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Form W-9 Requesf ~r Taxpayer Give Form to the
<br />(Rev. October 2018) Identification Number and Certification requester. Do not
<br />Department of the Treasury send to the IRS.
<br />Internal Revenue Service ► Go to www.lrs.gov/FonnW9 for instructions and the latest information.
<br />1 Name (as shown on your income tax return). Name Is required on this line; do not leave this line blank .
<br />JMB Cons truction Inc
<br />2 Business name/disregarded entity name, if different from above
<br />(")
<br />0) 3 Check appropriate box for fede ral tax class ification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
<br />gi following seven boxes . certa in entities, not indivlduals; see
<br />a. instructions on page 3):
<br />C □ lnd ividuaVsole proprietor or 0 C Corporation 0 S Corporation D Partnership D Trust/estate 0
<br />• Cl) single-member LLC Exempt payee code [rf any) CII C
<br />f~ D Limited liability company. Enter the tax class ificat ion (C::C corporat ion , S=S corporation , P=Partnership) ►
<br />~ 2 Note: Check the appropr iate box in the line above for the tax class ification of the single -member owner. Do not check Exemption from FATCA report ing c 1ii LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any} ·-C another LLC that Is not disregarded from the owner for U.S. federal tax purposes . Otherwise, a single-member LLC that .. -Q. CJ is disrega rded from the owner should check the appropriate box for the tax class ification of its owner . !i:
<br />0 D Other (see instructions) ► lA/)piies 10 scoounU maintained outside the U.S.) ~ "" 5 Address (number, street , and apt. or suite no.) See Instruct ions . Requester 's name and address (optiona Q
<br />Cl) 132 South Maple Ave Cl)
<br />Cl)
<br />6 City, state , and ZIP code
<br />South San Francisco, CA, 94080
<br />7 List account number(s) here (optionaQ
<br />.!or; ... ,ill ■ Taxpayer Identification Number (TIN}
<br />I Social security number I Enter you~ TIN in. the app_ro~ri_ate box. !h~ TIN provided must. match t~e name given on line 1 to avoid
<br />backup withholding . For 1nd1v1duals, this Is generally your social secunty number {SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
<br />entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
<br />TIN, later.
<br />[JI] -DJ -I I I I I
<br />or
<br />Note: If the account is in more than one name, see the instructions for line 1. A lso see What Name and
<br />Number To Give the Requester for guidelines on whose number to enter.
<br />I Employer Identification number
<br />94 -323056 4
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form is my correct taxpayer identification number (o r I am waiting for a number to be issued to me); and
<br />2 . I am not subj ect to backup withholding because: (a) I am exempt from backup withholding , or (b) I have not been notified by the Internal Reven ue
<br />Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or d ividends, or (c) the IRS has notified me that I am
<br />no longer subject to backup w ithholding; and
<br />3. I am a U.S. citizen or other U.S. person (defined below); and
<br />4 . The FATCA code(s) entered on this form Of any) indicating that I am exempt from FATCA reporting is correct.
<br />Certification instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withhold ing because
<br />you have failed to report all interest and dividends on you r tax return . Fo r real estate transactions, item 2 does not apply. For mortgage interest paid ,
<br />acquisition or abandonment of secured property, cancellation of debt , contributions to an individual ret irement arrangement (IRA), and generally, payments
<br />other than interest and dividends, ou are not required to si certification, but you must provide your correct TIN. See the instructions for Part 11 , late r.
<br />Sign
<br />Here
<br />Signature of
<br />U.S. person ►
<br />Section references are to the Internal Revenue Code unless ot herwise
<br />noted.
<br />Future developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov/FormW9 .
<br />Purpose of Fo rm
<br />An ind ividual or entity (Form W-9 requester) who is requ ired to fife an
<br />information return with the IRS must obtain your correct taxpayer
<br />identification number (TIN) which may be your social security number
<br />(SSN), individual taxpayer identification number (ITIN), adoption
<br />taxpayer identification number (ATIN ), or employer identification number
<br />(EIN), to report on an information return the amount pa id to you , or other
<br />amount reportable on an information return . Examples of information
<br />returns include, but are not limited to, the following.
<br />• Form 1099-INT (interest earned or paid)
<br />Ca t. No . 10231X
<br />Date ► I
<br />• Form 1099-DIV (dividends, including those from stocks or mutual
<br />funds)
<br />• Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-8 (stock or mutual fund sales and certain other
<br />transactions by brokers}
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage interest), 1098-E (student loan interest),
<br />1098-T (tu ition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U .S. person (including a res ident
<br />alien), to provide your correct TIN .
<br />If you do not return Form W-9 to the requester with a TIN, you might
<br />be subj ect to backup withholding. See What is backup withholding,
<br />later.
<br />Form W-9 (Rev . 10-2018)
<br />DocuSign Envelope ID: 7FAA54C3-9A1A-4C50-9AAD-7467E7B73787
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