Rhonda's Promise ❑ MAIL CHECK TO VENDOR 0 RETURN CHECK TO DEPT. ❑ INCLUDE BACK-UP W/ CHECK
CITY OF BOYNTON BEACH
DIRECT PAYMENT REQUISITION
Please issue a check in the amount of $500.00
VENDOR #: W-9
TO: Rhonda's Promise, Inc.
3349 South Federal Highway#D
Boynton Beach, FL 33435
FOR: Community Support/Funds Distribution
Mayor Ty Penserga
City of Boynton Beach
Requested By: Tammy Stanzione Date:
FUND DEPT BASIC ELE OBJ AMOUNT
Approvals: 001 1110 511 83 05 500.00
C
Div Head (LA _0 L. i
Mayl,e ii- Jesus
Finance Dept.
Peter Kajokas
City Manager
Dan Dugger
500.00
R15-055
R22-140
EXHIBIT "A"
COMMUNITY SUPPORT FUNDS
REQUEST FORM
Part I - Summary of Request (to be completed by City Clerk)
Date of Request: August 15, 2024
Requested by Mayor/Commissioner: Mayor Penserga
Amount Requested: $500
Recipient/Payee: Rhonda's Promise
Description of project, program, or activity to be funded:
Part II - Availability of funds
The annual appropriation of funds available to the requesting Member of the
Commission listed above is $6,000.
The balance of funds available for the requesting Member of the Commission is
$1,500.
Accordingly:
✓ There are funds available as requested
There are insufficient funds available as reques ed
Dated: _9_ S B : tal
Maylee
esus, C' Clerk
Part III-Eligibility Evaluation
✓ Public funds will not be used to improve private property unless there is a clear
public need, purpose and benefit
✓ The recipient/payee provides services within the City
✓ The public purpose is beneficial to the entire community served by such donation
Dated: g(�I `I
By: f ,.
Requestin• ►�.-!!'"�—he City Commission
S:\CC\WP\COMMUNITY SUPPORT FUNDS\FY 2023-2024\Penserga\Rhonda's Promise.doc
Form W-9 Request for Taxpayer Give Form to the
�, October 2018) Identification Number and Certification requester.Do not
send to the IRS.
Department of the Treasury
Mensal Revenue Service le 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 riot leave tins tiro liar,'
Rhonda's Promise, Inc.
2 Sesames name/disregarded entity name,if different from above
O 3 Check appropriate box for federal tax classification of the
person whose name a entered on tris 1.Check o.ry one of m. E,srp.npttcns Yfm_ scaryy'-�
em following sever boxes. cerJrn wigwagwigwagra r6rx7uars see
rm
otet rrs on;woe ir
g ❑ Individual/sole proprietor or ❑ C Corporation El Corporation 1:1 Partnership C:1Tn�Uestate
O
• single-member LLC Esarro perm f.0e td any
ao
❑ Limited liability company Enter the tax classification(C=C corporation.S=S corporation,P=Partnarshrp)►
0 2 Note:Check the appropnate box in the line above for the tai clasrfication of the single-member owner Do not check Era-00n!tont FA-CA-.Icor'r
Z a LLC if the LLC a classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC a code 61 i
ryl
a5. another LLC that is not disregarded born the owner for U.S-federal tax purposes.Otherwise,a smgie-member LLC that
G is disregarded from the owner shard check the appropriate box for the tax classification of its owner.
e II Other(see first,;drone)► N a Act C L r
-k :Mon......At. ssav mssv .,.-x
to 5 Address(number.Street,and apt.or state no.)Sae Instructs. Requester s name and address t
t 3349 South Federal Highway fD
6Cay.Mate,and ZP code
Boynton Beach, Florida 33435
7 List accountrxmber(at tee(optional)
cieboilafi
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid 1 Social soctrihr raanb•r
backup withholding.For individuals,this is generally your social security number(SSN).However,for a ( i
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other I I I - i -I I j1 i
entities,it is your employer identfication number(EIN).If you do not have a number,see How to get a i
77N,later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and (Employer identdlcafian number
Number To Give the Requester for guidelines on whose number to enter.
8 - 1 3 ' 6 918 6
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 art 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 sub)ect to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that t am
no longer subject to backup withholding;and
3.I am a U.S.citizen or other U.S.person(defined below):and
4.Tho FATCA coders)entered on this form(it 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 w;thrv:to.ng teca:rsa
you Farre tailed to report ail interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage:newest pts
acqurstion or abandonment of secured property,cancellation of debt.contributions to an individual retirement arrangement(IRA).and general►.payrnerts
other than interest and eividerids.you are not required to sign the cetification,but you must provide your correct TIN.See the rtsaucaons for Part 1,later
Sign ,f �}� ���
Here u.s.p«son► �C .- Date► i& 4- ea.Da
/
General Instructions •Fonn 1099-DiV(dividends.including those from stocks ornur.,af
funds)
Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISCvarious( typos of income.prizes awares 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 rrs.goviForrnW9
•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 MN which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption •Form 1099 A(acquisition or abandonment of sensed
taxpayer identification number(ATiN).or employer identification number property
(Elf).to report on an Inrtorrratton 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. d
returns include,but are not limited to,the following. If you do not return Form W-9 to the
•Form 1099-INT(interest earned or pad) be subject to backupWhat r backupwith a inti old m.gPr
wrdnhvldbrrg.Ser!What is waVMtCtidY*g,
later
Cat.No.10231X Form W-9 fRev 1O-20t0(