City of Everett
Supplier Registration Form
For Everett Use Only
Vendor No:_________________
City of Everett
Purchasing Division
3200 Cedar Street
Everett, WA 98201
Fax: 425-257-88864
Subject: SUPPLIER REGISTRATION
We request to be added to your Supplier Database in accordance with your governing guidelines.
Firm Name:
Contact:
Address:
City: State: Zip:
“Remit To” Address (if different):
Telephone: Day Night Fax
City of Everett Business License No., if
applicable:
Certified Minority-owned Business: Yes No #
Certified Woman-owned Business: Yes No #
Other disadvantaged qualifications, explain:
Do you offer an early payment discount? No Yes
State terms:
Please write commodity numbers and names that you would like an opportunity to sell to the City of
Everett. (NOTE: Commodities 092001 - 092199 require a Small Works Application instead of this
supplier registration form):
Commodity Number Commodity Name
Visit our web site at www.everettwa.org
Are you able to receive MS Word or Excel files via email?
Yes No
Email Address:
_______________________________________________
Website Address:
_______________________________________________
1
City of Everett Commodity Listing
001300 *ACCOUST TILE/INSULATING MATL
001353 FIBERGLASS/BATTS,BLANKETS,ROLL
001500 *ADDRESS,COPY MACH SUPP/CHEM
001503 BLUEPRINT PAPER & SUPPLIES
001515 CHEM/SUPP FOR BOND PAPER COPIE
002000 *AGRICULTURAL IMPLEMENTS
002002 BACKHOE (FOR FARM TRACTOR)
002004 BRUSH AND TREE CHIPPERS
002017 CUTTERS (LARGE MOWERS) PARTS
002030 GANG MOWERS, REEL TYPE, TOWED
002032 GARDEN TRACTORS, PLOWS,CULTIVA
002040 IMPLEMENT PARTS
002060 TOP DRESSERS/SPREADERS
002065 UTILITY CARTS
002500 *AIR COMPRESSORS & ACESSORIES
003100 *AIR COND/HEATING PARTS
003133 DUCT, METAL
003145 FILTERS
003157 HEATERS, FANS, PORTABLE
003500 *ANIMAL SVC MISC SUPPLIES
004500 *APPLIANCES AND EQUIPMENT
004524 DISHWASHERS
004552 OVENS/MICROWAVE
004554 RANGES, STOVE TOPS, OVENS
004566 REFRIGERATORS & FREEZERS
004594 WASHERS & DRYERS
005000 *ART/CRAFT EQUIP & SUPPLIES
005030 CRAFT SUPPLIES
005040 DRAWING & PAINTING SUPPLIES
005060 PICTURE FRAMES/FRAMING SUPPL
005200 *ART OBJECTS
005264 PHOTOGRAPHS
005272 POSTERS & PRINTS (NOT ORIGINL)
005500 *AUTO & TRUCK ACCESSORIES
005504 AIR COND/HEAT PTS,EQUIP,REPAIR
005506 AUTOMOTIVE LIGHTS & REFLECTORS
005508 BELTS, SAFETY & CHILD RESTRAIN
005515 BUS SIGN CURTAINS
005521 COUPLINGS & HITCHES
005526 EMERG VEHICL LIGHTS/LIGHT BARS
005538 HEATERS
005545 MIRRORS, REARVIEW
005553 SEATS, AUTOMOTIVE
005555 SIRENS & BACK UP ALARMS
005559 SWITCHES & FLASHERS, AUTOMOTIV
005590 WHEELCHAIR LIFTS,ACCESS&REPAIR
006000 *AUTO & TRUCK MAINT ITEMS
006003 ANTIFREEZE
006004 ANTIFREEZE, RECYCLED
006012 BATTERIES, AUTOMOTIVE
006015 BRAKE SYSTEMS & PARTS
006016 COOLING SYSTEM PARTS
006017 DRIVE TRAIN PARTS
006018 ELECT SYS PARTS:GEN/ALT/IGNITN
006019 ELECT WIRING PARTS & ACCESS
006038 ENGINES, AUTOMOTIVE
006041 EXHAUST SYSTEM
006042 FILTERS/AIR, FUEL, OIL
006045 FLUID, BRAKE & HYDRAULIC
006047 FUEL SYSTEMS/CARBS,PUMPS,ETC
006060 HOSE, AUTOMOTIVE
006070 SUSPENSION & STEERING PARTS
006094 VEHICLE BODY REPAIR
006096 WHEELS & RIMS & ALIGNMENTS
006500 *AUTO BODIES & SPECIAL PARTS
006510 BODIES,UTILITY, MAINT & REPAIR
006530 DUMP BODIES & MAINT & REPAIR
006535 POLICE CAR ACCESSORIES
006575 REFUSE/GARBAGE COLLECTION BODY
006585 TOOL COMPARTMENT BOXES/TRUCKS
006594 WINCHES & CRANES & MAINTENANCE
007000 *AUTOMOTIVE MAJOR TRANS EQUIP
007003 AMBULANCE AND RESCUE VEHICLES
007005 AUTOMOBILES
007012 BUSES, NEW AND USED
007020 LIFT TRUCKS, ALL TYPES
007036 MOTORCYCLES AND SCOOTERS
007040 POLICE VEHICLES
007042 SHORT WHEELBASE, 2 & 4WD
007045 TRUCK TRACTORS
007046 TRUCKS, CAB & CHASSIS ONLY
007047 TRUCKS, DUMP & FLAT BED
007048 TRUCKS, FIRE PROTECTION
007050 TRUCKS, ONE TON & LESS
