17-044 Curren Consulting 2017 Pavement Maintenance Project Phase 1, Project No. 2017-104 (W-9 Info)Form W-9
(Rai. Deosrnber 2014)
Daparmisnto tha Treasury
Intamsl Revenue Ssntlce
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do noi
send to the IRS.
1 Name (as si'own on your income tax return). Nams is required on this line: do not leave this line blank.
Paul R. Curren
2 Business name/disregarded entity name, if different lrom above
Curren Consulting
3 Check appropriate box Toy federal tax classification; check only one of the following seven boxes:
Qlndividual/sole proprietor or [] C Corporation 0 S Corporation 0 Partnership 0 Trust/estatesingle-member LLC
[]Limited liability company. Enter the tax classification (C=C corporation, S:_S corporation, P=partnership) >
Note. For a single-member LLC that is disregarded. do not check LLC: check the appropriate box in the line above forthe tax classification of the single-member owner.
4 Exemptlons (codes apply only to
cenain entities, not individuals: see
instructions on page 3):
, Exempt payee code (if any)
Exemption from FATC,A reportingI
i code (if any)
[]Other (see instructions) k
llAppllas to occoums mmnlained nu(slde rhe U S l5 Address (number, sireet, and apt. ot suite no.)
214 Bodega Avenue
Requesteras name and address (optional)
iCity of Cupertino
2017 Pavement Maintenance Project
iCity Project 2017-104
6 City. state, and ZIP code
Petaluma, CA 94952
7 List account numberis) here (optional)
g Taxpayer Identification Number (T IN)
2
I
7 8 5
F!
CQ
IWr
Enter
backi
resid;-
entitic
TIN on page 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 forguidelines on whose number to enter.
or
E:mployer identfflaatlon number
Certification
Llnder penalties of per%ury, I certify that:
L The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal RevenueService (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me tha! I a(nno longer subject to backup withholding; and
3. I am a u.s. citizen or other u.s. person (defined below), and
4. The FATCA code(s) entered on this form (if any) indlcating that I am exempt from FATCA reporting is correct.
CertHication tnstructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholdingbecause you have failed to report all interest and dlvidends on your tax return. For real estate transactions, item 2 does not apply. For mortgageinterest pald, acquisition or abandonment secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), andgenerally, payments other than ' and ' you are not required to sign the certification, but you must provide your correct TIN. See theinstructions on page 3. /
s'Gln Signature ot
Here u.s. person >
General I ons h Form 1098 (home morigage mterest). 1098-E (student loan interest), 1098-7(tuition)
Sedion references are to the Internal Rgvenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs.goWfw9
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 (T IN)
which may be your social secunty number (SSN), Individual taxpayer identification
number (ITIN), adopiion 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 eamed or paid)
ii Form 1099-DIV (dividends, including those from stocks or mutual funds)
* Form 1099-MISC (various types of income, pnzes, awgds, or gross proceeds)
* Form 1099-B (s!ock or mutual fund sales and certain other transactions by
brokers)
ii Form 1099-S (proceeds from real estate transactions)
ii Form 1 099-K (merchant card and third party nehvoik transactions)
* Form 1099-C (canceled debt)
a Form 1 099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a u.s. perSOn (including a resident alien), toprovide your correct TIN.
If you do nor retum Form W-9 to the requester wHh a nN, you rrught be subject
to backup withholdrng. See Whak is backup wrthholding? on pagei 2.
By srgning the filled-out form. you:
'1. Certify that the TIN you are giving is correct (or you are waiiing for a numberto be issued),
2. Certify that you are not subjed to backup withholding, oy
3. Claim exemption from backup withholding if you are a U.S. exempt payee li
applicable, you are also certifying that as a u.s. perSOn. your allocable share of
any partnership income from a u.s. trade or business is not subject to the
withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you a(e
exempt from the FATCA reporting, is conect. See What is FATCA reporfing? onpage 2 for further infomiation.
Cat. No. 10231X