HomeMy WebLinkAboutIFB Mid Size SUV 2025197-03 FINAL w w9INVITATION FOR BIDS
Notice is hereby given that sealed bids will be received by the Franklin County Controller’s Office, Franklin
County Administration Building, 272 North Second Street, Chambersburg, PA 17201 for a Mid-Size SUV for the
Franklin County Sheriff’s Office until 4:00 PM prevailing time on Tuesday August 5, 2025. All bids so received
will be publicly opened and read on Wednesday August 6, 2025, at 10:00 AM prevailing time at the Franklin
County Commissioners’ Office, 272 North Second Street, Chambersburg, PA 17201
Specifications, instruction and bid forms will be furnished by the Franklin County Procurement Office upon
request at 272 North Second Street, Chambersburg, PA 17201, or by calling (717) 261-3890.
The Franklin County Commissioners reserve the right to reject any or all bids and to waive any or all defects,
errors, omissions, irregularities or informalities in any bid.
Awards shall be made only to responsible bidders that possess the potential to perform successfully under the
terms and conditions of this procurement. Consideration shall be given to such matters as bidder integrity,
compliance with public policy, record of past performance and financial and technical resources when
determining responsibility.
FRANKLIN COUNTY COMMISSIONERS
Dean A. Horst, Chairman
John T. Flannery
Robert G. Ziobrowski
LEGAL AD
Request for Bid for Mid-Size SUV for the Franklin County Sheriff’s Office
Proof of Publication Requested
Please Publish – July 21, 2025, and July 25, 2025
INVITATION FOR BID
MID-SIZE SUV
FOR FRANKLIN COUNTY SHERIFF'S OFFICE
COUNTY OF FRANKLIN, PENNSYLVANIA
IFB# 2025197-03
County of Franklin, PA 272 North Second Street Chambersburg, PA 17201
Table of Contents
INTRODUCTION ....................................................................................................................................................... 1
1. GENERAL INFORMATION ........................................................................................................................... 1
2. DESCRIPTION OF THE GOVERNMENT. ....................................................................................................... 1
3. TIME REQUIREMENTS: ............................................................................................................................... 1
INSTRUCTIONS TO BIDDERS .................................................................................................................................... 2
1. PREPARATION OF BID ................................................................................................................................. 2
2. AWARD AND EXECUTION OF THE CONTRACT............................................................................................ 2
3. WITHDRAWAL OF BIDS .............................................................................................................................. 2
4. RIGHT TO REJECT BIDS ............................................................................................................................... 3
5. TIME OF COMPLETION/DELIVERY .............................................................................................................. 3
6. VEHICLE TITLING, REGISTRATION AND STATE INSPECTION ....................................................................... 3
7. EXEMPTION FROM FEDERAL EXCISE AND PENNSYLVANIA SALES TAX ...................................................... 3
8. MANUFACTURER’S PRICE REDUCTION OCT 2006 ...................................................................................... 3
9. PROTECTION BY VENDOR ........................................................................................................................... 4
10. QUESTION AND ANSWER PERIOD ......................................................................................................... 4
11. NONDISCRIMATION CLAUSE .................................................................................................................. 4
12. CONTRACT PROVISIONS......................................................................................................................... 4
BID SPECIFICATIONS ................................................................................................................................................ 6
ATTACHMENT A
ATTACHMENT B
BID FORM
BID CHECKLIST
1
INTRODUCTION
1. GENERAL INFORMATION. The County of Franklin, PA (“County”) is requesting bids from qualified
vendors to provide a new 2026 or newer mid-size SUV for the Sheriff’s Office.
2. DESCRIPTION OF THE GOVERNMENT. The County of Franklin, PA was incorporated on September 9,
1784. The County is a fourth class county with a population of 155,932 (2020 Census). It operates under a
three member elected Board of Commissioners. The County provides service to its citizens such as judicial
administration, human services, public safety, public works, economic development and general
administration. The Franklin County Sheriff’s Office is responsible for enforcement of laws throughout the
county as well as serving warrants and other legal documents, providing court security and transportation
of prisoners.
