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HomeMy WebLinkAboutWilliams Plumbing and Heating Performance Bond for Swim Center Heater Replacement PERFORMANCE BOND Any singular reference to Contractor, Surety,Owner,or other party shall be considered p I ural where applicable. ...........- I,.-,--, CONTRACTOR(Natne and Address): SURETY(Name and Address of Principal Place of Business): Williams Plumbing,Heating, &Utilities, Inc. Western Surety Company 2131 Industrial Drive 101 So. Phillips Avenue Bozeman, MT 59715 Sioux Falls, SD 57192 OWNER. arne and Address): City of rozeman PO Box 1230 Bozeman, NIT 59771 CONTRACT Date: February 13, 2012 Amount:$74,325,00 Description(Name and Location): City of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Contract Date), February 13,2012 Amount: $74,325.00 Modifications to this Bond Form: Surety and Contractor,intending to be legally bound hereby, subject to the terms printed on the reverse side hereof,do each cause this Performance Bond to be duty executed on its behalf by its authorized officer,agent,or representative, CONTRACTOR AS PRINCIPAL SURETY Company. Williams lumbing, Heatin Utilities Inc. J Signature: (Seal) Western Surety Company (Seat) Name and Ti Surety' N me C rpora Zeseal By: Signature and Titil Dale J.Anderson,Attorney-In-Fact Space is provided below for signatures of additional (Attach Power of Attorney) parties,if required.) Attest: T-, 'h.o Signature and Title CONTRACTOR AS PRINCIPAL SURETY Company: Signature: (Seal) (Seal) Name and Title Surety's Name and Corporate Seal By' Signature and Title (Attach Power of Attorney) Attest: Signature and Title EJCDC No.C-610(2002 Edition) Originally prepared through the joint efforts of the Surety Association of America, Engineers Joint Contract Documents Committee, the Associated General Contractors ofAmerica,and the American institute of Architects. 00610-1 PAYMENT ROOD Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable. CONTRACTOR(Name and Addres SURETY me and Address of Principal Place of Business).. Williams Plumbing, Heating, & 51ifities Inc, Western Surety Company 2131 Industrial Drive 101 So, Phillips Avenue Bozeman, MT 69715 Sioux Falls, SD 57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, IVIT 59771 CONTRACT Effective Date of Agreement: February 13, 2012 Amount: $74,325.00 Description(Name and Location): The city of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Effective Date of Agreement): February l3,2012 Amount: $74,325.00 Modifications to this Bond Form.- See Attached Paragraph Surety and Contractor,intending to be legally bound hereby,subject to the terms set forth below,do each cause this Payment Bond to be duly executed by an authorized officer,agent or representative,, CONTRACTOR AS PRINCIPAL SURETY Williams Plumbing, Heating, &Utilites, Inc. Contractor's Name end Corporate Seal (Seal) Western Sure Company (Seal) Surety's Name and Corporate Seal By: Y' 13 Si store Signature(A o ch Power,f Attorney) t Q,W Dale J.Anderson Print Name Print Name Attorney-In-Fact Title Title Attest; of Attest: __. C signature Signature <�1�R Surety Customer Service Agent Title Title Note, Provide execution b additional parties, such as venturers, Ifnecessqr y y, (MWO01504,1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page I of 3 10. Surety hereby waives notice of any change, including changes of time, to the Contract or to related subcontracts,purchase orders, and other obligations. 11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the Work or part of the work is located or after the expiration of one year from the date (1) on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph 4.2.3, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Contract, whichever of (1) or (2) first occurs,. If the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. 12. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the addresses shown on the signature page. Actual receipt of notice by Surety, Owner, or Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on the signature page. 13. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory Bond and not as a common law bond. 14. Upon request of any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made, 15. Definitions 15.1 Claimant: An individual or entity having a direct contract with Contractor, or with a first-tier subcontractor of Contractor, to furnish labor, materials, or equipment for use in the performance of the Contract. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment"that part of water, gas, power, light, beat, oil, gasoline, telephone service, or rental equipment used in the Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials, or equipment were furnished. 15.2 Contract: The agreement between Owner and Contractor identified on the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of Owner, which has neither beers remedied nor waived, to pay Contractor as required by the Contract, or to perform and complete or otherwise, comply with the other terms thereof. FOR INFORMATION ONLY—(AWme, Address, and Telephone) Surety Agency or Broker Owner's Representative(Engineer or other) {MW001504;1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 3 of 3 Modification: Paragraph 6 of this Bond is deleted in its entirety and replaced with the following provision: "Within a reasonable time (1) after the Claimant has satisfied the conditions of Paragraph 4 and (2) after the Surety has reviewed all supporting documentation it requested to substantiate the amount of the claim, the Surety shall pay or arrange for payment of any undisputed amounts. Failure of the Surety to satisfy the above requirements shall not be deemed a forfeiture or waiver of the Surety's or the Contractor's defenses under this Bond or their right to dispute such claim, However, in such event the Claimant may bring suit against the Surety as provided under this bond." 2. Form F8176-4-2010 Western Surety Company POWER OF ATTORNEY"POINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Lorain A Darby,Dianne L Meinhardt, Timothy G Lightbourne,Dale J Anderson,Individually of Great Falls,MT,its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to be hereto affixed on this 4th day of August,2010. WESTERN SURETY COMPANY I. qM 14 R'1`19 Paul:FrBruflat,Senior Vice President State of South Dakota ss County of Minnehaha I On this 4th day of August 2010,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota-,that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;that he knows the seal of said corporation,that the seal affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires D. KRELL November 30,,2012 aEAL NOTARY PUBLICS I SOUTH DAKOTA QU + Z D.Krell,No Public CERTIFICATE 1, L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney bereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 13---day of_ FEBRUARY _ 2012 WESTERN SURETY COMPANY 01 At Form F4280-09-06 L.Nelson,Assistant Secretary PERFORMANCE BOND Any singular reference to Contractor, Surety, Owner,or other party shall be considered plural where applicable. CONTRACTOR(Name and Address): SURETY(Name and Address of Principal Place of Business): Williams Plumbing,Heating,&Utilities, Inc. Western