HomeMy WebLinkAboutMINUTES - 06202006 - C.23 TO: BOARD OF SUPERVISORS AS GOVERNING �E. Contra
BOARD OF THE FLOOD CONTROL& WATER
_ Costa
CONSERVATION DISTRICT _ n `
FROM: MAURICE M. SHIU, CHIEF ENGINEER °os:•,. c3`,4
T'4 COUN County
DATE: June 20, 2006
SUBJECT: APPROVE contract with the Urban Creeks Council, in the amount of$25,000for the period July 1,
2006 through June 30, 2007, Countywide. (Cities and County Stormwater Utility Fee Assessment
Funds) (All Districts) Project No. 7519 6x7173
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDED ACTION:
APPROVE and AUTHORIZE the Chief Engineer,Flood Control and Water Conservation District,or designee,on
behalf of the Contra Costa Clean Water Program,to execute a contract with the Urban Creeks Council in the amount
not to exceed $25,000 for Streamside Management Program for Landowners for the period July 1, 2006 through
June 30,2007, Countywide.(Cities and County Stormwater Utility Fee Assessment Funds) (All Districts) Project
No. 7519 6x7173
CONTINUED ON ATTACHMENT: FE SIGNAT
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDAT F ARD COMMIT
APPROVE OTHER
SIGNATURE(S): ,
ACTION OF BO ON L�i�s"Y7�i oGi�L APPROVED AS RECOMMENDED ✓ OTHER
VOTE OF SUPERVISORS: I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT
_/ COPY OF AN ACTION TAKEN AND ENTERED ON
Y UNANIMOUS(ABSENT MINUTES OF THE BOARD OF SUPERVISORS ON THE
AYES: NOES: DATE SHOWN.
ABSENT: ABSTAIN:
Contact:
G:\NPDES\BO—Res—Contracts—Agmt\Urban Creeks Council\06 07\SMPL BU.doc ATTESTED
JOHN CULLEN,CLERK OF THE BOARD OF
SUPERVISORS
cc:
BY: DEPUTY
—r
loor
SUBJECT: APPROVE contract with the Urban Creeks Council, in the amount of$25,000for the period July
1, 2006 through June 30, 2007, Countywide. (Cities and County Stormwater Utility Fee
Assessment Funds) (All Districts) Project No. 7519 6x7173
DATE: June 20, 2006
PAGE: 2 of 2
FISCAL IMPACT:
The cost is estimated to be$25,000;and,shall be funded by stormwater utility fee assessments collected by the cities
and county proportioned to their respective populations.
REASONS FOR RECOMMENDATION AND BACKGROUND:
The United States Environmental Protection Agency issued the National Pollutant Discharge Elimination System
(NPDES)Regulations for municipal stormwater discharges on November 16, 1990 requiring Contra Costa County,
nineteen(19)of its incorporated cities and the Contra Costa County Flood Control and Water Conservation District
to obtain a Joint Municipal NPDES permit from the San Francisco Bay and Central Valley Regional Water Quality
Control Boards. The Permits require municipalities to eliminate all pollutants from entering the municipal storm
drain system.
The Urban Creeks Council provides a technical contact point for landowners who want to correctly mitigate and
improve the quality of their creeks. The municipalities refer residents calling with problems.
CONSEQUENCES OF NEGATIVE ACTION:
The Urban Creeks Council provides a clearing house of focusedinformation for landowners in all municipalities.
The loss of this resource to municipal landowners would be a substantial loss for all.
CONSULTING SERVICES AGREEMENT
1. Special Conditions. These Special Conditions are incorporated below by reference.
(a) Public Agency: Contra Costa County Flood Control and Water Conservation District
on behalf of the Contra Costa Clean Water Program
(b) Consultant's Name &Address: Urban Creeks Council
1250 Addison Street, Suite 107
Berkeley, CA 94702
(c) Project Name, Number, & Location: Streamside Management Program for Landowners (SMPL) Project No. 7519 6x
7173
(d) Effective Date: July 1, 2006 (e) Payment Limit(s): $25,000
(f) Completion Date(s): June 30, 2007
2. Signatures. These signatures attest the parties'agreement hereto.
PUBLIC AGENCY CONSULTANT
By: Maurice M. Shiu
Public Works Director/ By: t?-0 A 2.
