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INVITATION FOR BIDS
BID DUE DATE: April 15, 2015 5: 00 pm MDST)
DESCRIPTION: Invitation for Navajo Division of Transportation trucks —
Two( 2) Tractor Heavy Haul, one( 1) Full Service w/Crane Body
BID NO. 15- 03- 1356LE
v .-x * ; ti.-'.f.+i-h: T.r! Lt-?. P': n9tD ' r,
t,i: _•: ii= Ss: fi.' 9 ` :. •' T." ::. + ._ si ' MAW
CONTACT PERSON: Ray Russell, Department Manager IDepartment of Roads
Navajo Division of Transportation
THE NAVAJO NATIONTelephone Number: (505) 372- 8329
OR
Ben Manuelito, Department Manager III
Fleet Management DepartmentDivision of General Services
THE NAVAJO NATION
Telephone Number: ( 928) 871- 6425
Fax Number: ( 928) 871- 7038
RETURN ALL RESPONSES TO:
DELIVER TO: THE NAVAJO NATION
Purchasing Services DepartmentAdmin Building One, Window Rock Blvd.Window Rock, Arizona 86515
ATTN: Lorita EtsittyBID NO. 15- 03- 1356LE
OR
MAIL TO: THE NAVAJO NATION
Purchasing Services DepartmentPost Office Box 9000
Window Rock, Arizona 86515
ATTN: Lorita EtsittyBID NO. 15- 03- 1356LE
Must identify Bid# and Company Name on the outside of all sealed package/ envelop)
Please submit an original, and two (2) copies of your bid
1
DEPARTMENT OF ROADS
NAVAJO DOT
INVITATION FOR BIDS
For (2) 2015- Tractor Heavy Haul
Meets
A. GENERAL Spec Y/ N
MODEL AND YEAR Model 389 and Year: 2015
ISX1S 550 @2000 GOV@2000 2050
ENGINE MANUFACTURER @1200
MAKE AND TYPE Semi-Tractor- Heavy Haul
All" Meet Specs" must be marked with either a " YES" or" NO"," Confirms" or Meets Intent" is NOT acceptable.
Any other wording other than " YES" or" NO" will disqualify complete Bid.An Answer of" NO" does not meet specification, does not necessarily disqualify bidder' s proposal.
B EQUIPMENT DESCRIPTION YES/ NO EXCEPTION
Heavy Haul Unit: Tractor used to transport heavy, non-divisible1. loads, such
As earth moving equipment, electrical transformers, pressurevessels, etc.
GCW can be from 80,000 lbs to extremely heavy. Frame& Equipment 10-3/ 4in Steel Rails to 354in:
2 10.75x3. 5x. 375,
Dimension, 2, 136,000 RBM; Yield Strength: 120,000 psi.
Section Mod-
ulus: 17. 8 cubic inches, Weight: 134 lbs/ inch pair
3. Heavy- Duty Iron Front Spring Brackets( Forward& Rear)
4. EOF Square with Heavy-Duty Steel Xmbr, 3/ 8in thick
5. Rear Mudflaps, Straight Hangers
Furnish Mudflaps Hanger Only, Omit Flaps6. ( Mudflaps/ Hanger option is required)
7 Stainless Steel Quarter Fenders
8 Holland FW35 Fifth Wheel Top Plate
9 Fifth Wheel Setting Behind C/ L Bogie 10in
10 LH Fifth Wheel Release
11 8.86in-9. 25in Fifth Wheel/ Height
12 Heavy Duty Air Slide1
13 48 in Air Slide
14 Frame Mounted Deck Plate and Access Pkg. Both SideFront Axle& Equipt: Dana Spicer D2000F 20,000 lb, 3. 5 in
15 Drop
16 Taper Leaf Springs, Shocks 20,000 lb
1FB for (2) 2015- Tractor Heavy Haul
17 Power Steering Sheppard M100 Dual E
18 Power Steering Reservoir Frame mounted w/ Cooler
19 PHP 10 Aluminum PreSet Plus Hubs-Air Disc
20 Greasable Front Spring Pins
