PROJECT MANUAL OWNER DESIGNER

Transcription

1 PROJECT MANUAL ESL CLASSROOM RENOVATIONS McREYNOLDS ROOM 219 AUSTIN PEAY STATE UNIVERSITY CLARKSVILLE, TENNESSEE PROJECT # OWNER AUSTIN PEAY STATE UNIVERSITY 601 COLLEGE STREET CLARKSVILLE, TN DESIGNER UNIVERSITY DESIGN AND CONSTRUCTION AUSTIN PEAY STATE UNIVERSITY 317 COLLEGE STREET CLARKSVILLE, TN (931)

2 DIVISION 0 TABLE OF CONTENTS TABLE OF CONTENTS Division 0 BIDDING & CONTRACT REQUIREMENTS SECTION TTITLE Table of Contents Drawings Invitation to Bid Instructions to Bidders for Non-Delegated Projects Bid Envelope Form Bid Form Stipulated Sum for Non-Delegated Projects W-9 Request for Taxpayer Identification Number and Certification Substitution Request Form General Conditions of the Contract for Construction of Non-Delegated Projects Division 1 GENERAL REQUIREMENTS Summary of Work Division 2 EXISTING CONDITIONS Selective Demolition Division 3 7 (N/A) Division 8 OPENINGS Hollow Metal Frames Flush Wood Doors Door Hardware Division 9 FINISHES Gypsum Board Assemblies Resilient Base and Accessories Resilient Tile Flooring Interior Painting Division (N/A) Division 23 HEATING, VENTILATING AND AIR CONDITIONING (HVAC) Duct Insulation Low-Pressure Sheetmetal Ductwork Diffusers, Registers and Grilles Division 25 (N/A) McReynolds 219 Table of Contents, Page 1 of 2

3 DIVISION 0 TABLE OF CONTENTS Division 26 ELECTRICAL Conductors 600-volt and Below Raceways and Conduit Systems Outlet Boxes Lighting Control Devices Exit Signs McReynolds 219 Table of Contents, Page 2 of 2

4 1 A-1

5 1 A-2

6 1 2 A-3

7 BID NUMBER: PROJECT NUMBER: PROJECT LOCATION: INVITATION TO BID PROJECT TITLE: Addition of wall, two doors, extension of supply and return air ducts and minor BRIEF PROJECT electrical work to subdivide classroom 219 into two separate classrooms. OVERVIEW: Sealed Bids shall be mailed or delivered to APSU Procurement and Contract Services The Procurement office will serve as the presiding official at the bid opening, receive sealed bids, review bid envelopes, record the time and date of receipt, and maintain security of the bid envelope and its contents. BID INVITATION IS ISSUED PRE-BID CONFERENCE LOCATION: McReynolds Hall, Room 219 McReynolds 219 Renovations McReynolds Hall, 327 Drane Street, Clarksville, TN SCHEDULE OF EVENTS EVENT DATE TIME July 18, 2018 July 25, :30 PM 2:00 PM DEADLINE FOR ALL WRITTEN QUESTIONS DEADLINE FOR RESPONSES AND ADDENDA (CONTRACTORS ARE RESPONSIBLE FOR OBTAINING ALL ADDENDA) BID DEADLINE/OPENING LOCATION: 505 York Street Clarksville, TN Phone: (931) ANTICIPATED CONTRACT AWARD ANTICIPATED PRE-CONSTRUCTION MEETING CONSTRUCTION DURATION July 31, 2018 August 3, 2018 August 8, days after bid opening 3-5 days after contract execution 45 days after NTP 4:30 PM 4:30 PM 11:00 AM A. All bid questions shall be referred to the Designer in writing. Designer Name: Philip Zoch B. Bidding Documents are located at the following location(s): zochp@apsu.edu Pricing per set varies on selection. C. See Instructions to Bidders for detailed instructions on the completion of the bid forms. D. Bidders submitting bids equal to or greater than $25,000 in value are required to be licensed in accordance with state law. APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 1 of 2 Designers Manual V

