Item J AGREEMENT BETWEEN
THE MONROE COUNTY VALUE ADJUSTMENT BOARD
and
for
SPECIAL MAGISTRATE SERVICES
This Agreement is made and entered into, on the date last below written, by and between
the MONROE COUNTY VALUE ADJUSTMENT BOARD, 500 Whitehead Street, Key West,
FL 33040 (hereinafter referred to as "VAB "), and the individual identified and executing this
Agreement as the undersigned (hereinafter referred to as "Contractor ").
1. RECITALS.
1.1 The VAB requires the services of one or more individuals to act as a Special
Magistrate for the purpose of taking testimony and receiving evidence at the hearings, as
provided by Chapter 194, Florida Statutes, and Rule 12D -9, Florida Administrative Code
(F.A.C.), and making recommended findings of fact and conclusions of law to the VAB.
1.2 Contractor desires to provide such services to the VAB as an independent contractor.
1.3 Contractor certifies that Contractor possesses the minimum qualifications required by
Section 194.035, Florida Statutes, and Rules 12D -9.010 and 12D- 9.012, F.A.C., to provide
services as a Special Magistrate.
1.4 In consideration of the mutual terms and conditions, promises, covenants and
payment hereinafter set forth, the VAB and Contractor enter into this Agreement as set forth
herein.
2. SERVICES
2.1 Contractor shall perform professional services to the VAB as a Special Magistrate.
Contractor's services shall include, but not be limited to, the following:
2.1.1 Taking testimony at hearings provided pursuant to Chapter 194, Florida
Statutes and Rule 12D -9, F.A.C.
2.1.2 Receiving evidence into the hearing record.
2.1.3 Ruling of objections made during the hearing by either of the parties to the
hearing.
2.1.4 Making recommended findings of fact and conclusions of law to the VAB.
Revised 04/2012 Item J
2.1.5 Preparing and submitting such reports and other documents as the VAB or
the Clerk of the VAB may from time to time require.
2.2 Contractor shall be responsible for complying with all federal, state and local rules,
regulations, statutes, laws or ordinances, regarding payment for his or her services under this
Agreement, and any reporting requirements thereunder.
2.3 During any hours Contractor provides services to the VAB, Contractor shall devote
his full time and effort to the services being performed for the VAB. Contractor shall truthfully
and accurately maintain all records and make such reports as the VAB may require.
2.4 Contractor agrees that this contract for Special Magistrate services is not exclusive to
Contractor, and that the VAB may, and probably will, enter into agreements with other
contractors to perform Special Magistrate services for the VAB. Further, Contractor agrees that
this Agreement does not require the VAB to request any particular services of the contractor.
2.5 Upon receipt of the docket for hearing, the contractor shall review the petitioners'
names and addresses for a potential conflict of interest. If a potential conflict of interest exists,
the contractor shall immediately notify the Clerk of the VAB who shall reassign the case to
another Special Magistrate.
2.6 The contractor shall receive and retain all exhibits presented during a hearing, and
shall transmit the record along with the original copy of the recommended order to the Clerk of
the VAB, pursuant to Rule 12D- 9.025(7).
3. FEES.
3.1 The VAB shall pay Contractor at the rate of One Hundred Fifty dollars ($150.00) per
hour for Contractor's services under this Agreement. Billable time shall commence at the
scheduled start of a hearing or at the time of the Contractor's arrival and set -up, whichever is
later. For each day that the Contractor is scheduled to serve as a Special Magistrate, there shall
be a minimum payment due to the Contractor of $225.00. In the event a scheduled hearing date
is cancelled in its entirety, there shall be a payment due to the Contractor of $225.00. There is no
half -day cancellation fee.
3.2 Except as provided herein, no travel expenses or travel time shall be paid for travel to
and from hearing sites, nor shall ordinary office supplies consumed in the course of the
Contractor's services be reimbursed. The VAB shall pay for the Contractor's mileage, at the rate
established in the Monroe County Code of Ordinances, for travel to and from hearing sites that
are outside of the Contractor's home district. Upon the execution of this Agreement, the
Contractor shall notify the Clerk of the VAB of his or her home district (i.e. Lower Keys, Middle
Keys, Upper Keys). Mileage will not be reimbursed for travel within a district.
