AG 21-201 - HISTORICAL SOCIETY OF FEDERAL WAYRETURN TO: Pam Jones EXT: 2402
I CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM I
1. ORIGINATING DEPT./DIV: Mayor's office
2. ORIGINATING STAFF PERSON: Pam Jones
EXT: 2402 3. DATE REQ. BY: 1018121
4. TYPE OF DOCUMENT (CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT
❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ ORDINANCE ❑ RESOLUTION
❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL
Lit OTHER Deed of Gift
5. PROJECTNAME: Deed of Gift - Historical Society of Federal Way
6. NAME OF CONTRACTOR: Historical Society of Federal Way
ADDRESS: 1600 B SW Dash Point Road #125, Federal Way, WA 98003 TELEPHONE 253-945-7842
E-MAIL: contactus@federalwayhistory.org FAX:
SIGNATURENAME: Karen Nelson 'TITLE Administrator
7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT DATE: NIA
9
COMPLETION DATE: NIA
TOTAL COMPENSATION $ NIA (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE -ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED AYES 10NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO: wA
10. DOCUMENT/CONTRACT REVIEW
❑ PROJECT MANAGER
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAW
11. COUNCILAPPROVAL(IF APPLICABLE)
INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC' I ). _
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE
(Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.)
INITIAL / DATE SIGNED
❑ I, DEPARTMENT
1GNATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK 11D
❑ ASSIGNED AG# AG#
COM ENTS:
:C' Cc,,
S 4It
Ict .-- C
7
- 1600 B SW Dash Pt Road - #125
Federal Way, Washington 98023
253.945.7842 - www.federalwayhistory.org
'�istoriraf
gociiet
October 1, 2021
Mayor Jim Ferrell
33325 8th Ave S
Federal Way, WA 98003
Dear Mayor Jim Ferrell,
On behalf of the Officers and Directors of the Historical Society, the community, and visiting
researchers, I would like to thank you for your recent gift to the Historical Society of Federal Way.
Accession# 2021.015
Donation:
Map of WA, gifted to Federal Way at incorporation. Map is signed (on back) by Governor
Gardener and Secretary of State Munro (dated 1 /90).
Map shows WA at time of statehood (1889).
In order to complete the donation, please sign both copies of the Deed of Gift. Please return the
original in the self-addressed, stamped envelope enclosed. You may retain the copy for your
records.
Again, thank you for your generous gift.
Kti.,e,. NeG,a,,
Karen Nelson
Administrator
Enclosures: Deed of gift (2) and self-addressed, stamped envelope (1)
DEED OF GIFT
Historical Society of Federal Way, 1600B SW Dash Point DR #125, Federal Way
98023
Name:
Address:
1:ra i WA.Uj Date: 0 2?
City: State: WA Zip: 28003
PhoneH/W: 53 8 -24 Fax:
I own the property described below /represent the owner and desire to give said property to the Historical
Society of Federal Way (HSFW). I am legally authorized and do hereby irrevocably and unconditionally give
and transfer to the HSFW all right, title, and interest, including all copyright, trademark, and related interests,
in and to the following described property.
Description of Gift:
Map of WA, gifted to Federal Way at incorporation. Map is signed (on back) by Governor Gardener and
Secretary of State Munro (dated 1/90).
Map shows WA at time of statehood (1889).
By my signature below I accept the foregoing conditions and acknowledge reading any attached information.
This gift is given in memory of:
Dated: 0 G 1
Date received: -2-q 174'L1
Donor/agentent
Received by:
THE GIFT DESCRIBED ABOVE IS ACCEPTED FOR HISTORICAL SOCIETY OF FEDERAL WAY
By V-A"- --
name
title date
Accession# 2021.015