85222 C2b484b614667f4ffff8004ffffe906

LORENZO'S

TRUCKING

SERVICES

INFORMATION

LORENJOS

TRUCKING

SERVICES

STARTED:

JUNE/2008

MCS

663226

FED

)O*

26-0452579

USOOT

a

J24W21

BOND

INFORMATION:

PACIFIC

FINANCIAL

ASSOCIATION

SAN

DIEGO.

CALIFORNIA

PHN;

800.595.2616

EFFECTIVE'

NOVEMBER

I

2008

BOND

POLICY

#22512

BOND

LIMIT:

$10,000.00

WAIN

OFFICE;

1517

E.

ALBA

DRIVE

CASA

GRANDE.

AZ

85222

PHN

S20.836.8083

FAX:

S20.838

2115

OWNER

/

DISPATCH:

JOSE

GARCIA

ACCOUNTS PAYABLE:

BERENICE

GARCIA

ACCOUNTS

RECIEVEABLE:

DEMISE

GARCIA

OTHER

LOCATIONS.

PHOENIX.

AZ

fREDDY

GONZALEZ

PHN

623

385

6084

FAX:

623.386

2696

LOS

ANGELES,

CA

ROSALlO

TAPIA

PHN:

SKT05.S373

FAX 626

918.5122

-LOS ANGELES

JOSEPH

LOPEZ

PHN:

951.243

2566 FAX;

9S1.413.B3O5

LOS

ANGELES,

CA

ABLE

V1DALES

PHN:

951.462.3077

FAX

861.242.0147

BILLING

INFORMATK3N:

MAIN

OFFICE

-1517

E

ALBA

DRIVE

CASA

GRANDE.

AZ

85222

PHN

520.836 8083

FAX

520

836.2115

OWNER

'

DISPATCH:

JOSE

GARCIA

ACCOUNTS PAYABLE:

BERENICE

GARCIA

ACCOUNTS

RECtEVEABLE:

DEMISE

GARCIA

i

LOAD PAPERWORK

MUST

BE

SENT

TO THE

MAIN OFFICE

FOR

PAYMENT,

LORENZO

WILL

REMIT

PAYMENT

WITHIN

3Q

i

DAYS

FROM

RECEIVING

PAPERWORK

AS

LONG

AS

ORIGINAL

SIGNED

BILLS,

CLEAR

DELIVERY

RECEIPTS,

CURRENT

!

INSURANCE.

SIGNED

CONFIRMATION

SHEET

IS ON

FILE

FOR

BILLED

SHIPMENT,

AND

LOAD

HAS

BEEN

DELIVERED

i

CLEAR

OF ANY

CLAIMS

AND/OR

EXCEPTIONS

PAf.f.

I

/

S

1S17E-ALOA

DRIVE

CASA

GRANDS.

ARIZONA

851

22

M.IIN

szn

.tm.soa:)

FAX

szo.B3fi.2iir.

ALTERNATE

szo

431.5168

LORENZO'S

TRUCKING

SERVICES

WWW.LORENZOSTRUCKIN6LLC.COM

ANNOUNCEMENT

DEAR VALUED CUSTOMER,

JS

FREIGHT BROKERS WOULD

LIKE

TO

INFORM

YOU

THAT

WE

HAVE

CHANGED

OUR

COMPANY

NAME

EFFECTIVE

SEPTEMBER

1,2012

TO

LORENZOS

TRUCKING SERVICES.

OUR

NAME

HAS

CHANGED,

BUT THE

SERVICE

WE

PROVIDE WILL

REMAIN.

OUR

ADDRESS,CONTACTS

AND

PHONE

NUMBER

WILL

REMAIN

THE

SAME ALONG WITH

OUR

INSURANCE.AUTHORiTY.TAX

ID AND

LICENSE.

FOR ANY

QUESTIONS

OR

CONCERNS PLEASE FEEL FREE

TO

CONTACT

US. WE

APOLOGIZE

FOR ANY

INCONVINIENCE

THIS

MAY

CAUSE.

THANK

YOU AND WE

APPRECIATE YOUR BUSINESS

AND

WILL CONTINUE

TO

STRIVE

FOR THE

BEST.

FEEL

FREE

TO

CONTACT

US AT

520-636-8083

OR

JBGARCIA09@AOL.COM

YOU CAN

ALSO

VISIT

US

ONLINE

AT

WWW.LORENZOSTRUCKINGLLC.COM

THANK YOU!

