ocean county college purchasing departmentpurchasing.ocean.edu/dmdocuments/construction testing 15...

OCEAN COUNTY COLLEGE PURCHASING DEPARTMENT

REQUEST FOR QUOTATION

Ocean County College is seeking Requests for Proposals for: “CONTRUCTION TESTING

FOR THE NEW CHW PLANT BUILDING”. Specifications and requirements are enclosed for

your consideration. Submitters are to direct all questions in writing to: Mark Bowcock, Buyer at

[email protected]. No telephone calls or faxes will be permitted.

(1) Original and (3) Copies of submittals must be returned on or before January 29, 2016 at 1:00

p.m. prevailing time to:

Ocean County College

Administration Building, Room #12

College Drive

PO Box 2001

Toms River, New Jersey 08754-2001

Attention: Mark H. Bowcock, RPPS

ALL ENVELOPES MUST INDICATE THE FOLLOWING INFORMATION:

Attention: Mark H. Bowcock, Manager of the Purchasing Department

Title: “CONTRUCTION TESTING FOR THE NEW CHW PLANT BUILDING”

Reference Number: 15/16 Q-09

Due Date: January 29, 2016 at 1:00 p.m. in the Administration Building #1, room 12B

Deliver To: Administration Building Purchasing Office, Atten: Mark Bowcock

The following may be contacted with questions regarding this Request for Proposal:

Mark Bowcock, Manager of Purchasing, [email protected].

(No telephone calls or faxes)

THERE ARE FOUR (4) ATT ACHMENTS TO THIS DOCUMENT. IF YOU ARE HAVING TROUBLE FINDING THEM, PLEASE CONTACT THE BUYER AT: mbow [email protected]

mailto:[email protected]



OCEAN COUNTY COLLEGE

QUOTATION FOR CONSTRUCTION TESTING SERVICES INSTRUCTIONS TO RESPONDERS

The instructions to Responders form a part of the contract. Responders are urged to

carefully review the Contract Documents as a whole, and all matters described therein, prior

to submitting a Quote.

I. PURPOSE

The intent of this Request for Quotation and resulting contract is to obtain testing and

inspection services for a New Chilled Water Plant Building on Ocean County College’s main

campus in Toms River, New Jersey. Firms responding to this Request for Quotes should

have extensive experience and a knowledgeable background and qualifications in the

provision of the services described herein.

II. PROJECT SCOPE AND DELIVERABLES

The successful Testing and Inspection firm will provide professional services related to the

New Chilled Water Plant Building. Testing and Inspection Services will include earthwork,

reinforcing steel, concrete and fireproofing. Ocean County College (Owner) has contracted

with a construction management firm to provide overall project management as the College’s

agent, and coordinate all required inspections with the selected firm.

The Testing and Inspection firm’s scope (all supervised by a New Jersey licensed

Professional Engineer) will include but not necessarily be limited to the following:

A. Earthwork

1. Earthwork Quality Control Field Inspections to Provide the Following:

Soil Compaction Testing

Foundation/Footing Bottom Testing

Provide Daily Inspection Report

2. Soils Laboratory Testing

Gradation Sieve Analysis

Hydrometer Analysis

Plasticity Index

Moisture Density (Compaction)

B. Concrete

1. Concrete Quality Control Field Inspections to Provide the Following:

Concrete Mixing Procedure Compliance with Specifications

Verification of Concrete Inspections

Perform Slump Tests

Air Content Testing

Prepare Concrete Cylinders


Flatness/Levelness Testing

Moisture Testing

2. Concrete Laboratory Testing

Concrete Design Mix Certification

Compressive Strength Testing at 7 and 28 Days

Concrete Batch Plant Inspection

C. Reinforcing Steel

1. Reinforcing Steel Quality Control Field Inspections to Provide the Following:

Verification of Installation for Compliance with Approved Shop

Drawings


D. Testing and Inspection firms must have minimum qualifications including New Jersey

Department of Property Management and Construction (DPMC), and membership in the

American Concrete Institute (ACI), American Welding Society (AWS), and American

Society of Testing Materials (ASTM).

E. Inspections are to be scheduled between 7:30 AM and 4:30 PM.

F. Inspections scheduled on weekends or after 4:30 PM may be billed at 1.5 times the

standard rate.

G. The Owner or GC may cancel an inspection up to 5 hours prior to the scheduled

inspection Should a cancellation occur within the 5 hour period prior to a scheduled

inspection, a cancellation charge may NOT be billed.

H. All mileage and reimbursable expenses are to be included in proposed unit costs.

I. All reports are to be provided to the Owner via e-mail with (3) paper copies provided via

US mail.

Quote Terms

(a) Applicable Law - Refers to any federal, state, county or local regulation,

ordinance, resolution, enactment, requirement, permit, decision or ruling of any

government agency with which compliance is required.

(b) Award - The Owner's acceptance of the Quote of a lowest responsible

Respondent, the legal effect of which binds said Responder to further performance

required hereunder.

(c) Quote Submittal - All of the information submitted by the Responder in

response to the Owner’s solicitation for quotes. A quote shall be timely, complete and

conform to and comply with the requirements of the Quote Documents. The Quote

price shall be the full inclusive value of finished Work and shall cover profit and all

obligations of every kind which shall be borne by the successful responder.

(d) Responder(s) / Contractor(s) / Vendor(s) - Refers to any person or entity

(corporation, partnership, joint venture or otherwise) submitting a quote. The

recipient of an award of contract by the Owner, is referred to as the Contractor or

Vendor, as appropriate.

(e) Quote Date and Time - Refers to the point until which and in accordance with

the Quote Documents, responses will be received as timely, thereafter opened and

read aloud, as stated in the quote.

(f) Owner / College – Refers to Ocean County College

(g) Work – the provision of goods and/or services required by the Contract

Documents, and includes all other labor, materials, equipment and services provided

by the Contractor to fulfill the Contractor’s obligations. The Contractor shall fully

execute the Work described in the Contract Documents, except as specifically

indicated in the Contract Documents to be the responsibility of others.

(h) Contract Documents – the Agreement (Contract Form 1), any and all

Conditions of the Contract (General, Supplementary and other Conditions),

Instructions to Responders, Quote and Contract Forms, Drawings, Specifications,

Addenda issued prior to Quote, and modifications issued after execution of the

Agreement.

1. Right to Make Changes. Any description of the Work notwithstanding, the Owner retains the

absolute and unabridged right to alter the Work in any respect, at any time before or after

award of contract, including by withdrawing the Advertisement for quotes, changing, adding or

deleting its scope, or, in the case of a partial or revised Work for which an award is made, to

insist upon complete and satisfactory performance of Work consistent with the basis on which

said award is made.

