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HomeMy WebLinkAboutChinchor Electric Form of Agreement -2002 01 30 . , SECTION 00500. t FORM OF AGR.EEMENT THIS AGREEMENT made this 3(Jl!t' day of J.e"JU 1 ,2002 between the CITY OF WINTER SPRINGS of 1126 East State Road 4 4:J, Winter S rings, Florida 32708, Seminole County, State of Florida, herein referred to as.OWNER and Chlnchor Electric, Inc., State of Florida, herein referred to as CONTRACTOR, a person duly licensed as a Contractor in the State of Florida, as follows: 1. DESCRIPTION OF WORK. CONTRACTOR shall perform the work, in accordance with the Contract Documents for the construction of the Intersection Improvements State Road 434 and Vlstawllla Drive. 2. CONTRACT DOCUMENTS - The Contract Documents consist of this Agreement; all Technical, General and Supplementary Conditions and Sections contained in the Project Manual; the Drawings as listed on the Bid Form and Index to Drawings; all Addenda issued prior to and all Change Orders issued after execution of this Agreement. These form the Contract and are incorporated into this Contract by this reference. 3. CONTRACT TIME - The CONTRACTOR shall begin work within 1Q days after the issuance of a written Notice to Proceed and shall complete the work within 150 calendar days from the date of the Notice to Proceed. Extensions, if any, are authorized by OWNER, and may only be granted in writing. . 4. LIQUIDATED DAMAGES - OWNER and CONTRACTOR recognize that time is of the essence of this Agreement and that OWNER will suffer financial loss if the Work is not substantially complete within the time specified in Paragraph 3 above, plus any extensions thereof allowed in accordance with the General Conditions. They also recognize the delays, expense, and difficulties involved in proving in a legal or arbitration proceeding the actual loss suffered by OWNER if the Work is not substantially complete on time. Accordingly, instead of requiring any such proof, OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a penalty) CONTRACTOR shall pay OWNER $200.00 for each day that expires after the time specified in Paragraph 4 for final completion until the work is.finally complete, and that OWNER has paid to CONTRACTOR the consideration of Ten ($10.00) Dollars as consideration for this provision. 5. CONTRACT PRICE. UNIT PRICE CONTRACT - The OWNER will pay the CONTRACTOR in current funds for the performance of the work, subject to additions and deductions by Change Order, the Total Contract Price, of One hundred elaht thousand five hundred elahty one dollars and ninety six cents ($108.581.96), Payments will be made to the CONTRACTOR for actual quantities installed on the basis of the Schedule of Unit Prices included as a part of his Bid, which shall be as fully a part of the Contract as if attached or repeated herein. 6. PROGRESS PAYMENTS - OWNER shali make progress payments on account of the contract price to CONTRACTOR, on the basis of application for payments submitted to the City or their authorized representative, by CONTRACTOR as the work progresses, and in accordance with the Contract Documents. Thirty (30) days after presentation of the Application for Payment to Owner the amount recommended will (subject to the provisions of Article 14 and Article 15 of the Contract General Conditions) become due, and when due will be paid by Owner to Contractor. , : Progress payments may be withheld if: (A) Work is found defective and not remedied; (B) Contractor does not make prompt and proper payments to subcontractors; (C) Contractor does not make prompts and proper payments for labor, materials, or equipment furnished him; (D) Another Contractor is damaged by an act for which Contractor is responsible; (E) Claims or liens are filed on the job; or (F) In the opinion of the City of Winter Springs, Contractor's work is not progressing satisfactorily. 