HomeMy WebLinkAbout1994-241
Inn
RESOLUTION 94-241
1 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
2 EXECUTION OF AN AGREEMENT WITH THE STATE OF CALIFORNIA, DEPARTMENT
OF MENTAL HEALTH FOR THE PROVISION OF REFUSE DISPOSAL SERVICES TO
3 PATTON STATE HOSPITAL.
4 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO AS FOLLOWS:
5
SECTION 1. The Mayor of the City of San Bernardino is hereby
6 authorized and directed to execute on behalf of the City an
7 Agreement with the State of California, Department of Mental Health
8
for the provision
of refuse disposal services to
Patton state
9 Hospital, a copy of which is attached hereto marked Exhibit "A" and
10 incorporated herein by reference as fully as though set forth at
11 length.
12 SECTION 2. The authorization to execute the above referenced
13 Agreement is rescinded if the parties to the Agreement fail to
14 execute it within sixty (60) days of the passage of this Resolution.
15 SECTION 3.
16 other resolution
17 IIII
18 IIII
19 IIII
20 I II I
21 IIII
22 IIII
Resolution 92-426 and amendments thereto and any
in conflict herewith are hereby repealed.
23 I I II
24 II I I
25 IIII
26 IIII
27
28 July 27, 1994 1
.
94-241
.
.
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF AN AGREEMENT WITH THE STATE OF CALIFORNIA, DEPARTMENT
1 OF MENTAL HEALTH FOR THE PROVISION OF REFUSE DISPOSAL SERVICES TO
PATTON STATE HOSPITAL.
2
3 I HEREBY CERTIFY that the foregoing resolution was duly adopted
4 by the Mayor and Common Council of the City of San Bernardino at a
5 requ1ar
meeting thereof, held on the lSrh
day of n."gl1c+-
6 1994, by the following vote, to wit:
7 Council Members: AYES NAYS ABSTAIN ABSENT
8 NEGRETE x
9 CURLIN x
10 HERNANDEZ x
11 OBERHELMAN x
12 DEVLIN x
13 POPE-LUDLAM x
14 MILLER x
15
16
17
18
19
20
21
~
~
Clerk
The foregoing resolution is hereby approved this 19th
day of
Auaust
, 1994.
~i.~~
Tom Minor, Mayor
city of San Bernardino
22 Approved as to form
and legal content:
23
JAMES F. PENMAN,
24 City ttorney
25
26
27
28 July 27, 1994
/L~
2
8r.., ie OF CAliFORNIA
STANDARD AGREEME.NT - ~ri~~~~~ ~~:AL
STD. 2 (REV.5-41)
q;2.- c7-f1
CONTRACTOR cr~'!'
CONl'RACT NUMBER
94-30022
....NO.
nrrs AGREEMENT, made and entered into this 2nd day of June , 19.2i...,
in the State of California, by and between Stat<: of California. through its duly elected or appoinu:d, qualified and acting
TWAVER'S FEDERAl aFlDYER IDEHT1F1CATlOH NUWBER
95-6000772
TIn.e OF OFFICER ACT1NG FOR STATE
llep.lty Director, Div. of J\dninistrati
CONTRACTOR'S NAME
Ci t Y of San Bernardino ,hcreaftacalled the Contractor.
WITNESSETH: That the Contractor for and in consideration of the covenants, conditions, allI='lenlS, and stipulations of the State hereinafter cx~sed,
docs hereby agree to furnish to the State services and materials as follows: (Set forth s.rvic. to be rendered by Contractor, amolllll to be paid Contractor,
tim4for p.ifomumc. or compl.tio", and attach p/m&s and specifleatiollS, if any.)
tttctl'J!.O
~()~ '1. 3 ,~It
8Efust...
RECEIVED
NOV 2 3 1994
fl'r.t~ ,.... ~rrt..~.1 :-'r:,~
v:"" !.. ~ >.,J ... ...1 . t ,oJ ... '"
AGaCf
Department of Mental Health
Patton State Hospital
, hereafter called the Stat<:, and
Contractor agrees to provide the services specified in:
Exhibit "A" - Program Narrative
Exhibit "B" - Specific Provisions; and,
Exhibit "c" - General Provisions;
attached hereto and by this reference made a part of this
agreement.
