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HomeMy WebLinkAbout2024-149 AGRMT- Grabowski Paving LLC Goods and Services Agreement City Information Contractor Information City of Ashland Firm Name: Grabowski Paving LLC Attn: Kevin Caldwell Contact: Mike Grabowski 20 East Main Street Address: PO Box 3212 Ashland, Oregon 97520 Central Point, Oregon 97502 Phone: (541) 488-5340 Phone: (541) 601-3906 Email: kevin.caldwell@ashland.or.us Email: grabowskipaving@centurylink.net Contract Summary Procurement Method: Small Procurement Completion Date: 02/28/2025 Contract Amount: $ 11,744.00 Eleven thousand seven hundred and forty-four. Description of Services: Winburn Way Asphalt Patching Supporting Documents: Estimate#2440 Dated: 11/03/2024 Dated: Dated: Dated: This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter"City") and the Contractor listed under Contractor Information above, (hereinafter "Contractor"), for the services listed under Description of Services and the Supporting Documents as noted in the Contract Summary above. This Agreement and the Supporting Documents shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the Supporting Documents. In the event of conflict between provisions of the Supporting Documents, the Supporting Documents shall be given precedence in the order listed above.The Contractor's initials herein signify acknowledgment and agreement to this provision, if applicable, or if not sign "N/A". The goods and services defined and described in the Supporting Documents shall hereinafter be collectively referred to as"Work." Page 1 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC NO 1. Term and Termination 1.1. Term. This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date") and shall continue in full force and effect until the Completion Date indicated in the Contract Summary on page one of this Agreement unless sooner terminated as provided in Subsection 1.2. 1.1. Time is of the essence. Time is of the essence for Contractor's performance of each and every obligation and duty under this Agreement. City, by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this Agreement if Contractor fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. 1.2. Termination 1.2.1. The City and Contractor may terminate this Agreement by mutual agreement at any time. 1.2.2. The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 1.2.3. Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 2. Compensation 2.1. City shall pay Contractor the sum listed as the "Contract Amount" in the Contract Summary on page one of this Agreement as provided herein as full compensation for the Work as specified in the supporting documents. 2.2. In no event shall Contractor's total of all compensation and reimbursement under this Agreement exceed the "Contract Amount" listed in the Contract Summary without express, written approval from the appropriate Department Head or City Manager. Contractor acknowledges that any work delivered, or expenses incurred without authorization as provided herein is done at Contractor's own risk and as a volunteer without expectation of compensation or reimbursement. 3. Contractor's Obligations 3.1. Performance. Provide the goods or services as set forth in the Supporting Documents attached hereto and, by this reference, incorporated herein. 3.2. Nondiscrimination. Contractor agrees that no person shall, on the grounds of race, color, religion,creed,sex, marital status,familial status or domestic partnership, national origin,age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Contractor. Contractor agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Contractor agrees not to discriminate against a disadvantaged business enterprise, minority-owned business,woman- owned business, a business that a service-disabled veteran owns or an emerging small Page 2 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC AV business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 3.3. Subcontractor Notification. In all solicitations either by competitive bidding or negotiation made by Contractor for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Contractors of the Contractor's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 3.4. Living Wage Requirements. If the amount of this Agreement is $26,429.65 or more, Contractor is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Contractor is also required to post the notice attached hereto as "Exhibit A" predominantly in areas where it will be seen by all employees. 4. Contractor's Compliance with Tax Laws 4.1. Contractor represents and warrants to the City that: 4.1.1. Contractor shall, throughout the term of this Agreement, including any extensions hereof, comply with: • All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; • Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Contractor; and • Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 4.1.2. Contractor further certifies that contractor is not in violation of any Oregon tax laws referenced in ORS 305.380(4). 4.2. Tax Compliance Breach. Contractor's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Contractor's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement, at law, or in equity. 5. Insurance. Contractor shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall include: 5.1. Commercial general liability -- with a combined single limit, or the equivalent, of not less than $, 04two million dollars) per occurrence and $ 1¢ 000 (three million dollars) in the aggregate�for Bodily Injury and Property Damage. � U60a G(,(j Page 3 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC 5.2. Commercial Automobile Liability -- with a combined single limit, or the equivalent of not `�e ���� �``1�less than (two Property Dam ludin million dollars) °lfor owned,each accident for Bodily Injury and �" v�C� overaged, hired and nQn-owned vehicles. 