HomeMy WebLinkAboutLease LAG-97-005
OPTION AND SITE LEASE AGREEMENT
THIS OPTION AND SITE LEASE AGREEMENT(this"Agreement")is entered into this /g day of
,1997("Date of Agreement")by and between The City of Renton a Washington municipal
corporation ("Lessor")and Western PCS BTA I Corporation, a Delaware corporation("Lessee")
whose address is 2001 NW Sa unamish Road, Issaquah, WA 98027.
WHEREAS. Lessor is the owner of certain real property including structure(s)as more particularly
described in Exhibit A attached hereto and made a part hereof by this reference("Property"); and
WHEREAS,Lessee desires to obtain an option on the property for the purpose of occupying and installing
its communication facilities as more specifically set forth below.
WHEREFORE, Lessor and Lessee agree as follows:
1. Lessor for and in consideration of five hundred dollars($500.00),the receipt whereof is hereby
acknowledged,does hereby grant and convey unto Lessee, its successors,assigns, and agents an Option to lease
the Property for the permitted Use as set forth in paragraph three below. In addition, each month during the
Option Period Lessee shall pay one hundred($100.00)to Lessor until Option Period expires or the option to lease
is exercised.
2. Option. The option to lease Lessor's Property may be exercised by Lessee at any time within
the first twelve(12)months of the Date of Agreement("Option Period")by providing Lessor with written notice
of Lessee's intent. Lessor agrees that Lessee may extend the Option Period by twelve(12)additional months by
providing Lessor with written notice prior to the expiration of the original Option Period and by paying Lessor,
at the time Lessee requests the extension.
3. Permitted Use.
(a) Lessee shall have the right, at its expense, to install, construct, reconstruct and
maintain on the Premises communication facilities as outlined in Exhibit C including,without limitation, radio
and other communication transmitting and receiving antennas, support mounts,cables,equipment, equipment
storage structures and other improvements relating thereto(collectively the"Communication Facilities").
Lessee shall have the right to modify, supplement, replace or upgrade the Communication Facilities on the
Premises at any time during the term of the lease so long as said replacement or upgrade is made for the purpose of
improving the operation of its Communication Facilities. with prior written consent of Lessor,which consent shall
not be unreasonably withheld,or delayed.
(b) Lessee shall be entitled to reasonable access to the Premises 24 hours a day, seven days
per week, and shall have all additional rights of access, ingress and egress to and from the Premises,provided
however, except in the case of an city emergency,Lessee shall notify Lessor in advance of Lessee's proposed
construction, maintenance or repair activities to be performed on the Premises in order to coordinate said activities
with Lessor's operations.
(c) Lessee shall be entitled to install, and shall pay for the initial installation of any utilities
and services required for the Communication Facilities. Lessee shall directly pay for telephone service to the
telephone utility and for electrical power to the power utility.
(d) Lessee shall notify Lessor prior to accessing the Premises. The on-site contact to access
the Premises during business hours is Renton Utility Maintenance Department at phone number(425)235-2647;
the contact to access the Premises during non-business hours is Renton Police Department at phone number
(425)235-2600.
Site Number 5E-2505-C
Site Name:Renton East
Market:Seattle
(e) Lessee shall not weld to the wetted portion of the water tank without written consent from the
Lessor.
(f) All additions to the Premises shall be approved by the Lessor. Approval shall not be
unreasonably withheld.
4. Term. This Lease, if executed, shall be for a term of five years("Lease Term"), and shall
commence on the date that the Lessee places its written notice to the Lessor in the mailbox, return receipt
requested of its intent to execute its right to lease the Property. Lessee shall have the right to renew the Lease
Term four additional terms at five year terms each(each being a"Renewal Term").
5. Rent
(a) Lessee shall pay Lessor, as rent,the sum of eight hundred fifty Dollars($850.00)per
month. Beginning in September of each year, said rent shall be payable in advance to Lessor on or before the
first day of each calendar month. At the beginning of September thereafter, the monthly rent shall automatically
be increased in proportion to the percentage increase in the"All Item"category of the Consumer Price Index for
Urban Wage Earners and Clerical Workers published by the Bureau of Labor Statistics of the US Department of
Labor for Seattle Metropolitan Area( 1967+ 100)("the index") for the twelve month period ending in July of
each year. If an agreement is executed within six months prior to September,the increases will begin the
following September. If the Consumer Price Index declines during a July to July period, in no event shall the rent
be less than the original rent set forth in the agreement. If the above referenced Index is discontinued, the parties
agree to use a locally available comparable substitute.