2. Basis of Award: In the event the Owner determines to make an award, it will award the

contract to the responder submitting the lowest responsible price conforming to the invitation

for quote.

3. Method of Award: Notification of the acceptance of the Quote and award of a Contract will be

made within 60 (sixty) days after the opening of the Quotes. The Contract will be awarded

after due consideration of all relevant factors including, without limitation, quality

responsibility, experience and other matters affecting the responder, so that the Owner will,

consistent with the law, gain the advantage of the contract that will, in its judgment, best serve

the interests of the Owner and the public.

In the event of tie Quotes, final selection will be made at the Owner’s discretion.

4. Submission of Quotes:

(a) Quotes shall be submitted at the time and place indicated in the Advertisement for Quotes

and shall be included in an opaque sealed envelope addressed to Purchasing, Ocean County

College, 1 College Drive, Toms River, NJ 08754 and marked with the project title and name

and address of the responder and accompanied by any other required documents. The Owner

shall not be responsible for the premature opening and disqualification of any Quote not so

marked.

(b) No Quotes will be received after date and time indicated unless the contract is re-

advertised. Responders will be held responsible for ensuring that their Quotes are received in

accordance with the instructions stated herein and a late Quote will not be considered even

though it became late as a result of circumstances beyond the responder’s control.

Quotes received by the Owner after the deadline for submission of Quotes will be returned

unopened to the responder.

(c) A responder shall be responsible to assure that its Quote is prepared and submitted based

upon a complete set of Quote Documents, including all Addenda. Any failure to secure or

utilize complete Quote Documents, whether inadvertent or otherwise, shall remain the sole

responsibility of any prospective or actual responder.

(d) Responders will not be reimbursed for any costs incurred in connection with preparation or

submission of their Quote or for any visits to the Owner’s and/or the Architect/Engineer’s

offices, or the site.

5. Complete Quote Submittal:

(a) Manner of Completion: Responders shall fully and accurately complete all Quote Forms

as required, with all attachments. Failure to include any required pricing information will

render such Quote incomplete and non-responsive. A Quote covering only part of the

Work will be considered non-responsive and will be rejected. Any rejection of the

specified language and contents of the Quote Forms will also be sufficient grounds for the

rejection of the Quote. Conditional Quotes will not be considered. All blank spaces in the

Quote Forms applicable to the responder shall be completely filled in.

(b) All insertions in the Quote Forms and all other required submittals shall be typewritten.

Signatures shall be handwritten in ink only, preferably in blue and shall be fully legible

when photocopied. The responder shall type its name below its signature wherever it

appears on the Quote Forms. The completed Quote shall have no interlineations or

erasures except those necessary to correct errors made by the Responder. Responder shall

initial all corrections.

The Owner may consider informal any Quote not prepared and submitted in accordance with

the provisions hereof and may waive informalities or may for any reason reject any and all

Quotes.

6. Quote Modification, Withdrawal and Interpretation:

(a) A Responder may withdraw its Quote at any time before the scheduled Quote Date by a

signed, written notice to the Owner delivered to the address specified in the Advertisement for

Quotes, stating that the Responder is withdrawing its Quote as submitted and requesting its

return. Upon return of the Quote pursuant to such written request, the Quote shall be

considered withdrawn for all purposes. Responders withdrawing their Quotes may submit new

Quotes before the Quote Date and Time, provided that in all such cases the replacement Quote

is an entirely independent and conforming submission. Modifications of previously submitted

Quotes shall not be permitted. Responders seeking to make changes to their Quotes after they

are submitted, must withdraw and resubmit their Quotes in accordance with the requirements of

these Instructions.

(b) Responders may not modify a non-responsive Quote after opening of the Quotes in order to

make it responsive; however, the Owner may request a Responder to clarify its Quote as long as

no material modification is made.

Any request for clarification and the response shall be in writing or by fax, but no material change

in the price or substance of the Quote shall be sought, offered, or permitted, except as may be

required to confirm the correction of arithmetic or obvious clerical and/or typographical errors

as set forth herein.

(c) Any inconsistency between words and figures will be resolved in favor of words. Any

incorrectly totaled column of figures shall be deemed corrected to equal the mathematically

correct sum. The Owner shall retain the right, in its sole discretion, to reconcile any other

apparent or latent discrepancy or error, as it deems appropriate whether or not such resolution

results in rejection of a Quote.

7. Duration of Quote: Each Quote shall remain valid in accordance with N.J.S.A. 18A:64A-

25.18. Submission of a Quote constitutes an express representation of a responder that it will

not attempt to modify, withdraw or cancel its Quote for sixty (60) days after the Quote Date

and Time (or such longer time to which the responder may agree, provided the Responder

agrees to extend the validity of its Quote Security correspondingly).

8. Responder’s Duty to Notify of Errors:

(a) Responder’s Duty of Full Investigation: Responder shall carefully study, compare,

correlate and coordinate its obligations both within the Quote Documents and as to extrinsic

information that may in any way affect its obligations, including circumstances pertaining to

the description of the Work required by the Quote Documents, the site or the use thereof in the

performance of the Work, and any such other factors as may affect the Work. Except as

specifically provided in the Contract Documents, the Contractor/Vendor assumes all risks and

responsibility for any and all conditions and circumstances that pertain to the Work whether

same are known or unknown to the Contractor/Vendor at the time of Quote.

(b) Notice: Notice of any alleged error, omission or inconsistency that should have been

reasonably identified prior to submitting a Quote shall be provided to the Owner immediately

in order that the Owner in its discretion, may issue an Addendum. A Responder's failure to do

so constitutes an absolute waiver of any claims with respect to any error, omission or

inconsistency that may thereafter be asserted with respect thereto, and shall bar any recovery

regarding such claims.

9. Rejection of Quotes: All Responders are hereby notified that failure to comply with any of the

requirements listed may be cause for rejection of Quotes. If a prospective Responder has any

questions with reference to the Quote documents or form of Quote, he or she should contact

the Owner as specified in the paragraph headed “Addenda and Interpretation”.

10. Addenda and Interpretation

(a) No oral interpretation of the specifications or other contract documents will be given to any

Responder. Should any Responder find discrepancies or omissions in the specifications or

other contract documents, he shall at once notify the Owner which will send written

interpretations to all Responders.

Every request for such interpretation shall be addressed in writing to the Owner and, to be

given consideration, must be received by 5 pm, ten (10) business days prior to the Quote

due date. All such interpretations and supplemental instructions will be in the form of

written addenda to the specifications and drawings and will become a part of the contract

documents, and all such interpretations and supplemental instructions will be mailed by

overnight express services to all prospective Responders at their respective addresses

furnished for such purposes not later than seven (7) business days prior to the Quote due

date as required by N.J.S.A. 18A: 64A-25.14. The failure of any Responder to receive any

such addendum or interpretation shall not relieve any such Responder from any obligation

under his Quote as submitted.

