Backup Documents 01/12/2021 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO d 0
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. County Attorney Office—JAB, ACA County Attorney Office 1 ‘(2 1a1
2. BCC Office Board of County b
Commissioners 4.316
3. Minutes and Records Clerk of Court's Office
Pik Lt9
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Jennifer A. Belpedio,ACA STAFF PERSON 239-252-8194
Contact/ Department PHONE#
Agenda Date Item was 1/12/2021 Agenda Item Number 16 D 3
Approved by the BCC
Type of Document RESOLUTION(ONLY) Number of Original 1*
Attached Documents Attached
PO number or account N/A a,`r,a`1—DP
number if document is �'i/
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signa'sre STAMP OK 4Q,3
2. Does the document need to be sent to another agency for a•.' • -: •_ , res? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be Yes
signed by the Chairman, with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the Yes
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's Yes
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A(insert N/A
should be provided to the County Attorney Office at the time the item is input into SIRE. unless an
ordinance)
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on above date and all changes made during Yes N/A is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes, if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC, all changes directed by the BCC have been made, and the document is ready for the an option fo_T
Chairman's signature. dddd'""'" this lmeJ
*other documents that are back-up to the time will be signed by County Mana er designee once
Resolution is signed by Chairman.
1 6 D 3
MEMORANDUM
Date: January 14, 2021
To: Jennifer Belpedio, Assistant County Attorney
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Resolution 2021-06: DAS Donation from Sharol A. Murphy
Trust
Attached for your records is one (1) copy of the document as referenced above,
(Item #16D3) adopted by the Board of County Commissioners on Tuesday,
September 12, 2021.
The original is being held in the Minutes & Records Department as part of the
Official Records.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
1 6113
RESOLUTION NO. 2021- 0 h
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, TO AUTHORIZE THE COUNTY
MANAGER OR HIS DESIGNEE TO TAKE ALL REQUIRED ACTIONS
AND TO EXECUTE AND SUBMIT ALL REQUIRED DOCUMENTS TO
ACCEPT THE COUNTY'S BENEFICIAL INTEREST IN THE SHAROL
A. MURPHY REVOCABLE TRUST FOR USE AT DOMESTIC ANIMAL
SERVICES.
WHEREAS, Collier County has a beneficial interest in the Sharol A. Murphy Revocable
Trust; and
WHEREAS, to receive such beneficial interest it is necessary for Collier County to
appoint an authorized represented to act on its behalf.
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that the County Manager or his
designee is: 1) authorized to take all required actions and 2) execute and submit all required
documents to accept the County's beneficial interest in the Sharol A. Murphy Revocable Trust.
THIS RESOLUTION ADOPTED on this day of Jc :n icic Q 2021 after
motion, second and majority vote favoring adoption.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal Kinzel, Clerk of Courts COLLI COUNTY, FLORIDA
• t . f $ By:
A test 2s to ClglifinanlePuty Clerk Penny Taylor,Chairperson
Sty1citure only.
Approved as to form and legality:
Je ' er A. Belpedio ( C)-S?? ' ' i
Assistant County Attorne \`�1 1 u i'a 11142.4
f
.f ,' i�f/�l
e
1603
RAYMOND JAMES Trust
Charitable Entity Information Form
(Please Print or Type)
Organization's Legal Name: C-0 t t ie,*' Co n'E-y 3O A eo( of Co JCI+r Corn aiSS Tonne r S
Individual Contact Name*: Le b C- Ck Lr S t Sf •
Contact's Title: C.O. ^4^-f M a 1el a 3 e.r
Mailing Address: 3 Q q 9 A r.i s v,, i T24. ' / go 1 t
Ste. 1.. '0Q
[\J ptes FL 3 Yii ,o -57IC,
City Statet - Zip Code
Physical Address: S Q.M. a s A_Ib Od-e_
(Required ifMailing Address is PO Box)
City State Zip Code
Federal Tax ID Number: 5 q - 6, o D DO S g
Please furnish copy of IRS 501 (c)and/or 170(c)
Email Address:
General Phone# (239 )- 025 - 8 3 S 3
Direct Phone# (239 )- aSa - ,V-3 23
Toll Free Phone# ( )- -
The incorporation papers for the above organization were established and filed in the United States of America?
_Yes _No(Please explain below) Or Q a„;t_ hO+ 1 n c o r ea ec ok
Vr4,7\0.. 4.i-'at� Is V a 6Ca.t 964e. r,-,fr..,e•,-k- •
I confirm-Mat the above information provided is accurate and agree to provide written notification to Raymond
James Trust,N.A.of any changes to the above information.
BY: k
ee'�' ` f-- -C .•'" Date: I / IQ /20 0 1
Printed Name: L,e 0 F. C ,3"ira- •
Title: C.OJn-t-y Maw yPN
*Please attach a current and complete copy of your organization's Corporate Resolution or
Meeting Minutes identifying authorized individuals
1603
Form w
Request for Taxpayer Give Form to the
9 Identification Number and Certification requester.Do not
(Rev.Department
October he Tr send to the IRS.
Internl Revenue
ror a Trice �Go to www.Irs. ov/ForintW9 for Instructions and the latest information.