21 Air Disc. Front Brakes
22 Dust Shields, CAM And Air Disc Brakes, Front Axle
23 Rear Axle& Equip.: Meritor RT46- 160 46,000 lb
24 PHP 10 Aluminum PreSet Plus Hubs
25 Long Stroke Parking Brakes, Drive Axle( s)
26 0iff Lock Both Axles
27 Bendix Smart ATC Traction Control
28 Stability System Not Selected or Not Available
29 Anti- Lock Braking System ( ABS) 6S6M
30 Synthetic Axle Lubricant All Axles
31 Bendix Air Cam Rear Drum Brakes 16.5x5x7
32 Ratio 3. 91 Rear Axle
33 Air Track 46,000 lb
34 Dash Mtd Dump Switch with indictor fight
35 Engine Idle Shutdown Timer Disabled
36 Enable EIST Ambient Temp Overrule
37 Eff EIST NA Expiration Miles
38 Effective VSL Setting 65. 0 MPH or Greater( USA)
39 Remote PTO and Throttle Provision
47 CARB Engine Idling Compliance
41 160 AMP Alternator, 36 SI Brushless
42 immersion Type Pre- Heater 110- 120V
43 Oil Pan Heater 120V/ 300W
44 Block Heater Receptacle to be Mtd in Bumper
45 12V Starter
46 3 Premium 12V Dual Purpose Battery 2100 CCA
47 Big Switch Battery Disconnect
48 Battery Jumper Terminal Mounted Under Hood
49 2- Speed Fan Clutch For Frequent Start/ Stops
2
IFB for (2) 2015-Tractor Heavy Haul
50 18. 7 CFM Air Compressor
51 lnterbrake( Furnished on Engine)
52 High Efficiency Fuel/ Water Separator, Heated 12V
53 Engine Protection Shutdown
54 High Efficiency Cooling System
55 ( 2) 15in SS Air Cleaners, Cowl Mtd, SS Caps
56 Air Cleaner Locks
57 Exhaust Dual Side of Cab
58 Curved Tip Standpipe( s)
59 Chrome Finish Over Elbows For Dual Exhaust
60 Muffler Guard/ Fairing Stainless Steel
61 48in HT, 5in Dia Chrome, Clear Coat Standpipe(s)
62 7th Dia Chrome Plated Steel Standpipe( s) IPO 5in
63 Transmission& Equip.- Fuller RTL020918B 18 Speed
64 SDPL250HD- XL Driveline, 1 Midship Bearing
65 SPL 170- LX Inter axle Driveline
66 Manuel Shifter, Black
67 ! Heavy Duty Input Bearing For PTO Operation
I68 Remote Lube Hoses for Clutch Linkage Release
69 Air& Trailer Equip.: Bendix AD- IS Air Dryer with Heater
70 Berg Pull Cord Drain Valve(s)— All Air Tanks
71 Nylon Chassis Hose
72 Steel Painted Air Tanks
73 Polished Aluminum Air Tanks Outside Frame Rails
74 Clear Outside Frame of All air System Components
75 Trailer Hand Valve( Self Returning)
76 Chroming of Hose Tenna
77 A& E Conn EOF w/ 7- wat Socket( w/ Conn EOF Strapped)
78 A& E Connections BOC/ BOS with hose Tenna i
3
IFB for (2) 2015- Tractor Heavy Haul
79 12ft A& E Lines Straight& Two 7- way Plugs
80 Locater A& E Connections BOC/ BOS as far rearward
Tires& Wheels: FF: GY 20PLY 315/ 80R22. 5 G289 WHA
81 Duraseal
82 RR: MN 16PLY 11R24. 5 x XDN2— Code- rear Tire Qty 08
83 FF: ALCOA 893657LVL1 22.5x9.00 Alum Wheel
RR: ALCOA 983637 LVL1 24.5x8.25 ALM WHL: Code—rear
84 Rim Qty. 08
85 Fuel Tanks: 26in Aluminum 150 Gallon Fuel Tank RH BOC
86 26in Aluminum 150 Gallon Fuel Tank LH BOC
87 Location RH BOC 150 Gallon
88 Location LH BOC 150 Gallon
89 Fuel Tank Fill Rear
90 Hotline 60W Fuel Heater
91 Locate BOC Fuel Tanks Forward As Far As possible
92 Polish( 2) Aluminum Fuel Tanks