Chief Engineer, or Designee (Designate offic�capa�cityinhe business Type of Business:
(sole proprietorship, government agency, partnership, corporation, etc.)
If Corp ration, State of Incorporation:
y. By: AL)
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(Designate official capacity in the business)
�J — — _L�6 P-7 Ah,
Note to Consultant: For corporations, the contract must be signed by two officers. The first signature must be that of the
chairman of the board, president, or vice-president; the second signature must be that of the secretary, assistant secretary,
chief financial officer,or assistant treasurer. (Civ.Code,Sec. 1190 and Corps. Code.Sec.313.)The acknowledgment below
must be signed by a Notary Public.
CERTIFICATE OF ACKNOWLEDGMENT
State of California )
ss.
County of ALAM T 1= A )
On the date written below, before me, the undersigned Notary Public, personally appeared the person(s) signing above for
Consultant,personally known to me(or proved to me on the basis of satisfactory evidence)to be the person(s)whose name(s)
is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s)acted, executed the instrument.
WITNESS my hand and-9kial seal.
A
Dated: Jt.!/d , �oT) ��h �(�
Notary Public
(Notary's Seal)
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3. Parties.Effective on the above date,the above-named Public Agency and Consultant mutu ^mutually agree and promise as
follows:
4. employs Consultant, and Consultant accepts such employment, toperform the
professional services described herein, upon the terms and inconsideration ofthe payments stated herein.
5. Scope of Service.Qcope of service shall baasdescribed inAppendix A,attached hereto and made a part hereof by
this reference.
G. Report Disclosure Section.Any document or written report prepared hereunder by Consultant,or a subcontractor,for
Public Agency shall contain, in a separate section, the numbers and dollar amounts of this contract and all sub-
contracts relating to the preparation of such document or written report, provided that the payment limit specified in
Sec. I(e)exceeds$5,000.When multiple documents or written reports are the subject or products of this agreement,
the disclosure section may also contain a statement indicating that the total contract amount represents compensation
for multiple documents or written reports.
/. Insurance. Consultant shall, at no cost bnPublic Agency, obteinondnmintaindudngtheternhereot (a)Worke
'roCompensation Insurance pursuant Uostate law; (b) Professional Liability Insurance with minimum coverage of
$ 1.00U.00Oand amaximum deductible of$ 10O^OOO;and,(c)Comprehensive General Liability Insurance,including
blanket contractual(or contractual liability)coverage,broad form property damage coverage,and coverage for
owned
and non-owned vehicles,with a minimum combined single limit coverage of$1,000,000 for all damages due to bodily
injury, sickness or disease, or death to any person,and damage to property, including the loss of use thereof,arising
out of each accident or occurrence, and naming Public Agency, Contra Costa County, City of Antioch, City -fBvenbmood.City ufClayton,City ofConcord,Town ofDanville,QtyofBCerrito,City ofHenu/mm.City ofLafayette,City
oyMartinez,Town o[Morag .CityofOoNe8CityofOhnda.C/tyof pinolm.CityofPittsburg.Citymf --- ntHiU'Cdy
of Richmond, City ofSan Pab|o, City ofSan Ramon, City of Walnut Creek, eirgovarnin0 bodies, officers
and
employees as additional insureds. Consultant shall promptly furnish to Public Agency certificates of insurance
evidencing such coverage and requiring 30 days' written notice to Public Agency ofpoU policy cancellation or
material change incoverage.
