Common use of Purpose of Form Clause in Contracts

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes No

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 (ATINATlN), 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 : a Xxxxx 1099-INT 1NT (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 8 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S 5 (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interestintenest), 1098-1098- T (tuition) • Form 1099-C e (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including Oncluding a resident alien), to provide your correct TIN. TlN. If you do not return Form W-9 to the requester nequester with a TINnN, you might be subject SUbject to backup withholding. See What is backup withholding? on page 2. By signing the filled "out form, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noyou:

Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return retum 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) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-1098- 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 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 withholdingWithholding. See What is backup withholdingWithholding? on page 2. By signing the filled-out form, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noyou:

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 1011-20182017) Attachment CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity FORM CIQ This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. OFFICE USE ONLY Date Received Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFPemployment or business relationship described. GENERAL INFORMATION Name Attach additional pages to this Form CIQ as necessary. X. Is the local government officer or a family member of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available officer receiving or likely to complete receive taxable income, other than investment income, from the scope of work remotelyvendor? Yes No EXPERIENCE Number B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of staff dedicated to this contract: Have you provided on-call services for other jurisdictionsthe local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes No Cumulative years other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of experience one percent or more. Check this box if the vendor has given the local government officer or a family member of staff dedicated to the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx Revised 1/1/2021 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Code may be found at xxxx://xxx.xxxxxxxx.xxxxx.xxxxx.xx.xx/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this contract: Brief summary form. Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of relevant credentials for staff dedicated to this contract: CAPACITY one of the parties. The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete term does not include a connection based on-call tasks? Yes No:

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department November 8, 2022 BOARD OF COUNTY COMMISSIONERS ORANGE COUNTY, FLORIDA INVITATION FOR BID (IFB) Y23-105; ADDENDUM #4 MOTOR FUEL TRANSPORT DELIVERIES This Addendum is hereby incorporated into the bid documents of Community Development 000 000xx Xxxxxx SE ■ Sammamishthe project referenced above. The following items are clarifications, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamishcorrections, Washington INSTRUCTIONS Please complete this form additions, deletions, and/or revisions to and include it as shall take precedence over the first page in your RFP responseoriginal documents. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city Additions are indicated by underlining and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Nodeletions via strikethrough.

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete COMPASS WARRANTY PROGRAM ADDENDUM This DEALER AGREEMENT (“Agreement”) is entered into this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noday of

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) paid • Form 1099-DIV (dividends, including those from stocks or mutual mutua funds) • Form 1099-MISC (various types of income, prizes, awards, or gross gros proceeds) • Form 1099-B (stock or mutual fund sales and certain other othe transactions by brokers) • Form 1099-S (proceeds from real estate transactions) transactions • Form 1099-K (merchant card and third party network transactions) transactions • Form 1098 (home mortgage interest), 1098-E (student loan interest), ) 1098-T (tuition) • Form 1099-C (canceled debt) debt • Form 1099-A (acquisition or abandonment of secured property) 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, later. Cat. No. 10231X Form W-9 (Rev. 1011-20182017) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ SammamishForm W-9 (Rev. 11-2017) Page 2 By signing the filled-out form, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noyou:

Purpose of Form. An individual or entity (Form W-9 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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 1011-20182017) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ SammamishForm W-9 (Rev. 11-2017) By signing the filled-out form, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noyou:

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) • 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, later. CON2019-0058 Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ SammamishBy signing the filled-out form, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noyou:

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) • Form 1098 (home mortgage interest), 1098-E (student stUdent loan interest), 1098-1098- T (tuition) 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 SUbject to backup withholding. See What is backup withholding? on page 2. By signing the filled-out form, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes Noyou:

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phoneXXXXXX XXXX / EGFS CONSULTING INC XXXXX://XXXXXXXXXX.XXX HTTPS: XXXXX0XX.XXX CONTACT: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes No0000

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes NoTENANCY ADDENDUM

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 1011-20182017) Attachment CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity FORM CIQ This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. OFFICE USE ONLY Date Received 1 Name of vendor who has a business relationship with local governmental entity. Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFPemployment or business relationship described. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated Attach additional pages to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes NoForm CIQ as necessary.

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Electrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes No:

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ SammamishApplication for Coverage QFS Transportation, WA 98075 ■ phoneLLC Settlement Only Work Sheet Effective Date: 000-000-0000 ■ faxDate email received by TrueNorth SECTION 1 TRUCK OWNER INFORMATION Company Name: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP response. If responding to multiple support service RFP’s, you must complete a separate form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: EmailFirst/Last Name: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope City: State: Zip: Date of work remotely? Yes No EXPERIENCE Number of staff dedicated to this contractBirth: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contractCDL # Contact: Brief summary of relevant credentials for staff dedicated to this contractTelephone: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed under the state and county’s current COVID directions, do you anticipate any restrictions/limitations in the ability to complete on-call tasks? Yes NoFax:

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) • 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, later. Cat. No. 10231X Form W-9 (Rev. 1011-20182017) Attachment B Department of Community Development 000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: 000-000-0000 ■ fax: 000-000-0000 ■ web: xxx.xxxxxxxxx.xx SUPPORT SERVICES REQUEST FOR PROPOSALS COVER SHEET City of Sammamish Department of Community Development Sammamish, Washington INSTRUCTIONS Please complete this form and include it as the first page in your RFP responseNote. If responding you are a U.S. person and a requester gives you a form other than Form W-9 to multiple support service RFP’srequest your TIN, you must complete a separate use the requester’s form for each RFP. GENERAL INFORMATION Name of Company: Support Service: El ectrical Inspection Primary Contact: Title: Phone Number: Email: Address: What city and state are your offices located? Do your staff have the resources available to complete the scope of work remotely? Yes No EXPERIENCE Number of staff dedicated if it is substantially similar to this contractForm W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract: CAPACITY The City often requires fast turnaround of support. Does your current work program allow for this? Yes No Do • An individual who is a U.S. citizen or U.S. resident alien; • A partnership, corporation, company, or association created or organized in the staff dedicated to this contract have access to Bluebeam? Yes No Based on the work allowed United States or under the state and county’s current COVID directions, do you anticipate any restrictions/limitations laws of the United States; • An estate (other than a foreign estate); or • A domestic trust (as defined in the ability to complete onRegulations section 301.7701-call tasks? Yes No7).