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SOLID WASTE TRUCK WASH REPLACEMENT - 23-0021-SWSECTION V CONTRACT DOCUMENTS Table of Contents PUBLIC CONSTRUCTION BOND 1 CONTRACT 4 CONSENT OF SURETY TO FINAL PAYMENT 8 PROPOSALBID BOND 9 AFFIDAVIT 10 NON -COLLUSION AFFIDAVIT 11 PROPOSAL 12 CITY OF CLEARWATER ADDENDUM SHEET 14 BIDDER'S PROPOSAL 15 SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS WITH CUBA AND SYRIA CERTIFICATION FORM 17 SCRUTINIZED COMPANIES THAT BOYCOTT ISRAEL LIST CERTIFICATION FORM 18 SECTION V Page i Updated: 7/9/2025 SECTION V — Contract Documents Bond No.: 1003337 PUBLIC CONSTRUCTION BOND (1) This bond is given to comply with § 255.05, Florida Statutes, and any action instituted by a claimant under this bond for payment must be in accordance with the notice and time limitation provisions in subsections (2) and (10). Pursuant to § 255.05(1)(b), Florida Statutes, "Before commencing the work or before recommencing the work after a default or abandonment, the contractor shall provide to the public entity a certified copy of the recorded bond. Notwithstanding the terms of the contract or any other law governing prompt ' payment for construction services, the public entity may not make a payment to the contractor until the contractor has complied with this paragraph." CONTRACTOR Principal Name C&T Contracting Services, LLC Principal Business Address 11023 Countryway Blvd Tampa, FL 33626 Principal Phone Number (813) 616-3210 SURETY Principal Name FCCI Insurance Company Principal Business Address 6300 University Parkway Sarasota, FL 34240-8424 Principal Phone Number (800) 266-3224 OWNER City of Clearwater Public Works PO Box 4748 Clearwater FL 33758-4748 (727) 562-4750 PROJECT NAME: Solid Waste Truck Wash Replacement (Rebid) PROJECT NO.: 23 -0021 -SW PROJECT DESCRIPTION: The scope of work includes replacement of the existing manual truck wash pad and its associated equipment, including new utility services, site lighting and paving. An Additive alternate is also included to construct a new automatic truck wash and its associated electrical, water and sewer utilities. The contractor shall provide 2 fixed project signs as described in Section III Section 23 of the Contract Documents. The fmal number of project signs will be determined at the beginning of the project based on the contractor's schedule of work submitted for approval. Additional project signs may be required at no additional cost to the city due to the Contractor's schedule of work. BY THIS BOND, We, C&T Contracting Services, LLC , as Contractor, and FCCI Insurance Company a corporation, as Surety, are bound to the City of Clearwater, Florida, herein called Owner, in the Six Million Two Thousand Three Hundred Fifty -Six and 25/100 Dollars bind ourselves, our heirs, personal representatives, severally. THE CONDITION OF THIS BOND is that if Contractor: 1. Performs the contract dated , between Contractor and Owner for construction of Solid Waste Truck Wash Replacement (Rebid) , the contract documents being made a part of this bond by reference (which include the Advertisement for Bids, Proposal, Contract, Surety Bond, Instructions to Bidders, General Conditions, Plans; Technical Specifications and sum of $1.--- $6,002,356.25 1 for payment of which we successors, and assigns, jointly and SECTION V Page 1 of 18 Updated: 7/9/2025 SECTION V — Contract Documents Appendix, and such alterations as may be made in said Plans and Specifications as therein provided for), at the times and in the manner prescribed in the contract; and 2. Promptly makes payments to all claimants, as defined in Section 255.05(1), Florida Statutes, supplying Contractor with labor, materials, or supplies, used directly or indirectly by Contractor in the prosecution of the work provided for in the contract; and SECTION V Page 2 of 18 Updated: 7/9/2025 SECTION V—Contract Documents Bond No.: 1003337 PUBLIC CONSTRUCTION BOND (2) 3. Pays Owner all losses, damages, expenses, costs, and attorney's fees, including appellate proceedings, that Owner sustains because of a default by Contractor under the contract; and 4. To the limits of § 725.06(2), Florida Statutes, shall indemnify and hold harmless Owner, their officers and employees, from liabilities, damages, losses and costs, including, but not limited to, reasonable attorney's fees, to the extent caused by the negligence, recklessness, or intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the performance of the construction contract; and 5. Performs the guarantee of all work and materials furnished under the contract for the time specified in the contract, then this bond is void; otherwise, it remains in full force. 6. Any action instituted by a claimant under this bond for payment must be in accordance with the notice and time limitation provisions in Section 255.05(2), Florida Statutes. 7. Any changes in or under the contract documents and compliance or noncompliance with any formalities connected with the contract or the changes do not affect Surety's obligation under this bond, and Surety does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. IN TESTIMONY WHEREOF, witness the hands and seals of the parties hereto this , of Ai -,5-A day (If sole Ownership or Partnership, two (2) Witnesses are required). C&T Contracting Services, LLC (If Corporation, Secretary only will attest and affix seal). 11023 Countryway Blvd.