Revised 04/2012
3.2.1 The VAB shall pay reasonable travel expenses to a Contractor who is located
outside of Monroe County when a Special Magistrate who is located in Monroe County is not
selected or is selected but is not available to perform the services set forth in this Agreement.
See the attached Monroe County Clerk of Court Expense Reimbursement Requirements.
3.3. If a Contractor does not render a recommended decision at hearing, therefore
requiring additional time for research and preparation of the recommended decision, then there is
a presumption that the Contractor shall require up to two hours of additional billable hours to
complete the work and VAB's obligation to pay shall be capped at two hours of billable time. If
the Contractor anticipates that the required time will exceed two hours, then the Contractor must
obtain written permission for specified additional time from the VAB Attorney.
3.3.1 The Contractor shall render his /her recommendation (findings and conclusions)
within seven (7) working days of the hearing; provided that, if the Contractor requires more time,
he /she shall obtain written permission for specified additional days from the VAB Attorney.
3.4 The Contractor understands and agrees that the VAB does not promise or guarantee
that the Contractor will be engaged to perform either a minimum or maximum amount of
services under this Agreement.
3.5 The Contractor understands and agrees that the time he or she must devote to Special
Magistrate training required by Rule 12D- 9.012, F.A.C., is not billable to and reimbursable by
VAB under this Agreement.
3.6 The Contractor shall cooperate with the VAB in any litigation or related matter that
might result from the Contractor's performance under this Agreement. Accordingly, the
Contractor shall be paid by VAB for such time at the rate established herein.
3.7 The Contractor understands and agrees that all bills paid pursuant to the terms of
Section 5 of this Agreement are subject to ratification by the VAB at a public meeting.
4. TERM/TERMINATION.
4.1 The term of this Agreement shall begin on the date last below written and shall
continue until the conclusion of the VAB hearings in the spring of 2011.
4.2 This Agreement may be terminated by either party, with or without cause, by written
notice to the other party of the intent to terminate. Such termination shall be effective
immediately upon receipt of such written notice of intent to terminate. No termination for cause
will be effective unless the defaulting party is first given ten (10) calendar days after receipt of
notice of intent to terminate in which to cure the cause for termination.
4.3 In the event of termination, Contractor shall be entitled to compensation for services
rendered and costs incurred through the effective date of termination. All finished or unfinished
documents prepared by Contractor shall become the property of the VAB and shall be delivered
by Contractor to the VAB immediately upon the effective date of termination.
Revised 04/2012
4.4 In the event of termination of this Agreement by the Contractor without cause,
Contractor shall be ineligible to be appointed as Special Magistrate to the VAB for a period of
five (5) years from the end of the calendar year in which such termination effected. This
provision shall survive the termination of this Agreement.
4.5 Contractor shall not represent any person or entity against either Monroe County or
the Monroe County School Board in a court case or administrative hearing at the time of
appointment. Any such representation that arises from the appointment through the final
meeting of the VAB will disqualify the Special Magistrate from any further hearings, and the
Clerk shall schedule another Special Magistrate to hear the matters scheduled for the disqualified
magistrate.
5. METHOD OF BILLING AND PAYMENT.
5.1 Contractor shall submit billings for payment of services actually rendered on a
monthly basis to the Clerk of the VAB for processing. Billings shall provide the nature of the
services performed.
5.1.1 Contractor shall maintain a record of his/her hours worked during and after the
close of a hearing when taking additional time to render a decision pursuant to Paragraph 3.3 of
this Agreement. Contractor shall provide the Clerk with detailed time records for each such case
taken after the close of a hearing.
5.2 Contractor acknowledges that each billing must be reviewed and approved by the
Clerk of the VAB or Clerk's designee. Should the Clerk of the VAB or the Clerk's designee
determine that the billing is not commensurate with services performed, work accomplished or
hours expended, Contractor shall adjust billing accordingly. Contractor shall be entitled to
payment of any portion of a billing not in dispute.
