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HomeMy WebLinkAbout29A - SMALL BUSINESS INCENTIVE PROGREQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: DECEMBER 2, 2013 TITLE: SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM CITY MANAGE RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED ❑ As Recommended ❑ As Amended ❑ Ordinance on 1" Reading ❑ Ordinance on 2ntl Reading ❑ Implementing Resolution ❑ Set Public Hearing For_ CONTINUED TO Approve the Santa Ana Small Business Incentive Program, subject to non - substantive changes approved by the City Manager and City Attorney. FINANCE ECONOMIC DEVELOPMENT AND TECHNOLOGY COMMITTEE REVIEW The Finance, Economic Development, and Technology Committee by a vote of 3:0 reviewed this matter at its meeting on October 14, 2013 and recommended that the City Council authorize staff to administer the Santa Ana Small Business Incentive Program. DISCUSSION In May 2013, the City Council approved the Annual Action Plan and the City submitted the document to the U.S. Department of Housing and Urban Development (HUD). The Annual Action Plan is the document whereby the City formally applies to HUD for the annual federal grant allocations and describes how the grants funds will be utilized. A program listed under the Annual Action Plan is Economic Development Micro - Enterprise Assistance. According to CDBG guidelines, a micro - enterprise is defined as a business that has five or fewer employees, one or more of whom owns the business. One purpose of the Micro - Enterprise Program is to provide financial assistance, technical assistance and general support services to small start -up businesses in the City. Another purpose is to meet a national objective, which is to create or make jobs available for low- income individuals. This is the first time the City included an economic development activity in the Annual Action Plan, therefore staff reviewed similar programs in other cities and interviewed their staff about common practices. Staff initially modeled the creation of the $2,000 grant program and its administration process after the City of Long Beach, which has successfully administered such small business incentive program for more than 20 years. 29A -1 Santa Ana Small Business Incentive Program December 2, 2013 Page 2 In July 2013, the Community Redevelopment and Housing Commission was given an overview of the Micro - Enterprise program. The general consensus from the Commission was that this program would be a valuable benefit to start -up businesses in the City and should be forwarded to City Council for approval. In August 2013, staff presented an overview of the proposed Micro - Enterprise Program, now named as the Santa Ana Small Business Incentive Program to the Finance, Economic Development and Technology Council Committee (Committee). Staff reviewed with the Committee the proposed $2,000 grant program for small business, the eligibility criteria for the small business to obtain the grant and the administration process. The Committee was in support of the proposed new business incentive program but had questioned whether the $2,000 grant would be enough to assist a start -up business. In October 2013, staff presented an update on the status of the Santa Ana Small Business Incentive Program to the Committee. Staff informed the Committee that more recent research indicated that City of Redlands has a higher grant program ($10,000). Based on an interview with their staff, it became evident that the administrative work and the required documentations from small businesses were complex and comprehensive. However, the grant amount has to be sizable to make it worthwhile for any small businesses to obtain such a grant. As a result of the new information, staff recommended an increase to the grant program from $2,000 to $5,000. The Committee was in support of the change. SUMMARY OF SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM 1. Businesses are eligible for the program if they meet one of the criteria listed below: A. Income Qualifying — The business owner is determined to be low- income pursuant to HUD requirements; or B. Geographic Area Qualifying: 1) Community Service Area Map - The business is a new community - serving retail or service -based business and located in the designated area (Exhibit 1 - Map A); or 2) Targeted Resident Area Map - The business owner or an employee lives in a designated area where 70% of households are low- income (Exhibit 1 - Map B); or 3) Targeted Business Area Map - The business is located in a designated area where 20% or more of the families are below the poverty level (Exhibit 1 - Map C); 2. Reimburse business start -up costs of up to $5,000. Approximately up to 56 new businesses could be assisted in the City. Expenses such as rent, insurance costs, utility connections, advertising, working capital, supplies, fixtures, furniture, equipment, or working materials could be reimbursed to businesses under this program. According to CDBG guidelines, reimbursement for this type of grant must be incurred within the first year of operation, with the new business creating a minimum of one job during its start -up phase. After initial review by Community Development staff, the City's Executive Director for Community Development will approve the final application and forward to the Finance department for audit and request for disbursement of funds. 