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Home My WebLink About20020618.tiff RESOLUTION RE: APPROVE AGREEMENT FOR IMPROVEMENTS FOR WCR 40.5, AUTHORIZE CHAIR TO SIGN, AND ACCEPT FORM OF COLLATERAL FOR A FIVE-LOT PLANNED UNIT DEVELOPMENT WITH ESTATE ZONE USES, S #625 - HOSKINS CONSTRUCTION, INC., C/O DAVID HOSKINS WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Department of Planning Services is processing Final Plan, S #625, for Hoskins Construction, Inc., do David Hoskins, 1511 Weld County Road 40.5, Berthoud, Colorado 80513, for a Planned Unit Development with E (Estate) zone uses, known as Dove Haven, for five (5) lots with 5.43 acres of open space on the following described real estate, to- wit: Lot B of Recorded Exemption #2954; being part of the W1/2 NE1/4 of Section 29, Township 4 North, Range 68 West of 6th P.M., Weld County, Colorado WHEREAS, pursuant to certain Conditions of Approval, the Board has been presented with an Agreement for Improvements for Weld County Road 40.5 between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, and Hoskins Construction, Inc., c/o David Hoskins, with terms and conditions being as stated in said agreement, and WHEREAS, the County Attorney staff has reviewed the form of a Standard Escrow Agreement as the desired form of collateral, and WHEREAS, after review, the Board deems it advisable to approve said agreement and accept the form of the Standard Escrow Agreement, copies of which are attached hereto and incorporated herein by reference, so long as modifications are made in the language of the Escrow Agreement to specifically include instructions that said Escrow Fund can only be released after five years or at the direction of the Chair of the Board of County Commissioners if before the five year period. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Agreement for Improvements for Weld County Road 40.5 between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, and Hoskins Construction, Inc., c/o David Hoskins, be, and hereby is, approved. BE IT FURTHER RESOLVED that the form of the Standard Escrow Agreement be, and hereby is, accepted, with modifications in the language of the Escrow Agreement to specifically include instructions that said Escrow Fund can only be released after five years or at the direction of the Chair of the Board of County Commissioners if before the five year period. 2002-0618 Pw, iV ' PL1568 IMPROVEMENTS AGREEMENT- HOSKINS CONSTRUCTION, INC., C/O DAVID HOSKINS PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 13th day of March, A.D., 2002. BOARD OF COUNTY COMMISSIONERS WEL COUN7 C ORADO ATTEST: /J ` L ��/�, � G1 Vaad, Cralr Weld County Clerk to est' f 0 c`Ox David E. Lo , ProTe BY: S-4O4 Deputy Clerk to the Q-1-6,Y eile APPROVE6AS TO � i ?Owe lligm H. Jerke Ynt-c-Attney itilejL— obert D. Masden 3 Date of signature: -�7 2002-0618 PL1568 661 AGREEMENT FOR IMPROVEMENTS FOR WCR 40.5 THIS AGREEMENT is made and entered into this /3 9i day of , .o©- by and between Hoskins Construction Incorporated, A Colorado Corporation, developer of Dove haven P.U.D., hereinafter referred to as "Developer", with an address of 1511 Weld County Road 40.5, Berthoud, 80513, Weld County Colorado, and the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, Colorado, hereinafter referred to as "County", with offices located at 915 10th Street Tenth Street, Greeley, Colorado 80631. WITNESSETH: WHEREAS, the Developer has obtained approval for a Site Specific Development Plan and Subdivision Final Plat for 5 lots for the Dove Haven P.U.D. hereinafter referred to as the "Development", and WHEREAS, WCR 40.5 from WCR 3 to WCR 5, hereinafter referred to as "the Road", will need paving, in part, due to the increased traffic generated by the Development, a distance of approximately one mile, and WHEREAS, WCR 40.5 abuts a portion of Dove Haven P.U.D., 5 of the lots will WCR 40.5 for access to the Development, and WHEREAS, the average daily trips anticipated from Dove Haven P.U.D., will constitute 20% of the traffic on the Road, and WHEREAS, the proportional costs of paving the Road attributable to the traffic generated by the lots in the Development using the Road, is estimated to be $14,000 per lot. NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto agree as follow: 1. TERM A. The term of this Agreement shall be from the date first written above to the completion of paving the Road and final accounting by County and payment of all land development charges by the Developer for the 5 lots accessing the Road, or five years if WRC 40.5 is not paved. 