I certify that I have reviewed this agreement,
meets current program and departmental policy.
t 'ia'lr (i~<-
W L AM L. SUMMERS
Executive Director
and it
<fit /flf
I I Date
-,;
CONTINUED ON SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreemcnL
IN WITNESS WHEREOF, this allI='lent has been execuu:d by the parties hereto, upon the date lint above wrincn.
STATE OF CALIFORNIA
CONTRACTOR
Administration
PROORAMlCATEGOAY (CODE AND TIllE)
Su ort
(OPTIONAL USE) Funding
the Bud et
CONTRACTOR (IIDlJWtItatIM...........,.,.~.~~ eIr:.)
Cit of San Bernardino
~
PRI 0 NAME AND Tm.E OF PEASCIH SIGNNG
Tom Minor, Mayor
ADDRESS 300 N. -0- Street
San Bernardino CA
FUNO TITlE
~~ Department of Mental Health
Patton State Hos ital
BV (AUTHORIZED S AE)
l>
PRINTEO NAME OF PERSON SIGNNG
LINDA A, POWELL, Deput Director
TITlE
Division of
AMOUNT ENCUMBERED BY Tl-41S
DOCUMENT
$ 30,000.00
PRIOR. AMOUNT ENCUMBERED FOR
THIS CONmACT
$
TOTAL. AMOUNT ENCUMBERED TO
DATE
$
92418 909 384-5145
rlmant of Ganaral Sam..a
, n
~~2LIC~ .B\l~.5,"f
Ocpartm,,:,.nt ~f G'2f1~,r~'S~~rvicel
of
ITEM
APPROVED
NOV J 111994
8Y ORIGINAL SIGNED BY
JOHN G. BRAKKE
4440-011 001
OBJECT OF EXPENOIlURE (CODE AND Tl1\.E)
348,50
I hereby certify upon my own perS<<lBI knowIecJge thet budgetsd funds
are available for the period and purpose of l11e expenditure statsd above.
SIGNATURE OF. Nl OFFICER
As.'t. Chi.f Coun..1
B.R NO.
l>
n ,,_.-:-.......,.......'"
n r"le"tr'" (l~ r;:::'''l SER 1 n 7CCNTROlLER
n
Su,. of Californi. - Hulth .noj WtIf.rlAljIIIncv
94 241
Department 01 'Mental H..lth
SMALL BUSINESS IDENTIFICATION QUESTIONNAIRE
MH 11511101841
INSTRUCTIONS. Please complete the following. and submit the
complered questionnilre with your bid packi)(Je The .nfor
mation is required for statlsllcal purposes and IS conslder~c1
confidential.
Name of Susinen IP'OdUCIS 0' Sen.,ce. P,""ded
~~ of SAn ~!.rn~rdino - t'ublic Service - Refuse Division Refuse pick up --
(Cityl IStace) (lip)
ddren treel
300 North IIDII Street Rm 421, Sa-,,- Ber:.nardino CA 92418-0001
-- --- ----
If your business is a nonprofit business or pub~c entity. please check this box ~ an.d do not ca~plete the remainder of thiS Question
naire. U your business is a For Profit Business, see definitions on back before completing the following.