007051 TRUCKS, OVER ONE TON
007053 TRUCKS WITH SPECIALIZED BODIES
007055 TRUCKS, SEWER PUMP
007061 TRAILERS, ALL EXCEPT MARINE
007063 UTILITY VEHICLE
007064 VANS, OTHER THAN POLICE
007500 *AUTOMOTIVE SHOP EQUIP/SUPPL
008000 *BADGES/OTHER ID EQUIP/SUPPL
008015 BADGES/EMBLMS,METAL,POLIC/FIRE
008018 BADGES & EMBLEMS, SVC AWARDS
008500 *BAGS/SAND OR BURLAP
010000 *BARRELS,DRUMS,KEGS,CONTAINRS
010500 *BEARINGS (EXCEPT AUTOMOTIVE)
011000 *BELTS/CONVEYOR,ELEV,NONAUTO
012000 *BOATS, MOTORS & MARINE SUPPL
012048 LIFE PRESERVERS
012083 SCUBA AND SKIN DIVING EQUIP
012090 TRAILERS, BOAT
2
012500 *BINDING SUPPLIES
015000 *BUILDERS SUPPLIES
015012 DOOR ASSYS & HARDWARE & REPAIR
015035 MOLDING & TRIM
015080 WINDOW ASSYS/HARDWARE & REPAIR
015500 *BUILDINGS, FABRICATED
015530 BUS SHELTERS
015542 GREENHOUSES & EQUIPMENT
016500 *CAFE/KITCHEN EQUIPMENT
016510 APPLIANCES, SMALL, AND REPAIR
016512 APPLIANCES, LARGE, AND REPAIR
016520 COOKWARE, UTENSILS & SERV SUPP
016552 ICE EQUIPMENT/REPAIR & MAINT
016560 NONCOOKWARE/DISHES,UTENSILS
017500 *CHEMICAL LAB EQUIP & SUPPLIE
017513 CHEMICALS, LABORATORY
017532 FILTER PAPER & MEMBRANES
017533 FILTERING APPARATUS & FILTERS
017542 GLASSWARE, LABORATORY
017565 PH BUFFER SOLUTIONS,INDICATORS
017568 PLASTIC WARE
017580 STAINLESS STEEL WARE
017584 STOPPERS, RUBBER & SYNTHETIC
017589 TUBING, PLASTIC
017590 TUBING, RUBBER
019000 *CHEMICALS,COMMERCIAL, BULK
019018 ACIDS
019081 SOLVENTS, NON-JANITORIAL
019200 *CLEANING COMPOSITIONS/SOLVNT
019300 *CLINCIAL LAB REAGENTS/TESTS
019500 *CLOCKS, TIMERS, WATCHES
020000 *CLOTHING, UNIFORM, APPAREL
020012 CAPS & HATS, ALL TYPES
020018 COATS, JACKETS, VESTS
020021 EMBLEMS AND SHOULDER PATCHES
020022 FIREFIGHTERS BOOTS
020024 FIREFIGHTER, BUNKER GEAR
020043 POLICE/MOTORCYCLE APPAREL
020045 RAINWEAR, COATS, HATS, SUITS
020057 SHIRTS & PANTS, UNIFORM
020058 SHOES AND SHOE REPAIR
020063 SWEATERS, MENS & WOMENS
020500 *COMPUTERS, EQUIPMENT & SOFTW
020501 IBM PC CLONES
020502 COMPAQ PC
020503 PORTABLE PCS (LAPTOPS, HANDHEL
020504 SERVERS
020505 MINICOMPUTERS (RS6000)
020506 MONITORS
020507 PC PERIPHERALS (EXTERNAL)
020508 PC COMPONENTS (INTERNAL)
020509 NETWORK COMPONENTS
020510 CABLES AND CONNECTORS
020511 COMPUTER PRINTERS
020544 COMPUTER MEDIA (DISKS/CARTRIDG
020572 GRAPHIC PLOTTERS
020580 MICROSOFT SELECT SOFTWARE
020585 DATA PROCESSING SERVICES/CUSTO
020590 BOXED SOFTWARE (NOT MICROSOFT)
021000 *CONCRETE/CORRUG METAL PRODUC
021005 CEMENT
021010 CONCRETE
021016 CORRUG METAL CULVERTS/PIPE/FIT
021045 CONCRETE PULL BOXES
021080 TIES,ANCHORS/MASONRY WALL REIN
021500 *CONSTRUCTION MATLS & SUPPLIE
022000 *CONTROL,INDICAT,RECRD INSTRU
022015 FLOW CONTROLLERS FOR LIQUIDS
022033 LIQUID LEVEL CONTROLLERS/INDIC
022045 PRESSURE CONTROLLERS/IND/REC
022054 RECORDERS/PLOTTERS, GEN & LAB
022500 *COOLERS, DRINKING WATER
026500 *DRAPES,CURTAINS,SHADES,BLIND
028000 *ELECTRICAL CABLE AND WIRES
028070 TELEPHONE CABLE & WIRES
028500 *ELECT EQUIP AND SUPPLIES
028506 BALLASTS, ALL KINDS
028514 CIRCUIT BKRS, PANELBOARDS
028519 CONDUIT, FITTINGS & HARDWARE
028527 CONTROL DEVICES, LIGHTING
028530 EXIT SIGNS, LIGHTED
028532 ELECTRICAL SWITCHES
028534 FUSES, FUSE BLOCKS, LINKS, ETC
028537 GENERATORS, PORTABLE & STATION
028546 LAMPS, FLUORESCENT, ALL TYPES
028548 LAMPS, INCANDESCENT, ALL TYPES
028550 LAMPS, STREETLIGHT, ALL TYPES
028553 LENS, REPLACEMENT (FLUOR FIXT)
028555 LIGHT FIXTURES, INSIDE, ALL
028576 STREETLIGHTS & STANDARDS
028593 WIRE MOLDING,RACEWAYS,ACCESSOR
028595 WIRING DEVICES/ADAPT,CAPS,CONN
028700 *ELECTRONIC COMPONENTS
028724 CIRCUIT BRDS/MODULAR,PCB,PROTO
028750 DRIVE, ADJUSTABLE FREQUENCY
028760 REPAIR EQUIP, ELECTRONIC
028766 REPLACEMENT & COMPONENT PARTS
028772 SHELF HARDWARE, ELECTRONIC
028796 WIRE/CABLE,AUDIO,COAX/LEAD-IN
029500 *ELEVATORS, BUILDING TYPE
