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AG 13-236RETURN TO: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: 2. ORIGINATING STAFF d1" EXT: 11 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 ❑ CONTRACT AMENDMENT (AG #): ❑ INTERLOCAL OTHER Lt jo A AL 5. PROJECT NAME: 2.O G k3 FGr Aye zmm- 6. NAME OF CONTRACTOR.' ' ' U4 ADDRESS: qb AA SIGNATURE NAME: Q SG J ! GTO TELEPHONE 206' Z `L0 - 5ZA FAX: TITLE 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: I ZI LZ p I COMPLETION DATE: 12,1131 2- 013 9. TOTAL COMPENSATION $ to 0617// (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 ❑ 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 SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: 11/9 INITIAL/ DATE SIGNED AG# t3 -Z 6 L DATE SENT: I Funding Approval /Agreemeo U.S. Department of Housin Urban Development Title I of the Housing and Community Office of Community Planning a id Development Development Act (Public Law 930383) Community Development Block Grant Program OMB Approval No. HI- 00515R of 20515R 2506 -0193 (exp 1/31/2015) 1.Name of Grantee (as shown in item 5 of Standard Form 424) 3a. Grantee's 9 -digit Tax ID Number: 3b. Grantee's DUNS Number: 4. Date use of funds may begin (mm /dd /yyyy): City of Federal Way 91- 1462550 61- 2509901 01/01/2013 2. Grantee's Complete Address (as shown in item 5 of Standard Form 424) 5a. Project/Grant No. 1 6a. Amount Approved B- 13 -MC -53 -0015 $606,711.00 33325 81" Avenue South 5b. Project/Grant No. 2 6b. Amount Approved Federal Way WA 98003 5c. Project/Grant No. 3 1 6c. Amount ACpproved 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 1 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(8) 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 I Citv of Federal Wav Title Title Director, Community a ing and Development Signatu Date mm /dd /yyyy) Signature eN%,� _ Date (mm /dd/yyyy) FM 176 FM 0 0 D [[] I I I 7. Category of Title I Assistance for this Funding Action (check only one) ® 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) ❑ e. Surplus Urban Renewal Funds, Sec 112(b) ❑ f. Special Purpose Grants, Sec 107 ❑ g. Loan Guarantee, Sec 108 8. Special Conditions (check one) ❑ None ❑ Attached 9a. Date WJ5 Received Submission (mm /dd /yyyy) 11/17/2012 10. check one ® a. Orig. Funding Approval ❑ b. Amendment Amendment Number 9b. Date Grantee Notified (mm /dd /yyyy) JUL 2 6 2013 9c. Date of Start of Program Year (mm /dd /yyyy) 01/01/2013 11. Amount of Community Development Block Grant FY (2013) FY ( ) FY ( ) a. Funds Reserved for this Grantee Project Number Amount ❑Y b. Funds now being Approved 606711 c. Reservation to be Cancelled Y Project Number 11a minus 11b 12a. Amount of Loan Guarantee Commitment now being Approved 121b. 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) F FM 176 FM 0 0 D [[] I I I I 1 10 Project Number Amount ❑Y Y Project Number Amount Date Entered PAS (mm /dd /yyyy) I Date Entered LOCCS Number By 24 CFR 570 form HUD -7082 (11/10)