obtain coverage in the amount required by
law may result in civil and criminal liabilities. CONTRACTOR is fully
responsible for ascertaining if such insurance is required and shall maintain
insurance in compliance with that Act. CONTRACTOR is responsible for
all civil and criminal liability that may arise from the failure to maintain such
coverage.
Certain work or services under this Contract may require insurance
coverage for seamen injured during employment resulting from the
negligence of the owner, master or fellow crew members as provided in 46
U.S.C.A. Section 688. Failure to obtain coverage in the amount required by
law may result in civil and criminal liabilities. CONTRACTOR is fully
responsible for ascertaining if such insurance is required and shall maintain
insurance in compliance with that Act. CONTRACTOR is responsible for
all civil and criminal liability that may arise from the failure to maintain
coverage.
C. Commercial General Liability and Employers Liability Insurance: Prior
to the start of work under this Contract, CONTRACTOR shall maintain
commercial general liability coverage (policy form CG0001 or equivalent)
for wrongful death, bodily injury, personal injury and property damage,
subject to limits of not less than one million dollars ($1,000,000) per
occurrence. The general aggregate limit shall apply separately to this
Contract and be no less than two million dollars ($2,000,000).
The general commercial liability policy will contain an endorsement naming
FCEM, its officials, officers, employees and agents as an additional insured
(CG2010) and an endorsement that specifically states that
CONTRACTOR's general liability policy shall be primary, and not
contributory, with any other insurance maintained by FCEM.
The CONTRACTOR will provide commercial general liability coverage that
does not exclude any activity to be performed in fulfillment of this Contract
and does not exclude liability pursuant to the indemnification requirement
under Section [7]. Specialized forms specific to the industry of the
CONTRACTOR will be deemed equivalent; provided, coverage will be no
more restrictive than would be provided under a standard commercial
general liability policy and will include contractual liability coverage.
If CONTRACTOR has any employees, CONTRACTOR also shall maintain
employers liability insurance with limits of not less than one million dollars
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($1,000,000) each incident for bodily injury by accident or one million dollars
($1,000,000) each employee for bodily injury by disease.
d. Automobile Liability: [This section requires either the 1st or 2nd blank
be checked by FCEM if CONTRACTOR'S services involve the use of
vehicles by CONTRACTOR or the transportation of FCEM employees
or third parties].
The CONTRACTOR shall maintain automobile liability insurance as follows
I/ The CONTRACTOR shall maintain Business Automobile Liability
Insurance with a limit of not less than One Million Dollars ($1,000,000.00)
each accident combined Bodily Injury and Property Damages. Coverage
shall include owned, hired, and non -owned automobiles.
•N
The CONTRACTOR shall maintain Automobile Liability Insurance or
equivalent form with a limit of not less than One Hundred Thousand Dollars
($100,000.00) each accident combined Bodily Injury and Property Damage.
The aggregate limit shall be at least Three Hundred Thousand Dollars
($300,000.00). If a personal lines Automobile Liability policy is used to meet
this requirement, it must include a business rider and must cover each
vehicle to be used in the performance of this Contract and the certificates
of insurance must evidence these conditions have been met. If the
CONTRACTOR will use non -owned vehicles in performance of this
Contract, the coverage shall include owned, hired and non -owned
automobiles.
•o
Not Applicable.
e. Other Insurance Provisions:
(1) The CONTRACTOR'S liability insurance provisions shall be primary
with respect to any insurance or self-insurance programs covering
FCEM, its elected and appointed officers, officials, employees and
agents.
(2) The CONTRACTOR'S liability insurance policies shall contain no
special limitations on the scope of protection afforded to FCEM, its
officials, officers, employees or agents as an additional insured.
(3) Any failure to comply with reporting provisions of the policies shall
not affect coverage provided to FCEM, its officers, officials,
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employees or agents.
(4) The CONTRACTOR'S insurance shall apply separately to each
insured against whom claim is made or suit is brought, except with
respect to the limits of the insurer's liability.
(5) The CONTRACTOR shall include all subcontractors as insureds
under its policies or shall furnish separate certificates and
endorsements for each subcontractor. All coverage for
subcontractors shall be subject to all of the requirements stated
herein.
(6) The insurance limits mandated for any insurance coverage required
by this Contract are not intended to be an indication of exposure nor
are they limitations on indemnification.
(7) The CONTRACTOR shall maintain all required policies in force from
the time services commence until services are completed.
Certificates, policies, and endorsements expiring before completion
of services shall be promptly replaced. All liability insurance required
under this Contract, except for professional liability under Section
[8(a)], shall be written on an Occurrence Policy form. Professional
liability insurance on a Claims Made form shall have a retroactive
date prior to or coincident with the effective date of this Contract.
f. Verification of Coverage and Acceptability of Insurers: All insurance
required under this Contract shall be issued by companies admitted to do.
business within the State of Washington and have a rating of A-, Class VII
or better in the most recently published edition of Best's Reports. Any
exception to this requirement must be reviewed and approved in writing by
FCEM's Risk Manager. If an insurer is not admitted to do business within
Washington State, all insurance policies and procedures for issuing the
insurance policy must comply with Chapter 48.15 RCW and 284-15 WAC.
