HomeMy WebLinkAboutInsurance Guidelines• Insurance Guidelines for the City of Renton
The City of Renton requires current insurance certificates for one or
more of the following lines of coverage and minimum insurance limits:
• $1,000,000 per occurrence and $2,000,000 aggregate for Commercial General Liability
(CGL) or Special Event coverage. Limits may be increased for higher than usual or special
liability exposures.
• $1,000,000 combined single limit for Auto Liability. Required if a commercial vehicle will
be used in performance of work or delivery of products, beyond normal commutes.
• Proof of Workers' Compensation coverage, as required by the State of Washington
(provide the Washington L&1 or excess coverage policy number).
• Excess Liability or Umbrella. Required only if needed to reach minimum CGL or auto
liability coverage limits.
• $1,000,000 Professional Liability. Required if professional services (e.g. architect,
engineering, surveying, legal, or medical) are being provided to the city and if those
professional services are excluded from the CGL policy.
• $1,000,000 Pollution Liability. Required if work involves a pollution risk to the
environment.
• $2,000,000 Cyber Liability Insurance. Required for information technology professional
services agreements. Limits may be higher for special liability exposures.
• Builders Risk. May be required up to the amount of the completed value of a new
building or major construction project.
• $1,000,000 per occurrence Aircraft Liability (Single Limit Bodily Injury and Property
Damage Liability). Required coverage only for aircraft tie -down leases.
Additional requirements unique to the City of Renton:
• Name the City of Renton as a certificate holder and a Primary and Non -Contributory
Additional Insured on the policy,
This requirement applies to Commercial General, Auto Liability, Excess/ Umbrella, Special
Event, and Aircraft Liability policies; it does not apply to Professional Liability, Workers'
Compensation, nor Cyber Insurance.
• The Certificate Holder should read:
City of Renton
ATTN: [your City contact's name & department]
1055 South Grady Way
Renton, WA 98057
• The City shall be provided with written notice of any policy cancellation within a
minimum of two business days of receipt of such notice by the policy holder.
• The city does not represent that the minimum required insurance coverage or limits are
adequate to protect the vendor/contractor/consultant from all liabilities.
• Insurance certificate requirements and minimum limits can only be waived or modified
with Risk Manager approval.
Direct any questions, comments, or concerns to: Knsta Kolaz, Risk Management
425-430-7669
kkolaz@rentonwa.gov
Revised 6/8/23
Vendor Setup Form
City of Renton Finance Department
1055 South Grady Way — 51h Floor
Renton, WA 98057
www.rentonwa.gov
Instructions: Complete a I sect ons of this form and return this form by fax (425) 430-6957, U.S. Mail or email.
Failure to submit a W-9 can create a de ay in our payments to you, and your payment(s) could be subject to the
IRS required back up withholding
Name
Check Payable to if different than above
Address
City State Zip
Please check all that apply:
❑ Disadvantaged Business Enterprise
❑ Minority Business Enterprise
❑ Women Business Enterprise
Who is your contact person at the City of Renton?
City of Renton Department you are working with?
Account #
Pease attach a voided check or direct deposit letter from your bank
EIN
Accounts Receivable Contact
Accounts Receivable Phone Number
Please Provide a Current W-9 form
https://www.irs.gov/pub/irs-pdf/fw9.pdf
City of Renton Business license is required by City of
Renton municipal code, Business regulation #5-5-3.
Renton Business license #
State of Washington UBI #
Questions? Contact Business Licensing at
https://rentonwa.gov/businesslicensing
Routing #,
I/we hereby give the City of Renton the authority to make EFT direct depos is to the bank account described above. I/we understand that if this EFT
agreement is to be changed or canceled in any way that I/we must provide 30 day advance written notice to the City of Renton at the above
address.
Signature
Printed Name
Date
w_9
Request for Taxpayer
Give Form to the
Form
Identification Number and Certification
requester. Do not
(Rev. October2018)
Department of the Treasury
send to the IRS.
Internal
Revenue Service
► Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this ine, do not leave this line blank.
2 Business name/disregarded entity name, if d fferent from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
following seven boxes.
certain entities, not individuals: see
n
o
❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporal on ❑ Partnership ❑ Trust/estate
instructions on page 3):
a
c
single -member LLC
Exempt payee code (if any)
p❑
Limited liability company. Enter the tax classification (C-C corporation S-S corporation, P-Partnership) ►
`p 2
Note: Check the appropriate box in the line above for the tax classification of the single member owner. Do not check
Exemption from FATCA reporting
in
.1 Z
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
code (if any}
d o
another LLC that is not disregarded from the owner for U.S. federal tax purposes Otherwise, a s ngle-member LLC that
is disregarded from the owner should check the appropriate box for the tax c assification of its owner.
tv
❑ Other (see instructions) ►
(A re: io —is w f—d wtvde vre u s
y
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optiol
�i
m
6 City, state, and ZIP code
7 List account number(s) here (optional)
JLiUM
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, fora
resident alien, sole proprietor, or disregarded ent ty, see the instructions for Part I, later. For ocher
entities, it is your employer identification number (EIN). If you do not have a number, see Now to get a
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and j Employer identification number
Number To Give the Requester for guidelines on whose number to enter. F—T-1
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later.
