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HomeMy WebLinkAboutOpening of Qualifications - Lead Hazard Reduction Program Pre-Qualified Contractors RFQ - House Doctor RenovationsExhibit A: Lead Hazard Reduction Program Contractor Application City of South Bend Lead Hazard Reduction Program Contractor Application Company Name: Street Address: LS e 0 i a i cm s( -- City: &kMq &_�D State: Z& Zip Code: Business Owner's D r� Name: l)AOAI –LQ l P)Onnil.Q Phone: .1—TilA Email: 1. Is applicant a Licensed Indiana Abatement Contractor? 111/yes ❑ No If yes, provide a copy of license. 2. Will the applicant have at least one licensed Lead Project Supervisor on-site? F(yes ❑ No If yes, provide a copy of licenses of Lead Project Supervisor(s) and Lead Worker(s) for all employees or subcontractors who will be performing lead abatement work. 3. Is applicant an EPA approved Renovation, Repair and Painting certified firm? I"Yes ❑ No If yes, provide a copy of certification. 4. Does applicant have required Commercial General Liability Insurance? 19 Yes ❑ No If yes, provide a copy of the Statement of Coverage. It must include a minimum coverage of per Person in the amount of $50,000 and per Occurrence in the amount of $1,000,000. 5. Does applicant have Worker's Compensation Insurance? 12"Yes ❑ No If yes, provide a copy of the Statement of Coverage. 6. Are you or any of your employees licensed to do electrical, heating or plumbing work in the City of South Bend? ❑ Yes ❑ No (If yes, provide name and license information below): Name: License Type: License Number: Exhibit B: Lead Hazard Reduction Program—Non-Collusion Affidavit w7wRAarto Vff4fpda any ebL&",4Vhwsw (Must be c4mVleted f4w 0quotas and bins. $ Ime type dor pl3Tt0 NATE OF SS, COUNTY The twdemigoed Cantractor,'bang dub nvemn up m hi AuJi9s oak affaraots imde the penalties of PeljwU that yMd I Contractor has =, .wr has any swees or:. to,, nor an affiliate 4f Conftwkwa _eal;gaged:: in insestmeat activities in kML a: For pwptases of 6xis Certification, "bran'' ,means flm gaveammem# off Fran and any agcy or insbunamiality of3xan, or as othervrise defined a#!xL Code § 5-22-16.5-5, as armed fimm tinw4o4ime.... ls. As grovi ied by In Gn+ie 5 5-22-165-8, as ameaded ffacmt -to-trace, a Coubwb©r is eng3ged to intmskoent whT.7t9es m Iran if either: i ' G'on actdrr, its matmemor or its affiliate, prolaides goods or r e� of twlentf milliCE drrllam 20,0411,000) or more in value in &e energy sector of Iran, or d: youtz- IW fur,, its snoxeseoFr or its aff6liate is a financial insfiltdion boat eKtoods twemly mullion dollars ($20,000,000) 00) oor uore in credit to, amot$cr person for forty -&-e (45) days or more, if that person wM (i) use the creelit to pzundes goods and services in 7 ;wNF nvbmnmAffibut?dmhmt� I Exhibit B: Lead Hazard Reduction Program — Non -Collusion Affidavit I.: 4 ���: NN e 4 an.A`r - Nt. 4. NA'.NN�'ii ;e 21A19 41.' A I -A -Y •h. ti� II11', .. .'G.N A A.14,1, iY 211. ',.4 L.4K.n' 4 }.. �...�YY: 41 4 •. �::YA6tl:2 ,A-11 'GN 4U 1&III! 1'4.1 I.: li.•'F4 �fl..al hexa YI:'JN 4 .l1 AMW I}atie13 t69s g fMAP - 1 [t. 29-2024 gs, NOTARY rri•N'k R�gUG J2o: Q Q S� OSEPN '�Q $ q OF' c10 66' "�IIIII...... 1166 CITY OF SOUTH BEND, INDIANA REQUEST FOR QUALIFICATIONS LEAD HAZARD REDUCTION PROGRAM PRE -QUALIFIED CONTRACTORS The City of South Bend, Indiana (City) on behalf of the Indiana Housing & Community Development Authority (IHCDA) is soliciting responses (Responses) to this Request for Qualifications (RFQ) from qualified lead contractor to serve as Pre -Qualified Lead Contractors for its Lead Hazard Reduction Grant Program. Responses shall meet the Minimum Specifications and Program Conditions (Requirements) as listed in the RFQ. The City of South Bend has received two grants to fund this Lead Hazard Reduction Program to control or eliminate lead hazards in properties owned or leased by low-income households. One grant is with the Indiana Housing & Community Development Authority ("IHCDA") and the second grant is with the Department of Housing and Urban Development's Office of Lead Hazard Control and Healthy Homes ("OLHCHH"), both have the same requirements. It is anticipated that available resources will allow for lead hazard reduction work at over 100 houses as part of the grant program. It is the purpose of this RFQ to establish a registry of pre -qualified lead contractors who will be notified of opportunities to bid on Lead Hazard Reduction Program work. Lead Contractors must indicate on the application if they wish to be notified of work from the IHCDA grant, the OLHCC grant, or both grants. Additionally, both grants contain a Healthy Homes Supplement that allows for minor home repairs in homes undergoing lead hazard reduction work. Contractors that are also licensed to perform heating, plumbing, and/or electrical work in South Bend are encouraged to provide license information as part of their Response, as additional work might be available to these