• Tampa, FL,33626 [TYPE LEGAL NA OFC ✓ RACTOR] By: Title: President Print Name: Christ Telson WITNESS: _ WITNESS: Corporate Secretary or Witness Print Name: _Lot') (I .. (afx corporate seal) SECTION V PrinName: ,Gyl X14 Vl j GVYI� FCCI Insurance Company 6300 University Parkway Sarasota, FL 34240-8424 (Corporate Surety) By: -� AT EY -IN -FA Print N e: Jorge L. Bracamonte, Attorney -In -Fact FL Resident Agent (affix corporate seal) (Power of Attorney must be attached) Inquiries: 321-800-6594 Page 3 of 18 Updated: 7/9/2025 GENERAL POWER OF ATTORNEY Know all men by these presents: That the FCCI Insurance Company, a Corporation organized and existing under the laws of the State of Florida (the "Corporation") does make, constitute and appoint: Jorge Bracamonte; Jessie Sloan; Hallie Martin Each, its true and lawful Attorney -In -Fact, to make, execute, seal and' deliver, for and on its behalf as surety, and as its act and deed in all bonds and undertakings provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed the sum of (not to exceed $30,000,000.00): $30,000,000.00 This Power of Attorney is made and executed by authority of a Resolution adopted by the Board of Directors. That resolution also authorized any further action by the officers of the Company necessary to effect such transaction. The signatures below and the seal of the Corporation may be affixed by facsimile, and any such facsimile signatures or facsimile seal shall be binding upon the Corporation when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached. In witness whereof, the FCCI Insurance Company has caused these presents to be signed by its duly authorized officers and its corporate Seal to be hereunto affixed, this 20th day of December, 2024. Attest: Christina D. Welch, President FCCI Insurance Company State of Florida County of Sarasota Before me this day personally appeared Christina D. Welch, who is personally known to me and who executed the foregoing document for the purposes expressed therein. SEAL 1994 01410)/ Christopher Shoucair, EVP, CFO, Treasurer, Secretary FCCI Insurance Company My commission expires: 2/27/2027 PEGGY NOW Conwrilieloa#HH326535 Wee_ 0027.2627 Notary Public State of Florida County of Sarasota Before me this day personally appeared Christopher Shoucair, who is personally known to me and who executed the foregoing document for the purposes expressed therein. My commission expires:' 2/27/2027 eYID�'..� '�y�t+ 'PEGGYSNO V Comniselon0tiff 326535 'OP Egs4eaiFebiitary2lVC CERTIFICATE Notary Public I, the undersigned Secretary of FCCI Insurance Company, a Florida Corporation, DO HEREBY CERTIFY that the foregoing Power of Attorney remains in full force and has not been revoked; and furthermore that the February 27, 2020 Resolution of the Board of Directors, referenced in said Power of Attorney, is now in force. 140NA-3592-NA-04, 1/2025 Christopher Shoucair, EVP, CFO, Treasurer, Secretary FCCI Insurance Company SECTION V — Contract Documents CONTRACT (1) This CONTRACT made and entered into this — day of , 20_ by and between the City of Clearwater, Florida, a municipal corporation, hereinafter designated as the "City", and C&T Contracting Services, LLC, of the City of Tampa County of Hillsborough and State of Florida, hereinafter designated as the "Contractor". [Or,. if outof state:] This CONTRACT made and entered mto.t =Clearwater, Florida„ .2a municipal etween the ty orized to ,do 0 hereinafter` designated as the ; Contractor"? business State J3' WITNESSETH: That the parties to this contract each in consideration of the undertakings, promises and agreements on the part of the other herein contained, do hereby undertake, promise, and agree as follows: The Contractor, and his or its successors, assigns, executors or administrators, in consideration of the sums of money as herein after set forth to be paid by the City and to the Contractor, shall and will at their own cost and expense perform all labor, furnish all materials, tools and equipment for the following: PROJECT NAME:Solid Waste Truck Wash Replacement (Rebid) PROJECT NO.: 23 -0021 -SW in the amount of $6.002356.25 In accordance with such proposal and technical supplemental specifications and such other special provisions and drawings, if any, which will be submitted by the City, together with any advertisement, instructions to bidders, general conditions, technical specifications, proposal and bond, which may be hereto attached, and any drawings if any, which may be herein referred to, are hereby made a part of this contract, and all of said work to be performed and completed by the contractor and its successors and assigns shall be fully completed in a good and workmanlike manner to the satisfaction of the City. If the Contractor should fail to comply with any of the terms, conditions, provisions or stipulations as contained herein within the time specified for completion of the work to be performed by the Contractor, then the City, may at its option, avail itself of any or all remedies provided on its behalf and shall have the right to proceed to complete such work as Contractor is obligated to perform in accordance with the provisions as contained herein. SECTION V Page 4 of 18 Updated: 7/9/2025 SECTION V — Contract Documents CONTRACT (2) THE CONTRACTOR AND HIS OR ITS SUCCESSORS AND ASSIGNS DOES HEREBY AGREE TO ASSUME THE DEFENSE OF ANY LEGAL ACTION WHICH MAY BE BROUGHT AGAINST THE CITY AS A RESULT OF THE CONTRACTOR'S ACTIVITIES ARISING OUT OF THIS CONTRACT AND FURTHERMORE, IN CONSIDERATION OF THE TERMS, STIPULATIONS AND CONDITIONS AS CONTAINED HEREIN, AGREES TO HOLD THE CITY FREE AND HARMLESS FROM ANY AND ALL CLAIMS FOR DAMAGES, COSTS OF SUITS, JUDGMENTS OR DECREES RESULTING FROM ANY CLAIMS MADE UNDER THIS CONTRACT AGAINST THE CITY OR THE CONTRACTOR OR THE CONTRACTOR'S SUB CONTRACTORS, AGENTS, SERVANTS OR EMPLOYEES RESULTING FROM ACTIVITIES BY THE AFOREMENTIONED CONTRACTOR, SUB CONTRACTOR, AGENT SERVANTS OR EMPLOYEES, TO THE LIMITS OF § 725.06(2). In addition to the foregoing provisions, the Contractor agrees to conform to the following requirements: In connection with the performance of work under this contract, the Contractor agrees not to discriminate against any employee or applicant for employment because of race, sex, religion, color, or national origin. The aforesaid provision shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; lay off or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post hereafter in conspicuous places, available for employees or applicants for employment, notices to be provided by the contracting