AG 23-215 - JAVIER CALVO & MARIA ISABEL LEON HERNANDEZ - PARCEL 0921049170RETURN TO: PW ADMIN EXT: 2700 ID #: 4307 / 4315
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT/DIV:. PUBLIC WORKS / Deputy Director
2. ORIGINATING STAFF PERSON: Desiree Winkler EXT: 2711 3. DATE REQ. BY: 9/29/23
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
m REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ ORDINANCE ❑ RESOLUTION
❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL
m OTHER Purchase & Sale Agreement
4. PROJECT NAME: Operations and Maintenance Facility -Property Acquisition PSA Master Template
5. NAME OF CONTRACTOR: Parcel Number: 0921049170
ADDRESS:
E-MAIL:
SIGNATURE NAME
TELEPHONE:
FAY.
TITLE.
6. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE p ALL OTHER
REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
CFW LICENSE # BL, EXP. 12/31/ UBI # _ , EXP. _/ /
7. TERM: COMMENCEMENT DATE: n/a
COMPLETION DATE: n/a
8. TOTAL COMPENSATION: $ 575,000.00 (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
in PURCHASING: PLEASE CHARGE TO: r36610-26110
9. DOCUMENT / CONTRACT REVIEW
❑ PROJECT MANAGER
❑ DIVISION MANAGER
8 DEPUTY DIRECTOR
❑ DIRECTOR
❑ RISK MANAGEMENT (1F APPLICABLE)
d LAW DEPT
INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
DSW 9I20/23
KVA 9/21 /2023
10. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE:
SCHEDULED COUNCIL DATE:
11. CONTRACT SIGNATURE ROUTING
COMMITTEE APPROVAL DATE:
COUNCIL APPROVAL DATE:
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC, D: 10/17/2023
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I 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
❑ FINANCE DEPARTMENT
I LAW DEPT
I SIGNATORY (MAYOR U IRECTOR)
6 CITY CLERK �J
9 ASSIGNED AG #
❑ SIGNED COPY RETURNED
AG#
DATE SENT: In .a.p;:D
COMMENTS:
EXECUTE " 1 " ORIGINALS
Requesting a review of this offer package as the "TEMPLATE" for all offer packages on this project, Once this one is reviewed and approved. we will make all offers on these same forms.
KVA 9/21/23 - template approved
1/2020
Ttlerra
A C L S C 0 M P A N V
DATE: 10/1712023
TO: City of Federal Way
Attn: Desiree S. Winkler, P.E.
Address: 33325 8`` Ave. S.
Federal Way, WA 98003
Phone: (253) 835-2711
RE: Project Name: Federal Way, O & M
Property Owner: Javier Calvo & Maria Isabel Leon Hernandez
Project Parcel No. 092104-9170
DOCUMENT(S) TRANSMITTED:
0 Hand Delivered ❑ US Mail ❑ Pick-un ❑ Other
Dated
No.
Item
9/22/2023
1
Offer Letter -signed acknowledgement
10/11/2023
2
Purchase and Sale A eement- for ci signatures
10/11/2023
3
Warranty Deed - for city signatures
10/11/2023
4
Real Estate Excise Tax Affidavit- for city signature
10/11/2023
5
Real Property Voucher- for processing payment
10/11/2023
6
2 W-9's for each owner - to process payment
10/14/2023
7
Seller's Disclosure Statement -for city review
10/14/2023
8
Utility Service Provider Contact List
10/11/2023
9
Escrow Agreement -need city signature, for escrow to process closing
0 For your Approval & Process
❑ For your Information
❑ As Requested
0 For your Signature
❑ For your Use
❑ For Review & Comment
❑ Other:
COMMENTS:
Desiree,
Please let me know if you will deliver signed original copies to Escrow/Title. I'd like to use an office in
Federal Way. This will make it more convenient when owners meet to sign final documents.
Thanks,
Marge
Marge R. Bailey
Project Manager
Tierra Right of Way Services, Ltd.
8685 Martin Way E., Ste 203, Lacey, WA 98516
253.439.7143 mobile 1 800. 887.0847 1 w'ww.tierr -r01A cane
RECEIVED BY: DATE:
Tierra Right of Way Services, Ltd,
Leslie Findlay Designa-ed Broke; #27965
8685 Martin Way Fast., Suite 203 a Lacey, Washington 98515 . Phone: 206 363 1556
Right of 'vvay a Cultural Resources . Environrrental Planning
Tcil F 800 887 0847 • tie ra-ro�% com
Tterroru
A C L S C 0 M P A N V
9/22/2023
Javier Calvo & Maria Isabel Leon Hernandez
31014 281h Ave S
Federal Way, WA 98003
Offer Letter
Project Title: City of Federal Way, Joint Operations & Maintenance Facility
Parcel No.: 092104-9170
Dear Javier Calvo & Maria Hernandez:
The City of Federal Way (City) plans to proceed with the above -titled public project. The City
will be constructing a new Operations and Maintenance Facility in the Steel Lake proximity.
The purpose of this letter is to notify you of the following:
• The City's interest in acquiring your property and/or property rights for this project.
• The City's determination of just compensation for your property and/or property rights.
• The basic protections afforded to you by law.
As outlined below, the City has established an amount it believes is just compensation based on
the market value estimated for your property. The City's offer is as follows:
Land and Improvements Conveyed in Fee:
$575,000.00
Total Amount
$575,000.0
Your property has been examined by a qualified appraiser and appraisal reviewer who has carefully
considered all the elements which contribute to the market value of your property. You, or your
designated representative, were provided with an opportunity to accompany the appraiser and
appraisal reviewers on all inspections of your property. By law, the appraisers and appraisal
reviewers must disregard any general increase or decrease in value caused by the project.
The City has determined that the project will displace you, your tenants, or your personal property.
By law, you are eligible for relocation assistance consistent with state and federal law and have
rights. Owners and tenants of dwellings, businesses, farm operations, or nonprofit organizations
being displaced cannot be required to move from the referenced property without being given a
written assurance of at least 90 days prior to the date by which they will be required to vacate the
property.
Tierra Right of Way Services, Ltd. LPA-350
Leslie Findlay, Designated Broker #27965 Rev 8/2022
8685 Martin Way East, Suite 203 e Lacey, Washington 98516 ■ Phone: 206.363.1556
Right of Way • Cultural Resources ■ Environmental Planning C
Toll Free: 800.887.0847 a www tierra-row,com
The City will provide this assurance as well as additional information regarding your eligibility in
forthcoming relocation letter entitled, "Notice of Relocation Eligibility, Entitlements, and 90-Day
Assurance". Occupancy of the property beyond the date the City acquires possession will require
that a rental agreement be signed and rent be paid. If the occupant vacates the property within 30
days after the "payment date", the City will refund all prepaid rent.
RCW 64.06 provides for a disclosure statement from sellers of residential property including
multi -family dwellings up to four units and condominiums unless the Purchaser elects to waive
the necessity of said statement. The City, as Purchaser of your property, does require you to
provide the disclosure statement.
