Loading...
HomeMy WebLinkAboutR&C Agency Management Corp THIS AGREEMENT made this 20th day of November, 2012, between the TOWN OF SOUTHOLD, a municipality of the State of New York, having its T principal office at 53095 Main Road (Route 25), P.O. Box 1179, Southold, New O York 11971 (the "Town") and (The Instructor): W R&C AGENCY MANAGEMENT CORPORATION N 44655 COUNTY RD 48 PO BOX 1345 SOUTHOLD NY 11971 C 765-4666 O WITNESSETH. P 1. The Town does hereby agree to hire the Instructor as an independent y contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: CPR COURSE 3. The Instructor hereby agrees to commence the rendering of services on April 13, 2013 and to render instructional services during the following time period: Saturday, April 13 8:00 a.m. -12 noon Southold Town Recreation Center 4. The Town agrees to pay the Instructor and the Instructor agrees to accept for such services, the compensation of 55 per slasslheur/person to be paid at semi-monthly intervals by the submission of vouchers therefore to the Town. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness, inability of the Instructor to conduct classes as and when scheduled, or cancellation due to inclement weather, the Instructor shall immediately notify the Recreation Department. The Instructor will assist and/or cooperate with the supervisor to contact all participants notifying them of the class cancellation and to provide for makeup classes. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 4 Maximum Enrollment 12 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Instructor agrees to carry appropriate insurance coverage from claims for bodily injury, death or property damage which may arise from the performance of their services under the Agreement in limits of $1,000,000 and $2,000,000 aggregate liability for bodily injury and property damage. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOWN SOUZ44~~- Sc6tt A. Russell, Supervisor C ~2 I tructor Instructor's Social Security Number B iness Name (if a icable) Federal ID Number (if applicable) THIS AGREEMENT made this 20th day of November. 2012, between the T TOWN OF SOUTHOLD, a municipality of the State of New York, having its O principal office at 53095 Main Road (Route 25), P.O. Box 1179, Southold, New W York 11971 (the "Town") and (The Instructor): R&C AGENCY MANAGEMENT CORPORATION N 44655 COUNTY RD 48 PO BOX 1345 C SOUTHOLD NY 11971 O 765-4666 P WITNESSETH: y 1. The Town does hereby agree to hire the Instructor as an independent contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: DEFENSIVE DRIVING COURSE 3. The Instructor hereby agrees to commence the rendering of services on March 2, 2013 and to render instructional services during the following time period: SATURDAY, MARCH 2 9:00 A.M. - 3:30 P.M. Southold Town Recreation Center 4. The Town agrees to pay the Instructor and the Instructor agrees to accept for such services, the compensation of 30 per elass/how/person to be paid at semi-monthly intervals by the submission of vouchers therefore to the Town. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness or inability of the Instructor to conduct classes as and when scheduled, the Instructor shall immediately notify the Recreation Supervisor. The Instructor will assist and/or cooperate with the supervisor to provide for makeup classes and/or substitute qualified instructors. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 12 Maximum Enrollment 40 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Instructor agrees to carry appropriate insurance coverage from claims for bodily injury, death or property damage which may arise from the performance of their services under the Agreement in limits of $1,000,000 and $2,000,000 aggregate liability for bodily injury and property damage. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOWN F SOUTH LD Sco A. Russell, Supervisor C I Ins uctor Instructor's Social Security Number A-1 7 aye 319 7'Busi ess Name (if applicable Federal ID Number (if applicable) THIS AGREEMENT made this 26th day of February. 2013, between the TOWN T OF SOUTHOLD, a municipality of the State of New York, having its principal O office at 53095 Main Road (Route 25), P.O. Box 1179, Southold, New York 11971 (the "Town") and (The Instructor): W R&C AGENCY MANAGEMENT CORPORATION N 44655 COUNTY RD 48 PO BOX 1345 C SOUTHOLD NY 11971 765-4666 O WITNESSETH. P 1. The Town does hereby agree to hire the Instructor as an independent y contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: DEFENSIVE DRIVING COURSE 3. The Instructor hereby agrees to commence the rendering of services on June 1. 2013 and to render instructional services during the following time period: SATURDAY, JUNE 1 9:00 A.M. - 3:30 P.M. Southold Town Recreation Center 4. The Town agrees to compensate the instructor for satisfactory performance as described herein in the amount of $ 30 per elssa4hew person to be paid in semi-monthly installments. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness or inability of the Instructor to conduct classes as and when scheduled, the Instructor shall immediately notify the Recreation Supervisor. The Instructor will assist and/or cooperate with the supervisor to provide for makeup classes and/or substitute qualified instructors. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 12 Maximum Enrollment 40 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Town of Southold shall, as part of the Instructor's compensation, cover the individual Instructor from claims for bodily injury, death or property damage which may arise from the performance of his/her services under the Agreement in limits of $1,000,000. and $2,000,000 aggregate liability for bodily injury and property damage. This coverage does not inure any other benefits upon the independent contractor nor does it alter or modify the Instructor's status as an independent contractor. