AG 22-132 - ELIZABETH KELLERMANRETURN TO: PW ADMIN EXT: 2700 ID #: 4164
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT/DIV: PUBLIC WORKS /
2. ORIGINATING STAFF PERSON: Desiree Winkler EXT: 2711 3. DATE REQ. BY: 11 /4/22
3. TYPE OF DOCUMENT (CHECK ONE):
p 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
m OTHER Major Sidewalk Repair Aareementa
4. PROJECT NAME: Major Sidewalk Repair Agreement - 4720 SW 315th PI
5. NAMEOFCONTRACI'OR: Elizabeth Kellerman
ADDRESS: 4720 SW 315th Place Federal Way,VII
E-MAIL: tali ref rtyahoomm
SIGNATURE NAME: Elizabeth Kellerman
6. EXHIBITS AND ATTACHMENTS: m SCOPE, WORK OR SERVICES
REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN
CFW LICENSE # n/a BL, EXP. 12/31/
TELEPHONE:
FAX:
TITLE: Property Owner
m COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER
❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
UBI # n/a , EXP.
7. TERM: COMMENCEMENT DATE: COMPLETION DATE: 1c��
8. TOTAL COMPENSATION: $ she pays City l q..W. 12S (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: ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
O PURCHASING: PLEASE CHARGE TO:
9. DOCUMENT / CONTRACT REVIEW INITIAL / DATE REVIEWED
❑ PROJECT MANAGER
❑ DIVISION MANAGER
8 DEPUTY DIRECTOR DSW 10/24/22
6 DIRECTOR N- -�
❑ RISK MANAGEMENT (IF APPLICABLE)
6 LAW DEPT KVA 10/27/2022
10. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: "a
SCHEDULED COUNCIL DATE: n/a
INITIAL / DATE APPROVED
COMMITTEE APPROVAL DATE:
COUNCIL APPROVAL DATE:
11. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT:
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATI
DATE REC' D:
(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
❑ FINANCE DEPARTMENT
❑ LAW DEPT
p(SIGNATORY (MAYOR OR IE EM' R
CITY CLERK
❑ ASSIGNED AG #
❑ SIGNED COPY RETURNED
COMMENTS:
EXECUTE " " ORIGINALS
Confirmed property owner via King County Assessor
ti � I z�zZ
AG
DATE SENT:
I/2020
CITY OF CITY HALL
Fe d e ra I Way Feder 8th Avenue South
Federal Way. WA 98003-6325
(253) 835-7000
www cityoffederalway com
REIMBURSEMENT AGREEMENT
FOR
SIDEWALK REPAIRS
This Reimbursement Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and the individual or entity identified below ("Responsible Person") (collectively "Parties"), and shall
be effective on the date of mutual execution below.
RECITALS
A. Federal Way Revised Code ("FWRC") 4.40.020 places responsibility for sidewalk maintenance, repair,
reconstruction, and/or construction upon the abutting property owner or occupant when damage to the sidewalk is
caused by the abutting property owner's act, error, or omission.
B. Under FWRC 4.40.025, when repair, reconstruction and/or construction of a sidewalk is necessary in the City's
determination, and where such work is the responsibility of the abutting property owner or occupant, the
responsible person must either perform the necessary repair, reconstruction and/or construction at their own
expense, or request that the City undertake the necessary work at the expense of the responsible person.
C. The City has determined that the Responsible Person is responsible for repair, reconstruction and/or construction of
sidewalk, and the Responsible Person has requested the City undertake the necessary work at the expense of the
Responsible Person.
D. The City has determined that it shall undertake the required work under FWRC 4.40.025, and has prepared this
Agreement to govern reimbursement of the costs associated with the required sidewalk repair, reconstruction
and/or construction by the Responsible Person.
Now, therefore, the Parties agree as follows:
AGREEMENT
1. SCOPE OF PROJECT; WORK TO BE PERFORMED. The location and scope of the sidewalk repair,
reconstruction and/or construction is specifically described in Exhibit A ("Sidewalk Work"), attached hereto and
incorporated by this reference. The City shall perform the Sidewalk Work with the City's own employees, or with a
contractor(s) of the City's choosing. The City is authorized to engage contractors at its sole discretion.
2. TIMING. City shall perform the Sidewalk Work within a reasonable time, as resources permit. Any project
schedule identified in Exhibit A or elsewhere in this agreement is an estimate only and subject to change with respect to
both commencement and completion.
3. ENGINEERING AND CONSTRUCTION COSTS_. The Responsible Person shall be responsible for the cost of
the Sidewalk Work in its entirety ("Engineering and Construction Costs"), and shall reimburse the City for the Engineering
and Construction Costs as provided in Section 4 below. The estimated Engineering and Construction Costs are Nine
Thousand Six Hundred Forty -Four and 18/100 dollars ($9,644.18) as listed in Exhibit B. The estimated Engineering and
Construction Costs identified in this section are an estimate only, and subject to change. The Responsible Person shall be
responsible for the full Engineering and Construction Costs even if all estimates are exceeded. The City waives and shall
not collect any applicable Street Use Permit fees.