officer setting forth the provisions of the non-discrimination clause. The Contractor further agrees to insert the foregoing provisions in all contracts hereunder, including contracts or agreements with labor unions and/or worker's representatives, except sub -contractors for standard commercial supplies or raw materials. It is mutually agreed between the parties hereto that time is of the essence of this contract, and in the event that the work to be performed by the Contractor is not completed within the time stipulated herein, it is then further agreed that the City may deduct from such sums or compensation as may be due to the Contractor the sum of $1,000.00 per day for each day that the work to be performed by the Contractor remains incomplete beyond the time limit specified herein, which sum of $1,000.00 per day shall only and solely represent damages which the City has sustained by reason of the failure of the Contractor to complete the work within the time stipulated, it being further agreed that this sum is not to be construed as a penalty but is only to be construed as liquidated damages for failure of the Contractor to complete and perform all work within the time period as specified in this contract. It is further mutually agreed between the City and the Contractor that if, any time after the execution of this contract and the public construction bond which is attached hereto for the faithful performance of the terms and conditions as contained herein by the Contractor, that the City shall at any time deem the surety or sureties upon such public construction bond to be unsatisfactory or if, for any reason, the said bond ceases to be adequate in amount to cover the performance of the work the Contractor shall, at his or its own expense, within ten (10) days after receipt of written notice from the City to do so, furnish an additional bond or bonds in such term and amounts and with such surety or sureties as shall be satisfactory to the City. If such an event occurs, no further payment shall be made to the Contractor under the terms and provisions of this contract until such new or additional security bond guaranteeing the faithful performance of the work under the terms hereof shall be completed and furnished to the City in a form satisfactory to it. SECTION V Page 5 of 18 Updated: 7/9/2025 SECTION V — Contract Documents CONTRACT (3) In addition to all other contract requirements as provided by law, the contractor executing this agreement agrees to comply with public records law. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, THE CONTRACTORS DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT. CONTACT THE CUSTODIAN OF PUBLIC RECORDS, Rosemarie Call, City Clerk, at Rosemarie.Call@myclearwater.com, 727-562-4092, 600 Cleveland St., 6th Floor, Clearwater, FL 33756. The contractor's agreement to comply with public records law applies specifically to: a) Keep and maintain public records required by the City of Clearwater (hereinafter "public agency") to perform the service being provided by the contractor hereunder. b) Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided for in Chapter 119, Florida Statutes, as may be amended from time to time, or as otherwise provided by law. c) Ensure that the public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the public agency. d) Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the contractor or keep and maintain public records required by the public agency to perform the service. If the contractor transfers all public records to the public agency upon completion of the contract, the contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. e) A request to inspect or copy public records relating to a public agency's contract for services must be made directly to the public agency. If the public agency does not possess the requested records, the public agency shall immediately notify the contractor of the request and the contractor must provide the records to the public agency or allow the records to be inspected or copied within a reasonable time. 1) The contractor hereby acknowledges and agrees that if the contractor does not comply with the public agency's request for records, the public agency shall enforce the contract provisions in accordance with the contract. g) A contractor who fails to provide the public records to the public agency within a reasonable time may be subject to -penalties under Section 119.10, Florida Statutes. h) If a civil action is filed against a contractor to compel production of public records relating to a public agency's contract for services, the court shall assess and award against the contractor the reasonable costs of enforcement, including reasonable attorney fees, if: 1. The court determines that the contractor unlawfully refused to comply with the public records request within a reasonable time; and SECTION V Page 6 of 18 Updated: 7/9/2025 SECTION V — Contract Documents CONTRACT (4) 2. At least 8 business days before filing the action, the plaintiff provided written notice of the public records request, including a statement that the contractor has not complied with the request, to the public agency and to the contractor. i) A notice complies with subparagraph (h)2. if it is sent to the public agency's custodian of public records and to the contractor at the contractor's address listed on its contract with the public agency or to the contractor's registered agent. Such notices must be sent by common carrier delivery service or by registered, Global Express Guaranteed, or certified mail, with postage or shipping paid by the sender and with evidence of delivery, which may be in an electronic format. j) A contractor who complies with a public records request within 8 business days after the notice is sent is not liable for the reasonable costs of enforcement. IN WITNESS WHEREOF, the parties to the agreement have hereunto set their hands and seals and have executed this Agreement, the day and