7. FINAL PAYMENT. OWNER shall withhold up to 10% of the Contract Price throughout the project. The Owner shall release '50% of the amount withheld upon issuance of the Substantial Completion Certificate. The remaining 50% of the amount withheld shall be released with the Final Payment after the issuance of the Final Completion Certificate. OWNER shall make final payment to CONTRACTOR within thirty (30) days after the work is fully and properly completed, if the .contract has been fully and timely performed, but subject to the condition that final payment shall not be due until CONTRACTOR has delivered to OWNER a complete release of liens arising out the contract, or receipt releases of lien fully covering all labor, materials and equipment for which a lien could be filed, or in the alternative a bond satisfactory to OWNER indemnifying him against such claims. By making payments OWNER does not waive claims including but not limited to those relating to: (A) Faulty work appearing after substantial completion has been granted; (B) Work that does not comply with the Contract Documents: (C) Outstanding claims of liens; or (D) Failure of Contractor to comply with any special guarantees required by the Contract Documents. CONTRACTOR, by accepting final payment, waives all claims except those, which he has previously made in writing, and which remain unsettled at the time of acceptance of payment pursuant to this contract. 8. DESIGNATION OF PROJECT DIRECTOR OR ARCHITECT OR ENGINEER: DUTIES AND AUTHORITY - The duties and authority of the City are as follows: a. General Administration of Contract. The primary function of the City is to provide the general administration of the contract. In performance of these duties George F. Edwards, P.E. or his authorized representative is the City's Project Director during the entire period of construction. The OWNER (City) may change the Project Director during the term of this contract. b. Inspections. Opinions. and Proaress Reports. The OWNER shall be kept familiar with the progress and quality of the work by CONTRACTOR and may make periodic visits to the work site. The OWNER will not be responsible for the means of construction, or for the sequences, methods, and procedures used therein, or for the CONTRACTOR's failure to perform the work in accordance with the Contract Documents. c.Access to Workslte for Inspections. The OWNER shall be given free access to the worksite at all times during work preparation and progress. The Project Director is not obligated to make exhaustive or continuous on site inspections to perform his duties of checking and reporting on work progress, and any such inspections shall not waive Owner's claim regarding defective work by Contractor. d. Interpretation of Contract Documents: Decisions on Disputes. The OWNER will be the initial interpreter of the contract document requirements, and make decisions on claims and disputes between Contractor and Owner. . e. Relectlon and StoDDaae of Work. The OWNER shall have authority to reject work which in its opinion <:loes not conform to the Contract Documents, and in this connection may stop the work or a portion thereof, when necessary. f. Payment Certificates. The'OWNER will determine the amounts owing to CONTRACTOR as the work progresses, based on CONTRACTOR's applications and OWNER's inspections and observations, and will issue certificates for progress payments and final payments in accordance with the terms of the Contract Documents. 