CONTRACT RE ONE HEALTH INITIATIVES WITH COUNCIL OF STATE & TERRITORIAL EPIDEMIOLOGISTS.PDF

GENERAL CONTRACT AGREEMENT
BUYER: SELLER:
Council of State & Territorial Epidemiologists Maricopa County by and through its Department
(CSTE) of Public Health
2872 Woodcock Blvd., Suite 250 4041 N Central Ave, Suite 600
Atlanta, GA 30341-4015 Phoenix, AZ 85012 .
Phone: (770) 458-3811 Phone: (602) 372-2601
Fax: (770) 458-8516
CSTE AUTHORIZING OFFICIAL: AUTHORIZING OFFICIAL:
Jeffrey Engel, MD Denny Barney
Executive Director Chairman of the Board
CSTE Maricopa County Board of Supervisors
CSTE PROJECT MANAGER: PROJECT MANAGER:
Nicole Bryan Kate Goodin, MPH
Associate Research Analyst Epidemiology and Data Services Program Manager
Phone: (770) 458-3811 Phone: (602) 372-2601
Email: nbryancste.org Email: KateGoodinOmail.maricopa.dov
PROJECT/PRODUCT DESCRIPTION (See Article land Statement of Work, Attachment 1):
Development and participation in pilot project designed to promote One Health initiatives and educate youth
on the epidemiology, prevention, and control of zoonotic diseases with public health impact.
DELIVERY SCHEDULE: See Statement of Work for delivery schedule (Article I and Attachment 1)
PERIOD OF PERFORMANCE: Start Date: End Date:
July 1,2014 June 30, 2015
CONTRACT PRICE (See Article I ): not to exceed $18,465.00
PAYMENTS TERMS (See Article IV)::
Funds shall not exceed the contract price above and will be dispersed upon receipt of invoices from the
seller for allowable costs and fees actually incurred and chargeable to CSTE in accordance with the budget
categories indicated in Attachment II.
The award will be made according to the schedule below:
Upon contract initiation — 25%
January 1, 2015 — 25%
April 1, 2015 — 25%
June 30, 2015— 25%
A final invoice is due by June 30, 2015.
TYPE OF CONTRACT: Fixed Price Contract (See Article Ill)
TERMS AND CONDITIONS: See Articles I through XXIV included as a part of this agreement for applicable
Terms and Conditions.
Jeffrey Engel, MD
Executive Director
Council of State & Territorial Epidemiologists

GENERAL CONTRACT AGREEMENT
CONTRACT TERMS AND CONDITIONS
Article I — Statement of Work
More details are set forth in Seller's Statement of Work as appended hereto as Attachment 1.
Article II — Cost
A. The total price to CSTE for the performance of this General Contract Agreement shall not
exceed $18,465.00 unless changed by written amendment to this Agreement. All funding
shall be contingent upon the availability of funds from the CDC (Cooperative Agreement
No. 1U38 0T000143).
B. Seller's budget is appended hereto as Attachment II,
Article III — Type of Contract
This Agreement is considered a Fixed Price contract. It is recognized by both parties that the
actual price for this project may vary either above or below the price set forth in Article II, but will
have no effect on that price, unless amended as set forth in Article XVI.
Article IV - Payment
A. CSTE shall reimburse Seller for allowable costs and fees actually incurred and chargeable to
CSTE in accordance with the budget categories indicated in Attachment ll upon being
invoiced by Seller and upon approval of the invoice by CSTE's Executive Director. Invoices
shall be submitted for partial payments or in full to:
Nicole Bryan
Council of State and Territorial Epidemiologists
2872 Woodcock Boulevard
Suite 250
Atlanta, GA 30341-4015
B. Payment shall be made by CSTE within thirty (30) days of receipt of invoice. All checks
should be made payable to:
Maricopa County Department of Public Health
and mailed to:
Maricopa County Department of Public Health
4041 N Central Ave, Suite 600
Phoenix, AZ 85012
Article V — Publicity
No party will use the name of any other party in any publicity, advertising, or news release without
the prior written approval of an authorized representative of that party.
Article VI — Governing Laws
This Agreement shall be governed and construed in accordance with laws of the State of Arizona.
Article VII — Regulatory Compliance
A. The Seller agrees to comply with and abide by all relevant and applicable laws and
regulations of federal, state, and local governments/agencies.
B. Seller assures that adequate safeguards shall be taken whenever using human subjects in
research projects and an institutional review committee composed of sufficient members with
varying backgrounds to assure complete and adequate review of projects involving the use of
human subjects has reviewed and approved the projects. Seller will abide by all applicable
provisions of the U.S, Department of Health and Human Services regarding the use of human
subjects.