year first above written. CITY OF CLEARWATER IN PINELLAS COUNTY, FLORIDA By: Jennifir Fb4rrier City Manager Countersigned: By: Attest: -Eo : Rosemarie Call City Clerk Approved as to form: Bruce Rector Mayor Contractor must indicate whether: XCorporation, Partnership, issa Isabel Senior Assistant City Attorney (Contractor) By: Li -1 LL (SEAL) Print Name: C6(,-1 iT cw Title: c -,e i4‘..,- The `i,.._The person signing shall, in his own handwriting, sign the Principal's name, his own name, and his title; where the person is signing for a Corporation, he must, by Affidavit, show his authority to bind the Corporation — provide Affidavit. Ii div d'ual SECTION V Page 7 of 18 Updated: 7/9/2025 SECTION V — Contract Documents CONSENT OF SURETY TO FINAL PAYMENT TO OWNER: City of Clearwater PROJECT NAME: Solid Waste Truck Wash Replacement (Rebid) Public Works 100 S Myrtle Ave CONTRACT DATE: PROJECT NO.: 23 -0021 -SW Clearwater, FL 33756 BOND_ NO.: ',(: 1, recorded in O.R. Book r Page [ ] of the Public Records of Pinellas County, Florida. CONTRACTOR: C&T Contracting Services, LLC Pursuant to § 255.05(11), Florida Statutes, and in accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the: [insert name &Surety] [address] [addressJ, SURETY, on bond of C&T Contracting Services, LLC 11023 Countryway Blvd Tampa, FL 33626 CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve Surety of any of its obligations to City of Clearwater Public Works PO Box 4748 Clearwater, FL 33758-4748, OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this _ day of Attest: (Seal): (Surety) (Signature of authorized representative) (Printed name and title) SECTION V Page 8 of 18 Updated: 7/9/2025 SECTION il-:Cont'ract Documents PROPOSAL/BID BOND (Not to be filled out if a certified check is submitted) KNOWN ALL MEN BY THESE PRESENTS: That we, the undersigned, C&T Contracting Services, LLC. as Contractor, and FCCI Insurance Company as Surety, whose address is 6300 University Parkway, Sarasota, FL 34240, , are held and firmly bound unto the City of Clearwater, Florida, in the sum of Dollars ($ ) (being a minimum of 10% of Contractor's total bid amount) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns. The condition of the above obligation is such that if the attached Proposal of C&T Contracting Services, LLC. as Contractor, and FCCI Insurance Company as Surety, for work specified as: Solid Waste Truck Wash Replacement (Rebid) - 23 -0021 -SW rebid all as stipulated in said Proposal, by doing all work incidental thereto, in accordance with the plans and specifications provided herefor, all within Pinellas County, is accepted and the contract awarded to the above named bidder, and the said bidder shall within ten days after notice of said award enter into a contract, in writing, and furnish the required Public Construction Bond with surety or sureties to be approved by the City Manager, this obligation shall be void, otherwise the same shall be in full force and virtue by law and the full amount of this Proposal/Bid Bond will be paid to the City as stipulated or liquidated damages. Limited Principal must indicate whether: Liability Corporation, Partnership, X Company, or Individual Signed this 12th day of August , ,2026 C&T Contracting Services. LLC. 11023 Countryway Boulevard Tampa, FL 33626 Contractor C&T Contracting Se Principal By: Title- Christopher 'FCCI Insurance Company e L. Bracamonte,Comey-In-Fact & lorida Licensed Resident Agent Inquiries: (321) 800-6594 The person signing shall, in his own handwriting, sign the Principal's name, his own name, and his title; where the person is signing for a Corporation, he must, by Affidavit, show his authority to bind the Corporation — provide Affidavit. SECTION V Page 8 of 16 Updated: 7/9/2025 SECTION V - Contract Documents AFFIDAVIT . r (To be filled in and executed if the bidder is a corporation) STATE OF FLORIDA ) COUNTY OF�[ � ?.-k i il6 ► r , �, ,,qu , beingduty worn, deposes and says that he/she is Secretary of I a corporation organized and existing under and by virt of the laws of the State of Florida, and having its principal ofa, f eat: in o -:,r p,,,„ I (Street & Number) (City) (� is Affiant fuitherr says that (Name of Corporation) he ( ounty) familiar with the records, minute books tki6 oSr-edruf-, OA— Affiant further, says tha (Officer's of the corporation, is duly 6L- is De(Ti U0sL authorized to sign the Proposal for or said corporation by virtue of (state whether a provision Board of Directors. If by Reso Swom to before me this l V day of %i . t, . 4 • Public fRYpep. Type/print/stamp na 1R�4 Nota 028 Ni a Louise B Eckhouse Title or rank, and Se 0l 14P 062 n (State) and by-laws of s or a Resolution ..."of a date of adoption). Affiant SECTION V Page 9 of 16 v Updated: 7/9/20251tk ' ` FCCIINsuuNcEp, • GENERAL POWER OF ATTORNEY Know all men by these presents: That the FCCI Insurance Company, a Corporation organized and existing under the laws of the State of Florida (the "Corporation") does make, constitute and appoint: Jorge Bracamonte; Jessie Sloan; Hallie Martin Each, its true and lawful Attorney -In -Fact, to make, execute, seal and deliver, for and on its behalf as surety, and as its act and deed in all bonds and undertakings provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed the sum of (not to exceed $30,000,000.00): $30,000,000.00 This Power of Attorney is made and executed by authority of a Resolution adopted by the Board of Directors. That resolution also authorized any further action by the officers of the Company necessary to effect such transaction. The signatures below and the seal of the Corporation may be affixed by facsimile, and _any such facsimile signatures or facsimile seal shall be binding upon the Corporation when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached. In witness whereof, the FCCI Insurance Company has caused these presents to be signed byits duly authorized. officers and its corporate Seal to be hereunto affixed, this 201h day of