Internal Rovorwe Service www.Irs.gov/Fom,W9
Name(as shown on your Income lax return) Name is required on tnls line;do not leave this line blank.C_.o II le.r Coo n+y Q ,�
oard o-f Co ,n+f w►
Coo+iSs ;ovie •-s
2 Business name/disregarded entity name,if different from above
M 3 Check appropriate box for federal tax classification of the person whose Warne Is entered on line 1.Check only one of Ira 4 Exemptions(codes apply only to
rn following seven boxes carte n entities.not individuals;see
re
a. Instrcctions on page 3):
p ❑ Individual/sole proprietor or ❑ C corporation ❑ s Corporation ❑ Partnership ❑Tr usUestate
single-member L.LC Exempt payee code(U any) 3
1. ❑ Limited liability company.Enter the lax classification(C-C corporation.S=S corporation.P.Partnership)►
p Note:Check the adprolxiate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA repenting
LLC if the LLC is classified as a single-member LLC that Is disregarded from the owner unless the owner of the LLC is tale(if any)
S.
a u anolner LLC that Is not disregarded from the owner for U.S.federal tax purposes,Otherwise,a single-member LLC that
disregarded from the owner should check the apixopriate box for the tax classibcatlon of its owner.
K. Other(see Instructions)► .1e`rY1 Yyt ev"%' l,iV7o,en,,r.:..•..,..ern.n iie.,el.•esr
y 5 Address(number,street.and apt.or suite no.)See Instructions. Requester's name and address(optional)
g 3 a 4 9 `Ta rn i a✓., .1 Tr-a i t 1st S-PC..70 6
cn
6 City.state.and ZIP code
(varies , F. Larla4 39II -5-7tt , _._..
7 List account number(s)here(optionatl
IZZI Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid
Social security number
backup withholding.For Individuals,this Is generally your social security number(SSN).However,for a r� — I -- --)_
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other J )I
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN,later. or
Note:If the account Is in more than one name,see the instructions for line 1,Also see Wont Name and I Employer ldentlfcetlon number
_T
Number To Give the Requester for guidelines on whose number to enter. rs: G� - (�Q b 5'Part II Certification
Under penalties of perjury,I codify 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 Revenue
Service(IRS)that I am subject to backup withholding as a result of a(allure to report all interest or dividends,or(c)the IRS has notified me that I arm
no 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 thls 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 withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to en Individual retirement arrangement(IRA),and generally,payments
other than Interest and dividends,yyou are not required to sign the certification,but you must provide your correct TIN,See the instructions for Part II,later.
Sign signature of Cs"- 1 �� I l i . /a o a
Here U.S.person S. 0 Date►
General instructions ' •Form 1099-DIV(dividends,Including those from stocks or mutual
7 funds)
Section references are to the Internal Revenue Code unless erwise •Form 1099-MISC(various types of Income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest information about developments •Form 1009-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/ForrrtW9' •Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-F(student loan Interest),
Information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property)
taxpayer Identification number(ATIN),or employer identification number
(EIN),to report on an Information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
returns include,but are not limited to,the following. I/you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later,
Cat.No.10231X Form W-9(Rev 10.2018)
1603
., •
i
i
1 Form W-9(Rev.10-2018) Page 2
By signing the filled-out form,you: Example.Article 20 of the U.S.-China income tax treaty allows an
! exemption from tax for scholarship income received by a Chinese
i.Certify that the TIN you are giving is correct(or you are wailing for a number to be Issued), student temporarily present In the United States,Under U.S.law,this
student will become a resident alien for tax purposes if his or her stay In
2.Certify that you are not subject to backup withholding,or the United States exceeds 5 calendar years.However,paragraph 2 of
3.Claim exemption from backup withholding if you are a U.S.exempt the first Protocol to the U.S.-China treaty(dated April 30,1984)allows
payee.if applicable,you are also certifying that as a U.S.person,your the provisions of Article 20 to continue to apply even after the Chinese
allocable share of any partnership income from a U.S.trade or business student becomes a resident alien of the United States.A Chinese
is not subject to the withholding tax on foreign partners'share of student who qualifies for this exception(under paragraph 2 of the first
effectively connected Income,and protocol)and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
4,Certify that exemptfro code(s)FATCAente reporting,e on this form(ifr any)t.See IndicatingW-9 a statement that includes the Information described above to
that you ere from the is correct. What Is support that exemption.
FATCA reporting,later,for further information.
Note:if you are a U,S.person and a requester gives you a form other If you are a nonresident alien or a foreign entity,give the requester the
than Form W-9 to request your TIN,you must use the requester's form if appropriate completed Form W-8 or Form 8233.
it Is substantially similar to this Form W-9. Backup Withholding
Definition of a U.S.person.For federal tax purposes,you are
considered a U.S.person if you are: What Is backup withholding?Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 24%of such
•An Individual who is a U.S.citizen or U.S.resident alien; payments.This is called"backup withholding." Payments that may be
•A partnership,corporation,company,or association created or subject to backup withholding Include interest,tax-exempt interest,
organized in the United States or under the laws Of the United States; dividends,broker and barter exchange transactions,rents,royalties,
•An estate(other than a foreign estate);or nonemployee pay,payments made in settlement of payment card and
•A domestic trust(as defined in Regulations section 301.7701-7). third party network transactions,and certain payments from fishing boat
g operators.Real estate transactions are not subject to backup
Special rules for partnerships.Partnerships that conduct a trade or withholding,
business in the United States are generally required to pay a withholding You wit not be subject to backup withholding on payments you
tax under section 1446 on any foreign partners'share of effectively receive If you give the requester your correct TIN,make the proper
connected taxable income from such business.Further,in certain cases certifications,and report all your taxable interest and dividends on your
where a Form W-9 has not been received,the rules under section 1446 tax return.
require a partnership to presume that a partner is a foreign person,and
pay the section 1446 withholding tax, therefore,if you are a U.S.person Payments you receive will be subject to backup withholding if:
that is a partner in a partnership concLicting a trade or business in the 1.You do not furnish your TIN to the requester,
United States,provide Form W-9 to the partnership to establish your 2.You do not certify your TIN when required(see the instructions for
U.S.status and avoid section 14,16 withholding on your share of Part II for details),
partnership Income.