8 INVITATION TO BID E. If bid exceeds $100, a 5% Bid Security is required and payable to Austin Peay State University, in addition if bidder is selected, the bidder shall be prepared to submit a Contract Bond in the amount of 25% of the contract amount. F. The Owner reserves the right to waive informalities and to reject bids. G. INFORMATION AVAILABLE; 1. This section identifies information that was gathered solely for the use of the Designer, is not a Bidding Document, but is available for review by Bidders. 2. The use and interpretation of this information is entirely the responsibility of the using party. The Owner is not responsible for variations in the actual composition of existing materials. Bidders shall decide for themselves the character of the material to be encountered. 3. Investigation Reports if available will be on file in the University Design & Construction office, a copy can be provided to any Bidder of Record upon request. 4. An Asbestos investigation has hasn t been performed at the project site to determine the presence and probable extent of asbestos in the existing building materials. Report if available, was obtained solely for design purposes and is not a part of the Contract Documents. 5. A Sub-surface investigation has hasn t been performed at the project site. Report if available, was obtained solely for design purposes and is not a part of the Contract Documents. 6. Additional Information provided: H. ALTERNATES 1. Section includes identification of each Alternate by number, and describes the basic changes to be incorporated into the Work if a particular Alternate is made a part of the work by specific provisions in the Agreement between the Owner and the Contractor. 2. Related sections are referenced in the definition of each Alternate. 3. Coordination of related work and modifications to surrounding work as required to properly integrate each Alternate, and to provide the complete construction required by the Contract Documents, is the responsibility of the Contractor. 4. All applicable alternates are listed as follows: APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 2 of 2 Designers Manual V

9 PART 1 GENERAL INSTRUCTIONS TO BIDDERS FOR NON-DELEGATED PROJECTS All interested Bidders shall APSU Procurement and Contracting Services at appurchasing@apsu.edu and request to become a bidder of record in order to receive updates and any addenda issued. All bidding documents will be located on the websites per the Invitation to Bid form. 1.1 EXAMINATION A. Bidders shall carefully examine site and documents to obtain first-hand knowledge of existing conditions and Work proposed prior to the Pre-Bid Conference. 1.2 QUESTIONS A. All bid questions shall be referred to Procurement and Contract Services in writing per Invitation to Bid form. B. Replies will be issued to Bidders of Record by addenda and will become part of the Contract Documents. C. Questions must be received at least six calendar days before bid opening date. D. No addenda affecting pricing will be issued fewer than three working days before bid opening date. 1.3 BID SUBMITTALS A Bid Envelope Form 1. Completed form shall be securely attached to the face of manila envelope. 2. Per the Tennessee Code Annotated (b) the name, license number, expiration date of the license and license classification of the contractors applying to bid for the prime contract and, for the electrical, plumbing, heating, ventilation and air conditioning contracts shall appear on the outside of the envelope containing the bid except when the bid is in an amount less than twentyfive thousand dollars ($25,000). When the bid is less than twenty-five thousand dollars ($25,000), the name of the contractor only may appear on the outside of the envelope containing the bid; and upon opening the envelope, if the bid is in excess of twenty-five thousand dollars ($25,000), the bid shall automatically be disqualified. Only one (1) contractor in each classification may be listed. 3. Prime contractor bidders who are to perform the electrical, plumbing, heating, ventilation and air conditioning or the geothermal heating and cooling must be so designated upon the outside of the envelope. 4. If no work is required in a category, write N/R (None required) or N/A (Not Applicable) in space provided for subcontractor(s). B Bid Form 1. Unit Prices solicited on the Bid Form and in any subsequent Modification shall be "net." The term "net" means that the Unit Prices offered by the Contractor and accepted by the Owner shall be inclusive of all sums for payment, repayment, reimbursement, remittance, remuneration, compensation, profit, cost, overhead, expense, loss, expenditure, allowance, charge, demand, hire, wages, salary, tax, cash, assessment, price, money, bill, statement, dues, recovery, restitution, benefit, recoupment, exaction or injury. 2. If a Bidder chooses not to bid an Alternate, Unit Price, or Base Bid in a multiple Base Bid project, write "No Bid" in the space. To indicate availability of an Add Alternate at no additional charge, write "No Charge" in the space. Additional stipulations or qualifications on Bid Form may cause bid to be rejected. 3. Bid Form shall be signed by person or persons legally authorized to bind Bidder to contract. C. Bidders are solely responsible for ensuring that bids are received by the time and at the place identified APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 1 of 4 Designers Manual V

