SUPPLIER SERVICES. New Supplier Packet Enrollment Instructions

Transcription

1 SUPPLIER SERVICES New Supplier Packet Enrollment Instructions

2 New Supplier Packet Enrollment Instructions When you become a Riverstone Compliant Supplier you are approved to offer your services to all properties owned and/or managed by Riverstone Residential Group across the country. To become compliant with Riverstone policies and insurance requirements, you must register with Compliance Depot and provide documentation per the attached checklist. The steps you need to follow are below: 1. Call Compliance Depot to enroll at x5. You will be asked for company information and an annual enrollment fee. Note: Your business will be categorized as an on-site or an off-site supplier based on whether or not you visit the property as part of your work. On-site suppliers are required to provide proof of insurance (general liability, workers compensation, auto, and other coverages where appropriate). Off-site suppliers are not required to provide proof of insurance. All suppliers must enroll and complete the approval process which includes a background check, providing a W-9, company information, any required license, and signing a Supplier Services Agreement. 2. Fax or scanned documents per checklist to Compliance Depot at or documents@compliancedepot.com. Do not fax documents to any Riverstone location. 3. Once completed, you may check your status via the Compliance Depot website at using the username and password you have been provided by Compliance Depot. 4. Upon approval, begin work for Riverstone. Notes: Until all requirements are met, the property staff may not hire you as a supplier. Approval as a Riverstone supplier does not guarantee being hired for work. Contact our property staff to be hired as a supplier. Contact Information: The on-site manager regarding payment of invoices Compliance Depot at x5 regarding approval status Thank you for your interest in Riverstone Residential Group. 2013/01/23/v1.0/tt

3 Supplier Checklist and Cover Sheet INSURANCE REQUIREMENTS (On-site Suppliers Only) GENERAL LIABILITY LIMIT EACH RENCE GENERAL AGGREGATE Category 1 * 1,000,000 2,000,000 Category 2 * 1,000,000 2,000,000 Category 3 * 1,000,000 2,000,000 Category 4 * 2,000,000 2,000,000 Professional * 1,000,000 1,000,000 Towing * 1,000,000 1,000,000 AUTO LIABILITY REQUIRED LIMIT COVERAGE Category 2,3,4,& Towing 1,000,000 Any auto Combined single limit Towing 50,000/100,000 On-Hook Cargo/Garage Keepers Category 1 & Professional 500,000 Any auto Combined single limit Attached If no owned vehicles, provide Hired Autos and Non-Owned Autos coverage in lieu of Any Auto. ECESS GL COVERAGE LIMIT EACH RENCE GENERAL AGGREGATE Category 2 * 1,000,000 1,000,000 Category 3 * 2,000,000 2,000,000 Category 4 * 3,000,000 3,000,000 WORKERS COMPENSATION REQUIRED LIMIT COVERAGE Workers Compensation Statutory Statutory Employer s Liability Each Accident, Disease Each 250,000 Category 1, Professional Employee, Disease Policy Limit Employer s Liability Each Accident, Disease Each 500,000 Category 2, 3, Towing Employee, Disease Policy Limit Employer s Liability Each Accident, Disease Each 1,000,000 Category 4 Employee, Disease Policy Limit If sole proprietor with zero employees, contact Compliance Depot to request an exemption from the Workers Compensation requirement. Policy certificate states 30 Day Notice of Cancelation Additional Insured language is included, as follows: Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insured on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. Excess policy to follow form. Certificate Holder box must list: Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box , Carrollton, T Off-Site suppliers are exempt from above insurance requirements. W-9 Form: signed and dated. Supplier Service Agreement: signed and dated. ADDITIONAL ITEMS (All Suppliers) Applicable licenses must be submitted. For example, an electrician must submit an electrical license. Background checks completed by Compliance Depot. * Category depends on Industry Code. Refer to Compliance Depot website for Industry Code ( 2013/01/23/v1.0/tt