93 Arctic Wrap on All Fuel Lines
94 Raise( 2) Fuel/ Hydraulic Tanks Approx. 2- 5/ 8 in
95 ( 2) Shut-Off Valves On Fuel Supply Lines
96 Polish All Fuel/ Hydraulic Tank Straps
97 Locking Fuel Tank Cap( s)
98 DEF Tank Mounted LH BOC
99 Polished Stainless Steel Cover for DEF Tank DFP Tank Large
100 Aluminum Battery Box, Non-Slip Step LH Under Cab
101 Polishing Battery/ Tool Box(s), DPF Cab Entry
102 DPF Cab Entry Aluminum Non-Slip Step RH Under Cab
103 Raise Battery/ Tool Box( s) 4 inches
104 Steel Bumper Deep Tapered Chromed
105 Heavy Duty External Tow Eye
106 Cab& Equip.: Alum Cab 123in BBC Alum Hood SFFA
4
IFB for (2) 2015- Tractor Heavy Haul
107 Thermal Insulation Package in Cab
108 10 inch Extension for Ultra Day Cab
109 Ultra Ride Driver Seat
110 Ultra Ride Passenger Seat
111 Drivers Armrest— RH Only
112 Passenger Armrest— LH Only
113 Black Seat Color IPO Standard Color
Air Ride Driver; High Back Driver; Mordura Driver; Air
114 Ride Passenger;
High Back Passenger; Mordura Passenger
115 Passenger Door Locks Both Doors
116 Adjustable Steering Coleman— Tilt/ Telescope
118 Prestige Interior- Arctic Gray
119 Dark Window Tint ipo STD Tint- Day Cab
120 Day Cab Rear Window
121 Two Piece Flat Windshield
122 Power Lift Window— Both Doors
123 Combo Fresh Air Heaters/ Air Conditioner
124 Comfort Control- Cab
125 Outside Sun visor— Stainless Steel
126 SSTL Mirrors Ea Side Heated and Motorized
127 ( 2) Convex 8 inch SS Mirror
128 ( 4) Round Air Horns Chrome ( 2) 30 in& ( 2) 37. 5 in
129 Standard Speaker Package for Cab
130 Concert Class w/ CD. Bluetooth Phone and Audio
131 Cobra 40 Channel CB Radio w/ Intergral Speaker
132 CB Antenna Brackets and Wire RH/ LH Mirror
133 Radio Antenna Mounted on LH Mirror Bracket
134 Plug- in Auto Reset Circuit Breaker
5
IFB for (2) 2015- Tractor Heavy Haul
135 Combo Bug screen Winter front
136 Removable Bugs screen behind Grills
137 Electric Windshield Wipers
138 Unibilt Cab Auto Suspension
139 Triangle Reflector Kit Shipping Loose
140 5 lb 3A: 40bc Fire Extinguisher Cab Mounted
141 Back- up Alarm( 107dB)
142 Main Transmission Temperature Gauge
143 Axle Temperature Gauges, Tandem Drive
144 Engine Oil Temperature Gauge
145 Air Application Gauge
146 Air Restriction Gauge on Dash
2) General Air pressure Gauges Plumbed to Firewall
147 Bulkhead
148 Air Restriction Indicator
149 Fuel Filter Restriction Gauges
150 Manifold Pressure Gauge
151 Suspension Pressure Gauge
152 Ammeter
153 Bright Bezel Gauges
154 Main Instrumentation Panel w/ Graphics Display
155 One( 1) Additional Dash Switch with Wiring
156 Up to 6 Additional Rocker Switches in D Panel
157 Projector Module Pod headlights
158 Five( 5) Marker lights, Bus LED Bullet
159 Two( 2) Fog Lights
160 One( 1) 6in Spotlight, Round Halogen LH
161 Two( 2) Strobe Lights, Roof Mounted
162 Switch and Wiring F/ O Auxiliary light l6
IFB for (2) 2015- Tractor Heavy Haul
163 Switch and Wiring F/ O Auxiliary Light on air cleaners
164 Daytime Running lights