Article VIII — Rights in Data, Publication, and Copyright
The Funding Agency reserves a royalty-free, nonexclusive, and irrevocable license to reproduce,
publish or otherwise use, any work developed under the Agreement.
Article IX — Intellectual Property
Existing and/or already conceived inventions, discoveries, patents, products, or other information
developed in whole or part in connection with this agreement shall be the exclusive property of
CSTE in accordance with 37 CFR Part 401.
Article X — Termination
A. Either party may terminate this Agreement hereto by giving written notice to the other party
thirty (30) days in advance of a specified date of termination.
B. Upon receipt of such notice from CSTE, Seller shall take all necessary action to cancel
outstanding purchase orders and other commitments relating to the project under this
Agreement, and shall exercise reasonable diligence to cancel or redirect commitments for
personnel services to its other activities and operations.
C. CSTE shall remain liable for all cost incurred under this Agreement, including any of the
above mentioned commitments entered into by Seller in good faith prior to the receipt of the
termination notice. Upon payment of such costs, CSTE shall be entitled to, and Seller agrees
to deliver, the information and items, which, if the Agreement had been completed, would
have been required to be furnished to CSTE.
Article XI — Non-Solicitation Agreement
During the term of this Agreement and for one (1) year thereafter, neither party nor any of their
affiliates will offer work to, solicit or induce for employment, employ, or contract with, personnel of
CSTE or their affiliates, without first obtaining the written consent of applicable Managing
Directors.
Article XII — Independent Contractor
A. In the performance of all services hereunder, Seller shall be deemed to be and shall be an
independent contractor.
B. No party is authorized or empowered to act as agent for any other for any purpose and shall
not on behalf of any other enter into any contract, warranty, or representation as to any
matter. None shall be bound by the acts or conduct of any other.
Article XIII — Indemnification
A. CSTE assumes all risk of liability with respect to its performance of any activities relating to
this project, other than liability arising out of an act of omission of Seller, and shall indemnify
and hold Seller harmless from all liability arising out of acts or omissions of CSTE, its
employees and agents.
B. Seller assumes all risk of liability with respect to its performance of any activity relating to this
project, other than liability arising out of any act or omission of CSTE, and shall indemnify and
hold CSTE harmless from all liability arising out of acts or omission of Seller, its employees
and agents.
Article XIV — Nondiscrimination and Affirmative Action
Seller certifies that it has an active program for compliance with ail applicable state and federal
regulations, executive orders and legislation concerning non-discrimination, equal opportunity, or
affirmative action, and that, whenever required, valid assurances of compliance are on file with
the cognizant enforcement agency. Whenever applicable, the above statement of certification
includes, but is not necessarily limited to, the following acts:
• Title IV of the Civil Rights Act of 1964
• Executive order 11246, "Equal Employment Opportunity," as amended by E.0, 11375,
Amending Executive Order 11246 Relating to Equal Employment Opportunity," and as
supplemented by regulations at 41 CFR Part 60, "Office of Federal Contract Compliance
Programs, Equal Employment Opportunity, Department of Labor
• Title VII of the Civil Rights Act of 1964 as amended by the EEO Act of 1972

