HomeMy WebLinkAboutCHILD ENRICHMENT INC OPERATING EXPENSES $25,500.00 This AGREEMENT made and entered this 1st day of January, 2010, between Augusta,
Georgia, acting by and through the Augusta - Richmond County Commission, a political
subdivision of the State of Georgia (hereinafter referred to as "Augusta" or "County "), and the
Child Enrichment Inc , (hereinafter referred to as the "Organization" or
"AGENCY "); WITNESSETH:
WHEREAS, the Augusta - Richmond County Commission desires to contract
with the above named Organization to PROVIDE FUNDS FOR THE OPERATIONS OF
THE AGENCY
Whereas the amount of $25,500.00 are now available for use by AGENCY.,
according to the GENERAL FUND BUDGET ADOPTED ON November 17,2009;
NOW, THEREFORE, for and in consideration of the mutual covenants and
agreements between the parties, it is agreed as follows:
The County agrees to appropriate the following sums to the Organization for the
purpose of: Operating Expenses $ 25,500.00
The Organization agrees to use such funds that it may receive, pursuant to this
Agreement, solely and exclusively for the above described Project; said Project, including the
Project Budget, is more specifically described at "Exhibits" attached hereto and incorporated
herein.
In consideration of the disbursement of said funds, AGENCY shall observe all
conditions that the law imposes on the use of said funds, which shall include, but not be
limited to, the following
1. The agency shall provide the county with a narrative description of the program and a
detailed program budget. The budget should include all funding sources that the
agency anticipates receiving.
2. The Agency shall provide the following information as part of the narrative:
a. Mission Statement
b. Performance Budget Overview
c. Budget Request
d. Summary
3. The Agency shall complete the following forms as part of the budgeting process:
a. Budget Preparation Checklist
b. Agency / Joint Funding Budget Request (Form AJ)
c. Agency / Joint Funding Budget Request Payroll Costs (Form AJ -1)
d. Copy of Agencies most recent financial statements.
4. The agency shall have an annual audit performed by an independent CPA Firm. The
Agency should specify the County as a funding source. The agency shall provide the
County a copy of the audited financial statements within 30 days of delivery of the
audit by the contractor. Said reports shall be delivered to Augusta Finance
Department, Municipal Building Augusta, GA 30911 to the attention of Ms. Donna
Williams, Finance Director or her Designee.
5. The agency shall also submit a completed form W -9 to Augusta Finance Department.
AUGUSTA - RICHMOND COUNTY CO MISSION
By:
Mayor
ATTEST: /
BY: /A I I / ,�i
Clerk of Commission
ORGANIZATION:
AGENCY /
By: _K)a- As its Exec.
ATTEST:
••
As its CA.. ..Q- ck;c-A QW,‘ce,r
Form 11 11-9 Request for Taxpayer Give form to the
(Rev. October 2007) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Intemal Revenue Service
Name (as shown on your income tax return)
Ch Business name, if different from above
0
o Check appropriate box: ❑ Individual /Sole proprietor ® Corporation ❑ Partnership Exempt
4:: ❑ Limited liability company. Enter the tax classification (D= disregarded entity, C= corporation, P= partnership) ► ❑ payee
o • ❑ Other (see instructions) ►
L c Address (number, street, and apt. or suite no.) Requester's name and address (optional)
a . 3oo W a c�J : O
O City, state, and ZIP code
m v.c.4 - C P's (o t 3oc\OLA
List accoilfl number(s) here (optional)
rn
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 your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
number to enter. k a $ 1'G ct
Part I1 Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or l 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 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. I am a U.S. citizen or other U.S. person (defined below).
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 an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign Signature of
U.S. person 9---0 � Ow $ Here US. person
[" ) . .L � Date - p -
General Instructions Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
• A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your correct taxpayer identification number (TIN) • An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate • A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701 -7).
abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA. trade or business in the United States are generally required to
Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
provide Form W -9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W -9. • The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W -9 (Rev. 10 -2007)