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Page 1 The Navajo Nation Department of Water Resources REQUEST FOR PROPOSALS PROPOSAL DUE DATE: September 2, 2015 @ 4:00 PM (MST) DESCRIPTION: Navajo Nation Department of Water Resources - Technical, Construction and Operations Branch BID# 15-08-1421VJ- Project# NN-12-12-034 Environmental Assessment Report Captain Tom Irrigation Project CONTACT PERSON: Reynalden Delgarito, Associate Civil Engineer Phone Number: (928) 729 4145 [email protected] RETURN ALL PROPOSALS CLEARLY MARKED, “DO NOT OPEN – BID No. 15-08-1421VJ, TO: DELIVER TO: Navajo Nation Department of Water Resources (FedEx/UPS Address) Technical, Construction, and Operations Branch Navajo Route 12 Fort Defiance, AZ 86504 MAIL TO: Navajo Nation Department of Water Resources Technical, Construction, and Operations Branch P.O. Box 678 Fort Defiance, AZ 86504 Attn: Reynalden Delgarito, Assoc. Civil Engineer The Navajo Nation Department of Water Resources Technical, Construction, and Operations Branch (TCOB) reserves the right to reject any or all proposals and to waive any informality in the proposals received whenever such rejection or waiver is in the best interest of the Navajo Nation.

The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

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Page 1: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 1

The Navajo Nation

Department of Water Resources

REQUEST FOR PROPOSALS

PROPOSAL DUE DATE: September 2, 2015 @ 4:00 PM (MST)

DESCRIPTION: Navajo Nation Department of Water Resources -

Technical, Construction and Operations Branch

BID# 15-08-1421VJ- Project# NN-12-12-034

Environmental Assessment Report – Captain Tom

Irrigation Project

CONTACT PERSON: Reynalden Delgarito, Associate Civil Engineer

Phone Number: (928) 729 – 4145

[email protected]

RETURN ALL PROPOSALS CLEARLY MARKED,

“DO NOT OPEN – BID No. 15-08-1421VJ, TO:

DELIVER TO: Navajo Nation Department of Water Resources

(FedEx/UPS Address) Technical, Construction, and Operations Branch

Navajo Route 12

Fort Defiance, AZ 86504

MAIL TO: Navajo Nation Department of Water Resources

Technical, Construction, and Operations Branch

P.O. Box 678

Fort Defiance, AZ 86504

Attn: Reynalden Delgarito, Assoc. Civil Engineer

The Navajo Nation Department of Water Resources – Technical, Construction, and Operations Branch (TCOB) reserves the right to reject any or

all proposals and to waive any informality in the proposals received whenever such rejection or waiver is in the best interest of the Navajo Nation.

Page 2: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 2

Navajo Nation Technical, Construction and Operations Branch

BID: 15-08-1421VJ

PART I

General Information

A. Request for Proposal: The Navajo Nation Department of Water Resources – Technical,

Construction, and Operations Branch (TCOB) is seeking qualified contractors to perform

an Environmental Assessment (EA) Report, to include a Biological Evaluation (BE) and an

Archaeological Survey (AS). The Captain Tom Irrigation Project is located within the

Newcomb and Two Grey Hills Chapters. These requirements are to adhere to all Tribal

and Federal Regulations, with a complete report of their findings. All interested firms are

invited to submit a proposal in accordance with instructions herein.

B. This RFP provides prospective firms with sufficient information to enable them to prepare

and submit proposals in the provision of environmental site assessment services to TCOB.

C. This RFP contains the instructions governing the proposal to be submitted and the

documents to be included therein and mandatory requirements which must be met to be

eligible for consideration.

D. Schedule of Activities:

1. Advertisement Period August 22-24, 2015

2. Proposal Due Date September 2, 2015 @ 4:00 PM (MST)

3. Evaluation of Proposals September 3-4, 2015

4. Notice of Intent to Contract September 8, 2015

E. Inquiries: Prospective Firms may make inquiries concerning the RFP to obtain

clarification of requirements by contacting Reynalden Delgarito, Associate Civil Engineer,

NNDWR – TCOB, at Phone: (928) 729-4145 or email: reynaldendelgarito@navajo-

nsn.gov.

