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Home My WebLink About060868-NC1 - General - Contract - Locality Media, LLCFORT WORTH� CSC No. 60968-NC1 Memorandum Date: 1/14/2026 To: Hye Won Kim, Assistant City Attorney K.A To: Kimber Allen — Sr. Contract Compliance Specialist 8K Brenda Ray — Purchasing Manger �" �w�.�.�. � .,�� To: Jannette Goodall, City Secretary Re: Name Change Only: Locality Media, Inc. to Locality Media, LLC Prior Name: Locality Media, Inc. New Name: L,ocality Media, LLC CSC: 60968 Name change only; tax id number remains the same. �� Approved By: Hye Won Kim, Assistant City Attorney 01/21/2026 Approval Date: OFFICIAL RECORD CITY SECRETARY Financial Management Services FT. WORTH, TX J Purchasing — Vendor Management City of Fort Worth • 100 Fort Worth Trail, Fort Worth, TX 76102 817-392-0000 • FAX 817-392-0000 TEXAS SECRETARY of STATE JANE NELSON Filing Number: Original Date of Filing Formation Date: Tax ID: Name: Address: Fictitious Name: Jurisdiction: Foreign Formation Date: BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY 804138155 Entity Type: Foreign Limited Liability Company (LLC) June 28, 2021 Entity Status: In existence N/A 32075679996 FEIN: 811388062 Locality Media, LLC 3071 Orange Street Miami, FL 33133 USA N/A DE, USA January 25, 2010 ASSOCIATED REGISTEREDAGENT FILING HISTORY NAMES MANAGEMENT ASSUMED NAMES ENTITIES INITIALADDRESS Name Name Status Name Type Name Inactive Date Consent Filing # Locality Media, Inc. Prior Legal August 14, 2025 0 Locality Media, LLC In use Legal 0 Order I Return to Search I Instructions: � To place an order for additional information about a filing press the 'Order' button. D r e awa e The First State Page 1 2, CHARUNI PATIBANDA—SANCHEZ, SECRETARY OF STATE OF THE STATE OF DELAWARE, DO HEREBY CERTIFY THAT THE ATTACHED IS A TRUE AND CORRECT COPY OF THE CERTIFICATE OF CONVERSION OF A DELAWARE CORPORATION UNDER THE NAME OF "LOCALITY MEDIA, INC." TO A DELAWARE LIMITED LIABILITY COMPANY, CHANGING ITS NAME FROM "LOCALITY MEDIA, INC." TO "LOCALITY MEDIA, LLC", FILED IN THIS OFFICE ON THE TWENTY—SIXTH DAY OF JUNE, A.D. 2025, AT 1:04 O�CLOCK P.M. 4780925 8100V SR# 20253195348 , C��tr�..,, [:F�' � 1� yw �. ,; _ �'F ti �ti"c ��' , k n •,,�; r;�� r, _ ,^ �L:-�t � � �.� `��%/ r � _ �� Cheruni Patihanda-Senahez, Secretery of 5#ate Authentication: 204051539 Date: 06-26-25 You may verify this certificate online at corp.delaware.gov/authver.shtml State of Dela��are Secretan� of State Di�ision of Corporations Delii�ered fl1:01P��706iZ6.�2025 FII.ED 01:04 P;li 06,�2612025 SR 2025314�348 - Filetiumber 47809Z5 STATE OF DELAWARE CERTIFICATE QF CONVERSIQN �'ROM A CORPORATION TO A D�LAWAR� LIM�T�D LIABiL�TY COMi'ANY PURSUANT TO SECTION 18-214 QF THE LIMITED LiABILITY COMPANY ACT � LOCALiTY MEDIA, INC. l. 2. 3 4. S The jurisdiction where Locality Media, Inc. (the "Coiporation") first formed is th� State of l�elaware. The jurisdiction of th� Coiporation immediately prior to filing this C�rtificate of Conversion is the State of Delaware. The date the Corporation first formed is January 2S, 2Q1Q under the nar�e of "Locality Media, i��+. �f. The name ofthe Carporation im�nediately priar ta �ling this Certi�cate of Gon�ersion is Locality Media, �nc. The name af the Lirr�ited Liability Cornpany as set forth in the Certificate of For-rrzatian is Locality M�dia, LLC. � � � � � KE 123517&38.2 �ocusign En�elope ID: 86C19flA2-6941-4510-AD4A-CE488C049D3A IN �1VITNESS WHEREOF, the undersigned has executed this Certificate of Conversion on the 26�' day of June, 2025. CONVERTING ENTITY: LOCALTTY MEDTA, TNC. �s�� : Q�.a�.vr,as id-�e.v� Name:��Andreas Huber Its: Chief Executive Officer Sgnature Page to Cerdificate of Conversion — Localit}� Media, Inc. e aware The First State I, CHARUNI PATIBANDA—SANCHEZ, SECRETARY OF STATE OF THE STATE OF DELAWARE DO HEREBY CERTIFY THAT THE ATTACHED IS A TRUE AND CORRECT COPY OF THE CERTIFICATE OF FORMATION OF Page 1 "LOCALITY MEDIA, LLC" FILED IN THIS OFFICE ON THE TWENTY—SIXTH DAY OF JUNE, A.D. 2025, AT 1:04 O'CLOCK P.M. 4780925 8100V SR# 20253195348 i thE�aHV�S..i' � ��? . . fi�� ?�� '�... . _ ,�•,d � `-. � � i ��` �r _ ��. y.k �, ��. � .. �my`� ` `�Fi�n w R�� ', .� � � �� Cheruni Patihanda-Senahex, Seceeteryaf5#ate Authentication: 204051539 Date: 06-26-25 You may verify this certificate online at corp.delaware.gov/authver.shtml State of Dela��are Secretan� of State Di�ision of Corporations Delii�ered fl1:04 P�I o6;26.�ZOZS CERTIFICATE QF FQRMATIQN FII.ED 01:04 P;li 06,�2612025 SR 2025314�348 - Filetiumber 47809Z5 :� LOCALITY MEDIA, LLC This Certificate of �`ormatio� is being executed as a�June 26, 2425, for the purpose of farming a lirnited liability company pt�rsuant ta the Delaware Limited Liability Campany Act, 6 Del. C. §§ 18-1p1, et se�c . The undersigned, being duly authorized ta execute and file this Certificate of Formation, does hereby certify as follaws: 1. Na�ne. The na�ne of the li�nited l�abi�ity company (the "Carnpany") is Locality Media, LLC. 2. Re�istered Office and Reeistered A�ex�t. The address of the Coinpany's registered aff'ice in the State of Delaware is 1209 Orange Street, Carparation Trust Center, in the City of Wilmi�gton, Caunty o� New Castle, Deiaware, 19841. The name af the Company`s registered agent at such address is The Corparation Trust Cornpany. TN WITNESS WHEREO�', the undersigned has duiy executed this Certi�'icate of Farmatian as of the date first abave written. /s/Sherie Hollin�er Sherie F-iollinger Autharized Person Form W-9 Request iior Taxpayer Gtiveform tothe .Revr Marcr 2024) $ dentfif icatf ion Number and Certfif icatfion requesterr po not Cepartment of tre Treasury send to the T RSr Go to www.irs.gov/FormW9 for fnstructtons and the aatest tnformattonr (nternae Revenue Servtce Before you beigtnr For gultlance reeated to tre purpose of Form We-9s see Purpose of Forms teowr 1 Name of entttyAndtvtdua¢r An entry is requtredr .For a so¢e proprtetor or disregarded entttys enter tre ownerrs name on e(ne 1 s and enter tre tusiness/d,sregardetl entttyrs name on etne 2r) FlOrst I:I.E HoUdlrgrsP� are. 2 Bustness name/dlsregarded enttty names tf different from atovei LoealJ Ity IloEdl af3 LLC dba FlOrst I:I.E M a� rn � n c 0 � N Q � �,.o i U O � c in � c � U .