9. RESPONSIBILITIES OF CONTRACTOR. CONTRACTOR's duties and rights in connection with the project herein are as follows: a. ResDonslblllty for SUDervlsion and Cons1tructlon. CONTRACTOR shall be solely responsible for all construction under this contract, including the techniques, sequences, procedures and means, for the coordination of all work. CONTRACTOR shall supervise and direct the work, and give it all attention necessary for such proper supervision and direction. b. DlsclDllne and EmDloyment. CONTRACTOR shall maintain at all times strict discipline among his employees, and he agrees not to employ for work on the project any person unfit or without sufficient skill to perform the job for which he was employed. . c. Furnlshlna of Labor. Materials. etc. CONTRACTOR shall provide and pay for all labor, materials and equipment, including tools, construction equipment and machinery, utilities, including water, transportation, and all other facilities and services necessary for the proper completion of work on the project in accordance with the Contract Documents. d. Payment of Taxes: Procurement of Licenses and Permits. CONTRACTOR shall sec'ure all licenses and permits necessary for proper completion of the work, paying the fees therefor. CONTRACTOR warrants that it (and subcontractors or tradesmen, if authorized in the Contract Documents) hold or will secure all trade or professional licenses required by law for CONTRACTOR to undertake the contract work. e. CO~RACTOR will provide written guarantee for work and materials for one (1) calendar year after acceptance by OWNER. 10. BOND i CONTRACTOR shall supply a materials, performance and payment bond(s) in accordance with Florida law and to the satisfaction of OWNER, in an amount specified in the Contract Documents. 11. MEDIATIONNENUE - The parties agree that should any dispute arise between them regardi~g the terms or performance of this Agreement, both parties will participate in mediation. The parties agree to equally share the cost of the mediator. Should the parties fail to resolve their differences through mediation, then any cause of action filed hereunder shall be filed in the Circuit or County Court for SE~minole County, Florida. 12. NOTICES. Any notice or approval under this CClntract shall be sent, postage prepaid, to the applicable party at the address shown on the first page of this Contract. i , I I . ., . . CTOR: N ~.....~~. if1J..rll e ~Jj J'Uck t./~~ o~ Ct~ 1Ft- ].l),,;> Address and Telephone Ofb) 77l{l--(o.l.o Date '-'J J4 ~ 0 ~ , ' OWNER: C~ER SP~INGS , . ?'J<<?'~ !'- By: R~nald W. ~ct8more " 9ity Mana,qer, '. . 1126 East' State Road 434 Winter Springs, FL. 32708 407-327-1800 f\ cJI:~' . (printName~~ ~-L..;tc.a END OF SECTION gp,vv t! V VL ~~ CERTIF! TE OF LI~BlLfTY INSU N~~xlEOOi °"ol` Z° io2 P~ooucER liuckl~rry, Sibley 4 Harvey ~ In9uraaae b HOnds , Iao . 