Size of Busin." Sex of Owner Ethnic Classification of Owners
o I am , pr.qualilied wn,1I businns with QSMB. o Male o Black o Polynesian o Caucasian I
o Female o Asian American o American Indianl White
o I em' small buliness, but h,.. not been prequalified with OSMB. Alaskian Native
:Mv business would nOI be considered I smlll business. o Hisplnic American o Filipino o All other
STATE USE ONLY
Amount Document Numblr F iscII Year Raporting Quarter
$
DEFINITIONS
SIZt OF BUSINFS5 Ch~ck. th~ IIfSf hox un1i If your hll\lnl'~S ha~ been prequdldwd fld thl~ ~(JlJII b\l~lncss preference by th<> Office of
Small dOff MinOrllY Businl!ss I05MBl CIlp.ck rh(' "'('contl hox if you feel yuur hU~lflcss I'> ,j sm<.Jlllnl'ilfll'SS, wt have not bl~Cfl prl~quoldl(~u
h't OSMB. Chl:ck. Hli' ,h,rd hox If you fet'1 '{Oi/f busln(~ss IS flat ,j smdll buslnp.ss
SEX OF OWNERS Thl' Female tlloc;k WIll hi.' checkf.'C1ln lhio; Itp.m jf a buSIness is at I~dst 50 percent woman.owned (Jr, in the case of
publicly owned husiness...s. at least 51 perr:enl of [h(' 'itor.k IS woman.owned. In all orher instances. [he Male hlock will bf? chcckcu.
ETHNIC CLASSIFICATION OF OWNERS The coele checked should reflect the ethniC anglO of the person who own at least 51 per.
cent ot the business, or in the case of a publicly uWlled business, at least 51 percent of the stuck In the case of an t:'qual PJrtnersh!p
~tween J Caucasian and minority group membt:r, the code of the minority group member will be marked Mark only aUf' block in
th,s item.
DePARTMENT INSTRUCTIONS
HEADQUARTERS: Offices awarding contracts will complete me Stare Use Only section on the front of thi1 form for each bidder
awarded a contract and submit the Questionnaire with the contract to Support Services Section, Administration Division.
STATE HOSPITALS: Complete the Stare Use Only section on the front of this form for each bidder awarded a contract, service order
or subpurchase order. For ContrBctt attach the completed Questionnair~ with the copy of the contract submitted to Support Services
Section. For Senllc~ Orders NJd Subpurchase OrdtJrT use the information collected to complete the Small Business Monitoring Report
(STO 810) each quarter, Submit the report by the 10th of the month following the reporting Quarter to: Department of Developmental
Services, Support Services Section, Administration DiYision, 1600 9th Screet, Sacramento, CA 95814.
94,241
. ~ -",,',"';"; . .
CONTRACTOR:
CONTRACT #:
CITY OF SAN BERNARDINO
94-30022
EXHIBIT "A"
Program Narrative
1, Contractor agrees to provide refuse disposal service for one
(1) 40-yard and four (4) 15-yard container bins at Patton
State Hospital,
2, Disposal service shall be provided by the Contractor, when
service is requested by the Project Coordinator.
3,
Contractor shall possess all applicable licenses, permits, and
insurance; and, must comply with any requirements set forth by
an authorized agency,
,c.
4, Contractor shall leave a receipt for pick-up of refuse with
the Project Coordinator,
5, Contractor shall abide by all applicable safety and code
regulations,
P~";::'VE"
.'-tr.~\.~A_~ u
NOV 2 3 1994
Pi'S' II" ,,,m;!CE"
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2 of 7
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,
94 241
CONTRACTOR:
CONTRACT #:
CITY OF SAN BERNARDINO
94-30022
EXHIBIT "B"
Specific Provisions
1. The term of this contract shall be July I, 1994 through June
30, 1995,
2, The State has designated Robert Abarca, Landscape Supervisor
II, to be its Project Coordinator.
3. Upon completion of the services in EXHIBIT "A", Program
Narrative, performed in a manner acceptable to the State, and
upon the submission of an invoice in triplicate as specified
in EXHIBIT "C", paragraphs 3 and 4, the State agrees to pay
Contractor, monthly in arrears.
4, The total amount payable under this contract shall not exceed
$30,000,00.
5. This contract shall not be effective until it has been
approved by the Department of General Services.
