2011 world sport chicago summer track program partner...

World Sport Chicago200 E. Randolph, 20th Floor Chicago, IL 60601Phone: (312) 861-4936Fax: (312) 861-4801Email: [email protected]

Dear Community Partner: World Sport Chicago is excited to announce the third season of our city-wide Summer Track Program! We’d like to offer you and your group an opportunity to field a team with us this summer. This free city-wide program, for boys and girls ages 6 – 14, is designed to provide basic training in the sport as well as community based programming to keep kids active during the summer. The program will run from June through August and is open to youth of all physical and visual abilities. Coaches and parent volunteers work with youth two to four times a week in practice and attend four track meets throughout the season. Last year over 400 children representing over 20 aldermanic wards participated in both track and field events. This year we hope to broaden the scope and reach of the program by inviting Chicago community-based organizations to become our program partners and field a team. We are very enthusiastic about the upcoming season and we hope your community group can participate. Here are some preliminary details:

Schedule: We hope to confirm our participating community groups and their coaching staff by the end of March. The program itself will run from June through August.

Partner Responsibilities: We ask each partner organization to identify a head coach and a primary point of contact for their organization. We also ask each partner to choose and secure their desired practice location which they will use through the summer. Finally, we ask each partner group to have a place, phone number and/or email address where parents can register for your team.

Budget: World Sport Chicago will be able to finance small stipends for the coaches; equipment for the teams; transportation to meets and water at each meet.

Our hope is to identify participating community group partners by the end of March. We will schedule an orientation meeting for all community partner representatives and coaches in April to make sure that the process runs smoothly. If you are interested in participating please review the attached informational packet, fill out the forms at the end of this packet and return to us by April 1st via fax at (312) 861-4801 or email at [email protected]. Please be aware that we need to cap the number of teams at 30, so if you are interested in fielding a team please complete and return the form to us as soon as possible as teams will be confirmed on a first come first served basis. You can also reach us at (312) 861-4936 if you have questions. Sincerely,

Scott Myers, Executive Director, World Sport Chicago

Obj ti d G l f th P Objectives and Goals of the Program: ◦ To build off of the success of last year’s program and increase the number

of participants and teams by extending opportunities for Chicago community groups to field a team.

◦ To instill Olympic values in youth participating in the program ◦ Provide a safe and fun environment for participants ◦ Keep kids active, excited and engaged in track and field ◦ Provide basic training in track and field events and opportunities for fun

and rewarding competition.

Key Dates: ◦ Practices start the week of June 20th (ideally 2- 3 per week 60 – 90Practices start the week of June 20 (ideally 2 3 per week, 60 90

minutes each) ◦ Practices are scheduled to end during the week of August 15th – 19th

◦ Registration is scheduled to open on April 19th

◦ Track Meet Dates: Saturday, June 25th (practice meet)

S d J l 16th ( i ) Saturday, July 16th (practice meet) Saturday, August 6th (qualifier meet) Saturday, August 20th (championship meet) Saturday, August 27th (rain date, if needed)

◦ Planning Meetings and Other Dates to Remember: Program Orientation and Informational meeting for community group Program Orientation and Informational meeting for community group

leaders – end of April or early May Coaches Informational Meeting – May

Participant Information: ◦ Boys and girls ages 6 – 14 are welcome to participate in the program y g g p p p g◦ Resources for Kids with Physical Disabilities: The program is open to

both able-bodied youth and youth with physical or visual disabilities. Specially trained coaches and equipment (including track racing chairs) will be provided by World Sport Chicago for kids who need them. For more information about the Summer Track Program for youth with physical or visual disabilities, contact World Sport Chicago’s Director of Disability and Paralympic Sport at track@worldsportchicago or or (312)Disability and Paralympic Sport at [email protected] or (312) 861-4848.

Community Group/Partner Organizations: ◦ Maintain a roster of at least (15) athletes ages 6 – 14 to practices and

meets. Teams should be introductory in nature and must be open regardless of race, gender and physical or visual ability.