F. Proposal Standards: The Proposal will not exceed 25 pages (8-1/2” X 11”) in length,

single-spaced, 12-pt. font, including resumes, title page, table of content, and other

pertinent forms that is required. Proposals that exceed these limitations will be

disqualified. Four over-sized sheets, up to 11” X 17” will be allowed as 8 ½” x 11” pages.

Additional over-sized sheets will be counted in terms of equivalent 8-1/2” X 11” pages.

Incidental use of fonts in charts and tables down to 10-pt. font necessary to make charts or

tables fit pages will be allowed. An original and six (6) copies of the proposal will be

submitted in a sealed envelope clearly marked, “Do Not Open –BID: No. 18-08-1421Vj”,

by September 2, 2015 @ 4:00 PM (MST). The Fee Schedule must be included in a

Page 3: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 3

separate, sealed envelope marked, “FEE SCHEDULE”. Mail Proposal addressed to the

Navajo Nation Technical, Construction, and Operations Branch, P. O. Box 678, Ft.

Defiance, AZ. 86504, or deliver, FedEx or UPS to the Navajo Nation Technical,

Construction, and Operations Branch, Navajo Route 12, Ft. Defiance, AZ, 86504,

Telephone: (928) 729-4145. Firms who are mailing their proposals should allow sufficient

time for mail delivery to ensure receipt by the time specified. No proposals will be

accepted after the due date. No faxed or e-mailed proposals will be accepted.

G. Late Receipt of Proposals: Late proposals will not be accepted. It is the responsibility of

the Firm to ensure the proposal arrives at TCOB before the due date and time specified.

H. Rejection of Proposals: The TCOB reserves the right to reject any or all proposals and to

waive informalities in the proposals received whenever such rejection or waiver is in the

best interest of the Navajo Nation.

I. Proprietary Information: Any restrictions on the use of data contained within any

proposal must be clearly stated in the proposal itself. Each and every page of the

proprietary material must be labeled or identified with the word, “Proprietary”.

J. Response Material Ownership: All material submitted regarding this RFP will become

property of TCOB and will not be returned to the Firm. Responses received will be

retained in a file. The TCOB has the right to use any or all system ideas presented in

response to this RFP, subject to limitations outlined in paragraph J above. Disqualification

or non-selection of a Firm or proposal does not eliminate this right.

K. Incurring Costs: The TCOB is not liable for any cost incurred by the Firm prior to

issuance of an agreement, contract and/or purchase order.

L. Acceptance of Proposal Content: The contents of the proposal of the successful firm will

become contractual obligations if acquisition action ensues. Failure of the successful firm

to accept these obligations may result in cancellation of the award and such firm may be

removed from future solicitation. The TCOB reserves the right to pursue appropriate legal

action in the set of circumstances in Navajo Nation Tribal Courts.

M. Acceptance Time: The TCOB intends to make a selection within thirty (30) calendar days

after the closing date of receipt of proposal. No inquiries will be accepted during the

evaluation period. The evaluation period will begin on the specified time and may last up

to ten (10) working days thereafter.

N. Notice of Intent to Contract: The successful Firm will be sent a notice of intent to

contract letter. If negotiations are successful, a contract will be developed, which includes

the scope of work, costs, and other elements of the proposal submitted.

Page 4: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

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O. Proposal Evaluation:

1. Proposal shall be evaluated on the basis of demonstrated competence and

qualifications for the type of service required, and shall be based on the evaluation

factors set forth in this RFP. For the purpose of conducting discussions, proposal

may be initially classified as:

a. Acceptable.

b. Potentially acceptable, that is, reasonably assured of being made acceptable.

c. Unacceptable (Firms whose proposals are unacceptable shall be notified

promptly).

2. The TCOB shall have the right to waive technical irregularities in the form of the

Proposal of the Firm, which do not alter the quality or quantity of the services.

3. Preference of Navajo and Indian-owned businesses will be given under the Navajo

Nation Business Opportunity Act, 5 NNC §201 et. Seq., and the Navajo Nation

Procurement Act, 12 NNC §203. The Navajo Nation Department of Justice has

determined that Navajo Preference does not apply to qualification based solicitations;

however evaluation points will be awarded to Navajo and minority respondents.

P. Standard Contract: The TCOB reserves the right to incorporate contract provisions

based upon the negotiations with the successful firm as a result of a proposal submitted in

response to this RFP.