(1) The CONTRACTOR shall furnish FCEM with properly executed and
unaltered Acord form certificates of insurance and, if requested, a
signed policy endorsement(s) which shall clearly evidence all
required insurance prior to commencing work under this Contract.
The certificates will, at a minimum, list limits of liability and coverage.
For any professional liability insurance, the CONTRACTOR agrees
that the insurance contract will not be canceled or allowed to expire
except on twenty-eight (28) days prior written notice to FCEM by the
CONTRACTOR. For other insurance policies, CONTRACTOR shall
not cancel or allow the insurance contract to expire except on forty-
five (45) days prior written notice to FCEM. CONTRACTOR shall
also instruct the insurer to give FCEM forty-five (45) days advanced
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written notice of any cancellation by the insurer. The certificate or
endorsement shall not limit or negate the insurer's obligation as
required by law to notify FCEM as an additional insured of
cancellation.
(2) The CONTRACTOR shall furnish FCEM with evidence that the
additional insured provision required above has been met.
Acceptable forms of evidence are the endorsement pages of the
policy showing FCEM, its officials, officers, employees, or agents as
an additional insured.
(3) Certificates of insurance shall show the certificate holder as "FCEM"
and include "c/o" FCEM'S Contract Representative. The address of
the certificate holder shall be shown as the current address of the
FCEM'S Contract Representative.
(4) If the CONTRACTOR or any subcontractor or sub -subcontractor has
any employees, CONTRACTOR shall request the Washington State
Department of Labor and Industries, Workers Compensation
Representative, to send written verification to FCEM that
CONTRACTOR is currently paying workers compensation.
(5) All written notices under this Section [8] and notice of cancellation or
change of required insurance coverages shall be mailed to the FCEM
at the following address:
Franklin County Emergency Management
Attn: Risk Manager
1011 E. Ainsworth Street
Pasco, Washington 99301
(6) The CONTRACTOR or its broker shall immediately provide a copy
of any and all insurance policies specified in this Contract upon
request of FCEM's Risk Manager.
(7) If CONTRACTOR is self-insured for worker's compensation
coverage, evidence of its status as a self-insured entity shall be
provided to FCEM. If requested by FCEM, CONTRACTOR must
describe its financial condition and the self-insured funding
mechanism.
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9. TERMINATION
a. FCEM may terminate this Contract in whole or in part whenever the FCEM
determines, in its sole discretion, that such termination is in the best
interests of FCEM. FCEM may terminate this Contract upon giving ten (10)
days written notice by certified mail to the CONTRACTOR. In that event,
FCEM shall pay the CONTRACTOR for all costs incurred by the
CONTRACTOR in performing the Contract up to the date of such notice.
Payment shall be made in accordance with the Compensation Section of
this Contract.
b. In the event that funding for this project is withdrawn, reduced or limited in
any way after the effective date of this Contract, FCEM may summarily
terminate this Contract notwithstanding any other termination provision in
this Contract. Termination under this paragraph shall be effective upon the
date specified in the written notice of termination sent by FCEM to the
CONTRACTOR. After the effective date, no charges incurred under this
Contract shall be allowed.
C. If the CONTRACTOR breaches any of its obligations hereunder, and fails
to cure the breach within ten (10) days of written notice to do so by FCEM,
the FCEM may immediately terminate this Contract by so notifying the
CONTRACTOR, in which case FCEM shall pay the CONTRACTOR only for
the costs of services accepted by FCEM, in accordance with the
Compensation Section of this Contract. Upon such termination, the FCEM,
at its discretion, may obtain performance of the work elsewhere, and the
CONTRACTOR shall bear all costs and expenses incurred by FCEM in
completing the work and all damage sustained by FCEM by reason of the
CONTRACTOR'S breach.
d. The CONTRACTOR will have all termination rights as FCEM and stated
above in Section 9. (a -c).
10. ASSIGNMENT, DELEGATION AND SUBCONTRACTING
a. The CONTRACTOR shall perform the terms of this Contract using only its
bona fide employees or agents, and the obligations and duties of the
CONTRACTOR under this Contract shall not be assigned, delegated, or
subcontracted to any other person or firm without the prior express written
consent of FCEM's authorized representatives.
b. The CONTRACTOR warrants that it has not paid nor has it agreed to pay
any company, person, partnership, or firm, other than a bona fide employee
working exclusively for CONTRACTOR, any fee, commission, percentage,
brokerage fee, gift, or other consideration contingent upon or resulting from
the award or making of this Contract.
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11. NON -WAIVER OF RIGHTS
The parties agree that the excuse or forgiveness of performance, or waiver of any
provision(s) of this Contract does not constitute a waiver of such provision(s) or future
performance, or prejudice the right of the waiving party to enforce any of the provisions
of this Contract at a later time. All waivers of any provision(s) of this Contract shall be in
writing and signed by the waiving party's authorized representatives, and in the absence
of such, no action or inaction shall be construed to be such a waiver.
