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<br /> i ' <br /> 25. This Agreement and the attached Project Proposal constitutes the entire agreement between the <br /> parties on the subject matter hereof. There are no.understandings, agreement, or representations, oral <br /> or written, not specified herein regarding this Agreement. No waiver, consent, modification or <br /> change of terms of this Agreement shall bind either party unless in writing and signed by both <br /> parties and all necessary State approvals have been obtained. Such waiver, consent, modification or <br /> change, if made, shall be effective only in the specific instance and for the specific purpose given. <br /> The failure of the OYCC to enforce any provision of this Agreement shall not constitute a waiver by <br /> the OYCC of that or any other provision. <br /> GRANTEE, BY EXECUTION OF THIS AGREEMENT, HEREBY ACKNOWLEDGES THAT <br /> GRANTEE HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE <br /> BOUND BY ITS TERMS AND CONDITIONS. <br /> GRANTEE DATA AND CERTIFICATION (NOT required if State or Local Government Agency) <br /> Name (tax fiiing): <br /> Address: <br /> Citizenship (if applicable): Non-resident alien [ ]Yes [ ] No <br /> Business Designation (check one): <br /> [ ]Corporation [ ]Partnership [ ]Limited Partnership [ ]Limited Liability Company [ ]Limited Liability Partnership <br /> [ ]Sole Proprietorslip [ ]Other <br /> _ _ _ _ <br /> Federal Tax ID#: # - ~ or SSN#: - - <br /> Above GRANTEE information must be provided prior to Agreement approval, by the Department of <br /> Administrative Services, if such approval is required. This information will be reported to the Internal <br /> Revenue Service (1RS) under the name and taxpayer identification submitted. (See IRS 1099 for additional <br /> instructions regarding taxpayer ID numbers.) Information not matching IRS records could subject <br /> GRANTEE to 31 percent backup withholding (ORS 305.385, OAR' 125-020-0410(3) and OAR <br /> 150.305_._100)..__._ _ _ <br /> Certification: The individual signing on behalf of GRANTEE hereby certifies and swears under penalty <br /> of perjury: (a) the number shown on this form is GRANTEE'S correct taxpayer identification; (b) <br /> GRAN'T'EE is not subject to backup withholding because (i) GRANTEE is exempt from backup <br /> withholding, (ii) GRANTEE has not been notified by the IRS that GRANTEE is subject to backup <br /> withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified <br /> GRANTEE that GRANTEE is no longer subject to backup withholding; (c) s/he is authorized to act on <br /> behalf of GRANTEE, s/he has authority and knowledge regarding GRANTEE'S payment of taxes, and to <br /> the best of her/his knowledge, GRANTEE is not in violation of any Oregon tax laws; (d) GRANTEE is an <br /> independent GRANTEE as defined in ORS 670.600; and (e) the above GRANTEE data is true and <br /> accurate. <br /> 5 <br /> <br />