10 INSTRUCTIONS TO BIDDERS FOR NON-DELEGATED PROJECTS for receipt of bids. Bids received late will be returned unopened. D. Bids sent by mail shall be enclosed in an envelope clearly marked "Bid Envelope Enclosed". E. Failure to completely fill out Bid Form may cause bid to be rejected. F. Each Bidder shall be prepared, if requested by Owner or Designer, to present, evidence of experience, qualifications, and financial ability to carry out the terms of the contract. 1.4 SUBSTITUTION REQUESTS A. Substitution requests must be submitted by Bidders and received by the Designer no later than ten calendar days before date set to receive bids. However, regardless of the date received, consideration of substitution requests is not an obligation of the Designer or Owner and the Designer will determine if sufficient time is available for evaluation of the request. B. Substitution requests must contain at minimum the following: 1. A completed Substitution Request Form , samples, 2. Material Safety Data Sheets (MSDS), 3. A list showing names of proposed manufacturers for each specified product and names of each applicable installer, whether Bidder or subcontractor, 4. An estimate of difference in cost as required for Designer s consideration. C. Substitution requests after contract award shall be permitted in accordance with APSU General Conditions of the Contract. D. Acceptable substitutions will be identified in addenda. E. Bidders submitting bids in reliance upon a substitution when the substitution has not been approved prior to bidding do so at their own risk. 1.5 LICENSING AND QUALIFICATIONS A. Bidders shall comply with and be licensed per the Tennessee Code Annotated Section , License classifications -- Specialty classifications -- Contractor's authority to bid and contract. B. Bidders are required by the Tennessee Code Annotated section (a) (3), et seq to submit an affidavit as part of their bid, that attests that they operate a drug-free workplace program or other drug or alcohol testing program with requirements at least as stringent as that of the program operated by the governmental entity. C. Bidders shall not include a contractor or subcontractor that is disqualified from participating in State construction projects under the supervision of the State Building Commission. D. A contractor who contracts, offers to engage, bids or obtains a permit without the required license or proper classification and monetary limit, is in violation of T.C.A Therefore, Contractor would be ineligible to be awarded the project; cannot participate in any rebidding of the project; may not receive a license for six (6) months; and also subject to civil penalties. A prime contractor who lists a subcontractor not properly licensed as required would not be allowed to be awarded the project and also in violation for accepting bid. E. For detailed License & Bidding requirements issued by the TN Dept. of Commerce & Insurance Board for Licensing Contractors go to the following link: nginformation_001.pdf and INSURANCE REQUIREMENTS A. All Bidders are required to carry the following insurance policies at time of bid and will be required to submit certificates as a part of the Contracting process if awarded. The Certificate shall contain the following express obligation: APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 2 of 4 Designers Manual V