3.The IRS tells the requester that you furnished an incorrect TIN,
In the cases below,the following person must give Form W-9 to the
partnership(or purposes of establishing its U.S.status and avoiding 4.The IRS tolls you that you are subject to backup withholding
withholding on its allocable share of net income from the partnership because you did not report all your interest and dividends on your tax
conducting a trade or business in the United States. return(for reportable interest and dividends only),or
•In the case of a disregarded entity with a U.S.owner,the U.S.owner 5.You do not certify to the requester that you are not subject to
of the disregarded entity and not the entity: backup withholding under 4 above(for reportable interest and dividend
•In the case of a grantor trust with a U.S.grantor or other U.S.owner, accounts opened after 1983 only),
generally,the U.S.grantor or other U S.owner of the grantor trust and Certain payees and payments are exempt from backup withholding,
not the trust;and See Exempt payee code,later,and the separate Instructions for the
Requester of Form W-9 for more Information.
•in the case of a U.S.trust(other than a grantor trust),the U.S.trust
(other than a grantor trust)and riot the beneficiaries of the trust. Also see Special rules for partnerships,earlier.
Foreign person.If you are a foreign person or the U.S.branch of a What is FATCA Reporting?
foreign bank that has elected to be treated as a U.S.person,do not use
Form W-9.Instead,use the appropriate Form W-8 or Form 8233(see The Foreign Account Tax Compliance Act(FATCA)requires a
Pub.515,Withholding of Tax on Nonresident Aliens and Foreign participating foreign financial institution to report all United States
Entities). account holders that are specified United States persons.Certain
Nonresident ailed who becomes a resident alien.Generally,only a payees are exempt from FATCA reporting.See Exemption from FATCA
reporting coda,later,and the Instructions for the Requester of Form
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 W-9 for more information,
treaties contain a provision known as a"saving clause."Exceptions Updating Your Information
specified in the saving clause may permit an exemption from tax to
continue for certain types of income oven after the payee has otherwise You must provide updated Information to any person to whom you
become a U.S.resident alien for tax purposes. claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
containedyou are a U.S.saving
resident s alien who is relying on an an exceptionxem person.For example,you mayneed to provide updated Information If
from
US. in the certain
clause off a taxoe,treatyo to claimstattach exemption are a C corporation that lects to b an S p or if you no
from U.S.tax on carte n types income,you must a statement youp corporation,
to Form W-9 that specifies the following live items. longer are tax exempt.In addition,you must furnish a new Form W-9 if
1.The treaty country.Generally,this must be the same treaty under the name or TIN changes for the account;for example,If the grantor of a
• which you claimed exemption from tax as a nonresident alien. grantor trust dies.
y . 2.The treaty article addressing the income. Penalties
. 3.The article number(or location)in the tax treaty that contains the
saving clause and its exceptions. Failure to furnish TIN.If you fall to furnish your correct TIN to a
' , 4.The type and amount of Income that qualifies for the exemption requester,you are subject to a penalty of S50 for each such failure
from tax. unless your failure is due to reasonable cause and not to willful neglect.
5.Sufficient facts to justify the exemption from tax under the terms of Civil penalty for false Information with respect to withholding.If you
the treaty article. make a false statement with no reasonable basis that results in no
backup withholding,you are subject to a$500 penalty.
)
16U
Form W-9(Roy.10-2018) Page 3
Criminal penalty for falsifying information,Willfully falsifying IF the entity/person on line 1 is THEN check the box for...
• certifications or affirmations may subject you to criminal penalties a(n),
1 including fines and/or imprisonment.
~
Misuse of TINs,If the requester discloses or uses TINs in violation of • Corporation Corporation
federal law,the requester may he subject to civil and criminal penalties. • Individual Individual/sole proprietor or single-
• • Sole proprietorship,or member LLC
Specific Instructions • Single-member limited liability
company(LW)owned by en
Line 1 individual and disregarded for U.S.
You must enter one of the following on this line;do not leave this line federal tax purposes.
blank.The name should match the name on your tax return. • LLC treated as a partnership for Limited liability company and enter
II this Form W-9 is for a joint account(other than an account U.S.federal tax purposes, the appropriate tax classification.
maintained by a foreign financial institution(FFI)),list first,and then • LLC that has filed Form 8832 or (P=Partnership;C.C corporation;
circle,the name of the person or entity whose number you entered In 2553 to be taxed as a corporation, or S=S corporation)
Part I of Form W-9.If you are providing Form W-9 to an FFI to document or
a joint account,each holder of the account that Is a U.S.person must • LLC that is disregarded as an
provide a Form W-9. entity separate from its owner but
a. Individual.Generally,enter the name shown on your tax return.If the owner is another LLC that is
you have changed your last name without informing the Social Security not disregarded for U.S.federal tax
Administration(SSA)of the name change,enter your first name,the last purposes.
name as shown on your social security card,and your new last name. ,
Note:!TIN applicant:Enter your Individual name as it was entered on • Partnership— —_—_ — Partnership
your Form W-7 application,line 1 a.This should also be the same as the • Trust/estate TrusVestate
name you entered on the Form 1040/1040A/1040EZ you filed with your Line 4,Exemptions
application.