3. TIME REQUIREMENTS:
Request for Bid Issued: July 21, 2025
Questions and Answers Ends: July 30, 2025, 4:00 PM
Due Date for Bids: August 5, 2025, 4:00 PM
Bid Public Opening: August 6, 2025, 10:00 AM
Delivery of SUV on or before: January 31, 2026
2
INSTRUCTIONS TO BIDDERS
1. PREPARATION OF BID
1.1 Bids shall be addressed to and will be received by the Franklin County Controller’s Office, Franklin
County Administration Building, 272 North Second Street, Chambersburg, PA 17201 until 4:00 PM
prevailing time on Tuesday August 5, 2025. All bids so received will be publicly opened and read at
the Franklin County Commissioners on Wednesday August 6, 2025 at 10:00 AM at their offices at
272 North Second Street, Chambersburg, PA 17201.
1.2 Bids shall be enclosed in sealed opaque envelopes. Bids shall be identified by disclosing on the face
of the envelope the bid number (IFB# 2025197-03), name of the project (Mid-Size SUV for the
Franklin County Sheriff’s Office) and the name of the bidder.
1.3 Attention is directed to the Bid Form in the Bidding Documents. Two (2) separate copies of the Bid
Form are furnished and both shall be used to submit a bid. Failure to fill out, execute and submit
these forms as specified is sufficient reason for rejection.
1.4 Bids must be signed by an owner, partner, or in the case of a corporation, by the President or Vice
President and attested by the Secretary, with Corporate Officer, a Power-of-Attorney must be
attached to the bid.
1.5 All applicable blank spaces in the bid shall be filled in clearly where indicated, either typed or
written in ink. Altering and/or changing any part of this bid will be sufficient reason for rejection.
1.6 Where so indicated by the makeup of the Bid Form, sums shall be expressed in both words and
figures, and in the case of discrepancy between the two, the amount written in words shall govern.
1.7 The owner reserves the rights to award the contracts to the other than lowest bidder if, in its
opinion, the products included within such bids are not equal to the standard established for such
projects in the specifications.
1.8 Each bidder shall be required to execute a Non-Collusion Affidavit (See Attachment A) and affix it
to the Bid Forms. No bid shall be considered unless accompanied by such executed affidavits.
1.9 Each bidder shall fully complete and include a current W-9 form with the bid. A W-9 form is
included within this bid in Attachment B.
2. AWARD AND EXECUTION OF THE CONTRACT
2.1 When the bid has been accepted by the County, notification of such acceptance will be mailed to
the successful bidder, at the address designated by the bidder on the BID FORM.
3. WITHDRAWAL OF BIDS
3.1 Bids may not be modified, withdrawn or cancelled by the bidder for thirty (30) days after the time
designated for the receipt of bids.
3
4. RIGHT TO REJECT BIDS
4.1 The County reserves the right in its discretion to reject any or all bids and to waive irregularities or
information in any bid and to award contracts on an item by item basis. Awards shall be made only
to responsible bidders that possess the potential ability to perform successfully under the terms
and conditions of this procurement. Consideration shall be given to such matters as bidder
integrity, compliance with public policy, record of past performance, and financial and technical
resources when determining responsibility.
5. TIME OF COMPLETION/DELIVERY
5.1 Delivery under this contract shall be fully and finally completed no later than January 31, 2026,
except as may be mutually extended by the Owner and Contractor. If delivery does not occur by
this deadline, the County reserves the right to cancel the contract.
5.2 Delivery shall be F.O.B. Destination which is
County of Franklin
Administration Building
272 N Second St.
Chambersburg, PA 17201
5.3 The vehicle delivery shall be by appointment only and will be coordinated with the Procurement
Department at 717-261-3890.
6. VEHICLE TITLING, REGISTRATION AND STATE INSPECTION
6.1 The vehicle shall have a valid Pennsylvania Inspection sticker and, if required, a valid Pennsylvania
emissions inspection sticker upon delivery, as well as any information required to establish vehicle
title and registration.
6.2 Title to the vehicle will pass to the purchaser only on inspection and acceptance of the vehicle. All
risk and loss remains with the contractor until title of the vehicle passes to the purchaser.
6.3 Municipal Government License Plates are required.
7. EXEMPTION FROM FEDERAL EXCISE AND PENNSYLVANIA SALES TAX
7.1 The County of Franklin, PA is exempt from Federal Excise Taxes and Pennsylvania Sales Taxes as a
political subdivision of the Commonwealth of Pennsylvania. Prices as shown in the bid shall
exclude such Federal and State Taxes.
8. MANUFACTURER’S PRICE REDUCTION (OCT 2006)
8.1 If, prior to the delivery of the awarded item(s) by the Contractor, a price reduction is announced
by the original equipment manufacturer, a comparative price reduction will be given to the
Purchaser by the Contractor.
4
9. PROTECTION BY VENDOR
9.1 The vendor agrees to indemnify and save harmless the County of Franklin, PA, its representatives,
employees and agents, from all claims, demands, actions, suits and liabilities arising from the Vendor’s
own fault or negligence or through the negligence or fault of the manufacturer of goods and
reasonable attorney fees incurred by the county in response to such claims, demands, actions or
liabilities, provided it ultimately determined that such claims result from the vendor’s or
manufacturer’s fault or negligence.