� n � � a� � 3a Creck tre approprtate tox for federa¢ tax ceasstftcatton of tre entttyAndtvtdua¢ wrose name (s entered on e(ne 1 r Creck oney one of tre fo�eowtng seven toxes ❑( ndt vt duae /so e proprtetor � C corporatton ❑ S corporatt on ❑ Partnersrt p ❑ Trustlestate ❑ LLCr Entertretaxc:asstftcatton .0 = C corporattons S= S corporattons P=Partnersr,p) r r r r Note' Creck tre 'LLC" tox atove ands tn tre entry spaces enter tre approprtate cotle .Cs Ss or P) for tre tax ceasstftcatton of tre LLCs uneess it is a disregarded entttyr A disregarded enttry srourd tnstead creck tre approprtate tox for tre tax c¢asstftcatton oftts ownerr ❑ Otrer .see t nstructt ons) 4 Exemptt ons .codes appe y on e y to certatn enttttess nottndtvtduaes) see f nstructt ons on page 3)) E xem pt payee cod e.tf an y) Exemptton from Foretgn AccountTax Comp¢ tance Act .FATCA) reportt ng cotle .tf any) 3b jf on etne 3a you crecked 'Partnersrlp" or'TrusVestate�" or crecked 'LLC' and entered 'P" as tts tax ceasstftcattons �Appliestoaccounts maintained and you are provtding tris form to a partnersrlps trusts or estate in wrlcr you rave an ownersrip Interesi creck outsidetheUnitedStates9) tris tox if you rave any foretgn partners: ownerss or tenefctartesr See tnstructtons r r r r r r r r r ❑ 5 Atldress .numter: streets and aptr or sutte nor)r See instructtonsr Requesterrs name and address .opttonae) 390 N E 1 91 rst St STE 1 7328 6 Cttys states antl Z( P cotle Ilolaml � FL 331 79 7 Ltst account numter.$) rere .opttonae) ' Taxpayer T denttftcatton N umber -TT N) Enter your T(N tn tre approprtate to�a Tre T(N provtded must matcr tre name given on etne 1 to avotd tackupwttrrotlingr Fortndtvtduaess trisisgeneraeeyyoursoctae securttynumter .SSN)r Howevers fora restdent aatens soee proprtetors or tlisregardetl entttys see tre tnstructtons for Part (s eaterr For otrer enttttess it is your emp?oyer tdenttftcatton numter .E�N )r (f you do not rave a numters see How to get a TINs eaterr Note' (f tre account ts in more tran one names see tre instructtons for etne 1 r See aaso What Name antl Number To Give the Requester for gutdeetnes on wrose numter to enterr � Socfaa securtty number _ m or � Emp�oyer tdenttftcatton number 3 9- 2 7 2 5 8 0 2 � Certtftcatton Under penaettesofperrurys ( certtfytrat) 1 r Tre numter srown on trls form is my correct taxpayer fdenttftcatton numter .or ( am watttng for a numter to te fssued to me)) and 2r � am not sutrect to tackup wttrro:dtng tecause .a) � am exempt from tackup wttrro:dtngs or .t) ( rave not teen nottfted ty tre (nternae Revenue Servtce .(RS) trat ( am sutrect to tackup wttrro�ding as a resuet of a fateure to report aee interest or divtdendss or .c) tre (RS ras nottfted me trat ( am no eonger sutrect to tackup wttrro�ding) antl 3r ( am a U r Sr cttt izen or otrer U r Sr person .deft ned te ow)) and 4r Tre FATCA codes) entered on trl s form .l f any) l ndt catt ng trat ( am exempt from FATCA reportt ng f s correctr Certtftcatton tnstructtonsr You must cross out ltem 2 atove lf you rave teen nottfted ty tre (RS trat you are currentey sutrect to tackup wttrroedtng tecause you rave fateed to report aee tnterest and divtdends on your tax return� For reaE estate transacttonss ttem 2 does not appeyr For mortgage tnterest patds acqutsttton or atandonment of securetl propertys canceeeatton of dett contrttuttons to an tndivtduae rettrement arrangement .(RA)s ands genera�eys payments otrer tran interest and tlivtdentlss you are not requtretl to stgn tre certtftcattons tut you must provttle your correct T(Nr See tre instructtons for Part (�s eaterr Stlgn Stignature of ��(�� H ere UrSr person �� Generaa Tnstructtons Sectton references are to tre (nterna� Revenue Code uneess otrerwlse notedr Future deiveaopments� For tre eatest tnformatton atout deveeopments reeatetl to Form We-9 and its tnstructtonss sucr as eegtseatton enactetl after trey were put tsreds go to wwwVirs9gov/FormW9i WhatEs New Ltne 3a ras teen modtfted to ceartfy row a disregarded enttty compeetes tris etner An LLC trat ts a tltsregardetl enttty sroued creck tre approprtate tox for tre tax c�asstftcatton of fts ownerr OtrenMses ft srouetl creck tre'LLC" tox antl enter tts approprtate tax caasstftcattonr Date 09/25/2025 New eine 3t ras teen added to trls formr Af�owetrrougr enttty ts requtretl to compeete trls eine to lntlicate trat tt ras dtrect or lntltrect foretgn partnerss ownerss or teneflclartes wren tt provtdes tre Form We-9 to anotrer fEowetrrougr enttty ln wricr tt ras an ownersrip tnterestr Trls crange is intentletl to provttle a feowetrrougr enttty wttr lnformatton regartltng tre status oflts intltrect foretgn partnerss ownerss or tenefl ci arl ess so trat l t can satt sfy any ap p t cafi e reportt ng requlrementsr For exampees a partnersrip trat ras any tntlt rectforetgn partners may te requfred to compeete Scredu:es Ke2 and Ke3r See tre Partnersrip (nstructtons forScredu:es Ke2 and Ke3 .Form 1 0B5)r Purpose of Form An tntltvtdua¢ or enttty .Form We-9 requester) wro ts requtred to ftee an informatton return wttr tre (RS is gtvtng you tris form tecause trey Catr Nor 1 0231 X Form WI-9 .Revr 3e2024) Form W-9 Rev) 3-2i24) must obtatn your correct taxpayer tdenttftcatton