29A -2 Santa Ana Small Business Incentive Program December 2, 2013 Page 3 3. In addition to the qualifying criteria, each business will be required to complete a business development training workshop in areas such as business plan assistance, access to capital and profit sustainability. The City will be working in partnership with the Orange County Small Business Development Center to offer these workshops to businesses for a nominal fee. This workshop fee can also be reimbursed through the grant program. Offering start -up businesses rebate money and requiring them to attend a business development training course will increase their likelyhood of succeeding. 4. Launching of the Program: Upon approval of this program, staff will develop a marketing package which will include printed media, as well as content for inclusion on the City's website. The City will also be working with local business associations such as the Santa Ana Chamber of Commerce, downtown business organizations, and the Santa Ana Merchants Association to disseminate information on this new program. A component of the program is to encourage new businesses to work closely with City staff to learn about other City business services and resources available to assist them. Each business will receive a City marketing package identifying various city business resources such as the site selection assistance, job hiring and employment training services, and how to find other available financial assistance. Small businesses are the backbone of any municipal economy, including Santa Ana. New small businesses usually do not have the personal assets to infuse into their entrepreneurial venture and may have a difficult time making it through the intial years of start -up. This grant incentive may provide the assistance needed to mitigate those costs, thus increasing the probability of a more successful venture. With the dissolution of Redevelopment programs and Enterprise Zones, this program will provide the City with a much needed economic development tool and offer financial assistance to the growth and prosperity of small businesses. FISCAL IMPACT Funds in the amount of $400,000 are available in the Community Development Block Grant account (no. 13518783 - various). APPROVED AS TO FUNDS AND ACCOUNTS Nanc ong, XICP Francisco Gutierrez eJ Interim Executive Di ector Executive Director Community Develo ment Agency Finance & Management Services Agency NF /MM /kg Exhibit: 1. Eligibility Maps 2. Terms and Conditions 3. Draft Application 29A -3 29A -4 EXHIBIT 1 Community Service Area Map 04 9ANf 7 4 Y V Y II1� r,R r�m,n ♦�!p p8� Qualified Area Map A 29A -5 -4� 0.0 0.5 1.0 Miles Targeted Resident Area Map u4 eawr a 4 iy ry R Qualified Area Map B 29A -6 i Miles Targeted Business Area Map eQ asxr s 4 v 1 V b 1.� c�G `F U 8 alb Qualified Area Map C 29 A -7 0.0 0.5 1.0 Miles 29A -8 Exhibit 2 T; CITY OF SANTA ANA SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM TERMS AND CONDITIONS I. Purpose The Santa Ana Small Business Incentive Program is designed to provide a $5,000 rebate to start -up businesses to locate in Santa Ana and receive specialized business development training in the process of receiving this grant. II. Eligible Reimbursements This incentive will provide a rebate up to $5,000 for start -up costs to businesses who qualify. Start-up costs can be, but not limited to: • City Business License Fee • Signage • Inventory Purchase • Utility connections /reconnections (Sewer, Water, Telephone) • Zoning Permit Fees • Architectural /Design fees • Shipping /Packaging Fees • Advertising/Printing /Website Presence • Accounting Services • Purchase of equipment or furnishings • Office Supplies • Internet Connection • Rent /Lease payments (1 month with copy of lease) • Insurance Costs • Business development training workshop fee • Other costs considered and approved by City staff that are associated with the costs for starting up a new business. III. Program Eligibility Requirements • The business must meet one of the following criteria: 1. Income Qualifying - The business owner is determined to be low - income pursuant to HUD requirements. Applicants must use total household size as their measure of eligibility. These income limits are determined annually by the Department of Housing and Urban Development (HUD) and listed in the below table. The Declaration of Income Form (attached), with supporting documentation needs to be filled out completely. 29A -9 Household Size Income Limit 1 Person $ 51,250 2 Persons $ 58,600 3 Persons $ 65,900 4 Persons $ 73,200 5 Persons $ 79,100 6 Persons $ 84,950 7 Persons $ 90,800 8 or More Persons $ 96,650 Geographic Area Qualifying — The business may also qualify for the grant if they satisfy ONE of the below requirements: a) Community Service Area Map - The business is a new community- serving retail or service -based business and located in the designated area (Map A). If your business is retail or service, City staff will determine if your business serves the immediate residents based on its proximity to neighborhoods and the goods /services it provides. b) Targeted Resident Area Map - The business owner or an employee lives in a designated area where 70% of households are low - income (Map B). If the owner or an employee of the applying business lives in the boundaries of Area Map B, then the business would qualify. Please provide one of the following: copies of an I -9 form, Driver's license