030500 *ENGINEERING EQUIPMENT
030528 DRAFTING & DRAWING INSTRUMENTS
030533 DRAFTING SUPPLIES
030535 DRAWNG BRDS,SQUAR,PROTRACT,ETC
3
030538 DUPLICATOR PAPER,BL/BR/WH PRNT
030555 LETTERING EQUIPMENT
030560 MEASURING EQUIP, FIELD
030578 SURVEYING INSTRUMENTS
031500 *ENVIRONMENTAL SUPPLIES
031501 ABSORBENT PADS FOR OIL SPILLS
031511 RICE HULL ASH
032000 *FASTENERS,STRAPPING/TYING EQ
032020 BOLTS, NUTS & WASHERS
032055 POWER ACTIVATED (EXPLOS) TOOLS
032060 ROPE
032070 SCREWS
032500 *FEED/BEDDING/ANIMAL SUPPLIES
033000 *FENCING MATERIALS
033013 CHAIN LINK FENCING & FITTINGS
033025 FENCE RENTALS
033095 WOOD FENCING & GATES
033500 *FERTILIZER/SOIL CONDITIONERS
034000 *FIRE PROTECTION EQUIP/SUPPL
034028 FIRE EXTINGUISHERS/RECHARGERS
034029 FIRE EXT SERVICE & REFILL
034056 HOSE, FIRE
034064 NOZZLES, FIRE HOSE
034080 SMOKE DETECTING EQUIPMENT
034500 *FIRST AID, SAFETY/TESTING EQ
034508 CLOTHING & BELTS: SAFETY
034518 EMERG SHOWERS & WASH STATIONS
034532 FIRST AID CABINETS,KITS,REFILL
034548 GLOVES & LINERS: ALL TYPES
034556 HATS & HELMETS, SAFETY
034564 HEAD,EAR,EYE,FACE PROTECTION
034580 RESPIRATORY PROTECTION EQUIP
034587 SAFETY FOOTWARE
034592 VESTS, SAFETY
035000 *FLAGS, FLAG POLES, BANNERS
036000 *FLOOR COVERING, INST & SUPPL
036015 CARPETS, RUGS, NOT INSTALLED
036022 INSTALLATION SUPPLIES
036075 TILE, ALL TYPES
036500 *FLOOR MAINT MACHINES,PARTS
037000 *FOODS
040000 *FOUNDRY CASTINGS,MACH SHOPWK
040500 *FUEL/OIL/GREASE/LUBRICANTS
040503 BUTANE AND PROPANE
040509 FUEL OIL, DIESEL
040512 FUEL OIL, HEATING
040515 GASOLINE, AUTOMOTIVE
040524 GREASE, LUBRICATION TYPE
040537 OIL, ALL TYPES: RECYCLED
040539 OIL, AUTOMOTIVE & 2 CYCLE
040551 OIL, HYDRAULIC
041500 *FURNITURE, LAB - SPECIALIZED
042000 *FURNITURE, NON-OFFICE
042024 FOLDING CHAIRS/TABLES, TRUCKS
042060 LOUNGE FURNITURE
042068 MATTRESSES & BEDSPRINGS
042094 WORKBENCHES & ACCESSORIES
042500 *FURNITURE, OFFICE
042503 BOOKCASES & BOOKSHELVES
042506 CHAIRS, ERGONOMIC
042507 CHAIRS, MANAGERIAL
042508 CHAIRS, STENO
042509 CHAIRS, SIDE
042510 COMPUTER FURNITURE, ALL TYPES
042513 CREDENZE, ALL TYPES
042520 DESKS & TABLES
042530 DRAFTING CHAIRS & STOOLS
042533 DRAFTING PLAN & MAP FILES, ALL
042537 DRAFTING TABLES
042539 FILING CABINETS, ALL TYPES
042553 LOCKERS, STORAGE, METAL
042554 MODULAR PANEL SYSTEMS
042556 PARTITIONS, FREE STANDING
042574 SAFES, VAULTS, AND SAFE FILES
042580 SHELVING
042583 STANDS, OFFICE EQUIP & MACHINE
042589 STORAGE CABINETS
043000 *GASES, HOSP/LAB/WELD & EQUIP
043027 GAS CYLINDERS, EMPTY
043042 LABORATORY GASES
043092 WELDING GASES
044000 *GLASS/GLAZING SUPPLIES
044016 GLASS, AUTOMOTIVE
044500 *HAND TOOLS (NOT CLASSIFIED)
044561 SCOOPS, SHOVELS, SPADES, FORKS
044579 TOOL BOXES (EXCEPT TRUCK)
045000 *HARDWARE, SHELF HARDWARE
045006 BATTERIES, DRY CELL
045015 CAMPING & OUTDOOR EQUIP
045028 EXHAUST FANS & PARTS
045032 FLASHLIGHTS,LANTERNS (BATT OP)
045033 FLASHLIGHTS, RECHARGEABLE
045048 LADDERS
045055 LOCKS,KEY BLANKS,LOCKSMTH TOOL
045077 TARPAULINS, COMMERCIAL WEIGHT
046000 *HOSE (NOT AUTO OR FIRE)
046010 AIR HOSE & FITTINGS
046030 GARDEN HOSE & ACCESSORIES
046045 HYDRAULIC HOSE AND FITTINGS
047500 *HOSPITAL SUNDRIES/EQUIP
047534 ELECTROCARDIAL EQUIP/SUPPLIES
047536 EYEWASH SYSTEMS
048500 *JANITORIAL SUPPLIES/GENERAL
048502 ANIMAL CAGE CLEANING COMPOUND
4
048510 BROOMS & BRUSHES
048516 CLEANER,HARD SURFACE, GEN PURP
048526 CLEANER, TOILET BOWL
048530 DEODERANT BLOCKS
048540 DISINFECTANTS
048544 DISPENSERS, SOAP
048546 DISPENSERS: TOWEL,TOILET SEAT
048550 DOOR MATS, ALL TYPES
048554 FLOOR POLISHES & WAXES
048558 FURNITURE POLISH
048570 MOPS & HANDLES
048578 RUG SHAMPOO
048585 SHOP TOWELS, WIPES, RAGS
048586 SOAP/HAND,BAR,LIQUID,POWDERED
048588 SQUEEGEES,SPONGES,SCRUB PADS
048592 TRASH RECEPTACLES & LINERS
049300 *LABORATORY EQUIPMENT(MAJOR)