} b. Sole proprietor or single-member LLC.Enter your individual If you are exempt from backup withholding and/or FATCA reporting,
name as shown on your 1040/1040A/1040EZ on line 1.You may enter enter In the appropriate space on line 4 any code(s)that may apply to
your business,trade,or"doing business as"(DBA)name on line 2. you.
C. Partnership,LLC that is not a single-member LLC,C
Exempt payee code,
corporation,or S corporation.Enter the entity's name as shown on the • Generally,Individuals(including sole proprietors)are not exempt from
entity's tax return on line i and any business,trade,or DBA name on backup withholding.
line 2. • Except as provided below,corporations are exempt from backup
d. Other entities.Enter your name as shown on required U.S.federal withholding for certain payments,Including interest and dividends.
tax documents on Tine I.This name should match the name shown on the• • Corporations are riot exempt from backup withholding for payments
charter or other legal document creating the entity.You may enter •
any made in settlement of payment card or third party network transactions.
business,trade,or DBA name on line 2. • Corporations are not exempt from backup withholding with respect to
e. Disregarded entity.For U.S.federal tax purposes,an entity that Is attorneys'lees or gross proceeds paid to attorneys,and corporations
•
• disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect
"disregarded entity." See Regulations section 301.7701.2(c)(2)(iiil.Enter• to payments reportable on Form 1099-MISC.
• the owner's name on line 1,The name of tho entity entered on line 1 The following codes identify payers are from backup
should never be a disregarded entity.The name on line 1 should be the withholding.follo Enter the identify
y appropriateacode that In the space exemptin line 4.
name shown on the Income tax return on which the income should be
reported.For example,If a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a),any IRA,Or
entity for U.S.federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7)if the account satisfies the
• person,the U.S.owner's name Is required to be provided on line 1.If requirements of section 4010)(2)
the direct owner of the entity is also a disregarded entity,enter the first 2—The United States or any of its agencies or instrumentalities
owner that is not disregarded for federal lax purposes.Enter the 3—A state,the District of Columbia,a U.S.commonwealth or
disregarded entity's name on line 2,"Business name/disregarded entity possession,or any of their political subdivisions or instrumentalities
name."If the owner of the disregarded entity Is a foreign person,the
owner must complete en appropriate Form W-8 instead of a Form W-9. 4--A foreign government or any of its political subdivisions,agencies,
This is the case even if the foreign person has a U.S.TIN. or instrumentalities
Line 2 5—A corporation
II you have a business name,trade name,ORA name,or disregarded 6—A dealer in securities or commodities required to register in the
II youtity name,you may enter it on line 2. United States,the District of Columbia,or a U.S.commonwealth or
possession
Line 3 7—A futures commission merchant registered with the Commodity
Check the appropriate box on line 3 for the U.S.federal tax Futures Trading Commission
classification of the person whose name is entered on line 1.Check only 8—A real estate investment trust
one box on line 3. 9—An entity registered at all times during the tax year under the
investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from lax under section 684 or described in section
4947
.
1 6 D 3 .
. ♦ y
Form W-9(Roy.1 a•2018) Page 4
The following chart shows types of payments that may be exempt M—A tax exempt trust under a section 403(b)plan or section 457(g)
from backup withholding.The chart applies to the exempt payees listed plan
above,1 through 13. Note:You may wish to consult with the financial institution requesting
IF the payment Is for... THEN the payment is exempt this form to determine whether the FATCA code and/or exempt payee
for... code should be completed.
Interest and dividend payments All exempt payees except Line 5
for 7 Enter your address(number,street,and apartment or suite number),
Broker transactions Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your Information
trough 11 and all C corporations. returns.If this address differs from the one the requester already has on
S corporations must not enter an file,write NEW at the top.If a new address Is provided,there Is still a
exempt payed code because they chance the old address will be used until the psyor changes your
are exempt only for sales of address In their records.
noncovered securities acquired Line 6
prior to 2012.
Enter your city,state,and ZlP code.
Barter exchange transactions and Exempt payees 1 through 4
patronage dividends Part I. Taxpayer Identification Number(TIN)
Payments over$600 required to be Generally,exempt payees Enter your TIN in the appropriate box.If you are a resident alien and
reported and direct sales over i through 5' you do not hove and are not eligible to get an SSN,your TIN Is your IRS
55,000' individual taxpayer identification number(ITIN).Enter it In the social
security number box.If you do not have an ITIN,see How to get a TIN
Payments made in settlement of Exempt payees 1 through 4 below.
payment card or third party network If you are a sole proprietor and you have an EIN,you may enter either
transactions your SSN or EIN.
'See Form 1099-MISC,Miscellaneous Income,and its instructions. If you are a single-member LLC that is disregarded as an entity
separate from its owner,enter the owner's SSN(or EIN,if the owner has
2 However,the following payments made to a corporation and one).Do not enter the disregarded entity's EIN.If the LLC is classified as
reportable on Form 1099 MISC are not exempt from backup a corporation or partnership,enter the entity's EIN.
withholding:medical and health care payments,attorneys'lees,gross Note:See What Name and Number To Give the Requester,later,for
proceeds paid to an attorney reportable under section 6045(f),and further clarification of name and TIN combinations.