1020 N Orlando ]1ve, 6tlite 200 THIS CER KATE I SUED MATTER FORMATION ONLY AND CONFERS NO FilOHTB UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER T'HE COVERAGE AFFORDED dY THE POLIgES BELOW. ~ Maitland FL 3271 ~ Phvre:407-647-1616 IN9URER5 AFFORDING COVERAGE D o+LSUNEan tJaitod National =assurance Ca INfiUfzER s; 9T PAT3L Chiachor >i] tr].C, Inc. ~ ~NSUR84C: CN]- INBURA>ITCJi COMQ]11TIES P . O. Sox a l ' Entsipriao 32725 INSr~ D: DtT . HADILaY INSURANCE CGi~tPANY ~ INSU~ ~; pral~rred al Ins Co V V • ~.f\,RLi W 7HF POUClS or INSURANCt uST!'D BELOW HAVfd BEEN 1$aueD rO Tr1E IN6URE0 NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrtHSTANDINC ANY ReOUII~h~ENT, TERM OR OON01710N OF ANY CONTRACT OR OTHGR pOCUAAPiNT W;TH RESPECT TO WHICH THIS C6RTIFIC-TB AMY DE 138UE0 OR NAY PERTNN, THE NSURANCi AFFOROiO 8Y T1iE POLICIES OESCRIBfiO HER6N t$ SUBJECT TO ALL Tt1E i ERMS, EXCLUSIONS AND CONDrt10NS OP dUCN POlICl68. AGGRQGATB LUARS SFIOWN MAY HAVE BEEN R60UCFD EY PAID CLAMS. LTR TYPE OFINSURANCi POLIGYNUNBER E NM UMIT9 GATN~tALLlAOLITY I EACr+D000RRENC¢ a 1000 000 A Z COMMERCIAL6ENERAIL!ABILRY L7120334 08/30JO1 06/30!02 FIREWIMAGQ(a+ ~~) s50 000 Y CLAIMS MADE ~ OCCUR IRD D~ (My aro pROnl $ ERClndad PERSONAL 6 ADV INJURY $ ], , 000 , OO 0 ~ .. ~ ~ ~ OENERALAGGREOA7E s2 000 000 GEMLAGOREWTEL[dfSAPPLIE3PC! PRO- ' PRODUCTB•CONNOPAGG 8~. 000,000 POLICY ~ LOC ( I ALIT OMOCILG LWi1L[TY H X ANY AUTO BA01003923 08/30/01 I 08/30/02 C ~A~I dm~~ INcLt uM1T ~E $1 ~ 000 , 00 0 ALL OWNED AUTOS ~ OCHFA U LED AIJTDB BODILYIWURY (Pr pu7or>) I5 I R NMIED AUTOS X NON-0WNED AUT08 CODILY INJURY (Pr aeodmg $ PROPERTYDAAMGE (Pr ooddontl $ GARAGi UA[W7Y I AUTO ONLY- fA ACGOENT s ANY ~0 ~ EA ACC ~0 CN YN $ AaG y lxC~ UPi°ILIn eACN aCeuaeeNCe $ 2 000 , 000 D OCCUR ~ c:AINeMaoe I MCU0003028 ~ 0813o/Ol 08/30/02 AOOREGATE $ 2 000 000 i S DEDUCTIBLE ~ f -~ 7C RETtNnoN s -0- s WORKKIq COAIPlN$AT10N AND I % ' Y INfTS ! ER C i GMPLOYf.Ri LIA~,ITY 2051368743 ~ I I ~ 08(30, O1 OB/30IOZ E.LEACNAC,.ioETR s 500,000 ELDi>;cA&6•EAEAK+LOY s 500,000 ~ ~ E.LDi3EA3E-POUCYUMIT 3500,000 oTN~R E Leased/&Rntad Elqui It105603 08/30/01 .08/30/02 zees®d/ R.onted P 50 000 DEBCRNRION OP OPERATIONSfLOCAT[ONBfVENICLEyp(CLUdIp(ys A001D 8Y EIIDORBEHENTISP~IAL PROYiBIONS Project: IatQrsgction 8igaalizat3.on Im~rovvmQnts, State Road 434 and Viataleilla Dr_vo, ProjQCt SITS 004-02/C3E ~:eR I IR1iA { C I'7ULQEFI N ~ ADDITIONAL R1.7UR:D; MSURlR LlYTL'R: GANCELLATION CI TYLPIS SHOULD ANY OP THt At10Vi; vA;fCKIOiD POUGICr; OG CANC8LL8D 6FFORE THE EXP81ATI01 DIITETHEi1B0F. 711E LSSUNG INSURER WILL ENDEAVOR TO AWL ~_ DAYS WRTiTCN N071CS T'O THE CERTIRCATa HOLDER NAMED TO T11E LGPT, SUT PM~YRB YO p0 80 SHALL Ci Ly Of Winter Springs IMPOSE NO O[u3AT10N OR LVUIILITY OM ANY KND UPON THE INSURER, 1T8 ACf]VTS OR 1126 East 9R 434 Hinter Springs E'L 32708 RcPRCCOIrATnr¢s ~9ea __ _ - _- _ , - - -_ _- -- - ~. ~ # _ - ~ _~~ - - _ _. y~ '= iF_ sv-ety comply` POWER OF !~~'TORNEY - - - KfU~W ALL MEN B~F~C~E PRESENTS: T1~~=QLD'R£PUBLIC SltFt~TY COMPANY, a Wisco stock insurance corporation, ,_ - -_ -= - does €nake, constitute -ar~~~~~rn~ - --- - -- - - - - _ __ - - - - - - ^l~f~~tt~.!? 8 E~~:~='t~~'~, 'J'R-~ ~, 1~~'B~ ~ I i~ U't -N I EL.~~4-3E#~ * E d~ ~..€]tt<JC?#:~C1 . ~L,- _ , - _ -- , its Prue-and lawful ~tc~n~~(-~€~ vr~h-fu}I p~r~r af~a~hau~ar and ori-bebal~ c~~epany as_saret~, t4 exe~ut~ =aptl deliver anc# affix-the sea! ~f the coran~ i~ret~=~if a ~s ~e, bant_i~vn~s,~_6i._ ~~^~ g~ ~e~ -ttb~atio~s ~t tie natt~~ #t~ee~ihan half bps, bank dap~sitor~ =€~iga a de~cT =- ~rxio_: a ~. bonEl~ itess'of mstat~ gua~ah~s~~el~surance'wvr~Ce~s compe~at~on =_ _ ~_- --_ ~~ f~ ~ _`p- ark note - - - n~ts~uaranteerng paybe~~ts as5est9s~baterrTe~wr€t~ivnds; was~~nad~~~~ bonds, hazardQ~we[e7'ta~ion tsoncJs~r=black lung-bonds); - = -- - _ - -- -= = _ - = -_ _ - - -_ -. _ - =7~1> =t-~1~~F~Ei~ -~'~~~F ~II~~ k~.lc~i ($-~-a$~~31~1 } _ - -_- _ - ~~_~~1-~ ~~C-rL,.