Q. The Laws, Rules and Regulations of the Navajo Nation Code, latest edition, shall govern

the procurement of these services, specifically, the Navajo Nation Business Opportunity

Act (5 NNC §201 et. Seq.), and the Navajo Nation Procurement Act (12 NNC §203).

R. Professional Liability Insurance: The successful Firm shall provide a Certificate of

Liability Insurance.

S. Protests: In accordance with Navajo Business Opportunity Act, any contractor who is

concerned about the award of a contract may protest to the Navajo Nation’s Business

Regulatory Department. The protest must be submitted in writing to:

Navajo Business Regulatory Dept. Mr. Najam Tariq, Director

P.O. Box 663 Navajo Nation Department of Water

Window Rock, AZ, 86515 Resources - Technical, Construction,

Tele: (928) 871-6714 or 6718 & Operations Branch

P. O. Box 678

Ft. Defiance, AZ 86504

Tele: (928) 729-4004 Protest must include the name and address of the protestant, the solicitation number, and a

statement of grounds for protest, including appropriate supporting exhibits.

Page 5: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

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PART II

Scope of Work

Summary:

The Navajo Nation Department of Water Resources (NNDWR) – Technical, Construction, and

Operations Branch (TCOB) is seeking qualified Firms to conduct Environmental Assessment, to

include a Biological Evaluation and Archaeological Survey, of an 18.1 mile total length of

irrigation canal located west of and within the Newcomb NavaFarm community. This system

will be evaluated and analyzed for canal rehabilitation and/or improvement. Alternatives are:

Diversion 1

1. Rehabilitate diversion structure;

a. Line canal with suitable material feeding the main canal into the Captain Tom

Reservoir meeting water management plans

b. Include a pump capable of drawing water up from a sump into an

underground pipe system at diversion 1, feeding the main canal into the

Captain Tom Reservoir meeting water management plans

2. Redesign and construct a new diversion structure;

a. Line canal with suitable material so as to meet water management plans for

Captain Tom Reservoir

b. Include a pump with underground pipe system so as to meet water

management plans for Captain Tom Reservoir

3. No action

Diversion 2

1. Rehabilitate Diversion 2;

a. Include a pump and pipe system meeting crop demand

2. Redesign and construct a new diversion structure;

a. Include a pump and pipe system meeting crop demand

3. No action

NavaFarm Canals

1. Line canals with suitable material to meet crop irrigating requirements

2. Place underground piping system to meet crop irrigating requirements

3. No action

Page 6: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

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Figure 1: Mapping location of site

(ESRI based GIS information will made available upon request)

Table 1: Site Information

The NavaFarm community currently uses an earthen canal to divert water form Captain Tom

Wash into Captain Tom Reservoir. A primary diversion structure with a manual gate is in place

approximately ¾ of a mile (3752 feet) west of Two Grey Hills Chapter house. Approximately

half the irrigation conveyance leading to Captain Tom Reservoir is a natural wash which will be

left undisturbed. The feeder canal from diversion 1 is to replenish the water supply for the

farming community. A concrete lined canal starts from the Captain Tom Reservoir to the

farming community to supply the farmers with water during non-monsoon seasons.

A secondary diversion is located approximately 1 mile (5100 feet) south of the Reservoir and

feeds directly into the farming community. There are several arterial canals feeding each farm

Page 7: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

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plot within the farming community and crossing under Highway 491. The community irrigation

canals are earthen and have turnouts for each farm plot to access flow from the main canals.

The Scope of Work is outlined in the Tasks that follow. The scope is divided into seven (7)

sections:

Task 1. Project Initiation

The Consultant will conduct a work session with NNDWR – TCOB to confirm project

objectives, define the proposed action and the range of alternative actions for evaluation in the

Environmental Assessment Report (EA), prepare a detailed project schedule and prepare a

detailed work plan. The cooperators on this project are the Newcomb NavaFarm Board,

Newcomb Chapter, and NNDWR - TCOB.

Task 2. Description of Project Purpose/Background and Alternatives

As a first step toward preparation of an EA, the Consultant will describe and document the

purpose and need for the action, the history and background of the proposed action, the essential

characteristics of the proposed alternative actions being considered for evaluation, and the

institutional framework for the environmental review process.