Surety Company 213,1 Industrial Drive 101 So. Phillips Avenue Bozeman, MT 59716 Sioux Falls, SID -57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, IVIT 59771 CONTRACT Date: February 13, 2012 Amount:$74,326.00 Description(Name and Location): City of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Contract Date): February 13,2012 Amount: $74,325.00 Modifications to this Bond Form: Surety and Contractor,intending to be legally bound hereby, subject to the terms printed on the reverse side hereof, do each cause this Performance Bond to be duly executed on its behalf by its authorized officer,agent or representative, CONTRACTOR AS PRINCIPAL SURETY Company: Williams Plumbing, Heatin Utilities Inc. Signature: —11,110 4�1 (Seal) Western Surety Company (Seal) Name and Ti Surety' ,Name and C rpora e Seal By, Signature and Title 'k Dale J.Anderson,Attorney-I n-Fact (Space is provided below for signatures of additional (Attach Power of Attorney) parties,if required.) Attest: Signature and.Title CONTRACTOR AS PRINCIPAL SURETY Company: Signature: (Seal) (Seal) Name and Title Surety's Name and Corporate Seal By: Signature and Title (Attach Power of Attorney) Attest: Signature and Title EJCDC No.0-610(2002 Edition) Originally prepared through the joint efforts of the Surety Association of America, Engineers Joint Contract Documents Committee, the Associated General Contractors ofAmerica,and the American institute of Architects. 00610-1 PAYM ENT BOND Any singular reference to Contractor,Surety,Owner, or other party shall be considered plural where applicable. CONTRACTOR(Name and Address): SURETY(Name and Address of Principal Place of Business): Williams Plumbing, Heating,&Utilities Inc. Western Surety Company 2131 Industrial Drive 101 So. Phillips Avenue Bozeman, MT 59715 Sioux Falls, SID 67192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, IVIT 59771 CONTRACT Effective Date of Agreement-, February l3,2012 Amount: $74,325.00 Description(Name and Location): The city of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Effective Date of Agreement): February 13,2012 Amount: $74,325.00 Modifications to this Bond Form: See Attached Paragraph 6 Surety and Contractor,intending to be legally bound hereby,subject to the terms set forth below,do each cause this Payment Bond to be duly executed by an authorized officer,agent,-or-representative.. CONTRACTOR AS PRINCIPAL SURETY Williams Plumbing, Heating, &Utilites, Inc. (Seal) Western Surety Comp��..._ (Seal) Name Contractor's 7d Corporate.Seal Surety's Name and Corporate Seal By: — �S i ISI4h Aftw2-of�Atton;—ey) -- u Dale J.Anderson Print Name Print Name CO 1 rr4- Attorney-In-Fact Title Title Attest: Attest: Signature Signature 6 IX F-Oct F%k Surety Customer Service Agent Title Title Note: Provide execution by additional parties, such a,3 joint venturers, ifnecessary, (MW001504;1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 1 of 3 10. Surety hereby waives notice of any change, including changes of time, to the Contract or to related subcontracts,purchase orders, and other obligations. 11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the Work or part of the work is located or after the expiration of one year from the date (1) on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph 4.2.3, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Contract, whichever of (1) or (2) first occurs. If the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. 12. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the addresses shown on the signature page. Actual receipt of notice by Surety, Owner, or Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on The signature page. 13. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory Bond and not as a common law bond. 14. Upon request of any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made. 15. Definitions 15.1 Claimant: An individual or entity having a direct contract with Contractor, or with a first-tier subcontractor of Contractor, to furnish labor, materials, or equipment for use in the performance of the Contract. The intent-of this Bond.shall-be -to include -without -limitation, in the-terms "labor, materials or equipment"that part of water, gas, power, light, heat, oil, gasoline, telephone service, or rental equipment used in the Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials, or equipment were furnished. 15.2 Contract., The agreement between Owner and Contractor identified on the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of Owner, which has neither been remedied nor waived,to pay Contractor as required by the Contract, or to perform and complete or otherwise comply with the other terms thereof. FOR INFORMATION ONLY—(Name,address, and Telephone) Surety Agency or Broker Owner's Representative (Engineer or other) (MWO01504;1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 3 of 3 Modification: Paragraph 6 of this Bond is deleted in its entirety and replaced with the following provision: "Within a reasonable time (1) after the Claimant has satisfied the conditions of Paragraph 4 and (2) after the Surety has reviewed all supporting documentation it requested to substantiate the amount of the claim, the Surety shall pay or arrange for payment of any undisputed amounts. Failure of the Surety to satisfy the above requirements shall not be deemed a forfeiture or waiver of the Surety's or the Contractor's defenses under this Bond or their right to dispute such claim. However, in such event the Claimant may bring suit against the Surety as provided under this bond," 2. - - - - - - - - - - - - - - - - - - Form F8176A-2010 Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY—IN—FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and sea]herein affixed hereby make,constitute and appoint Lorrin A Darby,Dianne L Meinhardt, Timothy G Lightbourne,Dale J Anderson,Individually of Great Falls,MT,its true and lawful Attomey(*in-Fact with full power and authority hereby conferred to sign,sea] and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation, In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate sea]to be hereto affixed onthis 4th day of August,2010. WESTERN SURETY COMPANY fps—CA 4 Paul 4FBruflat,Senior Vice President State of South Dakota ss County of Minnehaba On this 4th day of Augusts 2010,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;that he knows the seal of said corporation;that the seat affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires + X D. KRELL November 30,2012 NOTARY PUBLIC f(MSOUTH J)AKOTA f Jf D.Krell,NoV—y Public CERTIFICATE 1,L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 13--day of FEBRUARY _ 2012 WESTERN SURETY COMPANY SM. C L.Nelson,Assistant Secretary Form F4280-09-06 PERFORMANCE BOND Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable. CONTRACTOR(Name and Address): SURETY(Name and Address of Principal Place of Business): Williams Plumbing,Heating,&Utilities, Inc. Western Surety Company 2131 Industrial Drive 101 So.Phillips Avenue Bozeman,MT 59715 Sioux Falls, SID 57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, MT 59771 CONTRACT Date: February 13, 2012 Amount-.