Substitute W-9 Form Disclosures
The signatory of this document affirms they are authorized to represent the company. The signatory confirms that the number shown on this form is the company"s correct taxpayer identification number. He or she hereby certify under penalty of perjury under the laws of the State of Kansas that the information provided on this document is true and correct as it pertains to company"s business size and classifications as defined by the federal Small Business Administration’s (SBA) business size standards and other business classifications. Any misrepresentation may prevent the company from doing business with KCKPS, and be subject to any other penalties allowed by law. If any of the business information on this form changes, the vendor is responsible for advising and resubmitting a form with the new information Kansas City Kansas Public Schools Purchasing Office.
Pursuant to the Federal Privacy Act of 1974 (as of 2001) protects individuals by regulating when and how local, state and federal government and their agencies can request individuals to disclose their Social Security Number (SSN) and by requiring that Social Security Numbers must be maintained as confidential by those local, state and federal government and agencies.
STATE OF KANSAS
If any type of personal information is requested or volunteered by the user, State law, including the Kansas Open Records Act KSA 45-215 and the federal Privacy Act of 1974 may protect it. Information provided in this form, with the exception of a Social Security Number or federal tax identification, may be a public record and could be subject to public inspection and copying if not otherwise protected by federal or State law.
Insurance requirements are based on degree of risk rather than the dollar value of the contract, and will be reviewed with vendor prior to commencing business. Coverage must be current and in place at the time when a vendor is actively doing business with KCKPS. All insurance policies shall be subject to review and approval by the University, including submitting the firm’s current certificate of insurance.
PRIVACY ACT NOTICE:
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who are required to file information returns with the IRS to report interest, dividends, and certain other income paid to you; mortgage interest you paid, the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, or Archer MSA or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. possessions for use in administering their laws. The information may also be disclosed other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply for providing false or fraudulent information.
POSSIBLE IRS 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.
See IRS Form W-9, Request for Taxpayer Identification and Certification.