If a mutually agreeable settlement is not reached, the City, acting in the public interest, will use its
right of eminent domain to acquire property for public use. In conformity with the Washington
State Constitution and laws, the City's legal counsel will file a condemnation suit to obtain a "Court
Order of Public Use and Necessity", and a trial will be arranged to determine the just compensation
to be paid for the property. This action is taken to ensure your rights as an individual property
owner are protected. If a condemnation action is filed, you should consider consulting with an
attorney to ensure that you receive appropriate representation.
You may wish to employ professional services to evaluate the City's offer. If you do so, we suggest
that you employ well -qualified evaluators so that the resulting evaluation report will be useful to
you in deciding whether to accept the City's offer. The City will reimburse up to $750.00 of your
evaluation costs upon submission of the bills or paid receipts.
The Internal Revenue Service (IRS) requires that the City obtain your correct taxpayer
identification number (TIN) or social security number (SSN) to report income paid to you as a
result of this real estate transaction.
Payment for your property and/or property rights will be made available to you as soon as
reasonably possible after acceptance of the City's offer, provided that there are no delays in closing
the transaction. The date on which payment is made available to you is called the "payment date".
On that date, the City becomes the owner of the property rights purchased and responsible for its
control and management.
If you have personal property presently located on the property being acquired by the City that
needs to be moved, the City will reimburse you for the cost of moving it through the Relocation
Assistance program.
LPA-350 2
Rev. 8/2022
Enclosed please find the following:
• The necessary legal documents for the transferring of the property or property rights
• Real Estate Excise Tax Affidavit
• Real Property Voucher
• W-9 per IRS requirements
■ Utility Service Provider Contact Sheet
r Seller Disclosure Statement
• A copy of the valuation of your property
• Title Report
• Escrow Agreement
• Transportation Needs and You Brochure (explaining the Right of Way acquisition
process)
This letter has been sent to provide a concise statement of the City's offer and summary of your
rights. Please feel free to direct any questions you may have to the undersigned. Thank you for
your time and consideration.
Sincerely,
Brendenn Kralicek
Right of Way Agent
Tierra Right of Way Services, Ltd
8685 Martin Way E., #203
Lacey, WA 98516
bkralicek(a tierra-ro,-Ai.com
(206) 677-8361 mobile
Enclosures
Acknowledgment of receipt of Offer Letter
Signature: Cam- Date: S, 7 _2,02-3
Javier Calvo
1
Signature: 9. Date: Q
Maria Hernandez
Signatime atom does not mean acceptance or rjecfion of offer.
LPA-350
Rev. 8/2022
REAL ESTATE PURCHASE AND SALE AGREEMENT
THIS REAL ESTATE PURCHASE AND SALE AGREEMENT (hereinafter "Agreement") is
entered into by and between Javier Calvo & Maria Isabel Leon Hernandez, husband and wife
a (hereinafter "Seller") and The City of Federal Way, a municipal corporation and political
subdivision of the state of Washington (hereinafter "Purchaser"). Seller and Purchaser may
hereinafter collectively be referred to as "Parties" or individually as a "Party."
AGREEMENT
FOR AND IN CONSIDERATION of the mutual promises and covenants contained herein,
the sufficiency of which is unconditionally acknowledged by Seller and Purchaser, the Parties
agree as follows:
1. The ProperW. Seller is the sole owner in fee simple of a certain real property located in
King County, Washington legally described on the attached Exhibit A (the Property).
2. Purchase and Sale. Seller shall sell and convey to Purchaser, and Purchaser shall
purchase and accept from Seller, upon the terms, covenants, and conditions set forth in this
Agreement, all of Seller's right, title, and interest in and to the Property, including all after -
acquired property. Seller warrants that Seller has full right, title, authority, and capacity to execute
this Agreement and sell the Property. Purchaser warrants that Purchaser has full right, title,
authority, and capacity to execute this Agreement and purchase the Property.
3. Purchase Price and Payment., The total purchase price for the Property (hereinafter
"Purchase Price") is FIVE HUNDRED SEVENTY-FIVE THOUSAND DOLLARS and NO/100
Dollars ($575,000.00) and shall be paid by Purchaser to Seller by cashier's check, certified check,
or wire transfer of immediately available funds to Seller at closing.
4. Conveyance of Title. Seller shall convey title to the Property legally described on the
attached Exhibit A to Purchaser by Statutory Warranty Deed (hereinafter "Deed").
5. Closing; Possession. Closing shall occur upon payment of the Purchase Price to Seller
from Purchaser and delivery of the yxecuted Deed from Seller to Purchaser (hereinafter "Closing
Date"), but in no event later than j I I 2 W The Parties agree to execute any and all documents
necessary to effectuate the intent of this Agreement. Purchaser shall be entitled to possession of
the Property legally described on the attached Exhibit A as of the Closing Date.
6. Risk of Loss. Risk of loss of or damage to the Property shall be borne by Seller until the
Closing Date. Thereafter, Purchaser shall bear the risk of loss. In the event of material loss of or
damage to the Property prior to the Closing Date, Seller shall promptly notify Purchaser in writing
and Seller shall not be obligated to restore the Property nor pay damages to Purchaser by reason
of such loss or damage. Upon receipt of written notice pursuant to Section 10 below, Purchaser
may within five (5) business days terminate this Agreement by giving written notice of such
termination to Seller and such termination shall be effective immediately; provided, however, that
Purchaser may elect to purchase the Property in the condition then existing; provided that,
Purchaser delivers notice of such election pursuant to Section 10 below within five (5) business
days of receipt of Seller's notice of a material loss of or damage to the Property as provided for in
this Section 8.
7. Closing Costs & Prorations. Seller shall pay its own attorney fees. Purchaser shall pay
the cost of recording the Deed, its own attorney fees, and all other costs and expenses allocated to
Purchaser and Seller pursuant to the terms of this Agreement; excepting only the Seller's payment
Page 1 of 5
of its own attorney fees as provided for above in this Section 8 and any prorations for which it is
responsible pursuant to the following sentence. Any taxes, liens, assessments, insurance, or
charges imposed by law upon the Property shall be prorated as of the Closing Date, with such
prorations to be a final settlement between the Parties.
8. Notices. Except as specifically set forth herein, any demand, request or notice which either
Party desires or may be required to make or deliver to the other shall be in writing and shall be
deemed given when personally delivered, or when delivered by private courier service (such as
Federal Express), or three days after being deposited in the United States Mail first class, postage
prepaid and addressed as follows:
PURCHASER
SELLER
Javier Calvo &
City of Federal Way
Maria Isabel Leon Hernandez
33325 8th Ave. S.
31014 28t" Ave. S.
Federal Way, WA 98003
Federal Way, WA 98003
The foregoing addresses may be changed by written notices to the other party as provided herein.
9. Time. Time is of the essence in every provision herein contained.
10. Binding Agreement. This Agreement shall inure to the benefit of and be binding upon
the heirs, personal representative, successors, and assigns of the Parties.