number TTN)r wrtcr maybe your soctal securirynumber SSN)r tndtvtdual taxpayer tdenttftcatton number TTTN)r adoptton taxpayer tdenttftcatton number ATfN)r or employer tdent!ftcat�on number ETN)r to report on an tnformatton return tre amount patd to your or otrer amount reportable onantnformatton return) Examples oftnformatton returns tncluder but are not ltmtted tor tre followtng) � Form 1 i99-'fNT tnterest earned or pat�) � Form 1 i99-/TV dtvtdendsr tncludtng trose from stocks or mutual funds)) � Form 1i99-MTSC vartous types oftncomer prtzesr awardsr or gross proceeds)) � Form 1 i99-NEC nonemployee compensatton)) � Form 1i99-B stock ormutual fund sales and certatn otrer tran sactt ons by brokers)) � Form 1 i99-S proceeds from real estate transacttons)) • Form 1 i99-K mercrant card and trtrd-party network transacttons)) � Form 1 i98 rome mortgage tnterest)r 1 i98-E student loan tnterest)r and 1 i98-T tuttton)) � Form 1 i99-C canceled debt)) � Form 1 i99-A acqutsttton or abandonment of secured property)) UseForm W-9 onlytfyou are a U)SJ person tncludtng a res�dent al t en )r to provt de your correct TT N) Cautlonc Tf you donrt return Form W-9 to tre requester wttr a TTNr you mtgrt be subject to backup wttrroldtng) See What is backup withholding� I ater) By slgning tte Fliied-out formr youa 1) Certtfy trat tre Tf N you are gtvtng ts correct or you are wa(ttng for a number to be tssued)) 11 Certtfytratyou are not subject to backup wttrroldtng) or ll Clatm exemptton from backup wttrroldtng tfyou are a U)S) exempt payee) and �I Certtfy to your non-foretgn status for purposes of wttrrol dtng under crapter 3 or 4 of tre Code tf appl tcabl e)) and f'I Cert� fy tr at FATCA code s) entered on tr t s form t f any) tndt catt ng tr at you are exempt from tr e FATCA reportt ng t s correct) See What Is FATCA Reporting I aterr for fu rtr er t n format� on ) Notec Tf you are a UJSJ person and a requester gtves you a form otrer tran Form W-9 to request your TTNr you must use tre requesterrs form tf tt ts substant!allyscmtlar to trts Form W-9) Deflnitlon of a US _ personS For federal tax purposesr you are const dered a U J S) person tf you area � An tndtvtdual wro ts a U)S) ctttzen or UJS) restdent alten) � A partnersripr corporat!onr company� or associatton created or organ�zed tn tre Untted States or under tre laws of tre Untted Statesl � An estate otrer tr an a foret gn estate)) or � A domesttc trust as deftned tn Regulattons sectton 3i1 J77i1 -7)) Estabilsting US_ status for purposes of ctapter 3 and ctapter 4 wltttoidingS Payments made to foretgn personsr tncludtng certatn dtstrtbuttonsr allocattons of tncomer or transfers of sales proceedsr may be subject to wttrrol dtng under crapter 3 or crapter 4 of tre Code secttons 1 441 -1 474)) Under trose rulesr tf a Form W-9 or otrer certtftcatton of non-foretgn status ras not been recetvedr a wttrroldtng agentr transfereer or partnersrtp payor) generallyappltes presumptton rules trat may requtre tre payor to wttrrold appltcable tax from tre rectptentr ownerr transferorr or partner payee)) See Pub) 515r Wttrroldtng of Tax on Nonrestdent Altens and Foretgn Enttttes) Tre followtng persons must provtde Form W-9 to tre payor for purposesofestabltsrtng ttsnon-forefgn status) � T n tr e case of a d t sregarded entt ty wt tr a 0) S) ownerr tr e U) SJ owner oftre dtsregarded entttyand nottre dtsregarded enttty) � T n tr e case of a grantor tru st wt tr a U) S) grantor or otrer U) S) ownerr general I yr tr e U) S) grantor or otrer U) S) owner of tr e grantor tru st and not tr e grantor tru st) � Tn tre case of a U) S) trust otrer tran a grantor trust)r tre U) S) trust and nottre beneftctartes oftre trust) See Pub) 51 5 for more tnformatton on provtdtng a Form W-9 or a certtftcatton ofnon-foretgn status to avotd wttrroldtng) Page Forelgn personS Tfyou are a forecgn person or tre U) S) brancr ofa forefgn bank trat ras elected to be treated as a U)S) person under Regul at�ons sectton 1)1441 -1 b) 2) tv) or otrer appltcable sectton for crapter 3 or4 purposes)r do not use Form W-9) Tnsteadr use tre appropr�ate Form W-8 or Form 8233 see Pub) 51 5)) Tf you are a qualtfted foretgn penston fund under Regulattons sectton 1)8971)-1 d)r or apartnersrtp tratts wrollyowned byqualtfted forecgn penslon fundsr trat ts treated as a non-foretgn person for purposes of sectton 1 445 wttrrol dtngr do not use Form W-9) Tnsteadr use Form W-SEXP or otrer certt ft catt on of no n- fore� gn status)) Nonresldent ailen wto becomes a resldent ailenS _eneralyr only a nonres� dent alten tndtvtdual may use tre terms of a tax treaty to reduce or eltmtnate U)SJ taxon certa�n types oftncome) Howeverr mosttax treattes conta�n a provtslon known as a saving clause) Excepttons specifted tn tre sav�ng clause may permtt an exemptton from taxto conttnue for certa�n types oftncome even after tre payee ras otrerwlse become a U) S) res�dent alten for tax purposes) 'ff you are a U)S) restdent alten wro ts relytng on an exceptton conta�ned tn tre sav�ng clause of a tax treaty to clatm an exemptton from U) S) tax on certa�n types of tncomer you must attacr a statement to Form W-9 trat spectftes tre followtng ftve ttems) 1) Tre treary country) _ enera lyr trts must be tre same treaty under wr�cr you clatmed exempt�on from taxas anonres�dent alten) 1) Tre treaty arttcle addresstng tre tncome) "s� Tre article number or locatlon) tn tre tax treatytrat conta�ns tre sav�ng clause and tts except:ons) •'� Tre typeand amount oftncome tratqualtftes for tre exemptton from tax) ij Sufftctent facts to justtfy tre exemptton from tax under tre terms of tr e treaty artt cl e) Example. Arttcle 2i oftre U)S)-Crtna tncome taxtreatyallows an exemptton from taxforscrolarsrtp tncome recetved