8. Paymen . Public Agency shall pay Consultant for professional services performed atthe rates shown inAopendixB
attached henato,which include all overhead and incidental axpenaes,for which no additional compensation^shall be
allowed. Notwithstanding the foregoing, Uloaa incidental expenses specifically itemized inAop�end�ix-8oha-U be
reimbursable by Public Agency to Consultant,provided that Consultant submits copies of receiptsand,ifapplicable,a
detailed mileage log to Public Agency. In no event ohmU the total amount paid to Consultant exceed the payment
limit(s)specified in Sec. 1(e)without prior written approval of the Public Agency.Consultant'sbilling statements shall
be submitted at convenient intervals approved by Public Agency and shall list,for each item of services,the employee
categories, hours and rates. Public Agency will pay consultant in accordance with the requirements of Civil Code
Section 332Uemapplicable.
g. Status. The Consultant is an independent contractor, and shall not be considered an employee of Public Agency.
10. Time for Completion. Un|eaathatimaioextendedinm«itinQbyPub|icAoenny. Conau|tontmhoUoornp|eteoUservicaa
covered bythis Agreement no later than the Completion Date(s) |iobmd above.
11. Record Retention and Auditing.Except for materials and records delivered to Public Agency,Consultant shall retain all
materials and records prepared or obtained in the performance of this Agreement, including financial records,for a
period of at least five years after Consultant's receipt of the final payment under this Agreement. Upon request by
Public Agency,at no additional charge,Consultant shall promptly make such records available to Public Agency,or to
authorized representatives of the state and federal governments,at a convenient location within Contra Costa County
designated by Public Agency, and without restriction or limitation on their use.
12. Documentation.Conou|bantwhaUpnopmnaanddm|ivertopubUcAoenoyotnoaddiUono/oharQe.thmhemnudaeuribedin
Appendix Atodocument the performance ofthis Agreement and shall furnish hoPublic Aoencysuch infonnaUonasim
necessary toenable PuWicAgency tommonihorthe pe�oonancmofthis Aureen/ent. -
13. Ownership of Documents.AJI materialsun naoondoofa finished nature, such amfinal plans, specifications, reports,
and maps,prepared orobtained inthe performance Vfthku - ent,shall be delivered to and become the property
of Public Agency. All materials of a preliminary nature, such as survey noteo, oketo,ea, preliminary p|onm,
computations and other data, prepared or obtained in the performance of this Agreement, shall be made available,
upon request, to Public Agency at no additional charge and without restriction or limitation on their use,
14. Extra Work.Any work or services in addition to the work or services described in Appendix A shall be performed by
Consultant according to the rates or charges listed in Appendix B. In the event that no rate or charge is listed for a
particular type of extra work, Consultant shall be paid for the extra work at a rate to be mutually agreed on prior to
commencement of the extra work. In no event shall Consultant be entitled to compensation for extra work unless a
written authorization or change order describing the work and payment terms has been executed by Public Agency
prior to the commencement of the work.
15. Payment Retention'.Public Agency shall retain ten percent(10%)of the monies due the Consultant as security for the
fulfillment of this Agreement.After the Consultant has completed all work under this Agreement,submitted final billing,
and the Public Agency has found the work to be accurate,the Public Agency will pay all withheld funds.Public Agency
will pay withheld funds in accordance with the requirements of Civil Code Section 3320 as applicable.A retention will
not be withheld for any"on-call"work.
16. Termination by Public Agency.At its option, Public Agency shall have the right to terminate this Agreement at any time
by written notice to Consultant,whether or not Consultant is then in default. Upon such termination,Consultant shall,
without delay, deliver to Public Agency all materials and records prepared or obtained in the performance of this
Agreement, and shall be paid, without duplication, all amounts due for the services rendered up to the date of
termination.
17. Abandonment by Consultant. In the event the Consultant ceases performing services under this Agreement or
otherwise abandons the project prior to completing all of the services described in this Agreement, Consultant shall,
without delay, deliver to Public Agency all materials and records prepared or obtained in the performance of this
Agreement, and shall be paid for the reasonable value of the services performed up to the time of cessation or
abandonment, less a deduction for any damages or additional expenses which Public Agency incurs as a result of
such cessation or abandonment.