or State Identification Card, Lease or rental agreement, Utility bill, Landlord statement to show you or your employee's place of residence. c) Targeted Business Area Map - The business is located in a designated area with 20% or more of the families are below the poverty level (Map C). • Applications to participate in the Santa Ana Small Business Incentive Program need to be completed and submitted within the first year of operation. • The business must be located in a commercial /industrial storefront with an individual address. Shared suites and home -based businesses are not eligible. • The business must have 5 or fewer employees (including the owner) as defined by a mieroenterprise. • The maximum reimbursable rebate is $5,000 per business. • The business owner must submit receipts to the City for all approved costs. (See Reimbursement Instructions) The business must be active at the time of reimbursement. • The business owner must allow access to the City and its employees, as deemed necessary, for audit purposes and to assess the benefits derived from participating in the Santa Ana Small Business Incentive Program. • The business owner must complete an approved business development training workshop from the Orange County Small Business Development Center. (See attached) • The business must be licensed in the City of Santa Ana and in compliance with all City codes and regulations. 29A -10 • The business must register for a Data Universal Number System (DUNS) identification number. (See attached application) • The business must fill out a Form W -9 (Request for Taxpayer Identification Number and Certification) and submit with the application. (See attached application) • This is a one -time reimbursement per business. • Funding is not transferable and other restrictions may apply. IV. Application Approval Process • Upon receipt of application, City staff will verify its contents and check that all necessary items have been completed and attached. • Applicants will receive written notice of approval, or denial within 10 working days of application receipt. If the application is denied, it is the applicant's responsibility to recheck that all items have been included and resubmit the application. • The City's Executive Director for Connnunity Development will approve the final application and forward to the Finance department for audit and request for disbursement of funds. • Applications will be time - stamped and processed on a first -come, first- served basis. • Due to the limit in funding for the program, not all businesses that apply will receive the incentive. V. Completion of Approved Business Development Trainine Workshop The business owner must complete an approved business development training workshop prior to the disbursement of rebate funds. To sign up for an approved training workshop, please visit www.ocsbde.ore or call (714) 564 -5200. Applicants will not receive the grant if the training workshop has not been completed prior to the submittal of the application. V1. Other Please note that terms and conditions may be modified to comply with HUD and /or City requirements. 29A -11 29A -12 Exhibit 3 CITY OF SANTA ANA SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM Dear Business Owner: Thank you for your interest in the City of Santa Ana's Small Business Incentive Program. The City is dedicated to the support and growth of local businesses like yourself. We look forward to working with you personally, providing information on other City programs and services, and connecting you with the Orange County Small Business Development Center (SBDC). The Orange County SBDC will provide access to training and other business resources for businesses to grow and prosper. Enclosed is an application for the Santa Ana Small Business Incentive Program. Please complete the application and provide the following documentation: 1. A copy of your current City of Santa Ana business license. 2. Copies of bank statements, tax returns, and pay stubs from other sources of employment (if qualifying by the income criteria if applicable). 3. Conies of 1 -9 form, Driver's license or State Identification Card, Lease or rental agreement, or Utility Bill (if qualifying by target resident area). 4. Copies of your paid receipts (maximum $5,000 total) that you have spent during the start-up process for your business. (Do not include deposits) 5. Copy of the receipt for completion for the business development training workshop from the Orange County SBDC Once the City receives the items listed above, we will process your application. If eligible, you will be notified as to when you will receive your rebate. If your application is missing documentation or you are not eligible for the program, you will be notified as well. Please submit all documents (copies only, no originals) to: City of Santa Ana Economic Development Division Small Business Incentive Program 20 Civic Center Plaza, M -25, Santa Ana, CA 92701 Please note that funds are limited for this program. Applications will be processed on a first - come, first- served basis. Once the incentive funding is not available, the program will end. There may be additional funding in subsequent years if approval is granted. Again, thank you for choosing Santa Ana as the home to grow your business. Please contact our office at (714) 647 -6987 to learn more about this program and other City programs and services that could be