12. INDEPENDENT CONTRACTOR
a. The CONTRACTOR'S services shall be furnished by the CONTRACTOR
as an independent contractor and not as an agent, employee or servant of
FCEM. The CONTRACTOR specifically has the right to direct and control
CONTRACTOR'S own activities in providing the agreed services in
accordance with the specifications set out in this Contract.
b. The CONTRACTOR acknowledges that the entire compensation for this
Contract is set forth in Section [5] of this Contract, and neither the
CONTRACTOR nor its employees are entitled to any FCEM benefits,
including, but not limited to: vacation pay, holiday pay, sick leave pay,
medical, dental, or other insurance benefits, fringe benefits, or any other
rights or privileges afforded to FCEM's employees.
C. The CONTRACTOR shall have and maintain complete responsibility and
control over all of its subcontractors, employees, agents, and
representatives. No subcontractor, employee, agent, or representative of
the CONTRACTOR shall be or deem to be or act or purport to act as an
employee, agent, or representative of FCEM.
d. CONTRACTOR shall pay for all taxes, fees, licenses, or payments required
by federal, state or local law which are now or may be enacted during the
term of this Contract.
e. The CONTRACTOR agrees to immediately remove any of its employees or
agents from their assignment to perform services under this Contract upon
receipt of a written request to do so from FCEM's contract representative or
designee.
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13. COMPLIANCE WITH LAWS
The CONTRACTOR shall comply with all applicable federal, state and local laws,
rules and regulations in performing this Contract including requirements stipulated in
contract E19-090 (Attachment H).
14. INSPECTION OF BOOKS AND RECORDS
FCEM may, at reasonable times, inspect the books and records of the
CONTRACTOR relating to the performance of this Contract. The CONTRACTOR shall
keep all records required by this Contract for six (6) years after termination of this Contract
for audit purposes.
15. NONDISCRIMINATION
The CONTRACTOR, its assignees, delegates, or subcontractors shall not
discriminate against any person in the performance of any of its obligations hereunder on
the basis of age, sex, marital status, sexual orientation, race, creed, religion, color,
national origin, honorably discharged veteran or military status, disability, or any other
protected status.
16. OWNERSHIP OF MATERIALS/WORKS PRODUCED
a. All reports, drawings, plans, specifications, all forms of electronic media,
and data and documents produced in the performance of the work under
this Contract shall be "works for hire" as defined by the U.S. Copyright Act
of 1976 and shall be owned by FCEM. Ownership includes the right to
copyright, patent, register, and the ability to transfer these rights. FCEM
agrees that if it uses any materials prepared by the CONTRACTOR for
purposes other than those intended by this Contract, it does so at its sole
risk and it agrees to hold the CONTRACTOR harmless therefrom to the
extent such use is not agreed to in writing by the CONTRACTOR.
b. [For Design/Construction Contracts: All design work done by the
CONTRACTOR shall be done on AutoCAD, release 12 or higher or
other systems mutually agreed upon, an electronic copy of which shall
be submitted to FCEM upon request and/or at the end of the job.
Should a construction project result from the work of the
CONTRACTOR, the record drawings from the CONTRACTOR shall be
transposed onto the electronic design drawings and submitted to
FCEM.]
C. An electronic copy of all word processing documents shall be immediately
submitted to FCEM upon request or at the end of the job using the word
processing program and version specified by the FCEM.
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17. PATENT/COPYRIGHT INFRINGEMENT
The CONTRACTOR shall hold harmless, indemnify and defend FCEM, its officials,
officers, employees and agents, from and against any claimed action, cause or demand
brought against the FCEM, its officials, officers, employees and agents where such action
is based on the claim that information supplied by the CONTRACTOR or subcontractor
infringes any patent or copyright. The CONTRACTOR shall be notified promptly in writing
by FCEM of any notice of such claim.
18. DISPUTES
Disputes between the CONTRACTOR and FCEM, arising under and by virtue of
this Contract, shall be brought to the attention of FCEM at the earliest possible time in
order that such matters may be settled or other appropriate action promptly taken. Any
dispute relating to the quality or acceptability of performance and/or compensation due
the CONTRACTOR shall be decided by FCEM'S Contract Representative or designee.
All rulings, orders, instructions and decisions of FCEM'S Contract Representative shall
be final and conclusive, subject to CONTRACTOR'S right to seek judicial relief.
19. CONFIDENTIALITY
The CONTRACTOR, its employees, subcontractors, and their employees shall
maintain the confidentiality of all information provided by FCEM or acquired by FCEM in
performance of this Contract, except upon the prior written consent of FCEM's authorized
representatives or an order entered by a court of competent jurisdiction. The
CONTRACTOR shall promptly give the FCEM written notice of any judicial proceeding
seeking disclosure of such information.
20. CHOICE OF LAW JURISDICTION AND VENUE
a. This Contract has been and shall be construed as having been made and
delivered within the State of Washington, and it is agreed by each party
hereto that this Contract shall be governed by the laws of the State of
Washington, both as to its interpretation and performance.
b. Any action at law, suit in equity, or judicial proceeding arising out of this
Contract shall be instituted and maintained only in any of the courts of
competent jurisdiction in Franklin County, Washington.