(b) Submission of a Quote shall constitute the Responder's acknowledgment of its exclusive

responsibility to obtain and utilize all Addenda. All Addenda shall be acknowledged on the

form provided.

11. Pre-Quote Meeting: A pre-Quote meeting, if any, shall be held at the place, date and time

stated in the Advertisement for Quotes. If the Advertisement for Quotes indicates that

attendance at the Pre-Quote meeting is mandatory, Quotes will only be accepted from those

persons or entities represented at the Pre-Quote meeting. If the Pre-Quote meeting is not

indicated as mandatory, all prospective Responders are nevertheless strongly encouraged to

attend. It is each prospective Responder’s responsibility to ensure that the Owner is aware of

its attendance at a Pre-Quote meeting. Prospective Responders may attend a Pre-Quote

meeting either themselves or through a representative, provided that any representative advises

the Owner at the meeting as to the identity of all prospective Responders on whose behalf the

representative is attending.

12. Evaluation of Quote and Responder

(a) Evaluation of Quote: The Owner retains the right to reject all Quotes or any particular

Quote, including, without limitation, one that fails its evaluation, or that is in any way

unbalanced, unreasonable, non-conforming, qualified, incomplete, non-responsive or

otherwise irregular.

(b) Evaluation of Responder: The Owner will conduct such investigation as it deems

necessary within its sole discretion to assist in connection with the evaluation of any Quote, to

establish the responsibility, qualifications and financial ability of the Responder to perform as

required by the Quote Documents. The Responder shall provide to the Owner all the

information requested for this purpose. The Owner reserves the right to reject any Quote if its

investigation of the Responder reveals that, in the opinion of the Owner, the Responder is not

properly qualified to carry out the obligations of the contract and complete it as outlined

herein.

The Owner has the right to request at least three (3) references respecting similar work to that

specified in these Quote Documents. The Responder shall also provide upon the Owner’s

request the following: a.) copies of all current licenses required by applicable laws and

regulations for the Responder to perform the Work, and such proof of financial responsibility

as the Owner may deem necessary including without limitation copies of its financial

statements for three (3) prior years, prepared by an outside accounting firm.

The Owner, or its authorized representative, in judging the merits of the Responders shall take

into consideration, in awarding the contract, the qualifications, experience, financial

capability, and reputation of each Responder and shall award the contract to the lowest

responsive and responsible Responder.

(c) Discretionary Waiver Rights: The Owner reserves all rights to waive informalities or

irregularities in a Quote or to accept the Quote which accords with its best interests, in its

sole discretion.

13. New Jersey Business Registration Requirements:

All Responders must comply with the New Jersey Business Registration Requirements set

forth in P.L.2004, c.57 (N.J.S.A. 52:32-44). The Responder shall provide written notice to its

subcontractors of the responsibility to submit proof of business registration to the Responder.

Before final payment on the contract is made by the contracting agency, the Responder shall

submit an accurate list and the proof of business registration of each subcontractor or supplier

used in the fulfillment of the contract, or shall attest that no subcontractors were used.

A business organization that fails to provide a copy of a business registration as required

pursuant to section 1 of P.L.2001, c.134 (C.52:32-44 et al.) or subsection e. or f. of section 92

of P.L. 1977, c. 110 (C.5:12-92), or that provides false business registration information under

the requirements of either of those sections, shall be liable for a penalty of $25 for each day of

violation, not to exceed $50,000 for each business registration copy not properly provided

under a contract with a contracting agency.

14. SUBCONTRACTS

Each Responder is hereby advised that any person, firm or other party to whom it is proposed

to award a subcontract under their contract must be acceptable to the Owner.

15. LAWS AND REGULATIONS

The successful Responder is required to keep himself informed of and to comply with all

applicable Federal, State and Local laws and rules and regulations of all authorities having

jurisdiction over the subject matter of the contract. The successful Responder shall also be

responsible for securing and paying for all permits, governmental fees and licenses necessary

for the proper execution and completion of the work required by the Contract. All equipment

purchased must meet all applicable O.S.H.A. safety requirements.

16. TAXES

The Owner is established under the authority of the State of New Jersey and is exempt from

the New Jersey Sales and Use Tax.

17. RESPONDER SANCTIONS

Failure of a Responder to execute the contract awarded or to comply with any or all of the

terms and conditions therein may disqualify him/her from receiving future contracts. Such

disqualifications or the failure to disqualify shall not limit the remedies available to the Owner

upon default, and it may recover full damages in addition thereto in accordance with law.

18. POST-AWARD SUBMITTALS

The successful Responder shall provide its Post-Award Submittals, including all Contract

Forms, and a list of key personnel, including business, mobile and emergency telephone and fax

information, as and when required by the College.

RESPONDER’S CHECKLIST

This checklist is provided to assist the Responder in insuring that its Quote is complete and

responsive. It shall, however, remain the sole and exclusive responsibility of each Responder to

insure that its Quote complies with all requirements. Check off when complete:

____ Responder’s Checklist

____ Quote/Response & Fees Pages

____Responder’s Ownership Disclosure

____Responder’s Certification and Business Registration Requirements

____Responder’s Certification of Authority, Veracity, and Non Collusion & Non Debarment

____Responder’s Certification of Workforce Composition, Compensation & Working Conditions

(Equal Employment Opportunity Information)

____Quote Form 6: Disclosure of Investment Activities in Iran

By: _______________________________________

Print Name of Authorized Representative

________________________________________

Signature of Authorized Representative

QUOTE FORM

QUOTE OF __________________________________ hereinafter called “RESPONDER”

a corporation/partnership/joint venture/individual (strike out inapplicable terms) organized and

existing under the laws of the State of ___________________

TO: BOARD OF TRUSTEES OF OCEAN COUNTY COLLEGE 1 College Drive,

Toms River, NJ 08754 (hereinafter called College)

1. The Responder, having examined the specifications, Instructions to Responders, various

forms and related Contract Documents and being familiar with all the conditions surrounding the

proposed contract, including the availability of materials and labor, as relevant, hereby proposes to

perform the Work in accordance within the time set forth in the Contract Documents and at the

prices stated below.

2. Responder acknowledges receipt of the following Addenda:

Addendum No.___________________________ Dated ___________________



3. Responder agrees to complete Work as described in the Contract Documents

for the sum indicated on the attached Fees page.

4. Responder understands that the Owner reserves the right to reject any and all Quotes to the

maximum extent of its lawful discretion, and to waive any informality in the Quote.

5. Upon receipt of written notice of acceptance of this Quote and the award of the contract,

the Responder will execute the contract and within 10 days of such notice, will deliver a

performance and payment bond, if required by the Contract Documents.

