Mango Language CIQ 8.8.24Individual/
Sole
Proprietor
Partnership
Limited
Liability
Corporation
Other
Please specify:
Exempt
Payee
Business Type :Equipment
Rental/Lease (A-9)Royalties (A-2)
Medical/Health Care (A-6)
Merchandise-
Goods Only (A-7)
Merchandise &
Services (A-7)Legal Firm/Attorney (A-C)
Proceeds from
Real Estate
Purchases (S)
Type of Organization:Female Owned Non Profit Historically Underutilized
Business
City of Denton Purchasing
901-B Texas St. Denton, TX 76209
Phone: (940) 349-7100 Fax: (940) 349-7302
www.dentonpurchasing.com
Mailing Address:
Consultant/Prof
Fees (A-7)
Company Name:
Real Estate
Rental/Lease (A1)
Check appropriate box for federal tax classification (required):
*Definition of a U.S. Person-For Federal Tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or
U.S. resident (b) a partnership, corporation, company, or association created or organized in the United States or under the laws of the United
States (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Regulations Section 301.7701-7).
C
Corporation
Minority
Owned
Substitute W-9 Form
The IRS requires all vendors to complete a W-9 Form. The information on this form must be filled out, signed and submitted by a
vendor representative. All information must be completed before a purchase order or payment will be issued.
Name as shown on your income tax return: Creative Empire, LLC d/b/a Mango Languages
Tax ID/Social Security #: 20-0767000
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxtaxpayer 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 witholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding
as a result of 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 US citizen or other U.S. person-for fededral tax purposes as defined at the bottom of this page*.
Authorized Signature:____________________________ Printed Name:___Steve Perakis__________________________________
Services Only (A-
7)
Contact Name:
Address: Phone Number:
Fax Number:
S
Must designate C or S
Email:
Website:
COD Page 1 9/23/2011
Creative Empire, LLC d/b/a Mango Languages
Maureen Stegeman
invoice@mangolanguages.com
www.mangolanguages.com
248-254-7450P.O. Box 773164
Detroit, MI 48277-3164
x
LLC designated as a partnership
x
4. I unsderstand that I must disclose any conflict of interest in accordance with Section 176.006 (a-1) of the Local Government Code.
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
Remit Address (if different from above)
Email:
List Products and/or Services Interested in Bidding:
For Internal Use Only
Requesting Department: Date:
Purchasing Signature: Date:
ACH Information-Voluntary
Bank Name :
ABA Routing#:
Contact Name :
Bank Account#
Vendor Number
Company Name:
Contact Name:
Address:
ACH Email :
Phone Number: Phone Number:
Fax Number: Fax Number:
Vendor Change
Refund
New Vendor
I (we) authorize the City of Denton to deposit
payments into the checking account listed. The
authority remains in effect until the City of Denton
has received written notification from me of
termination in time to allow reasonable opportunity
to act on it, or until the City of Denton has sent me
written notice of termination of the agreement.
Vendor Signature __________________________
Print Name/Title: Steve Perakis/CFO
Date _____________________________________
Department Representative (Printed Name) ________________________________________________________
ACH Email :
Vendor Information Not Required for W-9 Form
COD Page 2 9/23/2011
Language learning software access
JPMorgan Chase Bank, N.A.
072000326
invoice@mangolanguages.com
invoice@mangolanguages.com
Maureen Stegeman
248-254-7450
519985165
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
8/8/2024
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined
by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after the
date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
misdemeanor.
1 Name of vendor who has a business relationship with local governmental entity.
2 Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day
after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section
176.003(a)(2)(A). Also describe any family relations hip with the local government officer. This section, (item 3 including subparts A, B, C & D), must be
completed for each officer with whom the vendor has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code.
Attach additional pages to this Form CIQ as necessary.
A.Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B.Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in
this section AND the taxable income is not received from the local governmental entity?
Yes No
C.Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer
or director, or holds an ownership of one percent or more?
