2013-152ORDINANCE NO. 2013-152
AN ORDINANCE OF THE CITY OF DENTON, TEXAS AUTHORIZING THE CITY
MANAGER TO EXECUTE A PROFESSIONAL SERVICES AGREEMENT BETWEEN THE
CITY OF DENTON AND WEAVER AND TIDWELL, L.L.P. FOR INDEPENDENT AUDITS;
AUTHORIZING THE EXPENDITURE OF FUNDS; AND PROVIDING AN EFFECTIVE DATE
(FILE 5259—AUDIT SERVICES AWARDED TO WEAVER AND TIDWELL, L.L.P. IN THE
NOT-TO-EXCEED AMOUNT OF $140,000 FOR 2013, $142,500 FOR 2414 AND $145,000 FOR
2015 FOR A TOTAL AWARD NOT-TO-EXCEED $427,500).
WHEREAS, the City's current agreement with Weaver and Tidwell, L.L.P. expires after
completion of the firm's audit services for the fiscal year ending September 30, 2012; and
WHEREAS, Chapter 2254 of the Texas Government code, known as the Professional
Services Procurement Act, generally provides that a city may not select a provider of professional
services on the basis of competitive bids, but must select the provider of professional services on the
basis of demonstrated competence, knowledge, and qualiiications, and for a fair and reasonable
price; and
WHEREAS, the City Council hereby finds and concludes that Weaver and Tidwell, L.L.P. is
appropriately qualified under the provisions of the law to be retained to provide auditing services and
has been selected on the basis of demonstrated competence, knowledge, and qualifications, and the
compensation paid is fair and reasonable; and
WHEREAS, the City Manager recommends and the City Council deems it in the public
interest that the City enter into a professional services agreement for independent auditing services
with Weaver and Tidwell, L.L.P. for the fiscal years ending September 30, 2013, September 30,
2014, and September 30, 2015, with the City's option to extend the agreement for two additional
years ending September 30, 2016, and September 30, 2017; NOW, THEREFORE,
THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS:
SECTION 1. The City Manager is hereby authorized to execute on behalf of the City, a
professional services agreement for auditing services between the City and Weaver and Tidwell,
L.L.P. for the independent auditing services, in substantially the form of the agreement which is
attached hereto and incorporated by reference herein.
SECTION 2. The City Manager is authorized to expend funds as required by the attached
contract.
SECTION 3. The findings in the preamble of this ordinance are incorporated herein by
reference.
SECTION 4. This ordinance shall become effective immediately upon its passage and
approval.
PASSED AND APPROVED this the ��ff� day of , 2013.
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
�
BY: G!���Cy../
APPROVED AS TO LEGAL FORM:
ANITA BURGESS, CITY ATTORNEY
BY: ` � , �
/
2-ORD-5259
PROF�SSIONAL SERVICE5 AGREEMENT
Contract # 5259
Audit�ng Services �vith Weaver and Tid�cvell, LLP
STATE OF TEXAS §
COUNTY' OP DENTOI�i §
��
THIS AGREEMENT is made and entered inta as of the 1 S�h day f�, 2013, by and
between the City of Denton, Texas, a Texas municipal co�poration, with its principal office at
215 East McKinney Stceet, Denton, Denton County, Texas 76201, hereinafter called "OWNER"
and Weaver and Tidwell, LLP., with its corpoxate o�f'xce at 12221 • Merit Drive, Suite 1400,
Dallas Texas, 75251, hereinafter called "CONSULTANT," acting herein, by and through their
duly authorized z�epresentatives.
WITNESSETH, that in consideration of the covenants and agreainents herein contained,
the parties hexeta do mufually agree as follows:
� ARTICLE I
EMPLOYMENT OF CONSULTANT
The OWNER her•eby con�hacts with the CONSUL,TAN'�', as a�. independent contractor,
and the CONSULTANT hereby agrees to perform the services herein in connection tivi�h the
Project as stated in the sections to follow, with diligence and in accordance with the h�ghest
professio�aal standa��ds customarily obfained for such services in the State of Texas. The
professional services set oui herein are in connection with the �ollowing described project:
The p�•oject shatl znc�ude, without limitation, review and audit sez�vices related to the Ciiy
of Denton's cash handling and receipts processes to verify that its intez�nal co�ntz�ols are adequate
to manage these processes effectively, contz•ol costs and reduce the risk of fraud or ei7or.
ARTICLE II
SCOPE OF SERViCES
The CONSULTANT shall perform the following seivices in a professional znanne�•:
A. The CONSULTANT shall perfoi�n all those services as necessary and as described and
as described in the Consultant's Fee praposal far Auditin� Services, Scone of �
services, Tir�nelitxe, En�a�ement Team, Affiiiations, and most x•ecent Pee�• revie�,
which is attached here#o as Exhibit "A" and is incorporated by refei•ence as if set forih
fizlly herein. To perform all those services set foi-th in CONSULT�INT's Praposal dated
May 1, 2013, which proposal is attached hereto as E:�hibit "A" and is inco�Poz•ated by
reference as if set foi`th fully herein.
B, CONSULTANT shall perfoim all tliose services set forth in individual task oxders which
shall be attached to this Agj.�eement and made a part hereof for alI purposes as sepa�•ate
agreements.
C. If there is any canflict between the tez�rns of this Ag��eernent and the exhibits attached to
tliis Agreement, the tezxns and conditions of this Agreement will control over the teims
and eonditions of the attached exhibits ox• task oz�ders,
Additional
OWNER, which
follows:
ARTICLE III
ADDITIONAL �ERVICES
services to be performed by the CONSULTANT, if
are not inc�uded in the above-described Basic Seiwices,
authorized by the
��e described as
A. During the course of tlxe Project, as requested by OWNER, the CONSULTANT wilI be
available to accompany OWNER'S persozzz�el when meeting with other agencies to
cozrununicate concerning aspects af the work perfoimed, The CONSULTANT tivill assist
OWNER's personnel on an as-needed basis in preparing data, analysis, prog��ess reports,
answexing rec�uests for information, an.d providing general techriical support for the
OWNER's efforts.
�3. Assisting OWNER or contractar in the defense or prosecution of litigation in cox�nection
with or in addition to those services contemplated by this Agreement. Such services, if
any, shall be fui�i.shed by CONSULTANT on a fee basis negotiated by the respective
� pai�tias outside of and in addition to this Agreement.
C. Providing other documentation or support, as requested, �elated to the provision of ihe
Baszc Services to be provided by CONSULTANT.
ARTICLE TV
PERIOD OF ��RVICE
This. Agreemeiit shall become ef#'ective upon execution of this Agreement by tlie
4VJNER and the CONSULTANT and upon issue of a notica to proceed by the OWNER, and
shall remain in foz•ce for the pe�7od which may x•easonably be required for the completion of the
Project, including Additional Se�vices, , if any, and any reqnired e�tensions approved by the
OWNER. Tlus Agi�eement may be sooner terminated in accoz�dance �vith the provisions hereof.
Tirna is of the essence in this Agreement, The CONSULTANT shall make al1 reasonable efforts
to complete the services set forth herein as expeditiously as possible and to meet the schedule
established by the OWNER, acting through its City Manager ox liis designee. .
ARTICL� V
COMP�NSATION
A.. COMPENSATION TERMS:
1. "Subcan#ractor Expenses" is defined as eKpenses incuzxed by the CONSULTANT
in employment of others in outside firms for services authorized in the process of
completing the Basic and Additional Sezvices.
2"Direct Non-Labor E�pense" is defined as that expense (other than "per diem"
� expense), based upon cost plus (15%), for any for any out-of-pocket expense
reasonably incurred by the CONSULTANT related to its performance of this
Agreement, foz• aong distanca telephone charges, telecopy charges, messenger
� services, printing and rept�oductzon eapenses, out-of-pocket expenses for
purchased computer time, piudently incui7•ed tz•avel e�penses rela#ed to the work
on the Pz�oject, and similar incidental expenses incurred in connection with the
Proj ect.
B. BYT�LING AND PA.YMENT: For and in considez�atian of the professional services to be
pe��formed by the CONSULTANT herein, the OVVN�R agrees to pay, monthly, based
upon the estimated cost proposal detail of rates for work conducted during the Audit
Services shown in Exhibit "A" which is attached hereto and is incoipoxated by z�eference
as if set forth fully in tl�is Agreement, a total fee not fo exceed �140,000, $1�#2,saa, and
�1�t5,000 for� Fsscal vears endin� 2013, 2014 and 2015 resnectivelv.
Partial payments to the CONSULTAi�TT will be made on the basis of detailed monthly
statements rendered to and approved by the OWNER through its City Manager or his
designee; however, under no cuct�mstar�ces shall any monthly statament for seivices
exceed tke value of the work pez•foxmed at the time a statement is rende�•ed.
Nothing contained in ihis Article shal! require tl�e OWNER to pay for any work which is
tuisatisfactory, as ��easonably c�etermined by the City Manager or his designee, or which is
not submitted in compliance with terms of this Agreement, The OWNER shal] not be
requirecl to make any payments to the C�NSULTANT when the CONSULTANT is
default under this Agreernent.
It is specifically tuiderstood and agreed that the CONSULTANT shall not be authorized
to undertake any work puz•suan.t to the Agreement tivhich would �•equire additional
payments by the OWNER for any charge, expense, oz• reimbursemant above ihe
ma.cimum not to. exceed fee as stated, withou# �rst having abtained �vritten attthorization
from t�Ze OWNER. The CONSULTANT shall not proceed to perfoi�rn the seitiices listed
in Article III "Additional Services" witl�out obiaining prior written autho�•ization from the
OWNEiZ,
C. ADD�TIONAL SERVICES: Foz� additional services authoi7zed in writing by the
OWNER in Ai�ticle III, the CONSULTANT shall be paid based. on the Schedule of
Charges, Pa3�ments fo� additional services shali be due and payable upon submission by
the CONSULTANT, and shall be in accordance with E�ibit "A" attached hereto.