18. Breach. In the event that Consultant fails to perform any of the services described in this Agreement or otherwise
breaches this Agreement, Public Agency shall have the right to pursue all remedies provided by law or equity.Any
disputes relating to the performance of this Agreement shall not be subject to non-judicial arbitration. Any litigation
involving this Agreement or relating to the work shall be brought in Contra Costa County, and Consultant hereby
waives the removal provisions of Code of Civil Procedure Section 394.
19. Compliance with Laws. In performing this Agreement, Consultant shall comply with all applicable laws, statutes,
ordinances, rules and regulations, whether federal, state, or local in origin.This includes compliance with prevailing
wage rates and their payment in accordance with California Labor Code, Section 1775.
20. Assignment. This Agreement shall not be assignable or transferable in whole or in part by Consultant, whether
voluntarily,by operation of law or otherwise;provided,however,that Consultant shall have the right to sub-contract that
portion of the services for which Consultant does not have the facilities to perform so long as Consultant notifies Public
Agency of such subcontracting prior to execution of this Agreement.Any other purported assignment,transfer or sub-
contracting shall be void.
21. Subcontracting.All subcontracts exceeding$25,000 in cost shall contain all of the required provisions of this contract.
Consultant will pay each subconsultant in accordance with the requirements of Civil Code Section 3321 as applicable.
22. Endorsement on Plans.Consultant shall endorse all plans,specifications,estimates,reports and other items described
in Appendix A prior to delivering them to Public Agency, and where appropriate, indicate his/her registration number.
23. Patents and Copyrights.The issuance of a patent or copyright to Consultant or any other person shall not affect Public
Agency's rights to the materials and records prepared or obtained in the performance of this Agreement.Public Agency
reserves a license to use such materials and records without restriction or limitation, and Public Agency shall not be
required to pay any additional fee or royalty for such materials or records.The license reserved by Public Agency shall
continue for a period of fifty years from the date of execution of this Agreement,unless extended by operation of law or
otherwise.
1 Not applicable
24. Indemnification. Consultant shall indemnify, defend, save, protect, and hold harmless Public Agency, its governing
body, officers, employees, representatives, and agents ("Indemnitees") from any and all demands, losses, claims,
costs,suits,liabilities,and expenses for any damage,injury,or death(collectively"Liability')arising directly or indirectly
from or connected with the services provided hereunder which is caused,or claimed or alleged to be caused,in whole
or in part, by the negligence or willful misconduct of Consultant, its officers, employees, agents, contractors,
subconsultants, or any persons under its direction or control and shall make good to and reimburse Indemnitees for
any expenditures, including reasonable attorneys' fees and costs, the Indemnitees may make by reason of such
matters and , if requested by any of the Indemnitees, shall defend any such suits at the sole cost and expense of
Consultant. Consultant's obligations under this section shall exist regardless of concurrent negligence or willful
misconduct on the part of the Public Agency or any other person; provided, however, that Consultant shall not be
required to indemnify Indemnitees for the proportion of liability a court determines is attributable to the negligence or
willful misconduct of the Public Agency, its governing body,officers,or employees. This indemnification clause shall
survive the termination or expiration of this Agreement.
25. Heirs Successors and Assigns. Except as provided otherwise in Section 20 above,this Agreement shall inure to the
benefit of and bind the heirs, successors, executors, personal representatives, and assigns of the parties.
26. Public Endorsements. Consultant shall not in its capacity as a Consultant with Public Agency publicly endorse or
oppose the use of any particular brand name or commercial product without the prior approval of the Public Agency's
governing board. In its Public Agency Consultant capacity, Consultant shall not publicly attribute qualities or lack of
qualities to a particular brand name or commercial product in the absence of a well-established and widely accepted
scientific basis for such claims or without the prior approval of the Public Agency's governing board. In its Public
Agency Consultant capacity,Consultant shall not participate or appear in any commercially-produced advertisements
designed to promote a particular brand name or commercial product, even if Consultant is not publicly endorsing a
product,as long as the Consultant's presence in the advertisement can reasonably be interpreted as an endorsement
of the product by or on behalf of Public Agency. Notwithstanding the foregoing, Consultant may express its views on
products to other Consultants,the Public Agency's governing board, its officers,or others who may be authorized by
the Public Agency's governing board or by law to receive such views.
