Bushel and a Peck

Soh eee
Town of Wickenburg

Commercial Fagade Grant Application

Organization Name: Bushel and a Peck AZ LLC

Address 3235 W Wickenburg Way, Wickenburg AZ 89490

Phone; 9165395293 9282313834

27 Phone,
orderabushelandapeck@gmail.com
Eman

Contact Name and Title: Jacque Grantham

Scope of Work:

Monument Sign to assist customers in seeing our business from the street as they are dnving by- $6,500
(Base: 2' x 4° x 12') Rock base with hanging sign from arched iron over rock base

Patio Yard enclosure- A rock and metal mixed fence and decorative rocks will enhance the natural rustic
venue that we are hoping to open on our side porch for micro events, weddings and more $10,381.50

East Gate Yard Enclosure for traffic control and designating event area to meet necessary AZ Liquor Law $
$1,744.30

West Gate and Wall for traffic control and designating event area to mect necessary AZ Liquor Law $
$2,338.25

Parking stopper fence- completing the front facade of our store we are hoping to add a decorative yet
functional fence as a blockade for cars driving to close to the building. $1.578

_Funding Amount Requested:— 910.000

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futhprized Agency Representative Title Date

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TOWN OF WICKENBURG, ARIZONA

155 Nocth Tepner Sireet, Suite A Wickenhorp, \Z 85390 MUST BL
M28) OM SLY Poems. (G02) 406.1622 / VAX: (602) 506.1580 | DISPLAYED IN A
CONSPICUOUS

INESS LICENSE: # 7748 PLACE
NON-TRANSFE RABLE : :

This Porat canner he traasterred Grose one Person te ane:

ther, Nonfy the Towns Clerk if business 1 discontoued, if there 4

chotige an the marie ot the business, a Change in trade name, change of locaton, change 1 oathng address or change in ownership

Dre tstow namedis horeby peemittcd te conduc business in the aaneuf tbe pence hese named ithe address shosan
BUSINESS LOCNETON: 1235 Wi Wickenburp Was

2025 LICENSE ORIGINATION DATES 498/23/2021

EXPIRATION DATE: 12/31/2025
TYPIE-OF PRHRMIT: Annual
ISSCED TO: Bushel and a Peck AZ DEC LACENSE IQESCRIPMVORermptapdard Face nse
OWNER: Cirantham Jacquchne - Member 4h i]
MAI. PO: 1235 W. Wickenburg Wav | l iY A» (aaa

Wichenburg AZ 85390 Pamela Black, Senior Financial Services Specialist

Proposed Work Cost Breakdown

Monument Sign

Est. Total:

Rock Fence

Est. Total:

Parking Stopper Fence

Est. Total:

15' East Gate

Est. Total:

15' West Gate & Wall

Est. Total:

Total Project Cost:

4”x4” steel arch
3-2"x2 7/8" Pipe
2- Sheet Metal
2- Wire Panels
3- Tons Rock
Labor

117' 2 7/8” Pipe
Welded Panels
Cement

Caps
Decorative Rock
Labor

62' 2 rail with 6' post centers
11 Caps
Cement
Labor

Square Tubing

C Panels

Gate Post

Trim, Keepers, etc
Cement

Labor

Square Tubing

C Panels

Trim, Keepers, etc
Cement

Labor

Short Wall

2,500.00
210.00
400.00
240.00
200.00

2,950.00

6,500.00

FAAF HAH HK

1,750.00
840.00
275.00

24.00
4,032.00
3,460.50

10,381.50

FPF HHH SK

$ 490.00
$ 33.00
$ 55.00
$ 1,000.00
$ 1,578.00

$ 270.00
$ 90.00
$ 98.00
$ 276.30
$ 20.00
$ 990.00
$ 1,744.30

$ 196.00
$ 36.00
$ 92.00
$ 20.00
$ 1,650.25
$ 344.00
$ 2,338.25

$ 22,542.05

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Request for Taxpayer Give Form to the

Form W-9

(Rev. October 2018) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service > Go to www.irs.gov/FormW9 for instructions and the latest information.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

and a Peck AZ LLC
2 Business name/disregarded entity name, if different from above

|_ __Rushel and a Peck AZ, |1C

3 Check appropriate box for federal tax classification of the person whose name |s entered on line 1. Check only one of the | 4 Exemptions (codes apply only to
following seven boxes. cartain entities, not individuals; see

Instructions on page 3):

Oo Individual/sole proprietor or oO C Corporation 7: § Corporation oO Partnership O Trustestate

single-member LLC Exempt payee code (if any)
Oo 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 | Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (i any)
another LLC that is not disregarded from the owner for U.S. faderal tax purposes, Otherwise, a single-member LLC that} y)
is disregarded from the owner should check the appropriate box for the tax classification of its owner.

oO Other (see instructions) >
§ Address (number, street, and apt. or sulte no.) See Instructions.

‘(Apples to accounts maintained outside the U.S.)
Requester’s name and address (optional)

6 City, state, and ZIP code

rg,.AZ 85390
7 Uist account number(s} here (optional)

Print or type.
See Specific Instructions on page 3.

urg. Way.
g y

(G2ua0 _ 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 |, 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. or
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. 87 46108 ¢ 99

Certification

Under penatties of perjury, | certify that:

1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and

2. 1am not subject to backup withholding because: {a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue
Service (IRS) that | 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 | am
no longer subject to backup withholding; and

3, lama U.S, citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that | 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 Il, later.

[ Soctal security number }

Sign Signature of
Here U.S. person >

Date > 01/17/2024

* Form 1099-DIV (dividends, including those from stocks or mutual
funds)

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 retum 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 retum 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-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 ev. 10-2018)
Doc ID: 14e5a26801d151b42603698f5581a1d8c0e2f9