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code.The following codes Identify How to get a TIN.If you do not have a TIN,apply for one immediately.
payees that aro exempt from reporting under FATCA.These codes To apply for an SSN,get Form SS 5,Application for a Social Security
apply to persons submitting this form for accounts maintained outside Card,from your local SSA office or gel this form online at
of the United States by certain foreign financial institutions,Therefore,if www,SSA.gov.You may also get this form by calling 1.800-772-1213.
you aro only submitting this form for an account you hold in the United Use Form W-7,Application for IRS Individual Taxpayer Identification
Slates,you may leave this field blank.Consult with the person Number,to apply for an ITIN,or Form SS-4,Application for Employer
requesting this form if you are uncertain If the financial institution Is Identiflcation Number,to apply for an EIN.You can apply for art EIN
subject to these requirements.A requester may Indicate that a code is online by accessing the IRS websito at www.irs.gov/Businesses and
clicking on Employer Identification Number(EIN)under Starting a
not required by providing you with a Form W-9 with"Not Applicable"(or Business.Go to www.irs.gov/Forms to view,download,or print Form
any similar indication)written or printed on the line for a FATCA W-7 and/or Form SS-4. Or,you can go to www.irs.gov/OrderForms to
exemption code. place an order and have Form W-7 and/or SS-4 mailed to you within 10
A—An organization exempt from lax under section 501(a)or any business days.
individual retirement plan as defined in section 7701(a)(37) If you are asked to complete Form W-9 but do not have a TIN,apply
B—The United States or any of its agencies or instrumentalities for a TIN and write"Applied For"in the space for the TIN,sign and dale
C—A state,the District of Columbia,a U.S.commonwealth or the form,and give It to the requester.For interest and dividend
possession,or any of their political subdivisions or Instrumentalities payments,and certain payments made with respect to readily tradable
D—A corporation the stock of which Is regularly traded on one or instruments,generally you will have 60 days to get a TIN and give It to
I more established securities markets,as described in Regulations the requester before you are subject to backup withholding on
section 1.1472-1(c)(1)(1) payments.The 60-day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
E—A corporation that is a member of the same expanded affiliated you provide your TIN to the requester.
group as a corporation described in Regulations section 1.1472-1(c)(1)(i) Note:Entering"Applied For"means that you have already applied for a
F—A dealer in securities,commodities,or derivative financial TIN or that you intend to apply for one soon.
instruments(including notional principal contracts,futures,forwards, Caution:A disregarded U.S.entity that has a foreign owner must use
and options)that Is registered as such under the laws of the United the appropriate Form W8.
S States or any state
is G—A real estate investment trust Part II. Certification
H—A regulated investment compile as defined In section 551 or an To establish to the withholding agent that you are a U.S,person,or
entity registered at all times during the tax year under the Investment resident alien,sign Form W-9.You may be requested to sign by the
Company Act of 1940 withholding agent even if Item 1,4,or 5 below Indicates otherwise.
I—A common trust fund as defined In section 584(a) For a joint account,only the person whose TIN Is shown In Part I
J—A bank as defined in section 581 should sign(when required).In the case of a disregarded entity,the
•
K—A broker person identified on line 1 must sign,Exempt payees,see Exempt payee
•
• L—A trust exempt from tax under section 664or describedn se code,earlier.
I section
4947(a)(1) Signature requirements.Complete the certification as indicated in
Items 1 through 5 below,
•
•
•
r
1
E
s
. 1603
Form W9(Rev.10-2018) Page 5
1.Interest,dividend,and barter exchange accounts opened For thls type of account: Give name and EIN of:
before 1984 and broker accounts considered active during 1983, 14.Account with the Department of The public entity
You must give your correct TiN,but you do not have to sign the Agriculture in the name of a public
certification. entity(such as a state or local
2.Interest,dividend,broker,and barter exchange accounts government,school district,or
opened after 1983 and broker accounts considered inactive during prison)that receives agricultural
1983.You must sign the certification or backup withholding will apply.If program payments
you are subject to backup withholding and you are merely providing
your correct TIN to the requester,you must cross out item 2 In the 16.Grantor trust filing under the Form The trust
certification before signing the form. 1041 Filing Method or the Optional
3,Real estate transactions.You must sign the certification.You may Form 1001)FlI'rg Method 2(see
cross out item 2 of the certification, Regulations section 1.671.4(b)(2}px6))
4,Other payments.You must give your correct TIN,but you do not 'List first and circle the name of the person whose number you furnish,
have to sign the certification unless you have been notified that you if only one person on a joint account has an SSN,that person's number
have previously given an incorrect TIN."Other payments"include must be furnished.
payments made in the course of the requester's trade or business for z Circle the minor's name and lurnlsh the minor's SSN.
rents,royalties,goods(other than bills for merchandise),medical and
health care services(including payments to corporations),payments to a You muse show your individual name and you may also enter your
a nonemployee for services,payments made in settlement of payment business or OBA name on the"Business name/disregarded entity"
card and third party network transactions,payments to certain fishing name line.You may use either your SSN or EIN(if you have one),but the
boat crew members and fishermen,and gross proceeds paid to IRS encourages you to use your SSN.
attorneys(Including payments to corporations). 'List first and circle the name of the trust,estate,or pension trust.(Do
5.Mortgage Interest paid by you,acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the
secured property,cancellation of debt,qualified tuition program legal entity itself is not designated in the account title.)Also see Special
payments(under section 529),ABLE accounts(under section 529A), rules for partnerships,earlier,
IRA,Coverdell ESA,Archer MSA or HSA contributions or 'Note:The grantor also must provide a Form W-9 to trustee of trust.
distributions,end pension distributions.You must give your correct Note:If no name Is circled when more than one name is listed,the
TIN,but you do not have to sign the certification. number will be considered to be that of the first name listed.
