AG 18-068 - Lakehaven Water & Sewer DistrictRETURN TO: PW ADMIN EXT: 2700 ID #: 22
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CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT/DIV: PUBLIC WORKS / 'Tit- ai EV S
2. ORIGINATING STAFF PERSON: es- I••,lm. NS"\ EXT: 2-1 11 3. DATE REQ. BY: 4.3 1 2 31 1 $
3. 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 0 MAINTENANCE AGREEMENT
o GOODS AND SERVICE AGREEMENT 0 HUMAN SERVICES / CDBG
o REAL ESTATE DOCUMENT o SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
o ORDINANCE ❑ RESOLUTION
o CONTRACT AMENDMENT (AG#): 0 INTERLOCAL
1 1
6aI OTHER Fa4i \ j +t t, I nJ+aMlaR+b'1 044et.0 rwJ►+ 'cO1r '('2..kOCL$tJ� \�y(�. i i SDC G-CG.+Sot 'iw tCP.S-
4. PROJECT NAME: G' R N NE, 31/I'` N Z Cjit -
S. NAME OF CONTRACTOR: (,,G c e.1-.utf' v3434 e c tr se y.Ntr 17 Z St r i c.}
ADDRESS: 31623 Z'. I, V•e_rlu p S P.(ilarc.\ %-411.\\NJA 98o 3 TELEPHONE: '7 53 . t-1S-/S5C7
E-MAIL: bu r.{0C AGNtthc+VCI%. o roo FAX: "2 -SI --5-2,- 4081
SIGNATURE NAME: T)' C.r /1c'ti1.)C TITLE: )evcNV I'.tn1- E. -nth; nttfino8.
6. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION 0 INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER
REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES o PRIOR CONTRACT/AMENDMENTS
CFW LICENSE # EXP. 12/31/ UBI # , EXP. / /
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7. TERM: COMMENCEMENT DATE: `) COMPLETION DATE: /N/k
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8. TOTAL COMPENSATION: $ NI 14 (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES ii•NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED: ❑ YES A NO IF YES, $ PAID BY: ❑ CONTRACTOR 0 CITY
RETAINAGE: RETAINAGE AMOUNT: RETAINAGE AGREEMENT (SEE CONTRACT) OR - RETAINAGE BOND PROVIDED
A
❑ PURCHASING: PLEASE CHARGE TO: N k+A
9. DOCUMENT / CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
o PROJECT MANAGER
o DIVISION MANAGER
A DEPUTY DIRECTOR 'G✓ 1c-5,1-.- (A IN 7.1ra
typoDIRECTOR - .11.12,
t ❑ RISK MANAGEMENT (IF APPLICABLE)
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LAW DEPT 1V V/j 'e CEJ) u/l1d/ig
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10. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: IJ kt COUNCIL APPROVAL DATE: NAA
11. CONTRACT SIGNATURE ROUTING ?� l �j
o SENT TO VENDOR/CONTRACTOR DATE SENT: t/�✓ [ 1 �/ DATE REC'D: J
o ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
o CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 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 -
4412 LAW DEPT ' k/l /
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SIGNATORY (MAYOR OR IRECTORR �A''��tt�7
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CITY CLERK IM`r-'lii
ASSIGNED AG #• f 8 - 6
SIGNED COPY RETURNED DATE SENT: 5-}-1 8
o RETURN ONE ORIGINAL
COMMENTS: n � c EXECUTE `"L" ORIGINALS OA D
5fl(
4/2017
Lakehaven
WATER & SEWER DISTRICT
FACILITIES INSTALLATION AGREEMENT
FEDERAL WAY GRAND STAIRCASE (Project No. 6318004)
The undersigned, CITY OF FEDERAL WAY, is/are owner(s) of the property & right-of-
way herein located at approximately 2100 S 316th St in Federal Way, WA. Owner's mailing
address is 33325 - 8th Ave S, Federal Way, WA 98003. The City requests that Lakehaven
Water and Sewer District allow The City to remove an existing water main stub & fire hydrant,
The City acknowledges that the above-described work is a benefit to the City and that the City
is solely responsible for all project costs, including those associated Lakehaven costs &
expenses necessary for completion of the work.
Prior to the project's water preconstruction meeting, the City shall provide to
Lakehaven:
1. Utility Contractor Information (company, foreman, etc.).
2. Material submittal for review/approval by Lakehaven.
Construction shall be performed in accordance with Lakehaven's approved plans,
standards and specifications and only under the supervision of workers or craftsmen
experienced in the installation of water distribution system facilities and the related work.
Testing of water facilities shall be performed as required by Lakehaven & only after satisfactory
tests have been completed & witnessed by Lakehaven's designated agent, will the work be
accepted.
Lakehaven shall determine, on a regular basis, its actual costs associated with the
project and shall submit to the City an invoice to repay the Lakehaven for its actual costs.
Payment shall be due as noted on said invoice. Failure to pay as required under this section
shall cause Lakehaven to suspend work/action on the project. In the event that the associated
project account has a surplus balance after the completion of construction, Lakehaven shall
issue to the City, at project closing, a refund of such surplus balance.
In the event new or modified Lakehaven easements are required over the City's
property described herein, such easements, in form acceptable to Lakehaven, shall be
delivered to Lakehaven as a condition of project closing.
Lakehaven FI Agr- 6318 0 0 4 (Form Update 3/12/18)
SIGNED:
CITY OF FEDERAL WAY
LAKEHAVEN WATER & SEWER DISTRICT
Federal Way, Washington King County, Washington
ByC(`Y'^ Ito .•�-�
Its Nl-c k X11 c_ Jo SL (`E L'Tp`
Date: (,W8\kS
By
!evelo 'ment Engineering Manager
Dated: Oaf/ZSI v
Approved as to form: Approved as to form:
c �
-col Title: City Attorney
Lakehaven FI Agr-6318004 (Form Update 3/12/18)
Steven *1 Pritchett
Title: General Counsel