HomeMy WebLinkAbout58-03 RESOLUTIONRESOLUTION NO. 58-03
A RESOLUTION AUTHORIZING THE FAYETTEVILLE POLICE
DEPARTMENT TO APPLY FOR AND ACCEPT A JUVENILE
ACCOUNTABILITY INCENTIVE BLOCK GRANT IN THE
AMOUNT OF THIRTY THOUSAND FIVE HUNDRED SIXTY-
TWO DOLLARS ($30,562.00) TO FUND D.A.R.E AND D.A.R.E.
PLUS PROGRAMMING; GANG RESISTANCE TRAINING; AND
SOFTWARE AND TRAINING TO CONDUCT THREAT
ASSESSMENTS FOR THE SCHOOL POPULATION.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1. That the City Council of the City of Fayetteville, Arkansas
hereby authorizes the Fayetteville Police Department to apply for and accept a
Juvenile Accountability Incentive Block Grant in the amount of Thirty Thousand
Five Hundred Sixty -Two Dollars ($30,562.00) To Fund D.A.R.E and D.A.R.E. Plus
programming; Gang Resistance Training; and software and training to conduct
threat assessments for the school population.
PASSED and APPROVED this 15th day of April, 2003.
vf;,
. .
ie e, FrCt,lf
• ,
:N A
By: f yttA/ w COV 1St'
SONDRA SMITH, City Clerk
APPROVED:
By
D N COODY, Mayor
NAME OF FILE:
CROSS REFERENCE:
m#
Date
•
Resolution No. 58-03
Document
•
1
04/15/03
Res. 58-03 w/Ex. A
2
04/15/03
Staff Review Form w/attachments
draft resolution
memo to mayor and city council
copy of Application for Federal Assistance
copy of
W-9
3
04/17/03
memo to Judy
Cohen
NOTES:
FAYETTEVtLE
THE CITY OF FAYETTEVILLE. ARKANSAS
DEPARTMENTAL CORRESPONDENCE
•
To: Judy Cohen
Police Department
From: Clarice Buffalohead-Pearman
City Clerk Division
Date: April 17, 2003
Re: Res. No. 58-03 and 59-03
My memo is just to confirm that you received a copy of above resolutions and received the
originals of those grants involved. I will forward a copy to Nancy Smith and file a copy of the
grants with the respective resolutions in the city clerk's office.
If anything else is needed please let the clerk's office know.
/cbp
cc Nancy Smith, Internal Auditor
X
For the
AGENDA REQUEST
CONTRACT REVIEW
GRANT REVIEW
Fayetteville City
STA. REVIEW FORM - FINANCIAL OBLIGA N
Council Meeting of:
April 15, 2003
NB410
ISIL)°,
jAvtrilict3
Q6,6yy
FROM:
Rick Hoyt
Name
Police
Division
Police
Department
City Council authorize Mayor Coody to apply for a federal grant to support Fayetteville
Police Department programs in Fayetteville Schools.
COST TO CITY:
$3,396.00
Cost of this request
1010-2940-5201.00
Account Number
Project Number
81,312.00
Category/Project Budget
37,538.00
Funds Used to Date
43,774.00
Remaining 3alance
Patrol Materials & Supplies
Program Category / Project Name
Patrol Materials & Supplies
Program / Project Category Name
General
Fund Name
BUDGET REVIEW:
Budget Manager
k Budgeted Item
1 -Illy u?
Date
Budget Adjustment Attached
CONTRACT/GRANT/LEASE REVIEW:
Accou9X4 g Manager,
Y/ 16/o3
Date In rnal Id:ditor
y a e lk�Q
Ca e
Purchasing Manager
'#lict /03
Date
Date
STAFF RECOMMENDATION:
Division Head
Department Director
Finance & Internal
Services Dir.
4 4—. /A..r::.
C ief 1
Mayor
nistrative Officer
Date
Date
r t O3
Date
910-a3
Date
to
Received in Mayor's Office
Cross Reference:
Previous Ord/Res#:
Orig. Contract Date:
Orig. Contract Number:
New Item:
Date
Yes No
• Staff Review Form - Page 2
Description Juvenile Accountability Incentive Block GrantMeeting Date April 15, 2003
Comments: Reference Comments:
Budget Manager
Accounting Manager
City Attorney
Purchasing Manager
ADA Coordinator
Internal Auditor
Grants Coordinator
• •
RESOLUTION NO.