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOW OF SOUTHOLD I Ai 7Sco A. Russell, az~ Supervisor r\ 0, Y ~ I 3-I-1~ Instr or Today's Date R.+-C A4vt,,, aM d 7 - 2-SS-34014 Busi ss N me (if a i Federal ID Number (if applicable) THIS AGREEMENT made this 7th day of May 2013, between the TOWN OF T SOUTHOLD, a municipality of the State of New York, having its principal office at 53095 Main Road (Route 25), P.O. Box 1179, Southold, New York 11971 (the 0 "Town") and (The Instructor): W R&C AGENCY MANAGEMENT CORPORATION N 44655 COUNTY RD 48 PO BOX 1345 C SOUTHOLD NY 11971 765-4666 0 WITNESSETH: P 1. The Town does hereby agree to hire the Instructor as an independent y contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: DEFENSIVE DRIVING COURSE 3. The Instructor hereby agrees to commence the rendering of services on August 10. 2013 and to render instructional services during the following time period: SATURDAY, AUGUST 10 9:00 A.M. - 3:30 P.M. Southold Town Recreation Center 4. The Town agrees to compensate the instructor for satisfactory performance as described herein in the amount of $ 30 per class/hour/person to be paid in semi-monthly installments. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness or inability of the Instructor to conduct classes as and when scheduled, the Instructor shall immediately notify the Recreation Supervisor. The Instructor will assist and/or cooperate with the supervisor to provide for makeup classes and/or substitute qualified instructors. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 12 Maximum Enrollment 40 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Instructor agrees to carry appropriate insurance coverage from claims for bodily injury, death or property damage which may arise from the performance of their services under the Agreement in limits of $1,000,000 and $2,000,000 aggregate liability for bodily injury and property damage. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOWN F SOUT LD Sco A. Russell, Supervisor C 5-?0 -13 Ins ctor Today's Date A Am,watoqA (;'P a'~ _a5SsH9J4 Business Name (if apptibable) Federal ID Number (if applicable) THIS AGREEMENT made this 7th day of May 2013, between the TOWN OF SOUTHOLD, a municipality of the State of New York, having its principal office at T 53095 Main Road (Route 25), P.O. Box 1179, Southold, New York 11971 (the O "Town") and (The Instructor): R&C AGENCY MANAGEMENT CORPORATION W 44655 COUNTY RD 48 N PO BOX 1345 SOUTHOLD NY 11971 C 765-4666 O WITNESSETH. p 1. The Town does hereby agree to hire the Instructor as an independent Y contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: CPR COURSE 3. The Instructor hereby agrees to commence the rendering of services on July 13. 2013 and to render instructional services during the following time period: Saturday, July 13 8:00 a.m. -12 noon Southold Town Recreation Center 4. The Town agrees to compensate the instructor for satisfactory performance as described herein in the amount of $ 55 per class/hour/person to be paid in semi-monthly installments. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness, inability of the Instructor to conduct classes as and when scheduled, or cancellation due to inclement weather, the Instructor shall immediately notify the Recreation Department. The Instructor will assist and/or cooperate with the supervisor to contact all participants notifying them of the class cancellation and to provide for makeup classes. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 4 Maximum Enrollment 25 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Town of Southold shall, as part of the Instructor's compensation, cover the individual Instructor from claims for bodily injury, death or property damage which may arise from the performance of his/her services under the Agreement in limits of $1,000,000. and $2,000,000 aggregate liability for bodily injury and property damage. This coverage does not inure any other benefits upon the independent contractor nor does it alter or modify the Instructor's status as an independent contractor. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOWN OF SOUTHOLD eu~ ~I tt A. Russell, Supervisor C?"I S-1o-13 I structor Today's Date 4y P a7-z51~ 3Ltgw Business Name (i applicab ) Federal ID Number (if applicable) C~-p THIS AGREEMENT made this 30th day of July. 2013, between the TOWN OF SOUTHOLD, a municipality of the State of New York, having its principal office at 53095 Main Road (Route 25), P.O. Box 1179, Southold, New York 11971 (the "Town") and (The Instructor): R&C Agency Management Attn: Chris Manfredi 44655 County Road 48 Southold NY 11971 765-4666 WITNESSETH: 1. The Town does hereby agree to hire the Instructor as an independent contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: CPR Course 3. The Instructor hereby agrees to commence the rendering of services on October 12. 2013 and to render instructional services during the following time period: 10/12/2013 Saturday 8:00 a.m. -12:00 p.m. Location: Southold Recreation Center 4. The Town agrees to compensate the instructor for satisfactory performance as described herein in the amount of $55/person to be paid in semi-monthly installments. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness, inability of the Instructor to conduct classes as and when scheduled, or cancellation due to inclement weather, the Instructor shall immediately notify the Recreation Department. The Instructor will assist and/or cooperate with the supervisor to contact all participants notifying them of the class cancellation and to provide for makeup classes. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 6 Maximum Enrollment 25 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Town of Southold shall, as part of the Instructor's compensation, cover the individual Instructor from claims for bodily injury, death or property damage which may arise from the performance of his/her services under the Agreement in limits of $1,000,000. and $2,000,000 aggregate liability for bodily injury and property damage. This coverage does not inure any other benefits upon the independent contractor nor does it alter or modify the Instructor's status as an independent contractor. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOWN O OUTHOLD Scott . Russell, Supervisor g-z -13 Instructor Today's Date +C Iq aemru MMq; ~ a7 -a583149 Bu ness me (if ap cable) Federal ID Number (if applicable) THIS AGREEMENT made this 30th day of July. 2013, between the TOWN OF SOUTHOLD, a municipality of the State of New York, having its principal office at 53095 Main Road (Route 25), P.O. Box 1179, Southold, New York 11971 (the "Town") and (The Instructor): R&C Agency Management x. Attn: Chris Manfredi 44655 County Road 48 Southold NY 11971 'All 765-4666 W/TNESSETH: 1. The Town does hereby agree to hire the Instructor as an independent contractor, and the Instructor does hereby agree to provide instructional services to the Town for the program(s) hereinafter described, subject to the terms and conditions hereinafter set forth. 2. The Instructor shall provide instructional services for the following program, to wit: Defensive Driving 3. The Instructor hereby agrees to commence the rendering of services on November 2. 2013 and to render instructional services during the following time period: 11/2/13 Saturday 9:00 a.m. - 3:30 p.m. Location: Southold Recreation Center 4. The Town agrees to compensate the instructor for satisfactory performance as described herein in the amount of $30/person to be paid in semi-monthly installments. 5. It is agreed that the Instructor shall report to the Supervisor for the Recreation Department of the Town. The Instructor shall determine that scope and manner of work to be performed and the hours for which it will be performed. 6. It is agreed that the Instructor shall be responsible for the establishment of the program, to assist with the solicitation of participants therein, and the completion of all the classes planned for such program. 7. In the event of the temporary illness, inability of the Instructor to conduct classes as and when scheduled, or cancellation due to inclement weather, the Instructor shall immediately notify the Recreation Department. The Instructor will assist and/or cooperate with the supervisor to contact all participants notifying them of the class cancellation and to provide for makeup classes. 8. In the event that the enrollment in the program is less than the minimum enrollment as hereinafter set forth, the Town shall have the right to terminate this agreement. In the event that the Instructor fails or neglects to perform such instructional services in accordance with provisions of this agreement, then and in such event, the Town in the exercise of discretion shall have the right to terminate this agreement. 9. The minimum and maximum enrollment of the class for the program is as follows: Minimum Enrollment 12 Maximum Enrollment 40 10. The Instructor agrees to prepare accurate attendance records of all persons enrolled in the program and to file the same with the Recreation Supervisor within one week after the last class of the program. 11. The Instructor represents that he or she is competent by reason of training and experience to provide the instruction provided for in this contract, and will provide such services in a competent and professional manner. The Instructor represents and agrees that he or she is an independent contractor and is solely responsible for payment of taxes arising out of this employment. The Instructor agrees that he or she is an independent contractor and that the Town of Southold shall not be liable for any taxes or withholding. There shall be no fringe benefits associated with this Agreement. There shall be no health benefits offered to the Instructor. There shall be no workers compensation benefits offered to the Instructor. The Instructor is expected to utilize his/her independent judgment in fulfilling his/her Instructor tasks. 12. The Instructor will not receive payment for any services rendered until this contract is signed and returned to the town clerk's office prior to the beginning of said program. 13. The Town of Southold shall, as part of the Instructor's compensation, cover the individual Instructor from claims for bodily injury, death or property damage which may arise from the performance of his/her services under the Agreement in limits of $1,000,000. and $2,000,000 aggregate liability for bodily injury and property damage. This coverage does not inure any other benefits upon the independent contractor nor does it alter or modify the Instructor's status as an independent contractor. IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals the day and year first above written. TOWN SOUTHOLD Sc A. Russell, Supervisor Z-13 Instructor Today's Date R+c(4Uw,,y Mgriga ,znu4 o,p a-I -ZS~-34q~ Business Name (if appli Vble) Federal ID Number (if applicable)