Yes No
D.Describe each employment or business and family relationship with the local government officer named in this section.
4 I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
Creative Empire, LLC d/b/a Mango Languages
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
8/8/2024
Revised 11/30/2015Form provided by Texas Ethics Commission www.ethics.state.tx.us
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/
Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties
based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an
agency of a federal, state, or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and
that is subject to regular examination by, and reporting to, that agency.
Local Government Code § 176.003(a)(2)(A) and (B):
(a)A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
***
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
(B) has given to the local government officer or a family member of the officer one or more gifts
that have an aggregate value of more than $100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code § 176.006(a) and (a-1)
(a)A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any
gift described by Section 176.003(a-1); or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application, response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity; or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a
family member of the officer, described by Subsection (a);
(B) that the vendor has given one or more gifts described by Subsection (a); or
(C) of a family relationship with a local government officer.
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
Email Phone
invoice@mangolanguages.com (248) 254-7450 x829
With the payment of this invoice, the customer agrees that all the terms and conditions of the previously executed Terms of Service, including any renewals thereof, shall remain in full force and effect for one year, and that the price for the renewal service will be at the rate indicated on the
invoice. The Terms of Service will be automatically renewed for successive one-year periods, unless either party provides written notice to the
other party not less than thirty (30) days prior to the end of the then current term.
PAYMENT INSTRUCTIONS
ACH/DIRECT DEPOSIT INSTRUCTIONS (FOR US CLIENTS): MAILING ADDRESS FOR CHECKS:Company name: Mango Languages Mango Languages
Company address: PO BOX 773164 Detroit, MI 48277-3164 P.O. Box 773164
Beneficiary Bank: Chase Bank Detroit, MI 48277-3164
Routing #: 072000326 (ACH) # 021000021 (Wires)/ Account Number: 519985165 Bank Address: 47350 Grand River Ave, Novi, MI 48374-3164
INTERNATIONAL WIRE INSTRUCTIONS: Company name: Mango Languages
Company address: PO BOX 773164 Detroit, MI 48277-3164
Beneficiary Bank: Chase Bank
Routing #: 021000021/ SWIFT Code: CHASUS33/ Account Number: 519985165
Bank Address: 47350 Grand River Ave, Novi, MI 48374-3164
PO Box 773164 Detroit, MI 48277-3164 | 1.877.Mango.11 www.mangolanguages.com
INVOICE
Remit to Address:
PO Box 773164
Detroit, MI 48277-3164
INVOICE DATE INVOICE #BILL
TO:
Denton Public Library, TX
3020 N. Locust St.
Denton, TX 76209 07/17/2024 INV014587
DUE DATE REP AM START DATE END DATE
08/16/2024 Adrienne Wells Cruz Pardo 07/01/2024 06/30/2025
ITEM #CATEGORY DESCRIPTION QTY UNIT PRICE AMOUNT
Mango
Conversations
Enterprise
Subscription
Renewal Mango Conversations Enterprise
Subscription
1 $5,512.50 $5,512.50
Subtotal $5,512.50
Tax $0.00
Total $5,512.50
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
Form W-9
(Rev. March 2024)
Request for Taxpayer
Identification Number and Certification
Department of the Treasury
Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.Print or type. See Specific Instructions on page 3.1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded entity’s name on line 2.)
2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes.
Individual/sole proprietor C corporation S corporation Partnership Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) ....
Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.
Other (see instructions)
3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
this box if you have any foreign partners, owners, or beneficiaries. See instructions .........
4 Exemptions (codes apply only to certain entities, not individuals;
see instructions on page 3):
Exempt payee code (if any)
Exemption from Foreign Account Tax
Compliance Act (FATCA) reporting
code (if any)
(Applies to accounts maintained
outside the United States.)
5 Address (number, street, and apt. or suite no.). See instructions.
6 City, state, and ZIP code
Requester’s name and address (optional)
7 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
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. See also What Name and Number To Give the Requester for guidelines on whose number to enter.