2. OBLIGATIONS OF THE COUNTY 11111111111111111111111111111 1111111111IIIVIII1111IIII 2002 0618 2934597 R 0.00I2D00.001W d County CO ukamoto A. Weld County plans to pave, within five years of the date first written above, • the Road at a current estimated cost of $350,000. The paving improvements are anticipated to be for 12 foot travel lanes with 4 foot shoulders designed in accordance with generally accepted engineering practices but the actual design shall be at the discretion of Weld County B. Design, construction, and maintenance of this portion of Road shall be the responsibility by the County. C. County must pave the roads within five years of the date first written above or forfeit all rights to land development charges, which are the obligation of the Developer whether already in escrow or remaining to be paid. D. Weld County shall perform a final accounting once paving is complete and may collect from the escrow account (or from the developer if the amount in the escrow is insufficient to satisfy developer's obligation ) up to 20% of the total cost of paving WCR 40.5. If additional traffic is generated prior to paving WCR 40.5, such that the percentage of traffic generated by the development is less than 20%, the County shall adjust the percentage charged to the developer proportionately. Any amount which must be collected from the developer which is not paid within 45 days of final accounting shall assessed interest in the amount of 8 % per annum. 3. OBLIGATION OF THE DEVELOPER A. Developer agrees to pay the amount of$14,000 per each lot accessing the Road. The actual amount to be determined in accordance with paragraph 2.D. B. The Developer agrees to escrow monies as follows At the sale of the first lot $5,000, at the sale of the second lot $5,000, at the sale D1the third lot $7,500, at the sale of the fourth lot$7500, at the sale of the fifth lot$45,000. The escrow account shall be set up according to paragraph 4 herein. C. The Developer shall not be released from this obligation unless County does not pave the road within the time frame set forth in paragraph 2.C. herein. In no event shall Developer's obligation under this Agreement exceed $70,000 subject to adjustment to a higher or lower figure from the first quarter of 2002 to the year and quarter in which the contemplated work is being performed based on "The State Highway Bid Price Index" contained in the "Quarterly Cost report" of The Engineering News-Record as published by The McGraw-Hill Companies. 111111 fill 1111111 III 1111111 2934597 03/19/2002 11:46A JA Suki Tsukamoto 2 of 5 R 0.00 D 0.00 Weld County CO • 4. ESCROW AGREEMENT , the terms of which will be subject to review by the County, that provides at least the following: A. The cash in escrow when fully funded is $70,000. B. The escrow agent guarantees that the escrowed funds will be disbursed according to the terms of this agreement and will not release any portion of the funds without prior written approval of the Weld County Board of County Commissioners . 5. SEVERABILITY If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable, this Agreement shall be construed and enforced without such provision to the extent that this Agreement is then capable of execution within the original intent of the parties hereto. 6. NO THIRD PARTY BENEFICIARY ENFORCEMENT. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties receiving services of benefits under this Agreement shall be an incidental beneficiary only. 7. MODIFICATION AND BREACH. This Agreement contains the entire agreement and understanding between the parties to this Agreement and supersedes any other agreements concerning the subject matter of this transaction, whether oral or written. No modification, amendment, notation, renewal, or other alteration of or to this Agreement shall be deemed valid or of any force or effect whatsoever, unless mutually agreed upon in writing by the undersigned parties. No Breach of any term, provisions, or clause of this Agreement shall be deemed waived or excused, unless such waiver or consent shall be in writing and signed by the party claimed to have waived or consented. Any consent by any party hereto, or waiver of, a breach by any other party, whether express or implied, shall not constitute a consent to waiver of, or excuse for any other different or subsequent breach. 8. NO WARRANTY. Neither County nor Developer, by virtue of their entering into this Agreement and upon their promises to perform the work described herein, make warranties, either 1111111111111111111111111111 1111111111IIIVIIIIIII IIII 2934597 3 of 5 R 0.002 002 11:46A JA � ukamoto D 0.00 IN d County CO • express or implied, that the improvement work and/or maintenance of these roads meet standards other than those generally required for counties and cities of the size and type similar to County. 9. BINDING This agreement shall be binding on the heirs, successors, and assigns of the parties. 