165 Truck lite 44030R2 LED Stop/ Turn/ Tail
166 Additional LED Round Turn Signal Mirror Mounted
Two( 2) Load Lights, Bracket Mounted Inboard Lock Day
167 Cab
One( 1) F/ O Load light, Switch&( 1) loft Wire Coil under/ in
168 cab/ sleeper
169 Paint: Standard White Paint Color Selection
Miscellaneous: Day cab/ Prestige Interior( DM) 2015 EPA171 Emissions Engine
Approximate Delivery Days Bid Cost Total
7
DEPARTMENT OF ROADS
NAVAJO DOT
INVITATION FOR BIDS
For 2015 Full Service Truck w/ 2015 Crane Body
Meets
Spec
A. GENERAL Y/ N
2015 Full Service Body w/ 2015MACHINE MANUFACTURER Maintainer BodyMODEL AND YEAR 2015 Stock 26000
ENGINE MANUFACTURER PX- 7300@2600GOV@2600660 @1600
MAKE AND MODEL Model 337
All" Meet Specs" must be marked with either a " YES" or" NO"," Confirms" or Meets Intent" is NOT acceptable.
An Answer of" NO" does not meet specification, does not necessarily disqualify bidder' s proposal.
B DESCRIPTION- EQUIPMENT YES/ NO EXCEPTION
Class 6 Chassis Weight Rating1. 26,000 lb. GVWR
2. Frame& Equipment: 10- 5/ 8 Steel Rails to 285 in
3. 154in: Wheelbase
Front Axle& Equipment:
Dana Spicer E10021
4. 10,000l b.
5. Taper Leaf Springs, Shocks 10,000 lb.
6. Power Steering TRW THP607. Power Steering Reservoir Frame Mounted8. PHP 10 Aluminum Hubs 19. Dana Spicer Wide Track IPO std, Front Axle
10. Bendix Air Cam Front Drum Brakes 16. 5x5
11. Dust Shields, CAM and Air Disc Brakes, Front Axle
12
Gusseted Cam Brackets, Steer Axle
13. Rear Axle& Equipment: 20,000 lb
14. PHP 10 Aluminum LMS Hubs
15. Parking Brakes16. Dust Shields for Cam Brakes, Drive Axle( s)
17. SBM Valve
18. Single Drive Axle
19. ISO 3731 Connector Trailer ABS Power
20. Anti- Lock Braking System( ABS) 4S4M21. _Bendix Air Cam Rear Drum Brakes 16.5x722. Ratio 6. 17 Rear Axle
23. Reyco 79KB Taper Leaf 21, 000 lb
24. Engine& Equipment: 300@2600 GOV @2600 660@1600
25. CARB Engine Idling Compliance26. _ Remote Throttle Control Provision
27 130 AMP Alternator, Brushless w/ Voltage
28. Immersion Type Pre- Heater 110- 120V
IFB for 2015 Full Service Truck w/2015 Crane Body
29. 12V Starter
30. Premium 12V Dual Purpose Batt 1400 CCA
31. Battery Jumper Terminal32. 2- Speed Fan Clutch for Frequent Start/ Stops
33. 18.7 CFM Air Compressor
34. Spin-On Fuel Filter Frame Mounted Heated
35. Engine Protection Shutdown
36. High Efficiency Cooling System
37 Radial Seal, Dry Type Air Cleaner, Frontal38. Exhaust Single RH Side of Cab
39. Curved Tip Standpipe( s)40. 24in Ht, 5in Dia Chrome, Clear Coat Standpipe( s)
41. Transmission& Equipment:
42. Allison 2500 RDS- P Transmission, Gen 5
43. ( 1) Dash Mounted Single Acting Air PTO Control44. Allison PTO Enable on Mode Button
45. Allison 6- speed Configuration
46. Dash Mounted Push Button Shifter
47. Allison Load Based Shift Schedule( LBSS)
48. Air& Trailer Equipment:
49. Bendix AD- IS Air Dryer with Heater
50. Berg Pull Cord Drain Valve( s)- All Air Tanks51. Nylon Chassis Hope
52. Steel Painted Air Tanks
53. Clear Outside Frame of All Air System Components