$74,325.00 Description(Name and Location): City of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Contract Date): February 13,2012 Amount. $74,325.00 Modifications to this Bond Form: Surety and Contractor, intending to be legally bound hereby, subject to the terms printed on the reverse side hereof, do each cause this Performance Bond to be duly executed on its behalf by its authorized officer,agent,or representative. CONTRACTOR AS PRINCIPAL SURETY Company. Wi[liamp i&rni ,Plumbing,Heat' Utilities Inc. Signature: olt4 6 (Seal) Westem Surety Company (Seal) Name and Ti? SuretyI' \Name C rpora�eSeal By. Signature and—TitV Dale J.Anders�on,Aftorney-ln-Fact (Space is provided below for signatures of additional (Attach Power of Attorney) parties,if required.) Attest: = Signature re and Title CONTRACTOR AS PRINCIPAL SURETY Company., Signature: (Seal) (Seal) Name and Title Surety's Name and Corporate Seal By: Signature and Title (Attach Power of Attorney) Attest-, Signature and Title FJCDC No.C-6 10(2002 Edition) Originally prepared through the joint efforts of the Surety Association of America, Engineer Joint Contract Documents Committed, Contractors of America,and the American Institute of Architects, the Associated Cameral 00610-1 PAYM ENT BOND Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable. CONTRACTOR(Name and Address): SURETY(Name and Address of Principal Place of Business): Williams Plumbing, Heating, &Utilities Inc. Western Surety Company 2131 Industrial Drive 101 So. Phillips Avenue Bozeman, MT 59715 Sioux Falls, SID 57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, MT 59771 CONTRACT Effective Date of Agreement: February 13,2012 Amount: $74,325.00 Description(Name and Location): The city of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Effective Date of Agreement): February 13,2012 Amount: $74,325.00 Modifications to this Bond Form: See Attached Paragraph 6 Surety and Contractor,intending to be legally bound hereby,subject to the terms set forth below,do each cause this Payment Bond to be duly executed by an authorized officer,agent,or-representative.. CONTRACTOR AS PRINCIPAL SURETY Williams Plumbing, Heating, &Utilites,Inc. (Seat) Western Sure Company (Seal) Contractor's Name end Corporate Seal Surety's Name and Corporate Seal Si attire By: By: Signature 0 —ach Power of Attorney) Dale J.Anderson Print Name Print Name PAttorney-in-Fact Title Title Attest: Attest- SioTature Signature 6�F-oct Surety Customer Service Agent Title Title Note: Provide execution by additional parties,such as joint venturers, ?f necessary, (MW001504;1 EJCDC C-615(A)Payment.Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 1 of 3 10. Surety hereby waives notice of any change, including changes of time, to the Contract or to related subcontracts,purchase orders, and other obligations. 11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the Work or part of the work is located or after the expiration of one year from the date (1) on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph 4.2.3, or (2) on which the last labor or service was performed by anyone or the last materials of equipment were furnished by anyone under the Contract, whichever of (1) or (2) first occurs. If the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable, 12. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the addresses shown on the signature page. Actual receipt of notice by Surety, Owner, or Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on the signature page. 13. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory Bond and not as a common law bond. 14. Upon request of any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall promptly famish a copy of this Bond or shall permit a copy to be made. 15. Definitions 15.1 Claimant: An individual or entity having a direct contract with Contractor, or with a first-tier subcontractor of Contractor, to furnish labor, materials, or equipment for use in the performance of the Contract. The intent-of this Bond-shall-be to- include without limitation- in the-terms "labor, materials or equipment!'that part of water, gas, power, light, beat, oil, gasoline, telephone service, or rental equipment used in the Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials, or equipment were famished. 15.2 Contract: The agreement between Owner and Contractor identified on the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of Owner, which has neither been remedied nor waived,to pay Contractor as required by the Contract, or to perform and complete or otherwise comply with the other terms thereof. FOR INFORMATION ONLY—(Name,Address, and Telephone) Surety Agency or Broker Owner's Representative (Engineer or other) (MWO01504;1 EJCDC C-615(A)Payment Bond Marcia 2008 Prepared by the Engineers Joint ControI Documents Committee Page 3 of 3 Modification: Paragraph 6 of this Bond is deleted in its entirety and replaced with the following provision: "Within a reasonable time (1) after the Claimant has satisfied the conditions of Paragraph 4 and (2) after the Surety has reviewed all supporting documentation it requested to substantiate the amount of the claim, the Surety shall pay or arrange for payment of any undisputed amounts. Failure of the Surety to satisfy the above requirements shall not be deemed a forfeiture or waiver of the Surety's or the Contractor's defenses under this Bond or their right to dispute such claim. However, in such event the Claimant may bring suit against the Surety as provided under this bond." 2. Form F8176-4-2010 Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Lorrin A Darby,Dianne L Meinhardt,Timothy G Lightbourne,Dale J Anderson,Individually of Great Falls,MT,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power Of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to be hereto affixed on this 4th day of August,2010. WESTERN SURETY COMPANY q Paul:1rBruflat,Senior Vice President State of South Dakota ss County of Minnehaba I On this 4th day of August,2010,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires + D. KRELL November 30,2012 fr(RNcrrmy PUBLIC SOUTH I)Axorri(IEAL J D,Krell,No Public CERTIFICATE 1,L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 13 -day of FEBRUARY . 