6. The Responder hereby certifies that all of the figures, computations and additions used

in estimating the Quote herein have been carefully checked and are accurate in all respects and no

claim shall be made as a basis for withdrawal of this Quote by reason of mathematical or

computational errors. All blanks on the Quote Form must be filled with a dollar amount, $0,

“No Charge (N/C),” or “No Quote”. Quotes containing blanks or phrases such as “Not

Applicable (N/A)” where the Quote Form calls for amounts to be filled in will be rejected as

nonresponsive.

7. By signing this Quote the signatory represents to the College that he/she is fully

authorized by the Responder to submit this Quote, is doing so with the knowledge and consent of

the Responder, and that the Responder consents to be bound by this Quote.

This Quote is respectfully submitted on this day of , 20__.

By:

(Print Name and Title of Signatory)

ADDRESS OF RESPONDER:

_____________________________

_____________________________

_____________________________

RESPONDER’S CONTACT: ____________________________________

CONTACT TELEPHONE AND FAX NUMBERS:

Telephone: _____________________________

Fax: _____________________________

FEES PAGES

ALL REIMBURSABLE EXPENSES ARE TO BE INCLUDED IN UNIT COSTS.

1. EARTHWORK (Soil Compaction / Footing

Bottom)

Unit Cost Estimated

Quantity*

Totals

a. Field Inspection Including Report (Full

Day)

$

/day

40 Days

$

b. Field Inspection Including Report (3

hours or less)

$

/day

10 Days

$

c. Laboratory Testing (Including Reports)

1. Sieve Analysis $ /ea 5 Each $

2. Gradation (Wet) $ /ea 1 Each $

3. Hydrometer Analysis $ /ea 1 Each $

4. Plasticity Test $ /ea 1 Each $

5. Compaction Standard Proctor $ /ea 5 Each $

6. Compaction Modified Proctor $ /ea 5 Each $

7. Pick Up Soil Samples $ /ea 8 Each $

Subtotal Earthwork $

2. CONCRETE Unit Cost Estimated

Quantity*

Totals


Day)

$

/day

25 Days

$


hours or less)

$

/day

10 Days

$

c. Concrete Batch Plant $ /ea 3 Each $

d. Laboratory Testing Including Reports

1. Concrete Compressive Tests 7

Day / 28 Day C

$

/ea

200 Each

$

2. Concrete Design Mix Review $ /ea 2 Each $

e. Pick Up Test Cylinders $ /ea 20 Each $

Subtotal Concrete $

3. REINFORCING STEEL Unit Cost Estimated

Quantity*

Totals


Day)

$

/day

15 Days

$


hours or less)

$

/day

5 Days

$

Subtotal Reinforcing Steel $

4. FEE SUMMARY

Earthwork $

Concrete $

Reinforcing Steel $

Total Testing and Inspection Fees $

*The estimated quantities stated are estimates and used for evaluation purposes only.

5. CONSULTATION SERVICES

a. Principal $ /hr

b. Project Engineer $ /hr

c. Field Engineer $ /hr

d. Technician $ /hr

e. Other $ /hr

f. Other $ /hr

OWNERSHIP DISCLOSURE

No corporation or partnership shall be awarded any contract for the performance of any work or the furnishing of any materials or supplies, unless, prior to the receipt of the bid or accompanying the bid of said corporation or partnership, there is submitted a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners in the partnership who own a ten (10) percent or greater interest therein. Form of Statement shall be completed and attached to the bid proposal. The Attorney General has concluded that the provisions of N.J.S.A. 52:25-24.2, in referring to corporations and partnerships, are intended to apply to all forms of corporations and partnerships, including, but not limited to, limited partnerships, limited liability corporations, limited liability partnerships, and Subchapter S corporations. Bidders are required to disclose whether they are a partnership, corporation or sole proprietorship. The Stockholder Disclosure Certification form shall be completed, signed and notarized. Failure of the bidder to submit the required information is cause for automatic rejection of the bid.

STOCKHOLDER DISCLOSURE CERTIFICATION This Statement Shall Be Included with Bid Submission

Name of Business:

I certify that the list below contains the names and home addresses of all

stockholders holding 10% or more of the issued and outstanding stock of the undersigned.

OR

I certify that no one stockholder owns 10% or more of the issued and outstanding

stock of the undersigned.

If a corporation owns all or part of the stock of the corporation or partnership submitting the bid, then the statement shall include a list of the stockholders who own 10% or more of the stock of any class of that owning corporation. If no one owns 10% or more stock, attest to that.

Check the box that represents the type of business organization:

Partnership Corporation Sole Proprietorship

Limited Partnership Limited Liability Corporation Limited Liability Partnership

Subchapter S Corporation

Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: ______________________________ Name: ______________________________

Home Address: _______________________ ____________________________________

Home Address: _______________________ ____________________________________

Name: ______________________________ Name: ______________________________

Home Address: _______________________ ____________________________________

QUOTE FORM CONTINUES ON NEXT PAGE

Home Address: _______________________ ____________________________________

Name: ______________________________

Name: ______________________________

Home Address: _______________________ ____________________________________

Home Address: _______________________ ____________________________________

Subscribed and sworn before me this ___ day of ___________, 20__. (Notary Public) My Commission expires:

__________________________________________

(Affiant)

________________________________ (Print name & title of affiant)

(Corporate Seal)

BID WILL BE VOID IF NOT COMPLETE

RESPONDER’S CERTIFICATION

State of )

SS:

County of )

The undersigned, having knowledge of and authority to bind the RESPONDER to the information

herein, hereby swears, upon his oath, according to law,

1. I am the undersigned, who, on behalf of the RESPONDER and with full authority to

do so, has executed this Certification in connection with its submission;

2. That the RESPONDER is registered with the State of New Jersey, Department of the Treasury, Division of Revenue (ATTACH COPY OF BUSINESS REGISTRATION CERTIFICATE);

Special Instructions

BUSINESS REGISTRATION CERTIFICATE

All contractors and subcontractors seeking to do

business with Ocean County College must have a

valid New Jersey State Business Registration

Certificate (BRC) from the New Jersey State

Department of the Treasury, Division of Revenue,

prior to contract award for all contracts $5,250.00 and greater.

If you are an existing company and need a New

Jersey Business Certificate you can file for one online

or through the mail. Information is available at:

http://www.state.nj.us/treasury/revenue/busregcert.shtml

or by calling (609) 292-9292.

*NOTE - If the bidder, including any named

subcontractor(s) of the bidder, does not possess a

valid Business Registration Certificate prior to

contract award, such bidder will be deemed ineligible

for contract award.

