NAVAJO NATION, DEPARTMENT OF DINE EDUCATION

Navajo Head Start

RFP#19-06-2097LE

Request for Proposal for Telecommunications and Fax Services

SCOPE:

Navajo Head Start (NHS) is seeking qualified companies to provide telephone, and fax services for the Navajo Head Start Program within the Shiprock District, Crownpoint District, Window Rock District, Chinle District, Tuba City District and Kayenta District.

Contract will commence July 1, 2019 and end February 29, 2021. The multi-year contract will begin March 1, 2020 to Febuary 29, 2021.

Because of the large service area and number of NHS centers, NHS has chosen to divide it into six (6) quadrants (District I Shiprock, District II Crownpoint, District III Window Rock, District IV Chinle, District V Kayenta/Tuba City) for the purposes of this solicitation. Vendors may choose to bid on one, two, three, or all six quadrants based on the capabilities of their firm. Award of one or more contracts will be made based upon the evaluation of all proposals received. A listing of the facilities included in each quadrant is listed in Appendix 1. See attached map of the location of each center.

SCOPE OF SERVICES

TELEPHONE SERVICE REQUIREMENTS:

• Plain Old Telephone Service (POTS) should be able to deliver the following features: o Voice line services should include Voicemail, Call Transfer, and long distance. o Keep existing phone numbers o We have approximately 100 phones between 80 locations here in the Navajo Nation. Navajo Head Start would like to minimize the initial investment by utilizing existing phones. We understand that our phones are at the end of their service life, therefore we would like to the proposal to include costs for the option of new phones.

FAX SERVICE REQUIREMENTS:

• Fax Service should be able to deliver the following features: o Keep existing phone numbers o Long distance

Consultant will be required to sign rules of conduct and comply with the rules during the duration of the contract. Consultant will be required to show professionalism and code of conduct while consulting with the Navajo Head Start Centers and Early Head Start. Internet, phone, and fax services will need to be turned off and not billed during normal summer school break or if a center closes.

Vendors may propose alternative internet, telephone, and fax services to those described above if the alternative services offer equivalent functionality and reliability.

RFP Submittal Deadline:

All RFPs must be received by Friday, July 19, 2019, at 3:00 pm DST and must be mailed or physically delivered to:

Navajo Head Start Attention: Principal Contract Analyst Post Office Box 3479 Window Rock, 86515

Courier Service/Delivery to: Navajo Head Start Attention: Principal Contract Analyst Southwest of US Highway 264 and Indian Route 12 Suite #2A Window Rock, Arizona 86515

Incurring Cost:

Any cost incurred by the respondent in preparing, transmitting, presenting, or modifying the proposal or material for this RFP shall be the responsibility of the respondent.

Amended Proposals:

A respondent may submit an amended proposal before the deadline for receipt of proposals. Such amended proposals must be complete replacement for a previously submitted proposal and must be clearly identified so in the transmittal letter.

Respondent’s Right to Withdraw Proposal:

A respondent may withdraw their proposal at any time prior to the deadline for receipts of proposals. The respondent must submit a written withdrawal request addressed to the Senior Contract Analyst.

Questions:

Any inquiries regarding this procurement should be submitted in writing to the Mr. Natani Pete, IT Technician for official response or Brent Nelson, Systems and Programming Manager NN/ Dept. of Diné Education. The respondent may contact Mr. Pete or Mr. Nelson verbally, however, verbal responses will be considered unofficial. Only written responses to question(s) will be official. All questions will be direct to Mr. Pete at 505-368-1204 or email ntpete@navajo- nsn.gov, or Mr. Nelson at 928-810-9702 or email [email protected] Questions regarding this procurement will be accepted until 5:00 pm MDST on Thursday, July 18, 2019.

Propriety Information:

Restrictions on any information included in the proposals must be clearly stated in the proposal itself. Propriety information submitted in response to this RFP will be handled in accordance with applicable purchasing procedures. Each and every page of the propriety material must be labeled or identified with the word “proprietary” or “confidential”.

Disclosure of Proposal Contents:

The proposal will be kept confidential.