9.2 The vendor shall not assign or otherwise transfer any of its responsibilities or obligations under the
contract to any other person or entity without prior written consent of the county.
10. QUESTION AND ANSWER PERIOD
10.1 Questions will be accepted until 4:00 PM Wednesday July 30, 2025 via email at
procurement@franklincountypa.gov. Answers will be posted at
https://www.franklincountypa.gov/current-solicitation-opportunities/.
11. NONDISCRIMATION CLAUSE
11.1 Franklin County assures that no person shall be excluded from participating in, be denied the benefits
of, or be otherwise subjected to discrimination on the grounds of race, gender, creed, color, sexual
orientation, gender identity or expression, or in violation of the Pennsylvania Hunan Relations Act,
which prohibits discrimination on the basis of race, color, religious creed, ancestry, age, sex, national
origin, handicap or disability, or in violation of any applicable local, state, or federal laws. With
advance notification, accommodations may be provided for those with special needs to language,
speech, sight or hearing. If you have a request for a special need, wish to file a complaint, or desire
additional information please contact the Risk Department at (717) 261-3819 or
riskmgt@franklincountypa.gov.
12. CONTRACT PROVISIONS
12.1 After Franklin County makes its selection, it shall proceed to negotiate a contract based on the bid
and scope of work for the project. If the County is unable to negotiate a satisfactory contract with the
most highly qualified bidder, the County shall formally end negotiations with that bidder and begin to
negotiate with the second most highly qualified bidder. Negotiations shall continue in this sequence
until a contract is agreed upon.
12.2 The performance of this contract shall be in accordance with all Federal, State and local laws as may
be applicable. Any contract between Franklin County and the awarded bidder shall be subject to the
rules and regulations of any agencies where funding is being requested. Franklin County reserves the
right to reject any and all proposals, and to waive irregularities. Additionally, in the event that
Franklin County procures grant funding assistance, the contract shall contain all necessary provisions
of that grant award contract.
12.3 The contract between the County and the selected bidder shall include the following non-negotiable
contact provisions:
12.3.1 Indemnification of the County.
12.3.2 Non-Indemnification of the contractor.
12.3.3 Forum Selection (Franklin County, PA Court of Common Pleas).
5
12.3.4 Choice of law (Commonwealth of Pennsylvania).
12.3.5 Termination for convenience/termination for cause by the County/nonappropriation.
12.3.6 Work-for-Hire Transfer of Copyrights/Intellectual Property.
12.3.7 County ownership of the instruments of service/deliverables.
12.3.8 Prevailing party attorneys’ fees.
12.3.9 Nondiscrimination.
12.3.10 Suspension and debarment.
12.3.11 Release of liability in favor of the County.
12.3.12 Non-release of liability of the contractor.
12.3.13 Insurance Coverage and County status as an additional insured.
12.3.14 Terms of payment and invoicing, including 45-day payment period after acceptance.
12.3.15 Data security, confidentiality, and use of County data and information.
12.3.16 Any and all federal and state provisions required as a result of grant funding.
12.4 The County reserves the right to request additional contract provisions it deems necessary as needed
to protect the best interest of the County.
6
BID SPECIFICATIONS
Bidders’ Minimum Qualifications
It is unlawful for any individual, corporation, partnership, association or other entity foreign or domestic to
engage in the business of salesperson, broker, dealer, manufacturer, factory branch, distributor, distributor
branch, factory or distributor representative or wholesaler within the Commonwealth of Pennsylvania unless
they have secured a license as required by Act No. 84 of 1983, known as the Board of Vehicles Act. Before a
contract is awarded to any Contractor, they must hold or secure an appropriate license issued by the State
Board of Vehicle Manufacturers, Dealers and Salespersons. Information and/or an application in regard to the
license requirement can be obtained from: Department of State Bureau of Professional and Occupational
Affairs:
State Board of Motor Vehicle Manufacturers, Dealers and Salesmen
P. O. Box 2649
Harrisburg, PA 17105-2649
The dealer shall submit proof of such license with the bid.
Vehicle Requirements
1. The vehicle must be a new mid-sized SUV such as a Chevy Traverse LT or an approved equal. The
model year shall be 2026 or newer. New shall mean that the County will be the first user after the
vehicle has been manufactured or produced. Re-manufactured vehicles are excluded.