A RESOLUTION AUTHORIZING THE FAYETTEVILLE POLICE
DEPARTMENT TO APPLY FOR AND ACCEPT A JUVENILE
ACCOUNTABILITY INCENTIVE BLOCK GRANT IN THE
AMOUNT OF THIRTY THOUSAND FIVE HUNDRED SIXTY-
TWO DOLLARS ($30,562.00) TO FUND D.A.R.E AND D.A.R.E.
PLUS PROGRAMMING; GANG RESISTANCE TRAINING; AND
SOFTWARE AND TRAINING TO CONDUCT THREAT
ASSESSMENTS FOR THE SCHOOL POPULATION.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1. That the City Council of the City of Fayetteville, Arkansas
hereby authorizes the Fayetteville Police Department to apply for and accept a
Juvenile Accountability Incentive Block Grant in the amount of Thirty Thousand
Five Hundred Sixty -Two Dollars ($30,562.00) To Fund D.A.R.E and D.A.R.E. Plus
programming; Gang Resistance Training; and software and training to conduct
threat assessments for the school population.
PASSED and APPROVED this 15th day of April, 2003.
ATTEST.
FAYETTEVILLE
THE CITY OF FAYETTEVILLE. ARKANSAS
DEPARTMENTAL CORRESPONDENCE
•
TO: Mayor Dan Coody and Members of the City Council
FROM: Rick Hoyt, Chief of Police -V -X 10-----
DATE: April 11, 2003
SUBJECT: Acceptance of the Juvenile Accountability Incentive Block Grant
Background
The City of Fayetteville has participated in the Juvenile Accountability Block Grant Program
for the past three years. These grants have provided 90% of the funding for the following
juvenile crime prevention programs; one School Resource Officer in 2000; enhancement of
the Drug Abuse Resistance Education (DARE) program by providing training and supplies;
purchase equipment to help prevent underage drinking in 2001 and; 2002 child identification
equipment and supplies to name a few. This grant allows us to train and equip officers with
items that tend to get cut from budgets when our tax base will only support the essentials.
Current Status
The Fayetteville Police Department provides DARE to both 5'h and 7th Grade students. The
current grant application will continue to enhance our D.A.R.E. program by providing
supplies and training for additional officers and enhance our community policing efforts in
preventing underage drinking and drug use. Also, this grant will allow two additional
officers to receive the Gang Resistance Education and Training Instructor Certification
Program to train other members of the Police Department. This grant will provide supplies
to begin an after school program using the DARE Plus program for 5th and 6'h grade students.
Finally, the grant will provide funds to purchase software and training to enhance our skills
in conducting threat assessments for the school population.
This grant application relates to several of the Fayetteville Vision 2020 Guiding Principals.
Financially Sustainable City Government as this is the fourth year the grant has funded up to
ninety percent of the cost of the programs offered by the police department to the Fayetteville
Schools. Due to the benefits the students gain from the programs teaching resistance to
drug, alcohol and gang related activities, Fayetteville is a safer community and more
specifically this grant provides a safer environment for our students and teachers at
elementary and middle school locations.
•
• •
Recommendation
It is recommended City Council approve for the Mayor's signature the application for the
JAIBG in the amount of 530,562.00. The 2003 adopted budget includes the S3,396 in the
Crime Prevention account, which will be used as matching funds for this grant.
OMB Approval No. 0348-0043
vrr r law-% u nen . van .
FEDERAL ASSISTANCE
2. DATE SUBMITTED
March 28, 2003
Applwant identifier
1.
TYPE OF SUBMISSION:
Preapplicatbn
3. DATE RECEIVED BY STATE
State Application Identifier
hon
stnicdon
• Construction
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
L.