11 INSTRUCTIONS TO BIDDERS FOR NON-DELEGATED PROJECTS "This is to Certify that the policies of Insurance described herein have been issued to the insured to whom this Certificate is executed and are in force at this time. In the event of cancellation or material change in a policy affecting the Certificate holder, thirty (30) days prior written notice will be given the Certificate holder." For the purposes of the contract, the contractor shall carry the following types of insurance in at least the limits specified below: COVERAGE Workers' Compensation Statutory LIMITS OF LIABILITY Employer's Liability Product Liability Bodily Injury Liability Except Automobile Property Damage Liability Except Automobile Bodily Injury Liability Automobile Property Damage Liability Excess Umbrella Liability ) ) ) ) ) As Required by Excess Umbrella Liability Policy for Underlying Coverage $1,000,000 Each Occurrence 1.7 MODIFICATION AND WITHDRAWAL PRIOR TO CLOSE OF BIDDING A. Modification: Bids, once submitted, may be modified before the scheduled opening time only upon receipt of a written modification signed by an authorized representative of the Bidder. Modification to a bid may be made as an Add or Deduct only. Modification to bid may be written on the Bid Envelope with the signature of an authorized representative of the Bidder also written on the Bid Envelope. Modification shall indicate only the amount of change, clearly identified as an Add or Deduct, and not indicate either the prior or resulting bid amount. B. Withdrawal: Bids, once submitted, may be withdrawn before the scheduled opening time only upon receipt of a written withdrawal request signed by an authorized representative of the Bidder. 1.8 POST-BID WITHDRAWAL OF BID FROM CONSIDERATION DUE TO MISTAKE A. Request to withdraw bid due to mistake must be in writing to Owner, delivered in person or postmarked certified or registered mail not later than twenty-four hours after the time fixed for receipt and opening of bids. Request shall acknowledge that bidder refuses to enter into contract based on bid and intends to submit original work papers, documents, and materials used in preparation of the bid in like manner within five working days following date of bid opening. 1.9 CONSIDERATION OF BIDS A. To be considered, bids shall be made in accordance with these Instructions to Bidders. Failure to comply with these requirements may cause bid to be rejected. B. The Owner reserves right to: reject Unit Prices proposed in a bid without invalidating other portions of bid; reject a bid which does not provide all required Unit Prices; waive informalities; and, reject any or all bids. C. It is Owner's intent to award contract, or multiple contracts in the case of multiple base bids, based upon lowest evaluated responsive bid submitted by responsible Bidder for Base Bid plus Alternates (if any) taken in order up to, but not to exceed the Bid Target. D. If the Base Bid of all bidders exceeds the established Bid Target, the low Bidder is determined by the lowest Base Bid submitted by a responsible Bidder irrespective of any Alternates (if any) bid. E. Alternates may be accepted or rejected at Owner's discretion, provided that final combination of Base Bid and accepted Alternates does not change low Bidder as established by above method. F. In the event of tie bids, preference will be given to in-state bidder over out-of-state bidder; and, if a tie APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 3 of 4 Designers Manual V

12 INSTRUCTIONS TO BIDDERS FOR NON-DELEGATED PROJECTS still exists, successful Bidder will be determined by chance, e.g. a coin toss. G. In the case of a multiple Base Bid, Owner may award a combined contract for the Work of more than one Base Bid if the same Bidder is the successful low Bidder on each POST-BID INFORMATION A. Presentation of Agreement form by Owner to Bidder for signature does not constitute award of Contract. Contract shall not be considered awarded until Bidder has received a fully executed Agreement. B. If a Bidder is presented the written Agreement form for signing, then that Bidder shall deliver to the Owner, within fourteen calendar days after presentation, the required number of counterparts of the signed Agreement Form, completed Contract Bond form in an amount equal to one hundred percent (100%) of the Contract Sum, Roof Bond (if required) in an amount stipulated on the Bid Form, and certificates of insurance. C. Failure of the Bidder to return the Agreement as stipulated above shall entitle the Owner to require forfeiture of Bid Security and to proceed with award to the next lowest responsive Bidder DIVERSITY PARTICIPATION A. It is the express desire of Austin Peay State University and the State Building Commission to include an emphasis on diversity in its contractual relationships with contractors for the construction, demolition or renovation of State projects under jurisdiction of the Commission. The Commission acknowledges that firms who demonstrate and embrace diversity within their programs and policies are assisting the State in achieving its goals in building a more reflective marketplace of the community within this State. B. It is a requirement of all successful Bidders or proposers on projects under the jurisdiction of the State Building Commission that they report to the State the names and amounts of contracts entered into with diversity-owned businesses on their contract with the State in order for the State to collect data on such participation. END OF SECTION APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 4 of 4 Designers Manual V

13 Bid Envelope Form to the STATE OF TENNESSEE and FOR Project No.: Project Title: Project Location: Project Manager: Designer(s): Bid deadline: Time: Date: A n y b l a n k s p a c e s m a y c a u s e b i d t o b e u n a c c e p t a b l e a n d r e j e c t e d. Bidder Identification: Bidder Name Address Tennessee Contractor License information: Provide complete information if licensed, or check here if Bidder unlicensed. License Number License Classification applicable to Project License expiration date $( ) Dollar Limit If work is required for trades listed below, list subcontractor(s) that will perform that work. If Bidder will perform that work with Bidder's own forces, fill in Bidder s name as subcontractor. If there is no work in a category, write "None Required" in the space. If acceptance of alternate or combination of alternates changes subcontractor, so indicate. Provide state contractor license number, expiration date, and applicable classifications for bidder and listed subcontractors. If value of subcontractor s work is such that no license is required, and subcontractor is unlicensed, fill in N/A in the license number column, but still fill in name. Provide all names in the same style as used for licensing and other legal transactions, without embellishment. Subcontractors to be used on this Project: Provide the following information for each listed subcontractor: Electrical Plumbing HVAC Geothermal Masonry Roofing Name License Number Expires Classification This Bid Envelope approved for public opening APSU Procurement & Contracting Services APSU University Design And Construction (UDC) APPENDIX 3, DIVISION 00 FORMS, Page 1 of 1 Designers Manual V

