HomeMy WebLinkAboutPeelle TechnologiesTHIS AGREEMENT 'Is made and entered *into on the... 13'f day of
uar 2-015 by -v and betwew the...... TOWN OF LOS ALT0'S:,HJ-.LLS (hereinedter referred
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I :h agree as. foil om,* nsmd erat, on, -o-. their muWW covenarft, the part, es ereto 1.
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�21. EXHIBITS., The f611 sr=rporated into and made.
owing alftache eWbft are heraby
a part, of this 4-reement.
Pro [ from CONTRACTOR dated OcW. e 14
posa b r 2014 and Janu y .71
2:015.
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cf. CONTRACTOR is. responsible for monAor*11:ng fts own forcesfiamp"eslagenw
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subcbMtacthrs to ensure deM.ry of :g... -A
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5, GENERAL JERMS AND !QONQITIONS.
WORKERS COMPENSATION INSURANCE: Minimum statutory
limits.
011111111
I 11�17
v,, NOTICE OF CANCELLATION: The: City requires 30 days written
I
notice of cancellation. Add.itionally, the notice statement on the
certificate should not i . n i s the wording "endeavor to" or "but failure
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to mail such notice shall impose no obligation or liability of any kind
upon the company,, its agents or representatives."
V I CERTIFICATE OF INSURANCE: Prior to commencement of services,
evidence of 'insurance coverage must be shown by a properly
executed certificate of insurance and it shall name "The Town of Los
Altos mills, its elective and appo I inted officers, employees, and
volunteers" as additionalinsure ds,11;
ilrent el10
v
m iance with this Agreement, the
i . To pevday and ensure co Aisne
certificates and endorsements must be submitted to.4
Town of Los Altos Hills
26379 Fremont Road
Los Altos Hills, CA 94022
Town of Los Altos Hills Page 2 of .4
Shod forM
Updated 4,113/10
C, ICON- DISCRIMINATION. No discrimination shall be rade in the employment of
persons under this Agreement because of the race, color, national origin, age,
ancestry, religion or sex of such person.
e. CHANGES. This Agreement shall not be assignedor transferred without
I a
advance written consent of the TOWN, No, changes or variations . nations of- any kind are
authorized without the written consent of the City Manager. This Agreement may
only be amended by a written 'instrument signed by both parties.,
f. TERMINATION. This Agreement may be terminated by TOWN upon seven (7)
days written notice to CONTRACTOR, Monies owed for work satisfactorily
completed shall be paid to CONTRACTOR within 14 days of termination,
Town of Los; Altos Hills Page 3 of 4
Short fdrm
Updated 4/23110
h. ENTIRE AGREEMENT. This Agreement represents the entire agreement
between the Parties. Any ambiguities or disputed terms between this Agreement
and any attached Exhibits shall be interpreted according to the language in this
Agreement and not the Exhibits.
6. INVOICING. Send all invoices to the contract coordinator at the address below.
This Agreement shall become effective upon its approval and execution by TOWN. In
witness whereof, the parties have executed this Agreement the day and year first
written above.
CONTRACT COORDINATOR and
representative for TOWN:
Deborah Padovan
City Clerk
Town of Los Altos Hills
26379 Fremont Road
Los Altos Hills, CA 94022
CONTRACTOR:
By: ,.,,
Signature Date
J�,VZA Vre
Print name, Title
Carl Cahill, City Manager Date
Town of Los Altos Hills Page 4 of 4
Short form
Updated 4/23/10
h. ENTIRE AGREEMENT, This Agreement represents the entire agreement
between the Parties. Any ambiguities or disputed terms between Chi's Agreement
and any attached Exhibits shall be *Interpreted according to the language ire this
Agreement and notthe Exhibfts.
6, INZO.ICING , Send all invoices to the contract coordinator atthea ddreal below.
This Agreement shall become effective upon its approval and execution by TOWN. In
S
witness whereof, the parfies have executed th" IAgreement the day and year first
w
rtt n above
CONTRACT COORDINATOR.and
41
representative for TOWN:
Debo.ra.h Padovan
Oy Clerk
Town of Los Altos, Hills
26379 Fremont, Road
Los Altos Hills, CA 94022
so
Imaly z
By. L.
Carl Cahill, Cid Manager
Town of Los Altos Hills Page 4 of 4
Shortfotm
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Formw=9 Request for Taxpayer
(Rev. December 2011)
Department of the Treasury Identification Nan
umber d Certification
Internal Revenue Service
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Name (as shown on your income tax return)
I Peelle Technologies, Inc.
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
n Individual/sole proprietor [] C Corporation ❑ S Corporation EJ Partnership E] Trust/estate
Give Form to the
requester. Do not
send to the IRS,
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) b- ................................. 13 Exempt payee
❑ Other (see instructions) 0,, -
Address (number, street, and apt. or suite no.) Requester's name and address (optional)
197 East Hamilton Avenue,, Suite 201
City, state, and ZIP code
Campbell,, CA 95008
List account number(s) here (optional)
Taxpayer 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
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN an 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. I I I I I I I I
im"MME"n"""r
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 M 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).
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 4.
Sign Signature of
�� ' '"`' '~Jc
Here U.S. person Ol-
— Date 110-
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with th6 IRS must
obtain your correct taxpayer identification number (TIN) to report, for
example, income paid to you, 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
3. 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.
Note. If 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 on any foreign partners' share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the 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 withholding on your share of partnership income.
Cat. No. 10231X Form W-9 (Rev. 12-2011)