11111 1111111 IIII 111111 III 1111111 III 111111111 till 2934597of5 R 0/0 D 0.001:46A JA Suki ukamoto Weld County CO V IN WITNESS WHEREOF the parties hereto have signed this Agreement this / 3 day of /tire , 4gr By:0, \i ,_...-/Ho ins Ccns ctior1Inc. by: David G. Hoskins, President Developer II 4\ COUNTY OF WELD, STATE OF COLORADO, by and through the Board 1861 lip of County Commissioners of Weld County OR fr By: Au i, . Wit, 'o the : •:rd GlennVaad, Cha __:T• - o Vi3`1"a-- APPROVED AS TO FAR ll: ix7y7omey 1111111111111111111 'III 111111IIIEIM MBE 1111III 2934597 03/19/2002 11:46A JA Suki Tsukamoto 5 of 5 R 0.00 D 0.00 Weld County CO ESCROW AGREEMENT Escrow Number:MT2950 Denver, Colorado Commitment Number: 2 950 Date: Closer: Amy Even The undersigned deposit with LAND TITLE GUARANTEE COMPANY as Escrow Holder, the items set forth in Schedule A, to be held by said Escrow Holder subject to the terms hereof and the Special Instructions set forth in Schedule 8 below. ®All cash deposits must be accompanied by a Form W-9 Request for Taxpayer Identification Number. "SCHEDULE A" (Deposits) "SCHEDULE B" (Special Instructions) Especial Instruction No. 1 (Repairs) Attached ['Special Instruction No. 2 (Intentionally Omitted) ['Special Instruction No. 3 (Lender Completion Instructions) Attached ['Special Instruction No. 4 (Indemnity Agreement-Cash Deposit) Attached Special Instruction No. 5 (Intentionally Omitted) Special Instruction No. 6 (Depository Instructions) Attached ['Special Instruction No. 7 (F.I.R.P.T.A.) Special Instruction No. 8 (Resolution of Miscellaneous Issues) All others (See attached Exhibit "A") The parties to the escrow, by signing below, agree that they have read and will be bound by the General Provisions to the Escrow Agreement on the following page. SELLER(S) BUYER/BORROWER(S) : (If applicable) (If applicable) Address Address Telephone# Telephone# SSN# or Tax ID# SSN# or TAx ID# Contact Person Contact Person LENDER: ESCROW FEES TO BE AS FOLLOWS: (If applicable) (a) Set up fee (b) Annual fee (c) Miscellaneous By Address Telephone# Contact Person Any correspondence regarding this escrow shall be Receipted and accepted as to Special Instructions and General addressed to: Provisions to Escrow Agreement. LAND TITLE GUARANTEE COMPANY LAND TITLE GUARANTEE COMPANY - ESCROW HOLDER 3033 E. 1ST AVENUE, SUITE 600 DENVER, COLORADO 80206 BY: ATTN: ESCROW COORDINATOR FORM EA LAND TITLE GUARANTEE COMPANY Initials • ESCROW AGREEMENT GENERAL PROVISIONS Initials 1. Form of Notice. Any instruction, notice or demand to, upon or by Escrow Holder shall be in writing and may be delivered personally, by U.S. or private mail, courier, telefax or telegram. Notice shall be deemed given on the first business date said notice is received by Escrow Holder. Telephone or other oral instruction, notice or demand need not be accepted by Escrow Holder, but Escrow Holder shall not be liable for damages or otherwise, if actions are taken based upon non-written instructions, if Escrow Holder shall have relied thereon in good faith. 2. Reliance on Notice. Escrow Holder may act in reliance upon any writing or instrument or signature which it, in good faith, believes to be genuine, and may assume the validity and accuracy of any statement or assertion contained in such a writing or instrument, and may assume that any person purporting to give any writing, notice, advice or instruction in connection with the provisions hereof has been duly authorized so to do. 3. Disbursement Time Requirements. Any notice to Escrow Holder hereunder, shall be given no later than 24 hours prior to the date and time for action by Escrow Holder. Escrow Holder agrees to act upon all notices given to it, which are fully approved by all appropriate parties and which are not conditioned upon any event other than Escrow Holder's actions, not later than 5:00 p.m. on the business day next following the date upon which such notice was received. 4. Laws of Escheat. All Parties are hereby advised that unclaimed funds may be payable to the State of Colorado at some future date pursuant to the laws of escheat, and should Escrow Holder pay any such funds held in the Escrow Deposit, Escrow Holder shall be released from all further responsibility under this Agreement and shall not be liable to any Party so long as such payment was made pursuant to the statutes of Colorado or regulations of the Colorado Department of Revenue. 5. Receipt and Deposit of Proceeds. Escrow Holder shall deposit and invest all the Escrow Deposit Funds in a federally insured institution. If the Escrow Deposit Funds exceed $100,000.00, Escrow Holder may invest the Escrow Deposit Funds in Government Repurchase Agreements for U.S. Treasury obligations. Escrow Holder shall not be responsible for maximizing the yield on the Escrow Deposit Funds. All Parties hereto shall execute and deliver to Escrow Holder all forms required by Federal, State or other governmental agencies relative to taxation matters and Escrow Holder will file appropriate 1099 or other required forms. 