2. The vehicle shall have an internal combustion engine. Electric and hybrid vehicles are excluded.
3. The exterior color shall be gray or other approved neutral color.
4. The interior color shall be black.
5. The seats shall be leather or vinyl or other approved equivalent material.
6. Other required features are:
6.1 All Wheel Drive (AWD)
6.2 2.5L Turbo engine
6.3 4 Doors
6.4 Power Steering and Locks
6.5 Air conditioning
6.6 Arm Rests
6.7 Factory Center Console/Arm Rest
6.8 Rear Cargo Area
6.9 Second Row shall be a bench seat
6.10 120 3 prong Outlet in front passenger area
6.11 Keyless Entry with Remote Start
7. Wheel/Rim size and type shall be original equipment brand and a standard consumer vehicle model,
not a police model. Tire inflation monitors shall be supplied as required by Federal Motor Vehicle
Safety Standard (FMVSS) 138.
8. The vehicle shall have completed the manufacturer’s recommended pre-delivery service.
9. The vehicle shall be clean, lubricated, serviced, fuel tank filled to the recommended capacity, all
adjustments completed, and all mechanical and electrical components fully functional and operational.
The vehicle shall be “road ready” for immediate use.
10. The vehicle furnished by the Contractor pursuant to the Contract must be manufactured in North
America. North America is defined as the United States, Canada, and Mexico. A motor vehicle is
7
manufactured in North America if a substantial majority of the principal components are assembled
into the final products in an assembly plant in North America. The Contractor shall be prepared to
prove that the motor vehicles that will be, or have been, furnished to the Commonwealth will be or
are, in fact, manufactured in North America in accordance with Sections 3731-3736 of the
Commonwealth Procurement Code (62 Pa. C.S. Sections 3731-3736), known as the Motor Vehicle
Procurement Act. No payment shall be made to the Contractor unless the County is satisfied that the
Contractor has complied with these provisions and the Motor Vehicle Procurement Act. Any payments
made to the Contractor, which should not have been made, shall be recoverable directly from the
Contractor. In addition to the withholding of payments, any person who willfully violates any of the
provisions of the Motor Vehicle Procurement Act may be prohibited by any public agency from
participation in Contracts awarded by the public agency for a period of five years from the date of
determination that a violation has occurred.
11. The vehicle shall include the proper forms to apply for Pennsylvania title and license. The title must be
free and clear of any liens and properly executed.
12. The vehicle shall include a copy of all warranty documents.
13. The County will inspect the vehicle prior to acceptance. If the vehicle is found not to meet the terms of
the bid submission, it will be the responsibility of the supplier to remove the vehicle within two (2)
working days after notification and return the vehicle to the County upon correction of deficiencies.
Date in service will be the date the vehicle is accepted by the County, not the date of delivery.
14. The County disclaims any liability for damage to vehicles not unconditionally accepted by the County.
15. The Contractor shall provide recall notification, regardless of level, to the Purchaser through the most
expedient method possible. The notice, at a minimum, shall include:
15.1 Complete product description and/or identification
15.2 Contract product delivered date
15.3 Purchase order number
15.4 Reason for recall
15.5 Instructions to acquire service and/or repair of product
16. Mileage shall not exceed 400 miles.
Upfitting Requirements
This vehicle requires upfitting prior to delivery, acceptance and payment for this vehicle by Franklin County.
The below items shall be delivered with the vehicle fully installed and in working order as prescribed by the
manufacturer.
1. Setina Front partition 10XL Horizontal Sliding/ Scratch Resistant Polycarbonate
2. Setina Rear partition 12VS Polycarbonate
3. Sound Off Public Address
4. Sound Off Handheld remote to control lights, siren and public address
5. Sound Off Slim Windshield visor mounted red/blue/white lights (both driver and passenger sides)
6. Sound Off Hideaway red/blue light in fog light area (tinted)
7. Sound Off Recessed covert front grill lights (tinted) Tricolor
8. Sound Off Slim Rear Window red/blue lights at top of window
9. Side lights red/blue in both passenger windows, left & right for both the 2nd & 3rd row
10. Locking Setina Rear Secure storage container (3rd Drawer) for electronics
11. All wiring, brackets, etc. needed for lights, siren, speaker install
8
12. 5% tint on all windows except windshield. 20% tint strip on windshield to cover lights
13. Panasonic Toughbook FZ-55 14" with the following features:
a. Intel Core i7-1370 P (up to 5.2 GHz)
b. 14” FHD 1000-nit Gloved Multi Touch
c. 16GB SDRAM
d. 512GB Solid State Hard Drive
e. Windows 11 Pro
f. 4G EM7595, Wi-Fi 6E, Bluetooth
g. Dedicated GPS, Dual Pass (Ch1:GPS/Ch2:WWAN)
h. Mic and Infrared 2MP Webcam
i. TPM 2.0, AMT
j. Emissive Backlit Keyboard
k. Standard Battery and AC Power Adaptor
l. Protection Plus Warranty (5 year)
ATTACHMENT A
NON-COLLUSTION AFFIDAVIT
INSTRUCTIONS FOR NON-COLLUSION AFFIDAVIT
1. This Non-Collusion Affidavit is material to any contract awarded pursuant to this bid and in accordance with the Pennsylvania Antibid-Rigging Act, 73 P.S. 1611 et seq.