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21. SUCCESSORS AND ASSIGNS
FCEM, to the extent permitted by law, and the CONTRACTOR each bind
themselves, their partners, successors, executors, administrators, and assigns to the
other party to this Contract and to the partners, successors, administrators, and assigns
of such other party in respect to all covenants to this Contract.
22. SEVERABILITY
a. If a court of competent jurisdiction holds any part, term or provision of this
Contract to be illegal, or invalid in whole or in part, the validity of the
remaining provisions shall not be affected, and the parties' rights and
obligations shall be construed and enforced as if this Contract did not
contain the particular provision held to be invalid.
b. If it should appear that any provision of this Contract is in conflict with any
statutory provision of the State of Washington, said provision which may
conflict therewith shall be deemed inoperative and null and void insofar as
it may be in conflict therewith, and shall be deemed modified to conform to
such statutory provision.
23. ENTIRE AGREEMENT
The parties agree that this Contract is the complete expression of its terms and
conditions. Any oral or written representations or understandings not incorporated in this
Contract are specifically excluded.
24. NOTICES
Any notices shall be effective if personally served upon the other party or if mailed
by registered or certified mail, return receipt requested, to the addresses set out in the
Contract Representatives Section of this Contract. Notice may also be given by facsimile
with the original to follow by regular mail. Notice shall be deemed to be given three days
following the date of mailing or immediately, if personally served. For service by facsimile,
service shall be effective at the beginning of the next working day.
25. SURVIVABILITY
All Contract terms, which by their context are clearly intended to survive the
termination and/or expiration of this Contract, shall so survive. These terms include, but
are not limited to, indemnification provisions (Sections [7] and [17]); extended reporting
period requirements for professional liability insurance (Section [8(a)]); inspection and
keeping of records and books (Section [14]); litigation hold notice (Section [26]); Public
Records Act (Section [27]) and confidentiality (Section [19]).
26. LITIGATION HOLD NOTICE
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In the event FCEM learns of circumstances leading to an increased likelihood of
litigation regarding any matter where the records kept by CONTRACTOR pursuant to
Section [14] of this contract may be of evidentiary value, FCEM may issue written notice
to CONTRACTOR of such circumstances and direct the CONTRACTOR to "hold" such
records. In the event that CONTRACTOR receives such written notice, CONTRACTOR
shall abide by all directions therein whether or not such written notice is received at a time
when a Contract between CONTRACTOR and FCEM is in force. Such directions will
include, but will not be limited to, instructions to suspend the six (6) year purge schedule
as set out above in Section [14].
27. PUBLIC RECORDS ACT
CONTRACTOR hereby acknowledges that FCEM is a governmental entity and as
such is subject to the requirements of the Public Records Act, RCW 42.56 et seq.
Accordingly, CONTRACTOR understands that to the extent a proper request is made,
FCEM may be required by virtue of that Act to disclose any records actually in its
possession or deemed by judicial determination to be in its possession, which may
include records provided to FCEM by CONTRACTOR that CONTRACTOR might regard
as confidential or proprietary. To the extent that CONTRACTOR provides any records to
FCEM that it regards as confidential or proprietary, it agrees to conspicuously mark the
records as such. CONTRACTOR also hereby waives any and all claims or causes of
action for any injury it may suffer by virtue of FCEM'S release of records covered under
the Public Records Act. FCEM agrees to take all reasonable steps to notify
CONTRACTOR in a timely fashion of any request made under the Public Records Act
which will require disclosure of any records marked by CONTRACTOR as confidential or
proprietary, so that CONTRACTOR may seek a judicial order of protection if necessary.
28. ACKNOWLEDGMENT
CONTRACTOR acknowledges that the FCEM, its facilities, and its offices therein,
contain records and information that is confidential or privileged by operation of law. As
a result, the CONTRACTOR acknowledges and agrees that in the course of performing
this Contract its employees or agents shall at all times refrain from engaging in any
activities that would expose them to, or others to, such confidential or privileged
information.
The parties to this Contract have executed this Contract to take effect as of the
date written below.
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CONTRACTOR:
Agency:
Signature
Agency:
Signature
City of Pasco — Fire Department
Dave ZalY6W,-Ia-it' Manage
Sean Davis, Director
Form of Contract pre -approved March
2014 by the Deputy Prosecuting Attorney
Deputy Prosecuting Attorney, Franklin
County 11/13/15
05 13 WI9
Date
Date
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Exhibit "A"
PROFESSIONAL SERVICES CONTRACT
FRANKLIN COUNTY EMERGENCY MANAGEMENT / CITY OF PASCO — Fire
Department
SERVICES PROVIDED BY THE PARTIES
1. The services to be performed by the CONTRACTOR under this Contract,
which are described in Section 3 of the Contract (SERVICES PROVIDED BY THE
CONTRACTOR), are set forth as follows:
a. Trainincl: Allowable training -related costs include overtime and backfill
funding for emergency preparedness and response personnel attending
Homeland Security sponsored and approved training classes; may also be
used for part-time and volunteer emergency response personnel
participating in Homeland Security training. Training workshops and
conferences, hiring of full or part-time staff or contractors/consultants to
support training -related activities, travel for employees attending
Homeland Security sponsored courses or on business related the planning
and conduct of the training project, supplies consumed or expended
during planning or conduct of the training is also allowable.