contractors through this program. Responses, including an application and all supporting documents, shall be submitted electronically to the Board of Public Works at bpwbids@southbendin.gov by 9:00 a.m., EST, on March 23, 2021. At any point in time following the RFQ, a lead contractor may request to be placed on or deleted from the Registry of Pre -Qualified Lead Contractors. To be added to the Registry, lead contractors must submit a completed application and all supporting documents as outlined in this RFQ to the Clerk of the Board of Public Works. Interested firms must register at https://southbendin.gov/doing-business/invitations-to-bid-city-contracts/. Complete RFQ packages and instructions are available for free download at this web page. Responses should be clearly marked "Lead Hazard Reduction Program Pre -Qualified Contractors RFQ" in the subject line of the email to which you have attached your Response. The name of the company/vendor, address, contact email address and phone number must be included in the body of the email, addressed to bpwbids@southbendin.gov. Detailed instructions and information, including the link to the Reserved Mailbox for electronic bid submittals, is available at south bendin.gov/bids. Questions about Response Requirements must be submitted via email no later than 5 p.m. on March 15, 2021 to Elizabeth Maradik at emaradik@southbendin.gov. Any questions received by the deadline will be addressed by an addendum to be issued no later than 5 p.m. March 17, 2021. If there are no questions about or updates to the RFQ, no addendum will be issued. Responses must meet the RFQ Requirements. There is no scoring matrix for this RFQ. All lead contractors whose Response meet the Requirements will be placed onto the registry of pre -qualified lead contractors. The City reserves the right to review and audit all documents related to the Response and to request additional information as determined necessary. Failure to comply with the City's request may be deemed grounds for dismissing the Response. I Lead Hazard Reduction Program —Request for Qualifications Minimum Specifications: Successful applications must be submitted by the deadline, complete, and meet the minimum specifications established by the City of South Bend. A completed application will include: a. Completed and signed Contractor Application Form (Exhibit A) b. Copy of State of Indiana Abatement Contractor License c. Copy(s) of Lead Project Supervisor License(s) & Lead Worker License(s) of employees and subcontractors d. Copy of EPA approved Renovation, Repair and Painting certification e. Proof of Commercial General Liability Insurance per Person in the amount of $50,000 f. Proof of Commercial General Liability Insurance per Occurrence in the amount of $1,000,000 g. Proof of Worker's Compensation Insurance h. Signed W-9 Request for Taxpayer Identification Number and Certification form i. Signed Non -Collusion Affidavit (Exhibit B) j. Signed City of South Bend COVID-19 Policy (Exhibit C) Program Conditions: Successful applicants must agree to the following program conditions: a. Contractors shall agree to warranty all work, materials, and workmanship for a minimum of one (1) year. b. Each Contractor must have at least one licensed Lead Project Supervisor on site. c. All contractors paid $3,500 or more through the Lead Hazard Reduction Program must be registered in the System for Award Management (SAM) and Federal Awardee Performance and Integrity Information System (FAPIIS). No contract award may be made to parties listed on the government wide exclusion in SAM or FAPIIS. d. Contractors must use lead -safe work practices per CDC and OSHA guidelines, rules, and regulations and Indiana state law. e. Clean-up should be conducted at the end of each workday, the end of each work shift or when workers are finished in one exterior work area and moving to another. Clean-up and lead waste disposal must adhere to local, state, and federal guidelines. f. All workers doing on-site work must be either a Licensed Lead Worker or Lead Project Supervisor. g. Payment is contingent on passing a clearance exam to ensure no lead hazards remain. h. Work must be completed within 10 days of receiving the notice to proceed unless an extension is approved by the City. The successful applicants shall comply with the City's ordinance and all other federal, state, and local laws and regulations governing nondiscrimination in employment. Registry of Pre -Qualified Lead Contractors Process: 1. Contractors must submit a completed application and all required documents to be considered for addition to the Registry. 2. The Registry of Pre -Qualified Lead Contractors will be maintained by the Lead Grant Program Manager in the Department of Community Investment (DCI). 