2. This Non-Collusion Affidavit must be executed by the member, officer or employer of the Bidder
who makes the final decision on prices and the amount quoted in the bid.
3. Bid rigging and other efforts to restrain competition, and the making of false sworn statements in
connection with the submission of bids are unlawful and may be subject to criminal prosecution.
The person who signs the Affidavit should examine it very carefully before signing and assure
himself or herself that each statement is true and accurate, making diligent inquiry, as necessary,
of all other persons employed by or associated with the bidder with responsibilities for the
preparation, approval, or submission of the bid.
4. In the case of a bid submitted by a joint venture, each party to the venture must be identified in
the bid documents, and an Affidavit must be submitted separately on behalf of each party.
5. The term “Complementary Bid” as used in the Affidavit has the meaning commonly associated
with the term in the bidding process, and includes the knowing submission of bids higher than the
bid of another firm, any intentionally high or noncompetitive bid, and any other form of bid
submitted for the purpose of giving a false appearance of competition.
6. Failure to file an Affidavit in compliance with these instructions will result in disqualification of the
bid.
7. A person’s affidavit stating that the person has been convicted or found liable of any act
prohibited by State or Federal law in any jurisdiction involving conspiracy or collusion with respect
to bidding in any public contract within the last three (3) years does not prohibit a governmental
agency from accepting a bid or awarding a contract to that person, but may be a ground for
administration, suspension or debarment in the discretion of a governmental agency under the
rules and regulations of that agency, or, in the case of a governmental agency with no
administrative suspension or debarment regulations or procedures, may be a ground for
consideration on the question whether such agency should decline to award the contract to that
person on the basis of a lack of responsibility.
NON-COLLUSION AFFIDAVIT
Contract/Bid No : 2025197-03
State of: ________________________:
: ss
County of: ______________________:
I state that I am ____________ of __________________________________________________
(Title) (Firm)
and that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and
officers. I am the person responsible in my firm for the price(s) and the amount of this bid.
I state that:
1. The price(s) and amount of this bid have been arrived at independently and without consultation,
communication or agreement with any other contractor, bidder or potential bidder.
2. Neither the price(s) nor the amount of this bid, and neither the approximate price(s) nor
approximate amount of this bid, have been disclosed to any other firm or person who is a bidder
or potential bidder, and they will not be disclosed before bid opening.
3. No attempt has been made or will be made to induce any firm or person to refrain from bidding
on this contract, or to submit a bid higher than this bid, or to submit any intentionally high or
noncompetitive bid or other form of complementary bid.
4. The bid of my firm is made in good faith and not pursuant to any agreement or discussion with, or
inducement from, any firm or person to submit a complementary or other noncompetitive bid.
5. ________________________________, its affiliates, subsidiaries, officers, directors, and
(Firm)
employees are not currently under investigation by any governmental agency and have not in the
last four years been convicted or found liable for any act prohibited by State or Federal Law in any
jurisdiction, involving conspiracy or collusion with respect to bidding on any public contract, except
as follows:
6. ___________________________ has or has not been convicted or found liable for any act
(circle one) prohibited by State or Federal Law in any jurisdiction involving conspiracy or collusion with
respect to bidding on any public contract within the last three (3) years.
I state that ____________________________________ understands
(Firm)
acknowledges that the above responsibilities are material and important,
and will be relied on by the Owner in awarding the contract(s) for which
this Bid is submitted. I understand and my firm understands that any
mis-statement in this affidavit is and shall be treated as fraudulent
concealment form the Owner of the true facts relating to the submission
of bids for this contract.
______________________________________
Name
______________________________________
Company Position
SWORN TO AND SUBSCRIBED
BEFORE ME THIS ___________
DAY OF _________, 20 _______.
_______________________________________
Notary Public
My Commission Expires:
ATTACHMENT B
W-9 FORM
Form W-9
(Rev. March 2024)
Request for Taxpayer
Identification Number and Certification
Department of the Treasury
Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.Print or type. See Specific Instructions on page 3.1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded
entity’s name on line 2.)