27. Project Personnel. In performing the services under this Agreement, Consultant shall use the personnel listed in
Appendix C, attached hereto and made a part hereof by this reference. Changes in project personnel may only be
made with Public Agency's written consent,and Consultant shall notify Public Agency in writing at least thirty(30)days
in advance of any proposed change. Any person proposed as a replacement shall possess training,experience and
credentials comparable to those of the person being replaced.
28. Disadvantaged Business Enterprise(DBE)Requirements(Federal aid projects only). Consultant shall complywith all
applicable provisions of 49 CFR, Parts 23 and 26, and the County's Disadvantaged Business Enterprise (DBE)
Program, which are incorporated into this Agreement by reference. In addition, in performing services under this
Agreement,Consultant shall utilize all DBEs listed in Consultant's written response to the Public Agency's request for
qualifications or request for proposal and shall pay to the listed DBEs the estimated amounts listed in Appendix B
attached to this Agreement. The Consultant shall not substitute a listed DBE at any time or decrease the amount to
be paid to a listed DBE without the advance,written consent of the Public Agency. If a listed DBE is proposed to be
replaced, Consultant shall make a good faith effort to replace the original DBE with another DBE and shall submit to
Public Agency written documentation of such effort.
29. Federal Cost Principles and Procedures (Federal aid proiects only). Consultant shall comply with the following
provisions,which are incorporated into this Agreement by reference:(a)the cost principles for allow ability of individual
items of costs set forth in 48 CFR, Chapter 1, Part 31: (b)the administrative procedures set forth in 49 CFR,Part 18;
and (c) the administrative procedures for non-profit organizations set forth in OMB Circular A-110, if applicable to
Consultant. In the event that payment is made to Consultant for any costs that are determined by subsequent audit to
be unallowable under 48 CFR, Chapter 1, Part 31, Consultant shall refund the payment to Public Agency within 30
days of written request from Public Agency. Should Consultant fail to do so, and should the Public Agency file legal
action to recover the refund, Consultant shall reimburse the Public Agency for all attorney's fees, costs, and other
expenses incurred by Public Agency in connection with such action.
Attachments:Appendix A,Appendix B,Appendix C
Form approved by County Counsel(11/00)
G:%GrpDatMNPDES\FORMS\CSA over 25000.doc
APPENDIX 44A)l
STREAMSIDE MANAGEMENT PROGRAM FOR LANDOWNERS (SMPL)
SCOPE OF WORK (2006-2007)
1. Clearing House and Referral System
a. The Urban Creeks Council (UCC) will respond on behalf of the Contra Costa
Clean Water Program (Program)to telephone requests for assistance in
mitigating creek problems and flood damage in Contra Costa County. From
information gathered during telephone conversations, UCC will provide one or
more of the following responses as deemed appropriate by UCC:
1. Site visit;
2. A detailed letter, listing observed problems with recommended actions for
resolution;
3. A list of Bay Area consultants and resources available for advancing
recommended in-the-ground stream restoration projects and bank
stabilization techniques;
4. A list of appropriate riparian plants native to the Bay Area;
5. Detailed information on soil bioengineering techniques from the Urban
Creeks Council library of materials based on the SMPL user's needs.
b. UCC will log incoming SMPL related calls into UCC's SMPL spreadsheet using
UCC's in-take form. All site visits will be conducted within 30 days of the caller's
initial request, with a letter of observations/recommendations mailed within 21
days of the visit.
c. The Program will receive upon request:
1. Electronic copy of each mailed consultation letter to landowners in the Contra
Costa County;
2. Fliers to be used to promote SMPL in the county;
3. A list of SMPL call-ins in spreadsheet or database format in the County;
4. Copies of any materials distributed to SMPL users from UCC's resource
library.