•Section 504 of the Rehabilitation Act of 1973
• The Age Discrimination Act of 1975, as amended
• Affirmative Action Obligations of Contractors and Subrecipients for Disabled Veterans and
Veterans of the Vietnam Era, Sub-part A, Paragraph 60-250.4
• Title IX of the Higher Education Act of 1972
Article XV — Seller Certifications
A. Debarment and Suspension
Seller certifies to the best of its knowledge and belief that it is not presently debarred,
suspended, or proposed for debarment or declared ineligible for the awards of Contracts, by
any Federal Agency, in accordance with OMB Guidelines (53 FR19161-19211).
B. Certification of Non-Delinquency of Federal Debt
Seller certifies that it is in compliance with the Non-Delinquency on Federal Debt criteria, in
accordance with OMB Circular A-129.
C. Certification of Drug-Free Workplace
Seller certifies that it has implemented appropriate policy in accordance with the Drug-Free
Workplace Act of 1988, 45 CFR, Part 76, Subpart F.
D. Certification Regarding Lobbying
Seller certifies to the best of its knowledge and belief that no Federal appropriated funds have
been paid or will be paid, by or on behalf of Seller, to any person or organization for
influencing or attempting to influence an officer or employee of a Federal agency, a member
of Congress, officer or employee of Congress, or an employee of a member of Congress in
connection with obtaining any Federal contract, grant or any other award covered by 31
U.S.C. 1362.
E. Conflicts of Interest
Seller certifies that it has established Conflict of Interest Policy that complies with all
requirements, rules and principles of 60 FR 35810, Part III incorporated herein by reference.
Misconduct in Science
Seller certifies that it has established as defined in Article XI, B, administrative policies as
required by 42 CFR Part 60, Subpart A.
Article XVI — Changes
The Agreement may be modified or amended if the amendment is made in writing and signed by
both parties.
Article XVII — Retention and Access to Records
Recipient shall retain records pertinent to this project for 3-years after the end of the project
unless any litigation, claim, financial management review, or audit is started before the expiration
of the 3-year period. In the case of any of these actions, records shall be retained until all actions
have been resolved. Recipient agrees to provide CSTE, the Comptroller General of the United
States, and if appropriate, the State, through their duly authorized representative, access to and
the right to examine all records, books, papers, or documents which are related to this project.
Article - XVIII — Clean Air Act and Federal Water Pollution Control Act
If the agreed to price of this agreement exceeds $100,000, Seller agrees to comply with all
applicable standards, orders, or regulations issued pursuant to the Clean Air act, 42 U.S.C. 7401
et seq., and the Federal Water Pollution Control Act, as amended 33 U.S.C. 1251 et seq.
Article XIX — Debt Collection
HHS Claims Collection Regulations (45 CFR Part 30, Subpart B), provides for interest and
penalties on all delinquent debts and will be applicable to this agreement if debt collection
becomes necessary.

Article XX — Smoke-Free Workplace
Recipient agrees to provide a smoke-free workplace and promote the nonuse of tobacco
products. Workplace is defined to mean office space (including private offices and other
workspace), conference or meeting rooms, corridors, stairways, lobbies, rest rooms, cafeterias,
and other public space.
Article XXI — Financial Audit
Recipient is subject to audit requirements as set forth in 45 CFR Part 74.26.
Article XXII — Confidentiality
Both parties acknowledge that during the course of this Agreement, each may obtain confidential
information regarding the other party's business. Both parties agree to treat all such information
and the terms of this Agreement as confidential and to take all reasonable precautions against
disclosure of such information to unauthorized third parties during and after the term of this
Contract.
Article XXIII — Severability
If any provision of this Contract shall be held to be invalid or unenforceable for any reason, the
remaining provisions shall continue to be valid and enforceable. If a court finds that any provision
of this Agreement is invalid or unenforceable, but that by limiting such provision it would become
valid and enforceable, then such provision shall be deemed to be written, construed, and
enforced as so limited.
Article XXIV - Warranty
Seller shall provide that any services provided under this contract will meet, or exceed, the local
standard of similar service providers in the community. Further, any products provided under
this contract shall meet the merchantability standards and meet fitness standards for the intended
purpose.

IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Ma ricopa County
Date

CSTE 4-H Grant Application Maricopa County Department of Public Health - Budget
VI. Budget
Item Cost (quantity) Total
Printed educational pamphlet 50,000 copies at $0.32 each $16,000
(similar to Georgia "Friends
Magazine")
Postage for pamphlets 15 chapter locations, $15 each $225
Posters 10 high-quality, large-format $500
• Zoonosis information copies of two fliers, $25 each
• Hand washing at fairs
Free-standing reusable $300 each, 2 sets $600
information displays
• What are zoonotic
diseases?
Hand washing demonstration $500, 2 sets $1,000
powder and black light
Mileage 5 trips, 50 miles round trip, at $140
$0.56 per mile
Total $18,465

Attachment I
Influenza Education among Youth in Agriculture Project
1. Name: Maricopa County Department of Public Health
2. Method of Selection: Competitive Bid
3. Period of Performance: July 1, 2014 June 30, 2015
4. Scope of Work
Background
Zoonotic diseases are infections that spread from animals to humans. More than 60% of
pathogenic infectious organisms in humans are zoonotic, and 75% of emerging pathogens are
zoonotic. Young people with close animal contact are at increased risk for infection and are
more likely to have complications from these diseases, especially influenza, Salmonella, and E.
coll.
Novel influenza A viruses can emerge when a single host (e.g., swine) is infected with different
influenza viruses. There may be little or no immunity against novel influenza A viruses in the
human population. A virus of this type could cause an influenza pandemic, as it did during the
2009 H1N1 pandemic. A recent large outbreak of influenza H3N2v occurred in 2012, primarily in
children with close contact with swine at agricultural fairs, many of whom were exhibitors
participating in 4-H. This demonstrates the need to fill gaps in members' knowledge of disease
and disease processes, particularly in the context of diseases that are transmitted between
animals and people.
In addition to promoting zoonotic disease education for youth, family, and the community, key
stakeholders at the state and national levels have identified the need for better collaboration
between public health, animal health, and members of the agriculture community that have
frequent contact with animals.
CSTE seeks to promote communication and increase collaboration between national, state, and
local partners through this project and for future endeavors. One key partner in this collaboration
is the National Association of State Public Health Veterinarians (NASPHV), a professional
organization of state public health veterinarians that addresses zoonotic issues of public health
concern. CSTE and NASPHV partner to provide resources for national and local regulatory
bodies and provide guidance on surveillance and public health practice with a One Health
approach.
Other key partners for the project include the U.S. Department of Agriculture's Animal Plant
Health Inspection Service (APHIS) and the 4-H National Office in the National Institute for Food
and Agriculture (NIFA) which have collaborated with CDC since 2011 on the zoonotic infection
prevention project for youth, following identification of a novel influenza virus (H3N2v). The
project focused primarily on education regarding influenza prevention for youth with swine
exposure at agricultural fairs.
These partnerships leverage the experience and ability of public and animal health zoonotic
disease experts in several organizations to create an integrated, One Health team which uses
an interdisciplinary approach to prevent and respond to zoonoses. The motivating principles of
this collaboration include reducing morbidity and mortality due to zoonotic diseases and
Page 1 of 4