2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check
only one of the following seven boxes.
Individual/sole proprietor C corporation S corporation Partnership Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) ....
Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate
box for the tax classification of its owner.
Other (see instructions)
3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification,
and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
this box if you have any foreign partners, owners, or beneficiaries. See instructions .........
4 Exemptions (codes apply only to
certain entities, not individuals;
see instructions on page 3):
Exempt payee code (if any)
Exemption from Foreign Account Tax
Compliance Act (FATCA) reporting
code (if any)
(Applies to accounts maintained
outside the United States.)
5 Address (number, street, and apt. or suite no.). See instructions.
6 City, state, and ZIP code
Requester’s name and address (optional)
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
––
or
Employer identification number
–
Part II 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 (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. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Here
Signature of
U.S. person Date
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
What’s New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate box for the tax classification of its owner. Otherwise, it
should check the “LLC” box and enter its appropriate tax classification.
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow-through entity in which it has an ownership interest. This
change is intended to provide a flow-through entity with information
regarding the status of its indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they
Cat. No. 10231X Form W-9 (Rev. 3-2024)
Form W-9 (Rev. 3-2024)Page 2
must obtain your correct taxpayer identification number (TIN), which
may be your social security number (SSN), individual taxpayer
identification number (ITIN), adoption taxpayer identification number
(ATIN), or employer identification number (EIN), to report on an
information return the amount paid to you, or other amount reportable
on an information return. Examples of information returns include, but
are not limited to, the following.
• Form 1099-INT (interest earned or paid).
• Form 1099-DIV (dividends, including those from stocks or mutual
funds).
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds).
• Form 1099-NEC (nonemployee compensation).
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers).
• Form 1099-S (proceeds from real estate transactions).
• Form 1099-K (merchant card and third-party network transactions).
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
and 1098-T (tuition).
• Form 1099-C (canceled debt).
• Form 1099-A (acquisition or abandonment of secured property).
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
Caution: If you don’t return Form W-9 to the requester with a TIN, you
might be subject to backup withholding. See What is backup
withholding, later.
By signing the filled-out form, you:
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; and
4. Certify to your non-foreign status for purposes of withholding under
chapter 3 or 4 of the Code (if applicable); and
5. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting is correct. See What Is
FATCA Reporting, later, for further information.
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).
Establishing U.S. status for purposes of chapter 3 and chapter 4
withholding. Payments made to foreign persons, including certain
distributions, allocations of income, or transfers of sales proceeds, may
be subject to withholding under chapter 3 or chapter 4 of the Code
(sections 1441–1474). Under those rules, if a Form W-9 or other
certification of non-foreign status has not been received, a withholding
agent, transferee, or partnership (payor) generally applies presumption
rules that may require the payor to withhold applicable tax from the
recipient, owner, transferor, or partner (payee). See Pub. 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities.
The following persons must provide Form W-9 to the payor for
purposes of establishing its non-foreign status.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the disregarded 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 grantor trust.
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
and not the beneficiaries of the trust.
See Pub. 515 for more information on providing a Form W-9 or a
certification of non-foreign status to avoid withholding.
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 (under
Regulations section 1.1441-1(b)(2)(iv) or other applicable section for
chapter 3 or 4 purposes), do not use Form W-9. Instead, use the
appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a
qualified foreign pension fund under Regulations section 1.897(l)-1(d), or
a partnership that is wholly owned by qualified foreign pension funds,
that is treated as a non-foreign person for purposes of section 1445
withholding, do not use Form W-9. Instead, use Form W-8EXP (or other
certification of non-foreign status).
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 their 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 their 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.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 24% of such
payments. This is called “backup withholding.” Payments that may be
subject to backup withholding include, but are not limited to, 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 instructions for
Part II 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, as described in item 4 under “By signing the filled-
out form” above (for reportable interest and dividend accounts opened
after 1983 only).
Form W-9 (Rev. 3-2024)Page 3
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
See also Establishing U.S. status for purposes of chapter 3 and
chapter 4 withholding, earlier.
What Is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all U.S. account
holders that are specified U.S. persons. Certain payees are exempt from
FATCA reporting. See Exemption from FATCA reporting code, later, 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 are
no longer 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 fail 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
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
• Individual. Generally, enter the name shown on your tax return. If you
have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note for ITIN applicant: Enter your individual name as it was entered
on your Form W-7 application, line 1a. This should also be the same as
the name you entered on the Form 1040 you filed with your application.
• Sole proprietor. Enter your individual name as shown on your Form
1040 on line 1. Enter your business, trade, or “doing business as” (DBA)
name on line 2.