2012 WESTERN SURETY COMPANY Wt 0 L.Nelson,Assistant Secretary Form F4280-09-06 PERFORMANCE BOND Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable, CONTRACTOR(Name and Address): SURETY(Name and Address of Principal Place of Business)- Williams Plumbing,Heating, &Utilities, Inc. Western Surety Company 2131 Industrial Drive 101 So.Phillips Avenue Bozeman, IVIT 59715 Sioux Falls,SD--57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, MT 59771 CONTRACT Date: February 13, 2012 Amount:$74,325.00 Description(Name and Location): City of Bozeman Swim Center Heater Replacement Project BOND bond Number: 71230887 Date(Not earlier than Contract Date): February 13,2012 Amount-, $74,325,00 Modifications to this Bond Form: Surety and Contractor, intending to be legally bound hereby, subject to the terms printed on the reverse side hereof,do each cause this Performance Bond to be duly executed on its behalf by its authorized officer,agent,or representative. CONTRACTOR AS PRINCIPAL SURETY Company, William lumbing, Heatin Utilities Inc. 17y Signature: (Seal) Western Surety Company (Seal) Name and Surety," Name ar�d C rpora e Seal u' Ti. Dale J. By: Signature and Titl,", Dale J.Anderson,Attorney-In-Fact (Attach Power of Attorney) (Space is provided below for signatures of additional parties,if required.) Attest: Signature and Title CONTRACTOR AS PRINCIPAL SURETY Company: Signature, (Seal) (Seal) Name and Title Surety's Name and Corporate Seal By: Signature and Title (Attach Power of Attorney) Attest: Signature and Title EJCDC No.C-610(2002 Edition) Originally prepared through the joint efforts of the Surety Association of America, Engineers Joint Contract Documents Committee, the Associated General Contractors of America,and the American Institute of Architects, 00610-1 PAYMENT BOND Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable. CONTRACTOR(Name and Address): SURETY me and Address of Principal Place of Business): Williams Plumbing, Heating, &Utilities Inc. Western Surety Company 2131 Industrial Drive 101 So. Phillips Avenue Bozeman, MT 59715 Sioux Falls, SD 57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, IVIT 59771 CONTRACT Effective Date of Agreement: February 13,2012 Amount: $74,325.00 Description(Name and Location): The city of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Effective Date of Agreement)., February 13, 2012 Amount: $74,325.00 Modifications to this Bond Form: See Attached Paragraph 6 Surety and Contractor,intending to be legally bound hereby,subject to the terms set forth below,do each cause this Payment Bond to be duly executed by an authorized officer,agent,or-representative.. CONTRACTOR AS PRINCIPAL SURETY Williams Plumbing, Heating, &Utilites, Inc. (Seal) Western Sure!y_gompany (Seal) Contractor's Name and Corporate Seal Surety's Name and Corporate Seal By: BY: Siqature Signature- ach Power of Attorney) Ae V) 1 p 0,W Dale J.Anderson Print Name print Name e('C5 I, Sp,a+ Attorney-I n-Fact Title Title A ttest: ) 001, Attest: Signature Signature 6?- `eJ Surety Customer Service Agent Title Title Nate: Provide execution by additionalparties,such as joint venturers, if necessary, W001504J EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page I of 3 10. Surety hereby waives notice of any change, including changes of time, to the Contract or to related subcontracts,purchase orders, and other obligations, 11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the Work or part of the work is located or after the expiration of one year from the date (1) on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph 4.2.3, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Contract, whichever of (1) or (2) first occurs. If the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. 12. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the addresses shown on the signature page. Actual receipt of notice by Surety, Owner, or Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on the signature page. 13. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory Bond and not as a common law bond. 14. Upon request of any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made. 15. Definitions 15.1 Claimant: An individual or entity having a direct contract with Contractor, or with a first-tier subcontractor of Contractor, to furnish labor, materials, or equipment for use in the performance of the Contract. The intent-of this Bond-shall-be to-include without limitation in the terms "labor, materials or equipment"that part of water, gas, power, light, heat, oil, gasoline, telephone service, or rental equipment used in the Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials, or equipment were furnished. 15.2 Contract: The agreement between Owner and Contractor identified on the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of Owner, which has neither been remedied nor waived,to pay Contractor as required by the Contract, or to perform and complete or otherwise comply with the other terms thereof. FOR INFORMATION ONLY—(Name, Address, and Telephone) Surety Agency or Broker Owner's Representative (Engineer or other) (MW001504;1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 3 of 3 Modification: Paragraph 6 of this Bond is deleted in its entirety and replaced with the following provision: "Within a reasonable time (1) after the Claimant has satisfied the conditions of Paragraph 4 and (2) after the Surety has reviewed all supporting documentation it requested to substantiate the amount of the claim, the Surety shall pay or arrange for payment of any undisputed arnounts. Failure of the Surety to satisfy the above requirements shall not be deemed a forfeiture or waiver of the Surety's or the Contractor's defenses under this Bond or their right to dispute such claim. However, in such event the Claimant may bring suit against the Surety as provided under this bond." 2. Foram F8176-4-2010 Western Surety Company POWER OF ATTORNEY APPOINTING MIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duty organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and sea]herein affixed hereby make,constitute and appoint Lorrin A Darby,Dianne L Meinhardt,Timothy G Lightbourne,Dale J Anderson,Individually of Great Falls,MT,its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,sea]and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate sea]to be hereto affixed onthis 4th day of August,2014. WESTERN SURETY COMPANY CA a Paul 4!Bruflat,Senior Vice President State of Sowli Dakota ss County of Mirinchalia I On this 4th day of August,2010,before me personally came Paul T.Bruflat,to me known,who,being by me duly swom,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument that he knows the sea]of said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that be signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires + D. KRELL November 30,2012 NOTARY PUBLIC ,(MSOUTH DAKOTA(Rif r X +.,.,. + Aaa k4_0_" ......Z 11 Krell,N—oN–Y Public CERTIFICATE 1, L,Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney bereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 13 —day of FEBRUARY 2012 WESTERN SURETY COMPANY Form F4280-09-06 L Nelson,Assistant Secretary PE"ORMANCE BOND Any singular reference to Contractor, Surety,Owner, or other party shall be considered plural where applicable. CONTRACTOR(Name and Address): SURETY(Name and Address of Principal Place of Business): Williams Plumbing,Heating,&Utilities, Inc. Western Surety Company 2131 Industrial Drive 101 So. Phillips Avenue Bozeman, NIT 59715 Sioux Falls,SD.-57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, MT 59771 CONTRACT Date: February 13, 2012 Amount.$74,325.00 Description(Name and Location)- City of Bozeman Swim Center Heater Replacement Project BOND Bond Number.