available to you. 29A -13 SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM APPLICATION Date Submitted: Business License No: Business Opening Date: Date Issued: (Please attach copy of current City of Santa Ana Business License) Business Owner /Operator: (Please include names of all owners /partners of the business) Business Name: Business Address: Business Phone: Home Address: Description of type of business and products or services provided: No. of Employees: How will these products /services be delivered to the customer? (i.e. retail from the business address, door -to -door delivery, mail, wholesale): Program Eligibility Guidelines (Please read carefully) 1. The business must meet one of the following criteria: Income Qualifying - The business owner is determined to be low- income pursuant to HUD requirements. Income limits are listed below. Applicants must use total household size as their measure of eligibility. 'These income limits are determined annually by the Department of Housing and Urban Development (HUD) and listed in the below table. The Declaration of Income Form (attached), with supporting documentation needs to be filled out completely. 29A -14 Household Size Income Limit 1 Person $ 51,250 2 Persons $ 58,600 3 Persons $ 65,900 4 Persons $ 73,200 5 Persons $ 79,100 6 Persons $ 84,950 7 Persons $ 90,800 8 or More Persons $ 96,650 Geographic Area Qualifying — The business may also qualify for the grant if they satisfy ONE of the below requirements: a) Community Service Area Map - The business is a new community- serving retail or service -based business and located in the designated area (Map A). If your business is retail or service, City staff will determine if your business serves the immediate residents based on its proximity to neighborhoods and the goods /services it provides. b) Targeted Resident Area Map - The business owner or an employee lives in a designated area where 70% of households are low- income (Map B). If the owner or an employee of the applying business lives in the boundaries of Area Map B, then the business would qualify. Please provide one of the following: I -9 form, Driver's license or State Identification Card, Lease or rental agreement, Utility bill, Landlord statement to validate you or your employee's place of residence. c) Targeted Business Area Map - The business is located in a designated area with 20% or more of the families are below the poverty level (Map C). Please state how you will be qualifying your business for this Program (See qualification criteria above): ❑ Income Qualifying El Community Service Area El Targeted Resident Area El Targeted Business Area 2. Applications to participate in the Santa Ana Small Business Incentive Program need to be completed and submitted within the first year of operation. 3. The business must be located in a commercial /industrial storefront with an individual address. Shared suites and bome -based businesses are not eligible. 4. The business must have 5 or fewer employees including the owner of the business. 5. The maximum reimbursable rebate is $5,000 per business. 29A -15 6. The business owner must submit receipts to the City for all approved costs. (See Reimbursement Instructions) The business must be active at the time of reimbursement. Only one application for your business will be accepted. 7. The business owner must allow access to the City and its employees, as deemed necessary, for audit purposes and to assess the benefits derived from participating in the Santa Ana Small Business Incentive Program. 8. The business owner must complete an approved business development training workshop from the Orange County Small Business Development Center. To sign up for an approved training workshop, please visit www.ocsbdc.ore or call (714) 564 -5200. 9. The business must be licensed in the City of Santa Ana and in compliance with all City codes and regulations. 10. The business must register for a Data Universal Number System (DUNS) identification number. (See attached) 11. The business must fill out a Form W -9 (Request for Taxpayer Identification Number and Certification) and submit with the application. (See attached) 12. Funding is not transferable and other restrictions may apply. NOTE: Any violation of the program guidelines will result in the businessperson promptly repaying the City any amount paid pursuant to this agreement. The business owner must complete an approved business development training workshop prior to the disbursement of rebate funds. To sign up for an approved training workshop, please visit www.ocsbde.org or call (714) 564 -5200. Applicants will not receive the grant if the training workshop has not been completed prior to the submittal of the application. Please provide following information: Name of Training Program (subject): Name of Instructor who provided the Training: Date(s) of Training: Total Hours: Important: Please keep a copy of your workshop receipt to submit with the application. Applicant Certification: I acknowledge and agree to the above eligibility requirements and certify that all information provided herein is true and complete to the best of my knowledge. Verification will be provided, if requested. Business Owner /Operator (Print of Type) Business Owner /Operator Signature Date Business Owner /Operator (Print of Type) Date Business Owner /Operator Signature City of Santa Ana, Economic Development Division 20 Civic Center Plaza, M -25, Santa Ana, CA 92701 (714) 647 -6987 29A -16 CITY OF SANTA ANA SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM REIMBURSEMENT CHECKLIST Submission of all items included in the following checklist will ensure the timely processing of your application and rebate check. 