bya Crtnese studenttemporartlypresenttn tre Untted States) Under U)S) lawr trts student wtll become a restdent alten for tax purposes tf tretr staytn tre Untted States exceeds 5 calendar years) Howeverr paragrapr 2 of tre ftrstProtocol to tre U)S)-Crtna treary dated Aprtl 3i 1984) allows tre provtstons of Arttcle 2i to contf nue to apply even after tre Crtnese student becomes a restdent alten of tre Untted States) A Crtnese student wro qual tftes for trts excepton under paragrapr 2 of tre ftrst Protocol) and ts relytng on trts exceptlon to cla�m an exemptlon from tax on tretrscrolarsrtp or fellowsrlp tncomewould attacr to Form W-9 a statement trat tncl udes tre tnformatton descrlbed above to support trat exemptlon) Tfyou are a nonrestdent alten or a foretgn entttyr gtve tre requester tre appropr� ate compl eted Form W-8 or Form 8233) Backup Wltttoiding Wtatls backup wltttoiding? Persons maktng certatn payments to you must under certatn condtttons wttrrold and payto tre TRS 24% of sucr payments) Trts ts called Sbackup wttrrol dtng) " Payments trat may be subject to backup wttrroldtng tncluder but are not Itmtted tor tnterestr tax-exempttnterestr dtvtdendsr broker and barter excrange transact�onsr rentsr royalttesr nonemployee payr payments made tn settlement of payment card and trtrd-partynetwork transacttonsr and certaln payments from ftsrtng boat operators) Real estate transacttons are not subject to backup wttrrol dtng) You wtll not be subject to backup wttrrol dtng on payments you rece�ve tfyou gtve tre requester your correct TTNr make tre proper certtftcattonsr and reportall your taxable tnterestand dtvtdends on your taxreturn) Payments you recelive wlii be subject to backup wltttoiding Ifc 1) You do not furntsr your T�N to tre requester) :I You do not certtfyyour TTN wren requtred see tre tnstructtons for Part T T for detall s)) "sj TreTRStells tre requester tratyou furntsred an tncorrect TTN) dj Tre TRS tells you tratyou are subject to backup wttrroldtng because you dtd not report all your tnterest and dtvtdends on your tax return forreportable tnterestand dtvtdends only)) or i You do not certtfy to tre requester trat you are not subject to backup wttrroldtngr as descrlbed tn ttem 4 under SBysigningthe filled- out form" above for reportabl e tnterest and dtvtdend accounts opened after 1983 only)) Form W-9 (Revt 3-2024) CertaSn payees and payments are exemptfrom tackup wStrropdSngt See Exempt payee codee p atere an d tr e sep arate R n stru ct5 on s for tr e Requester of Form W-9 for more SnformatSont See a;so Establishing U. S. status for purposes of chapter 3 and chapter4withholdinge earpSert What Ks FATCA Reporti ng? Tre ForeSgn Account Tax ComppSance Act (FATCA) requSres a partScSpatSng foreSgn fSnancSap SnstStutSon to report app UtSt account r op d ers tr at are sp ecS fS ed U t St p erson st CertaS n p ayees are exem p t from F ATCA rep ortS n gt See Exemption from FATCA reporting codee p atere an d tre RnstructSons for tre Requester ofForm W-9 for more SnformatSont U pdati n g You r K n form ati on You m u st p rovS d e u p d ated S n form atS on to an y p erson to wr om you cpasmed to te an exempt payee Sfyou are no ponger an exempt payee and antfcSpate receSvSng reportat{e payments Sn tre future from trSs persont For examppe- you mayneed to provSde updated Snformat!on Sf you are a C corporatSon trat e:ects to te an S corporatsone or Sf you are nopongertaxexemptt Rn addStSone you mustfurnSsr a new Form W-9 Sf tre name or TRN cranges for tre accounte for examppee Sftre grantor of a grantor trust dSest Pen ai ti es Fai i u re to fu rn i sh TK N. R f you fai p to fu rn S sr you r correct TR N to a req u estere you are su tject to a pen apty of $50 for eacr su cr faS p u re unpess your faSpure Ss due to reasonate cause and not to w5ppfup negpectt Ciivii penaityfor faise information with respect to withhoiding. Rfyou make a fapse statementwStr no reasonat�e tas!s tratresupts Sn no tackup wltrropdSnge you are sutject to a$500 pena,tyt Criminai penaityforfaisifying information. WSppfuppyfapsSfySng cert5f5catSons or affSrmatSons may sutject you to crSmSnap penaptSes SncpudSng fSnes and/or SmprSsonmentt Misuse ofTKNs. Rftre requester dSscposes or uses TRNs Sn vSopatSon of federap pawe tre requester mayte sutject to cSvSp and crSmSnap penaptSest Speci fi c K n stru cti on s Li ne 1 You m u st en ter on e of tr e fop p owS n g on trSs pS n ey do n ot peave trSs pS n e tpankt Tre name sroupd matcr tre name on your tax returnt RftrSs Form W-9 Ss for a joSnt account (otrer tran an account maSntaSnetl ty a foreign fSnancSap SnstStutSon (FFR��e pSst fSrste and tren c5 rcp ee tr e n am e of tr e p erson or en tS ty wr ose n u m ter you en tered S n PartR ofForm W-9t Rfyou are provSdSng Form W-9 to an FFR to document ajointaccounte eacr ro:der oftre accounttratSs a UtSt person must provSde a Form W-9t � Kndiividuai. Generappye enter tre name srown on your tax returnt Rf you rave cranged your pastname wStroutSnformSng tre SocSap SecurSty AdmSnSstratSon (SSA) oftre name crangee enter your ffrst name: tre past nameassrown on yoursocSa! securftycarde and yournewpastnamet Note for KTKN appiicant: Enter your SndSv:dua; name as St was entered on your Form W-7 apppScatfone pSne 1 at TrSs sroupd a!so te tre same as tre name you entered on tre Form 1040 you ffped w!tr your apppScatSont � Soie proprietor. Enter your SndSv!duai name as srown on your Form 1040 on pSne 1 t Enter your tuslnesse trade� or'do!ng tusiness as" (IBAA) name on pSne 2t � Partn ersh i p, C corporati on, 5 corporati on, or LLC, oth er th an a disregarded entity. Enter tre entSty...s name as srown on tre entSty...s tax return on psnel and anytus;nesse tradee or IBAAnameon pSne2t � Other