3. That the RESPONDER is authorized by the New Jersey Department of the Treasury

to perform work in New Jersey (ATTACH COPY OF CERTIFICATE OF

AUTHORITY TO PERFORM WORK IN NEW JERSEY); and

4. The RESPONDER has not, directly or indirectly, entered into any agreement,

participated in any collusion, or otherwise taken any action in restraint of free

competitive bidding in connection with the submission;

FORM CONTINUES ON NEXT PAGE

http://www.state.nj.us/treasury/revenue/busregcert.shtml

5. I further warrant that, no person or selling agency has been employed, or retained,

to solicit, or secure, such contract upon an agreement or understanding for a

commission, percentage, brokerage or contingent fee, except bona fide employee or

bona fide established commercial or selling agencies identified as follows:

6. The RESPONDER is not, as of this date, and has not been at any time within

three (3) years immediately preceding the date on which submissions were received,

included on the New Jersey State Treasurer's List of Debarred, Suspended or

Disqualified RESPONDERs; the RESPONDER hereby acknowledges that it may be

debarred, suspended or disqualified from contracting with the OWNER if it commits

any of the acts listed in N.J.A.C. 7:1-5.2 and further acknowledges its obligation to

notify the OWNER immediately if it appears that said RESPONDER may be added

to any such list.

7. All statements and representations contained in the RESPONDER’s submission

are true, complete and correct, and made with full knowledge that the OWNER

shall rely upon same in awarding a public contract for the Work as defined in the

Contract Documents. RESPONDER’s Authorized Representative (MUST BE PRINCIPAL OWNER OR OFFICER OF RESPONDER):

Signature Print or Type Name and Title Notary Public: Sworn and Subscribed before me on this day of , 20 :

Notary’s Signature Print or Type Notary’s Name Commission expires: Notary’s Seal:

The College hereby certifies that the NJ State Treasury Department debarment list has been

checked by the issuing buyer and the successful responder is not debarred.

_______________________________ ________________________

Signature (OCC Representative) Print or Type

Buyer’s Name

RESPONDER’S CERTIFICATION OF AUTHORITY, VERACITY, NON-COLLUSION

AND NON-DEBARMENT

Having complete knowledge as to the statements made herein, I, _______

hereby certify as follows: (PRINT NAME)

1. I am the undersigned, who, on behalf of the RESPONDER and with full authority to

do so, has executed this Certification in connection with its QUOTE;

2. The RESPONDER has not, directly or indirectly, entered into any agreement,

participated in any collusion, or otherwise taken any action in restraint of free

competitive quoting in connection with the within Quote;

3. I further warrant that, no person or selling agency has been employed, or retained, to

solicit, or secure, such contract upon an agreement or understanding for a commission,

percentage, brokerage or contingent fee, except bona fide employee or bona fide

established commercial or selling agencies identified as follows:

4. The RESPONDER is not, as of this date, and has not been at any time within three (3)

years immediately preceding the date on which Bids were received, included on the

New Jersey State Treasurer's List of Debarred, Suspended or Disqualified Bidders; the

REPONDER hereby acknowledges that it may be debarred, suspended or disqualified

from contracting with the OWNER if it commits any of the acts listed in N.J.A.C. 7:1-

5.2 and further acknowledges its obligation to notify the OWNER immediately if it

appears that said RESPONDER may be added to any such list.

5. All statements and representations contained in this response are true, complete and

correct, and made with full knowledge that the OWNER shall rely upon same in

awarding a public contract for the Work as defined in the Contract Documents.

RESPONDER's Authorized Representative:

_____________________________ __________________________________

Signature Print or Type Name and Title


RESPONDER’S CERTIFICATION OF WORK FORCE COMPOSITION,

COMPENSATION AND WORKING CONDITIONS

The RESPONDER hereby certifies that it and its subcontractor(s) shall comply with the

provisions of this Quote Form which is incorporated into these Quote Documents. This

Certification includes provisions for Equal Employment Opportunity; Americans with Disabilities

Act; Affirmative Action; Non-Segregated Facilities; Prevailing Wage Rates; and Worker's

Compensation; and all other provisions hereof.

BIDDER's Authorized Representative:

Signature

Print or Type Name and Title

Date

1.1. Prohibition against Discriminatory Employment Practices

1.1.1 The CONTRACTOR or Subcontractor(s), shall not maintain or provide for any

employee, any segregated facilities at any of the CONTRACTOR's establishments,

nor shall the CONTRACTOR permit said employees to perform their services at

any location, under the CONTRACTOR's control, where segregated facilities are

maintained.

1.1.2 The CONTRACTOR or Subcontractor(s), shall maintain a policy against sexual

harassment. The sexual harassment of any employee of OWNER or by any person

doing business with the OWNER shall constitute prohibited discrimination under

this policy.

1.1.3 The CONTRACTOR or Subcontractor(s), where applicable, shall comply with the

Americans with Disabilities Act, P.L. 101-336.

The CONTRACTOR shall (except where said CONTRACTOR has obtained identical Certifications from proposed subcontractor(s) for the same time period) obtain identical Certifications as set forth herein above, from proposed subcontractor(s) prior to the award of subcontracts exceeding Ten Thousand ($10,000.00) Dollars which are not exempt from the provisions of the Equal Opportunity provision, and shall retain such certifications in his/her files.

1.2 Equal Employment Opportunity

The CONTRACTOR agrees to be bound by the Equal Employment Opportunity

provisions set forth in the General Conditions, in the performance of the Work.

1.3 Worker’s Compensation Insurance

Worker's Compensation Insurance shall be carried by the CONTRACTOR or

Subcontractor specifically applying to the State of New Jersey as required by Applicable

Law.


DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or

renew a contract must complete the certification below to attest, under penalty of perjury, that the person or entity, or one of the

person or entity's parents, subsidiaries, or affiliates, is not identified on a list created and maintained by the Department of the

Treasury as a person or entity engaging in investment activities in Iran. If the Department of Treasury finds a person or entity to

be in violation of the principles which are the subject of this law, the Department of Treasury shall take action as may be

appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance,

recovering damages, declaring the party in default and seeking debarment or suspension of the person or entity.

I certify, pursuant to Public Law 2012, c. 25, that the person or entity listed below for which I am authorized to bid:

is not providing goods or services of $20,000,000 or more in the energy sector of Iran, including a person or entity that

provides oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or

liquefied natural gas, for the energy sector of Iran,

AND

is not a financial institution that extends $20,000,000 or more in credit to another person or entity, for 45 days or more,

if that person or entity will use the credit to provide goods or services in the energy sector in Iran.

In the event that a person or entity is unable to make the above certification because it or one of its parents, subsidiaries, or

affiliates has engaged in the above-referenced activities, a detailed, accurate and precise description of the activities must be

provided below to Ocean County College under penalty of perjury.

PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN

You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents,

subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below.

PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS TO

EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, USE ADDITIONAL PAGES

Name: _________________________________ Relationship to Bidder/Vendor: _____________________________

Description of Activities: _________________________________________________________________________

Duration of Engagement: ________________________________________________________________________

Bidder/Vendor

Contact Name: _________________________________ Contact Phone Number: ___________________________

Certification: I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments

thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of

the below-referenced person or entity. I acknowledge that Ocean County College is relying on the information contained herein

and thereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of

contracts with the College to notify the College in writing of any changes to the answers of information contained herein. I

acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and

if I do so, I recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of

my agreements(s) with Ocean County College and that the College at its option may declare contract(s) resulting from this

certification void and unenforceable.

Full Name (Print): ______________________ Signature: _________________________________

Title: ________________________________ Date: ___________________________

Bidder/Vendor: ________________________________________________________

14(R)3(R)

2

56

1 2

6

4(R)3(R)

H. George Buckwald Drive

to Hooper Ave

to Church Road

to Lot 1

to Lot 2

College Drive

40

66

6567

Baseball/Softball Fields

30S

Ocean County Stadium

101

3

4

56

78

9 29

12

11

131

2321

22 2527

10

2

to 30 Security/ Welcome Center

Key: Buildings & Locations 1 Administration Building ....... (ADMN)2 John C. Bartlett, Jr. Hall ..........(BART)3 Library ...........................................(LIBR)4 Health Science Building ...........(HSB)5 Instructional Building ...............(INST)6 TV Studio ...................................... (TVS)7 W. Kable Russell Building ..... (RUSS)8 Student Center ........ (Under Construction)9 College Center ........................... (CCTR)10 Bookstore/Conference ........... (BOOK)11 Grunin Center .............................(GRUN)12 Grunin Center .............................(GRUN)13 Robert J. Novins Planetarium ..(PLAN)

21 Green Energy Combined Cooling, Heating and Power Plant ............ (CHP)

22 Instructional Computer Center (ICCT)23 Information Technology ............ (OITE)25 Technology Building ................. (TECH)27 William T. Hiering Science Building ........................ (HIER)29 Health & Human Performance Center .................. (HPEC)30 SECURITY/WELCOME CENTER (SWC)40 O.C.E.A.N., Inc. Kids Child Development Center ........(KIDS)65 Maintenance Building ..............(MBLO)66 Facilities Management Bldg ... (WARE)67 Administrative Support Building (ADSB)

Upper Campus101 Gateway Building ....................... (GATE)

General Parking1 = Lot 1 2 = Lot 2 5 = Lot 5 6 = Lot 6

Reserved Parking 3(R) 4(R)

All Parking Lots also have designated Reserved and Handicapped areas.

map version 20-Aug-2014

VENDOR INFORMATION

MAILING ADDRESS FOR PURCHASE ORDERS:

Company Name (as recorded with IRS):________________________________________ DBA: ___________________________________

Mailing Name: ______________________________________________

Street Address: ____________________________________________________________ Suite: _______________

PO Box: ___________City: ______________________________________________________ State: ____________ Zip: _______________

MAILING ADDRESS FOR PAYMENTS (if different from above):

Company Name (as recorded with IRS):___________________________________

Mailing Name: ____________________________________________

Street Address: ____________________________________________________________ Suite: _______________

PO Box: ___________City: ______________________________________________________ State: ____________ Zip: _______________

Taxpayer Identification Number (TIN): ____________________________________________________

SALES CONTACT INFORMATION:

Name: _________________________________________________ Title: ________________________________________

Phone: ________________________________________________ Fax: __________________________________________

E-mail: _________________________________________________________________

ACCOUNTS RECEIVABLE CONTACT INFORMATION:

Name: _________________________________________________ Title: ________________________________________

Phone: ________________________________________________ Fax: __________________________________________

E-mail: _________________________________________________________________

E-CHECK INFORMATION:

Routing #: ________________________ Bank Account #: __________________________ Account Type: _______

I agree to have payments from Ocean County College direct deposited using the bank account information provided below. If my banking

information changes I agree to update this information in writing prior to submitting any future payment requests. In situations where a payment has been made in error, Ocean County College is authorized to correct that error and notify you accordingly. Initials: _____

Check those that apply: Ethnicity:

□ SBE Small Business Enterprise □ African American

□ MBE Minority Business Enterprise □ Asian American

□ WBE Woman Business Enterprise □ Caucasian American

□ MWBE Minority Woman Business Enterprise □ Hispanic American

□ SMBE Small Minority Business Enterprise □ Multiple Ethnicities

□ SMWBE Small Minority Women Business Enterprise □ Native American

□ SWBE Small Woman Business Enterprise □ Unspecified

COMMODITY CODE(s) ______, ______, ______, ______ (Reference NIGP Code Listing attached)

Continued to Next Page

CD # DESCRIPTION CD # DESCRIPTION CD# DESCRIPTION

005 Abrasives 201 Clothing Accessories 385 Foods,Frozen

010 Acoustical Tile, Insulating Materials 203 Computer Accessories/Supplies, EC 390 Foods: Perishable

015 Addressing, Copying Machine Supplies 204 Computer Hardware/Microcomputers 393 Foods: Staple Grocery

019 Agricultural Crops and Grains 206 Computer Hardware/Mini,Main Frame 395 Forms,Continuous:Comp Paper, Lbls, Fldrs

020 Agricultural Equip. Implements & Acc. 207 Computer Accessories/Supplies 400 Foundry Castings, E&S

022 Agricultural Equip. & Implement Parts 208 Computer Software/Microcomputers 405 Fuel, Oil, Grease/Lubricants

025 Air Compressors and Accessories 209 Computer Software/Mini,Main Frame 410 Furn:Health Care, Hosp/Dr Office

031 A/C Heating,Ventilating Equip. P&A 210 Concrete/Metl Prods,Pilings,Septics,Sup 415 Furniture: Laboratory

035 Aircraft/Airport Equip. P&A 220 Control,Measure,Monitor,Instr/Supplies 420 Furn. Café,Dorm,Household,Library,School

037 Amusement,Decorations,Entertain,Gifts225 Coolers,Drinking Water (Fountains) 425 Furniture: Office

040 Animals, Birds, Marine Life, Poultry 232 Crafts, General 430 Gases,Containers,Equip:Lab,Med,Welding

045 Appliances/Equip., Household Type 233 Crafts, Specialized 435 Germicides,Sani Prods/Healthcare Persnl

050 Art Equip./Supplies 240 Cutlery,Ckwre,Dishes,Glasses,Utensils 436 Germicides,Sani Prods/Healthcare Prof,EC

052 Art Objects 245 Dairy Equipment/Supplies 440 Glass, Glazing Supplies

055 Auto Accessories 250 Data Processing Cards/Paper 445 Hand Tools, A&S

060 Auto & Trailer Equip/Parts 251 Data Processing Cards/Paper, EC 450 Hardware, Related Items

065 Auto/Trailer Bodies, A&P 255 Decals and Stamps 460 Hose,A&S: Commercial & Garden

070 Auto Vehicles & Related Transp. Equip 257 Homeland Sec. Equip,Weapons,ACC 465 Hosp.,Surgical Equip,Instruments,Supplies