◦ Provide one or more coaches to work with the team throughout theProvide one or more coaches to work with the team throughout the summer. Coaches should have experience working with this age group and are subject to a background screening.

◦ Secure a practice location. WSC will provide support in working with the Chicago Public Schools and the Chicago Park District or other entities if needed.

◦ Have a place, phone number and/or email address where parents can p , p pregister for your team.

◦ Be a registered business or organization in the city of Chicago. ◦ Attend all scheduled meets.

Coaches Responsibilities: ◦ Coaches should be locals with an interest in athletics who can serve as◦ Coaches should be locals with an interest in athletics, who can serve as

role models. ◦ Coaches will run two – three practices a week (preferably 60 – 90 minutes

each). ◦ All coaches and assistant coaches are required to undergo a background

check. ◦ Coaches will also need to attend the coaches briefing meeting which will◦ Coaches will also need to attend the coaches briefing meeting which will

take place in May.

World Sport Chicago will: ◦ Provide basic equipment (batons, softballs, stop watches, measuring tape,

etc.) for practices. P id h l b t t ti f th t t d f t◦ Provide school bus transportation for the team to and from meets.

◦ Provide additional specialist support for athletes with physical or visual disabilities.

◦ Provide secondary accident insurance for all athletes and coaches. ◦ Manage administration and volunteer staff to run meets. ◦ Provide a $600 grant to each partner organization to cover coaching and

administrative expenses at the end of the summer.

How to Become a Partner (Partnership Commitment Form):

d i d b l d d In order to sign up a team and become a partner, please read and complete the partnership commitment form, the team information form and the W-9 form which can be found at the end of this packet. Return your completed forms to us as soon as possible or by April 1st. We need to cap the number of teams at 30 and teams will be confirmed on a first come first served basis as we receive the completed commitmentfirst come, first served basis as we receive the completed commitment forms.

How Kids Can Register for the Program: After we receive your completed partner commitment form, we will y p p ,

send you detailed information on how the registration process will work. Parents will need to sign up their child by completing a sign-up sheet and participant waiver which we will provide to you. Registration is scheduled to open on April 19th.

Coaches Required Background Check: All head and assistant coaches will need to submit to a standard

criminal background check performed for World Sport Chicago by a licensed third party.

How to Identify a Practice Location: We are asking each partner to do their best to secure a practice location.

WSC will provide support in working with the Chicago Public Schools and the Chicago Park District or other entities if needed. a d t e C cago a st ct o ot e e t t es eeded.

In order to sign up your group please complete and return this form to World Sport Chicago by April 1st or as soon as possible. The number of teams will be capped at 30 and groups will be confirmed on a first come, first served basis. Once the completed form is received we will contact you with more details.

O i i NOrganization Name:_____________________________________________________________________

Address: ______________________________________________________________________________

City: __________________________ ______ State: __________ Zip: __________________________

Group Leader Contact Name: ___________________________ ______ Title: ______________________p ___________________________ ______ ______________________

Email Address: _____________________________ _____ Website address: _______________________

Phone: ___________________________ Alternate Phone: ___________________________________

The partner organization listed above agrees to take on the following roles and responsibilities: Maintain a roster of at least (15) athletes ages 6 14 for practices and meets Teams should be introductory Maintain a roster of at least (15) athletes ages 6 – 14 for practices and meets. Teams should be introductory

in nature and must be open regardless of race, gender and physical or visual ability. Provide one or more coaches to work with the team throughout the summer. Coaches should have experience

working with this age group and are subject to a background screening. Secure a practice location. WSC will provide support in working with the Chicago Public Schools and the

Chicago Park District if needed. Have a place, phone number and/or email address where parents can register for your team. Be a registered business or organization in the city of Chicago. Attend all scheduled meets.