LORENZOS

TRUCKING

SERVICES

1517

E.

ALBA

DRIVE

CASA

GRANDfc

ARIZONA

85122

MAIN

520-836-8083

FAX

520-836-2115

ALTERNATIVE

520^31-5168

WWW.LORENZOSTRUCKINGLLC.COM

LORENZO'S

TRUCKING

SERVICES

LORENZO'S

TRUCKING SERVICES

/

CARRIER CONTRACT AGREEMENT

THIS

AGREEMENT MADE THIS

DAY

OF

20

BY

AND

BETWEEN

MC#

HEREINAFTER REFERRED

TO AS

"CARRIER1

AND

LORENZO'S

TRUCKING SERVICES,

MC-663225.

CARRIER REPRESENTS THAT

IT IS A

CONTRACT

CARRIER,

HAVING

APPROPRIATE REQUIRED AUTHORITY FROM

ANY AND ALL

GOVERNMENTAL AGENCIES

AND

DESIRES

TO

RETAIN

THE

SERVICES

OF

LORENZO'S

TRUCKING SERVICES

TO

OBTAIN GOODS

AND

MERCHANDISE

FOR

TRANSPORTING

AS ARE

OFFERED

BY

LORENZO'S

TRUCKING SERVICES. LORENZO'S TRUCKING SERVICES

DESIRES

TO

AVAIL ITSELF

OF

CARRIER'S

MOTOR CARRIER SERVICE.

NOW

THEREFORE.

IN

CONSIDERATION

OF

THE

PREMISES

AND THE

MUTUAL COVENANTS HEREWITH CONTAINED,

IT

IS

HEREBY AGREED

AS

FOLLOWS:

1.

LORENZO'S TRUCKING SERVICES WILL TENDER

A

SERIES

OF

SHIPMENTS

TO

CARRIER. CARRIER AGREES

TO

MAKE EQUIPMENT AVAILABLE

ON AN

"EXCLUSIVE USE" BASIS

OR TO

MEET

THE

"DISTINCT

NEEDS"

OF

LORENZO'S TRUCKING SERVICES.

2.

CARRIER RESERVES

THE

RIGHT

TO

REFUSE

TO

TRANSPORT

ANY

SHIPMENT

FOR ANY

REASON

IT

DEEMS

REASONABLE

BEFORE CONSIGNMENT; AFTER CONSIGNMENT,

HOWEVER,

CARRIER AGREES

TO

DELIVER EACH

SHIPMENT PURSUANT

TO ITS

DOT

/

FMCSA OBLIGATIONS.

3.

THE

RATE

AND

OTHER CHARGES

TO

APPLY

TO

EACH SHIPMENT TRANSPORTED UNDER THIS AGREEMENT

SHALL

BE SET

FORTH

IN THE

LORENZO'S TRUCKING SERVICES RATE CONFIRMATION SHEET, ISSUED

BY

LORENZO'S TRUCKING SERVICES WITHIN TWENTY-FOUR (24) HOURS

OF THE

ORAL AGREEMENT. UNLESS

OBJECTED

TO

WITHIN

TWENTY-FOUR

(24)

HOURS

OF ITS

RECEIPT,

CARRIER

SHALL

BE

CONCLUSIVELY

PRESUMED

TO

HAVE

AGREED THAT

THE

TERMS

AND

CONDITIONS

SET

FORTH

ON

SUCH

ARE

FULLY

AND

CORRECTLY STATED.

4.

CARRIER AGREES

TO

HAVE INSURANCE CARRIER FORWARD

A

CERTIFICATE

OF

INSURANCE SHOWING

LIABILITY

AND

CARGO INSURANCE WITH LORENZO'S TRUCKING SERVICES NAMED

AS

ADDITIONAL

INSURED.

CARRIER'S

CARGO INSURANCE SHALL

BE IN AN

AMOUNT SUFFICIENT

TO

COMPENSATE LORENZO'S TRUCKING

SERVICES,

OWNER,

OR

CONSIGNEE

FOR

LOSS

OR

DAMAGE

TO

PROPERTY

TRANSPORTED,

BUT IN NO

EVENT

IN

AN

AMOUNT LESS THAN $100,000. CARRIER ALSO AGREES

TO

PROVIDE

30

DAYS NOTICE PRIOR

TO THE

CANCELLATION

OF

INSURANCE.