Statements shall not be snhmitted more frequently than monthly,
D, PAYMENT: If the OWNER fails to make undisputed payments due the CONSULTANT
for seivices and expenses within thiz•iy {30) days after receipt of the CONSULTANT's
undisputed statement t�er�of, prompt payment act interest as set forth in Chapter 2251 of
the Te�as Govei�vnent Code shall be paid on the amoiints due the CONSULTANT. In
addition, the CONSITLTANT may, if it has not z•eceived payment by the thu-ty-first (315�)
day after receipt of pa�ment, after giving ten (10) days' written notice to the OWNER,
suspend serviees under this Agreement until the CONSULTANT has been paid in full all
amounts due for sezvices, expenses, and charges, provided, however, nothing herein shall
requiz•e the OWNER to pay prompt paymer�t act interes# if the OWNER has a bona fide
dispnte with the CONSULTANT concerning the payment or if the OWNER reasonably
deteimines that the work is unsatisfactory, in accordance with this Article V,
"Compensation."
A.RTICLE VI
OBSERVATION AND ItCVI�W Or THE WORK
The CONSULTANT will exercise reasonable cax•e and due diligence in discovering and
promptly reparting to the OWNER any defects or deficiencies in the work of the
CON5ULTANT or any subcontractors or subconsiiltants.
ARTICLE VII
OWNERSHIP OF DOCUY�NTS
All documents pz•epared or furnished by the CONSULTANT (and CONSULTANT's
sti�bcontaactors or subconsultants) pursuant to this Ag��eemeni are instz�uments of seivice, and
shall become the property of the �WNER upon the termznation of this Agreement. The
CONSULTANT is entitled to retain copies of atl such documents. The documents prapared and
finnished by the CONSULTANT are intendad onl� to be applicable to this Project, and
OWNER's use.of these documents in other projects shall be at OWNER's sole z•isk and eYpense.
In the event the OWNER uses any of the information or materials developed pursuant to this
Agreement in another project or for other purposes than speciiied herein, CONSULTANT is
released fiom any and alI Iiabiiity relating to their use in that project,
ARTICLE V�7
INDEPEND�NT CONTRACTOR
CONSULTANT shall provide services to 0'S�J�NER as an independent contractor, not as
an emplayaa of the OWNER. CONSULTANT sha11 not have or claim any right arzsing from
empla�ee status.
ARTICLE IX
II1iDEMNITY AGREEMENT , ,
The CONSULTANT shall indamcvfy and save and hold kat�nless the 4WNER and its
office�•s, agents, and employees frQm and against any and all liability, cIairns, demands, dafnages,
losses, a�d expenses, including, but not limited to court costs and reasonabla attorney fees
inciu7•ed by the OWNER, and including, without limitation, damages for bodily and personal
injuzy, death and �roperty damage, resulting fi•om the negligent acts or omissions of the
CONSULTANT or its officers, shareholders, agents, or employees in the execution, operation, or
performance of this Agreement. � .
Nothing in this Agreement shall be construed to create a liability to any pez�son who is not
a party to tius Agreement, and nothing herein shall waive any of the parties' defenses, both at
iaw or equity, to any claim, cause of action, or iitigation filed by an�one not a pai�ty #o this
Agreement, including the defense of goveinmenial irn.munity, which defenses are hereby
expressly reserved,
ARTYCT,E X
INSUR.AlYCE
D�.uing ihe performance of the services under this Agreement, CONSULTANT shall
maintain the following insurance vvith an insurance company licensed to do business in the State
of Texas by the State Insurance Commission ox• any successar agency that has a rating with Best
Rate Carxiezs of at least A or abov�:
A. Comprehansive General Liability Insuz�ance with bodiIy injury limits of �ot less than
$1,000,000 :for each occu�•rence and not Iess than $1,000,000 in the agg�•egate, and with
property da�nage lunits of not less than $100,000 for each occurrence and not less than
$100,000 in the aggregate.
B. Automobile Liability Insurance with bodi�y injury limits of not less than $SQ0,000 for
each person and not less than $500,000 for each accident, and with property damage
lirnits of not less than $100,000 for each accident. �
C, Worker's Compensation Insurance in accordance with statutory requu�ements, and
Ernployex�s' Liabiizty Insurance with limits of not less than $100,00� foz• each accident.
D. Professional LiaUility Insurance with limits of not less than $1,000,000 annual aggi•egate.
E. Ti�e CONSULTANT shall furiush insurance certif'tcates or insut�ance policies at the
OVINER's request to evidence snch coverages. The insurance policies shall name the
OWNER as an additional insured or� all such policies, and shall contain a provision ihat
such insurance shall not be canceled or madif'ied without thii�ty (30) days' prior written
notice to OWNER and CONSULTt1NT. In such event, the CONSUL`�'AN`I' sk�alI, pzior
to the effective date of the change or cancellation, sezve substitute policies furnishing the
same coverage.
ARTICLE XI
ARBITRA.TI�N AND ALTERNATE DISPUTE RESOLUTION
The pat�ties may agree to settle any disputes under this Agreement by submitting the
dispute to m�ediation. No mediation arising out of or relating to this Agreement may praceed
without the agreement of both pai�ties ta submit the dispute to mediation. The location for the
mactiaiion shall be the City of Denton, Denton County, Te�cas unless a different location is
agreed to by the pariies.
ARTYCLE XII
TERMTNATION OF .A.GREEM�NT
A. Notwithstanding any other provisian of this Agreem.ent, either party may terminate by
giving thirty (30) days' advance wx�itten notzce to the other party. .,
B, This Agreement may ba taiminated in whole or in part in the event of eithe� pa�ty
substantially failing to fuifill its obligations under this Agz�eement. No such tetrtnination
will be affected uz�less the ot�ex party is given (1) written notice (delivered by certified
mail, xetur� receipt reques�ed) of intent to termina#e and setting foz•th tkte reasons
specifying the non-pei�formance, and not Iess than thi��ty (30) calendar days to cura the
failure; and (2} an oppoz�tunity for consultation with the tei7ninating party pi�ior to
tez�ninatian.
C. If the Agreement is tetxninated piior to campletion of the services to be provided
hereu�nder, CONSULTANT shall irnmec�iately cease all sez�v�ices and shall render a f nal
bill for services to #he OWNER within thirty (30) days after t.�.e date of terminatian, The
�OWNER shali pay CONSULTANT for all services properly rendered and satisfactorily
performed and for reimbuxsable expenses to teimination incuz•�•ed prior to tke date of
teimination, in accordance with Article V"Compensati�n." Shonld the QWNER .
subsequentiy contract with a ne�v consultant for the continuatzon of �services on the
Project, CONSULTANT shall cooperate in providing informaiion. The CONSULTANT
shall tuin over all documents prepared or fui7v.shed by G4NSULTANT pi.�rsuant to this �
Agreement to the OWNER on or before the date of tei7nination, but may maintain copies
of such documents for its use.
ARTICLE XIII
RESP�NSTBILITY F�R CLAIMS AND LIABILIT�S
Approval by the OWNEIZ shall not constitute, noz• be deex�ed a release of the
a�esponsihility and liability of the CONSULTANT, its employees, associates, agents,
subcontractors, and snbconsttltants for the accuracy and conipetency of theu designs or other
work; nor shall such approval be deemed to be an �ssumption of such xesponsibility by the
OWNER for any defect in ihe design or other work prepa�•ed by the CONSI7LTANT, its
employees, - subcont�•actors, agents, and consultants. CONSULTANT retains design
responsibility and liahility at all times during tlus Agreement and after completzon of this
Agreement.
ARTICLE �V
N4TTCES
AIl notices, cammunications, and repoi�ts required or permitted under this Agreement
shall be personally delivered or mailed to the respective parties by depositing same in the United
States mail to the address shown below, cet�tified mail, retucn reeaipt requested, nnless otherwise
specifed herein. Mailed notices shall be deemed communicated as of three (3) days' rziailxng:
To CONSULTANT:
J''etxy L. Gaithex•
Pax�tner, Assurance Services
Weaver and Tidwell, LLP
12221 Merit Drive, Suite 1400
Dallas, Texas 75251
97�-�90-197� office
972-448-9263 direct
Jei�y. C'raitker� WeavexLLP . com
To OWNER:
City of Denton
George Campbell, City Manager
21.5 East 1VIcKinne� Street
Denton, Texas 76201
940-349-7100
t�urchasin�cr,citYofdenton.com
All notices shall be deemed effective upon receipt by the party to whom such notice is
given, or within three (3) days' mailing.
ARTICI,� XV
E,NTIRE AGREEMENT
..... :... .... ... . .. . .
T1�is Agreement, conszsting oi 10 pages and the 3 pages fo�� � the Exliibii .A hereto,
constitittes the complete and final expressian of the agreement of the pai�ties, and is intended as a
complete and exclusive statement of the tezxns of their agreements, and supersedes all prior
contempflraneaus offez�s, px•omises, representations, negotiations, discussians, communications,
and agreements which may have been made in connection with the subject matter hereof.
ARTICLE XVI
SEVERA�3TLYT'Y
If any pro�ision of this Agreement is found or deeined by a couz•t of competent
jurisdictian to be invalid or unenforceable, it shall be considered severable from the remainder of
this Agreement and shall not cause the remaindez• to be invalid or unenforceable, In such event,
the paities shall refor�n this Agreement to replace such stricken provision with a valid and
enforceable pxovision which cozxzes as close as possible to expi•essing the intention of the stricken
provision.