071 Automobiles,School Buses, SUVs, Vans 260 Dental Equipment and Supplies 470 Hosp,Nurs.Hm,ResSpec EQ/Handicap/Disab

072 Trucks 265 Draperies,Curtains,Upholst. Material 475 Hosp,Surg,Med Related Accessories

073 Trailers 269 Drugs, Pharmaceuticals 485 Janitorial Supplies,General Line

075 Auto Shop, Related Equip/Supplies 271 Drug/Feeding Admin,Irrigation E&S 486 Janitorial Supplies,General Line, EC

080 Badges, Awards, Name Tags & Plates 279 18th Century Reproduction Goods 490 Lab Equip, A&S:Genl Analytical

085 Bags, Bagging, Ties & Erosion Sheeting 280 Electrical Cables/wires (not electronic) 493 Lab Equip, A&S:Genl Analytical, EC

090 Bakery Equip, Commercial 285 Electrical E&S (except cable, wire) 495 Lab, E&S:Bio,Geol,Microbio,Zool

095 Barber & Beauty Shop Equip/Supplies 287 Electronic Equip.Components, P&A 500 Laund,Dry Clng, Equip,A&S/Commercial

100 Barrels, drums, Kegs & Containers 290 Energy Collecting Equip:Solar & Wind 505 Laund.Dry Clng,Compnds,Detergents/Sup

105 Bearings 295 Elevators,Escalators,Moving Walks 510 Laundry Textiles/Supplies

110 Belts & Belting: Auto & Industrial 305 Engrg, Architectural, Surveying Equip. 515 Lawn Maint Equip/Accessories

115 Biochemicals, Research 306Engrg.Architectural,Surveying Equip EC 520 Leather,Shoe Accessories,E&S

120 Boats, Motors & Marine Equipment 310Envelopes, Plain 525 Library,archival Equip Mach, Supplies

125 Bookbinding Supplies 312Environmental Protective Equip. 530 Luggage,Brief Cases, Purses

135 Bricks,Clay,Refractory Matls,Stone,Tile 315Epoxy Formulations Adhesives,Coatings 540 Lumber,Siding, Related Products

140 Broom, Brush, Mop Machy/Supplies 318Fare Collection Equip/Supplies 545 Machinery,Hardware/Industrial

145 Brushes 320Fasteners:Bolts,Nuts,Pins,Rivets,Screws 550 Markers,Plaques/Traffic Control Devices

150 Builder's Supplies 325Feed,Bedding,Vits/Supplements Animals553 Mfg. Components/Supplies

155 Buildings & Structures: Fab/Prefab 330Fencing 555 Metal,Paper,Plastic,Stencils & Devices

160 Butcher Shop & Meat Processing Equip 335Fertilizers/Soil Conditions 556 Mass Transportation - Transit Bus

165 Cafeteria & Kitchen Equip. Commercial 340Fire Portection Equip/Supplies 557 Mass Transportation - Transit Bus A&P

175 Chemical Lab Equip/Supplies 345 First Aid/Safety Equip 558 Mass Transit/Rail Vehicles & Systems

180 Chemical Raw Materials 350 Flags,Flag Poles,Banners, Accessories 559 Mass Transit/Rail Vehicles & Accessories

190 Chems & Solvents, Commerical (bulk) 360 Floor Covering,Installation/Removal EQ 560 Matl Handling,Conveyors,Storage E&A

192 Detergents,Solvents,Strippers - PrePak 365 Floor Maint. Machines, P&A 565 Mattress,Pillow Mfg Machy/Supplies

193 Clinical Lab Reagents & Tests 370 Food Processing Canning E&S 570 Metals:Bars,Plates,Sheets,Tubing,Fab

195 Clocks,Watches,Jewelry,Precious Stones375 Foods:Bakery Prods (Fresh) 575 Microfiche,Microfilm Equip & A&S

200 Clothing: Athletic, Dress, Uniform 380 Foods:Dairy Prods (Fresh) 578 Misc Prods (Not Classified)

NIGP COMMODITY CODES

580 Musical Instruments, A&S 770 Roofing Matls/Supplies 920 Data Proc,Comp,Prog&Software Svcs

590 Notions, Related Sewing A&S 775 Salt (Sodium Chloride) 924 Educational/Training Svcs

593 Nuclear Equip Components A&S 780 Scales/Weighing Apparatus 925 Engrg Svcs, Professional

595 Nursery (Plants) Stock, E&S 785 School Equip/Teaching Aids/Supplies 926 Environmental & Ecological Svcs

600 Office Machines, Equip, Accessories. 790 Seed,Sod,Soil & Inoculants 928 Equip Maint,Rpr Svcs,Auto,Truck,Bus

605 Office Mechl Aids,Small Mach.,Apparatus795 Sewing,Textile Machy & Accessories 929 Equip Maint,Rpr Svcs,Agri,Constr

610 Office Supplies:Carbon Paper, Ribbons 800 Shoes & Boots 931 Equip Maint,Repair Svcs, Appliance

615 Office Supplies, General 801 Signs,Matls,Sign Making E&S 934 Equip Maint,Rpr Svcs Laundry,Lawn

616 Office Supplies, EC 803 Sound Systems,Components & Access. 936 Equip Maint,Rpr Svcs, Genl Equip

620 Office Supplies:Ink,Lead,Pens,Pencils 804 Spacecrafts, Accessories&Components 938 Equip Maint & Repr/Hosp. Lab Equip

625 Optical Equip. A&S 805 Sporting & Athletic Goods & Equip. 939 EMR Svcs,Computers,Office,Radio & TV

630 Paint,Protective Coat,Varnish,Wallpper 810 Spraying Equip (No House,Plant,Paint) 940 Equip Maint,Rpr,Constr for Railroads