THE

CERTIFICATE

IS

REQUIRED BEFORE CARRIER

CAN BE

DISPATCHED

ON A

LOAD.

5.

CARRIER SHALL

BE

LIABLE

TO

OWNER

OF

CARGO, CONSIGNEE,

OR

LORENZO'S TRUCKING SERVICES

FOR

ANY

LOSS

OR

DAMAGE

TO THE

PROPERTY

OR

CARGO WHILE

IN THE

POSSESSION

OF OR

UNDER

THE

CONTROL

OF

CARRIER. CARRIER FURTHER AGREES

TO

INDEMNIFY

AND

SAVE HARMLESS LORENZO'S TRUCKING

SERVICES

FROM

AND

AGAINST

LOSS,

DAMAGE,

INJURY,

INCLUDING DEATH, AND/OR CLAIMS, INCLUDING

THE

DEFENSE

OF

ANY

LAWSUITS WHICH ARISE

BY THE

GROSS NEGLIGENCE

OF

CARRIER

IN

CONNECTION

WITH

THE

CARRIAGE

OF

ANY

AND ALL

COMMODITIES

OR

OPERATION

OF THE

MOTOR VEHICLE EQUIPMENT

UTILIZED

BY

CARRIER

HEREIN

UNDER

THIS AGREEMENT.

6.

CARRIER AGREES

TO

RETAIN THIS LORENZO'S TRUCKING SERVICES CONTRACT CARRIER AGREEMENT

AND

EACH

OF

LORENZO'S TRUCKING SERVICES RATE CONFIRMATION SHEET

FOR A

PERIOD

OF

THREE

(3)

YEARS.

PAGE

4/5

1517

E.

ALBA

DRIVE

CASA

GRANDE.

ARIZONA

85222

MAIN

520.836.8083

FAX

520.836.2115

ALTERNATE

520.431.5168

LORENZO'S

TRUCKING

SERVICES

WORKERS

COMPENSATION AGREEMENT

WE,

(CARRIER)

MC#_

,

SHALL

INDEMNIFY,

DEFEND

AND

HOLD HARMLESS LORENZO'S TRUCKING SERVICE FROM

AND

AGAINST

ALL

LOSS,

DAMAGE,

FINES,

EXPENSE,

ACTIONS,

AND

CLAIMS

FOR

INJURY

TO

CARRIERS

EMPLOYEES, AGENTS,

OR

SUBCONTRACTORS

(INCLUDING

INJURY RESULTING

IN

DEATH) ARISING

OUT OF OR

IN

CONNECTION WITH

THE

CARRIER'S

DISCHARGE

OF

DUTIES

AND

RESPONSIBILITIES

UNDER CARRIER CONTRACT AGREEMENT

BETWEEN

LORENZO'S TRUCKING SERVICES

AND

CARRIER.

I

HAVE

READ, UNDERSTAND

AND

AGREE

THE

ABOVE

STATEMENT

AS

OF

THIS.

DAY OF , 20 .

CARRIER:

MCS:

SIGNATURE:,

DATE:

PRINT NAME

/

OWNER:

PAGE

3/5

1517

E.

ALBA DRIVE

CASA

GRANDE,

ARIZONA

85222

MAIN

520.836.8083

FAX

520.836.2115

ALTERNATE

520.431.5168

LORENZO'S

TRUCKING

SERVICES

LORENZO'S

TRUCKING

SERVICES

/

CARRIER

CONTRACT

AGREEMENT

7.

CARRIER SHALL NEITHER

HAVE

NOR

CLAIM

ANY

LIEN RIGHTS

ON OR

AGAINST

ANY

PROPERTY

TRANSPORTED

UNDER

THIS

AGREEMENT.

HOWEVER,

SHOULD

A

CONSIGNOR

OR

CONSIGNEE

NOTIFY

LORENZO'S

TRUCKING

SERVICES

OF A

CLAIM

FOR

LOSS

OR

DAMAGE

TO

PROPERTY TRANSPORTED

BY

CARRIER UNDER

THIS

UNDER THIS AGREEMENT, CARRIER AGREES THAT

LORENZO'S

TRUCKING SERVICES

AND

CONSIGNOR/CONSIGNEE

SHALL HAVE

THE

RIGHT

TO

SET-OFF

AN

AMOUNT SUFFICIENT

TO

COVER SUCH

DAMAGES,

AND TO

DEDUCT

AND

WITHHOLD SUCH AMOUNT FROM

ANY

FREIGHT CHARGE PAYMENTS

DUE

CARRIER.