What Name and Number To Give the Requester Secure Your Tax Records From identity Theft
For this type of account: Give name and SSN of: identity theft occurs when someone uses your personal information
1.Individual The individual such as your name,SSN,or other Identifying Information,without your
2.Two or more individuals(joint The actual owner of the account or,if permission,to commit fraud or other crimes.An identity thief may use
account)other than an account combined funds,the first individual on your SSN to get a job or may file a tax return using your SSN to receive
maintained by en FFI the account' a refund.
3.Two or more U.S.persons Each holler of the account To reduce your risk:
(joint account maintained by en FFI) •Protect your SSN,
• 4.Custodial account of a minor The minor' •Ensure your employer Is protecting your SSN,and
(Uniform Gift to Minors Act) •Be careful when choosing a tax preparer.
5.a.The usual revocable savings trust The grantor-trustee' if your tax records are affected by identity theft and you receive a
(grantor is also trustee) notice from the IRS,respond right away to the name and phone number
b.So-called trust account that is not The actual owner' printed on the IRS notice or letter.
a legal or valid trust under state taw
If your lax records are not currently affected by identity theft but you
6.Sole proprietorship orw disregarded The oner3 think you are at risk due to a lost or stolen purse or wallet,questionable
entity owned by an individual credit card activity or credit report,contact the IRS Identity Theft Hotline
7.Grantor trust filing under Optional The gronior• at 1-800-908-4490 or submit Form 14039.
Form 1099 Filing Method 1(see For more Information,see Pub.5027,Identity Theft information for
Regulations section 1.67 i-4(b02Hi) Taxpayers.
fall Victims oh Identity theft who are experiencing economic harm or a
For this type of account: Give name and EIN of: systemic problem,or are seeking help in resolving tax problems that
8.Disregarded entity not owned by an The owner have not been resolved through normal channels,may be eligible for
individual Taxpayer Advocate Service(TAS)assistance.You can reach TAS by
9,A valid test,estate,t r pension trust Legal entity' calling the TAS toll-free case intake line al 1-877-777-4778 or TTY/TOD
•
1.800-029-4059.
10.Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes.
corporate status on Form 8832 or Phishirtg Is the creation and use of email and websites designed to
•
• Form 2553 mimic legitimate business emits and websites.The most common act
11.nssocla0on,slob,religious, The organization is sending an email to a user falsely claiming to be an established
charitable.educetkmni,or other tax- legitimate enterprise in an attempt to scam the user into surrendering
exempt organization private information that will be used for Identity theft.
•
12,Partnership or multi-member LLC The partnership
13.A broker or registered nominee The broker or nominee
3
1603
Form W-9(Rev.10-2018) Page 6
The IRS does not initiate contacts with taxpayers via emails.Also,the Privacy Act Notice
IRS does not request personal detailud Information through email or ask
taxpayers for the PIN numbers,passwords,or similar secret access Section 6109 of the Internal Revenue Code requires you to provide your
Information for their credit card,bank,or other financial accounts, correct TIN to persons(including federal agencies)who are required to
file Information returns with the IRS to report interest,dividends,or
If you receive an unsolicited email claiming to be from the IRS, certain other Income paid to you;mortgage interest you paid;the
forward this message to phishing 'irs.gov.You may also report misuse acquisition or abandonment of secured property;the cancellation of
of the IRS name,logo,or other IRS property to the Treasury Inspector debt;or contributions you made to an iRA,Archer MSA,or HSA.The
General for Tax Administration(FIGTA)at 1-800-366-4484.You can person collecting this form uses the information on the form to file
forward suspicious emails to the Federal Trade Commission at information returns with the IRS,reporting the above information.
spemauce.gov or report them at www.ttc.govicomplainf.You can Routine uses of this information include giving it to the Department of
contact the FTC at www.ltc.gov/ldtheft or 877-IDTHEFT(877-438-4338). Justice for civil and criminal litigation and to cities,states,the District of
If you have been the victim of identity theft,see www.IdenfityTheit.gev Columbia,and U.S.commonwealths and possessions for use in
and Pub.5027. administering their laws.The information also may be disclosed to other
Visit www.lrs.gov/ldontlfyTheft to taarn more about identity theft and countries under a treaty,to federal end state agencies to enforce civil
how to reduce your risk, 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 3408,payers
must generally withhold a percentage of taxable interest,dividend,and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
Ii
1603
RAYMOND JAMES Trust
DISCLOSURE STATEMENT
Raymond James Trust,N.A.(RJT)believes it is important for you to understand our corporate structure.Therefore,
we have prepared this Disclosure Statement so that you will be more comfortable with the selection of RJT to serve
you for years to come.
About our Firm: RJT is a national chartered trust company,chartered by the Office of the Comptroller of the
Currency("OCC").As such,we adhere to regulations set forth by the OCC and are subject to oversight by the OCC.
Affiliates: RJT is a wholly owned subsidiary of Raymond James Financial, Inc. ("RJF"), a financial holding
company. RJF owns all of the outstanding stock of RJT. RJF also owns Raymond James Bank, N.A. ("RJ Bank")
and two broker/dealers:Raymond James&Associates, Inc. (`RJA")and Raymond James Financial Services
("RJFS"), RJT receives certain services from the broker/dealers and Financial Advisors("FA")and they refer trust
business to RJT.The FAs are either employees or independent contractors of RJA or RJFS or they are employees
or independent contractors of independent firms with contractual relationships with RJFS and may receive a portion
of the total fee charged against the account by RJT.A FA has no authority to bind RJT to take any action or to
refrain from taking any action; however, a FA may assist in explaining the account investment strategy to you,
provide input into asset allocation and individual investment transactions,assist in communicating to you,
beneficiaries,or other third parties(i.e.accountants,attorneys,property managers,appraisers)or in other ways that
may assist RJT in providing its services efficiently and effectively.Additionally, RJF owns Carillon Tower Advisers,
Inc.,("CTA")which offers investment options through various managers and funds including Eagle Asset
Management, Inc. ("Eagle")and Carillon Fund Services, Inc.RJT may utilize the investment services and options
provided by CTA.
