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<br />~ <br />Redwood <br />G-.IV Dullfornla <br />fiiiiidediiij <br />~ <br /> <br />City of Redwood City <br />1017 Middlefield Rd., P.O. Box 391, Redwood City, CA 94063 <br />Phone: 650.780.7070 · Fax: 650.556.9266 <br />http://www.redwoodcity.org <br /> <br />SUBSTITUTE W-g <br /> <br />Ref: Vendor No. 41679 <br /> <br />~ IE ~1 ~~i-l1J <br />DEe 0 5 2006 & <br /> <br />ILLINGWORTH & RODKIN, INC. <br />505 PETALUMA BOULEVARD SOUTH <br /> <br />PETALUMA, CA 94952-5128 <br /> <br />_ C~}U';::;~i{~{~,;S':~~f.~TY <br /> <br /> <br />REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION <br />(To be completed by those receiving payments for services, rents, grants, or prizes and awards) <br />Federal law requires withholding of 31 % federal income tax from payments made to suppliers for which we do not have a tax identification <br />number for. Funds withheld can only be refunded by the IRS. <br /> <br />Name: <br /> <br />Business name (if any): / L. L-/ /1./ 6U/ &'(277+ -v j<2.-t)tJ ~I N , <br />. <br /> <br />/lVL <br /> <br />Complete street address: 0 t> S- PCTA t//Y\A -8L- V/). .5 efJT.)../- <br />City, state and ZIP code: P eTA t-(./ r)'l A C A c:; Lf 7S:--::> <br /> <br />I E-mail address (if any): <br />I Web site (if any): <br /> <br />Please check the box that reflects <br />your correct status <br /> <br />o Individual/Sole Proprietor <br />o Partnership <br />~poration / Incorporated <br />o Non-Profit Organization <br />o Other <br /> <br />Taxpayer Identification Number (TIN) <br />Enter 'yOur TIN in the appropriate box. For individuals, this is your social security number (SSN). For sole <br />proprietors, it may be your SSN or your Employer Identification Number (EIN) if you have one for your business. <br />All other entities must enter an EIN. <br />I Social Security Number: I or I Employee Identification Number: 6 ~-o jJ t:{3 I f3 <br /> <br />Certification: I certify, under penalties of perjury, that the number above is my correct taxpayer identification <br />number. <br /> <br />Date: <br /> <br />1//30 /o~ <br />).If /J,u ,hZ,[ t-I ~ <br /> <br />Phone Number: <br /> <br />/07 '/C 6 - 7"') (J 0 <br /> <br />I Print Name: <br /> <br />Title: tJ ? -C:/ ce .-?t a-, ~ ci'" 1 -e.r-- <br /> <br />Signature: <br /> <br />c~~ <br />