3 of 7
94 241
CONTRACTOR:
CONTRACT It:
CITY OF SAN BERNARDINO
94-30022
EXHIBIT "B-1"
Budget - Price Breakdown
Refuse Disposal
Disposal service for four (4) 15-yard bins owned by Patton State
Hospital:
Pickup {up to four (4) tons}
$
$
221.60
Over-weight {over four (4) tons}
36.65
Disposal service for one (1) 40-yard bin owned by Patton State
Hospital:
Pickup {up to eight (8) tons}
$
368.20
Over-weight {over eight (8) tons}
$
36.65
Rates are established by resolution of the City of San Bernardino
Mayor and Common Council.
4 of 7
~-
!l~ .....
CONTRACTOR:
CONTRACT ,;:
City of San Bernardino
94-30022
EXHIBIT "C"
General Provisions
1. Contractor shall submit. any 3UDcOtlt:-acts to the State for
appro\-al prior to implemen~a:.ion. l'pon termination of any
subcontract, the State shall be notified immediately.
2. By si;nin; this contract, contractor swears upon penalty of
perjury that no more than one final unappealable finding of
contempt of court by a Federal Court has been issued against
this contractor ,...ithin the immediately preceding t".o-year
period because of the contractor's failure to comply with an
order of a Federal court which orders the contractor to comply
with an order of the National Labor Relations Board (Public
Contract Code, Section 10296).
3 .
All reports, invo ices,
delivered to the Project
3102 E. Highland Avenue,
or other communications are to be
Coordi~aLor, Patton State Hospital,
Patton, CA 92369.
4, All invoices are to be submitted in triplicate, stating the
agreement number and the time period covered, to the Project
Coordinator as specified in EXHIBIT "B". It is further
understood that in no event shall the maximum price specified
in EXHIBIT "B" be exceeded.
5. This agreement may be canceled at any time by either party, by
giving 30 days written notice to the other party, and may be
amended upon mutual consent.
6, Contractor unde;:ostands that no Federal or State income tax
will be withheld from the payments under this contract,
However, the State is required to report all payments to the
Internal Revenue Service for tax purposes. No distinction of
fee, travel, or per diem will be made. No "age and ta::
statement (W-2) will be issued for the services performed
under this agreement.
7, Contractor understands that the product( s J and the contractor
staff services provided in fulfillment of the requirements of
this contract "ill be evaluated by the State (Public Contract
Code Section 103(0).
8, During the performance of this contract, contractor and its
subcontractors shall not unlawfully discriminate against any
employee or applicant for employment because of race,
religion, color, national ori~in, ancestry, ph~sical handicap,
medical condition. mar-ital stcltus, age (o.....er -lO), or se~.
Contractors and s\lbcontract8rs sleall comply with the
5 of 7
94 ~H
EXHIBIT "e"
General Provisions
(continued)
CONTRACTOR:
CONTRACT it:
City of San Bernardino
94-30022
provisions of the Fair Employment and Housing Ac~ (Government
Code, Sect ion 12900 et. seq.) and the appl icable regulations
promulgated thereunder (California Administrative Code, Title
2, Section 7285 et seq.). The applicable regulations of the
Fair Employment and Housing Commission implementing Government
Code Section 12990, set forth in Chapter 5 of Division ~ of
Title 2 of the California Administrative Code, are
incorporated into this contract by reference and made a part
hereof as if set forth in full, Contractor and its
subcontractors shall give ~ritten notice of their obligations
under this clause to labor organizations ~ith ~hich they have
a collective bargaining or other agreement. Contractor shall
include the non-discrimination and compliance provisions of
this clause in all subcontracts to perform work under the
contract (SAM 1204.51.
9. Should a dispute arise under this contract, contractor may in
addition to any other remedies which may be available, provide
written notice of the particulars of such dispute to the
Deputy Director, Division of .-\.dministration, Department of
Mental Health, 1600 \inth Street, Sacramento, CA 95814. Such
written notice must contain the contract number, Within ten
days of receipt of such no~ice, the Deputy Director, Division
of Administration, shall advise contractor of his findings and
a recommended means of resolving the dispute IPublic Contract
Code Section 10381).