~- __ - __ -- - _ -_ - - d~~tl"TCil~l, R~ri.~E~~ = ~.-~t~`3ER_ ~IF_-~t^~~~~~i~S, I~S~t~-~ -.THE. ,C~L~C~~3~hd - __ := - - - - - -_ ~~=c~~EQ f~€P[~BL~C BtJF#E'i~Cal=~f~tY Eby,: at~ct alb=o~~~a~t~;~ satc~A~€o~r~ie~~ir~~cursuant to theme ~ress~tS are _- C~JN~Af~#Y cxt ~_81~€u~ry €8 ~~8~. - _ ' _ sr~ _!~aY_ ActM~r-i~-#~~l- -~acF~cas~ ~ a+~t or}~el~al#-a~ tfitfe f~EVEI~ ~~~y bOrtC~=Under -- ~~=rtst~aec~fe p€er~ vt~e-~3 - ~~` `- _ (u~ -~thE~~~#-c the pr8€ic~~ at?Y ~_~ -- - =~e ~~~ efiel~~~on~f.a (trr~_=~ierf~g~ea€e~ite~3 a€_seafe~ ~t~~ - ~videriced bye Rower-f /homey ism ~;~L~C~iFli~~-~afign~v~ ~_ Matron-~~e~i=afe ~xact~orry _- ~ria~~re~d:~al'~f~ shell have il~ - = _ - =~ =- - ~' _- ~- - - ~3( rt rfa#€i -ssr -_ ~-~/~ __ -t -- shy= ac _ soh -- -` - - _- -- crt€~-~~e-ire i~di~ciua~'a~iea~so~t[~~~~#S~#IJ~tEfl~~€~~~~ eua~€~-ice ~=ae#crtQwied ~h~~x~t.~~€in o~the serve: a~ieing by. ~e dal~r=~v~r'r~ s~ve~lly pe~s~ s~ __ tE~~QI~@r~~t21'@S_~fr~, A~1tf t~lclfl~ ~2~~'8 t6 ~}1~3~~#f~ IF1'UITLt75 ~fE ~e~l ~t=~f'1e COE~1'~tt?<)rf rev s[ _- _ h ic~rs v~er~~tl~tfitst~d a~~ s~bst~ed acs tl~~_~ ir~t~r~e~t=~Yr~~it cSrpDreti~. ' = = - = - = = -- ,,, - _ -- ._: .o, X01 ARr `'s' -- - _ - _~ _ - , _ _~;~w~s?~ _ -~jf~f3~1'TFlafSS[€?(~ explieS. _ _ _:_- - - - - ___ - - - - - - _ __- - _ {~R~~4TE. = - - =- 41' ,vr tee! Qr assist=antcefary ar~€i cor~ntecs~QS ~~ct ~r`a~e~ parsuant t-o and itn the~rt ins -- - = -' ugktfixed, -ea~se~~~€esents to _ _ ~ _ __ ,.: _ - - - - - _ __ __ - - ~~ ~ _ - ,4 ~ ~~i~ ~ ~~*~*#r Sa~ety Company _ - POWER OF ATTORNEY FCNOW ALZ ME}k#$Y~E~€~E#'RESENTS: Tha# ©LD`Rf='PUBLIC SURETY COMPANY, a Wisconsir<-steek insurance carporatian, _ _ - -- -does make, ~¢>~~+ttat~~ns~s~ni: _, .- , _ _ D(3NALD B Fft~J(~~7A~, =,TR-. '~, `PRTRTCT}1` 4~~_ HTELSCHER "~,- QF LOI~GI~OD-, FL_ - _. _, _ _: _ -its true an~# lawftaJ ~tr~n~y(-~a€t; vw~#h-fu#l p~~r`and~at#~arity for and on_behal# ai=tf~e-~a~pany=as surety, t4_~ce~uE~,and rJe~Uver and~ffix-tTxe sea~r~f~he -- = - - - ~snerete~if a amts Few ba_.n~,u~ndertak~sF~zances 6~ oi~her ~r~et~8b~~a#io~s ~i tie nattte~bf ~ati~r~#han bad bs,~epgsiter~ - -, -- - - --- 4iftgage' de~cte ~r;c~-=~wr~a~e~~rarity t~az~arantees of ~siat#rnent p ark hots grrarant~r Winds; uis~€artce wer~C~~t~p~~ation ~ci~isante~ing pay~nerbene~ts asbestQs~batQmcor~iract,6ond~ w~sfe`~anageFneat bond-s, fia~ardQU~vaas~ rerr~e~iiat'trtnlfand~-0r~ack#[t~g finds), _ - _ ~~ _ _ ;- - _- -- -- - - _ -- - - == irtL~`,_~TTE~{_, I~STRt~ME-ACTS IN ~MQI.l~fi N0-T_,_rttJ ~~EG-E.~i3. ftt~f CfiR€G~~ OF =_. _4SVf<LtTQN_ FTt)E- qR~D'_ ~~1~A-= ~ ~~ 50U , Oi3C~~ - --- - ~ ~> > ~Y =ST~fOLE _ =. ~f3~.