ARTICL� XVII
COMPLIANC� WITA LAWS
The CONSULTANT shall comply with all federal, state, and local laws, rules,
xegulations, and ordinances applicable to the work covered hereunder as they may notiv read ar
he�•ei�after be amended,
ARTICLE XVIIY
DISCRIMINATION PROHIBITED
In perfoirning the services required hereunder, the C�NSULTANT shall not discriminate
agaiust any �erson on the basis of race, color, religzon, sex, natkonal origin or ancestry, age, or
physical handicap.
ARTICLE �X
PERSONNEL
.A., The CONSU�TANT represents that it has or will secure, at its own eYpense, aIl
personnel �equired to perform all �he services requued undex this Agreement, Such
persotuael shatl not be employees or.off'icers of, nox have any contractual relaiions with
the OWNER. CONSULTANT shall inform the OWNER of any conflict of interest o��
potential conflict of interest that may arise dltring the tei�n of this Agreement.
B. All services required hereunder will be pel�formed by the CONSLJLTANT or undez� its
supervision, All personnel engaged in work shall be qualified, and shall be authorized
and pez�mitted under state and local laws to perform such sezvices.
C. In those instances deemed necessary by th� OWNER, the CONSUI,'TANT, its employees
and/or its Sub-consultants shall be required to submit to hackgrounc� checks. .
ARTICL� XX
ASSIGNABII,ITY
Th� CONSULTANT sha11 not assign any of its scope of work under in thzs Agreemeni,
and shall not hansfer any of its scope of work undex this Agreement (whether by assignment,
novation, ox• otherwise) without the prio�• written consent of the OWNER. Should the
CONSULTANT assign any part of the monies due under this Agreernent, CONSULTANT is
requu•ed to provide w�•itten. notice of the same to OWNER, Any assignment of monies due under
this Agreement shall not change any of the teims ot• conditions of this Agreement to anclude but
not limited to the teims and conditions fox• payment under this Agreeinent.
ARTICI�� XXi
MODIFICATION
� No waivez• oz� modzfication of this Agreement or oi any covenant, condition, or limitation
herein contained shall be valid unless in writing and duly eYecuted by the paz•ty to be charged
therewith, anc� no evidence of any waivez• or modification shall be offered ar received in evidence
in any proceeding arising between the parties heieto out of or affecting this Agraement, or the
rights or obligations of the parties hereunder, and i�nless such waiver or modif'ication is in
writing and du�y e�ecuted;.and the parties further agree that the provisions of this section will not
be waived unless as set forth herein.
AR'TICLE XXII
MISCELLANE�US
A. The following exhibits are attached to and made a part of this Agreement:
E�hibxt A— Weaver and Tid�vcll Proposal dated.May lst, 2013.
Exliibit B— Substitute W-9 form foi� co�upletioz� by Contractor
Exhibit C-- Conflict of Ynterest foxm for completion by Contrnctor
B. CONSULTANT agrees that OWNER shall, until the expiration of five (5) years after the
final payment or after fznal completiou of all work xequired under this Agreement,
whichever is langer, have access to and the i�ight to examzne any dn•ectly pertinent books,
documents, papers, coi�espondence, io include e�mails, and records of the
CONSULTANT involving t�ansactxons relating to this Agreement. CONSULTANT is
requued to maintain a�d make available all electronzc records associated with this
Agreement for purposes of examination, CONSULTANT agrees that OWNER. shall
have access during normal working houx�s to a11 neeessai•y CONSULTANT facilities and
shall be provided adequate and appropriate working space in ot•der to conduct audits in
compliance witk� this section, OWNEIZ shall give CONSULTANT reasonable advance
notice of intended audits. This paragraph shall work in conjunction with the Audit
provision set forth in A�.•ticle XXIII.
C, Venue of any suit or cause of action under this Agreement shall lie exchisively in Denton
County, Texas. This Agreement shall be construed in accordanee with ihe laws of ihe
State of Texas.
D. For the puipose af this Agreement, the key persons who will perform most of the work
hereunder shall be Je�•ry L. Gaither, P�rtner, Assurance Services, However, nofhing
herein sha111imit CONSULTANT fi•oni using ather qualified and campatent members of
its fum to perform the seivices requu•ed l�erein. CONSULTANT understands that
OWNER is to be informed of the removal or loss of any of the key persons woi�king
under ihis Agreament. CONSULTANT aiso agrees to pz•ovide #he OWI�BR with natice
af the name(s} of who it intends to replace the key person. OWNER shall have a right ta
reject any replacement key peison(s) and CONSULTANT agrees to name a replacement
key pex•son(s) accaptable to the OWNER:
E. CONSULTANT shall commence, carry an, ancl complete any and all projects with all
applicable dispatch, in a sound, econoznical, and efficient manner and in accordance with
the pt•ovisions hereof. In aceomplishing the projects, CONSULTANT shall take such
steps as �ue appz•apriate to ensure that the work involved is properly coordinated with
related work being carried on by the 4WNER.
F. The OWNER shall assist the CONSULTANT by placing at the CONSULTANT's
disposal all available information pertinent to tk�e Project, including �revious repoi�ts, any
other data relative to the Project, and ar�anging for the access thereto, and make alI
provisions fo�• the CONSYJLTANT to enter in or upon public and private property as
required for the CONSULTANT to perform services under this Agreement.
G. The captions of this Agreement a�e for in�arznational purposes anly, and shall nat in an3T
u7ay affect the substantive terms az� coz�ditions of this Agx•eeinent.
ARTICLE XXIII
RIGI3T TO AUDIT
The OWNER shall have the righ.t to audit and make copies of the boaks, records and
computations pei�taining to this agreement. The C�NSIILTANT shail z�etain such books,
�ecords, dociunents and other evidence pertaining to this �lgreement during the contract period
and five years thereafter, except if an audit is in progress or aiidii findings are yet unxesolved, in
which case records shall be kept until all audii tasks are completed and resolved, These books,
records, documents and other evidence shall be available, within 10 business days of rvritten
request, Fui�ther, the CONSULTANT shall �also require all Subcontractors, material suppliers,
and other payees to retain all books, records, documerits and other evidence pertaining to this
agreement, and to allow the OWNER similar access to those documents. All b�oks az�d �•ecords
will be made a�vailable within a 50 mile radius of the City of Denton. The cost of the auc�it will
be borne by the OWNER unless the audit x•eveals an oveipayment of 1% or gre�te�•. Tf an
oveipayment of 1% or greater occurs, the i•easonable cost of the audit, inolui�ing any travel costs,
must be borne by the. CON�ULTEINT �vhich must be payable within five buszness days of
receip� of an invoice, �
Failure to comply with the p�•ovisions of this section shall be a material breach of this contract
ax�d shall constitute, in the OWNER'S sole discretian, grounds for te�znination thereo£ Each of
the terms "books", "records", "documents" and "othez• evzdence", as used above, shall be
consttved to include drafts and electronic files, eve� if such drafts or electronic files are
subsequently used to generate or prepare a%nal printed dacnment.
IN WITNESS HEREOF, the City of Denton, Texas has caused this Agreement to be
executed by its duly authorized City Manager, and CONSULTANT has executed this Agreeinent
tluough its duly authorized undersigned of�cer on this the 18th day of June, 2013.
w�- � �.�,�.-��.%/�
WEAVER AND TIDWELL, LLP
���
IGNATURE
/Zl �, ' � .l�rr�
MAILING ADDRESS
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PHONE N UMBER
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FAX NUIVIBER
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PRINTED NAME
CITY OF DENTON, TEXAS
BY: G-
ORGE C. CAMPBELL
CITY MANAGER
DAT'E: OG� I l�I I ��
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
,
BY:
APP VED AS TO LEGAL FORM:
ANITA BURGESS, CITY ATTORNEY
- >
BY: - � s
�X�il�l� �
Y���1
May l, 2013
Mi. Charles Springer
Finauce Duector
City of Denton
215 �ast McKinney Street
Danton, Texas 7G201
Dear Mr. Springer:
We appreciate the opportunity to provide the City of Denton (tha City) with fee estin�ates for the
City's fiscal years ending Septeinber 30, 2013, 2014 and 2015 Evith options to extend our
conhac# for an additional two years at the Ciry's option.
We liave enjoyed oi�r association with the City atid have been able to anaintain our fees for the
City's fiscal years ending Sepfemt�er 30, 2012 and 2011 at �lie same fee we proposed for 2010
due to ef�ciencies gained thx'ough grotiving ai�d contiuued kno�vledge of the City's opeiatiolis
aiid contuiued and expanded use of techrcology du�xng the audit.
Additionally, tlie U.S. Govet�t�netit Accountability Office (GOA) is expectad to adopt revised
compliance requirameiits for siiigle audits, We ex�ect, based on prelinlit�aiy analysis of esposure
drafts, that. there �vill be ft reduc�ion in the uahue and amount of co�.iipliance reqtiiiements for
siugle audits.
Considering the expected reduciioz�s and our expet�ieiice with the City for the past sevezal years,
�ve are pteased ia provide the follo�ving estimate:
FYE AttdidSingle Audit TCEQ Report Total
9/30/2013
9/30/2014
9/30/20I5
137,500
140,000
142,500
2,540 $ 140,000
2,500 t42,500
Z,soa ��s,000
The 2013 estimate represeuts aii approxiniate 10% decrease in #otaI fees foi 2012.
We are ct�rreittly tl�e auditor of ftve of the approximately fifteen Tetias cities �vith populations
bet�veen 100,OQ0 to 200,000 (siniilar size cities of Denton) �s �vell as being anditoi for ot�er 100
govei��mental entities that t'eeeive the GFOA ativard.