Non -Construction
0 Non.ConstrucUon
5. APPUCANT INFORMATION
Legal Name:
City of Fayetteville
Organizational Unit
Police Department
Address (give dry, county, State, and sip code):
113 W. Mountain St.
Fayetteville AR 72701
Name and telephone number of person to be contacted on matters hwoMn(
thb eppaeatbn(glve arse code)
Judy Cohea (479)587-3581
7. TYPE OF APPLICANT: (enter appropriate letter In box)
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
711
—161011181416121II
A. State H. Independent School DIM.
Higher Learning
B. TYPE OF APPUCATION:
B. County I. State Controlled Institution of
Municipal J. Private University
C.
til
New
■Continuation
• Revision
D. Township K. Indian Tribe
If Revision. enter appropriate letter(s) In box(es)
E. Interstate L Individual
F. Intennuni ipal M. Prom Organization
G. Special Dishlct N Other (Specify)
• A Inaease Award B. Decease Award C. Increase Duration
• D. Decease Duration Other(spedfy):
9. NAME OF FEDERAL AGENCY:
U.S. Dept of Health and Human Services
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER. •
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
1
—
11
TITLE: -
-
12. AREAS AFFECTED BY PROJECT (Cities. Counties, States, eta):
City of Fayetteville School District
13. PROPOSED PROJECT
JAIBG
14. CONGRESSIONAL DISTRICTS OF:
Third Congressional -District
Start Date
6/1/03
rI Ending
Date
a. Applicant
City of Fayetteville
b. Project
PLICATION
15. ESTIMATED
16/30/04
FUNDING:
18 IS SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal
5 30,562 m
a. YES. THIS PREAPPLICATIONIAPPUCATION WAS MADE
ORDER 12372
D. Applicant
oro
$
AVAILABLE TO THE STATE EXECUTIVE
PROCESS FOR REVIEW ON:
c. state
m
$
DATE 4/16/03
d. Local
$ .co
3.396
b. No. D PROGRAM IS NOT COVERED BY E. 0.12372
BY STATE
e. Other
S .co
0 OR PROGRAM HAS NOT BEEN SELECTED
FOR REVIEW
m
1. Program income
f
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
m
g. TOTAL
$
•
Yes If "Yes," attach an explanation. ❑ No
33,958 0
18. TO THE BEST OF MY KNOWLEDGE
DOCUMENT HAS BEEN DULY
ASSURANCES IF
AND BELIEF, ALL DATA IN THIS APPUCATIONIPREAPPUCATION
AUTHORIZED BY THE GOVERNING BODY OF THE APPUCANT AND THE
THE ASSISTANCE IS AWARDED.
ARE TRUE AND CORRECT, THE
APPLICANT WILL COMPLY WITH THE
ATTACHED
e; Type Name of Authorized Representative
b. Title
a Telephone Number
(479) 575-8330
DA Conayor
d. Sgnalurs d
J/
e. Date Signed
G Bi
/6/
/ /J Form 24 (Rev. 7-97)
Previous Editioni Usable
Authorized for Local Reproduction
Presated by OMB Circular A-102
1. Applicant
2002 JuveIccountability Incentive Block Grant Pro. Application
City of Fayetteville 16.
2. Mailing Address 113 W. Mountain St.
Fayetteville, AR
3. Phone Number (479)575L833(1rAXNumber (479)575-8257
4. Project CFDAM 16.523
5. Federal Congrcssimed District(s) served by this project
a. Third b.
c
6.
7.
8.
9.
judicial District(s)served Fourth
Type of Implementation Agency
A. Level of Government or Entity.
ColmtY
❑ Local
❑ Indian tribe performing law
enforcement functions
❑ Other.
17. B. Function of Implementing Agency:
® Law Enforcement
❑ Court
❑ Prosecution
❑ Detention
❑ Probation
❑ Social Soviet
❑ Schools
Pedant Employer Identification i 71-6018462 0 Other.
Counties saved by this project Washington
18. Amount Awarded 30.562
Program Propose Areas:
1 0 Construction of juvenile detention or correctional facilities, including training of persovnd.
2. 0 Accountability -based sanctions for juvenile offenders
3. 0 Firing of juvenile judges, probation officers, and defenders and funding pretrial services for juveniles
4. 0 }{ring of prosecutors, so that more cases involving juveniles can be prosecuted and backlogs reduced
5. 0 Funding of prosecutor -led youth drug, gang, and violence programs.
6. 0 Technology, equipment, and training programs to assist prosecutors in identifying and expediting the prosecution of
violent juvenile offendas..