(b) Lessee shall pay, as additional rent, any increase in real property taxes levied against
the Premises, any leasehold excise tax,which is directly attributable to Lessee's use of the Premises, and Lessor
agrees to furnish proof of such increase to Lessee.
6. Due Diligence. During the Option Period and any option extension,Lessee, its agents,
engineers, contractors shall have the right to enter upon Lessor's Property to inspect, examine, sample and conduct
all engineering tests or studies of the Site, to apply for and obtain all licenses and permits required for the Lessee's
Permitted Use from all applicable governmental or regulatory entities,and otherwise do those things on the
Premises that, in the opinion of Lessee, are necessary to determine the physical condition of the Premises, Lessor's
title to the Premises and the feasibility or suitability of the Premises for Lessee's Permitted Use, all at Lessee's
expense. Lessee shall not be liable to Lessor or any third party on account of any pre-existing defect or condition
on or with respect to the Premises,whether or not such defect or condition is disclosed by Lessee's inspection,
although Lessee shall be responsible for any damage, loss or destruction to the Premises as a result of the actions
of its employees,representatives or agents during the due diligence activities.
7. Interference
(a) Lessee shall not use the Premises in any way that interferers with the existing use by:
(i)Lessor or(ii)tenants or licensees of Lessor holding rights to the Property on the date of this Agreement
("Existing Tenants").
(b) Lessor agrees that it shall not use, nor shall it permit its tenants, Lessees,employees,
invitees or agents to use, any portion of the Property in any way which would interfere with the operation of Lessee
provided that continued use by Lessor or Existing Tenants in the same manner as existed at the time the Lease
was executed shall not constitute interference with Lessee's operations.
Site Number SE-2505-C
Site Name:Renton East
Market:Seattle
(c) In the event the Lessor elects to permit another communications user the right to use
any of Lessor's Property, Lessor agrees to notify Lessee thirty(30)days prior to the issuance of such authority for
the purpose of determining whether the third party communications user will interfere with Lessee's use or
intended use of the Premises. Should Lessee notify Lessor in writing that the third party communications will
interfere with Lessee's operations, then Lessor agrees not to permit the third party communications user the right
to use the Premises. Lessee's consent shall not be unreasonably withheld.
8. Environmental Matters.
(a) Lessor represents that it has no knowledge of any substance, chemical or waste
(collectively, "substance")on Premises that is identified as hazardous, toxic or dangerous in any applicable federal,
state or local law or regulation. Lessee shall not introduce or use any such substance on the Premises in violation
of any applicable law.
(b) "Hazardous Materials"means asbestos or any hazardous substance,waste or materials
as defined in any federal state,or local environmental or safety law or regulation including,but not limited to,
CERCLA.
(c) The obligations of this Section 8 shall survive the expiration or other termination of this
Agreement.
9. Insurance/Indemnification/Eminent Domain. Lessee shall maintain at its expense commercial
general liability insurance covering actions by Lessee providing for a limit of not less than$1,000,000.00 single
limits,bodily injury and/or property damage combined, for damages arising out of bodily injuries to or death of all
persons and for damages to or destruction of property, including the loss of use thereof. Coverage shall include
independent contractor's protection, premises-operations,products/completed operations and contractual liability
with respect to the liability assumed by lessee hereunder. In the event Lessee is self insured, Lessee shall supply
Lessor with a certificate of self-insurance which complies with the policy limitations set forth above. Each party
shall indemnify and defend the other against loss from their negligent acts and that negligent act of their
employees agents, licensees, and invitees.
10. Assignment
(a) Upon Lessor's written consent. which shall not be unreasonably withheld or delayed,
Lessee may assign this Lease, in part or in whole,including its right to renew,to any person or business entity
which is licensed by the Federal Communications Commission, and meets Lessors approval.
(b) Lessee may assign this Lease, or portion thereof,and its other rights hereunder to any
person or business entity which is a parent, subsidiary or affiliate of Lessee without Lessor's
consent.