6. Interest Earned on Escrow Deposit Funds. If the Deposit consists partly or entirely of money, then during the period the Escrow Holder is in possession of the Deposit, the money will be deposited in an FDIC insured institution (the "Institution"). Deposits of less than 85,000.00 shalt not bear interest. Deposits of $5,000.00 to 8100,000.00 shall bear interest at the rate paid by the Institution. Deposits of 8100,000.00 or more may be directed by the Parties hereto to other types of investments. Under no circumstances shall Escrow Holder be liable for loss of funds due to bank, savings and loan association or other institution failure, including employees or agents thereof, suspension or cessation of business, or any action or inaction on the part of the bank, savings and loan association or other Institution, or any delivery service transporting funds to and from such Institution. 7. Fees and Expenses of Escrow Holder. The Escrow Holder shall be entitled to reimbursement in full, or may demand payment in advance, for all costs, expenses, charges, fees or other payments made or to be made by Escrow Holder in the performance of Escrow Holder's duties and obligations under this Agreement. The Parties to the Agreement are jointly and severally liable for the payment to Escrow Holder of Fees and Expenses. Escrow Holder is hereby authorized and directed to disburse to itself in payment of Fees or Expenses from any funds in the Escrow Deposit, whether from principal or interest or both, at any time, and from time to time, as the same may be due and owing. Further, Escrow Holder is hereby authorized to withhold any Fees or Expenses from any disbursement or distribution of Escrow Deposit Funds to any Party hereto or to the Clerk of the Court upon interpleader. In the event that the Deposit shall consist of documents only and not funds, Escrow Agent may refuse to distribute any such documents or to otherwise act under this Agreement until all accrued but unpaid Fees and Expenses have been paid in full. 8. Non-liability of Escrow Holder. Escrow Holder shall not be liable for any mistakes of fact, or errors of judgment, or for any acts or omissions of any kind unless caused by the willful misconduct or gross negligence of Escrow Holder. Escrow Holder shall not be liable for any taxes, assessments or other governmental charges which may be levied or assessed upon the Escrow Deposit or any part thereof, or upon the income therefrom. Escrow Holder may rely upon the advice of counsel and upon statements of accountants, brokers or other persons reasonably believed by it in good faith to be expert in the matters upon which they are consulted, and for any reasonable action taken or suffered in good faith based upon such advice or statements Escrow Holder shall not be liable to anyone. 9. Indemnity of Escrow Holder. The Parties hereto, jointly and severally, agree to indemnify Escrow Holder and hold it harmless as to any liability by it incurred to any other person or entity by reason of this Escrow Agreement, or in connection herewith except for Escrow Holder's own willful misconduct or gross negligence, and to reimburse Escrow Holder for all its expenses, including, but not necessarily limited to attorneys' fees and court costs incurred in connection herewith. 10. Disputes and Interpleader. In the event of any dispute between the Parties as to either law or fact, or in the event any of the Parties hereto fail, for any reason, to fully receipt and acquit the Escrow Holder in writing, Escrow Holder may refuse, in its discretion, to carry out said escrow instructions or to deliver any funds, documents, or property in its hands to anyone and in so doing shall not become liable to demand. Escrow Holder shall be entitled to continue, without liability, to refrain and refuse to act: (a) until all the rights of the adverse claimants have been finally adjudicated by a court having jurisdiction over the Parties and the items affected hereby, after which time the Escrow Holder shall be entitled to act in conformity with such adjudication; or (b) until all differences shall have been adjusted by agreement and Escrow Holder shall have been notified thereof and shall have been directed in writing signed jointly or in counterpart by the Parties and all persons making adverse claims or demands, at which time Escrow Holder shall be protected in acting in compliance therewith. Escrow Holder also has the right to interplead into a court of competent jurisdiction at the expense of the Parties. 