2. Concentrated Assistance
a. Upon identifying areas of stream-related problems shared by multiple properties,
UCC will organize community workshops, where community agrees, to address
systematic problems rather than focusing on each property's problems. These
interactive workshops will be tailored to each individual watershed and creek.
Workshop attendees will receive a stream restoration manual created for SMPL,
so they can review information in common and hopefully initiate successful
restoration projects in a collaborative manner. Fundamental elements for SMPL
workshops will include:
1. An overview of creek and watershed functions, processes, and dynamics
(including the importance of riparian plants);
2. Likely causes of common creek-related problems;
3. Easily implemented stream management measures addressing erosion,
flooding, and pollution prevention; and,
4. Soil bioengineering techniques (whenever possible, a hands-on
bioengineering demonstration will be incorporated).
b. UCC will provide continuing support for streamside communities through SMPL,
including serving as a liaison between neighborhood groups and public agencies,
organizing workshops & community meetings, assisting in the development of
conceptual restoration strategies, and assisting in the navigation of regulatory
permit processes. Through SMPL, UCC will also provide grant writing assistance
as appropriate to support sustained community-based activities aimed at
resolving shared stream-related problems.
3. Follow-Up and Evaluation
a. UCC will follow-up with SMPL users about their creek-related problems within
one year of the initial phone call. SMPL user feedback surveys will also be
conducted annually. To gage how often SMPL recommendations are
implemented (or if not, why?), UCC will enter follow-up responses into its tracking
system. The review of this data will help UCC evaluate SMPL and develop
strategies for more effective future implementation.
4. Program Administration
a. UCC will submit SMPL quarterly progress reports to the Clean Water Program by
November 1, 2006, February 1, 2007, May 1, 2007 and August 1, 2007. Each
quarterly report will include an invoice of costs generated that quarter. The
quarterly reports will summarize program accomplishments for the quarter,
outlining how the activities conducted met the objectives of the program.
b. UCC will also submit a detailed end-of-year report by September 1, 2007
covering all program activities during the previous twelve (12) month period.
c. All reports will include 1) a financial summary detailing SMPL expenditures, 2) a
table of clearinghouse calls and site visits conducted, and 3) a summary of where
and when workshops were held, with a copy of the participant sign-in sheet.
d. In addition to reporting, SMPL administrative tasks will include program planning,
outreach materials development, database development& upgrade, and other
activities to promote and improve the program.
1
b. UCC will provide continuing support for streamside communities through SMPL,
including serving as a liaison between neighborhood groups and public agencies,
organizing workshops & community meetings, assisting in the development of
conceptual restoration strategies, and assisting in the navigation of regulatory
permit processes. Through SMPL, UCC will also provide grant writing assistance
as appropriate to support sustained community-based activities aimed at
resolving shared stream-related problems.
3. Follow-Up and Evaluation
a. UCC will follow-up with SMPL users about their creek-related problems within
one year of the initial phone call. SMPL user feedback surveys will also be
conducted annually. To gage how often SMPL recommendations are
implemented (or if not, why?), UCC will enter follow-up responses into our`
tracking system. The review of this data will help UCC evaluate SMPL and
develop strategies for more effective future implementation.
4. Program Administration
a. UCC will submit SMPL quarterly progress reports to the Clean Water Program by
November 1, 2006, February 1, 2007, May 1, 2007 and August 1, 2007. Each
quarterly report will include an invoice of costs generated that quarter. The
quarterly reports will summarize program accomplishments for the quarter,
outlining how the activities conducted met the objectives of the program.
b. UCC will also submit a detailed end-of-year report by September 1, 2007
covering all program activities during the previous twelve (12) month period.
c. All reports will include 1) a financial summary detailing SMPL expenditures, 2) a
table of clearinghouse calls and site visits conducted, and 3) a summary of where
and when workshops were held, with a copy of the participant sign-in sheet.
d. In addition to reporting, SMPL administrative tasks will include program planning,
outreach materials development, database development& upgrade, and other
activities to promote and improve the program.