developing relationships among stakeholders that would facilitate more effective and efficient
responses to important public and animal health issues.
Objectives
The partnership's motivating principles include facilitating prevention, detection, and monitoring
of zoonotic diseases, especially emerging diseases with epidemic potential.
1) Improve participant awareness and knowledge of zoonotic diseases, including zoonotic
disease transmission and prevention.
2) Motivate participants to adopt behavior that can help prevent zoonotic disease
transmission.
3) Increase participant awareness and knowledge of careers in public and animal health
and epidemiology.
4) Facilitate a better understanding among participants of the role of epidemiology, public
and animal health play in disease prevention.
5) Develop relationships among stakeholders that could be used to facilitate more effective
and efficient responses to important public and animal health issues (e.g., the response
to infectious disease outbreaks or epidemics).
Methods
Seller will use funding primarily to implement delivery of content developed in conjunction with
CSTE, Public Health, and Animal Health subject matter experts. Implementation can be of
newly-developed content or of materials that have already been developed and piloted by CDC
and USDA.
Deliverables and required activities
1) Invoices must be sent on a quarterly schedule for receipt of funding on a Firm-Fixed type
contract: upon contract initiation (25%), January 1 (25%), April 1 (25%), June 30
(25%).
2) Reports describing progress toward meeting the stated objectives and completing the
required deliverables as outlined in the application for funds. Awardee is responsible for
meeting proposed deliverables. •
a. Reports must be submitted to CSTE quarterly (January 1, April 1, and June
30). These reports may include progress associated with project, timelines for
completion of project, problems associated with the project, process metrics and
projections and recommendations for the remainder of the project. A report
template with questions will be provided.
3) Participate in quarterly and ad hoc calls with CSTE, CDC, and USDA representatives.
Maricopa County will:
1) Adapt the Georgia 4H "Friends Magazine'' to incorporate issues unique to Arizona
a. Distribute the magazine to youth members across 40 chapters within Maricopa
County
2) Recruit chapter leaders to participate in a zoonotic disease and influenza train-the-
trainer program
Page 2 of 4

3) Conduct quarterly web trainings for participants to refresh their knowledge and update
content
5. Roles and Responsibilities:
Recipient Rights and Responsibilities:
Each recipient public health department will have primary responsibility for the following:
• Providing management oversight for the overall project including collaborations with
national, state, and local partners.
• Obtaining the appropriate human subjects clearances at local sites if required.
• Providing written progress reports (on a quarterly basis) that describe performance
milestones and invoices to CSTE as required in the contract agreement. A template will
be provided.
• Initiating a formal agreement with state animal health, youth agricultural organization,
and other partners and to ensure participation by all parties in program activities.
• Collaborating with other awardees, CSTE, CDC, and USDA on quarterly calls.
• Participating in additional progress calls as needed.
CSTE Responsibilities:
During the established grant period, CSTE is responsible for:
• Monitoring the terms of the contract agreement between the recipient and CSTE.
• Collecting invoices from the recipient and paying invoices according to the terms of the
contract agreement between the recipient and CSTE.
• Providing information about the progress of the program to the CSTE Executive Board
and to CDC.
• Distributing progress reports and the final report and reviewing reports with CDC.
• Providing technical expertise.
• Convening an independent review panel of experts to provide an objective review of the
submitted applications.
• Providing CSTE staff to support the day to day activities of the project,
• Coordinating and participating in quarterly calls with awardees, CDC, and USDA.
CDC/Influenza Division and USDA Responsibilities:
CDC/Influenza Division and USDA will have programmatic involvement as described below:
• Providing technical assistance in developing project plans and materials.
• Assisting with review of proposed project plans and materials.
• Assisting with expansion of projects to other jurisdictions,
• Participating on an independent review panel convened by CSTE to provide an objective
review of the submitted applications.
• Participating in quarterly calls with awardees, and CSTE.
Page 3 of 4