051500 *LAWN EQUIPMENT
051505 AERATORS
051507 BLOWERS, LAWN, POWER
051510 EDGERS & TRIMMERS
051515 ENGINES,MOTORS,PARTS(LAWN EQU)
051520 FERTILIZER DISTRIBUTORS, LAWN
051530 LAWN MOWERS, ALL TYPES
051575 SPREADERS, FERTILIZER & SEED
051585 LITTER PICKUP DEVICES, VACUUMS
052000 *AGREEMENTS
054000 *LUMBER,PLYWOODS/PRESSBOARDS
054014 LUMBER, BOARD
054073 POSTS, ALL OTHER
054081 SHEETROCK & ACCESSORIES
054500 *MACHINERY & HEAVY HARDWARE
054509 CHAIN SAWS
054550 NOZZLES, HI VELOCITY(NOT FIRE)
054551 PRESSURE WASHERS/EQUIP
055000 *MARKERS,SIGNS,TRAFF CONT ITM
055020 FLARES & FUSES
055024 LETTERS & NUMERALS, METAL/PLAS
055028 MARKERS, PLAQUES, TABLETS
055030 MARKERS, TRAFFIC, ALL TYPES
055042 SAFETY BARRIERS, TRAFFIC
055054 SIGN POSTS STANDARDS & SUPPORT
055062 SIGNS, METAL (NOT BLANKS)
055066 SIGNS, PLASTIC
055078 TRAFF CONES/TRAFF LANE MARKERS
055082 TRAFF COUNTERS & ACCESSORIES
055085 TRAFF SIGNAL POLES/BRACKETS
055096 WARNING LIGHTS/FLASHERS/ARROWS
055500 *MAPS
057000 *METALS:BARS,PLATE,SHEET,POST
057028 GUARD RAILS & ACCESSORIES
057054 SHEET METAL, FABRICATED
057058 SIGN BLANKS & POSTS
057500 *MICROFICHE/MICROFILM EQ/SUPP
057800 *MISC (NOT ITEMIZED ELSEWHERE
057842 EMPLOYEE RECOGNITION AWARDS
059500 *NURSERY STOCK, EQUIP/SUPPL
059540 NURSERY,GREENHOUSE,FLORAL SUPP
059560 PLANT SPRAYERS,PROPAGATN MATS
059562 PLANTER BOXES-ALL TYPES
059563 LANDSCAPE ACCESSORIES
059565 SHRUBBERY
059567 ROCK
059570 TREES, ALL TYPES
059595 WOOD CHIPS & BARK
060000 *OFFICE MACHINES, EQUIPMENT
060015 ADDING MACHINES, CALCULATORS
060030 CASH REGISTERS, CASH DRAWERS
060038 COPIERS, COPYING MACHINES
060052 DICTATING/TRANSCRIBING MACHINE
060054 FAX MACHINES
060066 LABEL DISPENSING MACHINES/ACC
060071 MAILING MACHINES
060084 TONER
060085 TONER, RECYCLED
060086 TYPEWRITERS, ALL TYPES
061500 *OFFICE SUPPLIES
061552 OFFICE SUPP/BOISE CASCADE
061577 RUBBER STAMPS, STAMP PADS, INK
061585 POSTAGE STAMPS
062500 *OPTICAL EQUIPMENT
063000 *PAINT,WALLPAPER,PAINT EQUIP
063001 BEADS: GLASS, REFLECTIVE
063006 CAULKING COMPOUNDS
063051 PAINTS & PAINT SUPPLIES
063066 PAINTS, TRAFFIC
063085 SPRAYERS & SPRAY SYSTEMS
063093 WALL COVERINGS, WALL PAPER
064000 *PAPER/PLASTIC PROD:DISPOSABL
064015 BAGS, PAPER
064025 CORRUGATED BOXES & SHEETS
064026 ENVELOPES
064050 PAPER CUPS,NAPKINS,PLATES,TISS
064060 PLASTIC CUPS,FORKS,DISHES,WRAP
064075 TOILET TISSUE,SEAT COV/PAP TOW
064085 WIPERS, SHOP USE
064500 *PAPER, OFFICE & PRINT SHOP
064526 PAPER, CONINUOUS FORM
064536 PAPER: ANY GRADE,TYPE,SIZE,WT
064540 PAPER, FAX MACHINE
064550 PAPER PRODUCTS, RECYCLED
064565 PAPER, TELECOPIER
065000 *PARK,PLAYGROUND/SWIM EQUIP
065006 BENCHES, PARK
5
065010 BICYCLE RACKS
065036 PICNIC TABLES
065038 PLAYGROUND EQUIPMENT
065500 *PHOTOGRAPHIC EQUIP/SUPPLIES
065515 CAMERA ACCESSORIES
065535 CAMERAS, STILL
065550 COPYING EQUIP,SLIDE DUPL,ETC
065555 DARKROOM EQUIPMENT
065573 PHOTO IDENTIFICATION SYSTEMS
065575 PHOTOG CHEMICALS,FILM,PAPER
065588 STORAGE MATLS,FILES,SLEEVES
066500 *PLASTICS(NOT DISHES)LAMIN EQ
066524 BAGS & LINERS, PLASTIC
066542 LAMINATING PRESSES, SUPPLIES
066548 LIBRARY CARDS
066554 NAMEPLATES (ENGRAVED), EASELS
067000 *PLUMBING EQUIPMENT,FIXTURES
067017 IRRIGATION SYSTEMS,PARTS,SUPPL
067022 PIPE & FITTINGS, METAL
067023 PIPES & FITTINGS, PLASTIC
067055 PLUMB FIXT:SINKS,TUBS,FAUC,ETC
067061 SEWER PIPE CLEANING MACHINES
067070 VALVES, PARTS & ACCESSORIES
067075 WATER CONSERVATION DEVICES
067089 WATER HEATERS
067500 *POISONS, AGRICULT & INDUST
067540 INSECTICIDES & FUNGICIDES
067565 SEED/SOIL FUMINGANTS/STERILANT
067585 WEED KILLERS (HERBICIDES)
068000 *POLICE & SECURITY EQUIP/SUPP
068004 AMMUNITION
068016 BELTS,CASES,HOLSTERS,SCABBARDS
068018 BICYCLES,PARTS,SUPP,ACCESSORIE
068022 BALLISTIC PROTECTION EQUIP/SUP
068024 BREATH ALCOHOL TESTING EQUIP
068035 CANINE MISC SUPPLIES