�t�If�GEfEN4Ei1T Y161VERhNDtIp14ElLLU' UALLAS
f,1E�=iBER 4f �A{(ER TIIIY CCRTI€IE� �UBUCACCOUfItAtJTSAt;GCDI1Sl1fTAI1iS 122.71►.if,Rit -0RIYE, SUITE 14U0, oA�IAS, T%75251
IftiEHNAiItlffAi i'i;(Y15'iCq`IE�iI.P,COhi P:E�J2M�4Dt9?0 f;(972}T028321
Cify of Denton
May 1, 2�13
Page 2
Thank yoti for yotlr request for fee estiinates for the next tluee years and �ve look forward to a
continued association tvifll the City.
Sincerely,
��
Jerry L. Gaither
Partner
PROFESSIONAL SERVICE� AGREEMENT
FOR AUDITING SERVICES
FOR THE CITY OF DENTON, TEXAS
Scope of 5ervices
A. Weaver and TidweIl, L.L.P. (Weaver) will perfortn the annual audit of City of Denton,
Texas (the City), basic financial statements. Such audit will be conducted in accordance
with generally accepted auditing standards; Government Auditin� Standards, issued by
the Comptroller of the United States; the Single Audit Act of 1996; and the applicable
OMB Circular, Audits of State and Local Governments, and any other applicable
regulations as set forth by federal, state, or local regulating bodies.
B. Weaver will issue a management letter to the City reporting any mater-ial weaknesses in
the City's internal accounting controls discovered during the a.nnual audits of the Ciry's
financial statements.
C. Weaver wi11 perform the annual compliance audit and single audit of the City's federal
financial assistance programs. Such audit will be conducted in accordance with generally
accepted auditing standards; Government Auditing Standaxds, issued by the Comptroller
of the Uiiited States; OMB's Compliance Supplement for Single Audits of State and
Local Governments; the applicable OMB Circular, Audits of State and Local
Governments; and any other applicable regulations as set foi�th by federal, state, or local
regulating bodies, particularly the Governmental Accounting Standards Board as they
may now read or hereinafter be amended
D. Weaver will perfortn agreed upon procedures regarding the City's TCEQ compliance.
E. During any fiscal year covered by this Agreement, the City may request Weaver to
provide services in addition to the services provided hereunder. Weaver may, at its
option, agree to provide such additional services upon terms and conditions as �nutually
agreed upon. .
Duration of Agreement
F. This Agreement for audit setvices as specified herein for the financial statements of the
Ciiy pertains to the City's flscal years e.nding September 30, 2013, September 30, 2014
and September 30, 2015 and, if the City exercises its option for the City's fiscal years
ending September 30, 2016 and September 30, 2017 unless sooner terminated.
SERVICE TIMELINE
I'OR AUDITING SERVICES
FOR THE CITY OF DENTON, TEXAS
Proposed Schedule:
Finn's ability to meet the tuneline:
The schedule below indicates the dates of deliverables. We will work with the City to adhere to
the schedule.
WEAVER AND TIDWELL LLP
AUDIT TEAM
FOR THE CITY OF DENTON, TEXAS
Jerry L. Gaither, CPA
Parfner, Assurance 5ervices
Parfner in Charge, Public Sector Practice Group
Certified Public Accountant Texas
Cerfified Govemment Financial Manager
Professionai Experfence
• Thirfy-five years of public accounting experience, inciuding 27 years as an audit parfner, all at
Weaver
• Leader of the flrm's governmental and nonprofit practices, responsible for all services to those
clients: financiql audit, risk advisory services, forensic accounting, consulting, client
relationships, and quality assurance
• Directs Weaver's strategic growth plans, including the development of staff training,
methodology improvements, a financial audit handbook and market development
• Developed Weaver's audit methodologies for financial audifing of governmental entities such
as cities, regional governments and public school districts, including single audits meeting the
requirements of the U.S. Office of Management and Budget (OMB) A-133
• Has served for more than 3� years on the Government Finance �fficers Association (GFOA)
Special Review Committee, making him the committee's most experienced Texas member
• Engagement perrfner for 4 of the 25 largest cities and 3 of the 15 largest school districts in Texas
• Serves as audit engagement parfner for school districts with total assets up to $1.5 billion and
total revenues up to $825 million
� Serves as audit engagement parfner for governmental entities with governmental-wide assets
up to $1.3 billion and governmental-wide revenues up to $350 million
Represenfiative Client Experience
• City of Allen
• City of Azle
- City of Crowley
• City of Desoto
• City of Denton
• City of Duncanville
• City of Frisco
� City of Grand Prairie
- City oF Greenville
� City of Haltom City
• Ciiy of Highland
Village
• City of Killeen
• City of Lancaster
• City of Lewisville
• City of McKinney
• City of Rockwall
continued
• City of Rowlett
• City of Sachse
� City of University Park
• Town of Addison
• Town of Highland Park
• Town of Little Elm
• Town of Trophy Club
� Town of Westlake
• Birdville ISD
• Carrollton—Farmers
Branch ISD .
� Fort Worfh ISD
• Duncanville ISD
• Highland Park ISD
• Hurst-Euless-8edford
ISD
• Irving ISD
• Lancaster ISD
� Lewisville ISD
• Mansfield 15D
• Mesquite ISD
• Richardson ISD
• Plano ISD
- Norfh Central Texas
Council of
Governments
• Central Texas Council
of Governments
• Central Texas
Workforce
Development Board
� Greenville Electric
Utility
Jerry Gaither, contrnued
Professional Awards, Acflvifies and Memberships
Member, Texas Society of Cerfified Public Accountants (TSCPA) ;
Member, American Institute of Certified Public Accountants �AICPA)
Member, Association of Government Accountants
Member, Government Audit Quality Control Center
Associate Member, GFOA and member, Special Review Committee
Associate Member, GFOA Texas (GFOAT)
Associate Member, Association of School Business OfFicials; former member, Panel of Review
Former Member, Technical Issues Committee to AICPA as a liaison to the Government Accounting
Standards Board
Education
Bachelor of Business Administration, A�counting, Texas Christian University -
Currently meets continuing professional education required by Generally Accepted Government
Auditing Standci�ds and the Texas State Board of Public Accountancy
A total of 169 hours of continuing professionai educafiion over the past three years, including 92 yellow
book hours relating to governmental accounting and auditing
Governmental Continuing Educafion Detqil - Selected Courses
• AICPA National Government A&A Update �
• Weaver Public Sector Training
• Advanced Govemment
• Applying A-133 to Nonprofit and Govemmental Organizations
• GAQC Required Annual Update Webcast
• GFOA's 105th Annual Conference - Navigating the New Normal in Government Finance
• Independence Requirements for CPAs
� Intermediate/Advanced Government Course
� OMB Circular A-133 8� SAS 117
• Personal and Professional Ethics for Texas CPAs
• Single Audit/OMB Circular A-133
• Using the 2011 Yellow Book Independence-Nonaudit Services Documentation Practice Aid
� Leadership 7raining—Assurance Parfners
• Weavers Governmental and Nonprofit CPE Event
Sara Dempsey, CPA
Senior Manager, Audit Services
Cerfified Public Accountant, Texas
Professional Experience
• Nine years of experience in public accounting
• Practice emphasis in accounting and auditing for governmental and nonprofit entities, including
municipalities, public school districts, charfer schools, transportation authorities, and councils of
governments
• Manages the annual financial audit for three cities with government-wide net assets in excess of
$200 million
• Prepares the CAFR, A-133 single audit reporf, state single audit reporf, passenger facilities charge
program audit report, accountant's reports on debt coverage ratios, when applicable, for
approximately eight entities, all of which receive the GFOA award
• Supervises and reviews the work of engagement team staff
� Researches proper accounting for complex transactions and assists clients with implementation of
new accounting standards
Government Experience
• City of Denton
• City of Killeen
- City of Allen
• City of Rowlett
• City of Southlake
• City of University Park
� Town of Highland Park
• Irving 15D
• Mesquite ISD
• . Lewisviile ISD
- RockwalllSD
• Alamo Area Council of Governments
- East Texas Council of Governments
Professional Awards, Activities, and Memberships
� Member, Texas Society of Pubfic Accountants and its Dallas chapter
• Member, American Institute of Cerfified Public Accountants
� Member, Government Finance Officers Association
• Member, 5pecial Review Committee of the Government Finance Officers Association (GFOA)
• Dallas representptive, Women of Weaver
• Auditor of the year at Weaver
Presentaflons and Publications
• Speaker, Advanced Government Training, "GASB and Yellow Book Update" and "CAFR
Preparation," August 2012
• Speaker, 20 20 Audit Training, "New In-charge Training," June 2012
continued
Sara Dempsey,.continued
Education
• Bachelor of Business Administration, Accounting, Texas State University
• Currently meets continuing professional education required by Generally Accepted Government
Auditing Standards and Texas Stpte Board of Public Accountancy
• A total of 231.5 hours of continuing professional education over the past two years, including 95.5
yellow book hours relating to governmenta) accounting and auditing
Governmental Continuing Educaiion Detail - Selected Courses
• Advanced Government Auditing
• 2013 GAQC Annual Webcast
• 2013 AICPA Guides for State and Local Governme.nts, Not-for-Profits, and Yellow Book/Circular A-
133 Audits: What to Expect for Clarity, Auditor Reporf Changes, and More
• Annual GFOA Conference
• Baby Steps or Giant Leaps2 Sizing Up the Political Landscape
- Changing the Rules of the Race: GASB Update
• Pay to Play? A Look at the Financial Statements
• Roundtable: Hot Topics from the GFOAT Forum
• Running Amuck?I Best Practices in Accounting Policies and Internal Controls
• Insight: Single Audit Fundamentals Part III: Understanding and Testing of Controls and Compliance
• Single Audit/OMB Circular A-133
• Sampling in a Single Audit Environment
