AG 20-742 - R&R ChiropracticCITY OF FEDERAL ,W DEPARTMEROUTING r
1. ORIGINATING EPT./DIV: ECONOMIC DEVELOPMENT
ORIGINATING STAFF PERSON: _TIM JOHNSON EXT: ^ 2412 3. DATE REQ. BY.'—ASAP
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TYPE OF DOCUMENT (CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RF)
❑ 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
X OTHER CARES ACTFUNDS S BUSINESS SUPPORT GRANT AGREEMENT
NAME OF CONTRACTOR: R&R CHIROPRACTIC (DBA LIFE CHIROPRACTIC AND MASSAGE)
ADDRESS:34507•, . FEDERAL WAY WA *:01
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SIGNATURE NAME: •' r
EXHIBITSAND x D SCOPE,t• OR SERVICES ■ COMPENSATION El INSURANCEEl ALL
OTHER r EXHIBITS ■ PROOF OF t' TO SIGN ■ REQUIRED ■ PRIOR
I COMMENCEMENTix DATE -
9. TOTAL C® ENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND NO/100 ($2,000.00)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED ❑ YES X NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: TAINAGE OUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND
PROVIDED I
❑ PURCHASING: PLEASE CHARGE TO 001.1800-990-518-10-490 �Proiect Code #267662-25060
10. DOCUMENT/CONTRACT REVIEWDOCUMENT/CINITIAL / DATE REVIEWED INITIAL / DATE APPROVED
0 PROJECT MANAGER
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❑ RISKMANAGEMENT (IFAPPLICABLE) ` J
❑ LAW
11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
i♦ `• `' `i
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE C'D.
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION REMINDER/NOTIFICATIONFOR 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.)
ITIAL / DATE SIGNED
❑ LAW DEPARTMENT
NATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK k
❑ ASSIGNED AG# AG# 641;
COMMENTS:
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CARESACT -BUSIN"ESS:GUNT AGREEMENT;
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9/29/2020 Washington State Department of Revenue
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< Business Lookup
License Information:
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Entity name- R&R CHIROPRACTIC, LLC
Business name: LIFE CHIROPRACTIC AND MASSAGE
Entity type: Limited Liability Company
UB1 603-410-148
Business ID: 001
Location ID: 0001
Location: Active
Location address: 34507 PACIFIC HWY S STE 4
FEDERAL WAY WA 98003-6879
Mailing address: 34507 PACIFIC HWY S STE 4
FEDERAL WAY WA 98003-6879
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 dal
Federal Way General Business 14 -106442 -00 -BL
Active
Jun -30-2021
Dec -26-2014
Medical Radiographic 1
Active
Jun -30-2021
Aug -06-2018
X -Ray:
Active
Jun -30-2021
Aug -06-2018
Hospital/Medical/Chiropractic
Governing People May Id.de go—Ing p-ple —f Mbftmd fth SeaW-y 0!aft
Governing people Title
SIKKA, RICKY
Registered Trade Names
Registered trade names Status First issued
LIFE CHIROPRACTIC AND MASSAGE Active Jun -24-2014
The Business Lookup information is updated nightly. Search date and time: 9/29/202010:26:48 AM
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