3. DCI reserves the right to request additional information from perspective contractors in order to fully evaluate their pre -qualification. Lead Hazard Reduction Program — Request for Qualifications 4. In order to be approved for inclusion on the registry, a contractor must not be under investigation for criminal behavior by any State or Federal Agency. 5. The City reserves the right to reject any and all applications for Pre -Qualification, and refuse to include a contractor on the Registry if the City determines in its sole discretion that the Contractor lacks sufficient experience, financial strength, or technical expertise to perform the work under the City's Lead Hazard Reduction Grants, or has failed to comply with applicable statutes, ordinances, rules and regulations, or has failed to perform their work satisfactorily. 6. Contractors will be notified if they have been placed on the Registry following staff review of their Response. 7. The City will issue an RFQ for qualified lead contractors at least once every six months for the duration of the lead grants. Once a Contractor is added to the Registry, they can remain on it for the duration of the lead grants. The City may reach out to Contractors, from time to time, to confirm they are still interested in remaining on the Registry. 8. Contractors on the Registry must provide copies of licenses of any new employees or subcontractors that are hired by the Contractor, as well as ensuring all employees performing lead hazard control work maintain active Lead Project Supervisor or Lead Worker licenses (and provide the City copies if/when renewed). 9. At any point in time following the RFQ a lead contractor may request to be placed on or deleted from the Registry of Pre -Qualified Lead Contractors. To be added to the Registry, lead contractors must submit a completed application and all supporting documents as outlined in this RFQ to the Clerk of the Board of Public Works. 10. Contractors on the Registry will be notified of opportunities to bid on Lead Hazard Reduction Program work. It is the responsibility of the contractor to submit a complete bid, by the established deadline, in order to be considered for the award of a contract. Work will be awarded to the lowest, responsive and responsible bid. 11. The City reserves the right to remove contractors from the Registry based on non -responsiveness, quality of work, repeated failures of post -work clearance examination, or failure to provide updated information as reasonably requested by the City. Exhibit A: Lead Hazard Reduction Program Contractor Application Is applicant registered, or willing to register, in the System for Award Management (SAM) and the Federal Awardee Performance and Integrity Information System (FAPIIS)? M'Y'es, currently registered ❑ Not currently registered, but willing to complete (the City can provide a registration guide) ❑ Not registered, and will not complete 8. Do you want to be placed on the registry for one grantor both? ❑ IHCDA Grant Only ❑ OLHCHH Grant Only 2 5oth Grants 9. Please list any residential property owned solely or co -owned by you within the City of South Bend: I certify that the answers provided are true and accurate to the best of my knowledge: C9 Yes ❑ No I understand that if placed on the Registry, 1 will receive notice of opportunities to bid on Lead Hazard Reduction Program work. And I understand that work will be awarded to the lowest, responsive and responsible bid: 2'S'es ❑ No I have read and agree to the minimum specifications and program conditions for participation in the Lead Hazard Reduction Program's Registry of Pre -Qualified Contractors. Bes ❑ No 0j"Is Name Indiana State D64parintent of Health BARNEY L: BROOKS Effective: 09/07/2012 Birth Date: 09/13/1963 Height: 5' 10" Weight: 235 .onvvno 1: 08/26/2022 M r: Brown r: Black tcrdf4: arc o4lniti,af Yzrddng.a' Lead Renovator Cart. No.: R-1-8885.79-19186 laming Dates: 6101201916131x019 Exam Cet4: 91012019 Langlu9e: English CerUncado" Expl.s: 51312024 1 .... dby: EnNanmCntd fdala�mc-nt lnslltte.lnc. 5010 CrewloMwM1e Rd Ste. 1500 Indianapolis, IN. 46224-3787 (317)$484840 ed to: Barney Brooks 910 Leland Ave. South Bend, IN 46616 The Designated Representative of: - HOUSE DOCTOR RENOVATIONS Lead Contractor License # IND000330 Effective: 08/26/2009 Expiration: 08/26/2022 Birth Date: Gender: Height: Eye Color: Weight: Hair Color: Effective: 09/07/2012 Birth Date: 09/13/1963 Height: 5' 10" Weight: 235 .onvvno 1: 08/26/2022 M r: Brown r: Black tcrdf4: arc o4lniti,af Yzrddng.a' Lead Renovator Cart. No.: R-1-8885.79-19186 laming Dates: 6101201916131x019 Exam Cet4: 91012019 Langlu9e: English CerUncado" Expl.s: 51312024 1 .... dby: EnNanmCntd fdala�mc-nt lnslltte.lnc. 5010 CrewloMwM1e Rd Ste. 1500 Indianapolis, IN. 46224-3787 (317)$484840 ed to: Barney Brooks 910 Leland Ave. South Bend, IN 46616 Exhibit C: Lead Hazard Reduction Program—COVID-19 Policy City of South Bend COVID-19 Policy The City of South Bend ("the City") requires contractors participating in the Lead Hazard Reduction Program to follow physical distancing requirements established by the CDC, as well