11. Request for Written Instructions. Escrow Holder may at any time, and from time to time, request the Parties to provide written instructions concerning the propriety of a proposed payment of funds on deposit, distribution of documents, or other action or refusal to act by Escrow Holder. Should the Parties fail to provide such written instructions within a reasonable time, Escrow Holder may take such action, or refuse to act, as it may deem appropriate and shall not be liable to anyone for such action or refusal to act. Notwithstanding the foregoing, should the terms of the Escrow Agreement be complied with, in the judgment of Escrow Holder, then the Escrow Holder may disburse any funds, distribute documents, or take such action without specific further written instructions from any Party. 12. Resignation of Escrow Holder. Escrow Holder may resign under this Agreement by giving written notice to all of the Parties hereto, effective 30 days after the date of said notice. Upon the appointment by the Parties of a new escrow holder or custodian, or upon written instructions to Escrow Holder for other disposition of the Escrow Deposit, Escrow Holder shall, after retention of its accrued escrow fees and expenses, if any, deliver the Escrow Deposit within a reasonable period of time as so directed, and shall be relieved of any and all liability hereunder arising thereafter. FORM EA.GP (Revised 2/2000) Page I of 2 MT2950 13. Benefit. All rights and protections afforded to Land Title Guarantee Company hereunder shalt inure to and for the benefit of its underwriter. 14. Applicable Law. This Agreement shall be governed by the Laws of the State of Colorado. 15. Counterparts/Facsimile. This Agreement may be executed in any number of counterparts, each of which when so executed shall constitute the entire agreement between the parties hereto and may be executed in facsimile and such fac- simile signature shall be accepted as original signatures. The parties acknowledge and agree that there are no intended or unintended third party beneficiaries who may rely upon or benefit from the provisions of this agreement. • Form EA.GP (Revised 2/2000) Page 2 of 2 MT2950 • Form W-9 (Rev. December 1996) Request for Taxpayer Give form to the Department of the Treasury Identification Number and Certification requester. Do NOT Internal Revenue Service send to the IRS. Name(if a joint account or you changed your name, see Specific Instructions on page 2.) Business name, if different from above. (See Specific Instructionson page 2.) Check appropriate box: 1O Individual/Sole proprietor O Corporation O Partnership [] Other > Address(number, street,and apt.or suite no.) Requester's name and address(optional) City,state,and ZIP code ............................... I'aS I; Taxpayer Identification Number (TIN) List account number(s)here(optional) Enter your TIN in the appropriate box. For individuals,this is your social security number social Security number (SSN).However, if you are a resident alien OR a sole proprietor, see the instructions on page 2. For other entities, it is your employer OR identification number(EIN). If you do not have a f art t { For Payees Exempt From Backup number, see How To Get a TIN on page 2.) Employer Identification number Withholding (See the instructions Note: If the account is in more than one name, on page 2.) see the chart on page 2 for guidelines on whose number to enter. 'a;ielh1 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. I am not subject to backup withholding because: (a)I am exempt from backup withholding, (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. 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 or secured property,cancellation of debt,contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN: (See the instructions on page 2.) Sign Here Signature > Date > • Purpose of Form.--A person who is include interest,dividends, broker and 5. You do not certify your TIN when required to file an information return with barter exchange transactions,rents, required. See the Part Ill instructions on the IRS must get your correct taxpayer royalties, nonemployee pay,and certain page 2 for details. identification number(TIN)to report, for payments from fishing boat operators. Real Certain payees and payments are example, income paid to you,real estate estate transactions are not subject to exempt from backup withholding. See the transactions, mortgage interest you paid, backup withholding. Part 11 instructions and the separate acquisition or abandonment of secured If you give the requester your correct Instructions for the Requester of Form property, cancellation of debt,or TIN, make the proper certifications, and W-9. contributions you made to an IRA. report all your taxable interest and Use Form W-9 to give your correct TIN dividends on your tax return,payments Penalties to the person requesting it(the requester) you receive will not be subject to backup and, when applicable,to: withholding. Payments youreceive will be Failure To Furnish TIN.