December, 2024. . • Attest: Christina D. Welch, President FCCI Insurance Company State of Florida County of Sarasota Before me this day personally appeared Christina D. Welch, who is personally known tome and who executed the foregoing document for the purposes expressed therein. do 4'.4I..ct, PEGGYSNOW * * Commlttlonv14H3aSS %ort ` 691ro February 21 WN L SEAL ' t a 1994 Christopher Shoucair, EVP, CFO, Treasurer, Secretary FCCI Insurance Company My commission expires: 2/27/2027 Notary Public State of Florida County of Sarasota Before me this day personally appeared Christopher Shoucair, who is personally known to me and who executed the foregoing document for the purposes expressed therein. tP•+"� FEGGYSNOW + * CommhslonVIM &W S %owl l`explwFittwry27,2027 My commission expires: 2/27/2027 Notary Public CERTIFICATE I, the undersigned Secretary of FCCI Insurance Company, a Florida Corporation, DO HEREBY CERTIFY that the foregoing Power of Attorney remains in full force and has not been revoked; and furthermore that the February 27, 2020. Resolution of the Board of Directors referenced in said Power of Attorney, is now in force. 1a0NA4592-NA./,, 1t2025 Dated this 12 day of August , 2026 Christopher Shoucair, EVP, CFO, Treasurer, Secretary FCCI Insurance Company SECTION V —Contract Documents NON -COLLUSION AFFIDAVIT STATE OF FLORIDA COUNTY OF HILLSBOROUG1 CHRIS TELSON being, first duly sworn, deposes and says that he is OPERATIONS MANAGER of C&T CONTRACTING SERVICES the party making the foregoing Proposal or Bid; that such Bid is genuine and not collusive or sham: that said bidder is not financially interested in or otherwise affiliated in a business way with any other bidder on the same contract; that said bidder has not colluded, conspired, connived, or agreed, directly or indirectly, with any bidders or person, to put in a sham bid or that such other person shall refrain from bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference, with any person, to fix the bid price or affiant or any other bidder, or to fix any overhead, profit or cost element of said bid price, or that of any other bidder, or to secure any advantage against the City of Clearwater, Florida, or any person or persons interested in the proposed contract; and that all statements contained in said proposal or bid are true; and further, that such der ha not directly or indirectly submitted this bid, or the contents thereof, or divulged information o • ata re ve thereto to any association. or to any member or agent thereof. �tt?� Sworn to and subscribed before me this day of SECTION V Affiant 0 otary Public oi ��� t,„ ExPkos ��� Z/e. :moi T12212023 Louise B Eckhouse Q c: Niy.Commission 4=a %"9d),. 14H 569Q82 A `Ct." Page 10 of 16 Updated: 6/3/2024 SECTION V — Contract Documents PROPOSAL (1) TO THE CITY OF CLEARWATER, FLORIDA, for SOLID WASTE TRUCK WASH REPLACEMENT (REBID) and doing such other work incidental thereto, all in accordance with the contract documents, marked SOLID WASTE TRUCK WASH REPLACEMENT (REBID) Every bidder must take notice of the fact that even though his proposal be accepted and the documents signed by the bidder to whom an award is made and by those officials authorized to do so on behalf of the City of Clearwater, Florida, that no such award or signing shall be considered a binding contract without a certificate from the Finance Director that funds are available to cover the cost of the work to be done, or without the approval of the City Attorney as to the form and legality of the contract and all the pertinent documents relating thereto having been approved by said City Attorney; and such bidder is hereby charged with this notice. The signer of the Proposal, as bidder, also declares that the only person, persons, company or parties interested in this Proposal, are named in this Proposal, that he has carefully examined the Advertisement, Instructions to Bidders, Contract Specifications, Plans, Supplemental Specifications, General Conditions, Special Provisions, and Public Construction Bond, that he or his representative has made such investigation as is necessary to determine the character and extent of the work and he proposes and agrees that if the Proposal be accepted, he will contract with the City of Clearwater, Florida, in the form of contract; hereto annexed, to provide the necessary labor, materials, machinery, equipment, tools or apparatus, do all the work required to complete the contract within the time mentioned in the General Conditions and according to the requirements of the City of Clearwater, Florida, as herein and hereinafter set forth, and furnish the required surety bonds for the following prices to wit: If the foregoing Proposal shall be accepted by the City of Clearwater, Florida, and the undersigned shall fail to execute a satisfactory contract as stated in the Advertisement herein attached, then the City may, at its option determine that the undersigned has abandoned the contract, and thereupon this Proposal shall be null and void, and the certified check or bond accompanying this Proposal, shall be forfeited to become the property of the City of Clearwater, Florida, and the full amount of said check shall be retained by the City, or if the Proposal Bond be given, the full amount of such bond shall be paid to the City as stipulated or liquidated damages; otherwise, the bond or certified check accompanying this Proposal, or the amount of said check, shall be returned to the undersigned as specified herein. SECTION V Page 12 of 18 Updated: 7/9/2025 SECTION V. -Con tfact:Documents' PROPOSAL' (2) Attached hereto is bond r certified check on Bank, for the sum of Five hundred forty five thousand, six'hundred sixtyi eight dollars ($545,668 00 (being a minimum of 10% of Contractor's total bid amount). The full names and residences of all persons and parties interested in the foregoing bid are as follows: (If corporation, give the names and addresses of the President and Secretary. If a firm or