11. Attorneys' Fees. In the event of any litigation regarding the rights and obligations of the
parties under this Agreement, the prevailing party shall recover its costs and attorneys' fees,
including such costs and attorneys' fees for appeals.
12. Negotiation and Construction. This Agreement was negotiated by the Parties and shall
be construed according to its fair meaning and not strictly for or against either Party.
13. Entire Agreement. This Agreement contains the entire understanding between the Parties
and supersedes any prior understandings and agreements between them regarding the subject
matter hereof. There are no other representations, agreements, or understandings, oral or written,
between the Parties relating to the subject matter of this Agreement. No amendment of, or
supplement to, this Agreement shall be valid or effective unless made in writing and executed by
the Parties.
14. Counterparts. This Agreement may be signed in two or more counterparts, which taken
together shall constitute the complete Agreement.
15. Invalid Provision. If any provision of this Agreement is held to be illegal, invalid or
unenforceable under present or future laws, such provision shall be fully severable; this Agreement
shall be construed and enforced as if such illegal, invalid or unenforceable provision had never
comprised a part of this Agreement; and the remaining provisions of this Agreement shall remain
in full force and effect and shall not be affected by such illegal, invalid or unenforceable provision
or by its severance from this Agreement.
[SIGNATURES & ACKNOWLEDGEMENTS APPEAR ON FOLLOWING PAGES]
Page 2 of 5
PURCHASER'S SIGNATURE PAGE
City of Federal Way
Date: ( - } C t-7 , 2023
EJ Walsh, P.E.
Direa6r of Public Works
r
STATE OF WASHINGTON
ss
County of � )
On this -- day of �2M) before me personally appeared EJ Walsh, P.E., to
me known to be the Director of Public Works, for the City of Federal Way, and that he
executed the within and foregoing instrument and acknowledged the said instrument to be the
free and voluntary act and deed of said City of Federal Way, for the uses and purposes
therein set forth, and on oath states that he is authorized to execute said instrument.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
M
chmticQW 01IOW2024 20103606
ATTEST:
�Iaatwl�
Skfha6le Courtney, CMC ty Clerk
�01��120�
Date
aq�JA�
Notaryeiblic in and for the State of
Washington, residing at � erg 'L
My commission expires
APPROVED AS TO FORM:
Ryan Call, City Attor
0' It /1-00
Date
Page 3 of 5
SELLER'S SIGNATURE PAGE
Date: 0 C 7' c0 J3 6:::- R- # � 2023
1 160 �r
Javier Calvo W, .
Maria Isabel Leon Hernandez
STATE OF WASHINGTON
ss
County of Ky,, _9 }
On this 11 day of or-Toi3 e- ►Q before me personally appeared Javier Calvo and
Maria Isabel Leon Hernandez to me known to be the individuals described in and who
executed the foregoing instrument and acknowledged that they signed and sealed the same as
their free and voluntary act and deed, for the uses and purposes therein mentioned.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
NOTARY PUBLIC
STATE OF WASHINGTON
PAULA I. FERREIRA-SMITH
License Number 104062
my cw w ns'm DO" 0541-2025
Pa,,C, F2.RRei RA - S rm;4,.
Notary Public in and for the State of
Washington, residing at /- Yr Y7 wvodl-wFI
My commission expires 05 - 0/ - a 0a2S
Page 4 of 5
EXHIBIT A
LEGAL DESCRIPTION
THE NORTH 75 FEET OF THE WEST 155 FEET OF THE SOUTH HALF OF THE SOUTHEAST
QUARTER OF THE NORTHEAST QUARTER AND THE NORTH 50 FEET OF THE EAST 27 FEET OF
THE WEST 182 FEET OF THE SOUTH HALF OF THE SOUTHEAST QUARTER OF THE NORTHWEST
QUARTER; ALL IN SECTION 9, TOWNSHIP 21 NORTH, RANGE 4 EAST, W.M., RECORDS OF KING
COUNTY, WASHINGTON.
EXCEPT THAT PORTION LYING WITHIN 28TH AVENUE SOUTH
SITUATE IN THE COUNTY OF KING, STATE OF WASHINGTON
Page 5 of 5
After recording return document to:
City of Federal Way
33325 8tn Avenue South
Federal Way, WA 98003
Document Title: Warranty Deed
Reference Number of Related Document:
Grantors: Javier Calvo and Maria Isabel Leon Hernandez
Grantee: City of Federal Way
Legal Description: PTN NW 1/4 SEC 9-21-4E, W.M.
Additional Legal Description is on Page 4 of Document.
Assessor's Tax Parcel Number: 092104-9170
WARRANTY DEED
City of Federal Way, Joint Operations & Maintenance Facility
The Grantors, Javier Calvo and Maria Isabel Leon Hernandez, husband and wife
for and in consideration of the sum of TEN AND NO/100 ($10.00) Dollars, and other valuable
consideration, hereby convey and warrant to the City of Federal Way, a municipal
corporation, Grantee, the following described real property situated in King County, in the
State of Washington, under the imminent threat of the Grantee's exercise of its rights of
Eminent Domain:
For legal description see Exhibit A
attached hereto and made a part hereof.
It is understood and agreed that delivery of this deed is hereby tendered and that the
terms and obligations hereof shall not become binding upon the City of Federal Way unless and
until accepted and approved hereon in writing for the City of Federal Way, by its authorized
agent.
Project No. 36610
LPA-302 Page 1 of (4) Pages Parcel No. 092104-9170
10/2014
WARRANTY DEED
D, 2023
Javier CaLvo
Maria lsabel Leon Hernandez
STATE OF WASHINGTON
ss
County of
On this 1 I day of O&T0 06 ]' before me personally appeared Javier Calyo and
Maria Isabel Leon Hernandez to me known to be the individuals described in and who
executed the foregoing instrument, and acknowledged that they signed and sealed the same
as their free and voluntary act and deed, for the uses and purposes therein mentioned.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
NOTARY pU C
S'NTE OF WAS81N
AAUL4 I. FE;j GTa�
Uoense Nv�+be► N-SMITH
�Y Coa'W Fjprr �&2025
P—Q, & r ln'—tA
Notary Public in and for the State of
Washington, residing at , n,,,) a8l WA
My commission expires , - / - � a -Is-
LPA-302 Page 2 of (4) Pages Parcel No. 092104-9170
10/2014
WARRANTY DEED
City of Federal Way
Date: 1-117 O-L3
{
f
EJ Walsh, P.E.
Director of Public Works
STATE OF WASHINGTON
ss
County of
On this day of OVp�P-K, 2-Wbefore me personally appeared EJ Walsh, P.E., to
me known to be the Director of Public Works, for the City of Federal Way, and that he
executed the within and foregoing instrument and acknowledged the said instrument to be
the free and voluntary act and deed of said City of Federal Way, for the uses and purposes
therein set forth, and on oath states that he is authorized to execute said instrument.
GIVEN under my hand and official seal the day and year last above written.
