HomeMy WebLinkAboutArt in Public Spaces Taxpayer ID �
VE IDIAN-
IDAHO
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER (W-9)
The City of Meridian is required by law to obtain the correct Taxpayer Identification Number (TIN) for each
individual and/or company to whom we make payments. Our files indicate that we either have an open
contract with you or your company or have made payments to you within the last year. Therefore to
adhere to the IRS requirements for disbursements, we must obtain your correct TIN. Please remit this
information with 30 days of this letter to the City of Meridian, 33 E Idaho Ave. Meridian, ID 83642 or you
may fax It to 208-887-4813 Attn: Accounting. If you choose you may submit a standard W-9.
If you do not provide us with this information, you may be subject to a $50 penalty imposed by the IRS
under Section #6723. We are also required to Withhold 31 % of certain payments made to you for failure
to furnish your TIN within 60 days of the first request.
Thank you,
The City of Meridian
Substitute Form W-9
Company Name: S®yGE Cg2E6N
DBA 'Tor GR.EGN
Address: 169-9 uUG-Sr c v A NfC-N yr M etP Di AJ-J_-XVA-10 R361r,6
Taxpayer Identification Number or
Social Security Number(furnish only one)
TYPE OF BUSINESS
( ) Corporation ( ) Government Entity ( ) Nonprofit Organization (Individual ( )
Partnership ( ) Other.
PLEASE CHECK THE SPACE BELOW THAT BEST DESCRIBES THE TYPE OF TRANSACTION FOR WHICH WE MAKE
PAYMENTS TO YOU. (CHECK MORE THAN ONE IF NECESSARY.) IF YOU ARE REQUESTING PAYMENT OF RENTS,
MEDICAL OR MISC. SERVICES, PLEASE BE ADVISED THAT PAYMENT MUST BE UNDER THE NAME AND SOCIAL SECURITY
NUMBER OR TIN OF THE PERSON OR COMPANY WHO SHOULD REPORT THIS TO THE IRS. PLEASE BE SURE THE SS#
OR TIN# WILL IDENTIFY THE NAME GIVEN.
( ) Merchandise ( ) Rents ( ) Service ( ) Medical ( ) Other:
Do You Cary Workers Compensation Insurance ( ) Yes (() No
IF YOU HAVE PROVIDED ON-SITE SERVICE FOR ANY DEPARTMENT WITHIN THE CITY OF MERIDIAN, PLEASE PROVIDE A
"CERTIFICATE OF INSURANCE" FOR WORKERS COMPENSATION. IF YOUR PROVIDER IS THE IDAHO STATE
INSURANCE FUND, PLEASE PROVIDE A COPY OF THE POLICY.
Certification: Under penalties of perjury, I certify that this statement is true:
1. The number provided above is my correct Taxpayer Identification Number, and
2. i am NOT subject to backup Withholding
Signature C1 Date
Print Name ZDyCE E . C�2E6A/ Title
City Hall 33 East Idaho Avenue Meridian, Idaho 83642 (208)8884433
CITY CLERK- FAX 888-4218FINANCE & UTILITY BILLING FAX- 887-4813 MAYOR- FAX 884-8119
IDIAN:--- 1 D
IDAHO
sEp 19 2008
lity of McTicEan
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER (W-gity Clerk Office
The City of Meridian is required by law to obtain the correct Taxpayer Identification Number (TIN) for each
individual and/or company to whom we make payments. Our files indicate that we either have an open
contract with you or your company or have made payments to you within the last year. Therefore to
adhere to the IRS requirements for disbursements, we must obtain your correct TIN. Please remit this
information with 30 days of this letter to the City of Meridian, 33 E Idaho Ave. Meridian, ID 83642 or you
may fax it to 208-887-4813 Attn: Accounting. If you choose you may submit a standard W-9.
If you do not provide us with this information, you may be subject to a $50 penalty imposed by the IRS
under Section #6723. We are also required to Withhold 31 % of certain payments made to you for failure
to furnish your TIN within 60 days of the first request.
Thank you,
The City of Meridian
Company
Addrei
U
Taxpayer Identification Number or
Social Security Number 5) 3 - b a - (fumish only one)
TYPE OF BUSINESS
( ) Corporation ( ) Government Entity ( ) Nonprofit Organization (x) Individual ( )
Partnership ( ) Other:
PLEASE CHECK THE SPACE BELOW THAT BEST DESCRIBES THE TYPE OF TRANSACTION FOR WHICH WE MAKE
PAYMENTS TO YOU. (CHECK MORE THAN ONE IF NECESSARY.) IF YOU ARE REQUESTING PAYMENT OF RENTS,
MEDICAL OR MISC. SERVICES, PLEASE BE ADVISED THAT PAYMENT MUST BE UNDER THE NAME AND SOCIAL SECURITY
NUMBER OR TIN OF THE PERSON OR COMPANY WHO SHOULD REPORT THIS TO THE IRS. PLEASE BE SURE THE SS#
OR TIN# WILL IDENTIFY THE NAME GIVEN.
( ) Merchandise ( ) Rents ( ) Service ( ) Medical ()4,) Other: Q/l-
Do You Cary Workers Compensation Insurance ( ) Yes (x) No
IF YOU HAVE PROVIDED ON-SITE SERVICE FOR ANY DEPARTMENT WITHIN THE CITY OF MERIDIAN, PLEASE PROVIDE A
"CERTIFICATE OF INSURANCE" FOR WORKERS COMPENSATION. IF YOUR PROVIDER IS THE IDAHO STATE
INSURANCE FUND, PLEASE PROVIDE A COPY OF THE POLICY.
Certification: Under penalties of perjury, I certify that this statement is true:
1. The number provided above is my correct Taxpayer Identification Number, and
2. 1 am NOT subject to backup withholding
Signature AAA oDate - iQOO?
Print Name (�-� v P S � . +�A+ L" a , Title 47A)TL2 1
City Hall 33 East Idaho Avenue Meridian, Idaho 83642 (208)888-4433
CITY CLERK- FAX 888-4218FINANCE & UTILITY BILLING FAX- 887-4813 MAYOR- FAX 884-8119