HomeMy WebLinkAboutUS Bank Apendix A
Appendix A
Account Signers
Customer Information
Tax Identification
Customer Name: Number:
TRUCKEE DONNER PUBLIC UTILITY DISTRICT 94-6001449
Account Information
Account Name Account Number Tax Identification Number
1-534-5984-2230 94-6001449
TRUCKEE DONNER PUBLIC UTILITY DISTRICT
STAMPEDE ENERGY EXCHANGE
1-534-9053-0695 94-6001449
TRUCKEE DONNER PUBLIC UTILITY DISTRICT
DONNER LAKE ASSESSMENT DISTRICT
1-534-9053-0786 94-6001449
TRUCKEE DONNER PUBLIC UTILITY DISTRICT
GENERAL FUND
1-534-9258-5101 94-6001449
TRUCKEE DONNER PUBLIC UTILITY DISTRICT
PROP 55 PRINCIPAL AND INTEREST ACCOUNT
Authorized Account Signers
Name Title Specimen Signature
Board President
General Manager
Michael D. Holley
Treasurer
Robert Mescher
Assistant Treasurer
Tricia Phillips
The Contract Signer listed below further represents and warrants to the Bank that the signatures listed above are the
true and authentic signatures of the Authorized Account Signer(s) and that Customer has taken all action required by
its organizational documents to appoint the Authorized Account Signer(s).
REQUEST FOR FEDERAL TAXPAYER IDENTIFICATION NUMBER
UNDER PENALTIES OF PERJURY I CERTIFY THAT:
A. THE NUMBER(S) SHOWN ABOVE IS/ARE THE CORRECT TAXPAYER IDENTIFICATION NUMBER(S)
FOR THE CORRESPONDING TAXPAYER.
B. I AM NOT SUBJECT TO BACKUP WITHHOLDING AS A RESULT OF FAILURE TO REPORT ALL
INTEREST OR DIVIDENDS SINCE I HAVE NOT BEEN NOTIFIED I AM SUBJECT TO OR HAVE BEEN NOTIFIED I AM NO
LONGER SUBJECT TO BACKUP WITHHOLDING BY THE INTERNAL REVENUE SERVICE. (IF YOU CANNOT CERTIFY
THIS, CROSS OUT STATEMENT B.)
C. I AM A U.S. PERSON (AS DEFINED IN THE IRS FORM W-9 INSTRUCTIONS, WHICH INSTRUCTIONS
WILL BE PROVIDED BY BANK UPON REQUEST).
D. I AM AN EXEMPT CUSTOMER AS LISTED IN THE IRS FORM W-9 INSTRUCTIONS - CHECK BOX
THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISIONS OF THIS
DOCUMENT OTHER THAN THE CERTIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING.
For Internal Use Only:
Authorized Signers are related to the Master Services Agreement dated: ____________________
Review________________ Validation Method _______________ TL Review________________ Imaged________________
Rev.3/29/2011 Appendix A
Version: 1/11
Appendix A
Account Signers
Contract Signer Signature: Print Title:
Treasurer
Print Name: Date:
Robert Mescher 12/19/2012
For Internal Use Only:
Authorized Signers are related to the Master Services Agreement dated: ____________________
Review________________ Validation Method _______________ TL Review________________ Imaged________________
Rev.3/29/2011 Appendix A
Version: 1/11