Task 3. Public Scoping

The Consultant will be responsible for arranging, noticing, and conducting any public scoping

meetings, and preparing and distributing scoping information to potentially affected and/or

interested individuals, organizations, and agencies.

The Consultant will be responsible for preparing and maintaining a complete and accurate record

of all public scoping meetings and public comments submitted as part of the scoping process.

Based on input from potentially affected/interested parties during the scoping process the

Consultant will identify any major issues and concerns relevant to the proposed action.

Task 4. Data Collection

The Consultant will identify and compile all existing data sources and baseline information. The

collection of baseline information will include information about the environmental effects of

implementing the proposed Federal action and other reasonably foreseeable development in the

area. The Consultant will also conduct a review of all pertinent existing documentation and

identify those subject areas requiring the generation of primary data. After conferring with the

NNDWR –TCOB and Newcomb Chapter, the Consultant will collect all primary data required

for the preparation of the EA, to include a BE and AS.

In compliance with Section 7 of the Threatened and Endangered Species Act, the document

preparer shall contact the Navajo Nation Fish and Wildlife - Natural Heritage Program

(NNNHP) for a Threatened and Endangered Species listing and prepare a biological assessment.

Task 5. Documentation of Existing Conditions for the Affected Environment

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The Consultant will define, describe and document the existing conditions of the affected

environment for the action alternatives based upon the data and information collected during

Task 4. In order to define the no action alternative, the Consultant will project current conditions

to the most reasonably foreseeable future conditions that would prevail in the absence of taking

the proposed Federal action.

Task 6. Prepare Draft EA

The draft EA will be prepared in accordance with the National Environmental Policy Act of

1969 (NEPA), the Council on Environmental Quality’s regulations for implementing NEPA (40

Code of Federal Regulations Parts 1500-1508), and the BIA’s Navajo Regional Office Division

of Environmental, Cultural and Safety Management’s Environmental Assessment Document

Content and Format (IAM Part 59, Chapter 3) (Attached)

The Consultant will provide DWR and BIA with one electronic version (MSWord preferred) and

10 copies of a preliminary draft EA for review. Following revisions based on input from

NNDWR - TCOB and BIA, the Consultant will provide 60 copies of the draft EA for public

distribution by NNDWR - TCOB and BIA.

Task 7. Prepare Final EA/Deliverables

At the end of the public review period, the Consultant will review public comments and, working

with DWR and BIA, determine the appropriateness of the comments, assist in preparing

responses to relevant questions/comments, and make revisions to the EA as appropriate. The

Consultant will prepare a preliminary final EA, revising the text as required in response to

comments, as well as an appendix of comment letters received and NNDWR - TCOB’s and

BIA’s responses. The Consultant will provide a signed FONSI from the BIA, as determined, and

identify all environmental permits needed for construction of the project.

A copy of the Cultural Resource Compliance Form, issued by the NNHPD, or equivalent

documentation, should be included as part of the EA submittal.

A copy of a Biological Resource Compliance Form, or equivalent, issued by the NNNHP, should

be part of the EA submittal.

The Consultant will provide NNDWR - TCOB and BIA with one electronic version (MSWord

preferred) and 10 copies of a preliminary final EA for review. Following revisions based on

input from DWR and BIA, the Consultant will provide 60 copies of the draft EA for public

distribution by DWR and BIA.

Page 9: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 9

Part III

RFP Evaluation Criteria and Requirements

Prospective firms must submit a complete response to the RFP. All proposals received in

response to this RFP will be retained by NNDWR-TCOB. Proposals should be prepared simply

and economically, providing complete details of the prospective firms’ abilities to perform

qualified, professional Engineering/Surveying Services.

A. Proposals must include the following:

1. General scope of services provided by the respondent firm (include business background

information).

2. Proposed scope of work to be performed. The plan should outline specific services the

firm will provide in the course of performing EA, BE, and AS for NNDWR-TCOB. A

projected schedule is to be included.

3. Proposed cost of performing afore mentioned services: provide percentage breakdown by

key cost components. Fee schedule will be included as a separate sealed envelope

marked “Fee Schedule”. The fee schedule will be opened by the Evaluation Committee if

and when a proposal is selected for negotiation.

4. Description of firm’s previous experience in the area of afore mentioned services for an

Indian Tribe or Federal Agency. (Please include a list of reference with at least two

current addresses on the Navajo Reservation).