partnership, the names and addresses of the members or partners. The Bidder shall list not only his name but also the name of any person with whom bidder has any type of agreement whereby such person's improvements, enrichment, employment or possible benefit, whether sub -contractor, materialman, agent, supplier, or employer is contingent upon the award of the contract to the bidder). NAMES: ADDRESSES: CHRIS TELSON 11023 COUNTRYWAY BLVD. TAMPA FL 33626 JOSE CISNEROS 11023 COUNTRYWAY BLVD.. TAMPA, FL 33626 Signature of Bidder: _! The person signing shall, in his own handwriting, sign the Principal's name, his own name and his title. Where the person signing for a corporation is other than the President or Vice President, he must, by affidavit, show his authority, to bind the corporation. Principal: CHR TELS N OPERATIONS MANAGER By: Title: Company Legal Name: C&T CONTRACTING SERVICES LLC. Doing Business As (if different than above): Business Address of Bidder: 11023 COUNTRYWAY BLVD . City and State: TAMPA FL Phone: 813-616-3210 Dated at OFFICE Zip Code 33626 Email Address: CHRIS@CTCONTRACTINGSERVICES . COM this 11TH day of AUGUST , A.D., 20 2P SECTION V Page 12 of 16 Updated: 6/3/2024. SECTION V— Contract Documents CITY OF CLEARWATER ADDENDUM SHEET PROJECT: OLI°D WASTE; `TRUCK.,WASHING REPLACEMENT (REBID) Acknowledgment is hereby made of the following addenda received since issuance of Plans and Specifications. Addendum No. 1 Date: 1/9/26 Addendum No, 2 Date: 7/30/26 Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: C&T CONTRA ING SERVICES LLC (Name Bi (Signature of 0 icer) OPERATIONS MANAGER (Title of Officer) 8/11/26 (Date) SECTION V Page 13 of 16 Updated: 6/3/2024. SECTION V — Contract Documents BIDDER'S PROPOSAL PROJECT: Solid Waste Truck Wash Replacement (Rebid) CONTRACTOR: C&T Contracting Services, LLC BIDDER'S GRAND TOTAL: $6,002,356.25 (Numbers) BIDDER'S GRAND TOTAL: Six million, two thousand, three hundred fifty six and twenty-five cents (Words) Base Bid Items Line Item Description Quantity Unit of Measure 1 General Conditions and Mobilization/Demobilization 1 LS 2 Maintenance of Traffic 1 LS 3 Manual Wash Improvements 1. LS 4 Site Electrical and Lighting 1 LS 5 New Asphalt Pavement 6850 SY 6 Pavement Striping 1 LS 7 Permit Allowance (enter $50,000) 1 LS Total Contingency Line Item Description Quantity Unit of Measure 8 Owner's Contingency Allowance (10% of the above Base Bid Subtotal) 1 LS Total Grand Total Base Bid Items SECTION V Page 15 of 18 Updated: 7/9/2025 SECTION V — Contract Documents Additive Alternate Bid Items Line Item Description Quantity Unit of Measure 1A Automatic Wash System Improvements 1 LS 2A Remove and Replace Contaminated Soil 100 CY Total Additive Alternate Bid Items Contingency Line Item Description Quantity Unit of Measure 3A' Owner's Contingency Allowance (10% of the above Additive Alternate Subtotal) 1 LS Total Grand Total Additive Alternate Bid Items Overall Grand Total Base Bid & Additive Alternates THE BIDDER'S GRAND TOTAL ABOVE IS HIS TOTAL BID BASED ON HIS UNIT PRICES AND LUMP SUM PRICES AND THE ESTIMATED QUANTITIES REQUIRED FOR EACH SECTION. THIS FIGURE IS FOR INFORMATION ONLY AT THE TIME OF OPENING BIDS. THE CITY WILL MAKE THE TABULATION FROM THE UNIT PRICES AND LUMP SUM PRICE BID. IF THERE IS AN ERROR IN THE TOTAL BY THE BIDDER, IT SHALL BE CHANGED AS ONLY THE UNIT PRICES AND LUMP SUM PRICE SHALL GOVERN. THE CONTRACTOR SHALL PROVIDE COPIES OF A CURRENT CONTRACTOR LICENSE/REGISTRATION WITH THE STATE OF FLORIDA AND PINELLAS COUNTY IN THE BID RESPONSE. SECTION V Page 16 of 18 Updated: 7/9/2025 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT ITB No. 23 -0021 -SW rebid Solid Waste Truck Wash Replacement (Rebid) Section V Contract Documents.pdf 7. W-9* Upload your current W-9 form. (available at https://www.irs.Rov/pub/irs-pdf/fw9.pdf) W-9_C&T_Contracti ng_2025. pdf BASE BID ITEMS The City anticipates making a single award for this solicitation. Alternative pricing is provided for informational and evaluative purposes only and shall not be considered part of the base bid. Line Item Description Quantity Unit of Measure Unit Cost Total [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT Invitation To Bid - Solid Waste Truck Wash Replacement (Rebid) Page 5 General Conditions and Mobilization/Demobilization Maintenance of Traffic 1 1 LS LS $115,000.00 $28,000.00 $115,000.00 $28,000.00 1 2 3 Manual Wash Improvements 1 LS $1,680,000.00 $1,680,000.00 4 Site Electrical and Lighting 1 LS $540,000.00 $540,000.00 5 New Asphalt Pavement 6,850 SY $81.75 $559,987.50 6 Pavement Striping 1 LS $15,000.00 $15,000.00 7 Permit Allowance (enter $50,000) 1 LS $50,000.00 $50,000.00 TOTAL $2,987,987.50 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT Invitation To Bid - Solid Waste Truck Wash Replacement (Rebid) Page 5 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT ITB No. 23 -0021 -SW rebid Solid Waste Truck Wash Replacement (Rebid) CONTINGENCY Line Item 8 Description Owner's Contingency Allowance (10% of the above Base Bid Subtotal) Quantity Unit of Unit Cost Total Measure 1 LS $298,798.75 TOTAL $298,798.75 $298,798.75 ADDITIVE ALTERNATE BID ITEMS Line Item 1A 2A Description Automatic Wash System Improvements Remove and Replace Contaminated Soil Quantity Unit of Unit Cost Total Measure 1 100 LS CY $2,430,000.00 $387.00 TOTAL $2,430,000.00 $38,700.00 $2,468,700.00 ADDITIVE ALTERNATE BID ITEMS CONTINGENCY Line Item 3A' Description Owner's Contingency Allowance (10% of the above Additive Alternate Subtotal) Quantity 1 Unit of Measure LS Unit Cost Total $246,870.00 TOTAL $246,870.00 $246,870.00 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT Invitation To Bid - Solid Waste Truck Wash Replacement (Rebid) Page 6 SCRUTINIZED COMPANIES FORMS SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS WITH CUBA AND SYRIA CERTIFICATION FORM IF YOUR B!D/PROPOSAL !S $1,000,000 OR MORE, THIS FORM MUST BE COMPLETED AND SUBMITTED WITH THE BID/PROPOSAL. FAILURE TO SUBMIT