4 PRODUCER Name of Agent Address of Agent INSURED Name of Supplier Address of Supplier GEN L AGGREGATE LIMIT APPLIES POLICY PROJECT CATEGORY 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A:Name of Carrier (B+ Rating or Better) INSURER B:Name of Carrier (B+ Rating or Better) INSURER C:Name of Carrier (B+ Rating or Better) INSURER D:Name of Carrier (B+ Rating or Better) INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L POLICYEFFECTIVE POLICYEPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY EACH RENCE 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) 100,000 B C D ACORDTM CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LIABILITY ECESS/UMBRELLA DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EECUTIVE OFFICER/MEMBER ECLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER MED EP (Any one person) PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 1,000,000 COMBINED SINGLE LIMIT (Ea accident) (Per person) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHERTHAN AUTO ONLY: EACH RENCE AGGREGATE W C STATUTORY EAACC AGG Other DATE (MM/DD/YYYY) 500,000 OR 100, , ,000 E.L. EACH ACCIDENT 250,000 E.L. DISEASE - EA EMPLOYEE 250,000 E.L. DISEASE - POLICY LIMIT 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / ECLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box Carrollton, T Fax: (877) ACORD 25 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 ORIGINAL MUST BE SIGNED DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD CORPORATION

5 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)

6 PRODUCER Name of Agent Address of Agent INSURED Name of Supplier Address of Supplier GEN L AGGREGATE LIMIT APPLIES POLICY PROJECT CATEGORY 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A:Name of Carrier (B+ Rating or Better) INSURER B:Name of Carrier (B+ Rating or Better) INSURER C:Name of Carrier (B+ Rating or Better) INSURER D:Name of Carrier (B+ Rating or Better) INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L POLICYEFFECTIVE POLICYEPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY EACH RENCE 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) 100,000 B C D ACORDTM CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LIABILITY ECESS/UMBRELLA DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EECUTIVE OFFICER/MEMBER ECLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER MED EP (Any one person) PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 1,000,000 COMBINED SINGLE LIMIT (Ea accident) (Per person) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHERTHAN AUTO ONLY: EAACC Other DATE (MM/DD/YYYY) 1,000,000 OR 500, , ,000 EACH RENCE 1,000,000 AGGREGATE 1,000,000 W C STATUTORY AGG E.L. EACH ACCIDENT 500,000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / ECLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. Excess policy to follow form. Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box Carrollton, T Fax: (877) ACORD 25 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 ORIGINAL MUST BE SIGNED DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD CORPORATION

7 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)

8 PRODUCER Name of Agent Address of Agent INSURED Name of Supplier Address of Supplier GEN L AGGREGATE LIMIT APPLIES POLICY PROJECT CATEGORY 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A:Name of Carrier (B+ Rating or Better) INSURER B:Name of Carrier (B+ Rating or Better) INSURER C:Name of Carrier (B+ Rating or Better) INSURER D:Name of Carrier (B+ Rating or Better) INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L POLICYEFFECTIVE POLICYEPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY EACH RENCE 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) 100,000 B C D ACORDTM CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LIABILITY ECESS/UMBRELLA DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EECUTIVE OFFICER/MEMBER ECLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER MED EP (Any one person) PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 1,000,000 COMBINED SINGLE LIMIT (Ea accident) (Per person) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHERTHAN AUTO ONLY: EAACC Other DATE (MM/DD/YYYY) 1,000,000 OR 500, , ,000 EACH RENCE 2,000,000 AGGREGATE 2,000,000 W C STATUTORY AGG E.L. EACH ACCIDENT 500,000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / ECLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. Excess policy to follow form. CERTIFICATE HOLDER Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box Carrollton, T Fax: (877) ACORD 25 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 ORIGINAL MUST BE SIGNED DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD CORPORATION

9 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)