068036 CANINE VETERINARY CARE/MEDICIN
068043 DARE COMMODITIES
068048 FINGERPRINTING EQUIP & SUPPLIE
068052 GUNS, PISTOLS, RIFLES, SHOTGUN
068068 POLYGRAPH EQUIPMENT & SUPPLIES
068088 TARGETS & TARGET PASTERS
068094 TIRE MARKERS & SUPPLIES
069500 *PRINTING,SILK SCREEN,DECALS
069510 DECALS, LABELS, ETC
069535 OFFSET PRINTING
069550 PRINTING BOOKS, PAMPHLETS, ETC
069552 PRINTING FORMS
069565 PRINTING BUSINESS CARDS
069562 PRINTING, QUICK COPY
069585 SILK SCREEN PRINTING
069590 STORES PRINTING
070000 *PRINTING PLANT EQUIP/SUPP
070030 GRAPHIC ART SUPPLIES
070060 PAPER & FILM SHREDDERS
071500 *PUBS/AUDIOVIS(PREPARED MATL)
071510 BOOKS,PAMPHLETS,NEWSPAPERS,ETC
071511 COLE DIRECTORIES
071555 MOVIES: TRAINING & ENTERTAINMN
071560 POLK DIRECTORIES
071580 SOUND TAPES (PRERECORDED)
071590 VIDEO MATLS FOR TV/COMP(PREREC
071595 ZIP CODE DIRECTORIES
072000 *PUMPS & PUMP ACCESSORIES
072033 GAS & DIESEL FUEL PUMPS
072064 SEWAGE & SLUDGE PUMPS
072500 *RADIO/TELECOMM EQUIPMENT
072513 BATTERIES
072523 FIBER OPTIC CABLES,CONN,ACCESS
072526 HEADPHONES & HEADSETS
072545 PAGING: RADIO
072550 RADIO TELEPHONES(INCL CELLULAR
072551 RADIOS, HOME & AUTO
072554 TELEPHONE DIAL & ANSWER MACHIN
072555 TELEPHONE EQUIP & PIECE PARTS
072556 TELEPHONE SYSTEMS
072557 TELEPHONE SYSTEM MAINT/REPAIR
072574 TWO WAY RADIOS & SUPP/REPAIRS
073000 *RADIO/TV/ELECTRONIC TEST EQU
073500 *RECYCLED PRODUCTS
074000 *REFRIGERATION EQUIP/ACCESSOR
074070 REFRIGERAT/FREEZERS:COMMERCIAL
074500 *ROAD/HIGHWAY BLDG MATLS
074507 ASPHALT,ROCK ASPH,ASPH CONCRET
074563 LIGHTWEIGHT AGGRATES
074577 SAND & GRAVEL
075500 *ROAD EQ:CONC & ASPH HANDLING
075510 ASPHLT DISTRIBUTRS,MIXRS,LEVLR
075540 ASPHALT TOOLS
075565 CONCRETE CUTTERS, SAWS & ACCES
075580 CONCRETE MIXERS
076000 *ROAD/HWY EQUIP:EARTH HANDLIN
076003 BACKHOE
076006 BLADES
076010 BUCKETS
076030 GRADERS, ALL TYPES
076044 LOADERS, ALL TYPES
076063 ROLLERS, ALL TYPES
076500 *ROAD EQ(EXCEPT ASPH,EARTH)
076549 PNEUMATIC MACH(DEMOLITION,ETC)
076551 PNEUMATIC TOOL ACCESSORIES
076561 SNOW PLOWS, TRUCK MOUNTED
076566 SPREADERS, TRUCK MOUNTED
076568 SPRAY TRUCK & ROADSIDE SPRAYER
6
076572 STRIPING MACHINES & ACCESSORIE
076575 SWEEPER ACCESSORIES:BROOMS,ETC
076577 SWEEPERS, DRAG BROOMS, ETC
077500 *SALT (EXCEPT TABLE)
077545 ROAD MAINTENANCE SALT
078000 *SCALES & WEIGHING APPARATUS
078200 *SEWAGE TREATMENT EQUIPMENT
078277 PUMP MAINTENANCE & REPAIR
078279 REPAIR PARTS FOR CHEM FEED SYS
078295 VALVES, FITTINGS & FLANGES
078500 *EDUCATIONAL SVCS/REGISTRATNS
078510 BOOKS,LAB FEES,RELATED ED MATL
079000 *SEED, SOD, SOIL & INOCULANTS
079050 SOD: GRASS
079070 TOP SOIL & FILL DIRT
080300 *SOUND SYS,MUSIC,INTERCOM,PA
080330 INTERCOM SYSTEMS
080340 MICROPHONES, EARPHONES
080345 MUSIC SYSTEMS & COMPONENTS
080355 PAGING SYSTEMS, LOUD SPEAKER
080361 PUBLIC ADDRESS SYSTEMS
080375 RECORDING TAPE, SOUND
080380 SPEAKERS & ACCESSORIES
080392 TAPE RECORDERS (NOT DICTATION)
080500 *SPORTING & ATHLETIC GOODS
080512 ATHLETIC APPAREL
080517 ATHLETIC FIELD MARKERS/SUPPLIE
080557 GYM APPARATUS & EQUIP
080570 SPORTING/ATHLETIC EQUIPMENT
083000 *TANKS, MOBILE & STATIONARY
083013 TANKS REMOVAL & DISPOSAL
083200 *TAPE(DUCT,MASKNG,FILAMNT,ETC
084000 *TELEVISION/VCR EQUIP & ACCES
084034 EDITING,TITLING,SPECIAL EFFECT
084040 RECORDING TAPE&CASSETTES:VIDEO
084056 TV EQUIP MAINTENANCE & REPAIR
084060 TELEVISION RECEIVERS & CONSOLE
084070 VIDEO CAMERAS,PORTABLE & ACCES
084074 VIDEO MONITORS, DEMODULATORS,
084082 VIDEO RECORDERS/ACCESS/PARTS
084086 VIDEO SYSTEMS-STUDIO QUALITY
084500 *TESTING APPARATUS (NOT ELECT
085000 *TEXTILES,HOUSEHOLD LINEN,ETC
085008 BEDSPREADS,BEDDING,SHEETS,ETC
085092 TOWELS, WASHCLOTHS, BATH MATS
085500 *THEATRICAL EQUIPMENT/SUPPLIE
086300 *TIRES AND TUBES
086301 TIRES, RECYCLED: PRODUCTS FROM
086375 TIRE RECAPPING & REPAIRS