8.

LORENZO'S TRUCKING SERVICES AGREES

TO PAY

CARRIER

FOR

SERVICES RENDERED

WITHIN

30

DAYS

OF

LORENZO'S

TRUCKING SERVICES RECEIPT

OF

CARRIER'S INVOICE, CLEAR ORIGINAL SIGNED ORIGINAL

BILL

OF

LADING,

PROOF

OF

DELIVERY, CURRENT INSURANCE

ON

FILE, SIGNED CONFIRMATION SHEET

IS ON

FILE

FOR

SHIPMENT

AND

LOAD

HAS

BEEN DELIVERED CLEAR

OF ANY

CLAIMS AND/OR EXCEPTIONS.

9.

CARRIER

SHALL

NOT

SOLICIT

TRAFFIC

FROM

ANY

SHIPPER,

CONSIGNEE,

OR

CUSTOMER

OF

LORENZO'S

TRUCKING SERVICES DURING

THE

TERM

OF

THIS AGREEMENT

AND FOR A

PERIOD

OF ONE

(1)

YEAR AFTER.

IF

CARRIER

"BACK-SOLICITS"

ANY OF

LORENZO'S

TRUCKING SERVICES SHIPPERS, CONSIGNEES,

OR

CUSTOMER

AND

OBTAINS TRAFFIC, LORENZO'S TRUCKING SERVICES

IS

ENTITLED

TO A

COMMISSION FROM

THE

CARRIER

OF

15%

OF ALL

TRANSPORTATION REVENUE RECEIVED

ON

SUCH TRAFFIC MOVEMENT.

10.

THIS AGREEMENT SHALL CONTINUE

IN

FULL FORCE

AND

EFFECT

FOR A

PERIOD

OF ONE (1)

YEAR, WHICH

TERM

SHALL THEREAFTER

BE

DEEMED AUTOMATICALLY RENEWED

FOR

SUCCESSIVE YEAR

PERIODS;

SUBJECT,

HOWEVER,

TO THE

RIGHT

OF THE

PARTIES

HERETO

TO

CANCEL

OR

TERMINATE

THE

SAME UPON PRIOR WRITTEN

30

DAY

NOTICE

TO THE

OTHER PARTY.

11.

THE

PARTIES AGREE

THAT,

SHOULD EITHER PARTY RESORT

TO

LEGAL ACTION

TO

ENFORCE

THE

TERMS

OF

THIS AGREEMENT,

THE

PREVAILING

PARTY

IN

SUCH LEGAL ACTION SHALL,

IN

ADDITION

TO ALL

OTHER

RELIEF,

RECOVER

ITS

ACTUAL

ATTORNEY'S

FEES

AND

COURT COSTS.

12.

IN THE

EVENT THAT LEGAL ACTION

TO

ENFORCE

THIS

AGREEMENT SHALL BECOME NECESSARY,

THE

PARTIES

AGREE

THAT

THE

LAWS

OF THE

STATE

OF

ARIZONA SHALL GOVERN

IT, AND

THAT JURISDICTION OVER

THE

PARTIES

AND

SUBJECT MATTER

OF THE

DISPUTE SHALL

BE

APPROPRIATE

IN

MARICOPA COUNTY, ARIZONA.

13.

THE

PARTIES

HERE

TO

AGREE THAT

FACSIMILE

SIGNATURES

MAY BY

AFFIXED

TO

THIS

AGREEMENT,

AND

THAT

ONCE

SO

AFFIXED, SHALL

BE

DEEMED

TO BE OF THE

SAME FORCE

AND

EFFECT

AS

ORIGINAL

SIGNATURES.

IN

WITNESS WHEREOF

THE

PARTIES HAVE EXECUTED THIS

AGREEMENT,

BY AND

THROUGH THEIR DULY

AUTHORIZED

REPRESENTATIVES,

AS OF THE

DATE

SET

FORTH ABOVE.

JOSE

GARCIA

PHN:

520.836.8083

FAX

520.836.2115

LORENZO'S TRUCKING SERVICES

ALL

DOCUMENTS MUST

BE

FAXED

TO

620.836.2115

CARRIER:

MC#

SIGNATURE:

PRINT

NAME/TITLE:

DATE:

PAGES/5

1517

E.