- 71230887 Date(Not earlier than Contract Date): February 13,2012 Amount. $74,325.00 Modifications to this Bond Form: Surety and Contractor,intending to be legally bound hereby, subject to the terms printed on the reverse side hereof,do each cause frils Performance Bond to be duly executed on its behalf by its authorized officer,agent or representative. CONTRACTOR AS PRINCIPAL SURETY Company.. Willia,7VIumbing, Heatin AUtilities Inc. Signature: (Seal) Western Surety Company 'Seal) Name andTil Surety' Name aid C rpora e Seal y By: Signature and Title Dale J.Anderson,Attorney-In-Fact (Attach Power of Attorney) (Space is provided below for signatures of additional parties, if required.) Attest: Signature and Title CONTRACTOR AS PRINCIPAL SURETY Company. Signature: (Seal) (Seal) Name and Title Surety's Name and Corporate Seal By: Signature and Title (Attach Power of Attorney) Attest: Signature and Title EJCDC No.C-610(2002 Edition) Originally prepared through the joint efforts of the Surety Association of America, 'Engineers Joint Contract Documents Committee, the Associated General Contractors of America,and the American Institute of Architects. 00610-1 PAYM ENT BOND Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable, CONTRACTOR(Name and Address): SURETY Tame and Address of Principal Place of Business): Williams Plumbing, Heating, &Utilities Inc, Western urety Company 2131 Industrial Drive 101 So. Phillips Avenue Bozeman, MT 59715 Sioux Falls,SD 57192 OWNER(Name and Address): City of Bozeman PO Box 1230 Bozeman, IVIT 59771 CONTRACT Effective Date of Agreement: February 13,2012 Amount: $74,325.00 Description(Name and Location): The city of Bozeman Swim Center Heater Replacement Project BOND Bond Number: 71230887 Date(Not earlier than Effective Date of Agreement): February I3,2012 Amount: $74,325.00 Modifications to this Bond Form: See Attached Paragraph to Surety and Contractor,intending to be legally bound hereby,subject to the terms set forth below,do each cause this Payment Bond to be duly executed by an authorized officer,agent or-representative- CONTRACTOR AS PRINCIPAL SURETY Williams Plumbing, Heating, &Uti[ltes, Inc. (Seal) Western Surety Company Contractor's Name and Corporate Sea] Surety's-Name and Corporate Seal (Seal) By: , By. —Si attire Power - i Dale J.Anderson ? L4,1 Print Name Print Name Attorney-In-Fact Title Title Attest: Attest: 9�tgnature Signature-- 6 VL P C-g PtS, Surety Customer Service Agent Title Title Note. Provide execution by additional parties, such as joint venturers, if necessary (MWO01504;1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 1 of 3 10, Surety hereby waives notice of any change, including changes of time, to the Contract or to related subcontracts,purchase orders, and other obligations. 11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the Work or part of the work is located or after the expiration of one year from the date (1) on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph 4,23, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were famished by anyone under the Contract, whichever of (1) or (2) first occurs. If the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. 12. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the addresses shown on the signature page. Actual receipt of notice by Surety, Owner, or Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on the signature page. 13. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory Bond and not as a common law bond, 14. Upon request of any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made. 15. Definitions 15.1 Claimant: An individual or entity having a direct contract with Contractor, or with a first-tier subcontractor of Contractor, to furnish labor, materials, Or equipment for use in the performance of the Contract.. The intent of this Bond shall.be to- include without limitation- in the -terms "labor, materials or equipment"that part of water, gas, power, light, heat, oil, gasoline, telephone service, or rental equipment used in the Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials, or equipment were furnished. 15.2 Contract: The agreement between Owner and Contractor identified on the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of Owner, which has neither been remedied nor waived,to pay Contractor as required by the Contract, or to perform and complete or otherwise comply with the other terms thereof. FOR INFORMATION ONLY—(Name,Address, and Telephone) Surety Agency or Broker Owner's Representative (Engineer or other) (MWO01504;1 EJCDC C-615(A)Payment Bond March 2008 Prepared by the Engineers Joint Control Documents Committee Page 3 of 3 Modification: Paragraph 6 of this Bond is deleted in its entirety and replaced with the following provision: "Within a reasonable time (1) after the Claimant has satisfied the conditions of Paragraph 4 and (2) after the Surety has reviewed all supporting documentation it requested to substantiate the amount of the claim, the Surety shall pay or arrange for payment of any undisputed amounts. Failure of the Surety to satisfy the above requirements shall not be deemed a forfeiture or waiver of the Surety's or the Contractor's defenses under this Bond or their right to dispute such claim. However, in such event the Claimant may bring suit against the Surety as provided under this bond." 2. Form F8176A-2010 Western Surety Company POWER OF ATTORNEY"POINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and sea]herein affixed hereby make,constitute and appoint Lorrin A Darby,Dianne L Meinhardt,Timothy G Lightbourne,Dale J Anderson, Individually of Great Falls,MT,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to be hereto affixed onthis 4th day of August,2010. WESTERN SURETY COMPANY & a Paul:FBruflat,Senior Vice President State of South Dakota ss County of Minnehaba I On this 4th day of August,2010,before me personally came Paul T.Bruflat,to me known,who,being by me duly swom,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota,that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal,that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires + D. KRELL November 30,2012 Z NOTARY PUBLIC X SEAL S L WbSOUTH DAKOTA(Rir .r t + D.Krell,No Public CERTIFICATE 1, L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hercinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 13 -day of FEBRUARY . 2012 WESTERN SURETY COMPANY Form F4280-09-06 L.Nelson,Assistant Secretary Forrnw-9 Request for Taxpayer Give Form to the (Rev.December 2011) requester. Do not Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service Name(as shown on your income tax return) MONTANA READY MIX LTD Business name/disregarded entity name,if different from above rn re CL Check appropriate box for federal tax classification: c U0 Ll Indivicluiai proprietor C Corporation S Corporation ❑ Partnership F-1 TrusUestate CL 0 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)O� Exempt payee 0 --------------------- -------- Other(see instructions)111-- Address(number,street,and apt.or suite no.) Requester's name and address(optional) cL 209 EAST CEDAR STREET C4,state,and ZIP code BOZEMAN,MONTANA 59715 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 the"Name"line Social security number to avoid backup withholding.For individuals,this is your social security number(SSN),However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to got a TIN on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. Kil -1 0 � 4 4 � 4 � 5 6 8 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 i 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). 