10 PRODUCER Name of Agent Address of Agent INSURED Name of Supplier Address of Supplier GEN L AGGREGATE LIMIT APPLIES POLICY PROJECT Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box Carrollton, T Fax: (877) CATEGORY 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A:Name of Carrier (B+ Rating or Better) INSURER B:Name of Carrier (B+ Rating or Better) INSURER C:Name of Carrier (B+ Rating or Better) INSURER D:Name of Carrier (B+ Rating or Better) INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L POLICYEFFECTIVE POLICYEPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY EACH RENCE 2,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) 100,000 B C D A ACORDTM CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LIABILITY ECESS/UMBRELLA DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EECUTIVE OFFICER/MEMBER ECLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER Pollution Liability DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / ECLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS MED EP (Any one person) PERSONAL & ADV INJURY 2,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 COMBINED SINGLE LIMIT (Ea accident) (Per person) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHERTHAN AUTO ONLY: Other 1,000,000 OR 500, , ,000 EACH RENCE 3,000,000 AGGREGATE 3,000,000 E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 2,000,000 Each Occurrence 2,000,000 Aggregate Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. Excess policy to follow form.. CERTIFICATE HOLDER CANCELLATION W C STATUTORY EAACC AGG 30 DATE (MM/DD/YYYY) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ORIGINAL MUST BE SIGNED DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 ACORD CORPORATION

11 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)

12 PRODUCER Name of Agent Address of Agent INSURED Name of Supplier Address of Supplier GEN L AGGREGATE LIMIT APPLIES POLICY PROJECT TOWING CATEGORY INSURERS AFFORDING COVERAGE NAIC # INSURER A:Name of Carrier (B+ Rating or Better) INSURER B:Name of Carrier (B+ Rating or Better) INSURER C:Name of Carrier (B+ Rating or Better) INSURER D:Name of Carrier (B+ Rating or Better) INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L POLICYEFFECTIVE POLICYEPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY EACH RENCE 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) 100,000 B C D ACORDTM CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LIABILITY ECESS/UMBRELLA DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY C On-Hook Cargo Garage Keeper Liability ANY PROPRIETOR/PARTNER/EECUTIVE OFFICER/MEMBER ECLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / ECLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS MED EP (Any one person) PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 PRODUCTS - COMP/OP AGG 1,000,000 COMBINED SINGLE LIMIT (Ea accident) (Per person) PROPERTY DAMAGE Other 1,000,000 AUTO ONLY - EA ACCIDENT 100,000 EACH RENCE AGGREGATE E.L. EACH ACCIDENT 500,000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 500,000 50, ,000 DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. OTHERTHAN AUTO ONLY: W C STATUTORY Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. EAACC AGG CERTIFICATE HOLDER Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box Carrollton, T Fax: (877) ACORD 25 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 ORIGINAL MUST BE SIGNED DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD CORPORATION

13 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)

14 PRODUCER Name of Agent Address of Agent INSURED Name of Supplier Address of Supplier GEN L AGGREGATE LIMIT APPLIES POLICY PROJECT Professional Category INSURERS AFFORDING COVERAGE NAIC # INSURER A:Name of Carrier (B+ Rating or Better) INSURER B:Name of Carrier (B+ Rating or Better) INSURER C:Name of Carrier (B+ Rating or Better) INSURER D:Name of Carrier (B+ Rating or Better) INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L POLICYEFFECTIVE POLICYEPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY EACH RENCE 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) 100,000 B D C ACORDTM CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LIABILITY ECESS/UMBRELLA DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EECUTIVE OFFICER/MEMBER ECLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER Professional Liability DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / ECLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS MED EP (Any one person) PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 PRODUCTS - COMP/OP AGG 1,000,000 COMBINED SINGLE LIMIT (Ea accident) (Per person) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT EACH RENCE AGGREGATE Other 500,000 OR 100, , ,000 E.L. EACH ACCIDENT 250,000 E.L. DISEASE - EA EMPLOYEE 250,000 E.L. DISEASE - POLICY LIMIT 250,000 Each Claim 1,000,000 DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. OTHERTHAN AUTO ONLY: W C STATUTORY Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. EAACC AGG Riverstone Residential Group c/o Compliance Depot, LLC P.O. Box Carrollton, T Fax: (877) ACORD 25 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 ORIGINAL MUST BE SIGNED DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD CORPORATION

15 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)