Cash Management: Cash(including Automated Clearing House(ACH),checks,and wires)received by RJT prior
to 2:00 PM Eastern Time is deposited into client accounts each business day. Cash received by RJT after 2:00
PM Eastern Time each business day will be deposited the next business day. Currency is not accepted unless
approved by RJT.Cash deposits made by check are subject to a three-day hold.
RJT utilizes the Raymond James Trust Sweep Program("RJTSP")for accounts with available, uninvested cash.
Pursuant to the RJTSP, available, uninvested client cash is swept each business day to a government money
market mutual fund offered by Fidelity Investments, Inc.("Fidelity"),the Fidelity Investments Money Market
Treasury Portfolio—Institutional Class(Ticker: FRBXX)(the"Fidelity Fund"). Funds deposited in your account after
a cutoff time,which will ordinarily be 11:00 a.m. Eastern Time,will be swept to the Fidelity Fund on the next
business day. RJT may adjust the cutoff time in its sole discretion from time to time.The Fidelity Fund invests
primarily in cash, U.S.Treasury securities,and repurchase agreements for such securities. Investments in the
Fidelity Fund are not guaranteed or insured by the Federal Deposit Insurance Corporation,or by any other
government agency.The Fidelity Fund does seek to preserve the value of an investment at$1.00 per share,but
the value of the investment is not guaranteed.
Fidelity retains an expense ratio of 18 bps(0.18%)on cash invested in the Fidelity Fund, of which it reimburses 4
bps(0.04%)to the Institutional Class shareholders,for net expenses of 14 bps(0.14%). By way of example,this
means that on an investment of$10,000 left in the Fidelity Fund for 1 year, Fidelity would receive$14. If fund
expenses fall below 14 bps(0.14%), Fidelity may recoup amounts it previously paid to reimburse net expenses
over that amount. Fidelity represents that if the Fidelity Fund's weekly liquid assets fall below 30%of Its total
assets because of market conditions or other factors, the Fidelity Fund will not impose a fee upon the sale of
shares, nor temporarily suspend the ability to sell shares.
The prospectus and related information for the Fidelity Fund is available at https://fundresearch.fidelity.com/
mutual-funds/summary/31607A885,from Fidelity or by contacting your financial advisor or trust officer.The
information provided herein regarding the Fidelity Fund is excerpted from the Fidelity Fund prospectus,and is
is qualified in its entirety by the prospectus itself. For detailed information about the RJTSP, please refer to
i. www.raymondjames.com/rjtsp/disclosure.
Fees: RJT maintains a published fee schedule for its services. RJT reserves the right to amend the fee schedule
• from time to time.The fee schedule includes extraordinary fees that may apply in unusual situations. RJT currently
bills client accounts in arrears quarterly,or in some instances,monthly.
Rev. Jan 2020 Page 1 of 3
fit
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Investments:Investment products and accounts are not insured by the Federal Deposit Insurance Corporation
("FDIC")or Securities Investor Protection Corporation("SIPC")and are not deposits or other obligations of,or
guaranteed by, RJT or its affiliates.All investments are subject to investment risks, including possible loss of
principal amount invested.
Investment Objectives and Asset Allocation Guidelines:
• Income(0-20%Equity;80-100%Fixed Income):Seeks stability and liquidity;preserve capital while providing
income with some capital appreciation.
• Income Primary(20-40%Equity;60-80%Fixed Income): Seeks income with modest capital appreciation
while minimizing the potential loss of principal.
• Balanced(40-60%Equity;40-60%Fixed Income):Seeks moderate growth with stable income while
accepting moderate risk and principal fluctuation.
• Growth Primary(60-80% Equity;20-40%Fixed Income):Seeks above average growth with moderate to high
levels risk and principal fluctuation,
• Growth(80-100%Equity; 0-20%Fixed Income):Seeks above average growth with moderate to high levels of
significant risk and principal fluctuation.
• Custody-Indicates RJT has no investment authority on theaccount.
• Closing•Indicates the account is in the closing process.
• Settlement—Indicates the account is in the estate/trust settlement process.
Asset allocations within an account may differ from the ranges as outlined above depending on any number of
factors, including but not limited to,the role of that specific account in the broader client asset allocation,client
direction,and market conditions.With respect to accounts over which you retain ownership or investment authority,
please promptly notify your FA or Trust Officer,in writing,of any changes to the investment objectives or if you
wish to Impose or modify reasonable restrictions with regard to the investment management of the account.
Should the rebalancing of an account be appropriate,a reasonable amount of time will be required. If you have any
questions regarding the investment objective of your account, please contact your FA or your Trust Officer.
Common Trust Funds(CTF): RJT maintains two collective investment funds, referred to as Common Trust
Funds(CTF),exclusively for the collective investment and reinvestment of monies in structured settlement
administration trusts and special or supplemental needs trusts.All CTF participants receive the Plan of Common
Trust Funds document at account opening and at any such time thereafter as the Plan document is amended.