No Obligation:

This RFP in no manner obligates the Navajo Nation or any of its agencies to the eventual rental, lease, purchase, etc., of any equipment, software or services offered until a valid contract is executed.

Termination:

This RFP #19-06-2097LE may be canceled at any time, and proposals may be rejected in whole or in part when the Senior Contract Analyst determines that such action is in the best interest of the Navajo Nation. All RFPs are subject to funds availability.

Sufficient Appropriation:

Any contract awarded as a result of this RFP#19-06-2097LE is contingent upon the appropriation of funds. A contract award may be determined or reduced in scope if sufficient appropriate or authorization does not exist. Such terminations will be effected with written notice to the contractor. The Senior Contract Analyst’s decision as to whether sufficient appropriations and authorizations are available will be accepted by the contractor as final.

Legal Review:

All respondents must agree to be bound by the general requirements contained in this RFP. Any concerns should be brought to the attention of the Senior Contract Analyst immediately. Any formal appeals shall abide by Title 12, §360 of the Navajo Nation Procurement Code. Governing Law:

This procurement and any RFP#19-06-2097LE with respondents that may result shall be governed by the laws of the Navajo Nation and applicable federal law. Nothing herein shall be construed as a waiver of the Navajo Nation’s sovereign immunity. In addition, the Navajo Nation Business Opportunity Act will apply to the RFP.

Choice of Forum:

The courts of the Navajo Nation will have jurisdiction over any dispute that may arise out of this procurement and any RFP with the respondent.

Terms and Conditions:

The contents of a successful proposal will become part of the contract upon award. The Navajo Head Start reserves the right to negotiate with the successful respondent any additional provisions to those contained in this RFP.

Right to Waive Informality and Ambiguity:

The Senior Contract Analyst shall reserve the right to decide and interpret if there is a waiver of informality, situation, and ambiguity. This is a sole right of the Senior Contract Analyst.

Ownership of Proposals:

All documents submitted in response to this RFP shall become the property of the Navajo Nation and will not be returned to the respondent. Responses received will be retained by Navajo Head Start.

Background Check Requirements:

The successful consultant will be required to submit to a tribal and federal background check and assessment per Navajo Head Start policies and procedures and Head Start Performance Standards. All potential consultants must successfully pass a background check process before a contract is awarded and the duration of the contract.

Proposal Format:

1. Respondent(s) must indicate if they are priority vendor with the Navajo Nation. 2. All proposals must be typewritten on standard 8-1/2 x 11” paper and placed within a binder with tabs delineating each section. Larger paper is permissible for charts, maps, or the like. 3. An original RFP#19-06-2097LE response and 3 copies must be provided in sealed envelope. 4. The proposal must be organized and indexed in the following format: a. Letter of Transmittal b. Statement of Qualifications c. Proposal on Contract Approach d. Proposed Cost (Sealed in Separate Envelope) Within each section of the proposal, respondents should address the items in the order in which they appear in this RFP#19-06-2097LE. Any proposal that does not adhere to the requirements may be deemed non-responsive and rejected on that basis.

5. Each proposal must be accompanied by a letter of transmittal. The letter of transmittal must: a. Provide background on company. b. Identify the name of the person responding to the RFP#19-06-2097LE. c. Identify the name, title, and telephone numbers of person authorized to negotiate on behalf of the organization; d. Identify the names, files, and telephone numbers of person to be contacted for clarification; e. Explicitly indicate acceptance of the conditions governing this procurement; f. Be signed by the person responding to the RFP#19-06-2097LE; and g. Acknowledge receipt of any and all amendments to the RFP#19-06-2097LE. 6. The respondent must submit a statement of qualifications. a. The respondent must submit a resume. b. Number of years of experience working with government entities. c. Number of years providing. d. The respondent must provide license(s) to provide Internet services for and Arizona. e. The respondent will provide three (3) references. Each reference must include the name, address, and telephone number of a contact person who can describe, in some detail, the quality, quantity, and substance of services provided. f. The respondent will provide certificate of liability insurance. 7. The respondent must provide proposal on contract approach. a. Provide in detail how they would accomplish the objectives described in the scope of work. b. Provide number of employees in the company. c. Ability to provide Internet Services to Head Start Centers and Early Head Start on monthly basis for all districts. 8. Proposed cost: a. The respondent will provide detail cost for labor, supplies, and equipment to provide Internet Services for Head Start Centers and Early Head Start.