(SEAL) 022t:v
Notary ublic in and for the State of
Washington, residing at Qmk i� ' j HalfEm
My commission expiresM
ATTEST:
wb6u� &U&W
Sk&laie Courtney, CMC ity Clerk r�
Date
APPROVED AS TO FORM:
Date
LPA-302 Page 3 of (4) Pages Parcel No. 092104-9170
10/2014
WARRANTY DEED
EXHIBIT A
LEGAL DESCRIPTION
THE NORTH 75 FEET OF THE WEST 155 FEET OF THE SOUTH HALF OF THE
SOUTHEAST QUARTER OF THE NORTHEAST QUARTER AND THE NORTH 50
FEET OF THE EAST 27 FEET OF THE WEST 182 FEET OF THE SOUTH HALF OF THE
SOUTHEAST QUARTER OF THE NORTHWEST QUARTER; ALL IN SECTION 9,
TOWNSHIP 21 NORTH, RANGE 4 EAST, W.M., RECORDS OF KING COUNTY,
WASHINGTON.
EXCEPT THAT PORTION LYING WITHIN 28TH AVENUE SOUTH.
SITUATE IN THE COUNTY OF KING, STATE OF WASHINGTON.
Grantor's Initials
M LA
LPA-302 Page 4 of (4) Pages Parcel No. 092104-9170
10/2014
_
Request for Taxpayer
Give Form to the
Form
(Rev. October2018)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
► Go to www.irs.gov/ForrnW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
JAvI
2 Business name/disregarded entity name, if different from above
M
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
following seven boxes.
certain entities, not individuals; see
a
o
Individuallsole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/.tate
instructions on page 3):
ai
single -member LLC
Exempt payee code (if any)
0.0
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
p`
Note: Check the appropriate box in the line abrne for the tax classification of the single -member owner. Do not cheek
Exemption from FATCA reporting
H
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
LLC from for U.S. federal Otherwise,
code if any)
(
.c U
another that is not disregarded the owner tax purposes. a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
V
m
❑ Other (see Instructions) ►
(AWias to axwnrs manlakn d outside the U.S.)
N
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
in
D�
6 City, state, and ZtP code
7 List account numbar(s) here (aptional)
10 Ma Taxpayer Identification Number ff IN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other I �
backup withholding. For individuals, this is generally your social security number ( later. However, fora _ 1W _
�
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a �e /
TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Er plvyer identification number
Number To Give the Requester for guidelines on whose number to enter. FT-7
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. 1 am 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 subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (f 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 withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
Sign Signature of
Here U.S. person ►Atc—t/ y 1
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to wwwJrs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
Date ► /0
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231 X Form W-9 (Rev. 10-2018)
Request for Taxpayer
Give Form to the
Form
(Rev. October2018)
Identification Number and Certification
requester. Do not
Department of the Treasury
Internal Revenue Service
► Go to www.irs.gov/FormW9 for instructions and the latest information.
send to the IRS.
1 N(as shown on your incomeMrn). Name Is required=hise; do not I ave th ais line blank.
2 Business name/disregarded entity name, if different from above
m
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
following seven boxes.
f certain entities, not individuals; see
a
0
IV Individual/sole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrust/estate
I instructions on page 3):
0
to
single -member LLC
Exempt payee code (if any)
ao
�'"'�
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
`p r
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
I w
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
for federal
i
code (f any)
IL u
another LLC that is not disregarded from the owner U.S. tax purposes. Otherwise, a single -member LLC gnat
is disregarded from the owner should check the appropriate box for the tax classification of its owner -
Other (s e2 ins tr uctlonS)►
(Applies to accounts m inlained miside the U.S.)
CL
5 Address (number, street, and apt. or sui no.) See instructions.
Requester's name and address (optlonai)
D
m
31 z
6 Cst ,and ZIP de
l
7 List account numbers) here (opti al)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
(v1
l
MO4 _
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see Now to qet a
i[J
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1
Number To Give the Requester for guidelines on whose number to enter.
Under penalties of perjury, I certify that:
or
Also see What Name and I Employer identification number
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. 1 am 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 subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if 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 withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Signature of
Here I U.S. person ►
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
Date ►
Mae
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
REAL PROPERTY VOUCHER
AUhNCY NAME
City of Federal Way
33325 8th Ave. S.
Federal Way, WA 98003
I h ere by certj under pe nal ty of perjury th at th e items an
amounts listed herein are proper charges against the Agency,
that the same or any part thereof has not been paid, and that I am
authorized to sign for the claimant.
SIGNATURE (IN INK) FOR EACH CLAIMANT
DATED
GRANTOR OR CLAIMANT (NAME, ADDRESS) TINISSN:
Javier Calvo & Maria Isabel Leon Hernandez
31014 28th Ave S. 1R 1)I) — Dq - t 7 bS
Federal Way, WA 98003
Javter Calvo
PROJECT NO. AND TITLE
936610 - City of Federal Way, Joint Operations & Maintenance Facility
FEDERAL AID NO.
PARCEL NO.
1092104-9170
Marta Isabel Leon Hernandez
In full, complete and final payment and settlement for the title or interest conveyed or
released, as fully set forth in:
DATED
$ AMOUNT
LAND: Land and Improvements Conveyed in Fee
+
$575,000.00
IMPROVEMENTS:
Cost to Cure +
Proximity +
Other +
SPECIAL
JC (Just Compensation) Amount
$575,000.00
Uneconomic Remnant +
Excess Acquisition +
DEDUCTIONS:
Amount Previously Paid
Performance Bond
Salvage Amount
Pre Paid Rent
Other
ADMINISTRATIVE SETTLEMENT +
STATUTORY EVALUATION ALLOWANCE +
ESCROW FEE +
REAL ESTATE EXCISE TAX +
OTHER:
ACQUISITION AGENT
Brendenn Kralicek
DATE
D
Voucher No.
TOTAL AMOUI PAID
$575,000.00
AUTHORIZED AGENT FOR AGENCY
DATE
LPA-321 l 012014
Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
This form is your receipt when stamped by cashier. Please type or print.
❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name.
1 Seller/Grantor 2 Buyer/Grantee
Name Javier Calvo and Maria Isabel Leon Hernandez Name Citv of Federal Way
Mailing address 3739 South 168th Street
City/state/zip SeaTac,WA 98188
Phone (including area code) 253.548.5208
3 Send all property tax correspondence to:0 Same as Buyer/Grantee
Name
Mailing address
City/state/zip
Mailing address 33325 8th Ave. S.