086500 *TRAFFIC SIGNAL EQUIPMENT
086510 CONTROLLERS
086550 OPTICOM DISCRIMINATOR
086555 PEDESTRIAN SIGNAL HEADS
086560 SIGNALS:ELEC SYS/PARTS
086600 *UTILITIES
086610 CABLE TV
086620 GARBAGE & SOLID WASTE DISPOSAL
086630 NATURAL GAS
086640 POWER & LIGHT
086645 RADIO AIR TIME
086650 TELEPHONE SERVICES
086660 WATER, SEWER, DRAINAGE SVCS
087000 *VENETIAN BLINDS,AWNINGS,SHAD
088000 *VISUAL EDUCATION EQUIP/SUPP
088043 PROJECTION SCREENS
088045 PROJECTORS, LCD & COMPUTER
088049 PROJECTORS, FILM STRIP
088061 PROJECTORS, OVERHEAD & ACCESS
088064 PROJECTORS, SLIDE
088500 *WATER TREATING CHEMICALS
088520 ALUMINUM SULFATE
088538 CHLORINE-LIQUIFIED (IN CYL)
088564 FILTER AIDS,DIATOMAC EARTH,ETC
088566 FLUORIDE
088568 HYDROGEN PEROXIDE
088580 CATIONIC POLYELECTROLYE
088583 SODA ASH
088584 SODIUM BISULFITE
088585 SODIUM HYPOCHLORITE
088595 WATER TESTING KITS
089000 *WATER SUPPLY EQUIPMENT
089030 MANHOLE COVERS,FRAMES,GRATES
089040 METER BOXES & VALVE BOXES
089045 WATER METERS
089078 WATER FILTERS & FILTER ELEMENT
089500 *WELDING EQUIP & SUPPLIES
089570 WELDING ACCESS: TIPS,HOSE,ETC
089571 WELD ELECTRODES,FLUX,RODS,WIRE
089572 WELDING PROTECTION, WORN
091000 *BLDG MAINT/REPAIR SVCS
091017 DOOR REPAIRS
091031 HEATING & AIR CONDITIONING SVC
091035 JANITORIAL CUSTODIAL SVCS
091094 WINDOW CLEANING SERVICES
091500 *COMMUNICA/MEDIA RELATED SVCS
091503 ADVERTISING/PUBLIC RELATIONS
091538 FILM PROCESSING/DUPLICATNG SVC
091548 GRAPHIC ARTS SERVICES
091552 MAILING LABELS, PREPRINTED
091568 MICROFILM/MICROFICHE SERVICES
092200 *DATA PROCESSING SVCS*USE 020
092210 MICROSOFT SELECT SOFTWARE*USE
092248 SOFTWARE MAINTENANCE CONTRACTS
092500 *EQUIP MAINT AGREEMENTS
7
092501 *EQUIP REPAIR
092510 AUTOMOBILE REPAIR
092518 CAMERA, CAMERA EQUIP MAINT/REP
092520 COMPUTER EQUIP MAINT AGREEMENT
092521 COMPUTER EQUIP REPAIR
092530 COPY MACHINE MAINT AGREEMENT
092531 COPY MACHINE REPAIR
092543 HEAVY EQUIP MAINT & REPAIR
092544 FAX MACHINE MAINT & REPAIR
092550 LAB EQUIP & INST MAINT & REPAI
092552 MAILROOM EQUIP MAINT & REPAIR
092553 MARINE EQUIP MAINT & REPAIR
092555 MOTORCYCLE REPAIR
092558 POWER TOOL MAINT & REPAIR
092560 RADIO/TELECOMM/PHONE MAINT/REP
092565 TRUCK & BUS MAINT & REPAIR
092567 SEWER EQUIP MAINT & REPAIR
092568 STREETLIGHT POLE MAINT/REPAIR
092570 TYPEWRITER REPAIR
092578 FURNITURE MAINT & REPAIR
093000 *EQUIP RENTAL SVCS,SHORT TERM
093010 AUTOMOBILE/PASSENGER VAN RENTL
093032 CONSTRUCTION EQUIPMENT RENTAL
093050 INDUSTRIAL EQUIPMENT RENTAL
093085 TRUCK RENTAL
093200 *FINANCIAL SVCS
094000 *LAUNDRY & DRY CLEAN SVCS
094500 *LIBRARY SVCS
094700 *MISCELLANEOUS SERVICES
094701 ANIMAL DISPOSAL SERVICES
094702 ARTISTIC SERVICES
094705 ARCHITECTURAL SERVICES
094707 AUCTIONEERING SERVICES
094749 LEGAL SERVICES
094752 METAL FABRICATION SERVICES
094765 PEST CONTROL SERVICES
094766 PHOTOGRAPHIC SERVICES
094791 WEATHER INFO SERVICES
094793 TREE SERVICES/REMOVAL
094796 WASTE OIL COLLECTION SVCS
094797 TRAINING SERVICES
094798 PROGRAMMING / IT SERVICES
094799 PROPERTY CLEANUP
096000 *ROADSIDE,GROUNDS,PARK SVCS
096500 *SECURITY,FIRE,SAFETY SVCS
096505 ALARM SERVICES
096510 ARMORED CAR SERVICES
096530 FIRE & SAFETY SERVICES
096578 POLYGRAPH TESTING SERVICES
097000 *SPACE RENTAL / LEASE SVCS
Form W-9
(Rev. January 2011)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax
classification (required):
Individual/sole proprietor
C Corporation S Corporation Partnership
Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)
Other (see instructions)
Exempt payee
Address (number, street, and apt. or suite no.)
City, state, and ZIP code
Requester’s name and address (optional)
List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line
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 get 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