entities. Enter your name as srown on requsred UtSt federap tax documents on pSne 1 t TrSs name sroupd matcr tre name srown on tre crarter or otrer pegap documentcreatSng tre entStyt Enter anytusSnesse trade� or IBAAnameon pSne2t � Dlsregarded entity. Rn generape a tusiness entSty trat ras a s!ngie ownere SnaudSng an LLC+ and Ss not a corporatSone Ss dssregarded as an entStyseparate from Sts owner (adSsregarded entSty)t See Regupaions sectSon 301t7701-2�c��2)t Adssregarded entStysroupd creck tre ap p rop rS ate tox for tr e tax cp asslff catS on of S ts own ert E n ter tr e own er... s nameon pSneltTrenameoftreownerentered on pSne1 sroupd never te a dSsregarded entStyt Tre name on psne 1 sroupd te tre name srown on tre Sncome tax return on wrScr tre Sncome sroupd te reportedt For Page 3 exam ppe� Sf a foreSgn LLC trat Ss treated as a dSsregarded entSty for UtSt federap tax purposes ras a s!ng:e owner trat Ss a UtSt persone tre UtSt owners name Ss requsred to te provSded on pSne 1t Rftre dsrect owner of tre entStySs apso a dSsregarded entStye enter tre ffrst owner trat Ss not dSsregarded for federap tax purposest Enter tre dSsregarded entSty...s name on psne tt Rf tre owner of tre dSsregarded entSty Ss a foreSgn persone tre owner must comppete an appropriate Form W-8 Snstead ofa Form W-9t TrSs Ss tre case even Sftre foreSgn person ras a UtSt TRNt Line 2 Rfyou raveatus5ness namee trade namee IBAAnamee ordSsregarded entStynamee enterston psne2t Li n e 3a Creck tre approprsate tox on pSne 3a for tre UtSt federap tax c:assif�catSon of tre person wrose name Ss entered on pSne 1 t Creck onpy one tox on pSne 3at KFthe entity/indiividuai on iine 1 THEN check the boxfor ... isa�n)... � Corp orat5 on Corp oratS on t � RndSvSduap or RndSvSduap/soe proprSetort � Sop e p rop rS etorsr S p � LLC cpassSfSed as a partnersrSp LSmSted pSat!pSty company and for U t St fed erap tax p u rp oses or en ter tr e ap p rop rf ate tax � LLC trat ras fjped Form 8832 or cp ass fS cation" 2553 e,ectsng totetaxed asa P= PartnersrSpe corporatS on C= C corporat5one or S= S corp orats on t P artn ersr S p P artn ersr S p t Tru st/estate Tru st/estatet Line 3b Creck trSs tox Sf you are a partnersrSp �Snc:udSng an LLC c;assfffed as a partnersrSp forUtSt federap taxpurposes�e truste orestatetratrasany foreSgn partnerse ownerse or tenefSclariese and you are provSdSng trSs form to a partnersrSpe truste or estatee Sn wrScr you rave an ownersrSp Snterestt You must creck tre tox on pSne 3t Sfyou recefve a Form W-8 (or d ocu m en tary evS d en ce) from an y p artn ere own ere or ten ef5 cS ary estat:SsrSng foreSgn status or Sfyou recefvea Form W-9 from any p artn ere own ere or ten efS cS ary tr at r as cr ecked tr e tox on p S n e 3tt N ote: A p artn ersr S p tr at p rovS d es a F orm W- 9 an d cr ecks tox 3t m ay te req u S red to com p p ete Scr ed u p es K- 2 an d K- 3(F orm 1 065)t F or m ore S n form atS on e see tr e P artn ersr S p R n stru ctS on s for Scr ed u p es K- 2 an d K- 3 (F orm 1065)t Rfyou are requSred to comppete pSne 3t tutfaSp to do soe you may not receS ve tr e S n form atS on n ecessary to ff p e a correct S n form atS on retu rn w:tr tre R RS or fu rn S sr a correct payee statem en t to you r p artn ers or tenefScSarSest Seee for examppee sectSons 6698e 6722e and 6724 for penaptSes trat mayapppyt Line 4 Exemptions Rfyou are exempt from tackup wStrropdSng and/or FATCAreportSnge enter Sn tre approprSate space on pSne 4 any code(s) trat may apppy to yout Exempt payee code. � Generappye SndSvSduaps (SncpudSng sope propr5etors) are not exempt from tackup wftrropdsngt � Except as provSded tepowe corporatSons are exempt from tackup witrro,dSng for certaSn paymentse Snc:udSng Snterest and dsvidendst � Corporat5ons are not exempt from tackup wStrropdSng for payments made Sn settpement of payment card or trSrd-party network transactSonst � CorporatSons are notexemptfrom tackup wStrropdSng wStr respectto attorn eys... fees or gross p roceed s p aS d to attorn eyse an d corp oratS on s trat provsde medScap or reaptr care services are not exempt wjtr respect to p aym en ts rep ortat{ e on F orm 1099- M R SCt Tre foppowSng codes SdentSfy payees trat are exempt from tackup wStrropdSngt Enter tre approprSate code Sn tre space on pSne 4t 1- An organSzatSon exempt from tax under sect;on 501 (a�e any RRAe or a custodSap accountunder section 403(t)(7)Sftre accountsatSsfSes tre req u S rem en ts of sectf on 401 (f)(2)t Form W-9 (Rev. 3-2024) 2- Th e U n 1 ted States or an y of I ts agen c� es or 1 n stru m en tal l f es. 3- A state' the D 1 strl ct of Columb I a' a U. S. comm onwealth or terrl tory' or anyofthe�r polltical subdlv-s�ons or lnstrumentalltles. 4- Aforelgn governmentoranyofltspolltical subdlvls�ons' agenc�es' or I n sh-u m en tall tl es. 5- A corp orat on . 6- A d eal er l n secu rl tl es or comm od l tl es req u l red to regl ster 1 n th e U n l ted States' th e D 1 strl ct of Col u m b l a' or a U. S. comm on weal th or terrl tory. 7- A fu tu res comm 1 ssl on m erch an t regl stered wl th th e Comm od 1 ty Futures Trading Commisslon. 8- A real estate I n vestm en t tru s� 9- An en tl ty reg 1 stered at al I tl m es d u ri n g th e tax year u n d er th e 3 n vestm en t Com p an y Act of 1 940. 1 0- A comm on trust fund operated by a bank under sectlon 584(a). 11 - A flnanc�al lnstl tutlon as defl ned under sect_on 581 . 12- A ml ddleman known ln the Investment community as a nominee or cu stod I an . 