14 BID FORM - STIPULATED SUM FOR NON-DELEGATED PROJECTS TO: APSU Procurement and Contract Services 505 York St. Clarksville, TN Phone: (931) Web: DATE: appurchasing@apsu.edu FROM: BIDDER S NAME: BIDDER S ADDRESS: FOR: PROJECT NUMBER: PROJECT TITLE: The Bidder hereby acknowledges, attests, certifies, warrants, and assures that: 1. Bidder has received, read and understands the Bidding Documents and this bid is made in accordance therewith. Failure to complete this Bid Form, provide required attachments, or comply otherwise with instructions to Bidders, may be cause for rejection of bid. 2. Bidder has visited the site and become familiar with the local conditions under which the work is to be performed, and has correlated all observations with the requirements of the Bidding Documents. 3. Contractors and Subcontractors that have been disqualified from participating in State projects have not been included in this bid and will not be allowed to perform work under this contract. 4. Bidder shall not knowingly utilize the services of an illegal immigrant in the performance of this Contract and shall not knowingly utilize the services of any subcontractor or consultant who will utilize the services of an illegal immigrant in the performance of this Contract. 5. If Bid has exceeded $100, the required Bid Security, in the amount of five percent (5%) of the total amount of bid, including alternates, is attached hereto. 6. The person who signs this bid on behalf of the Bidder is legally empowered to bind the Bidder to a Contract. 7. Neither the Bidder nor Subcontractors in the performance of this Contract will utilize materials, procedures or processes that knowingly or intentionally containing Hazardous materials as defined in the Resource Conservation and Recovery Act of 1976 (RCRA), the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), or Environmental Protection Agency (EPA) regulations, rules, or requirements, as amended, and/or State and local regulations, rules, or requirements that are equivalent or more stringent than the Federal regulations to include, but are not limited to, products such as asbestos, lead, and other materials that have proven to cause a health risk by their presence. 8. Iran Divestment Act. The Contractor certifies, under penalty of perjury, that to the best of its Knowledge and belief the Contractor is not on the list created pursuant to Tenn. Code Ann The Contractor further certifies that it shall not utilize any subcontractor that is on the list created pursuant to Tenn. Code Ann APSU University Design And Construction (UDC) APPENDIX 3 DIVISION 00 FORMS, Page 1 of 3 Designers Manual V

15 BID FORM - STIPULATED SUM FOR NON-DELEGATED PROJECTS 9. The Bidder and/or any of the Bidder s employees, agents, independent contractors and/or proposed Subcontractors have been convicted of, pled guilty to, or pled no contest to any contract crime involving a public contract. Yes N o 10. The Bidder is a Certified Diversity or Disadvantaged Business Enterprise, Women Owned, Minority Owned, or Small Business, per TCA If Yes, then indicate the applicable status and name the Certifying Agency below. If No, Indicate N/A. Status: 11. Bidder has received the following addenda: Addendum No. Certifying Agency: Dated: Addendum No. Addendum No. Addendum No. Dated: Dated: Dated: 12. Bidder understands and agrees that the lump sum bid price includes all taxes such as sales, use, excise, licenses, etc., now or hereafter imposed by Federal, State or other government agencies upon the equipment, labor and materials specified, and that all said taxes shall be paid by the Contractor. 13. This Bidder agrees to: A. Honor this bid for a period of sixty (60) days following the date of the scheduled opening of bids. B. Enter into and execute a contract, if presented on the basis of this bid, and to furnish certificates(s) of insurance, bond(s), and other documents related to the contract as required by the Bidding Documents. C. Accomplish the Work in accordance with the Contract Documents. D. Achieve Substantial Completion of the Work in accordance with the number of calendar days Contract Time set forth, allotted from and including the date stipulated in the Notice to Proceed; and, accept the conditions for Liquidated Damages in the amount set forth per calendar day. Phase Commencement Contract Time Liq. Damages ALL Notice to Proceed for All Work 30 $ Per Day E. Subject to Owner acceptance, the Proposed Unit Prices are attached for inclusion in the Agreement. F. Complete the Work of this project for the lump sum of (in both words and figures): BASE BID: and /100ths Dollars $ APSU University Design And Construction (UDC) APPENDIX 3 DIVISION 00 FORMS, Page 2 of 3 Designers Manual V