1. Complete and signed application with all the following requested materials: • Small Business Incentive Application • Copy of current City of Santa Ana business license • Declaration of Income Form with Supporting Documentation (if qualifying by income criteria) • Copy of I -9 form, Driver's license or State Identification Card, Lease or rental agreement, Utility bill, Landlord statement (if qualifying by target resident area) • Duns Number Form • Completed Receipt Form from the Orange County SBDC indicating the workshop taken. • Copies of paid receipts totaling at least $5,000 of expenses you have invested in the start- up of this business. Receipts are required to document all business start -up costs. Please note that this is a one -time reimbursement for up to $5,000. Eligible Use of Incentive Funds The Santa Ana Small Business Incentive Program is designed to provide a $5,000 incentive to start-up businesses to locate in Santa Ana and receive specialized business development training in the process of receiving this grant. This incentive will provide a rebate up to $5,000 for start up costs to businesses who qualify. Start-up costs can be, but not limited to: • City Business License Fee • Signage • Inventory Purchase • Utility connections /reconnections (Sewer, Water, Telephone) • Zoning Permit Fees • Architectural/Design fees • Shipping /Packaging Fees • Advertising/Printing /Website Presence • Accounting Services • Purchase of equipment or furnishings • Office Supplies • Internet Connection • Rent /Lease payments (1 month with copy of lease) • Insurance Costs • Business development training workshop fee 29A -17 • Other costs considered and approved by City staff that are associated with the costs for starting up a new business. All qualified reimbursements must be supported by paid receipts, detailed statements or invoices clearly identifying the expense and how that expense supports the start -up of a new business. Please make sure all eligible receipts for reimbursement are not combined with other non program related expenditures. The completed application should be sent to: City of Santa Ana Economic Development Division Small Business Incentive Program 20 Civic Center Plaza, M -25, Santa Ana, CA 92701 29A -18 CITY OF SANTA ANA SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM REIMBURSABLE RECEIPT FORM Please list all reimbursable receipts below. City staff has the right to approve and/or deny requests for reimbursements. Attach copies of your listed receipts to this form. Reimbursable Receipts (Explanation) Total 1. $ 2. $ 5. 6. 7. 9. $ 10. $ 29A -19 Total: $ CITY OF SANTA ANA SANTA ANA SMALL BUSINESS INCENTIVE PROGRAM DECLARATION OF INCOME Applicant Name: Income for: A Declaration of Income should be filled out for the head of household and each working member of the household. Check only one box and complete only that section ❑ I certify, under penalty of perjury, that I currently receive the following income: Income source: Amount: Frequency: Income source: Amount: Frequency: Income source: Amount: Frequency: ** Employment income should include the total income, before taxes and deductions are taken out. Freauenev Key Paid weekly: 52 times /year Paid every other week (biweekly): 26 times /year Total Monthly income: Paid twice a month (semimonthly): 24 times /year Total Expected Annual income: Paid monthly: 12 times /year Please attach any relevant documentation of this household member's income that you collected such as bank statements, pay stubs and tax returns. Remember, one of these forms should be filled out for the head of household and each working member of the household. I certify, under penalty of perjury, that I have no other income or assets other than what I have stated above. Applicant Signature: Date: ❑ I certify, under penalty of perjury, that I do not have any income from any source at this time. Applicant Signature: Staff Verification Staff Signature: 29A -20 Date: Date: 0 CITY OF SANTA ANA SANTA ANA SMALL BUSINESS GRANT PROGRAM OBTAINING A DUNS NUMBER The Federal government requires that all applicants for Federal grants and cooperative agreements have a DUNS number. The Federal government will use the DUNS number to better identify related organizations that are receiving funding under grants and cooperative agreements, and to provide consistent name and address data for electronic grant application systems. Data Universal Number System (DUNS) Number • The Data Universal Numbering System (DUNS) number is a unique nine -digit identification number provided by Dun & Bradstreet (D &B). • In order to provide on- the -spot DUNS number assignment, the requester should do this by telephone. (See telephone number below.) Obtaining a DUNS Number • You should verify that you have a DUNS number or take the steps needed to obtain one as soon as possible, if there is a possibility you will be applying for future city grants. • If you already have a DUNS number. If you, as the business applying for the grant obtained a DUNS number, please use that on the applications. It is not necessary to request another. • If you are not sure if you have a DUNS