• Partnership, C corporation, S corporation, or LLC, other than a
disregarded entity. Enter the entity’s name as shown on the entity’s tax
return on line 1 and any business, trade, or DBA name on line 2.
• Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. Enter any business,
trade, or DBA name on line 2.
• Disregarded entity. In general, a business entity that has a single
owner, including an LLC, and is not a corporation, is disregarded as an
entity separate from its owner (a disregarded entity). See Regulations
section 301.7701-2(c)(2). A disregarded entity should check the
appropriate box for the tax classification of its owner. Enter the owner’s
name on line 1. The name of the owner entered on line 1 should never
be a disregarded entity. The name on line 1 should 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 line 1. 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 line 2. 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.
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, enter it on line 2.
Line 3a
Check the appropriate box on line 3a for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3a.
IF the entity/individual on line 1
is a(n) . . .
THEN check the box for . . .
• Corporation Corporation.
• Individual or
• Sole proprietorship
Individual/sole proprietor.
• LLC classified as a partnership
for U.S. federal tax purposes or
• LLC that has filed Form 8832 or
2553 electing to be taxed as a
corporation
Limited liability company and
enter the appropriate tax
classification:
P = Partnership,
C = C corporation, or
S = S corporation.
• Partnership Partnership.
• Trust/estate Trust/estate.
Line 3b
Check this box if you are a partnership (including an LLC classified as a
partnership for U.S. federal tax purposes), trust, or estate that has any
foreign partners, owners, or beneficiaries, and you are providing this
form to a partnership, trust, or estate, in which you have an ownership
interest. You must check the box on line 3b if you receive a Form W-8
(or documentary evidence) from any partner, owner, or beneficiary
establishing foreign status or if you receive a Form W-9 from any
partner, owner, or beneficiary that has checked the box on line 3b.
Note: A partnership that provides a Form W-9 and checks box 3b may
be required to complete Schedules K-2 and K-3 (Form 1065). For more
information, see the Partnership Instructions for Schedules K-2 and K-3
(Form 1065).
If you are required to complete line 3b but fail to do so, you may not
receive the information necessary to file a correct information return with
the IRS or furnish a correct payee statement to your partners or
beneficiaries. See, for example, sections 6698, 6722, and 6724 for
penalties that may apply.
Line 4 Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third-party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys’ fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space on line 4.
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).
Form W-9 (Rev. 3-2024)Page 4
2—The United States or any of its agencies or instrumentalities.
3—A state, the District of Columbia, a U.S. commonwealth or territory,
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 U.S. commonwealth or
territory.
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 as defined under section 581.
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 patronage dividends
Exempt payees 1 through 4.
• Payments over $600 required to
be reported and direct sales over
$5,0001
Generally, exempt payees
1 through 5.2
• Payments made in settlement of
payment card or third-party
network transactions
Exempt payees 1 through 4.
1 See Form 1099-MISC, Miscellaneous Information, and its instructions.
2 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 reportable under section 6045(f), 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 requester may indicate that a code is
not required by providing you with a Form W-9 with “Not Applicable” (or
any similar indication) entered on the line for a FATCA exemption code.
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 U.S. commonwealth or
territory, 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 Regulations
section 1.1472-1(c)(1)(i).
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i).
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.
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 664 or described in section
4947(a)(1).
M—A tax-exempt trust under a section 403(b) plan or section 457(g)
plan.
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, enter “NEW” at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
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 ITIN. Enter it in the entry space for the Social security number. 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.
If you are a single-member LLC that is disregarded as an entity
separate from its owner, enter the owner’s SSN (or EIN, if the owner has
one). If the LLC is classified as a corporation or partnership, enter the
entity’s EIN.
Note: See What Name and Number To Give the Requester, later, 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 SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 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.irs.gov/EIN. Go to
www.irs.gov/Forms to view, download, or print Form W-7 and/or Form
SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and
have Form W-7 and/or Form SS-4 mailed to you within 15 business
days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and enter “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, you will generally 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. See also Establishing U.S.
status for purposes of chapter 3 and chapter 4 withholding, earlier, for
when you may instead be subject to withholding under chapter 3 or 4 of
the Code.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Form W-9 (Rev. 3-2024)Page 5
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 item 1, 4, or 5 below indicates 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 line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 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), ABLE accounts (under section 529A),
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.