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 an page 4. Sign Signature of ��J30 Here U.S.person 0- / Date 11� I, � 0 General Instructions Note.If a requester gives you a for oche l than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An Individual who is a U,S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation -An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. Use Form W-9 only if you are a U.S,person(including a resident •A domestic trust(as defined in Regulations section 301,7701-7). alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding 1.Certify that the TIN you are giving Is correct(or you are waiting Fora tax on any foreign partners'share of Income from such business.Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U,S.person that is a 3.Claim exemption from backup withholding If you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S, allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income, Cat.No.10231X Form W-9(Rev,12-2011) Form W-9(Rev,12-2011) Page 2 The person who gives Form W-9 to the partnership for purposes of Certain payees and payments are exempt from backup withholding. establishing its U.S.status and avoiding withholding on its allocable See the instructions below and the separate Instructions for the share of net income from the partnership conducting a trade or business Requester of Form W-9. in the United States is in the following cases: Also see Special rules forpartnerships on page 1, •The U.S,owner of a disregarded entity and not the entity, Updating Your Information •The U,S.grantor or other owner of a grantor trust and not the trust, and You must provide updated information to any person to whom you •The U.S,trust(other than a grantor trust)and not the beneficiaries of claimed to be an exempt payee if you are no longer an exempt payee the trust. and anticipate receiving reportable payments in the future from this person. For example,you may need to provide updated information if Foreign person.If you are a foreign person,do not use Form W-9, you are a C corporation that elects to be an S corporation,or if you no Instead,use the appropriate Form W-8(see Publication 515, longer are tax exempt. In addition,you must furnish a new Form W-9 if Withholding of Tax on Nonresident Aliens and Foreign Entities), the name or TIN changes for the account,for example,if the grantor of a Nonresident alien who becomes a resident alien.Generally,only a grantor trust dies, 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 Penalties treaties contain a provision known as a"saving clause."Exceptions Failure to furnish TIN.If you fail to furnish your correct TIN to a specified in the saving clause may permit an exemption from tax to requester,you are subject to a penalty of$50 for each such failure continue for certain types of income even after the payee has otherwise unless your failure is due to reasonable cause and not to willful neglect. become a U.S.resident alien for tax purposes. Civil penalty for false information with respect to withholding.If you If you are a U.S.resident alien who is relying on an exception make a false statement with no reasonable basis that results in no contained in the saving clause of a tax treaty to claim an exemption backup withholding,you are subject to a$500 penalty. from U.S.tax on certain types of income,you must attach a statement to Form W-9 that specifies the following five items- Criminal penalty for falsifying information.Willfully falsifying certifications or affirmations may subject you to criminal penalties 1.The treaty country.Generally,this must be the same treaty under including fires and/or imprisonment. which you claimed exemption from tax as a nonresident alien. Misuse of TINS.If the requester discloses or uses TINS in violation of 2.The treaty article addressing the income. federal law,the requester may be subject to civil and criminal penalties. 3.The article number(or location)in the tax treaty that contains the saving clause and its exceptions. Specific Instructions 4.The type and amount of income that qualifies for the exemption from tax. Name 5.Sufficient facts to justify the exemption from tax under the terms of If you are an individual,you must generally enter the name shown on the treaty article. your income tax return. However,if you have changed your last name, for instance,due to marriage without informing the Social Security Example.Article 20 of the U.S,-China income tax treaty allows an Administration of the name change,enter your first name,the last name exemption from tax for scholarship income received by a Chinese shown on your social security card,and your new last name. 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 If the account is in joint names,list first,and then circle,the name of the United States exceeds 5 calendar Years.However,paragraph 2 of the person or entity whose number you entered in Part I of the form, the first Protocol to the U.S.-China treaty(dated April 30,1984)allows Sole proprietor.Enter your individual name as shown on your income the provisions of Article 20 to continue to apply even after the Chinese tax return on the"Name"line.You may enter your business,trade,or student becomes a resident alien of the United States.A Chinese "doing business as(DBA)"name on the"Business name/disregarded student who qualifies for this exception(under paragraph 2 of the first entity name"line, protocol)and is relying on this exception to claim an exemption from tax Partnership,C Corporation,or S Corporation.Enter the entity's name on his or her scholarship or fellowship income would attach to Form on the"Name"line and any business,trade,or"doing business as W-9 a statement that includes the information described above to (DBA)name"on the"Business name/disregarded entity name"line. support that exemption. Disregarded entity.Enter the owner's name on the"Name"line.The If you area nonresident alien or a foreign entity not subject to backup name of the entity entered on the"Name"line should never be a withholding,give the requester the appropriate completed Form W-8. disregarded entity.The name on the"Name"line must be the name What is backup withholding?Persons making certain payments to you shown on the income tax return on which the income will be reported, must under certain conditions withhold and pay to the IRS a percentage For example,if a foreign LLC that is treated as a disregarded entity for of such payments.This is called"backup withholding," Payments that U.S.federal tax purposes has a domestic owner,the domestic owner's may be subject to backup withholding include interest,tax-exempt name is required to be provided on the"Name"line,If the direct owner interest,dividends,broker and barter exchange transactions,rents, of the entity is also a disregarded entity,enter the first owner that is not royalties,nonemployee pay,and certain payments from fishing boat disregarded for federal tax purposes. Enter the disregarded entity's operators.Real estate transactions are not subject to backup name on the"Business name/disregarded entity name"line.If the owner withholding. of the disregarded entity is a foreign person,you