5.3 The VAB shall pay Contractor's billings in accordance with Section 218.70 through
218.79, Florida Statutes, the Florida Prompt Payment Act.
6. STANDARDS AND CORRECTIONS ERRORS.
6.1 Contractor shall perform or furnish to the VAB professional services in accordance
with the generally accepted standards of Contractor's profession or occupation and in accordance
with any laws, statutes, ordinances, codes, rules and regulations governing Contractor's services
hereunder.
6.2 Contractor shall, without additional compensation, correct and revise and errors,
omissions, or other deficiencies in Contractor's work product, services, or materials arising from
the negligent act, error or omission of Contractor. The foregoing shall be construed as an
independent duty to correct rather than waiver of the VAB's rights under any applicable statute
of limitations. The review of, approval of, or payment for any of Contractor's work product,
services, or materials shall not be construed to operate as a waiver of any of the VAB's rights
Revised 04/2012
under this Agreement, or cause of action the VAB may have arising out of the performance of
this Agreement.
7. NO CONTINGENT FEES. Contractor certifies that Contractor has not employed or
retained any company or person, other than a bona fide employee working solely for Contractor,
to solicit or secure this Agreement and that Contractor has not paid or agreed to pay any person,
company, individual or firm, other than a bona fide employee working solely for Contractor, any
fee, commission, percentage, gift or other consideration contingent upon or resulting from the
award or making of this Agreement. For the breach or violation of this provision, the VAB shall
have the right to terminate the Agreement without liability at its discretion, to deduct from the
contract price, or otherwise recover, the full amount of such fee, commission, percentage, gift or
consideration.
8. NO ASSIGNMENT. This Agreement, or any interest herein, shall not be assigned,
transferred or otherwise encumbered, under any circumstances by Contractor without the prior
written consent of the VAB. Further, no portion of this Agreement may be performed by
subcontractors or sub - consultants without written notice to and approval of such action by the
VAB.
9. SEVERABILITY/NO WAIVERS. In the event any provision of this Agreement shall
be held invalid and unenforceable, the remaining provisions shall be valid and binding upon the
parties. One or more waivers by either party of any breach of any provision, term, condition or
covenant shall not be construed by the other party as a waiver of any subsequent breach.
10. GOVERNING LAW/VENUE. This Agreement shall be governed and construed in
accordance with Florida law. In the event litigation arises involving the parties in connection
with this Agreement, venue for litigation shall be in Monroe County, Florida.
11. INDEPENDENT CONTRACTOR STATUS. Contractor is an independent contractor
and is not an employee, servant, agent, partner or joint venturer of the VAB or Monroe County
or the Monroe County School Board.
12. CERTIFICATIONS BY CONTRACTOR.
12.1 Contractor understands that Contractor need not be a resident of Monroe County.
12.2 Contractor understands that Contractor shall not serve as a Special Magistrate in the
same tax year in which he or she represents a person before the VAB, and that during the term of
this Agreement Contractor shall not undertake to represent or advise any taxpayer or petitioner
before the VAB.
12.3 Contractor certifies that Contractor is not an elected or appointed official or
employee of Monroe County or of the Monroe County School Board.
12.4 Contractor certifies that Contractor is not an elected or appointed official or
employee of a taxing jurisdiction.
Revised 04/2012
12.5 Contractor certifies that Contractor is not an elected or appointed official or
employee of the State of Florida.
12.6 Contractor certifies that Contractor possesses the following minimum qualifications
(CHECK ALL THAT APPLY):
[ ] Contractor is a member of The Florida Bar with no less than 5 years' experience in the
area of ad valorem taxation, and is qualified to hear petitions involving issues related to
exemptions and classifications.
[ ] Contractor is a state certified real estate appraiser with not less than 5 years'
experience in real property valuation, and is qualified to hear petitions involving issues regarding
the valuation of real estate.
[ ] Contractor is a member of a nationally recognized appraiser's organization with no
less than 5 years' experience in tangible personal property valuation, and is qualified to hear
petition involving issues regarding the valuation of tangible personal property.