number to enter.
Social security number
Employer identification number
Part II 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, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. I 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 on page 4.
Sign
Here
Signature of
U.S. person
Date
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) 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 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners’ share of
effectively connected income.
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.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign partners’ share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 1-2011)
Form W-9 (Rev. 1-2011)
Page 2
The person who gives Form W-9 to the partnership for purposes of
establishing its U.S. status and avoiding withholding on its allocable
share of net income from the partnership conducting a trade or business
in the United States is in the following cases:
• The U.S. owner of a disregarded entity and not the entity,
• The U.S. grantor or other owner of a grantor trust and not the trust,
and
• The U.S. trust (other than a grantor trust) and not the beneficiaries of
the trust.
Foreign person. If you are a foreign person, do not use Form W-9.
Instead, use the appropriate Form W-8 (see Publication 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a “saving clause.” Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items:
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity not subject to backup
withholding, give the requester the appropriate completed Form W-8.
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS a percentage
of such payments. This is called “backup withholding.” Payments that
may be subject to backup withholding include interest, tax-exempt
interest, dividends, broker and barter exchange transactions, rents,
royalties, nonemployee pay, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See the instructions below and the separate Instructions for the
Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account, for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name shown on
your income tax return. However, if you have changed your last name,
for instance, due to marriage without informing the Social Security
Administration of the name change, enter your first name, the last name
shown on your social security card, and your new last name.
If the account is in joint names, list first, and then circle, the name of
the person or entity whose number you entered in Part I of the form.
Sole proprietor. Enter your individual name as shown on your income
tax return on the “Name” line. You may enter your business, trade, or
“doing business as (DBA)” name on the “Business name/disregarded
entity name” line.
Partnership, C Corporation, or S Corporation. Enter the entity's name
on the “Name” line and any business, trade, or “doing business as
(DBA) name” on the “Business name/disregarded entity name” line.
Disregarded entity. Enter the owner's name on the “Name” line. The
name of the entity entered on the “Name” line should never be a
disregarded entity. The name on the “Name” line must be the name
shown on the income tax return on which the income will be reported.
For example, if a foreign LLC that is treated as a disregarded entity for
U.S. federal tax purposes has a domestic owner, the domestic owner's
name is required to be provided on the “Name” line. If the direct owner
of the entity is also a disregarded entity, enter the first owner that is not
disregarded for federal tax purposes. Enter the disregarded entity's
name on the “Business name/disregarded entity name” line. If the owner
of the disregarded entity is a foreign person, you must complete an
appropriate Form W-8.
