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Form �' Request for Taxpayer Give form to the
<br /> (Rev.October200� Identiflcation Number and Certification requester. Do not
<br /> Department of ihe 7reasury Se�d to th9 IRS.
<br /> intemal Revenua Servico
<br /> Name (as shown on your income tax return)
<br /> � Critical Syslem Solutions LLC
<br /> a Business name, if different from above
<br /> c
<br /> O
<br /> a o Check appropriate box: ❑ Ind(vidual/Sole proprietor ❑ Corporation ❑ Partnership Exem t
<br /> `� A' P Y• ( 9 tY P P P) p
<br /> �" Limited Ilabili com an Enter the tax classitication D=disre arded enti C=cor oration. P= aRnershi ►.Cr_. __ ❑
<br /> a � ❑ Other (see insWctio�) 1
<br /> L � Address (number, street, and apt. or suite no.) Requester's name and address (optional)
<br /> a� 2830 Scherer Drive, Suite 300
<br /> �� City, state, and ZIP code
<br /> y Saiot Petersburg, Florida 33716
<br /> � List account number(s) hero (optfonal)
<br /> Taxpayer ldentification Number IN)
<br /> Enter your TIN in the appropriate box. The TIN provided must rnatch the name given on Line 1 to avoid Social security number
<br /> backup withholding. For individuals, this is your social security number (SSN}. However, for a resident
<br /> alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is
<br /> your employer identification number (EIN). If you do not have a number, see How to get a T1N on page 3. or
<br /> Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer ldentification number
<br /> number to enter 20 ; 3072689
<br /> Certification
<br /> Under penalties of perjury, I certify that:
<br /> 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
<br /> 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
<br /> 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
<br /> notified me that I am no longer subject to backup wilhholding, and
<br /> 3. I am a U.S. citizen or other U.S. person (defined below).
<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
<br /> withholding because you have failed to re all interest and dividends on your tax return. For real estate transactions, item 2 does not apply
<br /> For mortgage interest paid, acquisition ab ndonm secured property, cancellation of debt, contributions to an individual retirement
<br /> arrangement (IRA), and generally, pa ent other an in rest and dividends, you are not required to sign lhe Certification, but you must
<br /> provide your correct TIN. See the i truc ' ns on age 4
<br /> Sign Signature ot
<br /> Here U.S. person . Date ►
<br /> General Instru t10 Definition of a U.S. person. For federal tax purposes, you are
<br /> considered a U.S, person if you are:
<br /> Section references are to e Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien,
<br /> otherwise noted.
<br /> • A partnership, corporation, company, or association created or
<br /> Purpose of Form organized in the United States or under the laws of the United
<br /> A person who is required to file an iniorrnation return with the States,
<br /> IRS must obtain your correct taxpayer identitication number (fIN) • An estate (other than a foreign estate), or
<br /> to report, for example, income paid to you, real estate • A domestic trust (as defined in Regulations section
<br /> transactions, mortgage interest you paid, acquisition or 301.7701-7).
<br /> abandonment of secured property, cancellation of debt, or
<br /> contributions you made to an IRA. Specia� rules for partnerships. Partnerships that conduct a
<br /> Use Forrn W-9 only if you are a U.S. person (including a trade or business in the United States are generally required to
<br /> resident alien), to provide your correct TIN to the person Pay a withholding tax on any foreign partners' share of income
<br /> from such business. Further, in certain cases where a Form W-9
<br /> requesting it (the �equester) and, when applica6le, to: has not been received, a partnership is required to presume that
<br /> 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
<br /> waiting for a number to be issued), Therefore, if you are a U.S, person that is a partner in a
<br /> 2. Certify (hat you are not subject to backup withholding, or Partnership conducting a trade or business in the United Slates,
<br /> provide Form W-9 to the parinership to establish your U.S.
<br /> 3. Claim exemption frorn backup withholding if you are a U.S. status and avoid withholding on your share of partnership
<br /> exempt payee. If applicable, you are also certifying that as a income.
<br /> U.S. person, your allocable share of any partnership income from The person who gives Form W-9 to the partnership for
<br /> a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
<br /> toreign partners' share of effectively connected income. on its allocable share of net income from the partnership
<br /> Note. If a requester gives you a form oiher than Form W-9 to conducting a trade or business in the United States is in the
<br /> request your TIN, you must use the requester's form if it is following cases:
<br /> substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity,
<br /> Cat. No. 10231X Form w-9 (Rev. 10-200�
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