THIS FORM AS REQUIRED MAY DEEM YOUR SUBMITTAL NONRESPONSIVE. The affiant, by virtue of the signature below, certifies that: 1. The vendor, company, individual, principal, subsidiary, affiliate, or owner is aware of the requirements of section 287.135, Florida Statutes, regarding companies on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaging in business operations in Cuba and Syria; and 2. The vendor, company, individual, principal, subsidiary, affiliate, or owner is eligible to participate in this solicitation and Is not listed on either the Scrutinized Companies with Activities In Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Sector List, or engaged in business operations in Cuba and Syria; and 3. Business Operations means, for purposes specifically related to Cuba or Syria, engaging in commerce In any form in Cuba or Syria, including, but not limited to, acquiring, developing, maintaining, owning, selling, possessing, leasing or operating equipment, facilities, personnel, products, services, personal property, real property, military equipment, or any other apparatus of business or commerce; and 4. If awarded the Contract (or Agreement), the vendor, com any, individual, principal, subsidiary, affiliate, or owner will immediately notify the City of Clearwater in writing, o later n five (5) calendar days after any of its principals are placed on the Scrutinized Companies with A ities r udan List, the Scrutinized Companies with Activities in the Iran Petroleum Sector List, or engaged i usir operations in Cuba and Syria. STATE OF cA,.(/R?t Dm) COUNTY OF /I ho ou- Authorized Signature Printed Name Titl 5e/v11-0-1 '?LC Name of Entity/Corporation-' The foregoing Instrumgnty� as acknowle ged before me by my ans of physical pr nce or 0 online notarization on, this /o ti' iay of err . r, . 4 . , 20 , b 5 (name of person whose signature is bein'notarized) as the P-3 (titl of (name of corporatio entity), personally known , or produced (type of Identification) as Identific- ion, and who did/did not take an oath. My Commission Expires: NOTARY SEAL ABOVE' Printed Name Expires Cf/ $* 7/22/428 l�y Loui$e B Eckhouse ..1 My Commission Q .rx HH 569082 •\ SCRUTINIZED COMPANIES FORMS SCRUTINIZED COMPANIES THAT BOYCOTT ISRAEL LIST CERTIFICATION QPOSAL THIS FORM MUST BE COMPLETED AS RREQUIRED AND ,TTED MAY DEEM YOUR SUBMITTAL TH THE FAILURE TO SUBMIT THIS FORM The affiant, by virtue of the signature below, certifies that: 1. The vendor, company, individual,i ,negaarding companies sliate, or owner is aware of on the Scrutinized Compathe nies thatBements oycott of section 287.135, Florida Statutes, regarding 2. The vendor, company, individual, principal, subsidiary, affiliate, or owner eligibles to oa�tin this engaged In a Israel List, or engaged in a boycott of Israel; and solicitation and is not listed on the Scrutinized Companies that BoyCott Israeboycott of Israel; and business 3. ther"Boycottc Ions orit "boycottof ael" means relat ons with Israel, fo deal, or persons or entittiii s doing business in Israel or other actions to limit commercialthat it is in Israeli -controlled territories, in a discriminatory manner. A statement by a company ott f Isrelparticipating in a boycottc of Israel, or in furtherance initiated boycott boycott of Israel, may be considered as of Israel or in compliance with, evidence that a company is participating in a boycott of Israel; and individual, principal. subsidiary, affiliate, 4. If awarded the Contract (or Agreement), the vendor, company, or owner will Immediately notify City of Clearwater in ng, no la calendar days after any of its principal aep aed onteScrutinizedCompanes th Boycott Israel List, or engaged � in a boycott of Israel. STATE OF AP COUNTY C t /L4c Authorized Signature lnf•` Printed Name Title Name of Entity/CorpCri- or to ow dged before me by 2 The foregoing instru nkwas ackrt 1e notarization on, this ,Q day of (1� (name of person whose signature Is produced an oath. My Commission Expires: NOTARY SEAL'ABOVI± : -; be notarized) as the (name of corporatio Iden ication) as -Scry►�.u.S . sicalence, r 0 online entity), personally known rd , or tion, .pd who did/did not take W24272401 4ki Ez co Louise a Eckhouse y My Commission .) r% H Ss9082 tea,: /0 F . oi+1 i 11111 N\ Compliance with Anti -Human Trafficking Laws Pursuant to Section 787.06 (13), Florida Statute, a contract Is executed, is form must be completed ore end d representative of a non-governmental entity when between the non-governmental entity and the City of Clearwater. The undersigned, on behalf of the entity listed below ("Entity"), hereby attests under penalty of. perjury that: Entity does not use coercion for labor or services as defined in Section787.06, Florida Statutes: The undersigned is authorized to execute this form on behal Date: A‘,.. 5,44 , 20 Signed: Entity: OIT l's►. c s. tip `<�erv,e4Name: Title: City of Clearwater Public Works Marcus Williamson, Department Director 100 South Myrtle Avenue, Clearwater, FL 33756 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT ITB No. 23 -0021 -SW rebid Solid Waste Truck Wash Replacement (Rebid) RESPONSE DEADLINE: August 12, 2026 at 2:00 pm Report Generated: Wednesday, August 12, 2026 C&T Contracting Services, LLC Response Company: C&T Contracting Services, LLC Email: ctcontractingservicesllc@gmail.com Contact: Christopher Telson Address: 11023 Countryway Blvd. Tampa, FL 33626 Phone: N/A Website: www.ctcontractinggroup.com Submission Date: Aug 12, 2026 1:47 PM (Eastern Time) [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT ITB No. 23 -0021 -SW rebid Solid Waste Truck Wash Replacement (Rebid) DDENDA CONFIRMATIO, Addendum #1 Confirmed Aug 11, 2026 5:52 AM by Christopher Telson Addendum #2 Confirmed Aug 11, 2026 5:52 AM by Christopher Telson ESTIONN 1. Certified Business* Are you a Certified Small Business or a Certified Minority, Woman or Disadvantaged Business Enterprise? No 2. Vendor Certification* By submitting this response, the Vendor