EMPLOYEE CERTIFICATIONOF PER DIEM AND RIG PAY SUBSTANTIATION REQUIREMENTS EMPLOYEE CERTIFICATION OF PER DIEM AND RIG PAY SUBSTANTIATION REQUIREMENTS This certification is made for the purpose of receiving money in the form of per diem and/or rig pay. As a Frontier Environmental, Inc. employee, I am aware that under § 274(d) of the Internal Revenue Code and § 1.274–5 of the Income Tax Regulations, I may qualify for non-taxable per diem and/or rig pay. I understand the allowances must not exceed the federal per diem and rig pay rates with respect to the amount of ordinary and necessary business expenses paid or incurred while traveling away from home. Therefore, in consideration of my receipt of per diem and rig pay allowance under an accountable plan, I, (Print Full Name)Represent the following to Frontier Environmental, Inc.:1.My Permanent residence location and tax home as defined by the IRS is:Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 2.I perform a small portion (less than 10%) of my business within the vicinity of my permanent home when residing atmy permanent home. I understand any expense reimbursement for the time spent within the vicinity of my permanenthome is to be included in taxable income on my personal income tax return. 3.That I incur duplicate expenses because my business requires me to be away from my permanent home or incur rigexpenses in the course of performing my job duties. 4.Members of my family (marital or lineal) reside at my permanent home, or if I am single, I use my permanent homefrequently for lodging. 5.That the intent of this assignment, located at various job sites in Ohio, Pennsylvania and West Virginia is to betemporary.FURTHERMORE, BY SIGNING BELOW, I ACKNOWLEDGE THAT THE ABOVE STATEMENTS ARE RELIED ON BY FRONTIER ENVIRONMENTAL, INC. FOR THE PURPOSE OF REMITTING PER DIEM AND RIG PAY ALLOWANCES, AND I HOLD HARMLESS FRONTIER ENVIRONMENTAL, INC. FROM ANY PENALTIES, BACK TAXES OR INTEREST THAT MAY RESULT DUE TO ANY CHANGES IN MY RESIDENCE OR ASSIGNMENT THAT MAKE UNTRUE OR FALSE THE STATEMENTS MADE ABOVE, OR AS A RESULT OF ANY INTERNAL REVENUE SERVICE TAXPAYER COMPLIANCE EXAMS. I ALSO ACKNOWLEDGE THAT IF THE REPRESENTATION CONTAINED HEREIN CHANGES, CEASES TO EXIST AND/OR THE ASSIGNMENT EXCEEDS A PERIOD OF 12 MONTHS, I WILL NOTIFY THE COMPANY IMMEDIATELY AND PROVIDE A NEW CERTIFICATION.EmployeeEmployee Signature: Date MM slash DD slash YYYY Last 4 Digits SSN:Frontier WitnessFrontier Witness (print): Date MM slash DD slash YYYY Last 4 Digits SSN:Frontier Witness Signature: Date MM slash DD slash YYYY Last 4 Digits SSN:*Document must be witnessed by an authorized representative of Frontier Environmental, Inc.*