City/state/zip Federal Way, WA 98003
Phone (including area code) 253-835-2711
List all real and personal property tax
Personal
Assessed
parcel account numbers
property?
value(s)
092104-9170
❑
497.000.00
❑
snnn
❑
$ 0.00
4 Street address of property 31014 28th Ave S
This property is located in Federal Way (for unincorporated locations please select your county)
❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal description of property (if you need more space, attach a separate sheet to each page of the affidavit)
THE NORTH 75 FEET OF THE WEST 155 FEET OF THE SOUTH HALF OF THE SOUTHEAST QUARTER OF THE
NORTHEAST QUARTER AND THE NORTH 50 FEET OF THE EAST 27 FEET OF THE WEST 182 FEET OF THE
SOUTH HALF OF THE SOUTHEAST QUARTER OF THE NORTHWEST QUARTER; ALL IN SECTION 9, TOWNSHIP 21 NORTH, RANGE 4 EAST, W.M., RECORDS OF KING COUNTY,
WASHINGTON. EXCEPT THAT PORTION LYING WITHIN 28TH AVENUE SOUTH. SITUATE IN THE COUNTY OF KING, STATE OF WASHINGTON.
5 11 - Household, single family units
Enter any additional codes
(see back of last page for instructions)
Was the seller receiving a property tax exemption or deferral
under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior
citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No
Is this property predominately used for timber (as classified
under RCW 84.34 and 84.33) or agriculture (as classified under
RCW 84.34.020) and will continue in it's current use? If yes and
the transfer involves multiple parcels with different classifications, []Yes 0 No
complete the predominate use calculator (see instructions)
7 List all personal property (tangible and intangible) included in selling
price.
N/A
If claiming an exemption, list WAC number and reason for exemption.
WAC number (section/subsection) WAC- 458-61A-206
Reason for exemption
Threat of Eminent Domain
6 Is this property designated as forest land per RCW 84.33? ❑Yes ONO
Type of document WarrantyDeed
Is this property classified as current use (open space, farm , �i I TO �2,
and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No Date of document
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes 0 No
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land
or classification as current use (open space, farm and agriculture, or
timber) land, you must sign on (3) below. The county assessor must then
determine if the land transferred continues to qualify and will indicate
by signing below. If the land no longer qualifies or you do not wish to
continue the designation or classification, it will be removed and the
compensating or additional taxes will be due and payable by the seller
or transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior to
signing (3) below, you may contact your local county assessor for more
information.
This land: ❑ does ❑ does not qualify for
continuance.
Deputy assessor signature Date
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property, sign
(3) below. If the new owner(s) doesn't wish to continue, all additional tax
calculated pursuant to RCW 84.26, shall be due and payable by the seller
or transferor at the time of sale.
(3) NEW OWNER(S) SIGNATURE
Signature Signature
Print name
Print name
Gross selling price .
575 000.00
*Personal property (deduct)
0.00
Exemption claimed (deduct)
575,000.00
Taxable selling price
0.00
Excise tax: state
Less than $525,000.01 at 1.1% 0.00
From $525,000.01 to $1,525,000 at 1.28% 0.00
From $1,525,000.01 to $3,025,000 at 2.75% 0.00
Above $3,025,000 at 3% 0.00
Agricultural and timberland at 1.28% 0,00
Total excise tax: state 0.00
Local 0.00
*Delinquent interest: state 0.00
Local 0.00
*Delinquent penalty 0,00
Subtotal 0.00
*State technology fee 5.00
Affidavit processing fee 5.00
Total due 10.00
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
I CERTIFY UNDER PENALTY OF FJRJURY THAT THE FOREGO I G IS TR E AND CORRECT
Signature of grantor or agent p Signature of grantee or agent
Name (print) ') '� 11,. dame (print). LJ%Xk�e �i- irecloC
Date & city of signing /0 -. ?� � Dc�4L (AL} I Date & city of signing t^w1Z — t k w~'1,
Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five ears, or by
a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021(1)(c)).
To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705.Teletype
(TTY) users may use the WA Relay Service by calling 711.
REV 84 0001a (02/28/23)
THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER
Page 1 of 6
SELLER DISCLOSURE STATEMENT (RCW 64.06 020) Page 1 of 6
INSTRUCTIONS TO TF{E SELLFR
Please complete the following form. Do not leave any spaces blank. If the question clearly does not apply to the property check "N/A." If
the answer is "yes" to any • items, please explain at the end or on attached sheets. Please refer to the question numbers when you
provide your explanations. For your protection you must date and initial each page of this disclosure statement and each attachment.
Delivery of the disclosure statement must occur not later than five business days, unless otherwise agreed, after mutual acceptance of a
written contract to purchase between a buyer and a seller.
NOTICE TO IHE BUYER
THE FOLLOWING DISCLOSURES ARE MADE BY THE SELLER ABOUT THE CONDITION OF THE PROPERTY LOCATED AT
31016 28ah Ave S Fed" Way. WA98003 ("THE PROPERTY"), OR AS LEGALLY DESCRIBED ON ATTACHED EXHIBIT A.
SELLER MAKES THE FOLLOWING DISCLOSURES OF EXISTING MATERIAL FACTS OR MATERIAL DEFECTS TO BUYER BASED ON SELLER'S
ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME SELLER COMPLETES THIS DISCLOSURE STATEMENT. UNLESS YOU AND SELLER
OTHERWISE AGREE IN WRITING, YOU HAVE THREE BUSINESS DAYS FROM THE DAY SELLER OR SELLER'S AGENT DELIVERS THIS
DISCLOSURE STATEMENT TO YOU TO RESCIND THE AGREEMENT BY DELIVERING A SEPARATELY SIGNED WRITTEN STATEMENT OF
RESCISSION TO SELLER OR SELLER'S AGENT. IF THE SELLER DOES NOT GIVE YOU A COMPLETED DISCLOSURE STATEMENT, THEN YOU MAY
WAIVE THE RIGHT TO RESCIND PRIOR TO OR AFTER THE TIME YOU ENTER INTO A SALE AGREEMENT.
THE FOLLOWING ARE DISCLOSURES MADE BY SELLER AND ARE NOT THE REPRESENTATIONS OF ANY REAL ESTATE LICENSEE OR OTHER
PARTY. THIS INFORMATION IS FOR DISCLOSURE ONLY AND IS NOT INTENDED TO BE A PART OF ANY WRITTEN AGREEMENT BETWEEN
BUYER AND SELLER.
FOR A MORE COMPREHENSIVE EXAMINATION OF THE SPECIFIC CONDITION OF THIS PROPERTY YOU ARE ADVISED TO OBTAIN AND PAY
FOR THE SERVICES OF QUALIFIED EXPERTS TO INSPECT THE PROPERTY, WHICH MAY INCLUDE, WITHOUT LIMITATION, ARCHITECTS,
ENGINEERS, LAND SURVEYORS, PLUMBERS, ELECTRICIANS, ROOFERS, BUILDING INSPECTORS, ON -SITE WASTEWATER TREATMENT
INSPECTORS, OR STRUCTURAL PEST INSPECTORS. THE PROSPECTIVE BUYER AND SELLER MAY WISH TO OBTAIN PROFESSIONAL ADVICE OR
INSPECTIONS OF THE PROPERTY OR TO PROVIDE APPROPRIATE PROVISIONS IN A CONTRACT BETWEEN THEM WITH RESPECT TO ANY
ADVICE, INSPECTION, DEFECTS OR WARRANTIES.