7. 0 Probation programs for juvenile offenders. •
8 0 Gum courts for the adjudication and prosecution of juvenlle fueaffi offenders
9. 0 Drug courts for juvenile offenders with substance abuse problems
10. 0 information sharing systems to bdp identify, control, supervise, and treat juveniles who repeatedly commit serious
delinquent or criminal acts.
11. ® Accountability -based programs for law enforcement referrals or that are designed to protect students and school
personnel from drug, gang, and youth violence.
12 0 Controlled substance toting (including interventions) for juvemies in the juvenile justice system
10. Project Din:dor:Cap t a in Frank inhns od Phone 5: (479)587-3510
11. Mailing Address P 0 BOX 1988
_Fayetteville AR 77702
12. Financial Officer Judy Cohea Phone M• (479)587-9581
13. Project Site City of Favet[evil]e
14. County(ies)orCity (ies)Served: Fayetteville
15. Project Duratina: Me dmum 24 months
Expected Start Date
Expected Number of Poems to benefit from Project
21 months
6-01-03
1.600
19. I eat* to the ben army lmowtedge sod belie( the the data in this ppliestioa is true and coma. The doc>mtent has been duly authorized by
the governing body of We apt/tient and the applicant will comply with the general and special conditions outlined in the application if approved
for Media&
•Slgudure of Astbodsed Meld
4/16/03
Date Signed
•77reAalhotkrd pfridal aunt have legal authody to represent a local anti ofgovernment
FOR DYS USE ONLY
Arend Start Date: Total Amount Approved:
Subtenant Year: ['First Yea ['Second Year [Mad Year ['Other Pass
Subgraut
❑Yes age
• •
JAIBG WAIVER REQUEST FORM
City of Fayetteville
Name of County/City/Town
Captain Tracey Risley
Name of Project Director
P.O. BOX 1988
Mailing Address
Faayyeeptteville, AR 72702
CI
(479) 587-3510 StateStateZi(pp
479) 587-3522
Telephone Number FAX Number
30,562
Amount of Funds Received
For DYS Use Only
WAIVER
Local units of govemment must provide an assurance that, other than funds set aside for
administration, not less than 45 percent is allocated for program purpose areas 3-9, and not Tess than
35 percent Is allocated for program purpose areas 1, 2 and 10. This allocation is required uniessthe
local unit of government certifies, in the space provided below, that the interest of public safety and
juvenile crime control would be better served by expending its funds In a proportion other than the 45
and 35 percent minimums. This certification/waiver should provide information concerning the
availability of alternative funding sources, existing structures, and the reasons for the alternative use.
However, with or without this waiver, all funds must be expended for programs within Me
12 authorized program purpose areas (P/ease use no more than the space available on this page
for your explanation)
The City of Fayetteville Police Department will utilize
the funds provided by the JAIBG td 8uppOtt 011 of the
authorized programs purpose area. The County and State
provides services for the other purpose areas.
4/16/03
*Signature of Authorized • Date
*The Authorized 0 h' al must have legal authority to represent a local unit of government.
• •
JAIBG CASH MATCH REQUIREMENT FORM
Cash Match
A local unit of government may allocate up to 10 percent of the total program cost for
administrative costs related to the JAIBG programs All funds used for administrative costs are
subject to the Cash Match requirement. The local govemment reapient of the JAIBG award
�i contribute (in the form of a Cash Match) 10 percent of the total program cost (other than
costs of construction of permanent correctional fadiities, which require a 50 percent match).
The total program cost is made up of the Federal award amount and the Cash Match. If only
the Federal amount is known, the calculation of the match requirements Is as follows:
1. Convert the Federal award amount percentage to a fraction (example, 90 percent =
9/10).
2. Invert the fraction from 9/10 to 10/9.
3. Multiply the Federal award amount by the numerator (example, 10,000 x 10 =
$100,000).
4. Divide the result by the denominator to determine the total program cost (example,
$100,000/9 = $11,111 11)
5. Subtract the amount of the Federal award from the total program cost to determine the
Cash Match (example, $11,111.11 — $10,000 = $1,111)
Allowable Sources of Cash Match are:
1. City and County Appropriations
2. Housing and Community Development Act
3. Equitable Sharing Program, a Federal asset forfeiture distnbution program to state and
local officials
4. Appalachian Regional Development Act
5. Private Funds
By signing this form you are confirming you have read the above mentioned
stipulation and have included the required Cash Match is induded in your budget
41 4/r/
*Signatures &'Authorized Official
4/16/03
Date
*The Authorized Official must represent a local unit of government e.g., a mayor or county
Judge.