Coaches responsibilities will include the following: Coaches should be locals with an interest in athletics, who can serve as role models. Coaches will run two – three practices a week (preferably 60 – 90 minutes each) during evening hours. All coaches and assistant coaches are required to undergo a background check. Coaches will also need to attend the coaches briefing meeting which will take place in May. g g p y

World Sport Chicago will provide the following: Provide basic equipment (batons, softballs, stop watches, measuring tape, etc.) for practices. Provide school bus transportation for the team to and from meets. Provide additional specialist support for athletes with physical or visual disabilities. Provide secondary accident insurance for all athletes and coaches. Manage administration and volunteer staff to run meets Manage administration and volunteer staff to run meets. Provide a $600 grant to each partner organization to cover coaching and administrative expenses at the end of

the summer.

I ______________________________, represent the above listed partner organization. I have read and understand the above partnership and coaches responsibilities and agree to commit to executing these responsibilities.

Signature of Community Partner Group Leader:Signature of Community Partner Group Leader: ____________________________________________________

Date: _____________________________________________________

Please return this form to World Sport Chicago, Attn: Amanda Sowa Fax: (312) 861-4801Email: [email protected]

Please complete and return this form to World Sport Chicago by April 6th.

Community Organization/Group Name:_________________________________________________

Practice Information:

Practice Location: ________________________________________________________________________

Add f P ti L tiAddress of Practice Location: ______________________________________________________________

On which days of the week will practices be held?: ____________________________________________

What times will practices be held? __________________________________________________________

Registration Information:

Registration Location (please list the location and address where your group plans on taking registration here):

_______________________________________________________________________________________

Phone # for Registration: ______________________ __ Fax # (if applicable): ____________________

Email Address for Registration: ___________________________________________________________

Office/Administrative Contact: ____________________________________________________________

Coach Information:

Name of Head Coach: ___________________________________________________________________

Phone number for Head Coach: ___________________________________________________________

Email address for Head Coach: ____________________________________________________________

Mailing Address for Head Coach: ___________________________________________________________

Assistant Coach (if you have any assistant coaches, please list their names here:)

__________________________________________________________________________________________________________________________________________________________________________________

Please return this form to World Sport Chicago, Attn: Amanda Sowa

Fax: (312) 861-4801

Email: [email protected]

INSTRUCTIONS TO PRINTERSFORM W-9, PAGE 1 of 4MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES. PRINTS: HEAD to HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")PERFORATE: (NONE)

Give form to therequester. Do notsend to the IRS.

Form W-9 Request for TaxpayerIdentification Number and Certification

(Rev. October 2007) Department of the TreasuryInternal Revenue Service Name (as shown on your income tax return)

List account number(s) here (optional)

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Pri

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2.

Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoidbackup withholding. For individuals, this is your social security number (SSN). However, for a residentalien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it isyour employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Social security number

or

Requester’s name and address (optional)

Employer identification number Note. If the account is in more than one name, see the chart on page 4 for guidelines on whosenumber to enter. Certification

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 I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the InternalRevenue 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 hasnotified me that I am no longer subject to backup withholding, and

2.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backupwithholding 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 retirementarrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you mustprovide your correct TIN. See the instructions on page 4. SignHere

Signature ofU.S. person ©

Date ©

General Instructions

Form W-9 (Rev. 10-2007)

Part I

Part II

Business name, if different from above

Cat. No. 10231X

Check appropriate box:

Under penalties of perjury, I certify that:

13 I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

TLS, have youtransmitted all R text files for this cycle update?

Date

Action

Revised proofsrequested

Date

Signature

O.K. to print

Use Form W-9 only if you are a U.S. person (including aresident alien), to provide your correct TIN to the personrequesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you arewaiting 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 aU.S. person, your allocable share of any partnership income froma U.S. trade or business is not subject to the withholding tax onforeign partners’ share of effectively connected income.

3. I am a U.S. citizen or other U.S. person (defined below).

A person who is required to file an information return with theIRS must obtain your correct taxpayer identification number (TIN)to report, for example, income paid to you, real estatetransactions, mortgage interest you paid, acquisition orabandonment of secured property, cancellation of debt, orcontributions you made to an IRA.