All requirements and stipulations in contract E19-090 will be followed by
the CONTRACTOR
CONTRACT NUMBER: E19-090 (SHSP '18) Page 1 of 1
Exhibit "B"
PROFESSIONAL SERVICES CONTRACT
FRANKLIN COUNTY EMERGENCY MANAGEMENT / CITY OF PASCO — Fire Department
COMPENSATION
1. The CONTRACTOR'S compensation under this Contract, which is
described in Section 5 of this Contract (COMPENSATION), is set forth as follows:
a. 10,000.00 for Training— Pasco FD NIMS/ICS training
Total Contractual Amount: $10,000.00
CONTRACT NUMBER: E19-090 (SHSP '18) Page 1 of 1
Washington Military Department Contract Number: E19-090
Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
NAME
Doing business as (DBA)
City of Pasco
ADDRESS
Applicable Procurement
WA Uniform Business
Federal Employer Tax
525 N. Third Ave.
or Solicitation #, if any:
Identifier (UBI)
Identification #:
Pasco, WA 99301
91-6001264
This certification is submitted as part of a request to contract.
Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower
Tier Covered Transactions
READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulations require contractors and bidders to sign and
abide by the terms of this certification, without modification, in order to participate in certain transactions directly or
indirectly involving federal funds.
1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an
erroneous certification, in addition to other remedies available to the Federal Government the department or agency
with which this transaction originated may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the department, institution or office to
which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was
erroneous when submitted or had become erroneous by reason of changed circumstances.
4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning
set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the
person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the department or agency with which this
transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered
Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the
method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required
to, check the List of Parties Excluded from Federal Procurement and Non -procurement Programs.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause. The knowledge and information of a participant is not
required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the department or agency with which this transaction originated may
pursue available remedies, including suspension and/or debarment.
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier
Covered Transactions
The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor its
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participation in this transaction by any Federal department or agency. Where the prospective lover tier
participant is unable to certify to any of the statements in this certification, such prospective participant shall
attach an explanation to this form.
Bidder or Contractor Signature: Date:
Print Name and Title: Dave Zabell, City Manager - Pasco
Washington Military Department Contract Number: E19-090
FEDERAL DEBARMENT, SUSPENSION
INELIGIBILITY and VOLUNTARY EXCLUSION
(FREQUENTLY ASKED QUESTIONS)
What is "Debarment, Suspension, Ineligibility, and Voluntary Exclusion"?
These terms refer to the status of a person or company that cannot contract with or receive grants from a federal agency.
In order to be debarred, suspended, ineligible, or voluntarily excluded, you must have:
• had a contract or grant with a federal agency, and
• gone through some process where the federal agency notified or attempted to notify you that you could not contract
with the federal agency.
• Generally, this process occurs where you, the contractor, are not qualified or are not adequately performing under a
contract, or have violated a regulation or law pertaining to the contract.
Why am I required to sign this certification?
You are requesting a contract or grant with the Washington Military Department. Federal law (Executive Order 12549)
requires Washington Military Department ensure that persons or companies that contract with Washington Military
Department are not prohibited from having federal contracts.
What is Executive Order 12549?
Executive Order 12549 refers to Federal Executive Order Number 12549. The executive order was signed by the
President and directed federal agencies to ensure that federal agencies, and any state or other agency receiving federal
funds were not contracting or awarding grants to persons, organizations, or companies who have been excluded from
participating in federal contracts or grants. Federal agencies have codified this requirement in their individual agency
Code of Federal Regulations (CFRs).
What is the purpose of this certification?
The purpose of the certification is for you to tell Washington Military Department in writing that you have not been
prohibited by federal agencies from entering into a federal contract.
What does the word "proposal" mean when referred to in this certification?
Proposal means a solicited or unsolicited bid, application, request, invitation to consider or similar communication from
you to Washington Military Department.
What or who is a "lower tier participant"?
Lower tier participants means a person or organization that submits a proposal, enters into contracts with, or receives a
grant from Washington Military Department, OR any subcontractor of a contract with Washington Military Department. If
you hire subcontractors, you should require them to sign a certification and keep it with your subcontract.
What is a covered transaction when referred to in this certification?
Covered Transaction means a contract, oral or written agreement, grant, or any other arrangement where you contract
with or receive money from Washington Military Department. Covered Transaction does not include mandatory
entitlements and individual benefits.
Sample Debarment, Suspension, Ineligibility, Voluntary Exclusion Contract Provision
Debarment Certification. The Contractor certifies that the Contractor is not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any
Federal department or agency. If requested by Washington Military Department, the Contractor shall complete
a Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion form. Any such form
completed by the Contractor for this Contract shall be incorporated into this Contract by reference.
2 CFR Part 200 Subpart F Audit Certification Form
Audits of States, Local Governments, Indian Tribes, and Non -Profit Organizations
Contact Information, ;
Subrecipient Name (Agency, Local Government, or Organization): City of Pasco
Authorized Chief Financial Officer (central accounting office):
Address: 525 N. Third Ave., Pasco, WA 99301
Email: st+ge}r@pasco-wa.gov Phone #: 509-544-3065
5/,..