• Employee Benefit Plan Update
Dallas Dugger, CPA
Senior Associate I, Audit services
Certified Public Accountant, Texas
Professional Experience
Overfouryears' experience in public accounting
Practice emphasis in accounting and auditing for a wide array of governmental entities and nonprofit
entities, including public school districts, private schools, colleges and universities, cities and
foundations
Plans and performs audits in accordance with the Single Audit Act, OMB Circular A-133, and generafly
accepted government auditing standards
Reviews financial statements for proper reporfing and disclosures
Supervises and reviews the work of engagement team stafF
Experience auditing and verifying valuation of alternative investments, especially for foundations,
endowments, religious organizations and higher educations
Experience auditing employee benefit plans, including both 401(k) and 403(bj plans
Supervises the financial audit of a private college; this nonprofit includes a single audit over federal
financial aid as well as procedures to examine the appropriate use and classificafion of restricted
funds
Supervises the annual financial audit for the fourth-largest schooi district in Dallas County, with total
assets up to $770 million and total revenues up to $511 million per year
Experienced as a senior auditor on annual financial and single audits following Governmentdl
Accounting Standards Board �GASB} requirements for a city with government-wide assets of $1.3
biliion and annual revenues of $340 miliion
Government Experience
City of Denton
City of McKinney
City of Southlake
City of University Park
Town of Addison
Garland ISD
Professional Affiliations
Member, Texas Socieiy of Certified Public Accountants {TSCPAJ
Member, American Institute of Certified Public Accountants (AICPA)
Board Member and Treasurer, Clear Springs Home Owners Association
Education
Bachelor of Science in Accounting, University of Norfh Texas
Currently meets continuing professional education required by Generally Accepted Government
Auditing Standards and Texas State Board of Public Accountancy
A total of 172.5 hours of continuing professional education over the past three years, including 118
yellow book hours relating to governmental accounting and auditing
contrnued
Dallas Dugger, contrnued
Governmental Continuing Educafion Detail - Selected Courses
Intermediate/Advanced Government Auditing -- - - -- - - - - -
Singie Audit/OMB Circular A-133
2013 GASB/GAAP/GAGAS Update
Sampling in a Fnanciai Statement Audit
Sampling in a Single Audit Environment
Employee Benefit Plan Audit
OMB Circular A-133 and SAS 117
ACL Intermediate
AuditWatch Level 4
Independence Requirements for CPAs
LeMas er Dani�ls PLLC
Certfied PublicAccountant5 andAdvisors
Bellevue SYSTEM PEER REVIEW '
i
Boise..... ... .......... ....... �_ .. . .. _.._. . . ... . , _..... ..._. . ... . .... .,_ . ... ..._,_.. ....,. , .. -._....._... . . . . , -�-I
Gmndview
AQoses Lake
Omak
otneno To the Partners of �
Q����y Weaver and TidwelI, L.L.P. �
sP°i:a"e • and the National Peer Review Committee of the
r��-cties Amexican Institute• of Cextified Public Accountants
Walla Walla
Wenatchee �
Yalclma
We have reviewed the system of quality control for the accounting and auditing practice of Weaver
and Tidwell, L.L.P. (the Firm) applicable to non-SEC issuers in effect for the year ended May, 31, 2010.
Our peer review was conducted in accordance with the Standards for Performing and Reporting on
Peer Reviews established by the Peer Review Board of the American Institute of Certified Public
Accottntants. The Firm is responsible for desigiling a system of quality control and complying with it
to provide the Firm with reasonable assuxance of performing and reporting in conformity with
applicable professional sEandards in aIl mafexial respects. Our responsibility is to express an opinion
on the design of the system of quality control and the Firm s compliance therewith based on our
review. The nature, objectives, scope, lixriitations of, and the procedures performed in a System
Revie� are described in the standards at www.aicpa.org/prstunmary.
As required by the standaxds, engagernents selected for revitew included engagements performed
under the GoaernmentAuditing Standards and audits of employee benefit plans.
In our opinion, the system of quality conirol for the accounting and auditing practice o# Weaver and
• Tidwell, L.L.P. applicable to non-SEC issuers in effect for the year ended May 31, 2010, has been
suitably designed and complied wifih to provide the Firm with reasonable assw�ance of performing
� and reporting 9n conformity with applicable professional standards in alI material respects. Firms can
receive a rating of pass, pass with deficiency(ies), or fail. Weaver and Tidwell, �.L.P. has received a peer
. review rating of pass. � �
� E�-ei- �/ �L �
C.
Spokane, Washuigton
September 30, 2010
� ;��� -��� - _
_ ��_ �-
- _ �� - _
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E�hib�i�
Ci�y o� Denton Purchasing
9o1-B Taxas St. -
��,� Denton, TX 76209
' Phone: (940? 349-i100 FaX: (940) 343-7302
.���--- � www.denlonpurchasinq.com
New Vendor lnfor�ma�ion Shee#
Tha !RS req�ires alf vendors to compleiz ths atta�hed W-9 Fonn.
(Compteted W-9 Form must be returned wittr Vendor Applfcaiion).
Rll inform�tlon must be tecelved before e purchase order ar paymant wi(I be tssued.
�[ W-9 Attached �
� New Vendpr �
_ p Vendor Change Vendor Nurnber (required if chang{ng iflforrnation)
[] Refund
ComEranyllndSvidual Nama: Wsavex and T�.clwell, LI,P
rax lnrsoclal security #: � 5- 0 7 8 6 3 Z 6
'�v.Ae nf Entitv: •
� �ndividuaU Q Corporafion �J Partnershlo C} Govecnmer�ial C Oihar: Pfease
Sofe EnE[ty Specify
Prapriefar . '
PC3 Address: �
Company Name: Weaver anci Tidwel.l, r LP
Cantact Name: Wi 11 i am Jones
Address: 2827 Y�zes� Sever��h S�reet
Suite 700
�'ort Worth, TX 761p7
Phone Ntrmber; 8� 7- 3 3 2- 7 9 0 5 � Emaii;
�ax Number; 817 � 4 2 9- 5 9 3 6 Wabs9te:
R�rnit Acfctress: (if different from �bove)
Company Narne:
Contact f�ama;
Addtess:
PF�one Number.
Fax Number. `
F,�, �[�t �� Request for iaxpayer
(qev,pecember2011) Edentificaiian Number and Certrfication
Dapar6�erA of the 7roaswy
Intemal Rev�nue Servke _
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W
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9haYm on youf 1nCOn1e tax reiu
& Tldwell, LLP
iameldisreyarded entlty namo,
Check approP�ato Eax for fedoral lex cfassiF.catlon; .
❑ IndMduaVsole prvprietor ❑ C Cacporallan ❑ S Corp�atbn Q Pazmershfp ❑'GvsVestata
� Llmfted Ilabffitycumpany, Fj�ter Ihe taz classlfkxlbn (C=C corporatlon, S=S corperation, P=partnersWp}►�
Other(see
Addrrss (numbef, sAeet, and apL or stnle no,)
2821 West Seventh Street, Suite 760
Fort Wprth, TX 76�Q7
�_ Texpayer ldeniification Number ('T"ItJJ
�nteryourllfV in Ihe appropria[e box The TfM provldect must match the name gtven on ihe'Name` Itr
#o evold backup wKhholding. Fot Indivlduals, thls is your sacial secur{ty number(55��. Flvwever, iora
tesldent allen, sote proprietor, or dlscegarded entity, see the Pwt 1 Instructlons on page 3. For other
enffUes, ft fs your employer ldenii6catlon number (EI{�l). It you do nol have a numbar, seo HoW togeta
77N on page 3,
Note.lf Ihe account is fn moro ti�an one name, see the chart on page 4tor guldellnes on whose
number ta enter.
name
Ciive Form to the
requester. Do not
send to the f RS.
Exempt payoe
Under penafdes of pequn�, I certtfy 1het:
1. 'fhe numbar shown on this fonn Is my corteci ta�ayer identilfcatfon numbar (or i am walNn9 for a number to be fssued fo me}, and
2, ! 2m not subJect to backup withholding because: (a} I am exempt from backup Y�Ithtwlding, or (h) i have not been notifled by the Intemal Revenue
Service (lRS} ihat I am sv6jec[ io bac;c�p wElhholding as a tesult o( a fallure fo repvrt a!f interast or divtdends, v! (c) the 1F1S hus notlfied me that I am
na bnger subjecl to backup wiEhhoiding, and �
3. 1 am a U.S, clHzen or ather U.S. person {defined befov�.
Certificallort instructians, You rnust cross ovl tlem 2 ebove it you hava been nodfied by the 1RS Ihat yau are currenily subject to beckup withha�dfng
because you have iailed to report ai3 Interest and dividands on yout lax retum. Por real astale hansactions, ftem 2 does not apply. For martg�ge
interest pzid, acqu[sflloh or abandonmeni of secur�d property, cancellatfon ol debt� conM6utfons to an 1nd[viduaf �eliroment artangement (IRA), and
generally, payments other than lntetest and JNldehcls, you ere not required to slgn ]hs certificaHon, hut you musi provida your corteci 71N, Sae the
Instructlons o n page 4. ___ 1 _
51gn s�gnature or " • �
Here u,5.pareonY��`���� ,'� ��,�� f
Generallnstructions ��
Sscllon reFerences are to lhe lnterna) Ravenue Gode unless olhalv�ise
noted. '
L 4
n _ Datef
Note. I! a reqvester gives you a torm olhar then Form W9 to request
your 71[J, yau must us� the Yequester's form K it Is subetanilally slmilar
to thLs Fotm N1-9. '
pafin'rtion of a U:S. person. Foriederal teX putposes, you ere
Purposs of Farm consldered a U.S. person f�youare:
A person tvho is required to file an infortna�ion retum vrith the IRS must '��n�vidua( who Is a U.S. cftlzen a U,S. reslden! aden,
obtaln your correct faxpayer ldent'�ficaffon number (IlN) to rapart, tor • A partnetship, corporation, company, or assaciaUortereated or
eXample, Incdme paid to you, real estate tranractions, mortgege tnterest organi�ed in Ehe United States ar under iha laNrs of the United States,
you pald, acquisttion or abandonment of secured properiy, cencellaUOn . p,,� �state (other than a forelgn estate), ar
o( debt, or contrihullons you rnade to an tWa. . q domestk trust (as defined In Regulatlons secdan 3D1J70i-�.
lJsa Form W9 on[y ff you are a U.S, gerson (ncluding a resident 5pecial rulas forparfierships_ Paftnershlps thal conducla tradeor
allen), to prov�da your correct TIN to the person requesting ft{ihe hustness [rt tha United States are genarally requlred to pay a withholding
requestar) ancf, when applicable, to; tax on any toralgn pariners' shore of Iricome from such buslness. _.