16 BID FORM - STIPULATED SUM FOR NON-DELEGATED PROJECTS This bid is submitted by: Authorized Signature: Print Name and Title: On Behalf of: Bidder Name: Bidder's Address: Bidder's Phone: Bidder's Fax: Bidder's END OF SECTION APSU University Design And Construction (UDC) APPENDIX 3 DIVISION 00 FORMS, Page 3 of 3 Designers Manual V

17 Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner. Other (see instructions) 5 Address (number, street, and apt. or suite no.) 6 City, state, and ZIP code 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) Requester s name and address (optional) 7 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 line 1 to avoid backup withholding. For individuals, this is generally 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 instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Social security number or 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); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. 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 3. Sign Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: Form 1099-INT (interest earned or paid) Form 1099-DIV (dividends, including those from stocks or mutual funds) Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) Form 1099-S (proceeds from real estate transactions) Form 1099-K (merchant card and third party network transactions) Date Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) Form 1099-C (canceled debt) Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled-out form, you: 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, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Cat. No X Form W-9 (Rev )

18 Form W-9 (Rev ) Page 2 Note. If you are a U.S. person and 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 ). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 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 section 1446 withholding on your share of partnership income. In the cases below, the following person must give 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: In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (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, give the requester the appropriate completed Form W-8 or Form Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% 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, payments made in settlement of payment card and third party network transactions, 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 Exempt payee code on page 3 and the separate Instructions for the Requester of Form W-9 for more information. Also see Special rules for partnerships above. What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information. 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 Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. If this Form W-9 is for a joint account, list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note. ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application. b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or doing business as (DBA) name on line 2. c. Partnership, LLC that is not a single-member LLC, C Corporation, or S Corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2. d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. 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 line 2. e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a disregarded entity. See Regulations section (c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. 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 line 2, Business name/disregarded entity name. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

19 Form W-9 (Rev ) Page 3 Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2. Line 3 Check the appropriate box in line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box in line 3. Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the Limited Liability Company box and enter P in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation, check the Limited Liability Company box and in the space provided enter C for C corporation or S for S corporation. If it is a single-member LLC that is a disregarded entity, do not check the Limited Liability Company box; instead check the first box in line 3 Individual/sole proprietor or single-member LLC. Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space in line 4 any code(s) that may apply to you. Exempt payee code. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 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 U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4 A foreign government or any of its political subdivisions, agencies, or instrumentalities 5 A corporation 6 A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7 A futures commission merchant registered with the Commodity Futures Trading Commission 8 A real estate investment trust 9 An entity registered at all times during the tax year under the Investment Company Act of A common trust fund operated by a bank under section 584(a) 11 A financial institution 12 A middleman known in the investment community as a nominee or custodian 13 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 13. IF the payment is for... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 7 Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to Barter exchange transactions and patronage dividends Payments over $600 required to be reported and direct sales over $5,000 1 Payments made in settlement of payment card or third party network transactions Exempt payees 1 through 4 Generally, exempt payees 1 through 5 2 Exempt payees 1 through 4 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 reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with Not Applicable (or any similar indication) written or printed on the line for a FATCA exemption code. A An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B The United States or any of its agencies or instrumentalities C A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section (c)(1)(i) E A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section (c)(1)(i) F A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state G A real estate investment trust H A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I A common trust fund as defined in section 584(a) J A bank as defined in section 581 K A broker L A trust exempt from tax under section 664 or described in section 4947(a)(1) M A tax exempt trust under a section 403(b) plan or section 457(g) plan Note. You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. Line 6 Enter your city, state, and ZIP code. 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 this page), 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 SSA office or get this form online at You may also get this form by calling 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 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 TAX-FORM ( ). If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and 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 U.S. entity that has a foreign owner must use the appropriate Form W-8.