Attached to this agreement are the following forms:
1. W -9 Request for Taxpayer Identification Number & Certification
2. Travel Voucher
3. Expense Reimbursement Requirements
IN WITNESS WHEREOF, the parties hereto have caused the execution of these
premises as of the date written below.
CONTRACTOR: VALUE ADJUSTMENT BOARD
MONROE COUNTY, FLORIDA:
By:
Signature of Contractor Chairman
Date:
Printed Name of Contractor
Address of Contractor
City, State, Zip
Revised 04/2012
Exhibit 1
Form .-9 Request for Taxpayer Give Form to the
(Rev. January 2011) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name (as shown on your income tax return)
N Business name /disregarded entity name, if different from above
a Check appropriate box for federal tax
c
classification (required): ❑ Individual /sole ro Corporation
p p rietor ❑ C p oration
❑ S Corporation 111 Partnership ❑ Trust/estate
ao
v ❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ► ❑ Exempt payee
«2
C n.
a 7 , ❑ Other (see instructions) ►
Address (number, street, and apt. or suite no.) Requester's name and address (optional)
•
o
o.
N City, state, and ZIP code
a�
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 the "Name" line 1 Social security number
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other - -
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose I Employer identification number
number to enter.
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).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 4.
Sign Signature of
Here U.S. person ► Date S.
General Instructions Note. If a requester gives you a form other than Form W -9 to request
your TIN, you must use the requester's form if it is substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W -9.
noted. Definition of a U.S. person. For federal tax purposes, you are
Purpose of Form considered a U.S. person if you are:
A person who is required to file an information retum with the IRS must • An individual who is a U.S. citizen or U.S. resident alien,
obtain your correct taxpayer identification number (TIN) to report, for • A partnership, corporation, company, or association created or
example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States,
you paid, acquisition or abandonment of secured property, cancellation • An estate (other than a foreign estate), or
of debt, or contributions you made to an IRA.
• A domestic trust (as defined in Regulations section 301.7701 -7).
Use Form W -9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or
requester) and, when applicable, to: business in the United States are generally required to pay a withholding
tax on any foreign partners' share of income from such business.
1. Certify that the TIN you are giving is correct (or you are waiting for a Further, in certain cases where a Form W -9 has not been received, a
number to be issued),
partnership is required to presume that a partner is a foreign person,
2. Certify that you are not subject to backup withholding, or and pay the withholding tax. Therefore, if you are a U.S. person that is a
3. Claim exemption from backup withholding if you are a U.S. exempt partner in a partnership conducting a trade or business in the United
payee. If applicable, you are also certifying that as a U.S. person, your States, provide Form W -9 to the partnership to establish your U.S.
allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership income.
is not subject to the withholding tax on foreign partners' share of
effectively connected income.
Cat. No. 10231X Form W -9 (Rev. 1 -2011)
i
Form W -9 (Rev. 1 -2011) Page 2
The person who gives Form W -9 to the partnership for purposes of Certain payees and payments are exempt from backup withholding.
establishing its U.S. status and avoiding withholding on its allocable See the instructions below and the separate Instructions for the
share of net income from the partnership conducting a trade or business Requester of Form W -9.
in the United States is in the following cases: Also see Special rules for partnerships on page 1.
• The U.S. owner of a disregarded entity and not the entity,
• The U.S. grantor or other owner of a grantor trust and not the trust, Updating Your Information
and You must provide updated information to any person to whom you
• The U.S. trust (other than a grantor trust) and not the beneficiaries of claimed to be an exempt payee if you are no longer an exempt payee
• T trust. and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
Foreign person. If you are a foreign person, do not use Form W -9. you are a C corporation that elects to be an S corporation, or if you no
Instead, use the appropriate Form W -8 (see Publication 515, longer are tax exempt. In addition, you must furnish a new Form W -9 if
Withholding of Tax on Nonresident Aliens and Foreign Entities). the name or TIN changes for the account, for example, if the grantor of a
Nonresident alien who becomes a resident alien. Generally, only a grantor trust dies.