1. Certlfy Ihai tha TIN you aze giving fs correct (a you are waiUng ior a ��, In certatn cases where a Form W-8 has not been recetved, a
number to be issued), partnersfilp Is requirad to presume that e pattner Is a fore(gn person,
2. Certtfy �hat you are not subjett to 4ackup �v'rthhpkling, or and pay lhe withholding lax• ThereTore, If you ere a U.S, person that Is a
3� Clalm exemptfon frnm backup wlthholding tf you are a U.S. oxeinpt P�� �$ P��hlp conducUng e trade or bustnass I� the Unfted
payee. If appilcable, you are a�so certifying ihat as a U,S, person, your r States, provida FoRn W-9 io iha partnership to estabilsh your U,S.
alloea6le shara of•any paru�ership Income Fran a U.S, Uade or business stetus and avotd withhoiding on your share n/ partrie�shlp tncome.
is notsubject io Nta Wilhhotd[ng laX on foteigry pati[iers' share of '
eHeoilvelyconneofed income.
Cat. No.1�17f ' Pomt �1i��9 (Aev, 72-2U7i)
,
Fam W-s (HOV. fazoo�l
• The U.S. gtanior or oiher ovmer of a grantor lrust artd not lhe
Wat, and
+ 7}[e LI.S, Irust (other ihan a grantor tnrsl} end not the
be�tiClades ot Ine irusl,
Forelpn person. ff you are a fare[9n person, da nol use Forrn
W-9. Instead, use Ihe approprlale Farm W-8 �see Pub�Calion
5i6, WtthhokJlog of 7ax an Nonrestdent Allen�s and For�slgn
Entilies},
NonroslcienE ation who b�comes e resident aEten. Generally,
on[y e nonresldenl allen Individual msy use Ihv iomis oi a iex
froaly to reduee or e�tmfnale U,S, 1ax on ceiiafn types o( Inaome.
However, most IEVC IroaUes contain a provlslon known as a
"savfng ciause." Exceptions spea(ied ]n lhe saving dause may
Pettnlf an exemption from tau to conqnue for cerlain types of
ncorna even atler lhc payee has otherwlse becoma a U.S,
resfdent alten far iax purposes.
If yvu are a U.S. rssident auen who ts retytng on an exception
conialned fn fhe saving clause of a tex Ireafy 10 clatm en
axempl3ori (rom u.S. lax on cerlsfi lypes of Incorne, you must
attaclt a sEaiemenE fo Form W-8-that specitles the toliovdng five
ifems; '
i. The treafy couniry. Generally, Ihls must be lhe s2rtte frealy
under which you datmed axempiton from tax as e nonresident
a4en.
2, 'The treaty artfcle addressfafl lhe (ncome.
3. Ttie articfo numbar (or tocatlon} tn the tax Iraaly ihat
cuntains the savJng clause and Its exCeplions.
d, ihs type and amounl o! Income Ihut q�taAfles for 1he
exempt}on lrom tax. �
5. Sufflcienl facts to justify the exempffon from tax under ihe
ferms of the Treaty aritote.
Example. ,4rticfe 20 of (he U.S: Chfna inoome tax troaty allows
an exerapllon tram tc� forscholarshfp lncome �ecelved by a
Chlnese sluclenf temporarily present k� the United Slalas, Under
U.S, (a�Y, this siacfent will become a resident 211en for tax
purpases 1f hls ar her stay in Iho United Staies excecda 5
calendat years. However, paragraph 2 ot ihe Ilrsl Pralocol to ihe
U,S.-Ch�na treafy (dalad April 3Q, i384j a1loYrs tt�e prov�sions of
,4riic(e 20 lo conlinue to app1y even after ths Chfnese shrdenl
becornes a resfdani alien oi the Un�led Siates. A Chfnesa
studept tvho qualifies for thfs oxceptlori (under paragraph 2 oi
ihe Qrst prol000Q and Is relying on Rhfs excepUon to cfafm sn
exempllon from lax on hls or her schafu5hlp or fepowsblp
Iricome wouid allach lo Form vl-8 a statement thal lndudes ihe
infwmapon dascribed above to svpport fhat exemptlon.
ff you are a nanresiden! aUen or a fo�eipn ehUry nol subJecl to
backup withhalding, g(ve Ihe raquss�er ftie approprfale
completed form NJ-8.
What ls baakup wilhholding7 Persons making cerlaln paymen[s
to you must under cartafn Condlllons withhold and pay tp the
IRS 2896 of suah paymenla liils ]s callnd "badcup wllhhoiding °
PaymanEs thal may be sut�Jecf io bacicup wilhhofding inr�uda
3nterest, tax-exempt Interest, d{vldands, broker and heMer'
exchange transaclbns, tents, royalltes, nonemployee pay, and
certafn paymenis trorn tl�h�ng 6oat operators. Roal eslafe
Iransacllons ere not suh)ect to hadcup ydlhholdinp.
You will noi be subject !o bad<up vriU�ftofding on paymenis
ycu receiva iF you givo the raquastar your corraol 71N, mslce lhe
proper corUilcutlons, arxt �epori all yarr laxabfo Irtlerest and
ckvtdends on your lax relum,
Paymenis You recelve �n�ifl be sub)ect to backup
withholding if:
t. Yau do aol (um?sh your TIN to lhs rec�uester,
2. Yau do not cerlify your TlN �,vhen reqWred (seo lhe E'�ri If
inslruclio�s on page 3 tordeialis),
3. Ttie IRS tel(s lhe raquester �hat you (ur�ilshed an (ncorr�cl
11N, � .
pago 2
4. Tha IRS tells you lhat you ars subJect to backup
vrEthholding beeause you �d nol rapoH alf your Interest and
dividsnds on your tax retum (ior reporiable Interest end
dFvidends only}, or
6. Yaa do not cartlfy to�the raquesiel Ihat you are Aot sub�ect
to backup'wMhhofd"�ng undet 4 above (for rsportaBle Mterest and
dividend accoants openec! aRer 1983 anlyj.
CeNaln payees and paymenfs are exempl frarri backup .
wllhhoiding, 5ee the InslruoUons belotv and Ihe saparale
Insiruattans for the Requaster of Form W 9,
A}so see specta! n1les for partnershlAS nn p�4a i,
Penaities
Faflura ta lurnlsh T1K.1t you lail to furnlsh yaur conect TiN to a.
requasiel, you are sub�eci to e pBnalty oi $50 for eaclt such
fai[ure unless your !al}ure ta due to reasonable cause and nof lo
wififul neglect,
ClYfl panaltyr for tafse fniormatlon wilh respeot to
withholding. lf you meka a talse s[atement tivllh na reasonabfe
basls Ihat results In no baokup wlthhoiding, you aze subJeat to a
$500 penally.
Criminal pena{ty for falslfyfng InformaEfon. Wi11[ufly talsHying
ceriiffcatlons or af6rmal;ons may subject you to criminal
genaitiea Iaciuding Mas andlor lmprlsonment.
tv[Isuse o! TINs, If iha requestsr dlscloses ar uses 7lNs !n
vioFation of faderal faw, Ihe requester may be subject lo civft and
cctminel penaflles�
Specific Instructions
Name
tt yau are an indlvlduaf, you must ge�nerally enter !he nems
shown on your lncome iax re[um. Nowaver, it you have changed
yo�u lasi name, tor Instance, due io marriage wilhout !n(orming
the Soclaf Sectxity Adtn(Nstrelian of the pame chenge, enter
your frst nama, the IasE name shotivn on your soctat aecc�ity
card, and your new East neme,
tt �he account Rs in Jo[nt nemes, llsl tirsl, and thett drela, the
name of Ehe person or eniity whose num6er you enlerad In f'art I
o! �he iorm.
Sole propr�elor. �rtler your individ�al name as shown on yo�r
Income tax retum an the °Neme' Ilns. You may enter your
business, hede, or'tlatng husiness as (DSA)" name on Ihe
"BUSlness name" llne.
Lfm}ted Ilablllty compa�y (LLC}, Gheck the "Umlled Ilablllty
companyf' box only and enter Ihe appropriete code tor the fax
ctessificailan C�" far dlstegazded enUty, "C" (vr oorparadon, 'P"
far parinecship) lrt the spaae provkied.
For a single-membor' LLC (EAChrding a foretgn LLC wilh a
domesqo ovrner) litat Is dfsregaYded as an enUty separa(e from
lts otvner under Regulallons secU4n 30t_7701-3, eMer ihe
o�vne�'s nama on [he'Name" Itno. Enter the LlC's name on 1he
"Buslness name° Itne,
Far an LLC classfited as a parinershfp ar e corporaflon, enter
tho LLCs name on the '�Namo" Ilne and eny buslness, trgde, or
pBq nEUne on lhe "Busfnass nama" Ilne.