(c) Upon notification to Lessor of any assignment, and written authorization by Lessor of
any assignment, Lessee shall be relieved of all performance, liabilities and obligations under this Option and Site
Lease Agreement.
11. Termination. This Option and Site Lease Agreement may be terminated as follows:
(a) by Lessor if Lessee fails to cure a default for payment of amounts due hereunder within
thirty(30)days after Lessee's receipt of written notice of default from lessor,
Site Number:SE-2505-C
Site Name:Remgalasi
Market:Seattle
(b) by the non-defaulting party if the other party defaults (other than a default described in
Section 11(a)above)and fails to cure such default within sixty(60)days after written notice of such default is
received by the defaulting party from the non-defaulting party; provided, however, that if such default is capable of
being cured, the lease may not be terminated so long as the defaulting party commences appropriate curative action
within such sixty(60)day period and thereafter diligently prosecutes such cure to completion as promptly as
possible;
(c) by Lessee upon sixty(60)days prior written notice.
(d) Lessor may terminate this lease if Lessor needs Premises for expansion of Lessor's
responsibility to provide its services, pursuant to law, provided Lessor provides Lessee written notice(12)months
in advance of Lessor's need to re-enter the Premises.
(e) upon a notice to terminate by Lessor or Lessee under the subsection 11 (a), (b), (c),and
(d)in this paragraph entitled"Termination,"the Lease shall terminate and be of no further force or effect. Unless
otherwise agreed between the parties,upon termination Lessee will be entitled and obligated to remove the
equipment placed on the Premises by Lessee.
12. Successors and Assigns. This Agreement shall run with the Property and shall be binding upon
and inure to the benefit of the parties, their respective successors, personal representatives and assigns.
13. Representation and Warranties. Each party covenants and warrants to the other that(i)it has full
right, power and authority to execute this Option and Site Lease Agreement and has the power to grant all rights
hereunder; (ii)its execution and performance of this Agreement will not violate any laws, ordinances, covenants,
or provisions of any mortgage, lease or other agreement binding on said party;and(iii)the execution and delivery
of this Agreement, and the performance of its obligations hereunder, have been duly authorized by all necessary
personnel or corporate officers and do not violate any provisions of law or the party's certificate of incorporation
or bylaws or any other arrangement,provision of law or court or decree.
14. Notices. All notices, requests,demands and other communications hereunder shall be in writing
and shall be deemed given if personally delivered, or mail by certified mail, return receipt requested,to the
following addresses:
1.1 to Lessor.to: If to Lessee.to:
The City of Renton Western PCS BTA I Corporation
200 Mill Avenue South 2001 NW Sammamish Road
Renton, WA 98055 Issaquah, WA 98027
Phone: (206)313-5200
Fax: (206) 313-5520
Attn: PCS Leasing Administrator
With a copy to: Attn.: Legal Department
Site Number SE-2505-C
Site Name:Renton East
Market:Seattle
15. Miscellaneous.
(a) This Option and Site Lease Agreement shall constitute the entire agreement and
understanding of the parties with respect to the Property that is the subject matter thereof and supersedes all offers,
negotiations and other agreements with respect thereto. There are no representations or understandings of any
kind not set forth herein. Any amendment to this Agreement must be in writing and executed by both parties.
(b) Either party hereto that is represented in this transaction by a broker,or agent or
commission salesperson(a"Representative")shall be fully and exclusively responsible for the payment of any fee,
commission or other compensation owing to such Representative, and shall indemnify and hold the other party
harmless from and against any claim to a fee, commission or other compensation asserted by such Representative,
including reasonable attorneys' fees and costs incurred in defending such claim.
(c) If any term of this Agreement is found to be void or invalid, such invalidity shall not
affect the remaining terms of this Agreement,which shall continue in full force and effect.
(d) By executing this Agreement,the parties are not establishing any joint undertaking,
joint venture or partnership. Each party shall be deemed an independent contractor and shall act solely for its own
account.
(e) A licensed engineer of the Lessor's choice shall review,inspect, and approve the
installation. Lessee shall bear the reasonable cost of such approval and inspection. All future modifications and
additions to the Premises may be subject to an inspection by a licensed engineer of the lessor's choice, if the
Lessor deems such approval and inspections necessary. Lessee shall bear the reasonable cost of such additional
inspections.