•
ASSURANCES AND CERTIFICATION BY APPLICANT
Assurances
Applicant assures and certifies that he/she has read and will comply with the following:
1. The Grantee shall provide the services under the terms of this agreement in
accordance with the purposes, goals, objectives, and target groups as so stated in
the application for funding and any approved addendum.
2. The Applicant possesses the legal authority to apply for this grant; a resolution or
motion has been adopted by the applicant's governing body which authonzes the
submittal of this application, mcluding all understanding and assurances contained
herein, directing and authorizing the `official representative" to act in connection
with the apphcation and to provide such addrtional information as may be
required.
3. The Grantee will comply with Titles IV and VI of the Civil Rights Act of 1964
and with Section 504 of the Rehabilitation Act of 1973, in that no person shall, on
the grounds of race, color, national origin or handicap, be excluded from
participation in, be denied benefits of, or otherwise be subjected to discrimination
under any program or activity receiving federal financial assistance. Equal
opportunity will also be assured in all employment practices.
4. Facilities, programs, and services supported through these funds will be located as
to be readily accessible, available, and responsible to the needs bfthe population
without discrimination because of sex, creed, race, or duration of residence
5. Safeguards will be established to prohibit employees from using their positions
for a purpose that is or gives the appearance of being motivated by a desire for
private gain for themselves or others, particularly those with whom they have
family, business, or other ties.
6. The Arkansas Department of Human Services, Division of Youth Services,
through any authorized representative or any duly authorized representative of
federal government, will have access to and the right to examine all records,
books, papers, or documents relating to the grant funding.
•
Juvenile bailee Program Assurances
7. The Grantee understands that failure to establish or operate the funded program
in accordance with the terms of the funded application, in the opinion of the
Division of Youth Services (DYS), may result in the awarded funds being
withdrawn.
8. An annual audit for the fiscal period of the grant shall be conducted by a Certified
Public Accountant in accordance with the generally accepted governmental audit
standards. Sub -recipients under this agreement should comply with -the guidelines
of the relevant OMB audit circular in effect at the close of the fiscal year of the
sub -recipient. State and local government sub -recipients should follow the
guidelines of OMB Circular A-128 or its successor. Non-profit organizations and
educational institutions should follow the guidelines of the provisions of OMB
Circular A-133. Audit reports should be submitted within f20 -Bars following the *
end of the subgrantee's fiscal year. One (1) original and two (2) copies of the
audit report should be submitted to the following address: Assistant Director
Office of Chief Counsel/Audit Section, Department of Human Services, Slot 900,
P.O. Box1437, Little Rock, Alt 72203-1437
9. The Grantee shall provide such program reports as requested, as well as a Final
Report, to DYS within 90 days of the end of the grant period or the end of the
proposed activities, whichever is sooner.
10. The Grantee shall provide Monthly/Quarterly Expenditure Reports to the
Division of Youth Services JJDP Unit. Failure to submit these reports will delay
the processing of requests for reimbursement grant payments.
11. The Grantee shall provide Monthly Activity Reports to the Division of Youth
Services/JJDP Umt, by the 15th of the following month. Any report received
after the 15th will be considered delinquent (unless the 15th falls on a weekend or a
holiday). The request for funds form will not be processed until both the financial
and subgrant activity reports have been received and approved by the JJDP Unit.
•
* The City of Fayetteville contract with a certified public accountant
requires audit to be completed and ready for distribution in 180 days.
180 days
Juvenile Justice Program Assurances
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, all grantees receiving Federal funds included in this Act, including but not
limited to State and local governments and recipients of Federal research grants, shall
clearly state:
1) The percentage of the total costs of the program or project, which will be financed
with federal money;
2) The dollar amount of federal funds for the project or program: and -
3) Percentage and dollar amount of the total costs of the project or program that will
be financed by nongovernmental sources.