Individual/Sole proprietor

Corporation

Partnership

Other (see instructions) ©

Note. If a requester gives you a form other than Form W-9 torequest your TIN, you must use the requester’s form if it issubstantially similar to this Form W-9.

● 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 UnitedStates, ● An estate (other than a foreign estate), or

Definition of a U.S. person. For federal tax purposes, you areconsidered a U.S. person if you are:

Special rules for partnerships. Partnerships that conduct atrade or business in the United States are generally required topay a withholding tax on any foreign partners’ share of incomefrom such business. Further, in certain cases where a Form W-9has not been received, a partnership is required to presume thata partner is a foreign person, and pay the withholding tax.Therefore, if you are a U.S. person that is a partner in apartnership conducting a trade or business in the United States,provide Form W-9 to the partnership to establish your U.S.status and avoid withholding on your share of partnershipincome. The person who gives Form W-9 to the partnership forpurposes of establishing its U.S. status and avoiding withholdingon its allocable share of net income from the partnershipconducting a trade or business in the United States is in thefollowing cases: ● The U.S. owner of a disregarded entity and not the entity,

Section references are to the Internal Revenue Code unlessotherwise noted.

● A domestic trust (as defined in Regulations section301.7701-7).

Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) ©

Exempt payee

Purpose of Form

INSTRUCTIONS TO PRINTERSFORM W-9, PAGE 2 of 4MARGINS: TOP 13 mm (1⁄ 2"), CENTER SIDES. PRINTS: HEAD to HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216 mm (81⁄ 2") 3 279 mm (11")PERFORATE: (NONE)

Form W-9 (Rev. 10-2007) Page 2

Sole proprietor. Enter your individual name as shown on yourincome tax return on the “Name” line. You may enter yourbusiness, trade, or “doing business as (DBA)” name on the“Business name” line.

13 I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING


Other entities. Enter your business name as shown on requiredfederal tax documents on the “Name” line. This name shouldmatch the name shown on the charter or other legal documentcreating the entity. You may enter any business, trade, or DBAname on the “Business name” line.

If the account is in joint names, list first, and then circle, thename of the person or entity whose number you entered in Part Iof the form.

Specific Instructions Name

Exempt Payee

5. You do not certify to the requester that you are not subjectto backup withholding under 4 above (for reportable interest anddividend accounts opened after 1983 only). Certain payees and payments are exempt from backupwithholding. See the instructions below and the separateInstructions for the Requester of Form W-9.

Civil penalty for false information with respect towithholding. If you make a false statement with no reasonablebasis that results in no backup withholding, you are subject to a$500 penalty. Criminal penalty for falsifying information. Willfully falsifyingcertifications or affirmations may subject you to criminalpenalties including fines and/or imprisonment.

Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to arequester, you are subject to a penalty of $50 for each suchfailure unless your failure is due to reasonable cause and not towillful neglect.

Misuse of TINs. If the requester discloses or uses TINs inviolation of federal law, the requester may be subject to civil andcriminal penalties.

If you are an individual, you must generally enter the nameshown on your income tax return. However, if you have changedyour last name, for instance, due to marriage without informingthe Social Security Administration of the name change, enteryour first name, the last name shown on your social securitycard, and your new last name.

If you are exempt from backup withholding, enter your name asdescribed above and check the appropriate box for your status,then check the “Exempt payee” box in the line following thebusiness name, sign and date the form.

4. The IRS tells you that you are subject to backupwithholding because you did not report all your interest anddividends on your tax return (for reportable interest anddividends only), or

3. The IRS tells the requester that you furnished an incorrectTIN,

2. You do not certify your TIN when required (see the Part IIinstructions on page 3 for details),

You will not be subject to backup withholding on paymentsyou receive if you give the requester your correct TIN, make theproper certifications, and report all your taxable interest anddividends on your tax return.

1. You do not furnish your TIN to the requester,

What is backup withholding? Persons making certain paymentsto you must under certain conditions withhold and pay to theIRS 28% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding includeinterest, tax-exempt interest, dividends, broker and barterexchange transactions, rents, royalties, nonemployee pay, andcertain payments from fishing boat operators. Real estatetransactions are not subject to backup withholding.