Collaborative Responsibilities:
CSTE, CDC, and USDA Collaborative Partnership in conjunction with the recipient contacts for
all awarded projects will participate in a Project Coordination Committee (PCC). Each recipient
contact will be a member of the PCC and will participate in its activities. The PCC will function
to:
• Establish goals, promote collaboration, share best practices, and coordinate project
activities among members of the PCC.
• Provide guidance to project coordinators regarding project implementation and
sustainability.
• Evaluate monthly progress of all funded project activities.
Reporting Guidelines
Seller agrees to provide CSTE reports as requested and agrees to perform all activities
described in the application submitted for this project.
All invoices must be received by June 30, 2015.
Progress reports will be required quarterly and should be submitted to Nicole Bryan
(nbryan©cste.orq) by January 1, 2015, April 1, 2015, June 30, 2015, and upon completion
of the project, if after June 30, 2015.
All deliverables, including a final project report will be prepared upon study completion and must
be received by CSTE by June 30, 2015 unless specified in a contract amendment.
Page 4 of 4

ATTACHMENT 2
Federal Funding Accountability and Transparency Act Reporting Requirement
To be completed by CSTE
Award Recipient's Name:
Amount of Award (obligated amount):
Funding Agency and Program Source:
CFDA Number:
Award Title Descriptive of the Purpose of the Funding Action:
To be completed by Recipient
Recipient's Location (Address): 4041 N Central Avenue, Suite 600
Phoenix, AZ 9-digit Zip Code: 85012
Recipient's Congressional District: 4
Recipient's Place of Performance (If different from location above):
9-digit Zip Code:
Recipient's Place of Performance Congressional District:
Recipient's Unique Identifier (DUNS #): 602062515
Recipient's Unique Identifier of Parent Organization [if applicable] (DUNS #):
Page 1 of 2

In order to determine whether you are required to provide executive compensation data,
please answer the following question(s):
1. In your business or organization's preceding completed fiscal year, did your business or
organization (the legal entity to which this specific CCR record, represented by a DUNS
number, belongs) receive:
a. 80 percent or more of your annual gross revenues in U.S. federal contracts,
subcontracts, loans, grants, subgrants, and/or cooperative agreements?
Yes No
b. $25,000,000 or more in annual gross revenues from U.S. federal contracts,
subcontracts, loans, grants, subgrants, and/or cooperative agreements?
Yes No
If you selected "Yes" for both a and b, please answer number 2 below. If you selected "No"
for either or both a and b, you are finished completing this form.
2. Does the public have access to information about the compensation of the executives in
your business or organization (the legal entity to which this specific CCR record,
represented by a DUNS number, belongs) through periodic reports filed under section
13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 780(d)) or
section 6104 of the Internal Revenue Code of 1986?
Yes No
If you selected "Yes", you are finished completing this form. If you selected "No", please
provide the Names and Total Compensation for your five highest compensated executives (i.e.
officers, managing partners, or any other employees in management positions):
Name: Total Compensation; $
Name: Total Compensation: $
Name: Total Compensation: $
Name: Total Compensation: $
177ttrr I otal Uompensation:
Page 2 of 2

Form W-9 Request for Taxpayer Give form to the
(Rev. October 2007) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name (as shown on your income lax return)
2.
'
page Business name, if different from above
on
Check appropriate box: . inch/dual/Sole proprietor 7 Corporation n Partnership Exempt
type • Limited liability company. Enter the tax classification (t.disregarded entity, tt corporation, R=partnership) 4 payee
or instructions Oilier (see instructions) A •
Print dress (number, street, and apt. or suite no,) Requesters name and address (optional)
Specific City, state, and ZIP code
See List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number
backup withholding. For individuals, this is your social security number (SSN). However, for a resident 1
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines On whose Employer identification number
number to enter.
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that 1 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).
Certification instructions, You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign Signature of
Here U.S. person 0 Date 0
General Instructions Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless
otherwise noted. • An individual who is a US. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your. correct taxpayer identification number (TIN) • An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate • A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701-7).
abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA. trade or business in the United States are generally required to
Use Form W-9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W-9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
2. Certify that you are not subject to backup withholding, or provide Form W-9 to the partnership to establish your U.S.
3 Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Farm W-9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form other. than Form W-9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity,
Cat No 10231X Form W-9 (Rev 10-2007)