54. 7- Way Electric Harness with Socket Mounted EOF55. Body Connections Sft BOC56. Tires& Wheels:
57. FF: 14 PLY 295/ 75R22. 5
58. RR: 14 PLY 295/ 75R22. 5
59. FF: ALCOA 885657 22.5x8.25
60. RR: ALCOA 885657 22. 5x8.25
61. 26in Aluminum 50 Gallon Fuel Tank LH U/ C
62. Location LHU/ C 50 Gallon
63. DEF Tank Mounted LH Under Cab
64. DEF Tank Small
65. Battery Box& Bumper:66. Install Batteries on Temp Plywood Support BOC67. DPF Cab Entry Aluminum Non- Slip Step RH Under Cab68. Steel Styled Aero Bumper Chrome
69. Cab& Equipment:
70. Alum Cab 108in BBC
71. Severe Service Cab Package# 1:
Includes Alum Side Skins, Alum Rear Skin, Steel Windshield
Mask,
Steel Firewall, and Steel Front Floor sheet on all cabs, and
Additional reinforcement structure on the back wall of the day
2
IFB for 2015 Full Service Truck w/2015 Crane Body
cab.
72. Thermal Insulation Package in Cab
73. UltraRide Driver Seat
74. UltraRide Passenger Seat
75. Driver Armrests- LH& RH
76. Air Ride Driver
77. High Back Driver
78. Vinyl Driver
79. Non- Air Ride Passenger
80. Vinyl Passenger
81. Adjustable Steering Column- Tilt/ Telescope
82. Interior Grey/ Black
83. Day Cab Rear Window84. One Piece Curved Windshield
85. Combo fresh Air Heater/ Air Conditioner
86. Outside Sun visor- Stainless Steel
87. Aero Mirrors Ea Side Htd& Mtrzd 4-WayAdjustable
88. Power Package
89. Air Horn 24.5in Chrome- Round w/ Horn Shield
90. 1) Standard Speaker Package for Cab
91. w/ AM/ FM, Radio
92. Electric Windshield Wipers
93. Air Restriction Indictor
94. Main Instrumentation Panel w/ Graphics Display
95. ( 5) Marker Lights, Aero LED
96. Daytime Running Lights97 Paint:
98 Color White- Standard
1) 2015 CRANE BODY
62" High x 23" Deep Compartments, 11' Long Body, 12 gaugewith 11- gauge deck- plate compartment tops& backs, 54" x 31"
wheel opening. Galvanneal Body includes Cabinets withreinforced floors, clean out drains and adjustable shelving
package, 3/ 16" Aluminum doors with Three Point D- Ring door
latches and gas spring door holders, 49" W centerdeck floor is1/ 8" diamond plate. Also includes wheel skirting, front bodybulkhead, rear 10" tall hinge down tailgate, mudflaps, rear bodygrab handles. ICC recessed LED lights& reflectors, 97dB backup
alarm, and mini I. C. C. Safety Kit( 2. 5 lb. Fire Extinguisher&Hazard reflectors). Body primed and under coated, splatter-
1. coating on compartment interiors.Crane Reinforcement 1 or 2 ton service body( up to 75,000
2. ft* lb)
3. Compartment Equipment& Accessories:
4. Pressurized Storage System ( PSS), 2- blowers with filter
Oxy/ Act bottle Storage w/ ratchet stap, vents, " J" hk.&5. reinforced floor l
3
IFB for 2015 Full Service Truck w/2015 Crane Body
6. Hydraulic Power Package:
Closed center LS hydraulic power package, includes PTO, pump,
7. std oil reservoir w/ in- tank filter, vent fill cap, sight gauge8. Crane Equipment& Accessories:
Crane 10, 000 LB max capacity( 75,000 ft* lb) with hydraulicextend-boom 13'- 25' Crane includes wireless remote, LMI.