Payments you receive will be subject to backupwithholding if:

If you are a nonresident alien or a foreign entity not subject tobackup withholding, give the requester the appropriatecompleted Form W-8.

Example. Article 20 of the U.S.-China income tax treaty allowsan exemption from tax for scholarship income received by aChinese student temporarily present in the United States. UnderU.S. law, this student will become a resident alien for taxpurposes if his or her stay in the United States exceeds 5calendar years. However, paragraph 2 of the first Protocol to theU.S.-China treaty (dated April 30, 1984) allows the provisions ofArticle 20 to continue to apply even after the Chinese studentbecomes a resident alien of the United States. A Chinesestudent who qualifies for this exception (under paragraph 2 ofthe first protocol) and is relying on this exception to claim anexemption from tax on his or her scholarship or fellowshipincome would attach to Form W-9 a statement that includes theinformation described above to support that exemption.

Note. You are requested to check the appropriate box for yourstatus (individual/sole proprietor, corporation, etc.).

4. The type and amount of income that qualifies for theexemption from tax. 5. Sufficient facts to justify the exemption from tax under theterms of the treaty article.

Nonresident alien who becomes a resident alien. Generally,only a nonresident alien individual may use the terms of a taxtreaty 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 maypermit an exemption from tax to continue for certain types ofincome 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 exceptioncontained in the saving clause of a tax treaty to claim anexemption from U.S. tax on certain types of income, you mustattach a statement to Form W-9 that specifies the following fiveitems: 1. The treaty country. Generally, this must be the same treatyunder which you claimed exemption from tax as a nonresidentalien. 2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty thatcontains the saving clause and its exceptions.

Also see Special rules for partnerships on page 1.

Foreign person. If you are a foreign person, do not use FormW-9. Instead, use the appropriate Form W-8 (see Publication515, Withholding of Tax on Nonresident Aliens and ForeignEntities).

● The U.S. grantor or other owner of a grantor trust and not thetrust, and ● The U.S. trust (other than a grantor trust) and not thebeneficiaries of the trust.

Limited liability company (LLC). Check the “Limited liabilitycompany” box only and enter the appropriate code for the taxclassification (“D” for disregarded entity, “C” for corporation, “P” for partnership) in the space provided. For a single-member LLC (including a foreign LLC with adomestic owner) that is disregarded as an entity separate fromits owner under Regulations section 301.7701-3, enter theowner’s name on the “Name” line. Enter the LLC’s name on the“Business name” line. For an LLC classified as a partnership or a corporation, enterthe LLC’s name on the “Name” line and any business, trade, orDBA name on the “Business name” line.


I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING



13

Part I. Taxpayer IdentificationNumber (TIN) Enter your TIN in the appropriate box. If you are a residentalien 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 nothave an ITIN, see How to get a TIN below.

How to get a TIN. If you do not have a TIN, apply for oneimmediately. To apply for an SSN, get Form SS-5, Applicationfor a Social Security Card, from your local Social SecurityAdministration office or get this form online at www.ssa.gov. Youmay also get this form by calling 1-800-772-1213. Use FormW-7, Application for IRS Individual Taxpayer IdentificationNumber, to apply for an ITIN, or Form SS-4, Application forEmployer Identification Number, to apply for an EIN. You canapply for an EIN online by accessing the IRS website atwww.irs.gov/businesses and clicking on Employer IdentificationNumber (EIN) under Starting a Business. You can get Forms W-7and SS-4 from the IRS by visiting www.irs.gov or by calling1-800-TAX-FORM (1-800-829-3676). If you are asked to complete Form W-9 but do not have a TIN,write “Applied For” in the space for the TIN, sign and date theform, and give it to the requester. For interest and dividendpayments, and certain payments made with respect to readilytradable instruments, generally you will have 60 days to get aTIN and give it to the requester before you are subject to backupwithholding on payments. The 60-day rule does not apply toother types of payments. You will be subject to backupwithholding on all such payments until you provide your TIN tothe requester.