must complete an You will not be subject to backup withholding on payments you appropriate Form W-8, receive if you give the requester your correct TIN,make the proper Note.Check the appropriate box for the federal tax classification of the certifications,and report all your taxable interest and dividends on your person whose name is entered on the"Name"line(Individual/sole tax return, proprietor,Partnership,C Corporation,S Corporation,Trust/estate). Payments you receive will be subject to backup Limited Liability Company(LLC).If the person identified on the withholding if: "Name"line is an LLC,check the"Limited liability company"box only 1.You do not furnish your TIN to the requester, and enter the appropriate code for the tax classification in the space provided.If you are an LLC that is treated as a partnership for federal 2.You do not certify your TIN when required(see the Part 11 tax purposes,enter"P"for partnership.If you are an LLC that has filed a instructions on page 3 for details), Form 8832 or a Form 2553 to be taxed as a corporation,enter"C"for 3.The IRS tells the requester that you furnished an incorrect TIN, 0 corporation or"S"for S corporation.If you are an LLC that is 4.The IRS tells you that you are subject to backup withholding disregarded as an entity separate from its owner under Regulation because you did not report all your interest and dividends on your tax section 301.7701-3(except for employment and excise tax),do not return(for reportable interest and dividends only),or check the LLC box unless the owner of the LLC(required to be identified on the"Name"line)is another LLC that is not disregarded for 5.You do not certify to the requester that you are not subject to federal tax purposes.If the LLC is disregarded as an entity separate backup withholding under 4 above(for reportable interest and dividend from its owner,enter the appropriate tax classification of the owner accounts opened after 1983 only), identified on the"Name"line. Form W-9(Rev.12-2011) Page 3 Other entities,Enter your business name as shown on required federal Part 1,Taxpayer Identification Number(TIN) tax documents on the"Name"line.This name should match the name shown on the charter or other legal document creating the entity.You Enter your TIN in the appropriate box.If you are a resident alien and may enter any business,trade,or DBA name on the"Business name/ you do not have and are not eligible to get an SSN,your TIN is your IRS disregarded entity name"line. individual taxpayer identification number(ITIN).Enter it in the social security number box,If you do not have an ITIN,see Now to get a TIN Exempt Payee below. If you are exempt from backup withholding,enter your name as If you are a sole proprietor and you have an EIN,you may enter either described above and check the appropriate box for your status,then your SSN or EIN.However,the IRS prefers that you use your SSN. check the"Exempt payee"box in the line following the"Business name/ If you are a single-member LILC that is disregarded as an entity disregarded entity name,"sign and date the form, separate from its owner(see Limited Liability Company(LLC)on page 2), Generally,individuals(Including sole proprietors)are not exempt from enter the owner's SSN(or EIN,if the owner has one).Do not enter the backup withholding.Corporations are exempt from backup withholding disregarded entity's EIN.It the LLO is classified as a corporation or for certain payments,such as interest and dividends. partnership,enter the entity's EIN. Note.If you are exempt from backup withholding,you should still Note.See the chart on page 4 for further clarification of name and TIN complete this form to avoid possible erroneous backup withholding, combinations. The following payees are exempt from backup withholding: 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 1.An organization exempt from tax under section 501(a),any IRA,or a Card,from your local Social Security Administration office or get this custodial account under section 403(b)(7)if the account satisfies the form online at www.ssa.gov.You may also get this form by calling requirements of section 401(f)(2), 1-800-772-1213.Use Form W-7,Application for IRS Individual Taxpayer 2.The United States or any of its agencies or instrumentalities, Identification Number,to apply for an ITIN,or Form SS-4,Application for 3.A state,the District of Columbia,a possession of the United States, Employer Identification Number,to apply for an EIN.You can apply for or any of their political subdivisions or instrumentalities, an EIN online by accessing the IRS website at wwwirs.gov/businesses 4.A foreign government or any of its political subdivisions,agencies, and clicking on Employer Identification Number(EIN)under Starting a Business.You can get Forms W-7 and SS-4 from the IRS by visiting or instrumentalities,or IRS.gov or by calling 1-800-TAX-FORM(1-800-829-3676). 5.An international organization or any of its agencies or If you are asked to complete Form W-9 but do not have a TIN,write instrumentalities. "Applied For"in the space for the TIN,sign and date the form,and give Other payees that may be exempt from backup withholding include: it to the requester.For interest and dividend payments,and certain 6,A corporation, 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 7.A foreign central bank of issue, are subject to backup withholding on payments.The 60-day rule does 8.A dealer in securities or commodities required to register in the not apply to other types of payments.You will be subject to backup United States,the District of Columbia,or a possession of the United withholding on all such payments until you provide your TIN to the States, requester. 9.A futures commission merchant registered with the Commodity Note.Entering"Applied For"means that you have already applied for a Futures Trading Commission, TIN or that you intend to apply for one soon, 10.A real estate investment trust, Caution:A disregarded domestic entity that has a foreign owner must 11.An entity registered at all times during the tax year under the use the appropriate Form W-8. Investment Company Act of 1940, Part fl. Certification 12.A common trust fund operated by a bank under section 584(a), To establish to the withholding agent that you are a U.S.person,or 13.A financial institution, resident alien,sign Form W-9.You may be requested to sign by the 14.A middleman known in the investment community as a nominee or withholding agent even if item 1,below,and items 4 and 5 on page 4 custodian,or indicate otherwise. 15.A trust exempt from tax under section 664 or described in section For a joint account,only the person whose TIN is shown in Part 1 4947. should sign(when required). In the case of a disregarded entity,the The following chart shows types of payments that may be exempt person identified on the"Name"line must sign.Exempt payees,see from backup withholding.The chart applies to the exempt payees listed Exempt Payee on page 3. above, 1 through 15. Signature requirements.Complete the certification as indicated in items 1 through 3,below,and items 4 and 5 on page 4. IF the payment is for... THEN the payment is exempt 1.Interest,dividend,and barter exchange accounts opened for.