Purpose: A§ apass-through entity of federal grant funds, the Washington Military Department/Emergency Management Division (Department)
is required by 2 CFR Part 200 Subpart F to monitor activities of subrecipients to ensure federal awards are used for authorized purposes and
verify that subrecipients expending $750,000 or more in federal awards during their fiscal year have met the 2 CFR Part 200 Subpart F Audit
Requirements. Your entity is a subrecipient subject to such monitoring by MIL/EMD because it is a non-federal entity that expends federal grant
funds received from the Department as a pass-through entity to carry out a federal program. 2 CFR Part 200 Subpart F should be consulted
when completing this form.
Directions: As required by 2 CFR Part 200 Subpart F, non-federal entities that expend $750,000 in federal awards in a fiscal year shall have
a single or program -specific audit conducted for that year. If your entity is not subject to these requirements, you must complete Section A of
this Form. If your entity is subject to these requirements, you must complete Section B of this form. When completed, you must sign, date,
and return this form with your grant agreement and every fiscal year thereafter until the grant agreement is closed. Failure to return this
completed Audit Certification Form may result in delay of grant agreement processing, withholding of federal awards or disallowance of costs,
and suspension or termination of federal awards.
SECTION 4: Entities NOT sub ect tit the audit requirements of 2 GFR Pa_ 200 Sub art F
Our entity is not subject to the requirements of 2 CFR Part 200 Subpart F because (check all that apply):
❑ We did not expend $750,000 or more of total federal awards during the fiscal year.
❑ We are a for-profit agency.
❑ We are exempt for other reasons (describe):
However, by signing below, I agree that we are still subject to the audit requirements, laws and regulations governing the program(s) in
which we participate, that we are required to maintain records of federal funding and to provide access to such records by federal and state
agencies and their designees, and that WMD/EMD may request and be provided access to additional information and/or documentation to
ensure proper stewardship of federal funds.
SECTION B: Entities that ARE sub ect to- the audit reguirements of 2 CFR Part 2_0 Subpart F
(Complete the information below and check the a ro riate'box
l We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] for Fiscal Year ending (enter date]. There
were no findings related to federal awards from WMD/EMD. No follow-up action is required by WMD/EMD as the pass-through entity.
A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is
either provided electronically to contracts.officeO-mil.wa.gov or provide the state auditor report number:
❑ We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] for Fiscal Year ending [enter date] There
were findings related to federal awards.
A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is either
provided electronically to contracts.office(a-)mil.wa.gov or provide the state auditor report number:
❑ Our completed 2 CFR Part 200 Subpart F Audit will be available on [enter date] for Fiscal Year ending
[enter date]. We will provide electronic copy of the audit report to contracts.officeRmil.wa.gov at that time or
_provide the state auditor report number:
I hereby certify that I am an individual authorized by the above identified entity to complete this form. Further, I certify that the
above information is true and correct and all relevant material findings contained in audit report/statement have been disclosed.
Additionally, I understand this Form is to be submitted every fiscal year for which this entity is a subrecipient of federal award
funds from the Department until the grant agreement is closed. I I
Signature of Authorized Chief Financial Officer: Date: 11,9
Print Name & Title: K i Ma -
Form 1009-13, 8/19/2013, Updated 9f IAM
FFATA FORM
Subrecipient Agency:. Citv of Pasco
Grant and Year: 2018
Agreement Number: E19-090
Completed Richa Sigdel
by:
Finance Director
509-554-3065
Name
Title
Telephone
Date Completed:
,� ?:t � �3' .- ,4 r j s` r � i � d�v�v, �s x c ��y''',s� tark'�*., a -d� "✓I . c�i..cyy,� ;,�... ��"'� �`'r ='
Is your grant agreement less than $25,000?
YES
STOP, no further
analysis needed,
GO to Step 6
NO
❑
GO to Step 2
STE,P.2
In your preceding fiscal year, did your
organization receive 80% or more of its annualF-1
gross revenues from federal funding?
YES
GO to STEP 3
NO
Elanalysis
STOP, no further
needed, GO to
Step 6
$TEP 3
In your preceding fiscal year, did your
organization receive $25,000,000 or more in
federal funding?
YES
GO to STEP 4
NO
❑
STOP, no further
analysis needed, GO to
Step 6
STEP 4 .
Does the public have access to information about
the total compensation* of senior executives in
your organization?
YES
a
STOP, no further
analysis needed,
GO to step 6
NO
❑
GO to STEP 5
ST
Executive #1
Name: .
Total Compensation amount: $
Name:
Executive #2
Total Compensation amount: $
Executive #3'Total
Name:
Compensation amount: $
Name:
Executive #4
Total Compensation amount: $
-Name:
Executive #5
Total Compensation amount: $
STEP 6 ..
