Wells Fargo Bank/SilverRock 04ATTACHMENT 1
WELLS FARGO BANK _,, N.A.
COMMERCIAL ACCOUNT AUTHORIZATION & AGREEMENT (SIGNATURE CARD)
(This document to be used when establishing a new account only.)
1. ACCOUNT NUMBER(S)
NEE
O
NE
II. ACCOUNT TITLE(S) SILVER ROCK RESORT GENERAL ACCOUNT
c/o CITY OF LA QUINTA
M. ACCOUNT TYPE (Check One Box Only)
IM Commercial Checking on Interest Commercial Checking with Interest Q Commercial Money Market Account
IV. BUSINESS INFORMATION
Customer Nime ("Accountholder")
SILVER ROCK RESORT
Business Location/Street Address
City
State
Zip
LA QUINTA
CA
92253.
Mailing Address
City
State
Zip
PO BOX 1504
LA QUINTA
CA
92247
Business Phone
Alternate Phone
Primary Contact Name
( ) - Ext. — 150
( ) Ext. (760) 777-7000
JOHN FALCONER
Type of Entity Check One Box Only)
Business
Public Funds
Financial Institution
❑ Corporation ❑ Business Trust
9 City / Municipality
❑ Commercial Bank
❑ Corporation (Professional) ❑ Real Estate Investment Trust
❑ County
❑ Savings Bank
❑ Corporation (Nonprofit) ❑ Association
❑ State
❑ Credit Union
❑ Partnership (General) Other
Federal US Government
❑ Partnership (Limited) Foreign
Internal
❑ Joint Venture ❑ Corporation
❑ Indian Tribal Entity
❑ WF & Co Sub
❑ Limited Liability Company ❑ Fin'l Institution
❑ WFBSubsidiary
Business Organized under the Laws of (Jurisdiction)
Annual Sales S
CALIFORNIA
4396009000
Date Business Established
Numbe�y Employees
1982
Date Current Owner Since / Mgmt Started
Wells Farao
Banker to Complete
Business License #: Dated:
Date of Last Banker Visit to Business Address:
Fictitious Name Statement Date
Banker Name & Customer ContaetfVisited
V. TAX REPORTING & CERTIFICATION
Taxpayer Identification Number ("TIN"): _ 95-3740431
TAX INFORMATION CERTIFICATION: (THE INTERNAL REVENUE SERVICE (IRS) REQUIRES YOUR EXEMPTION
CERTIFICATION BELOW TO AVOID BACKUP WITHHOLDING.) On behalf of the above -named Accountholder, I certify that: (i) the
Accountholder is a U.S. person (includes U.S. resident aliens), (ii) the Taxpayer Identification Number shown above is the Accountholder's correct
taxpayer identification, and (iii) the Accountholder is (check only one box):.[3 not subject to backup withholding because it is exempt fran backup
withholding (nonresident aliens and foreign corporations are generally exempt — see below); or ❑ not subject to backup withholding because it has
not been notified by the IRS that it is subject to backup withholding. (Note: Do not check either box if the Accountholder has been notified by the
IRS that it is currently subject to backup withholding because of underreporting interest or dividends on its tax return.)
The following section most also be completed if the Accountholder is exempt from back-up withholding based on foreign status: To remain
exempt from back-up withholding and/or reduced withholding rates based on income tax treaties or U.S. Law, nonresident aliens and other foreign
nonresident entities must certify foreign status by filing Form W-8 with Wells Fargo Bank _, N.A. On behalf of the above -named Accountholder, I
certify that the Accountholder understands and will promptly comply with the filing requirement in the preceding sentence, and that the
Pagel of 2 Revised 04/01/20033
twuumanu,acr is tcnecu only one oox): 1_,l a non-resident alien individual or non-resident foreign corporation (Form W-813EN); ❑ a foreign
partnership (Form W-8ECl or Form W-81MY); [Ia foreign tax-exempt organization or government (Form W-8ECi or Form W-8EXP); ❑ acting as
an intermediary (Form W-8IMY); or ❑ claiming exemption based on income effectively connected with the conduct of a trade or business %ithin
the United States. (Form W-8EC1).
The Accountholder's permanent address is:
By suing belAw, I certify under penalty of perjury that the information given in this Tax Reporting section is correct.
M
lure
Position / Title FINANCE DIRECTOR
Date 9/28/04
VL AUTHORIZED SIGNERS
(Sign within Box)
ature 1
Printed Name
Position / Title
.a
al)i "
I
DONALD 0. ADOLPH
MAYOR
Loj
Sixnature 2
Printed Name
Position / Title
STANiEY SNIFF.
MAYOR PRO —TEMP
Signature.Signatum.3
Printed Name
Position / Title
THOKAS P. GENEOVESE
CITY MANAGER
Signawre 4
Printed Name
Position / Title
JOHN M FALCONER
TREASURER/FINANCE DIRECTOR
Signature S Printed Name
Signature 6 Printed Name
VID. VII. ACKNOWLEDGEMENT &AGREEMENT
Position / Title
Position / Title
On behalf of the Accountholder, I hereby certify, by my signature below, that each of the individuals designated in Section VI above as an
"Authorized Signer" is authorized, acting alone, to (i) sign checks drawn on, and make cash withdrawals from, the Account, (ii) request stop payment
orders for checks drawn on the Account, and (iii) initiate funds transfers by ACH, wire or other means out of the Account in accordance with the
Accountholder's contractual arrangements with Wells Fargo regarding these services.
Wells Fargo may obtain credit reports or other information about the Accountholder. Wells Fargo may disclose information about each account to its
affiliates, to credit reporting agencies, and to other persons or agencies that, in Wells Fargo's judgement, have a legitimate purpose for obtaining the
information.
I acknowledge that the Accountholder has received a Commercial Account Agreement and agree that its terms and conditions, as amended
jutho
to 069
will govern e A nt.
d Si tune FINANCE DIRECTOR
8O8\\. Position Title
-FA t_C.oa t (!_---
Printed Name JOHN K FALCONER Date 9/28/04
BANK USE ONLY
ACCOUNT NOS :
Date Received
/ /20-
Banker Name
Banker Telephone
Banker MAC
AU
RAU
Officer Number
Family Name
Family Number
FORWARD VIA GOLD BAG TO DOCUMENT MANAGEMENT OR MAC N9777-133 .
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