bign signature of
Here U.S. person► Date►
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
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 1099-8 (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-5 (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acqu sition 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)
1055 S Grady Way Renton, WA 98057 L
425-430-6851 Renton Business License Application
taxand licensing@rentonwa.gov
Annual License Fee: $150.00 (if applying for the first time before July 1)
Pro -Rated License Fee $75.00 (if applying for the first time after July 1)
FILL OUT THIS FORM COMPLETELY (INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED)
Check all that apply: ❑ In City Business ❑ Outside City Business (Business located in another city, but entering Renton to engage in business)
❑ New Business ❑ Additional Location ❑ Location Change ❑ New Ownershlp ❑ Name Change
LEGAL ENTITY NAME
WA STATE UBI#
BUSINESS OR TRADE NAME (DBA)
BUSINESS PHONE
PHYSICAL ADDRESS OF BUSINESS
MAILING ADDRESS OF BUSINESS ❑ Check if same as physical address
BUSINESS LICENSE CONTACT NAME
PHONE
EMAIL ADDRESS
TAX CONTACT NAME
PHONE
EMAIL ADDRESS
LOCAL EMERGENCY CONTACT (OTHERTHANABOVE OROWNER)
PHONE
EMAILADDRESS
Is your business (check all that apply) ❑ Minority Owned Business ❑ Women Owned Business ❑ Veteran Owned Business
Business Entity Type
(check only one) ❑ Sole Proprietor ❑ Corporation ❑ Parntership ❑ LLC or PLLC ❑ Non -Profit S01 Government Entity
Must rovide copy of 501 IRS Uri
FIRST ACTIVITY DATE IN RENTON
PROJECTED ANNUAL REVENUE IN RENTON
NUMBER OF EMPLOYEES
NATURE OF BUSINESS CHECK ALL THAT APPLY
DETAILED DESCRIPTION OF PRINCIPAL BUSINESS ACTIVITY IN RENTON
❑ Retail Manufacturing -Extracting
❑ Service ❑ Utility
❑ Wholesale ❑ Gambling (Pull Tabs / Card Games)
❑ Printing/Publishing ❑ Charging Admission for Events/Shows
❑ Door to Door Sales ❑ Mobile Food Vendor
Other:
I hereby swear or affirm that the statements and information fumished by me on this application are, to my knowledge,
accurate, true and complete. I acknowledge these statements and information are public records that may be available for
public inspection pursuant to RCW 42-56, the Public Records Act, and that any inaccurate, false, or incomplete statement
may be a crime under the RCW and/or RMC, punishable under RCW 9.92 and/or RMC 1-3-1
APPLICANT'S SIGNATURE
PRINT NAME
TITLE
E-MAIL
PHONE #f
DATE SIGNED
FOR OFFICE USE ONLY
Date
Amount Paid
Payment Type
NAICS
Registration #
Edited 6/2022
Renton Business License Application City of Renton, Washington
WILL YOUR BUSINESS HAVE ANY OF THE FOLLOWING (check all that apply)
Will there be customers on premise
❑ Will Your business have shopping carts?
If so, how many per week?
If so how many?
Remodeling or alterations
❑ Fire Alarm
171 Additional Parking
❑ Sprinkler System
Exterior Storage
❑ Flammable Materials
C
OWNER'S LAST NAME
FIRST NAME
E-MAIL
H
E
C
❑
SOLE -
SPOUSE'S LAST NAME
FIRST NAME
E-MAIL
K
PROPRIETOR
OPERATED BY BOTH SPOUSES? ❑Yes ❑No
&
C
O
M
❑
PARTNERSHIP
1ST PARTNER'S LAST NAME
FIRST NAME
E-MAIL
2ND PARTNER'S LAST NAME
FIRST NAME
E-MAIL
P
3RD PARTNER'S LAST NAME
FIRST NAME
E-MAIL
L
E
T
PRESIDENT'S LAST NAME
FIRST NAME
E-MAIL
E
❑
O
VICE PRESIDENT'S LAST NAME
FIRST NAME
E-MAIL
N
CORPORATION
E
OR
SECRETARY'S LAST NAME
FIRST NAME
E-MAIL
LLC
TREASURER'S LAST NAME
FIRST NAME
E-MAIL
Restaurant and Food Handlers are required to submit a copy of their Health Department Certificate with their City of Renton Business License
Application. (WAC 246-217)
Portable fire extinguishers must be provided, 2A-10BC minimum size. Exact number and placement details can be obtained from Renton Regional
Fire Authority, Office of the Fire Marshal. Annual service required.
Permits may be required from Fire and/or the Building Department and the Water Utility for your proposed use, operation or remodeling.
Section 4-9-090 of the Renton Municipal Code allows certain types of businesses to be operated in residential areas. The zoning Administrator
must determine whether your application complies with the City's regulations.
Annual inspections will be conducted by the Renton Regional Fire Department, Community Risk Reduction per adopted City Ordinances.
Priof to commencing your business, you may be required to meet with Fire and/or the Building Department and the Water Utility to determine
whether your business will meet all applicable City codes for the type of business proposed.
5-5-7 REFUND OF LICENSE FEE:
A. Revocation: Upon revocation, suspension, or denial of any license as provided in this chapter, no portion of the license fee shall be
returned to the licensee.
B. License Application Withdrawn: Upon a licensee's request to withdraw their initial application, the fee paid shall be returned to the
applicant by the City, together with notice that the application has been withdrawn; provided that no refund shall be made where the
applicant has engaged in the business activity for which the license was intended, or where inspection has been performed by any Gty
department to review said license application.
PAYMENT PAYABLE TO AND MAILED TO: ADDITIONAL INFORMATION
City of Renton, Tax & License Division Apply on-line at www.filelocal-wa.gov
1055 S Grady Way Washington State Department of Revenue
Renton, WA 98057 www.dor.wa.gov 425-656-5100
Edited 6/2022