Social security number
––
or
Employer identification number
–
Part II 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 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 Date
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.
What’s New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate box for the tax classification of its owner. Otherwise, it
should check the “LLC” box and enter its appropriate tax classification.
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow-through entity in which it has an ownership interest. This
change is intended to provide a flow-through entity with information
regarding the status of its indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they
Cat. No. 10231X Form W-9 (Rev. 3-2024)
Creative Empire, LLC
Mango Languages
4 P
P.O. Box 773164
Detroit, MI 48277-3164
2 0 0 7 6 7 0 0 0
DocuSign Envelope ID: 5538F527-356F-45C8-8A3C-A7D4DD511BAB
3/17/2024
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
STEVE G PERAKIS
CREATIVE EMPIRE, LLC
2328 VENTURA DR
WOLVERINE LAKE, MI 48390-2461
October 17, 2023
Dear Steve G Perakis,
Below is the information that you requested for the Chase account verification.
Bank Name JPMorgan Chase Bank, N.A.
Bank Routing (used for US Wires)021000021
Bank Routing (used for ACH)072000326
SWIFT Code for International Wires CHASUS33
Account/Business Name CREATIVE EMPIRE, LLC
Account #519985165
Please let me know if you have further questions.
Sincerely,
JPMORGAN CHASE BANK, N.A.
Stefan Kalabat
Business Relationship Manager
248-449-9653
Docusign Envelope ID: D6B6D23C-1E86-4499-A6C4-78F72F14E0F4
Certificate Of Completion
Envelope Id: D6B6D23C1E864499A6C478F72F14E0F4 Status: Completed
Subject: Complete with Docusign: INV014587.pdf, 1Substitute W-9 Form 8-30-2017 (1).pdf, CONFLICT OF INTE...
Company:
Source Envelope:
Document Pages: 7 Signatures: 3 Envelope Originator:
Certificate Pages: 2 Initials: 0 Maureen Stegeman
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US &
Canada)
Comments: yes 20750 Civic Center Drive
STE 570
Southfield, MI 48076
maureen.stegeman@mangolanguages.com
IP Address: 35.149.193.10
Record Tracking
Status: Original
8/5/2024 10:03:59 AM
Holder: Maureen Stegeman
maureen.stegeman@mangolanguages.com
Location: DocuSign
Signer Events Signature Timestamp
micheal Fridman
michael.fridman@mangolanguages.com
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 172.58.124.194
Sent: 8/5/2024 10:09:01 AM
Viewed: 8/5/2024 11:22:57 AM
Signed: 8/5/2024 11:25:37 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kristen Sinclair
kristen.sinclair@mangolanguages.com
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 173.71.89.187
Sent: 8/5/2024 11:25:39 AM
Viewed: 8/6/2024 6:19:40 AM
Signed: 8/6/2024 6:21:02 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Angela Zografos
angela.zografos@mangolanguages.com
Corporate Counsel
Mango Languages
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 108.24.102.91
Sent: 8/6/2024 6:21:04 AM
Viewed: 8/6/2024 4:34:50 PM
Signed: 8/6/2024 4:36:09 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Steve Perakis
steve.perakis@mangolanguages.com
CFO
Mango Languages
Security Level: Email, Account Authentication
(None)
Signature Adoption: Drawn on Device
Using IP Address: 174.224.55.6
Signed using mobile
Sent: 8/6/2024 4:36:11 PM
Viewed: 8/6/2024 7:44:37 PM
Signed: 8/8/2024 5:09:34 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 8/5/2024 10:09:01 AM
Certified Delivered Security Checked 8/6/2024 7:44:37 PM
Signing Complete Security Checked 8/8/2024 5:09:34 AM
Completed Security Checked 8/8/2024 5:09:34 AM
Payment Events Status Timestamps