(f) Lessee shall maintain the installed facility, equipment and appurtenances in the
"as installed"condition less reasonable wear and tear for the term of the agreement.
(g) Lessee shall provide in escrow a performance bond in the amount of 30,000.00
to ensure the installation of the site is acceptable. Upon approved installation per subsection 15 (0 of this
paragraph, the money shall be returned to Lessee.
(h) Upon completion of the installation, an as-built or as-installed drawing will be supplied
to the Lessor by the Lessee showing the locations of the Lessee's facilities.
(i) The Lessee must move or relocate facilities, equipment and appurtenances as required
by Lessor's responsibility to provide its services,at Lessee's expense. If the Lessor chooses to work around the
Lessee's facilities, then the Lessee shall reimburse the Lessor for extraordinary cost associated
with accommodating the Lessee's facilities.
(j) Lessee shall install all underground conduits, including but not limited to power and
telephone. Lessee shall coordinate with additional carriers on the property, if any,for such installation.
(k) Lessee will not interfere with the Lessor's use of the tank for a reservoir. Nor will the
Lessee or the Lessee's equipment create an electrical current or field that will damage the Lessor's tank or
associated pipes.
•
Site Number:SE-2505-C
Site Name:Renton East
Market:Seattlq
(m) Lessor hereby waives any and all lien rights it may have, statutory or otherwise,
concerning the Antenna Facilities or any portion thereof which shall be deemed personal property for the purpose
of this Lease, regardless of whether or not the same is deemed real or personal property under applicable laws,
and Lessor gives Lessee and Mortgagee the right to remove all or any portion of the same from time to time,
whether before or after a default under this Lease, in Lessee and/or Mortgagee's sole direction and without
Lessor's consent.
The parties have entered into this Agreement as of the date first stated above.
Lessor: Lessee:
The City of Renton Western PCS BTA I Corporation
b,J5
By: J e�Tanner By:
•
Its: Mayor Its: ` -��"v1Ce -Pl't'yjereti7
S.S./Tax No: 91-6001271
ATTEST/ iT.L. .!
Marilyn tersen, City Clerk
Site Number:5E-2505-C
Site Name:Renton East
Market:Seattle
[Notary block for Corporation,Partnership,Limited Liability Company]
STATE OF WASHINGTON )
6).,\(.\ )ss.
COUNTY OF )
I certify that I know or have satisfactory evidence t �e 'e../C0''\XV ( is the person who
eared before me, and said person acknowledged th he he signed this instrument, on oath stated that
( she was authorized to execute the instrument and acknowledged it as the of
y Vt t:ActJl 0c la.f.h+ev- to be the free and voluntary act of such party for the uses and
purposes mentioned in the instrument.o
Dated: I` 1 `'9 9
Notary Public �� o� "Tr l.L V64 VA
Print Name \ l•
My commission expires S 261-c1°i
(Use this space for notary stamp/seal)
STATE OF WASHINGTON )
)ss.
COUNTY OF K1Vn )
I certify that I know or have satisfactory evidence that, / ,fl� c-14 is the person who
appeared before me, and said person acknowledged that he/ibe signed this instrument, on oath stated that
he/she was authorized to execute the instrument and acknowledged it as the A"--e -t. V P• of Western
PCS BTA I Corporation to be the free and voluntary act of such party for the uses and purposes mentioned in
the instrument.
Dated: 11.2, s� 1a°11
# .
,,4, _ILKAfw. i ft° ,,, cr, 4 _________.
�•..•„NNq..' S Notary Public
-� .• Print Name ( VUet 1V1iac1,.:'�K.,
'I.. NO1W :Z Z
My'commission expires 11'Ia-clg
PUBLIC a.
t.•,,..n, A°,•'c �
).. 9r.411�. 4
�ti••
•
(Use this space for notary stamp/seal)
EXHIBIT A
Legal Description
To the Site Lease with Option dated - (�. e17 ,between City of Renton as Landlord,and
Western PCS BTA L Corporation, as Tenant.
The Property is legally described as follows:
The east half of the southwest quarter of the southwest quarter of the southeast quarter of
Section 4,Township 23 North,Range 5 East, W.M. in King County, Washington;LESS county
road.
