AG 14-127 - CAFFE D'ARTERETURN TO: Jeri -Lynn Clark EXT: 2401
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: MAYOR'S OFFICE
2. ORIGINATING STAFF PERSON: JERI -LYNN CLARK EXT: 2401 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
5. PROJECT NAME: COFFEE SERVICE
6.
NAME OF CONTRACTOR: CAFFE D'ARTE
ADDRESS: 33926 9TH AVE SOUTH, FEDERAL WAY, WA 98003
E -MAIL: FRONTDESK @CAFFEDARTE.COM
SIGNATURE NAME:
TELEPHONE
FAX:
TITLE:
800 - 999 -5334
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
9
TERM: COMMENCEMENT DATE: COMPLETION DATE
TOTAL COMPENSATION $ (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
11. COUNCIL APPROVAL (IF APPLICABLE)
12. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR
INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
COMMITTEE APPROVAL DATE:
DATE SENT:
COUNCIL APPROVAL DATE:
DATE REC'D:
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSE, EXHIBITS
INITIAL / DATE SIGNED
❑ LAW DEPARTMENT
❑ SIGNATORY (MAYOR OR DIRECTOR) G
❑ CITY CLERK 8 4-
❑ ASSIGNED AG# AG#
• SIGNED COPY RETURNED DATE SENT 4--
COMMENTS:
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✓ NEW INSTAL
ACCOUNT
EXISTING ACCOUNT
11,1111I.—VT v v v I V (ttr tI L— r 1%
AGREEMENT'S
MULTI
LOCATION #
COMPANY d t
DELIVERY ADDRESS 7iM
CITY tt,� t� STATEI t. ZIP 6NO63
TELEPHONE_{ '�� S y o 1 CONTACT �;Y4-I.�{ 'vj' �(t
RESELLER PERMIT NUMBER ATTACHED El YES ❑ NO
BILL TO ADDRESS_ SAAA1 Go e0,C6V f_,
INSTALL DATE 2, Z('�
OFFICE USE ONLY
QB\&, -$L _ CS 1--*"FL
lor i i'o'? g_-; L1G
COFFEE BLEND 41 fv22o WB/GRN PRICE
COFFEE BLEND '0 -C!�Z WB /GRN PRICE
COFFEE BLEND WB /GRN PRICE
COFFEE BLEND WB/GRN PRICE
COFFEE BLEND WB /GRN PRICE
CITY STATE ZIP
CELL # ALT PHONE'; aa5 COFFEE BLEND
FAX # `-1 p-)
WB/GRN PRICE
DESCRIPTION SERIAL NO. VALUE WF {
1 Glass Pot brewer /Hard plumb
1
I
3
Stainless Steel pouring Carafes
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LtS'L"N
tU/
MARKETING
MATERIALS
I
Credit Card Type
CC # Exp. Date
Type of Service
Delivery, Ulf S, Will Call and Other
Route # Route Day 2i
1E(D3R NE-11_30 ❑ CAD El CHECK I
ARD
SERVICE AGREEMENT
AGREEMENT by and between Gaffe D'arte LLC (hereinafter referred to as "Distributor"), and the undersigned retail operator (hereinafter referred to as "Operatoe) for the following materials.
Distributor hereby loans unto Operator certain equipment or materials listed above for the use of and said by Operator. Operator accepts such equipment andfor materials and assumes responsibility for the care,
safety and maintenance of said equipment andfor materials.
Jperator will not remove or allow equipment and/or materials to be removed from the premises of Operator as specified above, and vAl keep such equipment and/or materials listed in good of order and candlion
as when received, normal wear and tear accepted. If Operator does rat promptly return listed equipment and/or materials upon termination of this Agreement, Distributor may repossess them, If fox any reason
.vnatsoever, regardless of cause, responsibility or control, said listed equipment and/or materials cannot be so returned in such good condf ion, Distributor agrees to pay Distributor value of equipment and or
materials listed at stated replacement value.
7perator understands that the bailment of Brewers) is contingent upon the purchase by Operator of a minimum of TEN (10) pounds of coffee/espresso from Gaffe D'arte LLC per week during the term of this
:ontract agreement.
)isuibutor shall supply the aforementioned equipment and/or supplies at n charge, provided that the Operator remains a customer of Caffe Uarte LLC. Espresso and Drip Coffees on a continuous and exclusive
>asis.
vly signature below authorizes Caffe D'arte to charge me for invoices due according to the established credit terms_ In the event that invoices become overdue, I authorize Caffe D'arte to charge
ny credit card for past due invoices to bring my aompnt current. Operator agrees to pay for service related to replacement [)arts fist above.
>ALES REPRESENTA
1 hereby represent that I am authorized to enter into this agreement on behalf
of customer. I accept & con "' ns of this agreement.
AUTHORIZED
SIGNATURE
PRINT NAME