ALBA

DRIVE

CASA

GRANDE.

ARIZONA

85222

MAIN

520.836.8083

FAX

520.836.2115

ALTERNATE

520.431.S168

LORENZO'S

TRUCKING

SERVICES

DEAR CARRIER.

THANK

YOU FOR

PARTNERING

WITH

LORENZOS

TRUCKING

SERVICES

TO

BETTER

SERVE

YOU &

EXPEDITE PAYMENT,

WE

MUST HAVE YOUR

COMPANY'S

COMPLETE

INFORMATION

IN OUR

SYSTEM.WE

ASK

THAT

YOU

PLEASE FILL

OUT

COMPLETELY

AND

PRINT LEGIBLY. THANK YOU.

Legal

Name:

Address:

Phone:

Cell:

DBA

Name:

City:.

State:

Zip:

Fax:

E-Mail:

Dispatch

Contact:

MC#

Ace

Contact:

USDOT#

FED

ID#

Type

Of

Equipment:.

Lanes/

States:

_How

Many:_

Size:

Additional

Info:

Notes:

Date Entered:Entered

By:

Time:

WE

ALSO REQUIRE

THE

FOLLOWING DOCUMENTS FILLED

OUT &

FAXED BACK

TO

COMPLETE

THE SET UP

PROCESS:

-CARRIERS CURRENT CARGO

&

LIABILITY

INSURANCE

-CARRIERS

MC/ICC

AUTHORITY

-CARRIERS

W9 TAX

FORM

-LORENZOS

CARRIER PACKET

FILLED

OUTRAGES

2-5

"ALL

DOCUMENTS MUST

BE

FAXED

TO

520-836-2115**

PAGE

2/5

1517

E.

ALBA DRIVE

CASA

GRANDE.

AZ

85122

MAIN:520-836-8083

FAX:520-836-2115

ALT:520-431-5168

Lorenzos

Trucking

Services

1517

E.

Alba

Dr.

Casa

Grande

AZ

85122

Phn:

520-836-8083 Fax:520-836-2115

E-Mail

ibgarcia09@aol.com

MC#

663225

Request

for.

To

Whom

It May

Concern

please

add

Lorenzos

Trucking

Services

as a

certificate

Holder.Fax

back

to

520-836-2115

Thank

You

AP

Department

Commercial

Certificate

of

Liability

Insurance

FARMERS

Agency

BRIAN

COX

INSURANCE

Name

2°°

s

LEROUX

ST

STE.

1

&

FLAGSTAFF,

AZ

86001

Address

Issue

Date

(MM/DD/YY)!

11/09/12

is.

Dist.Q2

Agent

_3i_

Insured

LORENZO'S

TRUCKING

LLC.

v

.

DBA: LORENZO'S TRUCKING SERVICES

l\arnt:

&

1517

E

ALBA

Address

CASA

GRANDE,

AZ

85122

This

certificate

is

issuwt

as a

natter

of

information

only

and

confers

no

rights

•poa

UK

certificate

holder.

This

certificate

does

net

affnnatively

or

nejativdy

amenl,

extend

or

alter

the

coverage

afforded

by

the

policies

shown

below.

This

certificate

of

insurance

does

not

constitute

a

contract

betwera

the

issuing

insurerd),

authorized

representative

or

producer,

and

the

certificate

holder.

Companies

Providing

Coverage

(NAIC

#):

Company

Letter

A

Truck

Insurance

Exchange

21709

Company

Letter

B

Farmers

Insurance

Exchange

21652

Company

Letter

C

Mid-Century Insurance

Company

21687

Company

Le

ttfr

D

Coverages

This

jg

to

certify

that

the

policies

of

Insurance

Jisced

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,

exclusions

and

conditions

of

such

oolicies.

Limits

shown

may

have been reduced

bv

paid claims.

Co.

Ltr,

C

Add'l

Insrd.

Type

of

Insurance

Genera]

Liability

_X_

Commercial

General

Liab.

Genera!