10, Contractor agrees to place in each of its subcontracts, which
are in excess of 510,000.00 and utilize State funds, a
provision that: "The contracting parties shall be subject to
the examination and audit of the Auditor General for a period
of three years after final payment under contract (GOVER~ME\T
CODE SECTION 105321". The Contractor shall also be subject to
the examination and audit of the Auditor General for a period
of three years after final payment under contract (GOVER~MEKT
CODE SECTION 10532),
11. It is mutually understood between the parties that this
contract may have been written and executed prior to July 1,
for the mutual benefit of bot:' parties, in order to avoid
program and fiscal delays which could occur if the contract
were executed after July 1, of the State fiscal year.
12. This contract is valid and enforceable, onl:, if sufficient
funds are made available by the Budget Act for this fiscal
year for the purposes of this program, In addition, this
contract is subject to any additional restrictions,
limitations, or conditions enacted by the Legislature which
may effect the provision. terms or funding of this contract in
any manner.
6 of 7
I
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94
94
~ . .
EXHIBIT "c"
General Provi~ions
(continued)
CONTRACTOR:
CONTRACT #:
City of San Bernardino
94-30022
13. It is mutually agreed that if the Budget Act does not
appropriate sufficient funds for the program, this contract
shall be invalid and of no further force and effect. In this
event, the State shall have no further liability to pay any
funds wh~tsoever to the contractor or to furnish any other
considerations under' this contract, and the contractor shall
not be obligated to perform any provisions of this contract.
7 of 7
STATE OF CALIFORNIA
DRUG-FREE WORKPLACE CERTIFICATION
STD. 21 (NEW 11-90)
94 :>,41
COMPANYIORGANllAT10N NAME
The contractor or grant recipient named above hereby cenifies compliance with Government Code
Section 8355 in matters relating to providing a drug-free workplace. The above named contractor or
grant recipient will:
1. Publish a statement notifying employees that unlawful manufacture, di3tribution, dispensation,
possession, or use of a controlled substance is prohibited and specifying actions to be taken against
employees for violations, as required by Government Code Section 8355(a).
2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to
inform employees about all of the following:
(a) The dangers of drug abuse in the workplace,
(b) The person's or organization's policy of maintaining a drug-free workplace,
(c) Any available counseling, rehabilitation and employee assistance programs, and
(d) Penalties that may be imposed upon employees for drug abuse violations.
3. Provide as required by Government Code Section 8355(c), that every employee who works on the
proposed contract or grant:
(a) Will receive a copy of the company's drug-free policy statement, and
(b) Will agree to abide by the terms of the company's statement as a condition of employment on
the contract or grant.
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized legally to bind the contractor or
grant recipient to the above described cenification. I am fully aware that this cenification, executed on
the date and in the county below, is made under penalty of perjury under the laws of the State of
California.
OFFICIAL'S NAME
Tom Minor, Mayor
DATE EXECUTED
CONTRACTOR or GRANT RECIPIENT SIGNATURE
EXECUTED IN THE COUNTY OF
San Bernardino
TiTlE
FEDERAL 1.0. NUMBER
95 6000772
.STA TE OF CALIFORNIA
NONDISCRIMINATION COMPLIANCE STATEMENT
~T1). 19 (REV. 3-91)
94 241
COMP~Y NAME
City of San Bernardino - Public Services - Refuse Division
The company named above (hereinafter referred to as "prospective contractor") hereby certifies,
unless specifically exempted, compliance with Government Code Section 12990 and California
Code of Regulations, Title 2, Division 4, Chapter 5 in matters relating to the development,
implementation and maintenance of a nondiscrimination program, Prospective contractor agrees
not to unlawfully discriminate against any employee or applicant for employment because of race,
religion, color, national origin, ancestry, physical handicap, medical condition (cancer related),
marital status, sex or age (over forty).