Planetary winch, crane hour meter, engine start/ stop, A2B,9. Overload& holding valves10. Outriggers& Accessories:
Outriggers for cranes up to 75,000 ft* Ib, hydraulic up/ down rearoutriggers( 2) with hydraulic extend in/ out on crane side ( 48"
11. extend)
Chassis Equipment& Accessories:
Spring or spacer leveling package added to one side of chassis12. suspension ( 2- ton)
Add charge to standard PTO for Allison automatic transmission
14. inlieu std manual transmission
15. Electronic engine spd. Control- computer set- electronic engine
16. Air Compressor Equipment& Accessories:
Vanair RC40 hydraulic driven recip. Air compressor/ 2- stagew/ 17 gallon air tank/ 40 CFM @ 100 PSI/ 40 CFM @ 150 PSI
17. includes cover/ hydraulic oil cooler built into assembly
18. Hose reel access out rear compartment
Air accessory package- Y2" x 50" Filter/ Lubricator/ Regulator,
19. spring rewind reel, hose& ball stopLighting/ Electrical Equipment& Accessories:Exterior 12V LED Flood light Pkg. 1- perm/ 1 remote( 2010- raw/ !,1350- Effective Lumens)
20. Interior 12V LED strip light( can be used in 0/ A compartments)
21. Painting Equipment& Accessories:22. Feet of unit painted urethane" WHITE" color.
Feet of Protective Spray covering- MTS- cargo center deck,compartment tops,& side, front bulkhead, tailgate& extension,
23. bumper and/ or workbench area.
24. Roll- Out Drawer and Tray Equipment& Accessories:5) Drawer aluminum std. set 18" W x 18" D x( 5)- 4 H, ( 300 lb.
cap. Per drawer) Overall height 28.75" Installed ( 2) permanent25. front-to-back divider,( 4) Removable Side- to-side Dividers
7) Drawer HD aluminum set 29" W x18' D x( 1)- 7". ( 3)-
3" H,( 3001b. cap.per drawer) overall height 40. 25", Installed( 2)permanent side to side dividers, removable front-to-back
26. dividers
27. Center Deck Equipment& Accessories:
28. Flush mount" D" ring tie-downs in bed floor, each29. Rear Bumper& Accessories:
26" steel workbench bumper with 2- side storage compartments 1.30. Note: Hitch and trailer plug to be quoted separately.
L31. Transverse bar storage compartment in workbench bumper ,
4
IFB for 2015 Full Service Truck w/2015 Crane Body
32. Trailer plug- in 7 prong flat blade( RV style)33. Miscellaneous Equipment& Accessories:
34. Vise/ Grinder removable mounting plate
Approximate Delivery Days Bid Cost Total
5
For„ W- 9 Request for Taxpayer Give Form to the
Rev. August 2013) Identification Number and Certificationrequester. Do not
Department of the Treasury send to the IRS.Internal Revenue Service
Name( as shown on your income tax return)
Business name/disregarded entity name, if different from above
mcom Check appropriate box for federal tax classification: Exemptions( see instructions):
o IndividuaVsole proprietor C Corporation S Corporation Partnership Trust/ estate
ai
aoExempt payee code( if any)
4't
2
ti Limited liability company. Enter the tax classification( C= C corporation, S= S corporation, P= partnership) reExemption from FATCA reporting
c • code( if any)
a.
c Other( see nstructions)
gAddress( number, street, and apt. or suite no.) f Requester' s name and address( optional)u
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 1 Social sacurityr numberto avoid backup withholding. For individuals, this is your social security number( SSN). However, for aresident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For otherentities, it is your employer identification number( EIN). If you do not have a number, see How to get a77N on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose I Employer identification numbernumber to enter.