Aggregate

Limit

Applies

Per

Location

Automobile

Liability

Any

Auto

-X

—

Scheduled

Autos

-X

—

Hired

Autos

X

Non-Owned

Autos

Garage

Liability

Any

Auto

Umbrella

Liability

Retention

$

Workers'

Compensation

and

Employers

Liability

Pokey

Number

604776860

Pufcy

Effective

Dau(Ut/DD/YY)

11/09/12

Policy

Expiation

fete (HH/DO/YV)

11/09/13

Policy

Limits

Each

Occurrence

Damage

To

Rented

Premiss

(Ea.

Occur.)

Medical

Expenses

(Any

one

person)

Personal

&

Adv.

Injury

General

Aggregate

Prod./Comp.

Ops.

Aggr.

Combined

Single

Limit

(Each

accldentf

Bodily

Injury

(Per

person;

Bodily

Injury

(Per

accident)

Property

Damage

(rer

accident;

Auto

Only-Ea.

Accident

Other

Than

Each

Accident

Auto

Only.

Aggregate

Limit

Statutory

Each

Accident

Disease

-

Ea.

Employee

Disease

-

Policy

Limit

$

1,000,000

$

2,000,000

$

1,000,000

$

s

$

s

$

Description

of

Operations/Vehiclcs/Restrictions/Special

items:

ALSO

CARRIES

$100,000

IN

CARGO

INSURANCE

-

POLICY

604776860-

EFFECTIVE

11/09/2012

-

EXPIRES

11/09/2013

Certificate

Holder

ne

UNIVERSAL

FOREST PRODUCTS

INC ITS

AFFILIATES

&

SUBSIDIARIES

g

SUITE

100

Cancellation

Should

any of the

above described

policies

be

cancelled

before

the

expiration

date thereof,

notice

wlil

be

delivered

in

accordance

with

the

policy

provisions.

Address

Authorized

ReprtSenta

56-2492

10-11

C249Z201

PAGE

1

OF

Z

W-9

Request

for

Taxpayer

Identification

Number

and

Certification

Give

Form

to the

requester.

Do not

send

to the

IRS.

Ar]ifri"-s

(ruiniht-ii.

street.

<ind

.tj>t.

or

suitu

no )

Oily,

stiilii.

,inii

ZIP

cndu

1

,^t

.11

i

'

i1,

inl

number

is)

hcic

(optional)

Taxpayer

Identification Number (TIN)

L:ntcr

your

I

IN in the

appropriate box.

The

I IN

provided must match

the

name

given

on

the

"Name"

line

to

avoid backup withholding.

For

individuals,

this

is

your

social security

number

(SSN).

I

lowever,

for a

resident

alien,

sole

proprietor,

or

disregarded

entity,

see the

Part

I

instructions

on

page

3. I or

other

entities,

it

is

your

employer

identification number

(FIN).

If you do not

have

a

number,

see How to

gef

a

UN

on

page

3.

Note.

If the

account

is in

more than

one

name-,

sno

the

chart

on

page

4 for

guidelines

on

whose

number

to

enter.

Social

security

number

ae

Em

ployer

identification number

-

f

Certification

Under

penalties

of

perjury,

I

certify

that:

1.

I he

number

shown

on

this form

is my

correct

taxpayer identification number

(or I am

waiting

for

a

number

to be

issued

to

me),

and

?.

I

arn

not

subject

to

backup withholding because;

fa) I am

exempt from backup withholding,

or (b) I

have

not

been notified

by the

Internal

Hevenue

Service

(IRS)

that

I am

subject

to

backup withholding

as a

result

of a

failuto

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

boon

notified

by

tho

IMS

that

you

are

currently subject

to

backup withholding

because

you

have failed

to

report

all

interest

and

dividends

on

your

tax

return.

F or

real

estate

transactions,

item

2

does

not

apply.

For

mortgage

interest

paid, aoquisition

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

IMS

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-'J

only

if you are a

U.S. person (including

a

resident

alien),

to

provide your correct

TIN to the

person requesting

it

(tho

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),

?..

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

ot any

partnership income

from

a

U.S. trade

or

business

is

not

subject

to the

withholding

tax on

foreign

partners'

shate

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.

I

or

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

301

./VU1

7).

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 arc 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.

l-orm

W-9

(Hov.

12-2011)

Paqc

3

Other

entities.

Enter

your business name

as

shown

on

required

federal

lax

documents

on the

"Name'1

line.

This

name should match

the

name

shown

on the

charter

or

85222 C2b484b614667f4ffff8004ffffe906

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