Site Number 22/3&
Site Namc Fatten East
Matket,mite
EXHIBIT B
Premises Location Within the Property
To the Site Lease with Option dated 9- /r- ' 7 ,between City of Renton as
Landlord. and Western PCS BTA I.Corporation. as Tenant.
The location of the Premises within the Property is more particularly
described and depicted as follows:
Cpeeoz-
® SUBJECT Cu GF Q_PnTT7�1 —h�CMiJII�1D5 .LS—l BY 9(lJ-lY B2S— PROJECT NO. DATE ,Z-/J0'-ID--
■■■■W■W■11■■■/■■■111111111111■Wt•1•■■/■■■■■■W■■il/■■■B/■ • •
�..;_.,.._�
.' , • ! • MEIM/IIIMI WW1111•111/W■1•/■■■/0■ff■MII■WW
■/Yo/■■■W/■/■0■■■■/■■m�/W/W/■■■■/■W .
L_..»�--. . ._
/!/■W■immW■■■■■■■W ■W■ ■■/W
-- : i IW��1/I�I�WWW■11■W �� �
• romps 1■ morim /■■■ ■/wu■W1/m■■■■nWW� WW■ ,summarmaiminummumusons
■//■■W■/■111rM■W■W■W11I�W■■■■■MI ' • • • ; ® • —
11■W1111/ .rLL►/A i 1 ■/
/ ■■■�: i ! • i _
m• ■/■W■/ �!'"�. mss. ■►�� Jffi
MIUMMAIlminalmulk_ �1 ; _ - -
ell 1 ..M
■/W■■■■■//■■ c /�WWiI ._al m rX111 r .
W/■11WH■/■W ■!�` /WIE".� JI I®CII I " '-
11.11/■■0■■/■/ME/m�IV W//■■Ji �l�■sI /WM �I�I 111,3� ._
W• W■W■11■■■W/W■W a■1111%AWMPGIME eElomm ■1 I i •
■W/■WHWW m/■■ W11r 1.111! ■►tim m■w►�a►��■n�i»ei uali
■WWW■11■//L.� �1/r/■W1!N�.V�� -- �
W/■■WW/WWW■ /%�Al� �. u —.i , • ! _
WW■WWW■WW RWMP Wiu h a�ra��ui
i
W/■/—/ r _
•
"■,�'. —
.
■ W■WW■W■■■■►: W■WaoWiilW�■■W■W■■■■WW■■■tE!/C=1i !!IWWt11■W '2
WW■W/ WWW . ■W/WI
■W■ W■WWE■ i�� IIMI •
■ ■■�d� � ■ W■W/ �: .
_-
-
MMIMMI
..
■®W H■11WW■W■■/■■■■WMIEIM■
WW■/0■/WWW/ i 1v
i J i i . . . 11 t t J ! i . 1 � ■WW■W■H■■■W '
Not to Scale
1. Final Antenna type and configuration subject to final radio frequency engineer and zoning analysis.
2. Actual equipment location and conduits subject to final architectural design.
3. Final equipment location subject to structural engineer analysis.
Site Number-2505-C
Site Name Recon East
Market
EXHIBIT C
Site Plan and Equipment
To the Site Lease with Option dated q- i '-q 1 ,between City of Renton as Landlord,
and Western PCS BTA I Corporation, as Tenant.
Site Plan and Equipment
Site with Exterior Cabinet
Three sector site with no more than three antenna on each sector which measures 72"x 12" x 6"
Installation of up to three equipment cabinets which measures 12' x 5' x 3' on pad as defined in
Exhibit B.
Microwave dish measuring not more than 4' in diameter.
Site Number.2505-C
Site Name$,fast
Market 5
EXHIBIT D
Memorandum of Lease and Option
9
To the Site Lease kith Option dated —/S(/ 9 ( ,between
G 3 7Y OF EA) To Al as Landlord and Western PCS BTA I
Corporation,as Tenant.
Memorandum of Lease and Option,with cover sheet,notary page(s) and Exhibit A.
Document Attached
Site Number: 5 E 2-50S---C 6
Site Name: RE AfTo A/ EAS
Market: 5EAT 76 6
Return Address:
Western PCS BTA I Corporation
2001 NW Sammamish Road, Suite 100
Issaquah,WA 98027
Attn: PCS Lease Coordinator
MEMORANDUM OF LEASE AND OPTION
Grantor:
CITY o f PE N To N
Grantee:
Western PCS BTA I Corporation
Legal Description:
Complete legal description is on page A-1 of document.