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax Penalties
treaties contain a provision known as a "saving clause." Exceptions Failure to fumish TIN. If you fail to furnish your correct TIN to a
specified in the saving clause may permit an exemption from tax to requester, you are subject to a penalty of $50 for each such failure
continue for certain types of income even after the payee has otherwise unless your failure is due to reasonable cause and not to willful neglect.
become a U.S. resident alien for tax purposes. Civil penalty for false information with respect to withholding. If you i
If you are a U.S. resident alien who is relying on an exception make a false statement with no reasonable basis that results in no
contained in the saving clause of a tax treaty to claim an exemption backup withholding, you are subject to a $500 penalty. I
from U.S. tax on certain types of income, you must attach a statement
to Form W -9 that specifies the following five items: Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
1. The treaty country. Generally, this must be the same treaty under including fines and /or imprisonment.
which you claimed exemption from tax as a nonresident alien.
Misuse of TINs. If the requester discloses or uses TINs in violation of
2. The treaty article addressing the income. federal law, the requester may be subject to civil and criminal penalties.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions. Specific Instructions
4. The type and amount of income that qualifies for the exemption Name
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of If you are an individual, you must generally enter the name shown on
the treaty article. your income tax return. However, if you have changed your last name,
for instance, due to marriage without informing the Social Security
Example. Article 20 of the U.S. -China income tax treaty allows an Administration of the name change, enter your first name, the last name
exemption from tax for scholarship income received by a Chinese shown on your social security card, and your new last name.
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in If the account is in joint names, list first, and then circle, the name of
the United States exceeds 5 calendar years. However, paragraph 2 of the person or entity whose number you entered in Part I of the form.
the first Protocol to the U.S. -China treaty (dated April 30, 1984) allows Sole proprietor. Enter your individual name as shown on your income
the provisions of Article 20 to continue to apply even after the Chinese tax return on the "Name" line. You may enter your business, trade, or
student becomes a resident alien of the United States. A Chinese "doing business as (DBA)" name on the "Business name /disregarded
student who qualifies for this exception (under paragraph 2 of the first entity name" line. -
protocol) and is relying on this exception to claim an exemption from tax Partnership, C Corporation, or S Corporation. Enter the entity's name
on his or her scholarship or fellowship income would attach to Form on the "Name" line and any business, trade, or "doing business as
W -9 a statement that includes the information described above to (DBA) name" on the "Business name /disregarded entity name" line.
support that exemption.
Disregarded entity. Enter the owner's name on the "Name" line. The
If you are a nonresident alien or a foreign entity not subject to backup name of the entity entered on the "Name" line should never be a
withholding, give the requester the appropriate completed Form W -8. disregarded entity. The name on the "Name" line must be the name
What is backup withholding? Persons making certain payments to you shown on the income tax return on which the income will be reported.
must under certain conditions withhold and pay to the IRS a percentage For example, if a foreign LLC that is treated as a disregarded entity for
of such payments. This is called "backup withholding." Payments that U.S. federal tax purposes has a domestic owner, the domestic owner's
may be subject to backup withholding include interest, tax- exempt name is required to be provided on the "Name" line. If the direct owner
interest, dividends, broker and barter exchange transactions, rents, of the entity is also a disregarded entity, enter the first owner that is not
royalties, nonemployee pay, and certain payments from fishing boat disregarded for federal tax purposes. Enter the disregarded entity's
operators. Real estate transactions are not subject to backup name on the "Business name /disregarded entity name" line. If the owner
withholding. of the disregarded entity is a foreign person, you must complete an
You will not be subject to backup withholding on payments you appropriate Form W -8.
receive if you give the requester your correct TIN, make the proper Note. Check the appropriate box for the federal tax classification of the
certifications, and report all your taxable interest and dividends on your person whose name is entered on the "Name" line (Individual /sole
tax return. proprietor, Partnership, C Corporation, S Corporation, Trust/estate).