EVALUATION AND CRITERIA:

1. A Selection Committee will review the proposals received in accordance with the general criteria described herein. The selection committee may request oral presentations by respondents. Respondents should be prepared to provide any additional information the selection committee feels necessary for the fair evaluations of proposals.

2. Failure of a respondent to provide any information requested in the RFP may result in disqualification of the proposal. All proposals must be endorsed with the signature of a responsible official having authority to bind the respondent to the execution of a contract. 3. The sole objective of the selection committee will be to evaluate and select the respondent who is most responsive to the needs of the Navajo Nation and recommend the respondent(s) who best meet(s) this objective.

4. Evaluation Criteria: Evaluation Criteria Points Proposal Organization 10 a. Typed written on 8-1/2” X 11” paper b. One (1) original RFP with three (3) copies c. Binding and indexing Letter of Transmittal 10 a. Provide background on company. b. Identifying individual(s) as specified above. Statement of Qualification 30 a. Resume. b. Number of years working with government agencies c. Valid NM and AZ license to Internet Services d. (3) References. e. Provide certificate of liability insurance. Proposed Contract Approach 30 a. Describe meeting objectives to scope of work. b. Provide number of employees in the company. c. Ability to provide Telephone and Fax Service to all of our Head Start Centers and Early Head Start Centers within all the six (6) Districts. Proposed Cost (Sealed in Separate Envelope) 20 a. Provide detailed cost for Telephone and Fax Service to all of our Head Start Centers and Early Head Start Centers within all the six (6) Districts. Total: 100