If your organization does not meet these criteria, specifically identify below each criteria that is not met for your
organization: For Example: "Our organization receive less than $25,000."
du9e o'�3 `6VI 4-- At" jAd bib - WW 4 7X
Signature:
Date: #4 ho A 9
* Total compensation refers to:
• Salary and bonuses
• Awards of stock, stock options, and stock appreciation rights
• Other compensation including, but not limited to, severance and termination payments
• Life insurance value paid on behalf of the employee
Additional Resources:
htti)://www.whitehouse.gov/omb/open
http://www.hrsa.govl.rants/ffata. html
httD://www.aDo.cov/fdsys/okq/FR-2010-09-14/pdf/2010-22705.pdf
hfto://www.grants.qov/
Page 1 of 3
FFATA PROVISIONS AND INSTRUCTIONS
For Compliance With The
Federal Funding Accountability and Transparency Act of 2006 (P.L. 109-282) (FFATA)
The Federal Funding Accountability and Transparency Act (FFATA) was signed on September
26, 2006. The FFATA legislation requires information on federal awards (federal financial
assistance and expenditures) be made available to the public via a single, searchable website.
Federal awards include grants, subgrants, loans, awards, cooperative agreements and other forms
of financial assistance as well as contracts, subcontracts, purchase orders, task orders, and
delivery orders. The legislation does not require inclusion of individual transactions below
$25,000 or credit card transactions before October 1, 2008. However, if an award is initially
below this amount yet later increased, the act is triggered. Due to this variability in compliance
Subrecipients are required by the Military Department to be familiar with the FFATA
requirements and complete this Worksheet for each contract for the State's submission in to the
FFATA portal.
ADDITIONAL PROVISIONS
A. This contract (subaward) is supported by federal funds, requiring compliance with the
Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act)
and Office of Management and Budget Guidance (OMB). Public Law 109-282 as amended
by section 6202(a) of Public Law 110-252 (see 31 U.S.C. 6101 note). By entering into this
contract, contractor agrees to provide all applicable reporting information to the Washington
Military Department (WMD) required by FFATA and OMB Guidance.
B. The FFATA requires the OMB to establish a publicly available online database
(USASpending.gov) containing information about entities that are awarded Federal grants,
loans, and contracts. As required by FFATA and OMB Guidance, certain information on the
first-tier subawards related to Federal contracts and grants, and the executive compensation
of awardees, must be made publicly available.
C. For new Federal grants beginning October 1, 2010, if the initial subaward is equal to or
greater than $25,000, reporting of the subaward and executive compensation information is
required. If the initial subaward is below $25,000 but subsequent grant modifications result
in a total subaward equal to or over $25,000, the subaward will be subject to the reporting
requirements as of the date the subaward exceeds $25,000. If the initial subaward equals or
exceeds $25,000 but funding is subsequently de -obligated such that the total award amount
falls below $25,000, the subaward continues to be subject to the reporting requirements of
the Transparency Act and OMB Guidance.
D. As a Federal grant subawardee under this contract, your organization is required by FFATA,
OMB Guidance and this contract to provide the WMD, as the prime grant awardee, all
information required for FFATA compliant reporting by WMD. This includes all applicable
subawardee entity information required by FFATA and OMB Guidance, subawardee DUNS
number, and relevant executive compensation data, as applicable.
1. Data about your organization will be provided to USASpending.gov by the WMD.
System for Award Management (SAM) is a government wide registration system for
organizations that do business with the Federal Government. SAM stores information
about awardees including financial account information for payment purposes and a link
to D&B for maintaining current DUNS information, www.sam.gov. WMD requires SAM
registration and annual renewal by your organization to minimize unnecessary data entry
Page 1 of 2
and re-entry required by both WNM and your organization. It will also reduce the
potential of inconsistent or inaccurate data entry.
2. Your organization must have a Data Universal Numbering System (DUNS) number
obtained from the firm Dun and Bradstreet (D&B) (www.dnb.com). A DUNS number
provides a method to verify data about your organization. D&B is responsible for
maintaining unique identifiers and organizational linkages on behalf of the Federal
Government for organizations receiving Federal assistance.
E. The WMD, as the prime awardee, is required by FFATA to report names and total
compensation of the five (5) most highly compensated officers of your organization (as the
subawardee) i£
1. Your organization (the subawardee), in the preceding fiscal year, received 80 percent or
more of its annual gross revenues from Federal awards and $25,000,000 or more in
annual gross revenues from Federal awards; and
2. The public does not have access to this information about the compensation of the senior
executives of your organization through periodic reports filed under section 13(a) or
15(d) of the Securities and Exchange Act of 1934 (15 U.S.C. §§ 78m(a), 78o(d) or
section 6104 of the Internal Revenue Code of 1986.
"Total compensation" for purposes of this requirement generally means the cash and non-
cash value earned by the executive during the past fiscal year and includes salary and bonus;
awards of stock, stock options and stock appreciation rights; and other compensation such as
severance and termination payments, and value of life insurance paid on behalf of the
employee, and as otherwise provided by FFATA and applicable OMB guidance.
F. If (1) in the preceding fiscal year your organization received 80 percent or more of its annual
gross revenues from Federal awards and $25,000,000 or more in annual gross revenues from
Federal awards, and (2) the public does not have access to this information about the
compensation of the senior executives of your organization through periodic reports filed
under section 13(a) or 15(d) of the Securities and Exchange Act of 1934 (15 U.S.C. §§
78m(a), 78o(d) or section 6104 of the Internal Revenue Code of 1986, insert the names and
total compensation for the five most highly compensated officers of your organization as
identified in Step 5 of the FFATA Form.