If you are a sole proprietor and you have an EIN, you mayenter either your SSN or EIN. However, the IRS prefers that youuse your SSN. If you are a single-member LLC that is disregarded as anentity separate from its owner (see Limited liability company(LLC) on page 2), enter the owner’s SSN (or EIN, if the ownerhas one). Do not enter the disregarded entity’s EIN. If the LLC isclassified as a corporation or partnership, enter the entity’s EIN. Note. See the chart on page 4 for further clarification of nameand TIN combinations.

Note. Entering “Applied For” means that you have alreadyapplied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign ownermust use the appropriate Form W-8.

9. A futures commission merchant registered with theCommodity Futures Trading Commission, 10. A real estate investment trust,

11. An entity registered at all times during the tax year underthe Investment Company Act of 1940, 12. A common trust fund operated by a bank under section584(a), 13. A financial institution,

14. A middleman known in the investment community as anominee or custodian, or 15. A trust exempt from tax under section 664 or described insection 4947.

THEN the payment is exemptfor . . .

IF the payment is for . . .

All exempt payees except for 9

Interest and dividend payments

Exempt payees 1 through 13.Also, a person registered underthe Investment Advisers Act of1940 who regularly acts as abroker

Broker transactions

Exempt payees 1 through 5

Barter exchange transactionsand patronage dividends

Generally, exempt payees 1 through 7

Payments over $600 requiredto be reported and directsales over $5,000 See Form 1099-MISC, Miscellaneous Income, and its instructions. However, the following payments made to a corporation (including grossproceeds paid to an attorney under section 6045(f), even if the attorney is acorporation) and reportable on Form 1099-MISC are not exempt frombackup withholding: medical and health care payments, attorneys’ fees, andpayments for services paid by a federal executive agency.

The chart below shows types of payments that may beexempt from backup withholding. The chart applies to theexempt payees listed above, 1 through 15.

1 2

7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in

the United States, the District of Columbia, or a possession ofthe United States,

2

The following payees are exempt from backup withholding: 1. An organization exempt from tax under section 501(a), any

IRA, or a custodial account under section 403(b)(7) if the accountsatisfies the requirements of section 401(f)(2), 2. The United States or any of its agencies orinstrumentalities, 3. A state, the District of Columbia, a possession of the UnitedStates, or any of their political subdivisions or instrumentalities, 4. A foreign government or any of its political subdivisions,agencies, or instrumentalities, or 5. An international organization or any of its agencies orinstrumentalities. Other payees that may be exempt from backup withholdinginclude: 6. A corporation,

Generally, individuals (including sole proprietors) are not exemptfrom backup withholding. Corporations are exempt from backupwithholding for certain payments, such as interest and dividends. Note. If you are exempt from backup withholding, you shouldstill complete this form to avoid possible erroneous backupwithholding.

1

1. Interest, dividend, and barter exchange accountsopened before 1984 and broker accounts considered activeduring 1983. You must give your correct TIN, but you do nothave to sign the certification. 2. Interest, dividend, broker, and barter exchangeaccounts opened after 1983 and broker accounts consideredinactive during 1983. You must sign the certification or backupwithholding will apply. If you are subject to backup withholdingand you are merely providing your correct TIN to the requester,you must cross out item 2 in the certification before signing theform.

Part II. Certification

For a joint account, only the person whose TIN is shown inPart I should sign (when required). Exempt payees, see ExemptPayee on page 2.

To establish to the withholding agent that you are a U.S. person,or resident alien, sign Form W-9. You may be requested to signby the withholding agent even if items 1, 4, and 5 below indicateotherwise.

Signature requirements. Complete the certification as indicatedin 1 through 5 below.



I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING


Give name and EIN of:

For this type of account:

3. Real estate transactions. You must sign the certification.You may cross out item 2 of the certification.

A valid trust, estate, or pension trust

6.