Other entlties, �ntef your busirtess name as shown on requtred
iederal tax documents on !he °t�tame" Ilne. ihls name shouid
malch the name sho�vn on 1he charier ar othar legal document
Grealing lha enlity. You may enter any busfness, irade, pr DBA
nam9 on ihe "9uslness name" ilna,
Nate. You are requested to check Ihe appropriate hnx lor your
slaius QndlvlduaYsole propdetor, corporaflon, alc).
Exempt Payee
If yau gre exempt from bacfcup withholdfng, enlet your name as
descrlbed above and chsck ihe uppropdale box lor your slah�s,
ih6n oheck the °�xempt payee" box !n lhe llne follawing the
husiness neme, s3gn and date the form. '
Farm W-9 �Rev. ia2oo7� � 3
GenetaNy, Ind[vlduals Qnduding sole ptoprletors) are not exempt
from backup ti�l�:holding. CorpW��tlons ara exernpl Gom hackup
wllld�blding for cerialn payments, such as lnterest and dlVidends.
Notfl, I( you aro e�cempt Irom backup wllhholGl�g, ycu sf�ould
sl�ff com�ete fhls lonn to avo{d posslble eroon�ous backup
vrithhold ng.
7tie (olfowing payaas ere exempt from backup wlfhholding�
1. An organizatlon exempt from tax under sactlon 50i (a), any
IRA, or a custodlal account under seotlon 403(bJ(� 1! ihe accaunt
satfsfles Ihe requlremerrts o{ seotian 401{9(2),
2. The Unfted Siales or any of Ets aganoles or
Instrumeatallltes,
3. A state, Iho Dlsirtct o( Cotumbfa, a possesslon of lhe Uniied
Siales, or any o� U�air pollUcal subdivislor�s at Irsstrumentallltes,
4, A forelgn govemrnant or any of Ils paOVcal subdlvtsions,
agencies, or loslrvmenlaliltes, or
b. M Irttema[ic�ial argantzatlon or any ot Its a�encles or
Instnrmentali�es. '
Qther payeos that may be exempt irom backup w[lhholding
Include:
6. A corporadon,
7. A lorefgn central 6anit ot )ssue,
8. A dealer 1n secudUes ar commodllles required to regisler in
lhe United state's, [he olstricl of Columbla, or a posse�lon of
the Ciniled Sfales,
9. A fatures cornmissbo merchaql �eglstared wllh the
Commadily �ulures Tradiag Commisslon,
iU. A rea! estaSe imesilnent trust,
1 i. M entity regls[ered at alf 11mes during the tax year under
the fnvesfinent Compeny.4ct of i8A0, -
12. A common irust fund operaled hy a i�ank under seclfen
sa���J,
13. A financlal InsiituUon,
1A. Amfddlaman known in [he invostmenl wmrnun(ty as a
nomince or coslodlen, or
18, A irust axempt from tax vnder sectlort 6B4 or Jescrfb�d In
seo{!on 4947.'
The chart belav shows rypes of paymenis ihat may ba
exempt (rom backup tvilhholding. Trio chart applfes to Ihe
exempt payees listed above, 1 livough '15,
IF tha paymont la tor ...
7HEtJ thv paymont Is exempt
for .
Ipteresi and dividend payments Au exempt payees except
tor 9
k�rokar transacNans Fxempt paye9s 1 lhrouc�h 13�
Nso, a pe►son regfslcrod under
lhe Inveslment Advlscrs Aal o(
f 940 who regulatly ects as a
braker
6arter exCf�ange iransactlons I Exampi payees f thwugh 5
end patronago �ividends
Paymenls ovQr 36D0 requlred Generally, aiempt payea�
to be �epo[tec! and dlteot 1 Ihrough T
saTes over $5,000` .
�See Form 10�9•T.S15C, t�4lscellaneaus I�como, t�nd iU IratrucUons,
'Howovof, lhe fotlovring payments mule to a corporoUon Qndudrg �
prOC�+Cds pald to an attorrtey Vndet secllon &045�Q, even !f lho allamoy Is m
corporaL'or� and repalabla on Form t�8•hSI5C arb nol exempl from
bacScup �vtlhlw}dlnp: mcdMal and heaRh care paymenls allorneys` fees, and
payrtfenle lor serNcat paM by e federal exeoWYaOgcVwy,
Part I, Taxpayer ldentif)cation
Number (T[Nj .
Enter your TIN ln ihe approprfato box. It you are a resideni
a�len and you do not have anc! ere not ellglble to get an 55N,
your TIN !s your IRS (ndividual tnxpayer (dentificaltan number
(I71t�. �nter fi �t the snala! security number box, fl you do noi
have en fflhf, sea How ta get a,7lN balow.
II yau are a sale propdeior and yau hava an EIN, you may
enter etther your S5N or BIN. Hbwever, !he IRS prafers Ihet yau
use yaur SSN.
if you ar� a single�msm6er LLC thal is d(sregarded as en
eniily separata from ifs owner (sae Ltmltsd pab171y company
(ZLC) on pape 2j, anter the owners SSN {or EIN, If tha owner
has one?, po not er�ief fhe dlsregerded enllty's E(N. If the LtC Is
classNfed as a corporalton or partnership, enter ff�e enilt�& �IN.
Nota. Sea iha chari on page A for {uriher clarif)cation ol neme .
and TIN combinalians.
How to get a TfN. If you do not�have a TiN, appty for one
lmmedlatefy So aFply Enr an SS�, gei Focm 5S-6, Appllcatian
for a 5co�ai sec�,dty Card, iram your lacal5xlal Secmity
Adm(r�slrallon ofllce nr get lhls (orrn onllne at ivwtt,ssa,gav. You
may a�so gel 1hSs fatm byoe11fr1g 1-8¢D-772•i213. Use Form
W-T, Appllcallop far IRS Irtdlvtdua( 7axpayer ldenqftcalfop
Numher, to app�y for an 1'FIN, ar Farm SS-4, Applfcation for
Fmployer fdenll�caUon NutnCer, to appfy ior an FJN. You can
apply for an EIN onl(ne by accessing ttte IA6 website ai
►vw4v.ks, ovlbustnesses end cackfng on �mployer )dsnlillcation
iVum�er�E3t�p under Starting a 6uslness. You can geF Forms W-7
and SS-4 from IhB Ips by v�slling w�vw.Gs,gav ar by caping
1-800-TAX-FORM {i-SDO-829-3676}.
I[ you are esked to complete Form W-$ bui do not hava a 71hf,
4Yrite "RppIf�d Fa° En ihe space lor the TIN, sfgn and BaEe ihe
Eorm, and give 91 fo tha requeslar. Far fnterest snd dtvidend
payments, and certaln payrnants made wlth rnspect to readily
tradabfe lnsinxne�ts, generaliy you vr�i have 60 days lo get e
71N and glve 1f to �he requester before you are subject l0 6aGl�up
wlthhofd,ng on payrnents.l'he sp-day n,la does not apply to
oiher{y�es of payrt�ents, You wfll be subJect to backup
�vithholding on nll such paymenls unUl you provlde yqur 77N to
fho reqvestef
Note, Enter�ng °Applled For' means lhet you hava e�ready
apptled for a�fN or Ihai you Intend to apply tar one soon,
Cau�ton:,4 dlsregerded domaslla enNly thal has a forelgn ownar
mus� iue fhe approprla(e �orm W-8,
Part fl. Certificatfan
Ta eslabllsb lo Ihe �vilhholclfng agent that you are a U.S. persatt,
or restdent anen, sfgn Form W-9. You may 6e raqvesiQd to slgn
by ihe wflhhofding aqant even 1f Items 1, 4, and S beloW [ncficatv
othenvkse.
For a}oint 2ccount, onfy Ihe person whnse SW ts sho�yn In
Part I shot►Id slgn (when reqvir'ecq. �xempt payees, see �irempi
Payes on page 2.
Slgnafura I'equirements, Comptete ihe ted'rfical[on as [ndlcated
in 1 �Uuougb 5 batow.
�. Interast, divtdend, end barler ezahange a�caunts
opened beforo i98�i and Broker eccaunts consfdered acUve
duripg 1983. You mvst 9ive your sornaat iIN, but you do noi
have to slgn 1he ceiiftfcallon.
2. Inierest, dlvidBrtd, bro[cer, and harter exchango
acoounb oponed aear i985 and broker accounts oonstdered
inactivs d�u�ing is89. You must sfgn ihe cerUficalion or backup
wflhhalding w[It epp(y, IP yo� are subJact to backup wRhltoldfng
end you ere merely praviding yaar correot T1N lo lhe requester,
�ou must cross out flem 2 In ihe oerliflcailon befo� slgnfng ihe
Ot(il,
F«m w-s (aav. �a2oo�
3. Reel estate iransactlons. Yoo musl slgn tho cerl�icaUoo.
Yau may oross out item 2 of Ihe cerUficat(on.
4. Other paymen�s. You must give your cotiecl 71N, but you
do rtot havo to slgn lite ceriifica�ion unless you havo been
nollfted khat you have }�revlousiy given en lnconect TtN, "OiFrer
paymanls" �nciude payments made in lhe course of ihe
requesler's trada or bus�ess !or rents, royaltles, goods (olher
tf�an 61tls for merchandise}, medical and heallh care sar�lces
pnduding payrnents to corporalions), paymen{s lo a
nonemptoyee (or sorvfces, paymenis lo ceriain Ilstdrtg boei wew
members and flsltermen, and gross praceeds patd Io eltomeys
(lncl�ding payments 10 corporatlons}. ,
5, Martgage interesY pald by you, acqulsiilon or
abandonment o( secured property, cancellatlon of debt,
qualifisd tuilion program paymenls (under seCtion 828), 1F3A,
Caverdoil ESA, Arclior MSA or HSA conlliGUHons ar
dlslribUllons, and penston dlslrfbullons, You must givu your
correal Tli�, bul you do nol have lo sign lhe cerUficallon,
What Name and NuttibeY To Glve the Requester
For 1hLS type of occouot•
1. tndMaua!