13-Ahust exempt from taxunder sectlon 664 or descrlbed ln sectlon 4947. The following chart shows types of payments that may be exempt from backup wlthholding. The chartapplles to the exemptpayees Ilsted ab ove' 1 th rou gh 1 3. IF the paymentiis for ... THEN the paymentiis exempt for... • 3nterest and dlv:dend payments All exemptpayees except for 7. • Broker tran sacton s Exemptpayees 1 through 4 and 6 th rou gh I 1 an d al I C corp orat 1 on s. S corporatl ons must not enter an exem p t p ayee cod e b ecau se th ey are exem pt on 1 y for sal es of n on covered secu rl tl es acq u l red p r or to 201 ?. • Barter exchangetransactons Exemptpayees 1 through 4. an d p atron age d I v d en d s • P aym en ts over $600 req u I red to G en eral 1 y' exem p t p ayees b e rep orted an d d 1 rect sal es over 1 th rou gh 5.'- $5' 0001 • Paymentsmadeln settlementof Exemptpayees 1 through 4. p aym en t card or th I rd - p arty n etwork tran sactl on s � See Form 1 099-M3SC' Mlscellaneous 3nformatlon' and lts lnstructlons. � However' the followi ng payments made to a corporatl on and reportable on Form I 099-M3 SC are not exemptfrom backup w th h ol d I n gB m ed I cal an d h eal th care p aym en ts' attorn eysS fees' gross p rocecd s p a d to an attorn ey rep ortab l e u n d er sect on 6045(�' an d p aym en ts for servl ces p a d b y a fed eral execu tl ve agcn cy. Exempti on from FATCA reporti n g icode. Th e fol I owi n g cod es I den tl fy payees that are exempt from reporting under FATCA. These codes apply to persons subm I tti ng thl s form for accounts mal ntal ned outsl de of the United States by certal n fore-gn fl nancl al lnstltutl ons. Therefore' 1 f you areonlysubmltting thlsform foran accountyou hold In theUnited States' you m ay I eave th I s fl el d b I an k. Con su I t wl th th e p erson requesting thls form lfyou are uncertaln ]ftheflnanc�al lnstltutlon ls su bj ect to th ese req u 1 rem en ts. A req u ester m ay I n d I cate th at a cod e I s notrequlred byprovlding you wlth aForm W-9 wlth "NotAppllcable" (or an y sl m I I ar I n d I catl on ) en tered on th e 1 I n e for a F ATCA exem p tl on cod e. A-An organlzatlon exempt from tax under sectlon 501 (a) or any lndlvldual retlrementplan asdeflned ln secton 7701 (a)(37). B- Th e U n I ted States or an y of 1 ts agen d es or I n stru m en tal I t: es. C-Astate' theDlstrlctofColumbla' aU.S. commonwealth or terr l tory' or an y of th e r p ol l tl cal su b d l v: s� on s or I n stru m en tal l t: es. D- A corp orat 1 on th e stock of wh I ch I s regu I arl y trad ed on on e or moreestabllshed securltlesmarkets' asdescrlbed ln Regulatlons sectlon 1 .1472-1 (c)(1 )(1). E— A corp oratl on th at 1 s a m em b er of th e sam e exp an d ed affl I 1 ated group as a corporatlon descrlbed In Regulatlons secton I.I 472-I (c)(1 )(1). P age F-Adealer In securltles' commodltles' or derlvative flnanclal lnstruments (lncluding notlonal princlpal contracts' futures' forwards' an d op tl on s) th at 1 s regl stered as su ch u n d er th e I aws of th e U n 1 ted States or an y state. G- A real estate lnvestment trus� H-Aregulated Investment company as deflned ln sectlon 851 or an en tl ty regl stered at al I tl m es d u ri n g th e tax year u n d er th e 3 n vestm en t Com p an y Act of 1 940. 3-Acommon trustfund asdeflned ln sect:on 584(a). J-Abankasdeflned ]n sect;on 581 . K- A b roker. L-Atrustexemptfrom taxunder sectlon 664 or descrlbed ln sectlon 4947(a)(1). M- A tax-exempt trust under a section 403(b) plan or section 457(g) plan. N ote: You m ay w_ sh to con su I t wl th th e fl n an cl al 1 n stl tu t on req u esti n g th 1 s form to d eterm I n e wh eth er th e F ATCA cod e an d lor exem p t p ayee cod e sh ou I d b e com p l eted . Line 5 Enter your address (number' street' and apartment or sulte number). Th 1 s I s wh ere th e req u ester of th 1 s F orm W-9 w 1 I I m al I you r I n form atl on retu rn s. 3 f th 1 s ad dress d 1 ffers from th e on e th e requ ester al ready h as on fl I e' en ter "N E W" at th e top . 3 f a n ew address I s p rovl d ed' th ere I s stl I a chance the old address wlll be used untll the payor changes your address ln thelrrecords. Line 6 Enter your clty' state' and Z3P code. Part I. Taxpayer l den ti fi icati on N um ber (TI N) En ter your TI N i n th e appropri ate box. 3 f you are a res 1 d en t al I en an d you d o n ot h ave' an d are n ot el 1 glb l e to get' an SSN' your TI N 1 s your 3RS 3T3N. Enter lt ln the entry space for the Socl al securltynumber. 3fyou d o n ot h ave an 3 T3 N' see How to get a TIN b el ow. 3 f you are a sol e p rop rl etor an d you h ave an E 3 N' you m ay en ter e th er yourSSN orE3N. 3 f you are a si n gl e- m em b er LLC th at 1 s d I sregard ed as an en tl ty sep arate from I ts own er' en ter th e own erS s SSN (or E 3 N' I f th e own er h as on e). 3 f th e LLC I s cl as sl fl ed as a corp oratl on or p artn ersh I p' en ter th e ent_rySs E3N. N ote: See What Name and Number To Give the Requester' I ater' for fu rtb er el ac f catl on of n am e an d T'� N com b 1 n atl on s. H ow to get a TI N.� f you do n ot h ave a T3 N' app I y for on e 1 m m ed I atel y. To apply for an SSN' get Form SS-5' Appl I catl on for a Socl al Securl ty Card' from your I ocal SSA off ce or get th I s form onl 1 n e at www. SSA. gov. You m ay al so get th I s form by cal l I n g 800- 772-121 3. U se Form W-7' Appllcatlon for3RS 3ndlvldual Taxpayer3dentlilcatlon Number' to apply for an 3T�N' or Form SS-4' Appl I catlon far Employer 3dentlflcatlon Number' to apply for an E3N You can apply for an E3N on I 1 n e b y accessi n g th e 3 R S web s te at www. irs. gov/EIN. G o to www. irs. gov/Forms to vl ew' download' or prl nt Form W-7 andlor Form SS-4. Or' you can go to www. irs. gov/OrderForms to pl ace an order and have Form W-7 andlor Form SS-4 malled to you wlthln 1 5 buslness d ays. 3f you are asked to complete Form W-9 but do not have a TIN' apply for a T; N an d en ter " Ap p I 1 ed F or" 1 n th e sp ace far th e