Legal entity 4

4. Other payments. You must give your correct TIN, but youdo not have to sign the certification unless you have beennotified that you have previously given an incorrect TIN. “Otherpayments” include payments made in the course of therequester’s trade or business for rents, royalties, goods (otherthan bills for merchandise), medical and health care services(including payments to corporations), payments to anonemployee for services, payments to certain fishing boat crewmembers and fishermen, and gross proceeds paid to attorneys(including payments to corporations).

The corporation

Corporate or LLC electingcorporate status on Form 8832

7.

The organization

Association, club, religious,charitable, educational, or othertax-exempt organization

8.

5. Mortgage interest paid by you, acquisition orabandonment of secured property, cancellation of debt,qualified tuition program payments (under section 529), IRA,Coverdell ESA, Archer MSA or HSA contributions ordistributions, and pension distributions. You must give yourcorrect TIN, but you do not have to sign the certification.

The partnership

Partnership or multi-member LLC

9.

The broker or nominee

A broker or registered nominee

10.

The public entity

Account with the Department ofAgriculture in the name of a publicentity (such as a state or localgovernment, school district, orprison) that receives agriculturalprogram payments

11.

Privacy Act Notice

List first and circle the name of the person whose number you furnish. If only one personon a joint account has an SSN, that person’s number must be furnished. Circle the minor’s name and furnish the minor’s SSN. You must show your individual name and you may also enter your business or “DBA” name on the second name line. You may use either your SSN or EIN (if you have one),but the IRS encourages you to use your SSN. List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TINof the personal representative or trustee unless the legal entity itself is not designated inthe account title.) Also see Special rules for partnerships on page 1.

Note. If no name is circled when more than one name is listed,the number will be considered to be that of the first name listed.

Disregarded entity not owned by anindividual

The owner

12.

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You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain otherpayments to a payee who does not give a TIN to a payer. Certain penalties may also apply.

Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, orcontributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federalnontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

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Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personalinformation such as your name, social security number (SSN), orother identifying information, without your permission, to commitfraud or other crimes. An identity thief may use your SSN to geta job or may file a tax return using your SSN to receive a refund.

What Name and Number To Give the Requester Give name and SSN of:

For this type of account:

The individual

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Individual The actual owner of the account or,

if combined funds, the firstindividual on the account

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Two or more individuals (jointaccount)

The minor 2

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Custodian account of a minor(Uniform Gift to Minors Act) The grantor-trustee

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a. The usual revocable savingstrust (grantor is also trustee) The actual owner

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b. So-called trust account that isnot a legal or valid trust understate law The owner

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5.

Sole proprietorship or disregardedentity owned by an individual

Call the IRS at 1-800-829-1040 if you think your identity hasbeen used inappropriately for tax purposes.

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To reduce your risk: ● Protect your SSN, ● Ensure your employer is protecting your SSN, and ● Be careful when choosing a tax preparer.

Victims of identity theft who are experiencing economic harmor a system problem, or are seeking help in resolving taxproblems that have not been resolved through normal channels,may be eligible for Taxpayer Advocate Service (TAS) assistance.You can reach TAS by calling the TAS toll-free case intake lineat 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishingschemes. Phishing is the creation and use of email andwebsites designed to mimic legitimate business emails andwebsites. The most common act is sending an email to a userfalsely claiming to be an established legitimate enterprise in anattempt to scam the user into surrendering private informationthat will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails.Also, the IRS does not request personal detailed informationthrough email or ask taxpayers for the PIN numbers, passwords,or similar secret access information for their credit card, bank, orother financial accounts. If you receive an unsolicited email claiming to be from the IRS,forward this message to [email protected]. You may also reportmisuse of the IRS name, logo, or other IRS personal property tothe Treasury Inspector General for Tax Administration at1-800-366-4484. You can forward suspicious emails to theFederal Trade Commission at: [email protected] or contact them atwww.consumer.gov/idtheft or 1-877-IDTHEFT(438-4338).

Visit the IRS website at www.irs.gov to learn more aboutidentity theft and how to reduce your risk.

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