4. REIMBURSEMENT.
4.1 Payment. Following completion of the Sidewalk Work, the City shall submit an invoice to the Responsible
Person containing an itemized list of Engineering and Construction Costs for the Sidewalk Work. The Responsible Person
shall tender payment for the full amount of the invoice to the City within thirty (30) days after receipt of the invoice, unless
SIDEWALK REIMBURSEMENT AGREEMENT - 1 - Rev. 9/2022
CITY of CITY HALL
33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
(253) 835-7000
www atyof ederalway com
the Responsible Person elects to pay in monthly installments as provided in Section 4.2.
4.2 Installments. Payment may be made in monthly installments of not less than Three Hundred and no/100
dollars ($300.00) per month until paid in full. A service charge of ten and 00/00 dollars $10.00 per month shall be added to
the total invoiced amount if the Responsible Person chooses to make installment payments.
4.3 Failure to Pax, Collection Procedures. Should the Responsible Person fail to timely pay the invoice, or fail
to timely pay an installment payment, the City may utilize any collection method to recover the full Engineering and
Construction Costs.
5. NOTICES.
The Parties are located and/or do business at the below addresses, which shall be valid for any notice required under this
Agreement:
RESPONSIBLE PERSON:
Elizabeth Kellerman
4720 SW 315" Place
Federal Way, WA 98023
818-468-2402 (telephone)
call ref(a)yahoo.com
6. GENERAL PROVISIONS.
CITY OF FEDERAL WAY:
Desire6 S. Winkler, P.E.
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835.2711 (telephone)
desiree.winkler@cityoffederalway.com
6.1 Indemnification. The Responsible Person agrees to release, indemnify, defend and hold the City, its
officers, directors, shareholders, partners, employees, agents, representatives, contractors and sub -contractors harmless
from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments,
awards, injuries, damages, liabilities, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation
expenses to or by any and all persons or entities, including without limitation, their respective agents, licensees, or
representatives, arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent
acts, errors, or omissions of the City.
6.2. Execution. Each individual executing this Agreement on behalf of the City and Owner represents and
warrants that such individual is duly authorized to execute and deliver this Agreement. This Agreement may be executed in
any number of counterparts, each of which shall be deemed an original and with the same effect as if all Parties hereto had
signed the same document. All such counterparts shall be construed together and shall constitute one instrument, but in
making proof hereof, it shall only be necessary to produce one such counterpart. The signature and acknowledgment pages
from such counterparts may be assembled together to form a single instrument comprised of all pages of this Agreement
and a complete set of all signature and acknowledgment pages. The date upon which the last of all of the Parties have
executed a counterpart of this Agreement shall be the "date of mutual execution" hereof.
[Signature page follows]
SIDEWALK REIMBURSEMENT AGREEMENT - 2 - Rev. 9/2022
CITY 4F
Federal Way
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoifederalway, com
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY:
E.J. 6alsh, Public Works Director
DATE: X\ \ \b`?p22
Elizabeth Kellerman:
By:
Printed Name:!c I l ec►MG^
Title: 0(,, „n e C
DATE: rI I I Z / 2-0'2-Z
STATE OF WASHINGTON )
ss.
COUNTY OF
On this day personally appeared before me, , to me known to be
the individual described in and who executed the foregoing instrument, and on oath swore that he/she/they
executed the foregoing instrument as his/her/their free and voluntary act and deed for the uses and purposes
therein mentioned.
GIVEN my hand and official seal this day of
Notary's signature
Notary's printed name
See Attached Certificate
20_
Notary Public in and for the State of Washington.
My commission expires
SIDEWALK REIMBURSEMENT AGREEMENT - 3 - Rev. 9/2022
CALIFORNIA ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California 1
County of San Francisco J}
On 12, 2021 before me. f%N'L l_llli A- ��u� iw IVai-Av l �—Li3Lit:
Date Here Insert Name and Title of the Officer
personally appeared r LI 2 ��� LLi}[ L a Z
Nome(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
PAULWlLLIAMYOUNAOIM MntarpPuhlie- iallturnta paragraph is true and correct.
San Fran[is[n ccun;y —
C9mmfsson p 22G9085 WITNESS my hand and official seal.
:tiy {^ nfi. E%p3rEi tiBC 1. 20
2i'
Signature-
Place Notary Seal and/or Stamp Above Signature of Notarypdb is
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Docu
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:
�)2019 National Notary Association
Number of Pages:
Signer's NarneF.- _
❑ Corporate Officer
❑ Partner — ❑ Limited ❑ G-arleral
❑ Individual ❑ Attorney -in- Fact
ElTrustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:
CITY OF CITY HALL
33325 8th Avenue South
Federal ay Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway. com
EXHIBIT A
SIDEWALK WORK
1. Location of Sidewalk Work: 4720 SW 315th Place, Federal Way, WA 98003
2. Scope of Sidewalk Work:
■ Concrete Panel Replacement (35 feet): Concrete sidewalk panel removal and disposal, tree and
tree root removal, crushed rock base installation and compaction, concrete panel placement,
landscape restoration, clean-up, and traffic control.
Schedule of Sidewalk Work: Work will be completed as part of the city's 2023 Asphalt Overlay
Project. Estimated schedule for this sidewalk work is between April 2023 and July 2023.
SIDEWALK REIMBURSEMENT AGREEMENT - 4 - Rev. 9/2022
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