hereby certifies that: A. It is under no legal prohibition on contracting with the City of Clearwater. B. It has read, understands, and is in compliance with the specifications, terms and conditions stated herein, as well as its attachments, and any referenced documents. C. It has no known, undisclosed conflicts of interest. D. The prices offered were independently developed without consultation or collusion with any of the other vendors or potential vendors or any other anti-competitive practices. E. No offer of gifts, payments or other consideration were made to any City employee, officer, elected official, or consultant who has or may have had a role in the procurement process for the commodities or services covered by this contract. The Vendor has not influenced or attempted to influence any City employee, officer, elected official, or consultant in connection with the award of this contract. [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT Invitation To Bid - Solid Waste Truck Wash Replacement (Rebid) Page 2 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT ITB No. 23 -0021 -SW rebid Solid Waste Truck Wash Replacement (Rebid) F. It understands the City may copy all parts of this response, including without limitation any documents or materials copyrighted by the Vendor, for internal use in evaluating respondent's offer, or in response to a public records request under Florida's public records law (F.S. Chapter 119) or other applicable law, subpoena, or other judicial process; provided that the City agrees not to change or delete any copyright or proprietary notices. G. It hereby warrants to the City that the Vendor and its subcontractors will comply with, and are contractually obligated to comply with, all federal, state, and local laws, rules, regulations, and executive orders. H. It certifies that Vendor is not presently debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded, or disqualified from participation in this matter from any federal, state, or local agency. I. It will provide the commodities or services specified in compliance with all federal, state, and local laws, rules, regulations, and executive orders if awarded by the City. J. It is current in all obligations due to the City. K. It will accept all terms and conditions as set forth in this solicitation if awarded by the City. L. The signatory is an officer or duly authorized representative of the Vendor with full power and authority to submit binding offers and enter into contracts for the commodities or services as specified herein. Confirmed 3. E -Verify System Certificattion* PER FLORIDA STATUTE 448.095, CONTRACTORS AND SUBCONTRACTORS MUST REGISTER WITH AND USE THE E -VERIFY SYSTEM TO VERIFY THE WORK_AUTHORIZATION STATUS OF ALL NEWLY HIRED EMPLOYEES. The affiant, by virtue of confirming below, certifies that: A. The Contractor and its Subcontractors are aware of the requirements of Florida Statute 448.095. B. The Contractor and its Subcontractors are registered with and using the E -Verify system to verify the work authorization status of newly hired employees. [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT Invitation To Bid - Solid Waste Truck Wash Replacement (Rebid) Page 3 [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT ITB No. 23 -0021 -SW rebid Solid Waste Truck Wash Replacement (Rebid) C. The Contractor will not enter into a contract with any Subcontractor unless each party to the contract registers with and uses the E -Verify system. D. The Subcontractor will provide the Contractor with an affidavit stating that the Subcontractor does not employ, contract with, or subcontract with unauthorized alien. E. The Contractor must maintain a copy of such affidavit. F. The City may terminate this Contract on the good faith belief that the Contractor or its Subcontractors knowingly violated Florida Statutes 448.09(1) or 448.095(2)(c). G. If this Contract is terminated pursuant to Florida Statute 448.095(2)(c), the Contractor may not be awarded a public contract for at least 1 year after the date on which this Contract was terminated. H. The Contractor is liable for any additional cost incurred by the City as a result of the termination of this Contract. Confirmed 4. Scrutinized Company Certification* Please download the below documents, complete, notarize, and upload. • SCRUTINIZED COMPANIES AND B... scrutinized_companies.pdf 5. Compliance with Anti -Human Trafficking Laws* Please download the below documents, complete, and upload. • Compliance with 787.06 form... Conpliance_anti-trafficing.pdf 6. Section V - Contract -Documents* Please download the below documents, complete, and upload. • Section V - Contract Docume... [C&T CONTRACTING SERVICES, LLC] RESPONSE DOCUMENT REPORT Invitation To Bid - Solid Waste Truck Wash Replacement (Rebid) Page 4 Form -9 (Rev. October 2018) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification ► Go to www.irs.gov/FormW9 for instructions and the latest information. Give Form to the requester. Do not send to the IRS. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. C&T Contracting Services LLC 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification of the person whose name Is entered on line 1. Check only one of the following seven boxes. ❑ Individual/sole proprietor or single -member LLC O Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑ Other (see instructions) ► ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate S 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no) See instructions. 11023 Countryway Blvd. Tampa, F1. 33626 Requester's name and address (optional) 7 List account number(s) here (optional) Part 1 Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Part 11 Certification Social security number or Employer Identification number 8 7 - 0 7 0 9 1 5 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Here Signature of �/ U.S. person ► L,._., Date 12/1/2025 General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018)