Note. Check the appropriate box for the federal tax classification of the
person whose name is entered on the “Name” line (Individual/sole
proprietor, Partnership, C Corporation, S Corporation, Trust/estate).
Limited Liability Company (LLC). If the person identified on the
“Name” line is an LLC, check the “Limited liability company” box only
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
tax purposes, enter “P” for partnership. If you are an LLC that has filed a
Form 8832 or a Form 2553 to be taxed as a corporation, enter “C” for
C corporation or “S” for S corporation. If you are an LLC that is
disregarded as an entity separate from its owner under Regulation
section 301.7701-3 (except for employment and excise tax), do not
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
federal tax purposes. If the LLC is disregarded as an entity separate
from its owner, enter the appropriate tax classification of the owner
identified on the “Name” line.
Form W-9 (Rev. 1-2011)
Page 3
Other entities. Enter your business name as shown on required federal
tax documents on the “Name” line. This name should match the name
shown on the charter or other legal document creating the entity. You
may enter any business, trade, or DBA name on the “Business name/
disregarded entity name” line.
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status, then
check the “Exempt payee” box in the line following the “Business name/
disregarded entity name,” sign and date the form.
Generally, individuals (including sole proprietors) are not exempt from
backup withholding. Corporations are exempt from backup withholding
for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should still
complete this form to avoid possible erroneous backup withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2),
2. The United States or any of its agencies or instrumentalities,
3. A state, the District of Columbia, a possession of the United States,
or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions, agencies,
or instrumentalities, or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt from backup withholding include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a possession of the United
States,
9. A futures commission merchant registered with the Commodity
Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under the
Investment Company Act of 1940,
12. A common trust fund operated by a bank under section 584(a),
13. A financial institution,
14. A middleman known in the investment community as a nominee or
custodian, or
15. A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 15.
IF the payment is for . . . THEN the payment is exempt
for . . .
Interest and dividend payments All exempt payees except
for 9
Broker transactions Exempt payees 1 through 5 and 7
through 13. Also, C corporations.
Barter exchange transactions and
patronage dividends
Exempt payees 1 through 5
Payments over $600 required to be
reported and direct sales over
$5,000
1
Generally, exempt payees
1 through 7
2
1
See Form 1099-MISC, Miscellaneous Income, and its instructions.
2
However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
services paid by a federal executive agency.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity
separate from its owner (see Limited Liability Company (LLC) on page 2),
enter the owner’s SSN (or EIN, if the owner has one). Do not enter the
disregarded entity’s EIN. If the LLC is classified as a corporation or
partnership, enter the entity’s EIN.
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local Social Security Administration office or get this
form online at www.ssa.gov. You may also get this form by calling
1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can apply for
an EIN online by accessing the IRS website at www.irs.gov/businesses
and clicking on Employer Identification Number (EIN) under Starting a
Business. You can get Forms W-7 and SS-4 from the IRS by visiting
IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, write
“Applied For” in the space for the TIN, sign and date the form, and give
it to the requester. For interest and dividend payments, and certain
payments made with respect to readily tradable instruments, generally
you will have 60 days to get a TIN and give it to the requester before you
are subject to backup withholding on payments. The 60-day rule does
not apply to other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to the
requester.
Note. Entering “Applied For” means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner must
use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, below, and items 4 and 5 on page 4
indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on the “Name” line must sign. Exempt payees, see
Exempt Payee on page 3.
Signature requirements. Complete the certification as indicated in
items 1 through 3, below, and items 4 and 5 on page 4.
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
Form W-9 (Rev. 1-2011)
Page 4
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. “Other payments” include
payments made in the course of the requester’s trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), IRA, Coverdell ESA, Archer MSA or
HSA contributions or distributions, and pension distributions. You
must give your correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals (joint
account)
The actual owner of the account or,
if combined funds, the first
individual on the account
1
3. Custodian account of a minor
(Uniform Gift to Minors Act)
The minor
2
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that is
not a legal or valid trust under
state law
The grantor-trustee
1
The actual owner
1
5. Sole proprietorship or disregarded
entity owned by an individual
The owner
3
6. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulation section 1.671-4(b)(2)(i)(A))
The grantor*
For this type of account:
Give name and EIN of:
7. Disregarded entity not owned by an
individual
The owner
8. A valid trust, estate, or pension trust
Legal entity
4
9. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
The corporation
10. Association, club, religious,
charitable, educational, or other
tax-exempt organization
The organization
11. Partnership or multi-member LLC
The partnership
12. A broker or registered nominee
The broker or nominee
13. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
The public entity
14. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulation section 1.671-4(b)(2)(i)(B))
The trust
1
List first and circle the name of the person whose number you furnish. If only one person on a
joint account has an SSN, that person’s number must be furnished.
2
Circle the minor’s name and furnish the minor’s SSN.
3
You must show your individual name and you may also enter your business or “DBA” name on
the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you
have one), but the IRS encourages you to use your SSN.
4
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 1.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, social security number (SSN), or other identifying
information, without your permission, to commit fraud or other crimes.
An identity thief may use your SSN to get a job or may file a tax return
using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Publication 4535, Identity Theft Prevention
and Victim Assistance.
Victims of identity theft who are experiencing economic harm or a
system problem, or are seeking help in resolving tax problems that have
not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration at 1-800-366-4484. You can forward
suspicious emails to the Federal Trade Commission at: spam@uce.gov
or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT
(1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce
your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with
the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation
of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS,
reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District
of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies
to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to
file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a
TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.