Assessor's Property Tax Parcel Account Number(s):
O'i z3o5 qI %
Site Number: S E Z So$-C 2
Site Name: (LEA/TOnl EAST
Market: SEHT1LE
After recording,please return to:
Western PCS BTA I Corporation
2001 NW Sammamish Road,Suite 100
Issaquah,WA 98027
Attn: PCS Lease Coordinator
Phone: (206)313-5200
Fax: (206)313-5520
Site Identification: 5 6. 2-So s-C Market: SEATTLE
Memorandum of Lease and Option Between
-I T Y v C &Ul T° 'V ("Landlord")and Western PCS BTA
I Corporation("Tenant")
A Site Lease with Option("Lease") dated as of , 199_by and between
G Z T Y OF 12ENT O ti ("Landlord") and Western
PCS BTA I Corporation("Tenant")was made regarding the following premises:
See attached Exhibit A.
Subject Lease is for a term of five(5)years and will commence on the date as set forth in
the Lease (the "Commencement Date") and shall terminate at midnight on the last day of the
month in which the 5th anniversary of the Commencement Date shall have occurred. Tenant shall
have the right to extend this Lease for five additional five year terms.
IN WITNESS WHEREOF, the parties hereto have respectively executed this
memorandum_day of , 199_.
LANDLORD: CZ T or f2 17OV
By: 4
Je e Tanner
Its: Mayor ATTEST:
Marilyn r. Ntersen, City Clerk
TENANT: Western PCS BTA I Corporation
By.
vi Ce / dent
Site Number: S C 2_5o o 5 -C 2 •
Site Name: QE vto iV E.4-5 T
Market: 5 Q g 7 T r_6
[Notary block for Corporation,Partnership,Limited Liability Company]
STATE OF WASHINGTON )
ss.
COUNTY OF 1 ,\ )
I certify that I know or have satisfactory evidence that (_\.es kf- 1-a ris the
person who appeare before me,and said person acknowledged thhe she signed this instrument,
on oath stated��th"a she was authorized to execute the instrument and acknowledged it as the
U\ Or of DI/144T- to be the free and
voluntary act of suc party for the uses and purposes mentioned in the instrument.
Dated: 1. -cy-7
4iruivach qT:Piyitr(0/(
Notary Public
Print Name �►�t�-
bfevvic 1.tS vou4
My commission expires R-Xcl -9"
(Use this space for notary stamp/seal)
STATE OF WASHINGTON )
)ss.
COUNTY OF 1\,\ 1/�(/\ )
I certify that I know or have satisfactory evidence thatt f i)( ,St,1i�b�ib-fit.ill is the
person who appeared before me,and said person acknowledge at he/she signed this instrument,
on oath stated that he/she was authorized to execute the instrument and acknowledged it as the_
Azi'/k, \i - of Western PCS BTA I Corporation to be the free
and voluntary act of such party for the uses and purposes mentioned in the instrument.
Dated: 1
idt le_ _—_
�is�t,A.IW(l�1,�i,. No Publ. lU I UCk )
ted'fii›.I SOTO( 1 I
:0. NO% P • Name;' ;' Z'. M commisBRAC
expires l2'La'��
, •
•1.,,(0.,...0.0,.._,4,8E14„........:0.4.041
o
, •
#°•,'•$Opt„a,r��►01
(Use this spa e"foi•notary`stamp/seal)
Site Number: S Cc 2 SU 5 - C 2
Site Name: /1C Al T O N 6AS T
Market: S<A t T t-E
EXHIBIT A
Legal Description
To the Site Lease with Option dated /—/g,97 , between City of Renton as Landlord,and
Western PCS BTA L Corporation, as Tenant.
The Property is legally described as follows:
The east half of the southwest quarter of the southwest quarter of the southeast quarter of
Section 4,Township 23 North,Range 5 East, W.M. in King County, Washington;LESS county
road.
Site Number 2.5O5-C
Site N®e Renton East
Market leak
EXHIBIT E
IRS Form W-9
To the Site Leaseewith Option dated s'— 7-.57 ,between
CI `Y OF f2_ iV To N as Landlord and Western PCS BTA I
Corporation,as Tenant.