These assurances are part of the project grant application. An Official who is a duly
authorized representative of the applicant must certify by his/her signature that the
organization will comply with the provisions of the applicable laws, regulations, and
policies related to the project
By signing in the designated area below, the applicant agrees to abide by the stipulation
contained in this application. Further, by virtue of these signatures, the applicant assures
that this application was presented to the applicant organization governing board and
received approval
Signature
(Board President if applicable)
Typed Name
Date
Signature
(Mayor, City Director, Co
Typed Name
Date
Dan Coody
4/16/03
Form W
-9
(Rev. January 20031
ocp.nnrs err w Tr-acy
weer Renner seem
i
• •
Request for Taxpayer
Identification Number and Certification
Give forth to the
requester. Do not
send to the IRS.
Name
City of Fayetteville
Business nss name. a different from above
aV 0 Corpora
appropriate bas: ❑ Solese proprietor
Address Ttanbe. sbm an0 apta side col
113 W Mountain St
Government ❑„ti , aOmbac
❑ Pautrap ®Oa -
City. sate. and ZIP mote
Fayetteville, AR 72701
tdst amount nunbeW Imre (0 a0
Requester's none and address (optimal)
Par 1
Taxpayer Identification Number (TM)
Eider your TN In the appropriate box. For IndNldue s. this is your social security number (SSN).
However,
idsole lers
disregarded entity,
1
nstructions an
page 3. Fuetahles you employer Identification number ((tIIN). you do not have a number.
see How to get a TN on page 3.
Nota if the attain is !h more than one name. see dee chert an page 4 for guidelines on *erase rumba
to ender.
CerUficaton
Part 11
Social saaatty rants
11414111
Of
Employer
I 0 8 4�
7 1 6 12
Under penalties of perjury. 1 artily that
1. The number shown on thls form Is my correct taxpayer identification number (or I em mating fa a number to be issued to me), and
2. I am not subject to backup withholding because (a) I am exempt Iran backup wi htderg. or 3$ I have not been notified by the Internal
Revenue Service (IRS) that 1 am subject to backup ...Mil/lolling as a resift of a failure to report all Interest or dividends. a (e) the IRS has
notified me that I am no longe subject to backup wkhtoidkx} and
3. 1 am a U.S. person (Including a U.S. resident alien).
wit holdings ec use oYou oed tocross rt t all interem 2 est amend dividends been
return.otifiedytFor reel RS that
estaatentra sactlons. item 2 doosscurrently subject to �not backup
For mo
withholding because youareport cancefadon of debt. marm%xbns to an IndkAdual retirement
For mortgage (IRA). n pail. sally. a aba+daman I of rsearedt property are not required to sigh the CaUflcadon. but you mat
arrangement and ganaaily, pa cher than Interest and dhridenM, you
provide your correct TIN. (See the • on page 1.)
Sign
j(ee
Here
Sivas or
US . •
Purpose of Form
A person who Is required to file an information retum
the IRS, must obtain your correct taxpayer Identification
number (TIN) to report, for example, income paid to you, real
estate transactions, mortgage interest you paid, acquisition
or abandonment of secured property, cancellation of debt, or
contributions you made to en IRA.
U.S. person Use Form W9 only if you area U.S. person
Pperson requesting it (the a resident reques�and liyour correct able, two'.
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be Issued).
2. Certify that you are not subject to backup withholding,
or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
Nota /f a requester gibes you a form other than Form W-9
to request TIN, you must use the requester's form if it /s
substantially to the Form W-9.
Foreign person. If you are a foreign person, use the
appropriate Form W-8 (see Pub. 515, Withholding of Tax an
Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien.
Generally, only a nonresident alien individual may use the
terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties contain a
provision known as a 'saving douse.' Exceptions specified
in the saving clause may permit an exemption from tax to
continue for certain types of income even after the redplent
has otherwise become a U.S. resident often for tax purposes.
11 you are a U.S. resident alien who is relying on an
exception contained in the saving douse of a tax treaty to
daim an exemption from U.S. tax on certain types of income,
you must attach a statement that specifies the following five
items
1. The treaty country. Generally, this must be the same
treaty under which you claimed exemption from tax as a
nonresident alien.
2. The treaty artide addressing the income.
3. The emote number (or location) in the tax treaty that
contains the saving cause and its exceptions.
4. The type and amotaht of Income that qualifies for the
exemption from tax.
5. Suffident facts to justify the exemption from tax under
the terms of the treaty article.
Ea No 10231X
Faro W-9 tRev. 1-2003)