Appendix I

Owner's District Facility District Site Status Phone Number Fax Number Mailing Name Owner Address P.O. Box 100 Nageezi Nageezi, New Shiprock District 1 Nageezi Open 505.960.6740 505.960.6739 Chapter Mexico - 87037 - P.O. Box 438 Nenahnezad Fruitland, Shiprock District 1 Nenahnezad Open 505.960.4068 505.960.4069 Chapter New Mexico - 87416 - P.O. Box 7982 Newcomb Newcomb, Shiprock District 1 Newcomb Open 505.696.3355 505.696.5466 Chapter New Mexico - 87455 - P.O. Box 422 Red Mesa Montezuma Shiprock District 1 Red Mesa Open 928.656.3660 Chapter Creek, - 84534 - P.O. Box 304 Red Valley Red Valley, Shiprock District 1 Red Valley Open 928.653.5998 Chapter Arizona - 86544 - P.O. Box 1636 San Juan Fruitland, Shiprock District 1 San Juan Open 505.960.0800 505.960.0801 Chapter New Mexico - 87416 - P.O. Box 219 Sanostee Sanostee, Shiprock District 1 Sanostee Open 505.723.2700 505.723.2446 Chapter New Mexico - 87461 - P.O. Box 3810 Shiprock Shiprock, Shiprock District 1 Shiprock Open 505.368.1202 Chapter New Mexico - 87420 - P.O. Box 1257 Upper Upper Fruitland, Shiprock District 1 Open 505.960.0001 Fruitland Fruitland New Mexico - Chapter 87416 - P.O. Box 6118 Bread Springs Gallup, New Crownpoint District 2 Baahaali Open 505.778.5788 Chapter Mexico - 87305 - Chichiltah P.O. Box 1436 Crownpoint District 2 Chichiltah Open 505.778.5441 Chapter Gallup, New Mexico - 87305 - P.O. Box 549 Church Rock Church Rock, Crownpoint District 2 Church Rock 1 Open 505.905.5420 505.905.5421 Chapter New Mexico - 87311 - P.O. Box 549 Church Rock Church Rock, Crownpoint District 2 Church Rock 2 Open 505.905.5420 505.905.5421 Chapter New Mexico - 87311 - P.O. Box 336 Crownpoint Crownpoint, Crownpoint District 2 Crownpoint Open 505.786.2029 Chapter New Mexico - 87313 - P.O. Box 336 Crownpoint Crownpoint Crownpoint, Crownpoint District 2 Open Warehouse Chapter New Mexico - 87313 - Littlewater Crownpoint District 2 Little Water Open 505-786-2483 Chapter P.O. Box 369 Nahodishgish Crownpoint, Crownpoint District 2 Nahodishgish Open (505) 786-2441 (505) 786-2442 Chapter New Mexico - 87313 - P.O. Box 3 Pinedale Church Rock, Crownpoint District 2 Pinedale Open 505.786.2213 Chapter New Mexico - 87311 - HRC 79 Box Pueblo Pueblo 3026 Cuba, Crownpoint District 2 Open 505.655.5414 Pintado Pintado New Mexico - Chapter 87013 - P.O. Box 2548 Red Rock Gallup, New Crownpoint District 2 Red Rock Open 505.905.2436 505.905.2437 Chapter Mexico - 87301 - P.O. Box 60 Smith Lake Smith Lake, Crownpoint District 2 Smith Lake Open 505.786.2147 Chapter New Mexico - 87365 - P.O. Box 899 Thoreau Thoreau, New Crownpoint District 2 Thoreau Open 505.905.1400 Chapter Mexico - 87323 - P.O. Box 1236 Tohatchi Tohatchi, Crownpoint District 2 Tohatchi Open 505.733.2810 505.733.2810 Chapter New Mexico - 87325 - P.O. Box 1024 Torreon Cuba, New Crownpoint District 2 Torreon Open 505.731.1501 Chapter Mexico - 87013 - P.O. Box 4424 Twin Lakes Yahtahey, Crownpoint District 2 Twin Lakes Open 505.735.2392 505.735.1020 Chapter New Mexico - 87375 - P.O. Box 478 Window Cornfields Ganado, District 3 Cornfields Open 928.755.4352 928.755.5919 Rock Chapter Arizona - 86505 - P.O. Box 775 Window Crystal Navajo, New District 3 Crystal Open 505.777.2667 505.777.2671 Rock Chapter Mexico - 87328 - HR 63 Box E Window Dilkon Dilkon, District 3 Dilkon Open 928.657.8087 928.657.8090 Rock Chapter Arizona - 86047 - P.O. Box 366 Window Fort Defiance Fort Defiance District 3 Open 928.729.4387 Fort Defiance Rock EHS Chapter 86504 P.O. Box 1757 Ganado Window Ganado, District 3 Ganado Open 928.755.5966 928.755.5967 Unified School Rock Arizona - District 86505 - P.O. Box 367 Keams Window Cedar Unified District 3 Jeddito Open 928.738.5211 928.738.5212 Canyon, Rock School District Arizona - 86034 - P.O. Box 860 Window Kin Da Lichii' St. Michaels, District 3 Kinlichii Open 928.755.5925 928.755.5928 Rock Chapter Arizona - 86511 - P.O. Box 403 Window Lupton Lupton, District 3 Lupton Open 928.688.4354 928.688.5752 Rock Chapter Arizona - 86508 - P.O. Box 7387 Window Nazlini Nazlini, District 3 Nazlini Open 928.755.5906 928.755.5908 Rock Chapter Arizona - 86540 - P.O. Box 400 Window Nahata Dziil Sanders, District 3 Rural Open 928.688.2273 928.688.5810 Rock Chapter Arizona - 86512 - P.O. Box 1786 Window Sawmill Fort Defiance, District 3 Sawmill Open 928.729.4378 