1
APPENDIX "B"
Streamside Management Program for Landowners
Fiscal Year 2005/2006 Program Costs
Costs shall not exceed totals below without prior written approval from the
Program.
TASK TOTAL
1. Clearing House and Referral System $ 14,000
(Calls, Site Visits, Letters, Peer Review of Plans)
2. Concentrated Assistance $5,000
(Community building, Workshops, Long-term Efforts)
3. Follow-Up and Evaluation $2,000
(Calls and surveys to Past SMPL Users)
4. Administrative $3,000
(Reporting, Invoicing, Program Planning and Development)
5. Associated Costs $1,000
(Consultant will be reimbursed for actual costs for photographic
reproductions and postage. Consultant will be reimbursed for
mileage at 44.5¢/mi. and photocopies at the rate of .07¢ per page.
Costs under this paragraph shall not exceed $1,000).
TOTAL $25,000
2
Appendix "C"
Urban Creeks Council Personnel Rates for SMPL
No specific required project personnel.
Position Hourly Rate
Executive Director $85.00
Project Manager $85.00
Outreach Coordinator $85.00
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Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. For individuals,this is your social security number(SSN). Social security number
However,for a resident alien,sole proprietor,or disregarded entity,see the Part I 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. or
Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number Employer identification number
to enter. 4 3 3 $
IM Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and
2. 1 am not subject to backup withholding because: (a)I am exempt from backup withholding, or(b)I have not been notified by the Internal
Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends, or(c)the IRS has
notified me that I am no longer subject to backup withholding,and
3. 1 am a U.S. person(including a U.S.resident alien).
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.)
Sign Signature of cl-- ct�,�
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Purpose of Form What is backup withholding?Persons making S.You do not certify to the requester that you
certain payments to you must under certain are not subject to backup withholding under 4
A person who is required to file an information conditions withhold and pay to the IRS 30%of above(for reportable interest and dividend
return with the IRS must get your correct such payments after December 31,2001 (29% accounts opened after 1983 only).
taxpayer identification number(TIN)to report,for after December 31,2003).This is called "backup Certain payees and payments are exempt
example, income paid to you,real estate withholding."Payments that may be subject to from backup withholding.See the instructions on
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and, when applicable,to: penalty of$50 for each such failure unless your
PP on payments you receive if you give the failure is due to reasonable cause and not to
1.Certify the TIN you are giving is correct(or requester your correct TIN,make the proper willful neglect.
you are waiting for a number to be issued), certifications,and report all your taxable interest
and dividends on your tax return. Civil penalty for false information with respect
2.Certify you are not subject to backup to withholding.If you make a false statement
withholding,or Payments you receive will be subject to with no reasonable basis that results in no
backup withholding if: backup withholding,you are subject to a$500
3.Claim exemption From backup withholding if P g•y �
our TIN to the penalty.
1.You do not furnish
you are a U.S.exempt payee. y
If you are a foreign person,use the requester,or Criminal penalty for falsifying information.
appropriate Form W-8.See Pub.515, 2.You do not certify your TIN when required Willfully falsifying certifications or affirmations
Withholding of Tax on Nonresident Aliens and (see the Part 11 instructions on page 2 for may subject you to criminal penalties including
Foreign Entities. details),or fines and/or imprisonment.
Note: If a requester gives you a form other than 3.The IRS tells the requester that you Misuse of TINs.If the requester discloses or
Form W-9 to request your TIN,you must use the furnished an incorrect TIN,or uses TINS in violation of Federal law,the
requester's form if it is substantially similar to this 4.The IRS tells you that you are subject to requester may be subject to civil and criminal
Form IN-9. y y � penalties.
backup withholding because you did not report
all your interest and dividends on your tax return
(for reportable interest and dividends only),or
Cat.No.10231X Form W-9 (Rev.1-2002)