AG 20-256 - Green House AFHCITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV-- -ECONOMIC DEVELOPMENT
i'STAFF PERSON: TIM JOHNS
_I ON_____.___,
ANKMINIAM41 "WIZINjagnmel
11 PUBLIC WORKS CONTRACT 0 SMALL OR LIMITED PUBLIC WORKS CONTRACT
Ej PROFESSIONAL SERVICE AGREEMENT 0 MAINTENANCE AGREEMENT
11 GOODS AND SERVICE AGREEMENT 0 HUMAN SERVICES/ CDBG
* REAL ESTATE DOCUMENT 0 SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
* ORDINANCE 0 RESOLUTION
* CONTRACT AMENDMENT (AG); 0 INTERLOCAL
* OTHER CAPES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
NAME OF CONTRACTOR: GREEN HOUSE ADULT FAMILY HOME
ADDRESS. 29654 20TH AVE S, FEDERAL WAY, WA, 98003
E-MAIL: LSOHN77@YAHOO.COM
SIGNATURE NAME: LINA SOHN TITLE: SEE ATTACHED
iA
EXHIBITS AND ATTACHMENTS: Li SCOPE, WORK OR SERVICES 0 COMPENSATION 11 INSURANCE REQUIREMENTS/CERTIFICATE Ll All
OTHER REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES DPRIOR CONTRACT/AMENDMEN-rS 0
I TERM: COMMENCEMENT DATE: --SEE ATTACHIEDAGPgEM=�.- COMPLETION DATE:
TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NO1100 (SI'000m)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: C] YES X NO IF YES, MAXIMUM DOLLAR AMOUNT:
IS SALES TAX OWED 0YES X NO IFYES,$___,__ PAID BY: El CONTRACTORD CITY
RETAINAGE. RETAINAGEAmoUNT: -L] RETAINAGE AGREEMENT (SEE CONTRACT) OR EIRETAINAGEBOND
ROVIDED
El PURCHASING: PLEASE CHARGE TO: 00 1- 1800-990-5 IL*429L EMAIN-t-
0. DOCUMENT/CONTRACT REVIEW INITIAL DATE REVIEWED INITIAL /DATE APPROVED
0 ZP JECT MANAGER
N, RIECTOR,
0 RISKMANAGE MENT (IFAPPLICABLE)
C1 LAW
1. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: ComwrEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
111-MWIMIRAM1411 5FTMETEWL,
C1 SENT TO VENDORICONTRACTOR DATE SENT: —, DATE
0 ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
I-] CREATE ELECTRONIC REMINDERJNOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE
(include dept. support staff if necessary and feel ftee to set notification more than a month in advance ifcouncil approval is needed.)
INITIAL / DATE SIGNED
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13 CITY CLERK
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eServices
Services Business Lookup GREEN HOUSE ADULT FAMILY HOME
License Information:
Entity name: GREEN HOUSE ADULT FAMILY HOME FEDERAL WAY LIMITED LIABILITY COMPANY
Business name: GREEN HOUSE ADULT FAMILY HOME
Entity type: Limited Liability Company
UI #: 602-870-016
Business ID: 001
Location ID: 0002
Location: Active
Location address: 29654 20TH AVE S
FEDERAL WAY WA 98003-4241
Mailing address: 32204 51 ST AVE S
AUBURN WA 98001-3613
Excise tax and reseller permit status: Click here
Secretary of State status: Click here
Endorsements
Endorsements held at this location License # Count Details Status Expiration date First issuance
Federal Way General Business 08 -104998 -00 -BL Active Sep -30-2020 Nov -07-2008
Governing People May include governing people not registered with Secretary of State
Governing people Title
KIM, DAE
SOHN, LINA
Registered Trade Names
Registered trade names Status First issued
GREEN HOUSE ADULT FAMILY HOME FEDERAL WAY Active Feb -02-2009
LLC.
mr-77100=1
The Business Lookup information is updated nightly. Search date and time: 7/25/2020 1:08:41 PM
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