T!N' s gn an d d ate the form' and glve ltto the requester. For Interestand dlv_dend p aym en ts' an d certal n p aym en ts m ad e w_ th resp ect to read 1 I y trad ab l e 1 n stru m en ts' you w: I I gen eral I y h ave 60 d ays to get a T; N an d g� ve I t to therequesterbeforeyou aresubjecttobackup wlthholding on p aym en ts. Th e 60- d ay ru I e d oes n ot ap p I y to oth er typ es of p aym en ts. You wlll be subjectto backup wlthholding on all such payments untl you p rovl d e you r T; N to th e req u ester. Note: Entering "Applled For" means thatyou have already applled for a T3 N or th at you I n ten d to ap p I y for on e soon . See al so Establishing U. S. status for purposes of chapter 3 and chapter 4 withholding' earl I er' for when you may lnstead be subject to wl thholding under chapter 3 or 4 of the Code. Caution: A dlsregarded U. S. enfty that has a forelgn owner must use th e ap p rop r: ate F orm W- 8. Form W-9 4Rev. 3-2024) Part II. Certification To establ l sr to tre wt trrol d i ng agent trat you are a U. S. personr or rest dent al f en r st gn Form W- 9. You may be requested to st gn by tre wttrrol dfng agent even tf ttem 1 r 4r or 5 below tndtcates otrerwlse. For a jot n t accountr on I y tre person wrose TP, N t s srown f n Part R sroul tl slgn 4wren requlretl). Rn tre case of a tllsregarded entttyr tre person fdenttfted on Itne 1 must stgn. Exempt payeesr see Exempt payee coder earl l er. Signature requirements. Complete tre certtftcatton as lndtcatetl ln ltems 1 trrougr 5 below. 1. I nterest, di ivi tlentl, antl barter exchange accounts opened before 1 984 antl broker accounts considered actiive during 1 983. You must glve your correct TRNr but you tlo not rave to slgn tre certt ft catt on . 2. I nterest, di ivi dend, broker, and barter exchange accounts opened after 1 983 and broker accounts considered inactiive tluring 1983. You must slgn trecerttftcatton orbackup wltrroltltng wtll apply. Rf you are subject to backup wltrrol df ng and you are merel y provtdf ng your correct TRN to tre requesterr you must cross out ttem 2 ln tre certt ft catt on before st gn f ng tre form . 3. Real estate transactions. You must stgn tre certtftcatton. You may cross out t tem 2 of tre certt ft catt on . 4. Other payments. You must gfve your correct TRN r but you do not rave to sl gn tre certt fl catt on un I ess you rave been nott it ed trat you rave prevtously gtven an tncorrect TNN. 'Otrer payments" lnd utle payments made ln tre course oftre requesterrs trade or bustness for rentsr royalttesr goods 4otrer tran bflls for mercrandtse)r medtcal and real tr care servtces 4f ncl udt ng payments to corporattons)r payments to a nonempl oyee for servtcesr payments made ln settl ement of payment card and trfrd-party network transacttonsr payments to certatn ftsrtng boat crew members and ftsrermenr and gross proceeds patd to attorneys 4lncludtng payments to corporattons). 5. Mortgage i nterest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tu i ti on program payments (under section 529), ABLE accounts (under section 529A), I RA, Coiverdell ESA, Archer MSA or H SA contributions or tlistributions, antl pension distributions. You must gtve your correct T3 N r but you do not rave to st gn tre certt ft catt on . WhatName and Number To Giive the Requester For this type of account: Giive name and SSN of: 1. RndtNdual Tre indtvtdual 2, Two or more tndtvtdual s 4jofnt account) Tre actual owner of tre account orr otrer tran an account matntatned by tfcombtnetl funtlsr treftrsttntltvitlual an FFE on tre account� 3, Two or more U.S. persons Eacr rolderoftreaccount 4jotnt account matntatned by an FFR) 4, Custodtalaccountofamtnor Tre mtnorz 4U n t form Gt ft to M t nors Act) 5, a. Treusual revocablesavtngs trust Tre grantor-trustee' 4gran tor t s al so tru stee) , b. So-called trust account trat ts not Tre actual owner alegal orvaltd trustunderstatelaw 6, Sole proprtetorsrip or dtsregarded Tre owner3 entttyownetl byan tndtvtdual l Grantor tru st ft I t ng under Optt onal Tre grantor" F t I t ng M etrod 1 4see Regul att ons sectt on 1 . 671-44b)42)4t )4A))" Page 5 For this type of account: Giive name and EIN of: 8. .tsregarded enttty not owned by an Tre owner fntltvtdual 9. A val t d tru str estater or penst on tru st Legal entt ry^ 10. Corporatt on or LLC el ectt ng corporate Tre corporatt on status on Form 8832 or Form 2553 11. Assoctattonr clubr reltgtousr crarttabler Tre organtzatton educattonalr or otrer tax-exempt organt zatt on 1 2. Partnersrlp or multt-member LLC Tre partnersrtp 1 3. A broker or regtstered nomt nee Tre broker or nomt nee 1 4. Account wttr tre . epartment of Tre publ tc enttty Agrtculture�n tre name ofa publ�c entt ty 4sucr as a state or I ocal governmentr scraol dtstrtctr or prtsan) trat recet ves agrt cu I tu ral program payments 1 5. Grantor trust ftltng Form 1 041 or Tre trust under tre Opttonal Ftltng Metrod 2r requtrtng Form 10994seeRegulattons sectt on 1. 671 - 44b)42)4t )46 ))" � Lfst ftrst and circle tre name of tre person wrose number you furnfsr. Rfonlyone person on ajotntaccount ras an SSNr tratpersonrs number must be furnisred. zCtrcle tre minorrs name and furnlsr tre mtnorrs SSN. 3You must srow your lndtvtdual name on Itne 1 r and enter your bustness or _ BA namer tf anyr on Itne 2. You may use ettrer your SSN or ER N 4tf you rave one)r but tre R RS encourages you to use your SSN . 