Seller 0 is 0 Is not occupying the property.
1. SELLER'S DISCLOSURES
'If you answer "Yes" to a question with an asterisk (0), please explain your answer and attach documents, if available and not otherwise
publicly recorded. If necessary, use an attached sheet.
1. TITLE
YES
NO
DON'T
KNOW
N/A
A. Do you have legal authority to sell the property? If no, please explain:
0 0
0
0
`B. Is title to the property subject to any of the following?
(1) First right of refusal
0
0
0
(2) Option
0
2-
0
0
(3) Lease or rental agreement
0
8"
0
0
(4) Life estate?
0
FY
0
0
•C. Are there any encroachments, boundary agreements, or boundary disputes?
0
0,�
0
0
•D. Is there a private road or easement agreement for access to the property?
0
20'
0
0
'E. Are there any rights -of -way, easements, or access limitations that may affect the Buyer's use of
0
B'
0
0
the property?
•F. Are there any written agreements for joint maintenance of an easement or right-of-way?
0
0
0
*G. Is there any study, survey project, or notice that would adversely affect the property?
Rr'
0
0
0
•H. Are there any pending or existing assessments against the property?
0
0�
0
0
'I. Are there any zoning violations, nonconforming uses, or any unusual restrictions on the property
that would affect future construction or remodeling?
Seller's Initials: -)I' C Date: /0—/c/-.0;�3 Seller's Initials: nLA Date: Ib- &-Zo
F
SELLER DISCLOSURE STATEMENT (� ,.� 4a_ 0i C-2J Page 2 of 6
`J. Is there a boundary survey for the property? 0 Cl Ief 0
•K. Are there any covenants, conditions, or restrictions recorded against the property? ❑ 9" 0 0
2. WATER
YES
NO
DON'T
KNOW
N/A
A. HOUSEHOLD WATER
(1) The source of water for the property is:
9 Private or publicly owned water system
0 Private well serving only the subject property
`0 Other water system:
*If shared, are there any written agreements?
0
i"
0
0
•(2) Is there an easement (recorded or unrecorded) for access to and/or maintenance of the
0
J9K
0
0
water source?
•(3) Are there any problems or repairs needed?
0
0/'
0
0
(4) During your ownership, has the source provided an adequate year-round supply of potable
0'
0
0
0
water? If no, please explain:
'(S) Are there any water treatment systems for the property?
0
12(
0
0
if yes, they are: 0 Leased 0 Owned
' (6) Are there any water rights for the property associated with Its domestic water supply, such
0
0
E"
0
as a water right permit, certificate, or claim?
(a) If yes, has the water right permit, certificate, or claim been assigned, transferred, or
0
B'
0
0
changed?
•(b) If yes, has all or any portion of the water right not been used for five or more successive
0
8'
0
0
years?
•(7) Are there any defects in the operation of the water system (e.g. pipes, tank, pump, etc.)?
0
gr
0
O
B. IRRIGATION WATER
(1) Are there any irrigation water rights for the property, such as a water right permit, certificate,
0
0
0
a/
or claim?
•(a) If yes, has all or any portion of the water right not been used for five or more successive
0
0
0
J�
years?
•(b) If so, is the certificate available? (If yes, please attach a copy.)
0
0
0
113-
'(c) If so, has the water right permit, certificate, or claim been assigned, transferred, or
0
0
0
changed?
'(2) Does the property receive irrigation water from a ditch company, irrigation district, or other
0
0
0
JE'
entity? If so, please identify the entity that supplies water to the property:
C. Outdoor Sprinkler System
0
0
❑
(1) Is there an outdoor sprinkler system for the property?
0(2) If yes, are there any defects in the system?
0
GK
0
❑
0(3) If yes, is the sprinkler system connected to irrigation water?
0
0
0
❑
3. SEWER/ON-SITE SEWAGE SYSTEM YES NO DON'T N/A
KNOW
A. The property is served by:
0 Public sewer system
"n-site sewage system (including pipes, tanks, drainfields, and all other component parts)
0 Other disposal system, please describe: /
B. If public sewer system service is available to the property, is the house connected to the sewer 0 fT ❑ 0
main? If no, pi ase explain.
Seller's Initials: ' C. Date: 0 ' as Seller's Initials: A-Ua, Date:AA:fq-20z3
I
SELLER DISCLOSURE STATEMENT (RCW 64,06,0201
Page 3 of 6
•C. Is the property subject to any sewage system fees or charges in addition to those covered in your
0
0
0
0
regularly billed sewer or on -site sewage system maintenance service?
D. If the property is connected to an on -site sewage system:
13
0
0
•(1) Was a permit issued for its construction, and was it approved by the local health
0
0
2(
0
department or district following its construction?
(2) When was it last pumped? /a- " PtO I *
011"
0
0
0
0(3) Are there any defects in the operation of the on -site sewage system?
C.
0
0
(4) When was it last inspected?
By whom?
(5) For how many bedrooms was the on -site sewage system approved?
0
E. Are all plumbing fixtures, including laundry drain, connected to the sewer/on-site sewage system?
0
0
0
If no, please explain:
*F. Have there been any changes or repairs to the on -site sewage system?
0
0
0
G. Is the on -site sewage system, including the drainfield, located entirely within the boundaries of
0
0
0
the property? If no, please explain:
*H. Does the on -site sewage system require monitoring and maintenance services more frequently
0
.T
0
0
than once a year? .
IF THIS SELLER DISCLOSURE STATEMENT 15 BEING COMPLETED FOR NEW CONSTRUCTION WHICH HAS NEVER BEEN
OCCUPIED, THE
SELLER IS NOT REQUIRED TO COMPLETE THE QUESTIONS LISTED IN ITEM 4. STRUCTURAL OR ITEM S. SYSTEMS
AND FIXTURES.
4. STRUCTURAL
YES
NO
DON?
N/A
KNOW
•A. Has the roof leaked within the last five years?
0
0
0
•B. Has the basement flooded or leaked?
0
0
O
Ar
`C. Have there been any conversions, additions, or remodeling?
0
JE(
0
0
'(1) If yes, were all building permits obtained?
0
0
0
'(2) If yes, were all final inspections obtained?
0
O
0
8'
D. Do you know the age of the house? If yes, year of original construction:
0
0
0
*E. Has there been any settling, slippage, or sliding of the property or its improvements?
0
0
0
*F. Are there any defects with the following: (If yes, please check applicable items and explain.)