16 SUPPLIER SERVICE AGREEMENT, (hereafter Supplier ) agrees to provide goods and/or services for Consolidated American Services, Inc., a Delaware corporation, Riverstone Residential Group, LLC, a Delaware limited liability company, or any of their affiliates (hereinafter collectively referred to as CAS ), as agent for its clients under the terms of various management contract(s). Supplier agrees that the following terms shall apply to all contracts and agreements between Supplier and any properties managed by CAS. A) LIABILITY FOR CHARGES: Supplier is an independent contractor and not an agent or employee of CAS. Any goods or services which are supplied by Supplier are supplied to the apartment communities and other properties managed by CAS (collectively the Property ) and/or to the owner or owners of the Property. Supplier hereby acknowledges that CAS has made known or offered to make known the identity of the owner or owners of the Property, and that Supplier has had a reasonable opportunity to review this agreement in light of such information. Supplier agrees to look solely to the Property, to which the goods or services have been provided, and/or the owner or owners of such Property, for the payment for such goods and/or services and for interest and collection of fees incurred by Supplier in making collection of any sums that are due and payable. CAS is not liable and is not to be held liable for the payment of any invoice for charges rendered to any Property or to the owner or owners of any Property, and CAS is not a guarantor for any indebtedness owed to Supplier related to the Property. No information, annotation or interlineation included on any invoice, correspondence or other writing received by CAS pursuant to or in relation to this agreement constitutes or is to be held to constitute any assumption by CAS of any obligation owed to Supplier. Supplier hereby agrees that in the event any collection action or legal proceeding is initiated by Supplier, or its representatives, against CAS in connection with any Property, Supplier shall indemnify and hold harmless CAS for any and all damages or costs (including, but not limited to, attorneys fees and costs) incurred by CAS in connection with CAS being named or pursued in any such action or proceeding. B) INSURANCE & COMPLIANCE; If Supplier is providing any type of good and/or service to CAS or to any Property, Supplier must have a completed (where applicable) W-9 and any applicable professional licenses on file with Compliance Depot. Additionally, if Supplier is providing any type of good and/or service that requires Supplier to send a Supplier employee or agent to any Property, Supplier must also have a current certificate of insurance and if required additional insured endorsement on file with Compliance Depot confirming continual compliance with the minimum insurance requirements as set forth by CAS requirements as they pertain to: (1)Commercial General Liability insuring bodily injury and property damage, including Products and Completed Operations Coverage and Personal and Advertising Injury, (2) Automobile liability on all owned, non-owned, hired or leased automotive equipment used in the performance of the work, (3) Workers compensation Insurance in compliance with the laws of the state where the work will be performed including Employers Liability. Umbrella and/or Excess liability, professional liability, on-hook/cargo, garage keepers, or pollution liability may also be required if deemed appropriate by the scope of service provided. All liability coverages shall be primary and non-contributory and any deductibles and premiums for the above insurance will be the responsibility of the Supplier. Additional insured status should be indicated as follows: Consolidated American Services, Inc., Riverstone Residential Group, LLC, its affiliates, and the direct and indirect owners and advisors of their managed properties are included as additional insureds on the general liability policies as their interests may appear in regard to work performed or services provided by the named insured. Excess policy to follow form. A waiver of subrogation is to be issued in favor of the aforementioned parties on all policies as permitted by law. The certificate of insurance must remain current and any lapse in coverage will result in the termination of future purchases of goods and services. C) LOSS TO SUPPLIER S PROPERTY: Supplier will be responsible for insuring all personal property including personal property of its employees, and all materials and equipment brought onto any Property. Supplier will indemnify, defend and hold harmless Consolidated American Services, Inc., Riverstone Residential Group, LLC, their affiliates, and the direct and indirect owners of their managed properties and all such parties agents, officers, directors, owners, advisors and employees (hereafter the Indemnified Parties ) from any loss or damage to such property. Supplier waives any rights of subrogation against Indemnified Parties for damage to Supplier s personal property as described above, regardless of any actual or alleged negligence or fault of the Indemnified Parties. D) COMPLIANCE WITH SAFETY RULES: Supplier agrees to comply with all federal, state and local laws, regulations, and orders now or hereafter applicable to the work performed or services provided. Supplier shall comply with all safety rules and regulations set forth by the owner of the Property, or by the property manager at the locations where work will be performed, or where the goods are to be delivered. 2013/02/22/v1.0tt Page 1 of 3