Payments you receive will be subject to backup Limited Liability Company (LLC). If the person identified on the
withholding if: "Name" line is an LLC, check the "Limited liability company" box only
1. You do not fumish your TIN to the requester, and enter the appropriate code for the tax classification in the space
provided. If you are an LLC that is treated as a partnership for federal ,
2. You do not certify your TIN when required (see the Part II tax purposes, enter "P" for partnership. If you are an LLC that has filed a
instructions on page 3 for details), Form 8832 or a Form 2553 to be taxed as a corporation, enter "C" for
3. The IRS tells the requester that you furnished an incorrect TIN, C corporation or "S" for S corporation. If you are an LLC that is
4. The IRS tells you that you are subject to backup withholding disregarded as an entity separate from its owner under Regulation
because you did not report all your interest and dividends on your tax
section employment and excise d tax),
to not
check t he e LLC k
retum (for reportable interest and dividends only), or the b box ox (except for unless the owner of f the the LLC (required to be a
identified on the "Name" line) is another LLC that is not disregarded for
5. You do not certify to the requester that you are not subject to federal tax purposes. If the LLC is disregarded as an entity separate -
backup withholding under 4 above (for reportable interest and dividend from its owner, enter the appropriate tax classification of the owner
accounts opened after 1983 only). identified on the "Name" line.
1
f
Form W -9 (Rev. 1 -2011) Page 3
Other entities. Enter your business name as shown on required federal Part I. Taxpayer Identification Number (TIN)
tax documents on the "Name" line. This name should match the name
shown on the charter or other legal document creating the entity. You Enter your TIN in the appropriate box. If you are a resident alien and
may enter any business, trade, or DBA name on the "Business name/ you do not have and are not eligible to get an SSN, your TIN is your IRS
disregarded entity name" line. individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
Exempt Payee below.
If you are exempt from backup withholding, enter your name as If you are a sole proprietor and you have an EIN, you may enter either
described above and check the appropriate box for your status, then your SSN or EIN. However, the IRS prefers that you use your SSN.
check the "Exempt payee" box in the line following the "Business name/ If you are a single- member LLC that is disregarded as an entity
disregarded entity name," sign and date the form. separate from its owner (see Limited Liability Company (LLC) on page 2),
Generally, individuals (including sole proprietors) are not exempt from enter the owner's SSN (or EIN, if the owner has one). Do not enter the
backup withholding. Corporations are exempt from backup withholding disregarded entity's EIN. If the LLC is classified as a corporation or
for certain payments, such as interest and dividends. partnership, enter the entity's EIN.
Note. If you are exempt from backup withholding
Note. See the chart on page 4 for further clarification of name and TIN i
y p p g, you should still combinations.
complete this form to avoid possible erroneous backup withholding.
The following payees are exempt from backup withholding: How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS -5, Application for a Social Security
1. An organization exempt from tax under section 501(a), any IRA, or a Card, from your local Social Security Administration office or get this
custodial account under section 403(b)(7) if the account satisfies the form online at www.ssa.gov. You may also get this form by calling
requirements of section 401(f)(2), 1 -800- 772 -1213. Use Form W -7, Application for IRS Individual Taxpayer
2. The United States or any of its agencies or instrumentalities, Identification Number, to apply for an ITIN, or Form SS -4, Application for
3. A state, the District of Columbia, a possession of the United States, Employer Identification Number, to apply for an EIN. You can apply for
or any of their political subdivisions or instrumentalities, an EIN online by accessing the IRS website at www.irs.gov /businesses
and clicking on Employer Identification Number (EIN) under Starting a
4. A foreign government or any of its political subdivisions, agencies, Business. You can get Forms W -7 and SS -4 from the IRS by visiting
or instrumentalities, or IRS.gov or by calling 1- 800 -TAX -FORM (1- 800 - 829 - 3676).
5. An international organization or any of its agencies or If you are asked to complete Form W -9 but do not have a TIN, write
instrumentalities. "Applied For" in the space for the TIN, sign and date the form, and give .
Other payees that may be exempt from backup withholding include: it to the requester. For interest and dividend payments, and certain
6. A corporation, payments made with respect to readily tradable instruments, generally
you will have 60 days to get a TIN and give it to the requester before you
7. A foreign central bank of issue, are subject to backup withholding on payments. The 60 -day rule does
8. A dealer in securities or commodities required to register in the not apply to other types of payments. You will be subject to backup
United States, the District of Columbia, or a possession of the United withholding on all such payments until you provide your TIN to the
States, requester.