631 Paint,ProtectCoat,Varnish,Wallpper EC 815 Steam & Hot Water Fittings, A&S 941 EMR Power Gen. & Transm. Equip

635 Painting Equip/Accessories 820 Steam & Hot Water Boilers/Heat Equip 944 Farm & Ranch Svcs, Animals & Crop

640 Paper,Plastic Prods,Disposable 825 Stockman Equip & Supplies 945 Fish,Hunt,Trap,Game Propagation, Svcs

641 Paper,Plastic Prods,Disposable,EC 830 Tanks:Mobile,Portable,Stationary 946 Financial Services

645 Paper,Office/Print Shop Use 832 Tape (Not Data Proc.,Sound,Video) 947 Forestry Services

646 Paper,Office/Print Shop Use, EC 838 Telecom Equip, A&S 948 Health Related Services

650 Park,Rec Area,SwimmingPool E&S 839 Phone Equip, A&S 952 Human Services

652 Personal Hygiene/Grooming E&S 840 Television Equip & Accessories 953 Insurance & Insurance Svcs

655 Photo Equip,Film & Supplies 845 Test Apparatus & Instruments 954 Laundry & Dry Cleaning Svcs

658 Pipe,Tubing & Access (Not Fittings) 850 Textiles,Fibers,Household Linens,Goods 956 Library Services

659 Pipe & Tubing Fittings 855 Theatrical Equip & Supplies 958 Management Services

660 Pipes,Tobaccos,Smking Acc:Alcoholic Bev860 Tickets,Coupon Bks,Sales/Strip Books 959 Marine Constr,Equip Maint Repair

665 Plastics,Resins,Fibergl:Constr Molding EQ863 Tires and Tubes 961 Misc Svcs, No 1 (Not Classified)

670 Plumbing Equip,Fixtures & Supplies 864 Train Controls, Electronic 962 Misc Svcs. No 2 (Not Classified)

675 Pesticides/Chems:Agric/Industrial 865 Twine & String 963 Non-Biddable Misc Items

680 Police & Prison Equip & Supplies 870 Venetian Blinds,Awnings & Shades 965 Print Prep:Etch,FotoengraveMats,Neg,Plates

685 Poultry Equip & Supplies 875 Vet Equip & Supplies 966 Printing & Typesetting Svcs \

690 Power generation E&A&S 880 Visual Education Equip & Supplies 967 Production & Mfg Svcs

691 Power Transmission Equip 883 Voice Response Systems 968 Public Wks & Related Svcs

700 Printing Plant E&S (No Paper) 885 Water & Wastewater Chemicals 971 Real Prop Rental or Lease

710 Prosthetic Dev,Hrg Aids,Test EQ,Rdng EQ890 Water Supply,SewageTreatmt & Equip 975 Rental/Lease Agri,Air,Auto,Marine,Hvy EQ

715 Publications,A-V Matls,Books,Textbooks895 Welding Equip & Supplies 977 Rent/Lease Svcs Appliance,Café,Furn,Hdwr

720 Pumping Equip & Accessories 898 X-Ray,Other Radiology Equip & Supplies 979 Rent/Lease Svcs Engrg,Hosp,Scales,Test EQ

725 Radio,Phone,Telecom Equir, A&S 905 Aircraft&Airport Operations Svcs 981 Rent/Lease Genl Eq. (HVAC,Athl,Fire,Police)

726 Radio Comm. Equip. A&S 906 Architectural Services, Professional 983 Rent/Lease Svcs Clothing,Janitorial,Laund.

730 Radio Comm Test,Measure,Analyze EQ 907 Arch & Engrg Svcs, Non-Professional 984 Rent/Lease Svcs Comp, Data Proc. EQ

735 Rags,Shop Towels,Wiping Cloths 908 Bookbinding & Repair Services 985 Rent/Lse Svcs Off,Print,Radio,TV,Phone EQ

740 Refrigeration Equip & Accessories 909 Bldg Constr Svcs, Incl Maint & Repair 988 Roadside,Grnds,Rec & Park Area Svcs

745 Road & Hwy Bldg Matls (Asphalt) 910 Bldg Maint, Install & Repair Svcs 989 Sampling & Sample Prep Svcs (Testing)

750 Road & Hwy Bldg. Matls (Not Asphalt) 912 Constr Svcs, Genl (Maint/Repair) 990 Security,Fire Safety,Emergency Svcs

755 Road,Hwy,Asphalt/Concrete Equip. 913 Constr Svcs, Heavy (Maint/Repair) 992 Testing & Calibration Svcs

760 Rd/Hwy EQEarth Handlg,Grading,Moving914 Constr Svcs, Trade (New Constr) 998 Sale of Surplus & Obsolete Items

765 Road & Hwy Equipment 915 Communications & Media Svcs 999 NJ Specific Services

918 Consulting Services

KEY: EC = ENVIORNMENTALLY CERTIFIED; A&S = ACCESSORIES & SUPPLIES;P&A=PARTS/ACCESSORIESEC=ENVIRONMENTALLY CERTIFIED; A&S=ACCESSORIES & SUPPLIES; P&A=PARTS & ACCESSORIESE&S=EQUIP. & SUPPLIES

E&A=EQUIPMENT AND ACCESSORIES EMR= EQUIPMENT, MAINTENANCE & REPAIR ACC=ACCESSORIES

Form W-9(Rev. August 2013)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

Pri

nt o

r ty

pe

See

Sp

ecifi

c In

stru

ctio

ns o

n p

age

2.

Name (as shown on your income tax return)

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification:

Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Other (see instructions) ▶

Exemptions (see instructions):

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Requester’s name and address (optional)

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 the “Name” line 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 on page 3.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

Employer identification number

–

Part II CertificationUnder 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 on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection 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.irs.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 FormA 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

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, 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.

Cat. No. 10231X 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 Entities).

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 InformationYou 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.

PenaltiesFailure 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 InstructionsNameIf 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 (DBA)” 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.

ExemptionsIf 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.


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 patronage dividends

Exempt payees 1 through 4

Payments over $600 required to be

reported and direct sales over $5,0001Generally, exempt payees

1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous Income, 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, 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)(i)

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)(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

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.irs.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. CertificationTo 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 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), 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 RequesterFor this type of account: Give name and SSN of:

1. Individual The individual2. Two or more individuals (joint

account)The actual owner of the account or, if combined funds, the first individual on the account 1

3. Custodian account of a minor (Uniform Gift to Minors Act)

The minor 2

4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law

The grantor-trustee 1

The actual owner 1

5. Sole proprietorship or disregarded entity owned by an individual

The owner 3

6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(i)(A))

The grantor*

For this type of account: Give name and EIN of:

7. Disregarded entity not owned by an individual

The owner

8. A valid trust, estate, or pension trust Legal entity 4

9. Corporation or LLC electing corporate status on Form 8832 or Form 2553

The corporation

10. Association, club, religious, charitable, educational, or other tax-exempt organization

The organization

11. Partnership or multi-member LLC The partnership12. A broker or registered nominee The broker or nominee

13. 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

14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation 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 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 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.) Also see Special rules for partnerships on page 1.

*Note. 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 TheftIdentity 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 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 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 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 (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

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 [email protected]. 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 emails to the Federal Trade Commission at: [email protected] or contact them at www.ftc.gov/idtheft 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 NoticeSection 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.