Document Attached
Site Number: 56 2.5 7 5 - C 5
Site Name: 12 E o it! Elis T
Market: S E A T Tt,E
Form W-9 Request for Taxpayer Give form to the
(Rev.
March 1994) Identification Number and Certification requester Do NOT
peortmerx d the Treasury send to the IRS.
Mortal Revenue Srvice
Name(If pint names,list first and circle the name of the person or entity whose number you enter in Part I below. See instructions on page 2 If your name has changed.)
a
Business name(Sole proprietors see instructions on page 2.)
0
=a Please check appropriate box: ❑ Individual/Sole proprietor CICorporation ❑ Partnership ❑ Other o•
Address(number,street,and apt or suite no.) Requester's name and address(optional)
0
m
tl City,state,and ZIP code
Part 1 Taxpayer Identification Number (TiN) List amt number(s)here(optional)
Enter your TIN in the appropriate box. For
individuals, this is your social security number Soctai security number
(SSM. For sole proprietors, see the instructions 114. 1 + 111
on page 2. For other entities, it is your employer Part II For PayeesExemptFrom Backup
identification number(ESN). tf you do not have a OR
number, see How To Get a TIN below. Withholding(See Part II
Note:If the account is in more than one name, II identification"""'b°` instructions on page 2)
see the chart on page 2 for guidelines on whose 11- 111111
number to enter.
Part III 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. 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
Revenue Service 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 badcup.withholding.
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 of underreporting interest or dividends on your tax return. For real estate transactions, item 2 does not apply.For mortgage
interest paid,the 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. (Also see Part IiI instructions on page 2.)
Sign
Here Signature ► Date ►
Section references are to the Internal payments under certain conditions. This is interest and dividend accounts opened
Revenue Code. called "backup withholding." Payments after 1983 only),or
that could be subject to backup 5. You do not certify your TiN. See the
wrt
Purpose of Form.—A person who is ,
hholding include interest, dividends,
required to file an information return with broker and barter exchange transactions, Part III instructions for exceptions.
the IRS must get your correct TIN to report Certain �y and payments are
income paid to real estate • royalties, nonemployee pay, and
exempt from backup withholding and
transactions, mortgage interest you paid, certain from fishing boat
the acquisition or abandonment of secured operators. Real estate transactions are not reporting. See the Part II
Property, cancellation of debt, or subject to backup withholding. instructions and the separate Instructions
for the Requester of Form W-9.
contributions you made to an IRA. Use If you give the requester your correct How To Get a TIN.—if do not have a
Form W-9 to give your correct'TIN to the TiN, make the proper certifications, and you
requester(the person requesting your TiN) report all your taxable interest and • TiN, apply for one immediately.To apply,
and, when applicable, (1) to certify the TiN dividends on your tax return, your get Form SS-5,Application for a Social
you are giving is correct(or you are waiting payments will not be subject to backup Security Number Card(for individuals),
for a number to be issued), (2) to certify withholding. Payments you receive will be from your local office of the Social Security
you are not to backupwithholding, subject to backupwithholdingit Administration, or Form SS-4,Application
subject I � •
or(3) to claim exemption from backupfor Employer Identification Number(for
1.You do not furnish your TIN to the businesses and all other entities), from
withholding if you are art exempt payee. requester, or
Giving your correct TiN and making the your local IRS office.
appropriate certifications will prevent 2.The IRS tells the requester that you If you do not have a TIN,write "Applied
certain payments from being subject to furnished an incorrect TIN, or For" in the space for the TiN in Part I, sign
backup withholding. 3.The IRS tells you that you are subject and date the form, and give it to the
Note: If a requester gives you a form other to backup withholding because you did not requester. Generally, you will then have 60
than a W-9 to request your 77N, you must report all your interest and dividends on days to get a TiN and give it to the
use the requester's form if it is substantially your tax return (for reportable interest and requester. If the requester does not receive
similar to this Form W-9. dividends only), or your TIN within 60 days, backup
What Is BackupWithholding?—Persons 4. You do not certify to the requester withholding, If applicable,will begin and
making certain payments to you must that you are not subject to backup continue until you furnish your TIN.
withhold and pay to the IRS 31% of such withholding under 3 above (for reportable
Cat. No. 10231X Forth W-9 (Rev.3-94)