9. A futures commission merchant registered with the Commodity Note. Entering "Applied For" means that you have already applied for a
Futures Trading Commission, TIN or that you intend to apply for one soon.
10. A real estate investment trust, Caution: A disregarded domestic entity that has a foreign owner must
11. An entity registered at all times during the tax year under the use the appropriate Form W -8.
Investment Company Act of 1940, Part II. Certification
12. A common trust fund operated by a bank under section 584(a), To establish to the withholding agent that you are a U.S. person, or
13. A financial institution, resident alien, sign Form W -9. You may be requested to sign by the
14. A middleman known in the investment community as a nominee or withholding agent even if item 1, below, and items 4 and 5 on page 4
custodian, or indicate otherwise.
15. A trust exempt from tax under section 664 or described in section For a joint account, only the person whose TIN is shown in Part I
4947. should sign (when required). In the case of a disregarded entity, the
The following chart shows types of payments that may be exempt person identified on the "Name" line must sign. Exempt payees, see
from backup withholding. The chart applies to the exempt payees listed Exempt Payee on page 3.
above, 1 through 15. Signature requirements. Complete the certification as indicated in
items 1 through 3, below, and items 4 and 5 on page 4.
IF the payment is for ... THEN the payment is exempt 1. Interest, dividend, and barter exchange accounts opened
for ... before 1984 and broker accounts considered active during 1983.
Interest and dividend payments All exempt payees except You must give your correct TIN, but you do not have to sign the
for 9 certification.
2. Interest, dividend, broker, and barter exchange accounts
Broker transactions Exempt payees 1 through 5 and 7 opened after 1983 and broker accounts considered inactive during
through 13. Also, C corporations. 1983. You must sign the certification or backup withholding will apply. If
Barter exchange transactions and Exempt payees 1 through 5 you are subject to backup withholding and you are merely providing
patronage dividends your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
Payments over $600 required to be Generally, exempt payees 3. Real estate transactions. You must sign the certification. You may
reported and direct sales over 1 through 7' cross out item 2 of the certification.
$5,000
' See Form 1099 -MISC, Miscellaneous Income, and its instructions.
'However, the following payments made to a corporation and reportable on Form
1099 -MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
services paid by a federal executive agency.
Form W -9 (Rev. 1 -2011) Page 4
4. Other payments. You must give your correct TIN, but you do not Note. If no name is circled when more than one name is listed, the
have to sign the certification unless you have been notified that you number will be considered to be that of the first name listed.
have previously given an incorrect TIN. "Other payments" include
payments made in the course of the requester's trade or business for Secure Your Tax Records from Identity Theft
rents, royalties, goods (other than bills for merchandise), medical and Identity theft occurs when someone uses your personal information
health care services (including payments to corporations), payments to such as your name, social security number (SSN), or other identifying
a nonemployee for services, payments to certain fishing boat crew information, without your permission, to commit fraud or other crimes.
members and fishermen, and gross proceeds paid to attorneys An identity thief may use your SSN to get a job or may file a tax return •
(including payments to corporations). using your SSN to receive a refund.
5. Mortgage interest paid by you, acquisition or abandonment of To reduce your risk:
secured property, cancellation of debt, qualified tuition program
payments (under section 529), IRA, Coverdell ESA, Archer MSA or •Protect your SSN,
HSA contributions or distributions, and pension distributions. You • Ensure your employer is protecting your SSN, and
must give your correct TIN, but you do not have to sign the certification. • Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
What Name and Number To Give the Requester notice from the IRS, respond right away to the name and phone number •
For this printed on the IRS notice or letter.
type of account: Give name and SSN of:
If your tax records are not currently affected by identity theft but you
1. Individual The individual think you are at risk due to a lost or stolen purse or wallet, questionable
2. Two or more individuals (joint The actual owner of the account or, credit card activity or credit report, contact the IRS Identity Theft Hotline
account) if combined funds, the first
at 1 800 - 908 - 4490 or submit Form 14039.
individual on the account
3. Custodian account of a minor For more information, see Publication 4535, Identity Theft Prevention
The minor and Victim Assistance.
