AG 12-166 - U.S. DEPT OF HOUSING & URBAN DEVELOPMENTRETURN TO:
I*A9
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV: (,& S
2. ORIGINATING STAFF PERSON:T)" 6?%Wd gn EXT: 3. DATE REQ. BY
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
❑ CONTRAC14,MEN MENT (AG #): ❑ INTERLOCAL
�THER
5. PROJECT NAME:
6. NAME OF CONTRACTOR: i , u S L 11
ADDRESS:
E -MAIL: D 2
SIGNATURE NAME: ,?:.L in IA/_ �� /D✓ r
_ FAX:
TITLE h lee C,4 -
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:�/� COMPLETION DATE:
9. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOIZ 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
❑ PURCHASING: PLEASE CHARGE TO:
10. DOCUMENT /CONTRACT REVIEW
• PROJECT MANAGER
• DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAW
INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
• LAW DEPARTMENT
• CHIEF OF STAFF
PI'SIGNATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK
❑ ASSIGNED AG#
❑ SIGNED COPY RETURNED
COMMENTS:
11/9
INITIAL/ DATE SIGNED
G# ( 3 -o2
DATE SENT:
Funding Approval /Agreemok
Title I of the Housing and Community
Development Act (Public Law 930383)
HI- 00515R of 20515R
1. Name of Grantee (as shown in item 5 of Standard Form 4;
City of Federal Way
33325 8n' Avenue South
Federal Way WA 98003
U.S. Department of Housi4wd Urban Development
Office of Community Planning and Development
Community Development Block Grant Program OMB Approval No.
2506 -0193 (exp 1/31/2015)
3a. Grantee's 9 -digit Tax 3b. Grantee's DUNS Number: 4. Date use of funds may
ID Number: 61- 2509901 begin (mm /dd/yyyy):
91- 1462550
5a. Project/Grant No. 1 6a. Amount Approved
B- 12 -MC -53 -0015 $349,420.00
5b. Project/Grant No. 2 6b. Amount Approved
5c: Proiect/Grant No. 3 1 6c.
Grant Agreement: This Grant Agreement between the Department of Housing and Urban Development (HUD) and the above named Grantee is made pursuant to the
authority of Title I of the Housing and Community Development Act of 1974, as amended, (42 USC 5301 et seq.). The Grantee's submissions for Title I assistance, the
HUD regulations at 24 CFR Part 570 (as now in effect and as may be amended from time to time), and this Funding Approval, including any special
conditions /addendums, constitute part of the Agreement. Subject to the provisions of this Grant Agreement, HUD will make the funding assistance specified here
available to the Grantee upon execution of the Agreement by the parties. The funding assistance specified in the Funding Approval may be used to pay costs incurred
after the date specified in item 4 above provided the activities to which such costs are related are carried out in compliance with all applicable requirements. Pre-
agreement costs may not be paid with funding assistance specified here unless they are authorized in HUD regulations or approved by waiver and listed in the special
conditions to the Funding Approval. The Grantee agrees to assume all of the responsibilities for environmental review, decision making, and actions, as specified and
required in regulations issued by the Secretary pursuant to Section 104(g) of Title I and published in 24 CFR Part 58. The Grantee further acknowledges its
responsibility for adherence to the Agreement by sub - recipient entities to which it makes funding assistance hereunder available.
U.S. Department of Housing and Urban Development (By Name)
Grantee Name
John W. Peters
City of Federal Way
Title
Director, Office of Commu 'ty lanning and Development
Title A o ^ O
'v
Signature
a)
Date (mm /dd/yyyy)
10/31/2013
Date (mm /dd/yyyy)
IV7111
7. Category of Title 1 Assistance for this Funding Action
(check only one)
X a. Entitlement, Sec 106(b)
❑ b. State - Administered, Sec 106(d)(1)
❑ c. HUD - Administered Small Cities, Sec 106(d)(2)(B)
❑ d. Indian CDBG Programs, Sec 106(a)(1)
8. Special Conditions
(check one)
® None
❑ Attached
9a. Date HUD Received Submission
(mm /dd/yyyy)
10. check one
❑a. Orig. Funding
Approval
® b. Amendment
Amendment Number
2012-001
9b. Date Grantee Notified
(mm /dd/yyyy) 10/31/2013
9c. Date of Start of Program Year
I (mm /dd/yyyy)
❑ e. Surplus Urban Renewal Funds, Sec 112(b)
11. Amount of Community Development
❑ f. Special Purpose Grants, Sec 107
Block Grant FY (2012) FY (
) FY ( )
a. Funds Reserved for this Grantee
349420
❑ g. Loan Guarantee, Sec 108
b. Funds now being Approved
349420
c. Reservation to be Cancelled
ila minus lib
12a. Amount of Loan Guarantee Commitment now being Approved
12b. Name and complete Address of Public Agency
Loan Guarantee Acceptance Provisions for Designated Agencies:
The public agency hereby accepts the Grant Agreement executed by the
Department of Housing and Urban Development on the above date with
respect to the above grant number(s) as Grantee designated to receive
loan guarantee assistance, and agrees to comply with the terms and
12c. Name of Authorized Official for Designated Public Agency
conditions of the Agreement, applicable regulations, and other
requirements of HUD now or hereafter in effect, pertaining to the
Title
assistance provided it.
Signature
HUD Accounting use Only
Effective Date
Batch TAC Program Y A Reg Area Document No. Project Number Category Amount (mm /dd/yyyy)
FM 176 FRI 0 U 0 [E I I I 7_1 I
Y Project Number Amount
Y Project Number Amount
0 L I I I I I I I
Date Entered PAS (mm /dd/yyyy)
Date Entered L
Transaction Code I Entered By
ventieo tty
24 CFR 570 form HUD -7082 (11