5.3. Additional forms: 5r`� vt c:i~ c� "mac G1 fur "r` ` ���.bz iCt� � (LC �� '�' ' ( ee Attached) 5.4. Worker's Compensation. Contractor shall, at its own expense, maintain Worker's Compensation Insurance in compliance with ORS 656.017,which requires subject employers to provide workers' compensation coverage for all of its subject workers. As evidence of the insurance required by this Agreement, the Contractor shall furnish an acceptable insurance certificate prior to commencing any Work with limits not less than $500,000. 5.4.1. Workers' Compensation Exemption: If applicable, Contractor affirms and certifies that it is exempt from providing Workers' Compensation per ORS 656.027. Exemption criteria: Contractor initials if exempt: Date: 6. Additional Insured/Certificates of Insurance. The Contractor shall name the City of Ashland, Oregon, along with its elected officials, officers, and employees, as Additional Insureds on all insurance policies (excluding Professional Liability and Workers' Compensation) necessary for this Agreement. This inclusion applies solely to the services provided by the Contractor under this Agreement. The Contractor's insurance must be primary and non-contributory. Before commencing work, the Contractor must provide acceptable insurance certificates as proof of the required coverage. These certificates must specify all parties included as additional Insureds, treating each named and additional named insured as if they were covered under separate policies, without increasing policy limits. Insuring companies or entities must be accepted by the City. Upon request, the Contractor must provide complete copies of insurance policies and trust agreements to the City.Additionally,the Contractor must provide an endorsement naming the City, its officers, employees, and agents as additional insureds by the Effective Date of this Agreement, accompanied by approved certificate(s) of insurance. 7. Indemnity. Contractor shall defend, save, hold harmless and indemnify the City and its officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Contractor or its officers, employees, contractors, or agents under this Agreement. 8. Notice Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the addresses set forth above with a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, Oregon 97520 Phone: (541)488-5350 Page 4 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC VF 6. Remedies 6.1. In the event Contractor is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 6.1.1. Termination of this Agreement. 6.1.2. Withholding all monies due for the Work that Contractor has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively. 6.1.3. Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief. 6.1.4. These remedies are cumulative to the extent the remedies are not inconsistent, and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 6.2. Default: The Contractor shall be in default of this Agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Agreement; or, without written authorization by the City, attempts to assign rights in, or delegate duties under, this Agreement. 6.3. Liability Limitation. In no event shall City be liable to Contractor for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Contractor exceed the amount due, Contractor shall pay immediately any excess to City upon written demand provided. 7. General Provisions 7.1. Non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Contractor and is free to procure similar types of goods and services from other Contractors in its sole discretion. 7.2. Independent Contractor Status. Contractor is an independent contractor and not an employee or agent of the City for any purpose. 7.3. Statutory Requirements. The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 27913.220, 27913.230 and 27913.235 7.4. Assignment. Contractor shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. Page 5 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC f ��V 7.5. Force Majeure. Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the other's officers, employees or agents. 7.6. Deliveries F.O.B destination. Contractor shall pay all transportation and handling charges for the Goods. Contractor is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Contractor remains liable for latent defects, fraud, and warranties. 7.7. Goods Rejection. The City may reject non-conforming Goods and require Contractor to correct them without charge or deliver them at a reduced price, as negotiated. If Contractor does not cure any defects within a reasonable time,the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 7.8. Goods Warranty Representation. Contractor represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with Supporting Documents and be free from defects in labor, material and manufacture. Contractor shall transfer all warranties to the City. 7.9. Waiver of Breach. One or more waivers or failures to object by either party to the other's breach of any provision, term, condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach, whether or not of the same nature. 7.10. Jurisdiction.This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 7.11. Severance. If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Contractor and the City set forth in this Agreement. 