as rules and regulations from OSHA. Contractors participating in the program are strongly encouraged to perform a self -health check prior to visiting any residences. Contractors with a temperature greater than 100.47 or who has flu-like symptoms should not visit any City facility or any residence associated with the program. Contractors are required to wear a face mask that covers their mouths and noses at all times when at a residence enrolled in the program or at any City facility. Any contractor who believes they have COVID-19, has tested positive for COVID-19, or has been told to quarantine by a medical provider agree to the following: 1. Notify the City as soon as possible when they find out they have (or suspect they have) COVID- 19. 2. Refrain from working in any residence enrolled in the Lead Hazard Reduction Program until cleared by a medical provider. 3. Notify the City when they are cleared to return to work by a medical provider. Additionally, the City strongly encourages any contractor who has tested positive for COVID-19 or has been told to quarantine by a medical provider to participate in contact tracing thru the Indiana State Department of Health. 1 have read and agree to follow these requirements for a safe workplace during the,COVID-19 llate AC®R®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YWY) 03/18/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Mark Mondientz NE AIC. No, EXt : (574)277-5511 AIX No): (574)277-3707 Hoffman Insurance Group, Inc. E-MAIL ADDRESS: marm hi a en ADDRESS: C� 9 9 cY.com 52513 Gumwood Rd. INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 INSURER : Indian Harbor Insurance Co. Granger IN 46530 INSURED INSURERB : Erie Insurance Exchange INSURER C : House Doctor Renovations (dba) Barney Lee Brooks INSURER D : Liberty Mutual I nsruance Co. 1506 O'Brien Street INSURER E AUTOMOBILE LIABILITY ANYAUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY INSURER F South Bend IN 46628 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER EFF IMMIDDIYYYYI POLICY EXP IMMIDDIYYYYILIMITS A X COMMERCIAL GENERAL LIABILITY �/ CLAIMS -MADE X OCCUR N N 1300103075 10/01/20 10/01/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER : X POLICY ❑ PRO JECT F—] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY N N Q051131029 05/11/2020 05/11/2021 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEREXECUTIVE Y!N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A N WC5 395 748940 01 0 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 FE . DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION South Bend Board of Public Works 227 West Jefferson Blvd South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Fax: EmaiLbpwbids@ southbendin.gov © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Enter your TIN in the appropriate box. The TIN provided must match the name given online 1 to avoid Social security number Request for Taxpayer Give Form to the Fenn V�A TIN, later. - or (Rev. October 2018) Identification Number and Certification requester, Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.frs.govf vrmWg for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Barney Lee Brooks 2 Business name/disregarded entity name, if different from above House Doctor Renovations 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to m following seven boxes. certain entities, not individuals; see a instructions on page 3): o ®Individuallsole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrust/estate C ai 0 single -member LLC Exempt payee code (if any) , .2 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► `o 2 Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting 5 - LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is LLC is code if an ( y) 0. another that not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. d ❑ Other (see instructions) 0- MPPIe Wee Nmanlvw wwa me u.sJ y 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) N 1506 O'Brien St. 6 City, state, and ZIP code South Bend, IN 46628 7 List account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given online 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other 48 6 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 What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. F_F1 F_F_T_T__F 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. 1 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 failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 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 1 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 ofs red property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and divider you are not required tg on the certification, but you must provide your correct TIN. See the instructions for Part 11, later. oryn Signature of (1 Here U.S. Pers ► _ Data ► General Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.im.gov/For W9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018)