4 Lt st ft rst and ci rcl e tre name of tre tru str estater or penst on tru st. . o not fu rn f sr tre TR N of tre personal representatt ve or tru stee un I ess tre legal entttyftselfis not destgnated fn tre account tttle.) " N ote: Tre grantor must al so provt de a Form W- 9 to tre tru stee of tre tru st. '* For more t n formatt on on optt onal ft I f ng metrods for grantor tru stsr see tre R nstructt ons for Form 1 041 N ote: R f no name t s ct rcl ed wren more tran one name t s I t stedr tre number wtll be constdered to be trat of tre ftrst name Itsted. Secure Your Tax Records From IdentityTheft Rtlentttytreftoccurs wren someone uses yourpersonal tnformattonr sucr as your namer SSNr orotrertdenttfytng tnformatton� wttrout your permtsston to commttfraud orotrercrtmes. An tdentttytrtefmay use your SSN to get a job or may ftle a tax return ustng your SSN to recetve a refu n d . To reduce your rtsk, • Protect your SSN r • Ensure your employer ls protecttng your SSNr and • Be careful wren croostng a tax return preparer. Rf your tax records are affected by identtty treft and you recetve a nottce from tre RRSr respontl rlgrt away to tre name and prone number prt n ted on tre R RS nott ce or I etter. Rf your tax records are not currently affected by tdenttty treft but you trtnk you are at rtsk due to a lost or stolen purse or walletr questtonabl e cretltt cartl acttvttyr or a questtonabl e credtt reportr contact tre RRS Rdenttty Treft Hotltne at 800-908-4490 or submtt Form 1 4039. For more tnformattonr see Pub. 5027� RdentttyTreftRnformatton for Taxpayers. Form -9 Rev. 3-2[124) Va ct; ms of adent: ty treft wro are exper enc ng econom� c rarm or a system� c probl em� or are seek ng rel p a n resol va ng tax probl ems trat rave not been resol vetl tr rougr normal crannel sd may be el a g a b l e for Taxpayer Advocate Servi ce TAS) ass: stance. You can reacr TAS by cal I a ng tre TAS tol I- free case a n take I a n e at 877 - 777 - 4778 or TTYIT00 8[1[1-829-4[159. Protectyourseilflfrom suspcccous emacis or phcshcilg schemesC Pr�srang as tre creat:on and use of emaal and webs3tes desagned to mamac legatamate busa ness emaals antl webs�tes. Tre most common act as sendang an emaal to a user falselyclaamang to be an establasred leg�t�mate enterprase an an attempt to scam tre user anto surrenderang pravate anformat�on trat wall be usetl for adentatytreft. Tre T RS tloes not a n a t� ate contacts wa tr taxpayers va a emaa I s. AI sotl tre T RS does not request personal detaa I etl a n formata on tr rougr emaa I or ask taxpayers for tre PTN numbersd passwordstl or samalar secretaccess anformaton for trer cretlat cardtl banktl or otrer fanancaal accounts. Tfyou receave an unsol acatetl ema�l claamang to be from tre TRSd forward tras message to phishing@irs.gov. You may also report masuse oftre TRS nametl logod or otrer TRS property to tre TreasuryTnspector Ceneral for Tax Adm�nastrat3on TiCTA) at 8[1[1-366-4484. You can forwardsusp�caous emaGls to treFederal TradeCommassaon at spam@uce. gov or report trem at www. ftc. gov/complaint. You can contact tre FTC at www. ftc. gov/idtheft or 877-TOTH EFT 877-438-4338). T f you rave been tre va ct: m of a d en t; ty treftd see www. IdentityTheft. gov and Pub. 5[127. Co to www. irs. gov/IdentityTheft to I earn more about adenta ty treft and row to reduce your r: sk. Page Prc ivacy Act N otcce Sect3on 61 [19 of tre Tnternal Revenue Cotle requares you to provade your correct TiN to persons ancl ud�ng federal agencaes) wro are requared to fale anformat�on returns watr tre TRS to report anteresttl davadendstl or certaan otrerancome paad to youj mortgage anterestyou paadj tre acquasataon orabandonment ofsecured propertyj trecancellataon of tlebtj or contr� buta ons you matle to an T RAd Arcrer M SAtl or H SA. Tre person col I ecta ng tra s form uses tre a n format�on on tre form to f I e a n form a4 on retu rn s wa tr tre T RSd report� ng tre above a n form at on . Rout�ne uses oftras anformabon anclutle gavang atto tre Oepartment of Just:ce for caval and cramanal lataga4on antl to cataesd states: tre Oastnct of Col umba ad and U. S. commonweal trs and terratoraes for use an adm nasterang tre;r laws. Tre anformat�on may also be dasclosed to otrer co u n tr� es u n d e r a treaty� to federal a n d state a g e n ca es to enforce ca va I antl cramanal lawstl or to fetleral law enforcement and antellagence agencaes to combat terrorasm. You must provade your TiN wretrer or not you are requared to fale a taxreturn. Under sectaon 34[16� payors must generallywatrrold a percentage oftaxable anterestC davadendsd and certaan otrer payments to a payee wro does not gave a TiN to tre payor. Certaan penaltaes may also apply for provatlang false or fraudulent a n form at� on . F�RT��RTHo City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name Locality Media, Inc to Locality Media, LLC CSC 60968 Subject of the Agreement: Name change. Supplier kept same tax id numberjust updated name M&C Approved by the Council? * Yes ❑ No ❑✓ If �so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No ❑✓ If �so, provide the original contract number and the amendment number. Is the Contract "PermanenY'? *Yes ❑ No 0 If �unsure, see back page for permanent contract listing. Is this entire contract Confidential? *Yes ❑ No ❑✓ If only specific information is Confidential, please list what information is Confidential and the page it is located. Effective Date: NA Expiration Date: NA If different from the approval date. If applicable. Is a 1295 Form required? * Yes ❑ No ❑✓ *If �so, please ensure it is attached to the approving M&C or attached to the contract. Proj ect Number: If applicable. NA *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes ❑✓ No ❑ Contracts need to be routed for CSO processin� in the followin� order: 1. Katherine Cenicola (Approver) 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) *Indicates the information is required and if the information is not provided, the contract will be returned to the department. 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