0
;3"
0
0
0 Foundations 0 Decks 0 Exterior Walls
0 Chimneys 0 Interior Walls 0 Fire Alarm
0 Doors 0 Windows 0 Patio
0 Ceilings 0 Slab Floors 0 Driveways
0 Pools 0 Hot Tub 0 Sauna
0 Sidewalks 0 Outbuildings 0 Fireplaces
0 Garage Floors 0 Walkways 0 Siding
0 Wheelchair Lifts 0 Woodstoves 0 Elevators
0 Incline Elevators 0 Stairway Chair Lifts 0 Other:
*G. Was a structural pest or "whole house" inspection done? If yes, when and by whom was the fl ❑ ❑
inspection completed? V6 _
Seller's Initials: Dateio -11 -du 'n Seller's Initials: M-T.f„W Dater- 3
SELLER DISCLOSURE STATEMENT (RCW 64.06,02ti) Page 4 of 6
H. During your ownership, has the property had any wood destroying organism or pest infestation? 0 R/ 0 0
I. Is the attic insulated? J( la 0 0
J. Is the basement insulated? 0 ❑ O
S. SYSTEMS AND FIXTURES
YES
NO
DON'T
N/A
KNOW
`A. If any of the following systems or fixtures are included with the transfer, are there any defects? If
yes, please explain.
Electrical system, including wiring, switches, outlets, and service
f
1u
Q
0
0
Plumbing system, including pipes, faucets, fixtures, and toilets
0
0
0
Hot Water Tanks
p'
0
0
Q
Garbage Disposal
0
0
0
W
Appliances
0
if
0
0
Sump Pump
0
0
0
Heating and Cooling Systems
Z�
0
0
0
Security System 17 Owned p leased
0
0
0
Other:
0
0
0
•13. If any of the following fixtures or property is included with the transfer, are they leased? (If yes,
please attach copy of lease.)
Security System
0
J
H
0
0
Tanks (type: ]
0
JZr
0
0
Satellite Dish
13
0
0
Other:
0
,!r
0
0
*C. Are any of the following kinds of wood buming appliances present at the property?
(1) Woodstove?
Z
0
0 O
(2) Fireplace insert?
13
0 0
(3) Pellet Stove?
0
V
0 0
(4) Fireplace?
,'
0
0 0
If yes, are all of the (1) woodstoves or (2) fireplace inserts certified by the U.S. Environmental
0
0
0
Protection Agency as clean burning appliances to improve air quality and public health?
D. Is the property located within a city, county, or district or within a department of natural resources
e
0
0 0
fire protection zone that provides fire protection services?
E. Is the property equipped with carbon monoxide alarms?
iK
0
0 0
(Note: Pursuant to RCW 19.27.530the seller must equip the residence with carbon monoxide
alarms as required by the state building code.)
F. Is the property equipped with smoke detection devices?
0
0 ❑
(Note: Pursuant to RCW 43.44 11C, if the property is not equipped with at least one smoke detection
device, at least one must be provided by the seller.)
Seller's Initials' C. Date:/0 -AV-.2o.;A 3 Seller's Initials: u iLu. Date:"— IZ3
SELLER DISCLOSURE STATEMENT (RCW 64.06.020) Page 5 of 6
6. HOMEOWNERS' ASSOCIATIONS / COMMON INTERESTS
YES
NO
DON'T
N/A
KNOW
A. Is there a Homeowners' Association? Name of Association and contact information for an officer,
0
0
0
director, employee, or other authorized agent, if any, who may provide the association's financial
statements, minutes, bylaws, fining policy, and other information that is not publicly available:
B. Are there regular periodic assessments:
0
0
0
�} "
$ per 0 Month 0 Year 0 Other:
`C. Are there any pending special assessments?
0
.r
0
0
*D. Are there any shared "common areas" or any joint maintenance agreements (facilities such as
0
Jr
0
0
walls, fences, landscaping, pools, tennis courts, walkways, or other areas co -owned in undivided
interest with others)?
7. ENVIRONMENTAL
YES
NO
DON'T
N/A
KNOW
•A. Have there been any flooding, standing water, or drainage problems on the property that affect
0
J7
0
0
the property or access to the property?
'B. Does any part of the property contain fill dirt, waste, or other fill material?
'C. Is there any material damage -to the property from fire, wind, floods, beach movements,
0
0
0
earthquake, expansive soils, or landslides?
D. Are there any shorelines, wetlands, floodplains, or critical areas on the property?
El
0
0
•E. Are there any substances, materials, or products in or on the property that may be environmental
0
Ar
0
0
concerns, such as asbestos, formaldehyde, radon gas, lead -based paint, fuel or chemical storage
tanks, or contaminated soil or water?
OF. Has the property been used for commercial or industrial purposes?
0
E'
0
0
`G. Is there any soil or groundwater contamination?
0
Jr
0
0
H. Are there transmission poles or other electrical utility equipment installed, maintained, or buried
0
Je
0
0
on the property that do not provide utility service to the structures on the property?
'I. Has the property been used as a legal or illegal dumping site?
0
.i!r
0
0
'J. Has the property been used as an illegal drug manufacturing site?
0
iff'
0
0
•K. Are there any radio towers in the area that cause interference with cellular telephone reception?
0
i f
0
0
8. MANUFACTURED AND MOBILE HOMES
DON'T
If the property includes a manufactured or mobile home:
YES
NO
KNOW
N/A
'A. Did you make any alterations to the home? If yes, please describe the alterations:
0
❑
0
AIr
'B. Did any previous owner make any alterations to the home?
0
,0
17
0
*C. If alterations were made, were permits or variances for these alterations obtained?
0
0
0
9. FULL DISCLOSURE BY SELLERS NO DON'T N/A
KNOW
A. Other conditions or defects: � Ar 0
'Are there any other existing material defects affecting the property that a prospective buyer should
know about? y ,
Seller's =` G Date:�c,Zy� 3 Seller's Initials: My„w• Datella--u-foo
SELLER DISCLOSURE STATEMENT (RCW 64.06.020)
Page 6 of 6
if you answered Wes" to any questions with an asterisk (•), use the following space to provide an explanation for each answer.
Please refer to each question number. Attach additional pages if necessary (and initial and date each page):
B. Verification:
The foregoing answers and attached explanations (if any) are complete and correct to the best of my/our knowledge and I/we have
received a copy hereof. I/we authorize all of my/our real estate licensees, if any, to deliver a copy of this disclosure statement to other
real estate licensees and all prospective buyers of the property.
SELLER DATE
SELLER
DATE
NOTICE TO THE BUYER:
INFORMATION REGARDING REGISTERED SEX OFFENDERS MAY BE OBTAINED FROM LOCAL LAW ENFORCEMENT AGENCIES, THIS NOTICE
IS INTENDED ONLY TO INFORM YOU OF WHERE TO OBTAIN THIS INFORMATION AND IS NOT AN INDICATION OF THE PRESENCE OF
REGISTERED SEX OFFENDERS.
II. BUYER'S ACKNOWLEDGMENT
A. Buyer hereby acknowledges that: Buyer has a duty to pay diligent attention to any material defects that are known to Buyer or can
be known to Buyer by utilizing diligent attention and observation.
B. The disclosures set forth in this statement and in any amendments to this statement are made only by the Seller and not by any real
estate licensee or other parry.
C. Buyer acknowledges that, pursuant to RCW 64.06.050(2), real estate licensees are not liable for inaccurate information provided by
Seller, except to the extent that real estate licensees know of such inaccurate information.