5. Qualifications of personnel to be assigned to this project.

6. Proposal Submission: The proposal contains substantially all components specified in

PRT IV – PROPOSAL CONTENT AND EVALUATION CRITERIA.

7. Proposal Format: Upon submission of proposals, provide an original and six (copies)

proposal packets for the evaluation committee members. In addition, it is requested that

proposals be in flat bound form to facilitate filing. Please do not submit proposals in

loose-leaf binders (3-ring), these will be rejected as non-responsive. Proposals will be

submitted in a sealed envelope clearly marked, “Captain Tom Irrigation Project – 609-13-

0001-TF04/K133042 - DO NOT OPEN RFP -” and must be received by September 2,

2015, at 4:00 P.M., MST. The fee schedule must be included in a separate, sealed

envelope marked, “Fee Schedule”.

Page 10: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 10

PART IV

Proposal Content and Evaluation Criteria

The NNDWR-TCOB intends to retain the successful proposers on a “Best Value” basis, not a

“Low Bid” basis. Therefore, the NNDWR-TCOB can properly evaluate the offers received. All

proposals submitted in response to this RFP must be formatted in accordance with the sequence

noted below. Each category must be separated by index dividers numbered and labeled with the

corresponding tab reference also noted below.

A. Tab 1: Qualification of the Firm. Proposals must specifically address and affirm the

following: 1. Letter of Interest that indicates why your firm should be selected for the job.

2. Qualification of personnel to be assigned to this project.

3. Describe in detail how the service will be provided. Include a description of major tasks

and sub-tasks.

4. Detailed resume for all management and key personnel that will be involved with

projects, including the professional qualifications and experience and a statement

indicating task each individual will be assigned to perform.

5. Submit a project plan that details the work to be conducted. Include the time line (Gantt

chart showing each phase or task of the work, when that phase or task will begin, how

long it will continue, and when it should end) for completion of the EA, BE, and AS. The

schedule should clearly delineate each point in time where project deliverables and

reports are planned.

6. The proposal must contain sufficient detail to allow proper determination of the

proposer’s ability to commit sufficient time to this NNDWR-TCOB project. Staff-hour

commitments and percentage of time committed to other work for each member will be

specified.

7. For Navajo/Minority/Small Business Preference Requirements, submit the Certificate.

The Navajo Nation Department of Justice has determined that Navajo Preference does

not apply to qualification based solicitations; however points will be awarded to Navajo

and minority respondents.

Page 11: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 11

B. Tab 2: Experience 1. The Firm will provide evidence of experience and quality services rendered relating to

the required work in the Navajo Nation. Provide evidence of work with Navajo Nation

Chapters, Divisions, and Departments on planning or development projects.

2. Provide a list of five references for contracts of similar size and scope, including at least

two references for current contracts or those awarded during the past three years.

Reference must include name of company in contract with, the length of contract term,

contract persons, addresses and telephone numbers.

3. Provide evidence that the firm has the administrative, technical and financial capability to

perform the required services.

4. Business & Staff Experience: Management capacity; staff expertise; internal quality

control; organizational structure.

C. Tab 3: Record of Past Performance

The proposing firm must demonstrate it has the administrative and technical capability to

perform the required services on time and within the project budget.

1. Record of timely completion of Water Plan(s) and Systems Upgrade analysis.

2. Internal measures proposed for timely completion and cost control.

3. Person responsible for schedule and budget.

4. Any past client contractual issues/obstacles.

D. Tab 4: Financial Stability and Capability

The proposing firm must demonstrate it has the financial capability to perform the

required services. Proposers must provide; failure to provide will disqualify your

proposal.

1. Include in your proposal, the firm’s 2011 or more recent Year End Financial

Statements, which clearly depict the stability of the firm. Financial statements must

include the Balance Sheet, Income statement, Statement of Cash Flow.

E. Tab 5: Proposed Fees

1. Provide a detailed cost breakdown for all service elements within your total cost

proposal to carry out the Scope of Work. Include all personnel, time, equipment,

supplies, overhead expenses, and profits, as well as setting out any travel expenses or

Page 12: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Page 12

unusual expenses if applicable.

PART V

Rating System on Evaluation Criteria

The manner proposal will be evaluated and rated as follows. The descriptions of the

components are provided in Section IV. Proposal Content and Evaluation Criteria.