--If you fail to I. Certify the TIN you are giving is subject to backup withholding if: furnish your correct TIN to a requester,you correct(or you are waiting for a number to 1. You do not furnish your TIN to the are subject to a penalty of$50 for each be issued). requester,or such failure unless your failure is due to • reasonable cause and not to willful neglect. 2. Certify you are not subject to backup 2. The IRS tells the requester that you withholding,or furnished an incorrect TIN, or Civil Penalty for False Information With Respect to Withholding.-- If you make a 3. Claim exemption from backup 3. The IRS tells you that you are subject false statement with no reasonable basis withholding if you are an exempt payee. to backup withholding because you did not that results in no backup withholding, you Note: If a requester gives you a form other report all your interest and dividends on are subject to a$500 penalty. than a W-9 to request your TIN,you must use your tax return(for reportable interest and the requester's form if it is substantially dividends only), or Criminal Penalty for Falsifying Information.--Willfully falsifying similar to this Form W-9. 4. You do not certify to the requester certifications or affirmations may subject What Is Backup Withholding?--Persons that you are not subject to backup making certain payments toyou must withholding under 3 above(for reportable you to criminal penalties including fines P Y and/or imprisonment. withhold and pay to the IRS 31%of such interest and dividend accounts opened payments under certain conditions.This is after 1983 only),or Misuse of TINS.-- If the requester discloses or uses TINS in violation of called "backup withholding." Payments Federal law,the requester may be subject that may be subject to backup withholding to civil and criminal penalties. Form W9-1996-1 Address where 1099 interest statement is to be forwarded: M12950 Form W-9-1996 Page 2 Specific Instructions If you are exempt from backup withholding, You must provide your TIN whether or not you p you should still complete this form to avoid are required to file a tax return. Players must Name.--If you are an individual,you must possible erroneous backup withholding. Enter generally withhold 31% of taxable interest, generally enter the name shown on your social your correct TIN in Part I, write "Exempt" in dividend, and certain other payments to a payee security card. However, if you have changed your Part II,and sign and date the form. who does not give a TIN to a payer. Certain last name, for instance,due to marriage, without If you are a nonresident alien or a foreign penalties may also apply. informing the Social Security Administration of the entity not subject to backup withholding, give name change,enter your first name, the last name the requester a completed Form W-8, What Name and Number To shown on your social security card, and your new Certificate of Foreign Status. Give the Requester last name. If the account is in joint names, list first and then Part BI--Certification For this type of account: Give name and SSN o@ circle the name of the person or entity whose For a joint account,only the person whose number you enter in Part 1 of the form. TIN is shown in Part I should sign(when 1. Individual The individual Sole Proprietor.--You must enter your required). 2.Two or more The actual owner of the individual name as shown on your social security 1. Interest,Dividend,and Barter individuals(joint account or, if combined card. You may enteryour business, trade, or Exchange Accounts Opened Before 1984 account) funds,account thc first individual g Pe on the "doing business as" name on the business name and Broker Accounts Considered Active 3. Custodian account of The minor' line. During 1983. You must give your correct a minor(Uniform Gift Other Entities,--Enter the business name as TIN,but you do not have to sign the to Minors Act) shown on required Federal tax documents. certification 1 9 4.a.The usual The grantor-trustee This name should match the name shown on the 2. Interest,Dividend,Broker,and revocable savings charter or other legal document creating the Barter Exchange Accounts Opened After trust(grantor is entity. You may enter any business,trade,or 1983 and Broker Accounts Considered also trustee) "doing business as" name on the business name Inactive During 1983. You must sign the b. So-called trust The actual owner 1 line. certification or backup withholding will account that is not a legal or valid trust apply. If you are subject to backup under state