17 E) QUALIFICATIONS OF SUPPLIER S EMPLOYEES: Supplier agrees to use its best efforts and exercise due diligence in not placing any employees, laborers, or subcontractors to perform work within property boundaries and inside dwelling units who may have a history of criminal convictions or deferred-adjudication or pose a potential threat or risk of injury to residents and others. Unacceptable criminal history includes, but is not limited to, such crimes as rape, molestation, sexual assault, indecent exposure, indecency with a child, murder, kidnapping, burglary, theft, or robbery. Supplier also agrees to comply with Immigration and Customs Enforcement (ICE) regulations. F) NO DISCRIMINATION: Supplier shall not discriminate against any person or group of persons on account of race, color, religion, sex, individual gender, marital status, ancestry, national origin, handicap or disability, or familial status in the services provided, nor shall Supplier establish or permit any such practice or practices of discrimination amongst its employees or suppliers. G) CONDUCT OF SUPPLIER S EMPLOYEES: Employees, agents or sub-contractors of the Supplier agree to conduct themselves in a professional and ethical manner in all dealings with CAS, its agents and employees. Supplier acknowledges and understands that CAS has a policy prohibiting bribes, commissions or financial incentives of any kind. In the event Supplier shall induce an employee of CAS by any means other than those deemed fair and reasonable, Supplier may be eliminated from CAS s Approved Vendor List. H) INDEMNIFICATION: To the fullest extent allowed by law, Supplier shall indemnify, save harmless, and defend the Indemnified Parties from and against any all suits, actions, legal proceeding, claims, demands, damages, costs, and expenses of whatsoever kind or character (including but not limited to attorney's fees and litigation expenses) caused by any wrongful acts or any omission, fault, or negligence of Supplier, or of anyone acting on Supplier s behalf (including, but not limited to, subcontractors and sub-suppliers of Supplier; and Supplier s sub-subcontractors and sub-subsuppliers, and the employees and agents of any of the foregoing), in connection with or arising from this Agreement, work to be performed by Supplier, or the materials or goods to be supplied by Supplier hereunder, regardless of whether it was caused in part by the passive conduct, vicarious negligence, or implied omission of any Indemnified Party. However, this indemnity will not extend to any loss, damage, or expense arising out of the actions and sole gross negligence, willful misconduct or criminal acts of the Indemnified Parties. Such obligation shall not be construed to negate, or abridge, or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or persons described in this paragraph. Supplier s obligations shall continue without limitation as to time, notwithstanding the extinguishment of other rights and duties under this contract by completion, termination, or any other manner. If any one article, section, part or subpart of this Agreement is deemed to be invalid for any reason, all others remain in effect. I) WAIVER: Regardless of any fault of Indemnified Parties, Supplier waives all claims against the Indemnified Parties for injuries to Supplier or Supplier s employees in connection with their contracted work or services. J) WARRANTY: Supplier warrants that the goods and materials delivered to the Property shall be as specified in Supplier s proposal or invoice; and that the goods and materials will be installed in accordance with industry standards and to the specifications of the manufacturer of the goods and materials. Unless otherwise agreed, all warranties relating to defects in the goods and materials are made jointly by Supplier and by the manufacturer of the goods and materials. Supplier will assist CAS and the owner of the Property in asserting warranty claims against the manufacturer. K) ATTORNEYS FEES & COSTS: Should any party commence an action to enforce or to interpret the terms and conditions of this Agreement, the prevailing party in such action shall be entitled to recover the costs and expenses of such litigation, including reasonable attorneys fees, whether such costs and attorneys fees are incurred in a trial court, appellate court, or in an arbitration proceeding. L) SCOPE OF AGREEMENT: The terms of this Agreement shall be applicable to any and all contracts and order placed by any representative of CAS, on behalf of any property managed by CAS. Where the terms and provisions of this Agreement shall be in conflict with the terms of any separate contract, proposal or order placed by any employee or agent of CAS, or any employee of any property managed by CAS, the parties agree that the terms and provisions of this Agreement shall be controlling. No employee or agent of CAS or of any Property shall have the authority to modify or agree to modify any provision of this Agreement, without the express written authority of a Divisional President of a subsidiary of CAS or the CEO of CAS. 2013/02/22/v1.0tt Page 2 of 3