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 an exempt from backup withholding, or(b) I have not been notified by the Internal RevenueService( 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 amno longer subject to backup withholding, and
3. I am a U. S. citizen or other U. S. person( defined below), and
4. The FATCA code(s) entered on this form Of any) indicating that I am exempt from FATCA reporting is correct.Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholdingbecause you have failed to report all interest and dividends on your tax return- For real estate transactions, item 2 does not apply. For mortgageinterest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement( IRA), andgenerally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See theinstructions on page 3.
Sign Signature of
Here U. S. person Dete •
General Instructions withholding tax on foreign partners' share of effectively connected income, and4. Certify that FATCA code(s) entered on this form( if any) indicating that you are
Section references are to the Internal Revenue Code unless otherwise noted. exempt from the FATCA reporting, is cored.Future developments. The IRS has created a page on IRS. gov for information Note. If you are a U. S. person and a requester gives you a form other than Formabout Form W- 9, at www.irs.gov/w9. Information about any future developments W-9 to request your TIN, you must use the requester' s form if it is substantially
affecting Form W- 9( such as legislation enacted after we release it) will be posted similar to this Form W- 9.on that page.
Definition of s U. S. person. For federal tax purposes, you are considered a U.S
Purpose of Form person if you are:
A person who is required to file an information return with the IRS must obtain your •An individual who is a U. S. citizen or U. S. resident alien,
correct taxpayer identification number( TIN) to report, for example, income paid to • A partnership, corporation, company, or association created or organized in theyou, payments made to you in settlement of payment card and third party network United States or under the laws of the United States,
transactions, real estate transactions, mortgage interest you paid, acquisition or An estate( other than a foreign estate), orabandonment of secured property, cancellation of debt, or contributions you madeto an IRA
A domestic trust( as defined in Regulations section 301. 7701- 7).
Use Form W- 9 only if you are a U.S. person( including a resident alien), to Special rules for partnerships. Partnerships that conduct a trade or business in
provide your correct TIN to the person requesting it( the requester) and, when the United States are generally required to pay a withholding tax under section
applicable, to: 1446 on any foreign partners' share of effectively connected taxable income fromsuch business. Further, in certain cases where a Form W- 9 has not been received,
1. Certify that the TIN you are giving is correct( or you are waiting for a number the rules under section 1446 require a partnership to presume that a partner is ato be issued). foreign person, and pay the section 1446 withholding tax. Therefore. it you are a
2. Certify that you are not subject to backup withholding, or U. S. person that is a partner in a partnership conducting a trade or business in the
3. Claim exemption from backup withholding if you are a U.S. exempt payee. 11United States, provide Form W- 9 to the partnership to establish your U.S status
applicable. you are also certifying that as a U.S. person, your allocable share ofand avoid section 1446 withholding on your share of partnership income.
any partnership income from a U.S. trade or business is not subject to the
Cat. No. 10231X Form W- 9( Rev. 8- 2013)
NAVAJO NATION CERTIFICATION
Regarding Debarment andSuspension
Applicant acknowledges that to the best of his/ her knowledge that their company and principalparticipants on this contract:
1. Are not debarred, suspended, or otherwise slated for debarment, ineligible and/ orexcluded from participation on Federal, State, and Tribal Government contracts etc.
2. Are not presently nor have been under criminal indictment or civilly charged by agovernmental entity( Federal, State, and Tribal Government) for fraud, forgery,falsification, theft, bribery, destruction of records, receiving stolen property and othercriminal offenses in the administration of government contract.
3. Have not been terminated for cause or convenience by a government entity in theadministration of a government contract( Federal, State, and Tribal Government).
4. If the Navajo Nation determines that the Certificate provided herein is not true, it will be
grounds to terminate the contract and pursue other legal remedies.
Applicant' s Address Name& Signature of Applicant
Type or Print Name
Signature Date
Office of the Controller • PO Box 3150, Window Rock, AZ 86515 • ( 928) 871- 6316 • Fox( 928) 871- 7778