8. Merger. This agreement and the attached exhibits constitute the entire understanding and agreement between the parties. No waiver, consent, modification or change of terms of this agreement shall bind either party unless in writing and signed by both parties. Such waiver, consent, modification or change, if made, shall be effective only in the specific instance and for the specific purpose given. There are no understandings, agreements, or representations, oral or written, not specified herein regarding this agreement. Contractor, by signature of its authorized representative, hereby acknowledges that he/she has read this agreement, understands it, and agrees to be bound by its terms and conditions. Page 6 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC 1° a WITNESS WHEREOF, the parties have executed this Agreement in their respective names by their duly authorized representatives as of the dates indicated below. This Agreement may be executed in two counterparts,each of which shall be deemed an original,with equal force and effect as if executed in a single document. CITY OF SHLAND: Grabow ki Pa g LLC(CONTRACTOR): By, ... By: Signature Rocky Houston,Director (Signature Printed Name Printed Name Date ( � Title Purchase Purchase Order No. Date (W-9 is to be submitted with this signed Agreement) APPROVED AS TO FORM: City Attorney 11.21.24,Carmel Zahran CIA 4� ts�s P''a®r fo (�ej,i,( Sv to do Page 7 of 8: Goods and Services Agreement between the City of Ashland and Grabowski Paving LLC All: Grabowski Paving LLC Grabowski � Proposal PO Box 3212 P�VI1VG Central Point, OR 97502 LLC CCB#213159 Date Estimate# (541)601-3906 111312024 2440 email—grabowskipaving@centurylink.net Customer.- Ashland Parks Job Name/Information Winburn Way Job Site Address Lithia Park Description of Work to be Performed Total Asphalt Patching: Saw cut, excavate the areas to be paved, haul away the debris. Pave three 11,744.00 different failing areas totaling 2587 Square Feet with 3 inches of asphalt compacted. Payment Information/Terms Total Price $11,744.00 Total Due Upon Completion Any balance that is due pursuant to the terms and provisions of this agreement and remain unpaid after 30 days may be assessed interest at a rate of 18%per annum on unpaid balance. Contractor warrants all work to be free of defects in material and workmanship for a period of one year from the date work is completed. The sole and exclusive remedy of the buyer and obligation of contractor for matters set forth in this agreement and the work done by the contractor whether on warranty, contract, or negligence is the repair of the defect.Any change to the above described work made by the customer may result in a change of the total price. Customer has the right to resolve disputes through negotiation directly with the contractor.Acceptance of this proposal acknowledges that this proposal is also to serve as a notice of right to lien the above listed job site property. Upon ACCEPTANCE to have work done please Sign this form which will serve as a contract for the above described work and return to Grr�a//boows��ki Paving LLC. g,fAuthorized Signiture for Grabowski Paving LLC NAM �►/'�O�JfI� This Proposal may withdrawn if not accepted withhin 10 days. member/manager Customer Acceptance The above prices, specifications and conditions are satisfactory and are hereby accepted. Grabowski Paving LLC is herby authorized to do work as specified. Signature of Acceptance Date Printed Name of Customer Signing Contract CITY OF OREGON City of Ashland employersLIVING ALL .-. below must comply with City WAGE regulatingof Ashland laws payment of a living wage. 77 • per hour, effective June 30, 2024. The Living Wage is adjusted annually every ��11�J'�lim June 30 by the Consumer Price Index. • - - . - . , portion of the business of of health care, retirement, their employer, if the 401 K, and IRS eligible employer has ten or more cafeteria plans(including employees, and has received childcare) benefits to the For all hours worked under a financial assistance for the employee's amount of wages, service contract between their project or business from the employer and the City of City of Ashland over Note: For temporary and Ashland if the contract $26,429.65; part-time employees,the exceeds$26,429.65 or more. Living Wage does not apply If their employer is the City of to the first 1040 hours worked Y For all hours worked in a Ashland, including the Parks in any calendar year. For month, if the employee and Recreation Department. more details, please see spends 50%or more of the Ashland Municipal Code employee's time in that month ➢ In calculating the living wage, Section 3,12.020. working on a project or employers may add the value For additional information: Call the Ashland City Manager's office at 541-488-6002 or write to the City Manager, City Hall, 20 East Main Street, Ashland, OR 97520, or visit the City's website at www.ash land.or.us. Notice to Employers: This notice must be posted in areas where it can be seen by all employees. 7" V OF Client#: 172243 GRABPAVI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYr) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER5 024 THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Propel Insurance NAME: Nikki Russell PHONE -- —..— _..__..—. A/c,No Ext 800 499-0933 Fax 6 2045 Cardinal Avenue;Suite 300 — --_ _—. �A/c,�: 866 577-1326 EMAIL—nikki.russell ropelinsurance.com COM Middle Market AODREss:,_— @p Medford,OR 97504-9746 INSURER(S)AFFORDING COVERAGE NAIC# -- INSURER A:Cincinnati Insurance Company 10677 INSURED Grabowski Paving LLC INSURER B:SAIF Corporation 36196 PO Box 3212 INSURER C: Central Point,OR 97502 INSURER D: INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A!D L I -.