18 M) SCOPE OF WORK / SPECIFICATIONS: Where applicable, an addendum will be attached to this agreement outlining the work and/or services that the Supplier has agreed to provide to CAS. N) CONFIDENTIALITY: This Agreement is and will remain confidential, and Supplier may only make such limited disclosure of matters related to this Agreement as Supplier or its representatives reasonably deem to be required by subpoena or court order or as appropriate to comply with the rules, regulations and requirements of government agencies, state and federal courts; provided, however, that this Agreement may be disclosed to Supplier s affiliates, employees, accountants, attorneys and other advisors who have a need to know and have been advised of the confidential nature of this Agreement. Supplier shall consult with CAS in preparing any press release, public announcement, statement to the press, or other form of release of information concerning the existence of this Agreement, Supplier s work as an independent contractor with respect to any property managed by CAS, or the relationship of the parties hereto that is intended to provide any information to the news media or the public in any manner (a Press Release ). Without CAS s prior written consent, Supplier may not (a) issue or cause the publication of any Press Release, or (b) publish or display CAS s name, brand and/or logo in any online or printed materials. O) COMPLETE AGREEMENT: This Agreement sets forth the entire understanding of the parties with respect to the specific terms set forth herein and is binding upon both parties in accordance with its terms. This agreement may be modified or amended only by a writing signed by both parties. Any agreement purporting to limit the applicability of Section A must be signed by the CEO of CAS to be binding. The individual signing below on behalf of Supplier is authorized to represent Supplier and has proper authority to execute this document on Supplier s behalf. P) GOVERNING LAW AND VENUE: This Agreement shall be interpreted and construed according to, and governed by, the laws of the State of Texas without regard to the choice of law or conflict of laws provisions thereof. The parties hereto each hereby irrevocably submit to the exclusive jurisdiction of any state or federal court sitting in Dallas County, Texas for the purpose of any suit, action or other proceeding arising out of or based upon this Agreement. This Section P applies only to suits, actions or other proceedings which name CAS and/or its affiliates as a party. The supplier or property owner may file an action related to this Agreement in any appropriate venue outside the State of Texas so long as neither CAS nor any of its affiliates are named as a party to such action. Q) THIRD-PARTY BENEFICIARIES: Supplier acknowledges and agrees that the direct and indirect owners of the properties managed by CAS are intended to be third-party beneficiaries of this Agreement and Supplier will not challenge the enforceability of this Agreement, including without limitation Sections C and H, by such direct and indirect owners. Please sign below acknowledging receipt and agreement to the above terms. Changes or modifications to this agreement shall not be binding on CAS. Violation of any terms of this agreement will result in the termination of approval to perform work for CAS, or any Property. SUPPLIER: By: Print Name/Title Business Address City, State Zip Please forward the completed Supplier Service Agreement to Compliance Depot via ONE of the following methods: documents@compliancedepot.com or submit via fax at (877) /02/22/v1.0tt Page 3 of 3

19 Form W-9 (Rev. December 2011) Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Exempt payee Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Other (see instructions) Address (number, street, and apt. or suite no.) Requester s name and address (optional) City, state, and ZIP code 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 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 number to enter. Social security number Employer identification number Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). 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 Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. 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 requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners share of effectively connected income. 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 to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section ). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No Form W-9 (Rev )

20 Form W-9 (Rev ) Page 2 The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: 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, and The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a 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 treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese 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 the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called backup withholding. Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Also see Special rules for partnerships on page 1. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of 50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a 500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your income tax return on the Name line. You may enter your business, trade, or doing business as (DBA) name on the Business name/disregarded entity name line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the Name line and any business, trade, or doing business as (DBA) name on the Business name/disregarded entity name line. Disregarded entity. Enter the owner's name on the Name line. The name of the entity entered on the Name line should never be a disregarded entity. The name on the Name line must be the name shown on the income tax return on which the income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the Name line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the Business name/disregarded entity name line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the Name line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate). Limited Liability Company (LLC). If the person identified on the Name line is an LLC, check the Limited liability company box only 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 tax purposes, enter P for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter C for C corporation or S for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the Name line) is another LLC that is not disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the Name line.