Page 2 of 2
w111111119
Request for Taxpayer
Give Form to the
Fenn
(Rev. October 2018)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
► Go to wwwJrs.gov/F6rmW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
City of Pasco
2 Business nameldisregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
to
following seven boxes.
certain entities, not individuals; see
CL
p
❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
instructions on page 3):
H
ai
single -member LLC
Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
p «
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
cn
M
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
LLC that is disregarded
code (if any)
another not from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner�hould ghec the appropriate box for he tax classification of its owner.
IYI
v
Other (see instructions) ► pJl�nJ�" V
(Applies to accounts maintained outside the U.S.)
N
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
3525
ty Third Ave
Franklin County Emergency Management
6 City, state, and ZIP code
1011 E. Ainsworth Street
Pasco, WA 99301
Pasco, WA 99301
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSNHowever, for a - m -
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter. F -T-1
a titre iia n iia iiia � iiia iio
Certification
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 notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
11
Sign pof
U.S.ens � - Date ► A4[;011 ii
Here US. arson No-
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.gov/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)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (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.
If you do not return Form W-9 to the requester with a TIN, 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) Page 2
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (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).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners' share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a 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
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 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 II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, 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 specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. 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 Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1 a. This should also be the same as the
name you entered on the Form 1040/1040A/1040EZ 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)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1. If
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, "Business name/disregarded entity
name." If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
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.
Page 3
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 as a partnership for
Limited liability company and enter
U.S. federal tax purposes,
the appropriate tax classification.
• LLC that has filed Form 8832 or
(P= Partnership; C= C corporation;
2553 to be taxed as a corporation,
or S= S corporation)
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
• Partnership
Partnership
• Trust/estate
Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(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(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
possession
7—A futures commission merchant registered with the Commodity
Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Form W-9 (Rev. 10-2018) Page 4
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 13.
IF the payment is for ...
THEN the payment is exempt
for...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Barter exchange transactions and
Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be
Generally, exempt payees
reported and direct sales over
1 through 5Z
$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 payments made to a corporation and
reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys' fees, gross
proceeds paid to an attorney reportable under section 6045(0, and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar indication) written or printed on the line for a FATCA
exemption code.
A—An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1. 1472-1 (c)(1)(i)
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K -A broker
L—A trust exempt from tax under section 664 or described in section
4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 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 (]TIN). 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, apply for one immediately.
To apply for an SSN, get Form SS -5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 1-800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS -4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS -4. Or, you can go to www.irs.gov/OrderForms 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 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. "Other payments" include
payments made in the course of the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third 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: Give name and SSN of:
1. Individual I The individual
2. Two or more individuals (joint
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)
b. So-called trust account that is not
a legal or valid trust under state law
6. Sole proprietorship or disregarded
entity owned by an individual
7. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
The actual owner of the account or, if
combined funds, the first individual on
the account'
Each holder of the account
The minorZ
Page rJ
For this type of account: I Give 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)()(B))
' List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
2 Circle the minor's name and furnish the minor'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 (if you have one), but the
IRS encourages you to use your SSN.
° List first and circle the name of the trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, 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.
The grantor -trustee' If your tax records are affected by identity theft and you receive a
The actual owner' 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
The owner 3 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
The grantor* at 1-800-908-4490 or submit Form 14039.
For this type of account: I Give name and EIN of:
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 2553
11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
12. Partnership or multi -member LLC
13. A broker or registered nominee
The owner
Legal entity'
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
1-800-829-4059.
The corporation 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
The organization is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
The partnership
The broker or nominee
Form W-9 (Rev. 10-2018)
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 (iIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.ldentityTheft.gov
and Pub. 5027.
Visit www.irs.gov/ldentityTheft to learn more about identity theft and
how to reduce your risk.
Page 6
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their laws. The information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
ATTACHMENT "G"
NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) COMPLIANCE CERTIFICATION:
The Contractor understands National Incident Management System (NIMS) compliance is
required to receive Federal preparedness assistance grants beginning October 1, 2006. The
Contractor certifies, by signing this agreement, that the contractor and its principals have met
NIMS compliance requirements and state reporting requirements and shall meet NIMS
compliance requirements and state reporting requirements for subsequent federal fiscal years
during the performance period of this contract. The NIMS Integration Center (NIC) web page:
hftp://www.fema.gov/emergency/nims provides information about NIMS and guidance to
determine the extent to which jurisdictions are already compliant, as well as identify the NIMS
requirements that have not been met. The Contractor and its principals are required to report
NIMS compliance to the State via the online form available on the State's homepage:
http://www.emd.wa.aov/.
It is understood that failure to comply with NIMS standards/requirements will result in
loss/recapture of funding from Homeland Security Grants.
Bidder or Contractor Signature:
Print Name and Title: Dave Zabell, City Manager — City of Pasco
Date: T) r' 13 Ili,) tg 1
CONTRACT NUMBER: E19-090 (SHSP '18) Page 1 of 1