law Part I--Taxpayer Identification Number(TIN) withholding and you are merely providing N your correct TIN to the requester,you must 5. Sole proprietorship The owner' You must enter your TIN in the appropriate box. cross out item 2 in the certification before For this type of account: Give name and SSN of: If you are a resident alien and you do not have signing the form. 6. Sole proprietorship The owner' and are not eligible to get an SSN,your TIN is 3. Real Estate Transactions. You must your IRS individual taxpayer identification sign the certification. You may cross out 7. A valid trust, estate,or Legal entity number(ITIN). Enter it in the social security item 2 of the certification. pension trust number box. If you do not have an ITIN, see 8.Corporate The corporation How To Get a TIN below. 4. Other Payments. You must give your If you are a sole proprietor andyou have an correct TIN,but you do not have to sign 9. Association,club, The organization P P the certification unless you have been religious,charitable, EIN,you may enter either your SSN or EIN. notified that you have previously given an educational,or other However,using your EIN may result in incorrect TIN. "Other payments" include tax-exempt unnecessary notices to the requester. organization payments made in the course of the Note: See the chart on this page for further requester's trade or business for rents, 10. Partnership The partnership clarification of name and TIN combinations. royalties, goods(other than bills for 11. A broker or registered The broker or nominee How To Get a TIN.--If you do not have a TIN, merchandise), medical and health care nominee fservices(including payments to apply t or one immediately.your apply for c SSN, 12. rt with the The public entity get Form SS-5 from your local Social Security corporations),payments to a nonemployee Department of Administration office. Get Form W-7 to apply for services(including attorney and Agriculture in the name for an ITIN or Form SS-4 to apply for an EIN. accounting fees), and payments to certain of a public entity(such You can get Forms W-7 and SS-4 from the IRS fishing boat crew members. as a state or local by calling 1-800-TAX-FORM 5. Mortgage Interest Paid by You, government,or prison)school (1-800.829-3676 . Acquisition or Abandonment of Secured district,ee that q receives agricultural If you do not have a TIN, write "Applied For" Property,Cancellation of Debt,or IRA program payments in the space for the TIN,sign and date the form, Contributions. You must give your correct 1 TIN,but you do not have to sign the List first and circle the name of the person whose and give it to the requester. For interest and g number you furnish. If only one person on a joint dividend and certain payments made certification. payments, fucouht dos an SSN,that person's number must be instruments, with respect to readily tradable nstruments, you famished. will generally have 60 days toget a TIN and Privacy Act Notice Y Circle the minor's name and furnish the minor's give it to the requester. Other payments are Section 6109 of the Internal Revenue Code SSN. subject to backup withholding. requires you to give your correct TIN to a you must show your individual name,but you may persons who must file information returns also enter your business or"doing business as" Note: Writing "Applied For'means that with the IRS to report interest,dividends, you have already applied for a TIN OR that P name. You may use either your SSN or EIN you intend to apply for one soon. and certain other income paid to you, (if you have one.) mortgage interest you paid,the acquisition ' List first and circle the name of the legal trust, or abandonment of secured property, Part 11—For Payees Exempt From Backup estate,or pension trust. (Do not furnish the TIN of Withholding cancellation of debt,or contributions you the personal representative or trustee unless the legal made to an IRA.The IRS uses the numbers entity itself is not designated in the account title.) Individuals(including sole proprietors)are not for identification purposes and to help exempt from backup withholding. Corporations verify the accuracy of your tax return. are exempt from backup withholding for certain The IRS may also provide this information payments,such as interest and dividends. to the Department of Justice for civil and For more information on exempt payees, see criminal litigation and to cities,states, and Note: If no name is circled when more than one the separate instrucitons for the Requester of the District of Columbia to carry out their name is listed, the number will be considered to Form W-9. tax laws. be that of the first name listed. Form W9-1996.2 Closer ID : aeven Conmitment: 2950 Escrow No : MT2950 LTGC Form : L19-1996.2 (09/2001) Hello