CERTIFICATION
!, the official named below, hereby swear that! am duly authorized to legally bind the prospective
. contractor to the above described certification.! amfully aware that this certification, executed on
the date and in the county below, is made under penalty of perjury under the laws of the State of
California,
OFFICIAL'S NAME
Torn Minor, Ma or
DATE EXECUTED
eXECUTED IN THE COUNTY OF
San Bernardino
PROSPECTIVE CONTRACTOR'S SIGNATURE
PROSPECTIVE CONTRACTOR'S TITLE
PROSPECTIVE CONTRACTOR'S FEDERAL EMPLOYER IDENTIFICATION NUMBER
9'1-600077?
~ATE OF CALIfORNIA
94
241
VENDOR DATA RECORD
(Required In lieu of IRS W.g when doing business with the State of California)
~TO. 204 (REV. s-~
CONTRACT #94-30022
OEPARNENTJOFFICE PURPOSE: Information contained in this form
Patton State Hospital will be used by State agencies to prepare Infor-
PLEASE S"mEET ADDRESS mation Returns (Form 1099) and for withholding
RETURN
TO: 3102 E. Highland Avenue on payments to nonresident vendors.
CITY, STATE,ZIPCOOE (See Privacy Statement on reverse.)
~, Q'HQ
VENOOR'S BUSINESS NAME OWNERS FULL NAME (lut, First, ALl.)
City of San Bernardino Public Services - Refuse
S"mEET ADDRESS ARE YOU SUBJECT TO FEDERAl.. BACKUP
300 North "0" Street, Room 42l WlTHHOLDtfQ1
(s- ~ kK IRS Fomt~)
CITY, STATE, AND ZIPCOOE tEl NO
San Bernardino CA 924l8-000l DYES
INSTRUCTIONS:
(1). Check box Indicating type of business entity and provide taxpayer ident~ication number.
(2). Check box Indicating resident or nonresident. (586 reverse for additional information).
(3). Check one or more VENDOR ACTIVITY boxes spec~ying vendor activny type.
R7I CORPORA TlON
ICJ (En"" F..,. Ef'rIPIor-idtMtificatiott Nt./mbN)
191 sl-=.J 6 1 D 10 I 0 17 17 I 21
~ Resident - Qual~ied to do business in CA I
l.6J Permanent place 01 business in CA
o
MEDICAl SERVICES{IttcIutjng dentisll'y,
-.--....-.
..hi......_b....fIfc.)
~ SERVICES (NON MEDlCAlj
O EQUIPMENT ISUPPLIES
(Exompt_....._i
o
I
Non Resident (586 Reverse)
INDIVlDUAlJSOLE PROPRIETOR
(En"" Socitll s.cumr AccounI NumI>>I only, NOT FEIN)
o RENT
O OTHER
_i
o Resident
o Non Resident (5qa Reverse)
O NON EMPLOYEE COMPENSATION (IncIudng D EQUIPMENTISUPPUES
r.,-.WJd~,~, *) (&.".",frumsr...'iI/1itIthokJin)
O MEDICAl SERVICES(Inducting -tiny,
podi8y, pqr:hoII>>t-w, llIPbMll'y,
_....}
D INTEREST (&empt from St._ wmMoIding)
D RENT
D ROYAlTIES
D PRIZES AND AWARDS
o OTHER(_
l=J
l=J
o Non Resident (5ee Reverse)
o Resident
o
I
PARTNERSHIP
(En'" FtHiMtJJ Employer idtMtificalion Number)
1-=-1
o
1
ESTATE OR TRUST
(En"" F..,. Employer IdMttifation Numb<<)
L=-I
O Resident (Estate) - Decedent was a CA resident at
the time of death
O Reside~t (Trust) - At least one trustee is a CA
resident
MAYOR
SIGNATURE
CATE
TELEPHONE NUMBER
(909) 384-S133
o "ENT 0 OTHER
INITIALS
DATE INITIALED
NONRESOENT WlniHOlDING
o STANDARD RATE
o WAIVED
o REDUCED RATE
%
O NONEMPLOYEE 0 MEOICAl
COMPENSATION SERVICES
REPORTABLE INCOME CODE PER STATE ADMINISTRATIVE MANUAL SECTION 8422..19 (ChdOtN'
01 02 03 04 05 06 07
.'