928.729.4383 Rock Chapter Arizona - 86504 - P.O. Drawer Window Rock 260 Fort Window District 3 St. Michaels Open 928.871.7980 Unified School Defiance, Rock District Arizona - 86504 - Unit 42 HC Box 90 Window Steamboat District 3 Steamboat Open 928.736.2600 928.736.2600 Ganado, Rock Chapter Arizona - 86505 - P.O. Box 86 Window Tsayatoh Mentmore, District 3 Tsayatoh Open 505.905.8200 505.905.8201 Rock Chapter New Mexico - 87375 - Window District 3 Wide Ruins Open 928.652.3251 928.652.3286 Rock Chee Dodge Window Rock Window Window Rock Dr, Window District 3 Open 928-871-7980 Elementary Rock 1, 2, & 3 Rock, AZ School 86515 P.O. Box 4427 Blue Gap Blue Gap, Chinle District 4 Blue Gap Open 928.674.4474 Chapter Arizona - 86520 - P.O. Box 20 Hardrock Kykotsmovi, Chinle District 4 Hard Rock Closed Chapter Arizona - 86039 - P.O. Box 1809 Chinle Chinle, Chinle District 4 Chinle Open 928.674.2156 928.674.2163 Chapter Arizona - 86503 - P.O. Box 1809 Chinle Chinle, Chinle District 4 Chinle Valley Open 928.674.2157 928.674.2130 Chapter Arizona - 86503 - P.O. Box 1809 Chinle Chinle, Chinle District 4 Del Muerto Open 928.674.2137 928.674.2139 Chapter Arizona - 86503 - Dine College Chinle District 4 Open 928.724.6906 Dine College EHS P.O. Box 1139 Tselani / Chinle, Chinle District 4 Low Mountain Open 928.725.3704 928.725.3706 Cottonwood Arizona - Chapter 86503 - P.O. Box 248 Lukachukai Lukachukai, Chinle District 4 Lukachukai Open 928.787.2505 928.787.2508 Chapter Arizona - 86507 - Child Care P.O. Box 704 Many Farms 1 And Window Chinle District 4 Open 928.781.6381 928.781.6843 & 2 Development Rock, AZ - Fund 86515 - P.O. Box 185 Many Farms Many Farms, Chinle District 4 Many Farms 3 Open 928.781.3616 928.781.3623 Chapter Arizona - 86538 - P.O. Box 839 Pinon Unified Pinon, Chinle District 4 Pinon 1 Open 928.725.3366 928.725.3373 School District Arizona - No. 4 86510 - P.O. Box 839 Pinon Unified Pinon, Chinle District 4 Pinon 2 Open 928.725.3281 928.725.3239 School District Arizona - No. 4 86510 - P.O. Box 667 Tsaile / Tsaile, Chinle District 4 Tsaile Open 928.724.2211 928.724.2207 Wheatfields Arizona - Chapter 86556 - P.O. Box 279 Whippoorwill Whippoorwill, Chinle District 4 Whippoorwill Open 928.725.3506 Chapter Ariaona - 86510 - P.O. Box 2301 Dennehotso Dennehotso, Kayenta District 5 Dennehotso Open 928.658.3212 928.658.3212 Chapter Arizona - 86535 - P.O. Box 5214 Inscription Ts'ah Bii Kin Tonalea, Kayenta District 5 Open 928.672.2822 House Chapter Arizona - 86044 - P.O. Box 337 Kayenta Kayenta, Kayenta District 5 Kayenta 1 Open 928.697.5730 Unified School Arizona - District 86033-0337 P.O. Box 337 Kayenta Kayenta, Kayenta District 5 Kayenta 2 Open 928.697.5728 Unified School Arizona - District 86033 - P.O. Box 337 Kayenta Kayenta, Kayenta District 5 Kayenta 4 Open 928.697.5635 928.697.5633 Unified School Arizona - District 86033 - P.O. Box Navajo 10070 Navajo Kayenta District 5 Open 928.672.2407 Mountain Tonalea, Mountain Chapter Arizona - 86044 - P.O. Box 360455 Kayenta District 5 Oljato Open 435.727.3215 435.727.3102 Oljato Chapter , Utah - 84531 - P.O. box 7800 Shonto Shonto, Kayenta District 5 Shonto Open 928.672.2479 928.672.2810 Chapter Arizona - 86054 - P.O. Box 669 Cameron Cameron, Tuba City District 6 Cameron Open 928.679.2004 928.679.9802 Chapter Arizona - 86020 - P.O. Bos 207 Tonalea Tonalea, Tuba City District 6 Cowsprings Open 928.283.8802 Chapter Arizona - 86044 - P.O. Box 1546 Bodaway / Tuba City, Tuba City District 6 Gap Open 928.283.3228 Gap Chapter Arizona - 86045 - P.O. Box 207 Tonalea Tonalea, Tuba City District 6 Tonalea Open 928.283.3245 Chapter Arizona - 86044 - P.O. Box 727 To'Nanees'Dizi Tuba City, Tuba City District 6 Tuba City Open 928.283.3240 Chapter Arizona - 86045 - P.O. Box 3479 Navajo Central Window Central Head 928.871.6902 928.871.7866 Administration Rock, AZ - Start 86515 - P.O. Box 3479 Navajo Chinle District Window Chinle Head 928.674.2141 928.674.2147 Office Rock, AZ - Start 86515 - P.O. Box 3479 Navajo Window Window Rock Window Head 928.810.8520 928.871.6419 Rock District Office Rock, AZ - Start 86515 - P.O. Box 3479 Navajo Shiprock Window Shiprock Head 505.368.1200 505.368.1217 District Office Rock, AZ - Start 86515 - P.O. Box 3479 Navajo Shiprock Window Shiprock Head District 505.368.1200 505.368.1217 Rock, AZ - Start Warehouse 86515 -