The asset allocation between equities and fixed income securities of each CTF is as follows:
• The Raymond James Trust Income&Growth Fund asset allocation range is 40%-60%equities and
40% -60%fixed income securities.
• The Raymond James Trust Income Primary Fund asset allocation range is 20%-40%equities and
60%-80%fixed income securities.
RJT receives compensation in the form of an investment management fee, in the amount of.5%or 50 basis
points per annum. RJT's compensation is calculated and accrued on a daily basis but collected from the CTFs on
a monthly basis. In addition to the Plan document,an Annual Report for each CTF is available upon request. For
additional information regarding the CTFs,please refer to the Plan document and Annual Reports.
Life Insurance and Annuities: If your account holds one or more variable life insurance policies or annuity
contracts,the market values shown are based on the most recent statements from the issuing companies,which
may no longer be current or accurate. Please contact your FA or your Trust Officer if you require current market
values.
Other Investment Products:Mutual funds,exchange traded funds,life insurance,annuities and other investment
products may be subject to additional fees and expenses as charged by the funds or products. Mutual fund fees
are described in the mutual fund prospectus. Such fees are expenses of the mutual funds and are reflected in the
r investment returns,which are quoted net of all expenses.Mutual fund prospectuses are available upon request. If
you have any questions regarding the mutual funds or other investment products held in your account, please
contact your FA or your Trust Officer.
Valuations:Prices and information in the account statement are obtained from sources that RJT believes are
reliable. Quoted prices may differ from actual prices because of security size,market place,time,and demand.
Quoted prices are a snapshot in time and fluctuate with market conditions.We cannot guarantee that securities
• bought can be sold at these prices.Additionally,your statement may include values for illiquid securities or assets,
such as real property,partnership interests,closely held business interests,hedge funds,private equity,REITS or
other special assets or alternative investments that may be difficult to value.Values listed are an approximation
Rev. Jan 2020 Page 2 of 3
•
1603
and may be based on information provided by third parties,such as pricing services or appraisers,or determined
using common practices to value those types of assets.The cost of valuations performed by third parties will be
charged to the account.These values are provided for general information purposes only and may not reflect the
( actual proceeds that would be obtained upon the disposition of any such asset.Additionally, cost basis
information is not intended for tax reporting purposes.
Sundry/MIscellaneous Assets: If your account maintains holdings at a third-party custodian, RJT reflects the
activity and positions in your account in a manner believed to be as reliable and accurate as possible.You are
advised, however,that such a relationship is outside the normal and customary services provided,and that RJT
has no guarantee of the accuracy of the third-party custodian's controls,processes,or performance.Additionally,
RJT may not receive pricing updates timely from third-party custodians.You should consult reports generated
and provided by third-party custodian when making investment decisions.As a result of pricing methodology,
timing,and other factors,statements and reports produced by RJT and third-party custodians will frequently have
differences.
Cost Basis Reporting:When RJT is serving as the investment manager,custodian,guardian,or conservator on
a taxable account, IRS regulations require RJT to report to the United States Department of Treasury
("Treasury")and to the account owner,the adjusted cost basis information with respect to the sale,exchange,or
redemption of most fixed income securities and options acquired after January 1,2014.The Treasury refers to
such newly acquired fixed income securities and options as"covered securities."The required reporting for such
covered securities will be on form 10998.The adjusted cost basis for most fixed income securities will generally
be the original cost basis of the security adjusted for any required or elected amortization or accretion.
Additionally,as proscribed by these regulations, RJT will:
1. amortize bond premiums using the constant yield method;
2. not include accrued market discount as income on IRS Form 1099B;
3. accrue market discount using the ratable interest method;and
4. not treat all interest as original issue discount.
Please consult your tax advisor as to the application of these requirements with respect to your personal income
tax reporting requirements.
Tax Services: RJT may perform tax services and charge the account for such services in accordance with its
regular schedule of charges. RJT partners with a third party to provide tax return preparation services
and shares part of the tax preparation fee with the third party.
Privacy: RJT keeps client information confidential. RJT does not sell or provide client information to third
parties for marketing purposes. RJT does contract with third party vendors that provide services(such as
data processing,tax return preparation and performance reporting)to RJT as necessary to efficiently provide
our services.Any such third party vendors must agree to adhere to RJT's privacy policy. RJT may share
client information to its corporate affiliates within RJF. Both RJT and RJF have the same privacy policy with
respect to the confidentiality of client information.
Disclosure to Portfolio Companies: Unless we receive your objection in writing, RJT may be
required under the provisions of Rule 14b-2 of the U.S. Securities and Exchange Act of 1934, as
applicable,to release your name,address, and number of shares to issuers of securities you hold through
RJT. If you object in writing,you will not receive any corporate communications from the issuer other than
regulatory mailings required to be sent to all holders,which you will receive from us. If you wish to exercise
this preference, please contact your FA or Trust Officer in writing.
Class Action Law Suit Servicing: RJT utilizes a third party that specializes in class action settlements
to seek recovery in class action lawsuits involving assets that have been previously or are currently held in the
account. The third party receives a percentage of the recovery,if any,as its fee for the services provided.
Soft Dollars: RJT has an arrangement whereby it may obtain research products and services, in addition to
brokerage services,in exchange for directing client trades to the participating broker.This arrangement is known
as a"soft dollar`arrangement and is common in the investment advisory business.
Trading Errors:Client accounts will be credited for any trading errors that result in a loss to their account. If
trading errors result in a net gain to RJT over the course of a calendar year, the gain will be donated to charity.
Rev. Jan 2020 Page 3 of 3
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