"
STATE OF CALIFORNIA
VENDOR DATA PECORe
STD_ 2'l)4 (REV. 6-92) (REVERSE)
94
94"1
" ,
ARE YOU A RESIDENT OR A NONRESIDENT?
Each cnrporation. individual/sole Prof 'tor. pannership, es-
tate or C'Jst doing business with the Sue of c.~ fornia must
indicate their residency status along with their vendor identi-
fication number.
A corporation will be considered a "resident" if it has a
permanent place of business in California. A permanent place
of business has been established if the corporation is organized
and existing under the laws of this state or. if a foreign
corporation. it has qualified to transact intrastate business. A
corporation which has not qualified to transact business (e.g.,
a corporation engaged exclusively in interstate commerce)
will be considered as having a permanent place of business in
this state only if it maintains a permanent office in this state
which is permanently staffed by its employees.
For individuals/sole proprietors, the term "resident" includes
every individual who is in California for other than a temporary
or transitory purpose. And, any individual domiciled in
California who is absent for a temporary or transitory purpose.
Generally an individual who comes to California for a purpose
which will extend over a long or indefinite period will be
considered a resident. However. an individual who comes to
perform a panicular contract of short duration will be consid-
ered a nonresident.
For withholding purposes, a pannership is considered a resi-
dent partnership if it has a permanent place of business in
California. An estate is considered a California estate if the
decedent was a California resident at the time of death and a
trust is considered a California trust if at least one trustee is a
California resident.
More information on residency status can be obtained by
calling the numbers listed l>elow:
From within the United Jtates, call .......1-8QO-852-5711
From outside the United States. call...... 1-800-854-6500
For hearing impared with TOO, call...... 1-800-822-6268
It
, ).
'- ~...
ARE YOU SUBJECT TO NONRESIDENT
WITHHOLDING?
Payments made to n resident vendors, including corpora-
ti,ms. individuals. pannerships, estates and trusts, are subject
to withholding. Nonresident vendors performing services in
California or receiving rent, lease or royalty payments from
property (real or personal) located in California will have 7%
of their total payments withheld for state income taxes. How-
ever. no withholding is required if total payments to the vendor
for the calendar year are $1500 or less.
A nonresident vendor can request that income taxes be with-
held at a lower rate or waived. A waiver will generally be
granted when a vendor has a history of filing California returns
and making timely estimated payments. If the vendor activity
is carried on outside of California or partially outside of
California, a waiver or reduced withholding rate may be
granted. For more information, contact:
'l/lchise Tax Board
,'iithhold at Source Unit
Attention: State Agency Withholding Coordinator
P.O. Box 651
Sacramento, CA 95812-0651
(916) 369-4900 FAX (916) 369-4831
If a reduced rate or witbbolding or waiver bas been
authorized bi tbe Franchise Tax Board, attach a copy
to this rorm.
PRIVACY STATEMENT
Section 7(b) of the Privacy Actof 1974 (public Law93-5791) requires that any federal, state. or local governmental agency which requests
an indi vidual to disclose his social security account number shall inform that individual whether that disclosure is mandatory or voluntary.
by which statutory or other authority such number is solicited, and what uses will be made of it.
The State of Cali forni a requires that all parties entering into business transactions that may lead to payment(s) (rom the State must provide
their Taxpayer IdenL,cation Numb. (TIN) in order to facilitate the preparation of Form 1099 and otherinformation returns as required
by the Internal Rever :e Code. Section 6109 and the State Revenue and Taxation Code, Section 18934. The TIN for individual and sole
proprietorships is the Social Security Number (SSN).
It is mandatory Ie .mish the information requested. Federal law ,quires that payments for which the requested information is not
provided be subje<:lto a 20% withholding and State law imposes noncompliance penalties of up to $20.000.
You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the
business services unit or the accounts payable unit of the State agency(ies) with which you transact business.
If you have any questions regarding this notice, please call the Department ofFmance, Ftscal Systems and Consulting Unit, at (916) 324..0385.