A. Qualifications. (40 points) __________

B. Experience. (35 points) __________

C. Record of Past Performance. (15 points) __________

D. Financial Stability. (10 points) __________

1. 2011 or more recent Year End Financial Statements, which clearly:

A. Depicts the stability of the firm

B. Must include the Balance Sheet and Income Statement

C. Statement of Cash Flow

Total Points (100 points possible) =========

End of Proposal.

Thank you for your interest in working with the Navajo Nation Water Management Branch.

Page 13: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

NAVAJO NATION CERTIFICATIONRegarding Debarment and

Suspension

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 begrounds to terminate the contract and pursue other legal remedies.

Applicant' s Address Name & Signature of Applicant

Type or Print Name

SignatureDate

Office of the Controller • PO Box 3150, Window Rock, AZ 86515 • ( 928) 871- 6316 • Fox( 928) 871- 7778

Page 14: The Navajo Nation Department of Water Resources Navajo Business Regulatory Dept. Mr. Najam Tariq, Director P.O. Box 663 Navajo Nation Department of Water Window Rock, AZ, 86515 Resources

Form W' 9 Request for Taxpayer Give Form to theRev. December 2014)

Identification Number and Certificationrequester. Do not

Department of the Treasury send to the IRS.Internal Revenue Service

1 Name( as shown on your income tax return). Name is required on this line; do not leave this line blank.

N 2 Business name/disregarded entity name, if different from above

arrnalo. 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions( codes apply only to

Individual/ sole proprietor or C corporation certain entities, not individuals; seew

po S Corporation Partnership Trust/estate instructions on page 3):a co single- member LLC

Limited liability company. Enter the tax classification C= C corporation. S= S corporation. Exempt payee code( if any)ty P Y po poration, P= partnership)

Exemption from FATCA reportingc 2 Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for

E

the tax classification of the single-member owner. code( if any)a 0 Other( see instructions) P trodaasto accounts nwnrr dumotioned mew*

5 Address( number, street, and apt. or suite no.) Requester' s name and address( optional)

mnto 6 City. state, and ZIP coded

7 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 line 1 to avoid I Social security numberbackup withholding. For individuals, this is generally 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 aTIN on page 3. or

Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I Employer Identification numberguidelines on whose number 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 am 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( if 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 Date P.

General Instructions Form 1098( home mortgage interest). 1098- E( student loan interest), 1098- Ttuition)

Section references are to the Internal Revenue Code unless otherwise noted. Form 1099- C( canceled debt)Future developments. Information about developments affecting Form W-9( such •

Form 1099-A( acquisition or abandonment of secured property)as legislation enacted after we release it) is at www.irs.gov/1w9.

Use Form W- 9 only if you are a U. S. person( including a resident alien), toPurpose of Form provide your correct TIN.

An individual or entity( Form W- 9 requester) who is required to file an information you do not return Form W-9 to the requester with a TIN, you might be subject

return with the IRS must obtain your correct taxpayer identification number( TIN) to backup withholding. See What is backup withholding? on page 2.which may be your social security number( SSN). individual taxpayer identification By signing the filled- out form, you:number( ITIN), adoption taxpayer identification number( ATIN), or employer

1. Certify that the TIN you are giving is correct( or you are waiting for a numberidentification number( EIN), to report on an information return the amount paid toyou, or other amount reportable on an information return. Examples of information

to be issued),

returns include, but are not limited to, the following: 2. Certify that you are not subject to backup withholding, orForm 1099- INT( interest earned or paid) 3. Claim exemption from backup withholding if you are a U. S. exempt payee. IfForm 1099- DIV( dividends, including those from stocks or mutual funds) applicable, you are also certifying that as a U. S. person, your allocable share of

any partnership income from a U. S. trade or business is not subject to theForm 1099- MISC( various types of income, prizes, awards, or gross proceeds) withholding tax on foreign partners' share of effectively connected income. andForm 1099- B( stock or mutual fund sales and certain other transactions by 4. Certify that FATCA code(s) entered on this form( if any) indicating that you are

brokers) exempt from the FATCA reporting, is correct. See What is FATCA reporting? onForm 1099- S( proceeds from real estate transactions) page 2 for further information.

Form 1099- K( merchant card and third party network transactions)

Cat. No. 10231X Form W- 9( Rev. 12- 2014)