D. This information is for disclosure only and is not intended to be a part of the written agreement between the Buyer and Seller.
E. Buyer (which term includes all persons signing the "Buyer's acceptance" portion of this disclosure statement below) has received a
copy of this Disclosure Statement (including attachments, if any) bearing Seller's signature.
DISCLOSURES CONTAINED IN THIS DISCLOSURE STATEMENT ARE PROVIDED BY SELLER BASED ON SELLER'S ACTUAL KNOWLEDGE OF THE
PROPERTY AT THE TIME SELLER COMPLETES THIS DISCLOSURE STATEMENT. UNLESS BUYER AND SELLER OTHERWISE AGREE IN WRITING,
BUYER SHALL HAVE THREE BUSINESS DAYS FROM THE DAY SELLER OR SELLER'S AGENT DELIVERS THIS DISCLOSURE STATEMENT TO
RESCIND THE AGREEMENT BY DELIVERING A SEPARATELY SIGNED WRITTEN STATEMENT OF RESCISSION TO SELLER OR SELLER'S AGENT.
YOU MAY WAIVE THE RIGHT TO RESCIND PRIOR TO OR AFTER THE TIME YOU ENTER INTO A SALE AGREEMENT.
BUYER HEREBY ACKNOWLEDGES RECEIPT OF A COPY OF THIS DISCLOSURE STATEMENT AND ACKNOWLEDGES THAT THE DISCLOSURES
MADE HEREIN ARE THOSE OF THE SELLER ONLY, AND NOT OF ANY REAL ESTATE LICENSEE OR OTHER PARTY.
�wk� I011-7 IZ0,13 _
BUYER c-. ,r �( v C- G &Oc"L- -AN DATE BUYER DATE
Seller's Initials: J r C, Date: 11J-20Z3 Seller's Initials: T 1_ , Date:X- 1`1-XZA
Form Made Fillable by eForms
Name: Javier Calvo & Maria Hernandez
Phone: 253.548.5208
Address: 31014 28th Ave S. Federal Way, WA 98003
UTILITY SERVICE PROVIDER CONTACT SHEET
Water
Name
Address
EL
City, State Zip,
Woy A- R�E,3
Phone Number
Fax Number
Sewer
Name
Address
City, State Zip
Phone Number
Fax Number
Garbage
Name
Address
2
City, State Zip
0
Phon,c Number
Fax Number
Electricity
Name
T
Address
CAL
City, State Zip BeN
Q
W
Phone Number
Fax Number
25
Gas
Name Rdc�
Address '
P'.0 -k%cx
City, State Zip
Tne Number
tax Number
Internet
Name
Address
City, State Zip
Phone Number
Name
Address
City, State Zip
Phone Number
Fax Number
Fax Number
Cable
Leased Equipment
Name
Address
City, State Zip
Phone Number
Fax Number
Other:
ESCROW AGREEMENT
TO: Chicago Title Company of Washington OWNERS:
701 5" Avenue, Suite 2700 Javier Calvo & Maria Isabel Leon Hernandez
Seattle, WA 98104 31014 281 Ave. S.
(206)628-5600 Federal Way, WA 98003
CTISeattleTitleUnit4@ctt.com
Title Commitment Number: 0253203-04
Commitment Date: March 28, 2023
Parcel Number: 92104-9170
DATE: 10I j J ZVZ
City of Federal Way, and the undersigned, mutually agree and direct you to close this escrow in accordance with the following
instructions:
1. The undersigned grantors hereby authorize the issuance of a City of Federal Way warrant payable solely to the above -named
Escrow Agent, for our benefit.
2. Receive the Warranter handed herewith from us as grantors to the City of Federal Way as grantee, conveying the lands
described in your above -referenced Preliminary Commitment.
3. Receive the sum of $575.000.00 in the form of a City of Federal Way warrant that you are instructed to distribute as follows:
Pay and eliminate of record all encumbrances on said premises shown in your Preliminary Commitment 0253203-04 dated
March 28, 2023, with any other encumbrances appearing on record against said premise, on statement of holder or holder's
representative prior to closing, except those noted on: # 1, #2, #3, #4, #6 of Schedule B, Part 2- Special Exemptions.
4. Note: All escrow and recording Fees shall be paid by the City of Federal Way
5. The City of Federal Way, at its discretion, reserves the right to withdraw the funds for this transaction from escrow and close
this transaction independently or deposit said funds with the Clerk of the Court if deemed necessary.
6. When ready to vest title in City of Federal Way, record instrument shown in instruction 2 above (no recording fee or excise
tax is to be charged) and prepare CLOSING DETAIL STATEMENT as explained on the reverse hereof.
7. Remit the balance by your check to: Javier Calvo & Maria Isabel Leon Hernandez, 31014 281 Ave. S_ Federal Way, WA
98003 with your CLOSING DETAIL STATEMENT.
8. Issue standard form Owner's policy of title insurance in the sum of $575,000.00 insuring City of Federal Way as owner of the
estate conveyed.
9. Upon closing, mail recorded instruments, title policy, and copy of CLOSING DETAIL STATEMENT to City of Federal
Way. 33325 91 Ave, S.. Federal Way. WA 98003.
City of Federal Way
�j� /I/1/?its 101 V712.o73
By: Date
Public Works Director
E ) - 'AJ0-ksh,FE.
OwnersA�11� ( l
o
y: favier Calvo Date
— /=. // - 2
By: Maria lsabel Lori Hernandez Date
Javier Calvo & Maria Isabel Leon Hernandez.docx
CLOSING DETAIL STATEMENT
As indicated on the Escrow Instructions, the Escrow Agent shall furnish, upon the completion of the escrow
transaction, a CLOSING DETAIL STATEMENT that will show thereon:
(a) The date of receipt and total amount of escrowed funds.
(b) The fee for escrow services and a statement that the entire escrow fee has been paid solely by the City of
Federal Way.
(c) The date on which the City of Federal Way's grantor(s) is notified that the Escrow Agent is ready to disburse
funds to the City of Federal Way's grantor(s).
(d) Date of closing of the escrow.
(e) Detail of a mortgage payoff that includes:
Principal unpaid balance and date.
Accrued interest and dates for which interest is paid.
Prepayment penalty assessed, if any.
Offset of reserves held by mortgagee.
Net amount paid to mortgagee and date.
(f) Sums, if any, withheld from distribution to the City of Federal Way's grantors at time of closing, and for what
reason.
(g) Endorsements to the effect that:
1. The statement has been read by the City of Federal Way's grantor, approved, and
acknowledgment of receipt of the funds indicated as the net balance due from the Escrow
Agent.
2. The closing officer certifies that the statement is true and correct.
In case the Escrow Agent has withheld funds from distribution to the City of Federal Way's grantor(s) for any reason, the Escrow
Agent shall furnish to the City of Federal Way copies of correspondence transmitting such withheld funds at the time of their
final disposition.
Javier Calvo & Maria Isabel Leon Hemandez.docx