2. T1VO a mo� IndNMuais Cjojtl
accounq
3. Custodlan account oF a mtnar
(Unlfam GMt (o }Alnols Acy
4. a Tha ustra� ra�'ocablo sa�ngs
+nnt (grentor [s otso �cuslee}
b. So-callcd Ws[ eccouN ihet )s
nol a leg�l orval,�d Gust u-der
stato taw
5. 504e ptoptlelorshlp or dlSiEpardacf
entity ov�ned 6y an trw'NidVal
Gfvo namo ond SSN of,
Tl a G�d�/�duaf
Tl-,e actual ownerof lhe actount of,
if comb+�aa (w�ds, Ute rusl
IndMdu� m Iho a�ocount'
7�e mfnor'
Tne granlor-Irustee �
-rne ac�uat awr�er `
t�a v�mer'
�or thle type oI accounL � O[vo namo and EIN o!:
s, pisrega�ded enUty rrot ormed by an
htdtv(dual
7. A wd'�d tncsl, e�ta�e, w penslm �ta1
8. Co�paata a L,LC NeeUng
Cofporate slelus on Fornf N832
9. Assoc�atlon, cNp, rc1!gkus,
dleiilub�0, EdVt&IEonat� or oth¢r
tex-a+aempl otaa^halion
10, Pa�trerSAfp cr mUtl-mom6er LLC
i1. A brakera reglslarad nominee
12, Acoount with lha 4sparlme� ot
Pgrlwkureln tho name nf a pv6lk
esltHy (such as a siete a local ��
govemmen4 sclnwt dlsVrki. ar
prfson) Uaal receNes apdcuriurat i
program payman�s
rne otimcr
lcgal er�ity �
1'tie corpotalton
The orpanlzaUon
ihe partnershf�,
Th0 bfOk2f Of RotRf[le o
The �bik entity
'Ust 6Rt and t4de iTiO nuna aQ Vw 9:�� af�u�s nketu lrau tccrdsR u oriy um pe+ean
on e Joha1 aaunt has rn 55�, Nst p�scn'a narket nful ba furro.'�hed
tC�ICI6!}IB T{Ik10rS IUTP !.11d /II116}11IIB 1fN/F�0 SSN.
�YO(1 �Ktsl SfAST ]Wf V�W'fi fen'd E1d )Ztr Rvy ika e�N YOl7 6[ls�fes.6 pC'��'
nama on ita cuqM naTa rra You may �sa �dur�our S4H or EtN 4'� Y�+ haw ane).
b1A Iho If55 m�+fPg¢s )rou lo �ta )ccY SSH_
' tbt rtrx a,d ado uw rw+rn of u,e InA4 uacq a c�t+n wsi Wo not Mc�h ma nx
of �he Pasatal �cproxn4alw or hust�es attss� Ihalaqal en6tY 8selt ts tat des'9rutN fn
Iha �*zuql v�a1 Atr.o sea Spectv ndes fuo�'Js on p.iSe s.
Note. I( no neme is circled when more than one name is Ilsted,
lhe number wIU be consfdered to be that of Ihe (irsi nsme Ilsied.
� I'age �4
Secure Your Tax f�eaQrds from Ideniity Theft
Idenllty Ihefl occt►rs when saneone uses your personai
InfarmaHon such as yaur name, soclal security number (SSN), or
other identifying intorma�lon, vAltwut your permtsslon, to commlt
travd ar o{het cdmes. An fdenUry ihief may vsa your S5N to get
e job or may tile a tax relum usfng your SSN to recnlve a reiund.
To reduce your risk:
• Protect your SS�,
• Ertsure your employer Is protecli�g your SSN, and
• ee ceraful when choostng a tax preparer,
Call ihe IRS a1 f-BOO-82&i44o If you thlnk your ldenlity has
bEen vsed Imappropriately tar tax purposes,
Vlciims of idenlHy Iheft V�ho are expedertcing economlc harm
or a syslem problem, or ere seekfng help in resotv�eg fax
problems that have not been resolVed thrnugh norrnat chanrteis,
may be eflgf6lo for 7axpayer P.dvocale Servfce (TAS) asslstance,
You can reach TAS by calDng the TAS tod-free ense lntake Itne
at S-87T-777-4778 or TTYff'DO i•800-829-4059.
Protect y,ouraelf [rorri suspiciaus entails or phisding
schemes, Phlshing ts 1he aeatfon ortd use of emall anc!
websiles deslgned io mlmlc (eglllmate bvsti�ess emalls and
svebsites. The most common aot 1s seridtng an emeif to a user
falseiy ctalm(ng to be an eslabllshed }egil(mals enterptlsa (n an
attampt to scam l�s user Into surtendering }xivata In(ortttaifon
tha! will be used for tdeniity thefL •
The WS does not initfate coote�ls vrfth la�tpayers vIa ernafls.
Also, the IRS does nol requost parsorvil delailad fnFormapon
Utroagh email or ask taxpayers for the PW numhers, passtvords,
or slmllar secret access inEormailan far ihelr credlt prd, ban&, or
other fl�anctal accounts,
li you reaeiva an unsallcited emeil cialming lo be (tom Ihe 4RS,
(on�rercf Ihls rnessage to phfshing�lns.gov. Yau may alsa reporf .
misuse o{ the IRS name, logo, ar olher IR5 persorial property ta
ihe Traasury lnspacror c3eneral for Tax Adminlstrat[a� at
1-80a366-4d84. You can tor�vard susplclaus amslls to the
Fecferaf Trade Comrt�sslon at spam�uce,gov or conlaoi them at
mnv.consumer.gov/Idthelt or 1-677-ID7HEFT(438•d338).
Visit lha 1RS �vebslla a! www.frs,gov to leam more aboul
IdanUry ihaf� and how to reduce your risk.
Privacy Act Nolico '
Seotlon 6109 of 1ha Intem�! Re�renuo ccdo rcqukas you lo protiide your ooRect T�ta fo �etsons wtw must ela Informatbn rehara wtlh Iha lR9 to mpwt fntxmq
dh�ldends, mid ceitalh athet Incana pald to you, rmrigage lnlerest you pa(d, (ho aoqutsitbn or abendonment ol eeuxed propwty, c�rxetlatbn oI debl, w
cor.lribullore you mado ro on !R!� a rYc)wr 1ASA or FfSA. Thn 193 uses tha menbers fa tdanlfncatfon purppses and to heip vaiy ihe aavracy ol your Lax relum,
Tha IA3 may also prcvlde tlds infortnal;en ta the Dnpzrlmenl of Jwitce lor dvtt gnd crTmb�a] IiUga@oo, wid !o ulles, sfate9, tAa O{strtci aF Cdvm�ia, and US
possesslans to carry ou1 U�e+i te,� }aYrs. 5Vo mey aEso dlsciose (his tnformallon lo olher countAes upder a fax Ueary, !o federal end siale ependrs b entate (�eral
noRlax alminal lavrs, a to fedece� la�v enWrxmen( and tntoUlgence agendas lo combal lertorlsm,
Yov must prov:do ycur TIN vrMlher or notyou ere reqtrired 1a file e tex relum, Pay+ats must generdlry wNhhold 2896 of laamb�O intetast, divjdend, and Cerlaln aUler
�J3Yf[}C(VIS IO ${T3jIC0 R'I'p G�OPS J10L $IVU d Tlll ta a payer, Cerlaln penallSqs �[tay also apply. -
��hib�� C
CON�'L.1CT OF 1NTEREST QUESTIONNAIRE F'ORM CI
�or �endor or other erson doin business with local overnrriental entif
This questionnaire reflects changes made to the law by H.B. 1499, 80th Leg., Regwtar Session. OF'�fCE USE ONLY
This questionnaire is being filed in accordance with chapter 9 76 of the Local Government Code by a Date Received
person who has a business relationship as defined by Section 176.001(1-a) with a local
governmental entity and the person meets requirements. under Section 176.006(a).
By law this questionnaire must be fifed with the records administrator of the loca( government entity
not later than the 7th business day after the date the person becomes aware of facts ihat require the
statement to be filed. 5ee Section 176.006, Local Government Code.
A person commits an offense if the person icnowingly violates Section 176.006, Local Governmen#
Code. An offense under ihis section is a Class C misdemeanor.
� Name of persan who has a business retationship wifh loeaf governmentai entity.
2
n Check this box if you are filing an update to a previously filed questionnaire.
LJ
(The law requires that you flle an updafed completed questiannaire with ihe appropriate filing aufhority noi later than ihe 7'" business
day afier the date the originally filed questionnaire becomes incorrtplete or inaccurate.)
3
Name of local governmenf officer with whom fller has an empfoyment or husiness relationshlp.
�Iame of Officer
This section, (item 3 including subparls A, B, C& D), muat be completed for each officer with whom the filer has an employment or other business
re[aEionship as defined by Section 176.001(1-a), Local Government Code. Aitach additiona[ pages to this Form CIQ as necessary.
A. Is fhe local government offrcer named in this section receiving or tikely to receive faxabie income, other fhan investment incorne, from ihe
filer of #he questionnaire?
� Yes � No
B. Is the fifer of the quesfionnaire receiving or likely to receive taxable income, oiher than investment income, from or at ihe direction of the
local governmeni o(ficer named in this section AND the taxable income is not received from the local governmenial eniity?
0 Yes � No
C. Is the filer of th(s quesiionnaire employed by a corporaiion or other business eniity wiih respect to which fhe local government officer
serves as an officer or direcior, or holds an ovanership of 90 percant or more?
� Yes � No
D. Describe each afftiiation or business relatfonship.
�
Signature af person doing buslness with fhe governmental eniity Daie