number. Call D &B using the toll -free number, 1- 866- 705 -5711 and indicate that you are a Federal grant applicant/prospective applicant. D &B will tell you if you already have a number. If you do not have a DUNS number, D &B will ask you to provide the information listed below and will immediately assign you a number, free of charge. • If you know you do not have a DUNS number. Call D &B using the toll -free number, 1- 866- 705 -5711 and indicate that you are a Federal grant applicant /prospective applicant. D &B will ask you to provide the information listed below and will immediately assign you a number, free of charge. To Obtain Your DUNS Number • Please call the dedicated toll -free DUNS Number request line for Federal grant and cooperative agreement applicants or prospective grant applicants at: 1- 866 - 705 -5711 The number is staffed from 8 a.m. to 6 p.m. (local time of the caller when calling from within the continental United States) Calls placed to the above number outside of those hours will receive a recorded message requesting the caller to call back between the operating hours. • The process to request a DUNS number takes about 5 -10 minutes. • A DUNS number will be assigned at the conclusion of the call. • You will need to provide the following information: • Legal Name • Headquarters name and address for your organization 1 29A -21 • Doing business as (DBA) or other name by which your organization is commonly known or recognized • Physical Address, City, State and Zip Code • Mailing Address(is separate from Headquarters and /or physical address) • Telephone Number • Contact Name and Title • Number of Employees at your physical location 29A -22 Form w-9 Request for Taxpayer Give Form to the (Rev. August 2013) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service Name (as shown on your income tax return) N Business name /disregarded entity name, if different from above number to enter. m m m °- c Check appropriate box for federal tax classification: Exemptions (see instructions): ❑ Individual /sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust /estate N p Exempt payee code (if any) ❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ► Exemption from FATCA reporting c m code (If any) 0. 0 11 ❑ Cther(see 1- 'u Address (number, street, and apt. or suite no.) Requester's name and address (optional) v a City, state, and ZIP code m N List account numbers) here (optional) Tax aver Identification Number TIN Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number avoid backup withholding. For individuals, this is your social security number However, for re resident alien, sole proprietor, or disregarded entity, see the Part I instructions on n page 3. For other m _ entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer Identification number number to enter. rT-1 L ] 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 on page 3. Sign Signature of Here U.S. person 01 Date 11, General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. The IRS has created a page on IRS.gov for information about Form W -9, at www.im.gov /w9. Information about any future developments affecting Form W -9 (such as legislation enacted after we release it) will be posted on that page. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W -9 only if you are a U.S. person (Including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be Issued), 2. Certify that you are not subject to backup withholding, or S. Claim exemption from backup withholding if you are a U.S. exempt payee. If 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 are exempt from the FATCA reporting, is correct. Note. If you are a U.S. person and a requester gives you a form other than Form W -9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W -9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • 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 United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701 -7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners share of effectively connected taxable income from such business. Further, in certain cases where a Form W -9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W -9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. 2Cat, p. 110 X— Form W-9 (Rev. 8 -2013) Form W -9 (Rev. 8 -2013) Page 2 In the cases below, the following person must give Form W -9 to the partnership for purposes of establishing Its U.S. status and avoiding withholding on its allocable share of net Income from the partnership conducting a trade or business In the United States: • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity, • In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust, and • In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W -9. Instead, use the appropriate Form W -8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entitles). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien Individual may use the terms of a tax treaty 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 may permit an exemption from tax to continue for certain types of income 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 exception contained In the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W -9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S. -China income tax treaty allows an exemption from tax for scholarship Income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S. -China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W -9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W -8 or Form 8233. What Is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax - exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made In settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W -9 for more information. Also see Special rules for partnerships on page 1. What is FATCA reporting? The Foreign Account Tax Compliance Act ( FATCA) requires a participating foreign financial Institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W -9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W -9 If the name or TIN changes for the account, for example, If the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fall to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure Is due to reasonable cause and not to willful neglect. Civil penalty for false Information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying Information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and /or imprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an Individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is In joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your income tax return on the "Name" line. You may enter your business, trade, or "doing business as IDEA)" name on the "Business name /disregarded entity name" line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the "Name" line and any business, trade, or "doing business as (DBA) name" on the "Business name /disregarded entity name" line. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a "disregarded entity." See Regulation section 301.7701- 2(c)(2)(iii). Enter the owner's name on the "Name" line. The name of the entity entered on the "Name" line should never be a disregarded entity. The name on the "Name" line must be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that Is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name Is required to be provided on the "Name" line. If the direct owner of the entity Is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the "Business name /disregarded entity name" line. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W -8 instead of a Form W -9. This is the case even if the foreign person has a U.S. TIN. Note. Check the appropriate box for the U.S. federal tax classification of the person whose name is entered on the "Name" line (Individual /sole proprietor, Partnership, C Corporation, S Corporation, Trust /estate). Limited Liability Company (LLC). If the person identified on the "Name" line is an LLC, check the "Limited liability company" box only and enter the appropriate code for the U.S. federal tax classification in the space provided. If you are an LLC that is treated as a partnership for U.S. federal tax purposes, enter "P" for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter "C" for C corporation or "S" for S corporation, as appropriate. If you are an LLC that Is disregarded as an entity separate from Its owner under Regulation section 301.7701 -3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be Identified on the "Name" line) is another LLC that is not disregarded for U.S. federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the "Name" line. Other entities. Enter your business name as shown on required U.S. federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name /disregarded entity name" line. Exemptions If you are exempt from backup withholding and /or FATCA reporting, enter In the Exemptions box, any code(s) that may apply to you. See Exempt payee code and Exemption from FATCA reporting code on page 3. 29A -24 Form W -9 (Rev. 8 -2013) Exempt payee code. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following codes Identify payees that 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 account satisfies the requirements of section 401(f)(2) 2 —The United States or any of its agencies or instrumentalities 3 —A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities 4 —A foreign government or any of its political subdivisions, agencies, or instrumentalities 5 —A corporation 6 —A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States 7 —A futures commission merchant registered with the Commodity Futures Trading Commission 8 —A real estate investment trust 9 —An entity registered at all times during the tax year under the Investment Company Act of 1940 10 —A common trust fund operated by a bank under section 584(a) 11 —A financial institution 12 —A middleman known In the investment community as a nominee or custodian 13 —A trust exempt from tax under section 664 or described in section 4947 The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. IF the payment is for... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 7 Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. Barter exchange transactions and Exempt payees 1 through 4 patronage dividends Payments over $600 required to be Generally, exempt payees reported and direct sales over $5,0001 1 through 52 Payments made in settlement of Exempt payees 1 through 4 payment card or third party network transactions r See Form 1099 -MISC, Miscellaneous Income, and its instructions. z However, the following payments made to a corporation and reportable on Form 1099 -MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency. Exemption From FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial Institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form If you are uncertain if the financial institution Is subject to these requirements. A —An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B —The United States or any of Its agencies or instrumentalities C —A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or Instrumentalities D —A corporation the stock of which Is regularly traded on one or more established securities markets, as described In Reg. section 1.1472-1 (c)(1)(1) E —A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1 (c)(1)(1) F —A dealer in securities, commodities, or derivative financial instruments (Including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state Page 3 G —A real estate investment trust H —A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I —A common trust fund as defined in section 584(a) J —A bank as defined in section 581 K —A broker L —A trust exempt from tax under section 864 or described in section 4947(a)(1) M —A tax exempt trust under a section 403(b) plan or section 457(g) plan Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien 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 not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single- member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or EIN, If the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS -5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1 -800- 772 -1213. Use Form W -7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.1m.gov /businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W -7 and SS -4 from the IRS by visiting IRS.gov or by calling 1-800 - TAX -FORM (1 -800- 829 - 3676). If you are asked to complete Form W -9 but do not have a TIN, apply for a TIN and write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60 -day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W -8. Part II. Certification 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 sign by the withholding agent even if items 1, 4, or 5 below indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required(. In the case of a disregarded entity, the person identified on the "Name" line must sign. Exempt payees, see Exempt payee code earlier. Signature requirements. Complete the certification as indicated in items i through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. 29A -25 Form W-9 (Rev. 8-2013) What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual The Individual 2. Two or more individuals (joint The actual owner of the account or, account) if combined funds, the first individual on the account' 3. Custodian account of a minor The minor' (Uniform Gift to Minors Act) 4. a. The usual revocable savings The grantor- trustee trust (grantor is also trustee) b. So- called trust account that is The actual owner not a legal or valid trust under state law 5. Sole proprietorship or disregarded The owner' entity owned by an individual 6. Grantor trust filing under Optional The grantor` Form 1099 Filing Method 1 (see Regulation section 1.671- 4(b)(2)(1)(A)) For this type of account: Give name and BIN of: 7. Disregarded entity not owned by an The owner individual 8. A valid trust, estate, or pension trust Legal entity' 9. Corporation or LLC electing The corporation corporate status on Form 8832 or Form 2553 10. Association, club, religious, The organization charitable, educational, or other tax - exempt organization 11. Partnership or multi- member LLC The partnership 12. A broker or registered nominee The broker or nominee 13. Account with the Department of The public entity Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671- 4(b)(2)(l)(B)) ' List first and circle the name of the person whose number you furnish. If only one person on 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 "Business name /disregarded entity" name line. You may use either your SSN or ON (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 TIN of the personal representative or trustee unless the legal entity itself Is not designated in the account title.) Aso see Speclel rules for partnerships on page 1. "Nate. Grantor also must provide a Form W -9 to trustee of trust 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. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a lob or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by Identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen puree or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1- 800 - 908 -4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAB) assistance. You can reach TAB by calling the TAB toll -free case intake line at 1- 877 - 777 -4778 or TTY/TDD 1- 800 -829 -4059. Protect yourself from suspicious smalls or phlshing schemes. Finishing Is the creation and use of email and websites designed to mimic legitimate business smalls and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user Into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through small or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing @irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1 -800- 366 -4484. You can forward suspicious smalls to the Federal Trade Commission at: spam @uce.gov or contact them at www.ftc.gov /ldtheff or 1-877- IDTHEFT (1 -877-438-4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage Interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use In administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and Intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. 29A -26