**ALL invoicing will be mailed to: **

Central Administration Attn: Finance Dept. P.O. 3479 Window Rock, AZ 86515

Request for Taxpayer Form W-9 Give Form to the (Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ▶ Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see instructions on page 3): Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate single-member LLC Exempt payee code (if any) Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶ Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that

Print or type. is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions) ▶ (Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. Requester’s name and address (optional) See Specific Instructions on page 3. 6 City, state, and ZIP code

7 List account number(s) here (optional)

Part I 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 generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other – – entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. – Part II Certification Under penalties of perjury, I certify that: 1. The number 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 (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. 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 for Part II, later.

Sign Signature of Here U.S. person ▶ Date ▶

• Form 1099-DIV (dividends, including those from stocks or mutual General Instructions funds) Section references are to the Internal Revenue Code unless otherwise • Form 1099-MISC (various types of income, prizes, awards, or gross noted. proceeds) Future developments. For the latest information about developments • Form 1099-B (stock or mutual fund sales and certain other related to Form W-9 and its instructions, such as legislation enacted transactions by brokers) after they were published, go to www.irs.gov/FormW9. • Form 1099-S (proceeds from real estate transactions) Purpose of Form • Form 1099-K (merchant card and third party network transactions) An individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T (tuition) identification number (TIN) which may be your social security number • Form 1099-C (canceled debt) (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number • Form 1099-A (acquisition or abandonment of secured property) (EIN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a resident amount reportable on an information return. Examples of information alien), to provide your correct TIN. returns include, but are not limited to, the following. If you do not return Form W-9 to the requester with a TIN, you might • Form 1099-INT (interest earned or paid) be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)

NAVAJO NATION CERTIFICATION Regarding Debarment and Suspension

Applicant acknowledges that to the best of his/her knowledge that their company and principal participants on this contract:

1. Are not debarred, suspended, or otherwise slated for debarment, ineligible and/or excluded from participation on Federal, State, and Tribal Government contracts etc.

2. Are not presently nor have been under criminal indictment or civilly charged by a governmental entity (Federal, State, and Tribal Government) for fraud, forgery, falsification, theft, bribery, destruction of records, receiving stolen property and other criminal offenses in the administration of a government contract.

3. Have not been terminated for cause or convenience by a governmental entity in the administration of a government contract (Federal, State, and Tribal Government).

4. If the Navajo Nation determines that the Certificate provided herein is not true, it will be grounds to terminate the contract and pursue other legal remedies.

Applicant's Address Name & Signature of Applicant

Type or Print Name

Signature Date

Contracts and Grants Section, OMB P.O. Box 646, Window Rock, AZ 86515 (928) 871-6470, Fax 871-6567