�. ..—.......__._—._—.,. LTR TYPE OF INSURANCE INSR a POLICY NUMBER POLICY EFFyyy POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS A �( COMMERCIAL GENERAL LIABILITY � -- _. EPP0436407 5/01/2024 05/01/202 EACH OCCURRENCE $1 000000 .. , ... .. _ CLAIMS-MADE �X�OCCUR DAMAGE TO RENTED PREMISES Ea occurrence s500,000 X PD Ded:500 — ---- MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: JECPRO- GENERAL AGGREGATE $2,000,000 X POLICY E PRO F LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY EBA0436407 5/01/2024 05/01/202 COMBINED SINGLE LIMIT X ANY AUTO Ea accident $1,000,000 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X AUTOS HIRED OS ONLY X NON-OWNED PROPERTY DAMAGE AUTOS ONLY der accidents,� $ A X UMBRELLA LIAB X OCCUR EPP0436407 - 05/01/2024 05/01/202 EACH OCCURRENCE $2 QO0 Oq EXCESS LIAB CLAIMS-MADE - .. .—.. ..,—_.. —..---.--- AGGREGATE $2 000 O0O DED RETENTION$ B WORKERS COMPENSATION 871247 $AND EMPLOYERS'LIABILITY Y/N 5/01/2024 05/01/202 X STA TE OTH- ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) **Workers Comp Information** Proprietors/Partners/Executive Officers/Members Excluded: Wendi Grabowski,Member Michael Grabowski, Member (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Ashland-Legal Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE � r I ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S7036731/M6588524 TSK15 DESCRIPTIONS (Continued from Page 1) City of Ashland,Oregon along with its elected officials,officers,and employees. Additional Insured status applies per attached form(s),if required per written contract or agreement. SAGITTA 25.3(2016/03) 2 of 2 #S7036731/M6588524 Form W-9 Request for Taxpayer Give form to the (Rev.March 2024) Identification Number and Certification requester.Do not Department of the Treasury Internal Revenue Service Go to WwWJrs.gov/FormW9 for instructions and the latest information. send to the IRS. Before you begin.For guidance related to the purpose of Form W-9,see Purpose of Form,below. 1 Name of entity/individual.An entry is required.(For a sole proprietor or disregarded entity,enter the owner's name on line 1,and enter the business/disregarded entity's name on line 2.) Grabowski Pavin LLC 2 Business name/disregarded entity name,if different from above. 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1.Check t only one of the following seven boxes.CU 4 Exemptions(codes apply only to Q- certain entities,not individuals; o ❑ Individual/sole proprietor ❑ C corporation ElS corporation ElPartnership ❑ Trust/estate see instructions on page 3): y ❑✓ LLC.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership) a 0 p) P Exempt payee code(if any) Note:Check the"LLC"box above and,in the entry space,enter the appropriate code(C,S,or P)for the tax ` = classification of the LLC,unless it is a disregarded entity.A disregarded entity should instead check the appropriate 0 box for the tax classification of it Exemption from Foreign Account Tax os owner. (aCompliance Act(FATCA)reporting aS ❑ Other(see instructions) code(if any) v d3b If on line 3a you checked"Partnership"or"Trust/estate,"or checked"LLC"and entered"P"as its tax classification, and you are providing this form to a partnership,trust,or estate in which you have an ownership interest,check (Applies to accounts maintained yQ this box if you have any foreign partners,owners,or beneficiaries.See instructions ❑ outside the United States.) ca) 5 Address(number,street,and apt.or suite no.).See instructions. Requester's name and address(optional) PO Box 3212 6 City,state,and ZIP code City of Ashland 20 E Main St Central Point OR 97502 Ashland OR, 97520 7 List account number(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other - M entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN,later. or Note:If the account is in more than one name,see the instructions for line 1.See also What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. JIM 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.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 for Part 11,later. Sign Signature of Here U.S.person �.a Date General Instructions New line 3b has been added to this form.A flow-through entity is reqired to complete isit has direct or Section references are to the Internal Revenue Code unless otherwise fo eign partners,owners,for beof nedciariesatethat when itprovides the Fiorm W-9 noted. to another flow-through entity in which it has an ownership interest.This Future developments.For the latest information about developments change is intended to provide a flow-through entity with information related to Form W-9 and its instructions,such as legislation enacted regarding the status of its indirect foreign partners,owners,or after they were published,go to www.irs.gov/FormW9. beneficiaries,so that it can satisfy any applicable reporting requirements.For example,a partnership that has an indirect foreign What's New partners may be required to complete Schedules K-2 and K-3.See the Line 3a has been modified to clarify how a disregarded entity completes Partnership Instructions for Schedules K-2 and K-3(Form 1065). this line.An LLC that is a disregarded entity should check the Purpose of Form appropriate box for the tax classification of its owner.Otherwise,it should check the"LLC"box and enter its appropriate tax classification. An individual or entity(Form W-9 requester)who is required to file an information return with the IRS is giving you this form because they Cat.No.10231X Form W-9(Rev.3-2024)