(Uniform Gift to Minors Act)
4. a. The usual revocable savings The grantor Victims of identity theft who are experiencing economic harm or a
trust (grantor is also trustee) system problem, or are seeking help in resolving tax problems that have
b. So called trust account that is The actual owner ' not been resolved through normal channels, may be eligible for
not a legal or valid trust under Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
state law calling the TAS toll -free case intake line at 1- 877 - 777 -4778 or TTY/TDD
5. Sole proprietorship or disregarded The owner' 1 - 800 - 829 - 4059.
entity owned by an individual
6. Grantor trust filing under Optional The grantor' Protect yourself from suspicious emails or phishing schemes.
Form 1099 Filing Method 1 (see Phishing is the creation and use of email and websites designed to
Regulation section 1.671 4(b)(2)(i)(A)) mimic legitimate business emails and websites. The most common act
For this type of account: Give name and EIN of: is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
7. Disregarded entity not owned by an The owner private information that will be used for identity theft.
individual
8. A valid trust, estate, or pension trust Legal entity The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
9. Corporation or LLC electing The corporation taxpayers for the PIN numbers, passwords, or similar secret access
corporate status on Form 8832 or information for their credit card, bank, or other financial accounts.
Form 2553
10. Association, club, religious, The organization If you receive an unsolicited email claiming to be from the IRS,
charitable, educational, or other forward this message to phishing@irs.gov. You may also report misuse
tax exempt organization of the IRS name, logo, or other IRS property to the Treasury Inspector
11. Partnership or multi member LLC The partnership General for Tax Administration at 1- 800 - 366 -4484. You can forward
12. A broker or registered nominee The broker or nominee suspicious emails to the Federal Trade Commission at: spam @uce.gov
13. Account with the Department of The public entity or contact them at www.ftc.gov/idtheft or 1- 877 - IDTHEFT
Agriculture in the name of a public (1 - 877 - 438 - 4338).
entity (such as a state or local Visit IRS.gov to learn more about identity theft and how to reduce
government, school district, or your risk.
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulation section 1.671- 4(b)(2)(i)(13))
List first and circle the name of the person whose number you furnish. If only one person on a
Joint account has an SSN, that person's number must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
You must show your individual name and you may also enter your business or "DBA" name on
the "Business name/disregarded entity" name line. You may use either your SSN or EIN (if you
have one), but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 1.
'Note. Grantor also must provide a Form W -9 to trustee of trust.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with
the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation
of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS,
reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District
of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies
to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to
file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a
TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
Exhibit 2
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Exhibit 3
Monroe County Clerk of Court
Expense Reimbursement Requirements
This document is intended to provide "basic" guidelines for those who have
reimbursable expenses associated with Monroe County business. These guidelines,
as they relate to travel, are from Florida Statues 112.061.
Invoices should be billed to the contracting agency. Third party payment will not be
considered for reimbursement. The expense should be paid prior to requesting a
reimbursement. Only current charges will be considered —no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in
the contract. This document should not be considered all- inclusive. The Clerk's
Finance Department reserves the right to review reimbursement requests on an
individual basis.
Travel Expenses
Travel expenses must be submitted on a State of Florida "Voucher for
Reimbursement of Travel Expenses" form or an Expense Summary Report from
the contracting agency detailing charges for travel, hotel and food per diem, etc.
This expense report is to be signed by the traveler and approved by their supervisor.
Credit card statements are not acceptable documentation for reimbursement.
Airfare reimbursement requires the itinerary and boarding passes. If a change fee
is listed, an explanation must accompany it.
Auto rental reimbursement requires a copy of the rental agreement showing a zero
balance or a notation that the amount will be charged to a credit card. Fuel
purchases must be documented with paid receipts.
Taxis are not reimbursed if taken from one's residence to the airport. Parking is
considered a reimbursable travel expense at the destination with paid receipts.
A detailed list of charges is required for lodging invoices. Balance due must be zero.
The room must be registered in the traveler's name. The County will only
reimburse the actual room and related bed tax. Room service, movies and personal
telephone calls are not allowable expenses.
Mileage is reimbursed at .445 per mile.