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 account)
other than an account maintained by
an FFI
The actual owner of the account or,
if combined funds, the first individual
on the account1
3. Two or more U.S. persons
(joint account maintained by an FFI)
Each holder of the account
4. Custodial account of a minor
(Uniform Gift to Minors Act)
The minor2
5. a. The usual revocable savings trust
(grantor is also trustee)
The grantor-trustee1
b. So-called trust account that is not
a legal or valid trust under state law
The actual owner1
6. Sole proprietorship or disregarded
entity owned by an individual
The owner3
7. Grantor trust filing under Optional
Filing Method 1 (see Regulations
section 1.671-4(b)(2)(i)(A))**
The grantor*
For this type of account:Give name and EIN of:
8. Disregarded entity not owned by an
individual
The owner
9. A valid trust, estate, or pension trust Legal entity4
10. Corporation or LLC electing corporate
status on Form 8832 or Form 2553
The corporation
11. Association, club, religious, charitable,
educational, or other tax-exempt
organization
The organization
12. Partnership or multi-member LLC The partnership
13. A broker or registered nominee The broker or nominee
14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or prison)
that receives agricultural program
payments
The public entity
15. Grantor trust filing Form 1041 or
under the Optional Filing Method 2,
requiring Form 1099 (see Regulations
section 1.671-4(b)(2)(i)(B))**
The trust
1 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.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name on line 1, and enter your business
or DBA name, if any, on line 2. You may use either your SSN or EIN (if
you have one), but the IRS encourages you to use your SSN.
4 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.)
* Note: The grantor must also provide a Form W-9 to the trustee of the
trust.
** For more information on optional filing methods for grantor trusts, see
the Instructions for Form 1041.
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, SSN, or other identifying information, without your
permission to commit fraud or other crimes. An identity thief may use
your SSN to get a job 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 return 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 purse or wallet, questionable
credit card activity, or a questionable credit report, contact the IRS
Identity Theft Hotline at 800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Form W-9 (Rev. 3-2024)Page 6
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 877-777-4778 or TTY/TDD
800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails 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 email 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 (TIGTA) at 800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Go to www.irs.gov/IdentityTheft 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 territories for use in
administering their laws. The information may also 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, payors must
generally withhold a percentage of taxable interest, dividends, and
certain other payments to a payee who does not give a TIN to the payor.
Certain penalties may also apply for providing false or fraudulent
information.
BID FORM
IFB 2025197-03 MID SIZE SUV FOR THE SHERIFF’S OFFICE
To: Franklin County Controller’s Office
Franklin County Administration Building
272 North Second Street
Chambersburg, PA 17201
The undersigned, having carefully examined the specifications and instructions to bidders, and being familiar
with the various requirements concerning the work, agree to furnish all materials and preform all work
necessary in strict accordance with the Contract Documents for the consideration in the following amount:
Make _________________________
Model _________________________
Year _________________________
VIN _________________________
Mileage _________________________
Inspection expiration date _________________________
Price (numbers) _________________________
Price (words) _______________________________________________________________________
Exterior Color ________________________________________________________________________
Interior Color _________________________________________________________________________
Notice of acceptance, or request for additional information, may be addressed to the undersigned at the
address set forth below.
The undersigned hereby declares that this bid is made without connection with any other person or persons
making a bid for the same work and is without collusion or fraud.
Submitted by:________________________________
(Type Name)
Signed by: __________________________________
Title: ______________________________________
Business Name: _____________________________
Address: ___________________________________
Phone: ____________________________________
E-Mail: ____________________________________
Date: ______________________________________
BID FORM
IFB 2025197-03 MID SIZE SUV FOR THE SHERIFF’S OFFICE
To: Franklin County Controller’s Office
Franklin County Administration Building
272 North Second Street
Chambersburg, PA 17201
The undersigned, having carefully examined the specifications and instructions to bidders, and being familiar
with the various requirements concerning the work, agree to furnish all materials and preform all work
necessary in strict accordance with the Contract Documents for the consideration in the following amount:
Make _________________________
Model _________________________
Year _________________________
VIN _________________________
Mileage _________________________
Inspection expiration date _________________________
Price (numbers) _________________________
Price (words) _______________________________________________________________________
Exterior Color ________________________________________________________________________
Interior Color _________________________________________________________________________
Notice of acceptance, or request for additional information, may be addressed to the undersigned at the
address set forth below.
The undersigned hereby declares that this bid is made without connection with any other person or persons
making a bid for the same work and is without collusion or fraud.
Submitted by:________________________________
(Type Name)
Signed by: __________________________________
Title: ______________________________________
Business Name: _____________________________
Address: ___________________________________
Phone: ____________________________________
E-Mail: ____________________________________
Date: ______________________________________
Bid Checklist
Bid Form – 2 copies _____
Non-Collusion Affidavit _____
Proof of State License _____
Vehicle Specifications _____
Current W-9 _____