— before 1984 and broker accounts considered active during 1983. Interest and dividend payments All exempt payees except You must give your correct TIN,but you do not have to sign the for 9 certification. 2.Interest,dividend,broker,and barter exchange accounts Broker transactions Exempt payees 1 through 5 and 7 opened after 1983 and broker accounts considered inactive during through 13.Also,C corporations. 1983.You must sign the certification or backup withholding will apply. If Barter exchange transactions and Exempt payees 1 through 5 you are subject to backup withholding and you are merely providing patronage dividends your correct TIN to the requester,you must cross out item 2 in the certification before signing the form. Payments over$600 required to be Generally,exempt payees 3.Real estate transactions.You must sign the certification.You may reported and direct sales over I through 7 cross out item 2 of the certification. $5,000' 11 See Form I 099-MISO,Misceflaneous,Income,and its instructions. However,the following payments made to a corporation arid reportable on Form 1099-MISC are not exempt from backup withholding:medical and health care payments,attorneys'fees,gross proceeds paid to an attorney,and payments for services paid by a federal executive agency. Form W-9(Rev.12-2011) Page 4 4.Other payments.You must give your correct TIN,but you do not Note.If no name is circled when more than one name is listed,the have to sign the certification unless you have been notified that you number will be considered to be that of the first name listed. have previously given an incorrect TIN."Other payments"include payments made in the course of the requester's trade or business for Secure Your Tax Records from Identity Theft rents,royalties,goods(other than bills for merchandise),medical and Identity theft occurs when someone uses your personal information health care services(including payments to corporations),payments to such as your name,social security number(SSN),or other identifying a nonemployee for services,payments to certain fishing boat crew information,without your permission,to commit fraud or other crimes. members and fishermen,and gross proceeds paid to attorneys An identity thief may use your SSN to get a job or may file a tax return (including payments to corporations). using your SSN to receive a refund. S.Mortgage interest paid by you,acquisition or abandonment of To reduce your risk: secured property,cancellation of debt,qualified tuition program .Protect your SSN, payments(under section 529),IRA,Coverdell ESA,Archer MSA or HSA contributions or distributions,and pension distributions.You •E=nsure your employer is protecting your SSN,and must give your correct TIN,but you do not have to sign the certification. .Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a What Name and Number To Give the Requester notice from the IRS,respond right away to the name and phone number For this type of account: Give name and SSN of: printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you 1.Individual The individual think you are at risk due to a lost or stolen purse or wallet,questionable 2.Two or more individuals(taint The actual owner of the account or, credit card activity or credit report,contact the IRS Identity Theft Hotline account) if combined funds,the first ' at 1-800-908-4490 or submit Form 14039. individual on the account 3.Custodian account of a minor The minor' For more information,see Publication 4535,Identity Theft Prevention(Uniform Gift to Minors Act) and Victim Assistance. 4,a.The usual revocable savings The grantor-trustee' Victims of Identity theft who are experiencing economic harm or a trust(grantor is also trustee) system problem,or are seeking help in resolving tax problems that have b.So-called trust account that is The actual owner' not been resolved through normal channels,may be eligible for not a legal or valid trust under Taxpayer Advocate Service(TAS)assistance.You can reach TAS by state law calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 5.Sole proprietorship or disregarded The owner' 1-800-829-4059. entity owned by an individual Protect yourself from suspicious emails or phishing schemes. 6.Grantor trust filing under Optional The grantor* Finishing is the creation and use of email and websites designed to Form 1099 Filing Method 1(see Regulation section 1.671-4(la)(2)(i)(A)) mimic legitimate business emails and websites.The most common act For this type of account: Give name and EIN of: is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering 7,Disregarded entity not owned by an The owner private information that will be used for identity theft. individual s.A valid trust,estate,or pension trust Legal entity' The IRS does not initiate contacts with taxpayers via emails.Also,the 9.Corporation or LLC electing The corporation IRS does not request personal detailed information through email or ask corporate status on Form 8832 or taxpayers for the PIN numbers,passwords,or similar secret access Form 2553 information for their credit card,bank,or other financial accounts. 10.Association,club,religious, The organization If you receive an unsolicited email claiming to be from the IRS, charitable,educational,or other forward this message to phishing @irs,gov.You may also report misuse tax-exempt organization of the IRS name,logo,or other IRS property to the Treasury Inspector 11.Partnership or multi-member LLC The partnership General for Tax Administration at 1-800-366-4484.You can forward 12.A broker or registered nominee The broker or nominee suspicious emails to the Federal Trade Commission at;Spam @uce.gov 13.Account with the Department of The public entity or contact them at www.ffc.gov/rdtheff or 1-877-IDTHEFT Agriculture in the name of a public (1-877-438-4338). entity(such as a state or local Visit IRS.gov to learn more about identity theft and how to reduce government,school district,or your risk. prison)that receives agricultural program payments 14.Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2(see Regulation section 1.671-4(b)(2)(i)(B)) "List first and circle the name of the person whose number you furnish.If only one person on a joint account has an SSN,that person's number must be fumished.. 2 circle the minor's name and furnish the minor's SSN. 'You must show your individual name and you may also enter your business or"DRA"name on the"Business name/disregarded entity"name line.You may use either your SSN or PIN tit you have one),but the IRS encourages you to use your SSN. 'last first and circle the name of the trust,estate,or pension trust too not furnish the TIN of the personal representative or trustee unless the legal enti!.ty itself I is not designated in the account tille.)Also see Special rules forpadnerships an page 1.. 'Note.Grantor also must provide a Form w-9 to trustee of trust. Privacy Act Notice Section 6109 of the Internal Revenue Code requites 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.Routlne 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.possessions for use in administering their taws.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.