Attachment_4_Business_Partner_Form_1570_-_Rev_8-2014.pdf

Business Partner Form (BPF)

☐ New Vendor ☐ Change to Existing Vendor

Submission Instructions:

Completion of the Business Partner Form (BPF) is required to do business with CalSTRS. The BPF contains pre-populated drop down boxes that will aid you in answering questions. Items marked by asterisk (*) are required fields. Upon completion, sign, date, and print the completed BPF. Please e-mail a scanned copy to Partners@calstrs.com or via fax to (916) 414-4015.

BUSINESS INFORMATION

Provide business contact information below. The address provided here will be entered on the purchasing and/or contracting documents. List any different payee/remit address(es) on Page 3.

POINT OF CONTACT INFORMATION

The contact information provided here will be used as the vendor’s primary point of contact for managing general vendor account information with CalSTRS.

First and Last Name*:

Title*:

Telephone Number*:

Email Address*:

SMALL BUSINESS (SB), DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) & MICRO BUSINESS (MB) CalSTRS supports the SB, DVBE and MB community as integral to stimulating California’s overall economy. If you have a current SB, MB and/or DVBE Certification, registered with the Department of General Services (DGS), please provide the certificate number and expiration date.

Small Business /Micro Business Disabled Veteran Business Enterprise Certificate Number: Certificate Number:

Expiration Date: Expiration Date:

TAX REPORTING AND WITHHOLDING INFORMATION

The State of California requires vendors doing business with the State to submit a substitute Form W-9. This form meets the requirements for a substitute Form W-9. Information will be used by CalSTRS to prepare information returns (Form 1099) and for withholding on payments to non-resident vendors. Prompt and accurate completion of this BPF will prevent delays while processing your payments. All payments made by CalSTRS are subject to Federal and California State Tax laws. Payments to California non-residents and/or foreign vendors may result in tax withholding.

Note: Federal, State, and local entities (including school districts) are not required to submit this portion of this form.

Business Name*:

Payee’s Legal Name*:

(If different from above) Address *:

(Include: Suite/Room Number, Attn., Mail Stop) City, State, Zip Code*:

Country*:

(2-Letter Country Code; e.g. US, GB, etc.)

Telephone Number*:

(Inc. Extension Number, if applicable) Fax Number:

Email Address*:

Request for Proposal 5000000660 BusinessDirect Maintenance and Operations

Volume 1 – Part 7 Attachment 4, Business Partner Form Page 1 of 3

Foreign Tax Information Are you a foreign (not a U.S. Citizen or Permanent Resident Alien) vendor-Sole Proprietor (Individual), Partnership, or Corporation?* If yes, you must complete and submit the appropriate IRS Form W-8 series or Form 8233 (www.irs.gov).

Note: Prior to making payments to foreign vendors, United States tax laws require CalSTRS to perform a tax analysis with respect to country of citizenship to determine residency for Federal tax purposes. (see IRS Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities)

☐Yes ☐No

Will all services be performed outside the United States? If no, then payments to you for services performed within the United States could be subject to U.S. federal income tax withholding. The U.S.

federal income tax withholding rate is 30% for U.S. nonresidents.

☐Yes ☐No

If you answered "Yes" you are a Foreign vendor, please sign and date here, in addition to submitting a signed and dated W-8 series or Form 8233.

Signature Name Date

Federal Tax Information Tax Payer Identification Number (TIN)*:

For entities, other than Sole Proprietor (individuals), enter your employer identification number (EIN).

The number provided must match the name given in the “Payee’s Legal Name” to avoid backup withholding.

Social Security Number (SSN)*:

For Sole Proprietor (individuals), enter your social security number. If you do not have a SSN and are not eligible to obtain a SSN, provide an Individual Taxpayer Identification Number (ITIN) issued by the IRS.

Social Security Numbers are required for Individual/Sole Proprietor by authority of California Revenue and Taxation Code 18646. If are a resident alien and do not have a SSN, your TIN is your IRS individual taxpayer identification number (ITIN).

Federal Tax Classification – Business Entity Type*:

Note: If you are a Limited Liability Corporation (LLC), select the appropriate federal tax classification (Corporation, Partnership, Trust/ Estate) from the drop down menu to the right. The number provided must match the name given in the “Payee’s Legal Name” to avoid backup withholding.

Federal Tax Classification

Exemptions: Exempt payee code (if any) Exemptions: Exemption from FATCA reporting code (if any) If your Federal Tax Classifications is “Corporation” as indicated in the question above, do you provide either medical or legal services to CalSTRS?

Medical Services ☐Yes ☐No

Legal Services ☐Yes ☐No

State Tax Information Are you qualified to do business in California or do you maintain a permanent place of business in California?*

☐Yes ☐No

Do you have a Franchise Tax Board (FTB) waiver of state withholding? * If yes, please attach a copy of FTB’s determination letter.

☐Yes ☐No

Will all services be performed outside of the State of California? If no, then payments to you for services performed within the State of California could be subject to California state income tax withholding. The State of California income tax withholding rate is 7% for California nonresidents.

☐Yes ☐No http://www.irs.gov/

Please Read - United States Vendors only:

Under penalties of perjury, I certify that: 1) The TIN, SSN or ITIN 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 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, and 4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Signature Name Date

PAYMENT INFORMATION

Utilize this portion to add additional payment/remit addresses on record with CalSTRS. Please be sure to include any departments or individuals who should be referenced with payment.

Note: Invoices submitted to CalSTRS must match addresses on file.

Signature Name Date

Payee/Remit 1 Payee/Remit Name*:

Address *:

(Include: Suite/Room Number, Attn., Mail Stop) City, State, Zip Code*:

Country*:

(2-Letter Country Code; e.g. US, GB, etc.)

Payee/Remit 2 Payee/Remit Name*:

Address *:

(Include: Suite/Room Number, Attn., Mail Stop) City, State, Zip Code*:

Country*:

(2-Letter Country Code; e.g. US, GB, etc.)

Payee/Remit 3 Payee/Remit Name*:

Address *:

(Include: Suite/Room Number, Attn., Mail Stop) City, State, Zip Code*:

Country*:

(2-Letter Country Code; e.g. US, GB, etc.)

Payee/Remit 4 Payee/Remit Name*:

Address *:

(Include: Suite/Room Number, Attn., Mail Stop) City, State, Zip Code*:

Country*:

(2-Letter Country Code; e.g. US, GB, etc.)

Business Partner Form (BPF)