~/~TI~t, -R~DI.ESS ~7~ lfr ~9ER OF Tf~S~RUMEf~IfiS T~S~~ _~t fi~E flBLIGP-i~I~l~i --- =- - --_, _- _ ~~_~"#=_~F WI~SC~L~S_,. __-_ - OF iA/A~i}~~f#~=-_~ _- abov~i~strur~nt, an7=t y Bch aeKKrtowte~n~~:x~uit~n et-tne $erner aetng py_ me gt~ty-~v~n}s~ver~ty t~pc~se shy =_ - ., - - - _- _ ~hat_-i~ey-are e~~ffiicerf tt~ ~o~~o~~fio~e~, an~f t6e~3he ~ea1' affil to €~~=a~ee; ins€rum>s tF~ meal ~t 3he coq~tr~r~3 _- =an~=sad ~orPerf_~~±c~ tt~e~r st --_ -_~ ic~r`s v~er~~t~#t an~s_~__bb~ #a t~_ ~ir~sstrurrte~~r~io~it _ `_oirard'n~_'s#tre~~-__cc~€p_n_rati€~r. __. -_ - = - - _ =_ -- _ - - -= ¢z,d A ~ -- - -_ L~ l~aaranr ,,~~- _- _ _ - _ - _ _ ~ ~ '- _-= _ ~VotaEy-~ _ _ O _ __ - - = - - --= - - - - My cc~mmrnis~r~n expxe~ - €~t~~~ roan W-9 Request for Taxpayer Give form to the (Rev. November 1999) Identification Number and Certification requester Do NOT send to the IRS. Departmerrt or the Treawry Imernal Revenue Service y Name (If a joint account or you changed your name, see Specific Instructions on page 2.) O. T ~ Business name, if differern from above. (See Specific Instructions on page 2.) Chinchor Electric, Inc. a, Check appropriate box: ^ Individual/Sole proprietor Q Corporation ~ Partnership ~ Other - ______________________________________ Address (number, sweet, and apt. or suite no.) Requester's name and address (optional) d P.O. Box 4311 City of Winter Springs a City, state, and zIP code 1126 East S.R. 434 Enterprise, FL 32725 Winter Springs, Florida 32725 Enter your TIN in the appropriate box. For individuals, this is your 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 identification number (EIN). If you do not have a number, see How to get a TIN on page 2. Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number to enter. Certification Under penalties of perjury, I certify that: Social security rwnber OR Employer identification rxmber 5 9 3 0 4 4 7 0 3 List accourn number(s) here (optionaq For Payees Exempt From Backup Withholding (See the instructions on page 2.) 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, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. 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 on page 2.) Here I Signature - ~~. , C~.~~~ ' 9 _ _ pate - January 25, 2002 Purpose of form. A per~ip~Gvho is ~ required to file an information return with the IRS must get your correct taxpayer identification number {fIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9, if you are a U.S. person (including a resident alien), to give your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. If you are a foreign person, IRS prefers you use a Form W-8 (certificate of foreign status). After December 31, 2000, foreign persons must use an appropriate Form W-8. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. 1Nhat is backup withholding? Persons making certain payments to you must withhold and pay to the IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part III instructions on page 2 for details), or 3. The IRS tells the requester that you furnished an incorrect TIN, or 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only}, or 5. You do not certify to the requester that you are not subject to backup withholding under 3 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the Part II instructions and the separate Instructions for the Requester of Form W-9. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penaties. Cat. No. 10231X roan W-9 (Rev. 11-99) MEMORANDUM TO: Andrea Lorenzo - Luaces, City Clerk FROM: George Edwards, P.E., Capital Projects Coordinator RE: Documentation for Intersection SiQnalization Improvements State Road 434 and Vistawilla Drive City of linter Sprin4s Bid # ITB-004-02/GE DATE: February 6, 2002 Transmitted herewith are the following executed documents for your files: 1) Notice of Award 2) Agreement 3) Notice to Proceed 4) Certificate of Liability Insurance 5) Performance Bond and Labor and Materials Payment Bond GFE 7/Sro0 hlaowR WaE OxunerE