HomeMy WebLinkAboutPK18-349 - Original - King County Natural Resources and Parks - Youth & Amature Sports Grant for Lake Meridian Dock - 01/01/2018 ANT Records Management Document
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to the City Clerk's Office. All portions are to be completed.
If you have questions, please contact the City Clerk's Office at 253-856-5725.
❑ Blue/Motion Sheet Attached
❑ Pink Sheet Attached
Vendor Name: King County Dept. of Natural Resources & Parks
Vendor Number (]DE):
............... ..... .
Contract Number (City Clerk): �' � �
Category: Grant Related Aareement (Non Real Property)
Sub-Category (if applicable): ,,( tli.00,�,u , n i(l ai ei.
Project Name: YASG Grant for Lake Meridian Dock
Contract Execution Date: 7/30/2018 Termination Date: 12/31/18
Contract Manager: Lynn Osborn/BH Department: Parks
Contract Amount: $25 000.00
Approval Authority: ® Director ❑ Mayor ❑ City Council
Other Details: Grant from Kino County, reimbursement for Lake Meridian Dock
Replacement
.........__..._
Division Contract: #PPD18-19
L19 King County
Youth and Amateur Sports iGrant Agreemtent
Get Active/ Stay Active Project
Department/Division: Natural Resources and Parks / Parks and Recreation Division
Agency: City of Kent Parks and Recreation
Project: Lake Meridian Dock
Amount: $$25 000 00__ Project: 1134129 Contract: 6023440
Term Period: January_l,2018 To December 31,2018
THIS CONTRACT is entered into by KING COUNTY(the"County"), and City of Kent Parks and
Recreation (the"Agency"), whose address is: 220 Fourth Ave. S, Kent, WA 98032
WHEREAS,the Agency is either a public agency or a non-profit organization that provides youth or
amateur sports opportunities or are acts as a fiscal sponsor for such project;
WHEREAS,King County has selected the identified Agency to receive a Youth and Amateur Sports
Fund("YASF")Grant award to assist in projects that provide increased athletic opportunities for the
citizens of King County, Washington;
WHEREAS, the Agency shall utilize the award to address an athletic need in King County; and
WHEREAS, King County is authorized to administer the YASF grant project and enter into
agreements for the use of King County funds by public agencies or not-for-profit organizations to
provide a service to the public under King County Ordinance 18409;
NOW THEREFORE, in consideration of payments, covenants, and agreements hereinafter
mentioned, to be made and performed by the parties hereto, the parties covenant and do mutually
agree as follows:
The Agency shall provide services and comply with the requirements set forth hereinafter and
in the following attached exhibits, which are incorporated herein by reference:
® Scope of Services Attached hereto as Exhibit I
--. _
® Budget Attached hereto as Exhibit II
2. TERM OF (:,ONTTRRACT
This Agreement shall commence on Jamiary I,,2.018, and shall expire on the Dcccin er 31,
2018, unless extended or earlier terminated, pursuant to the terms and conditions of this
Agreement.
3. PREMISES
This grant project is located at:
14800 SE 272nd Street,Kent,WA.98042
4. PARTIES
All communication,notices,coordination,and other tenets of this Agreement shall be managed
by:
On behalf of County:
Butch Lovelace, YSFG Project Manager
King County Parks and Recreation Division
201 South Jackson Street, Suite 700
Seattle, WA 98104-3855
Email. hauaul_t„lovclacc iiak n cnonly ov_
Phone: 206.477.4577
On lrp 1fol'Aggev c :
Bryan Higgings Parks Capital Project Manager
City of Kent Parks and Recreation
220 Fourth Avenue South
Kent, WA 98032
Email: BHiggins@kentwa.gov
Phone:
5. COMPENSATION AND METHODOF PAYMENT
A. The County shall reimburse the Agency for satisfactory completion of the services and
requirements specified in this Agreement after the Agency submits an invoice and all
accompanying reports as specified in the attached exhibits. The County will initiate
authorization for payment after approval of corrected invoices and reports. The County
shall make payment to the Agency not more than thirty (30) days after a complete and
accurate invoice is received.
B. The Agency shall submit its final invoice and all outstanding reports within fifteen(15)days
of the date this Agreement expires or is terminated. If the Agency's final invoice and reports
are not submitted by the day specified in this subsection,the County will be relieved of all
liability for payment to the Agency of the amounts set forth in said invoice or any subsequent
invoice.
6. qL RA"I'INO BUDtiET
When a budget is attached hereto as Exhibit II, the Agency shall apply the funds received from
the County under this Agreement in accordance with said budget. If, at any time during the
Term of this Agreement,the Agency expects that the cumulative amount of transficrs among the
budget categories, i.e.Project Tasks, may exceed ten percent(10%) of the Agreement amount,
then the Agency shall notify County to request approval. Supporting documents necessary to
explain fully the nature and purpose of the change(s) and an amended budget must accompany
each request for such approval. County approval of any such amendment shall not be
unreasonably withheld.
7. CO PN'mUX C:A"1"1()N
The Agency shall recognize County as a fiscal sponsor for the grant project in the following
manner:
A. Events:The Agency shall invite and recognize,"King County Parks"at all events promoting
the project,and at the final project dedication.
B. Community Relations: The Agency shall recognize "King County Parks"as a fiscal
sponsor in all social media, websites, brochures, banners, posters, press releases, and other
promotional material related to the Project.
8. PRIORITY Of PUBLIC hCC�L59 SCl_E Y lTNO
These funds are provided for the purpose of developing and/or project sports activities for, but
not exclusively serving, persons under 21 years of age, and low and moderate income
communities within King County. Fees for the project shall be no greater than those generally
charged by public operators or project providers in King County.
9. INTURNAL CONTROL. AN) A{,KMI N'I'{N(i SYS"1"l' 4
The Agency shall establish and maintain a system of accounting and internal controls which
complies with applicable, generally accepted accounting principles, and governmental
accounting and financial reporting standards in accordance with Revised Code of Washington
(RCW)Chapter 40.14.
10. MAINTB LANCE OF RECORQS
A. The Agency shall maintain accounts and records, including personnel, property, financial,
and project records and other such records as may be deemed necessary by the County to
ensure proper accounting for all Agreement funds and compliance with this Agreement.
B. These records shall be maintained for a period of six(6)years after the expiration or earlier
termination of this Agreement unless permission to destroy them is granted by the Office of
the Archivist in accordance with RCW Chapter 40.14.
C. The Agency shall inform the County in writing of the location, if different from the Agency
address listed on page one of this Agreement, of the aforesaid books, records, documents,
and other evidence and shall notify the County in writing of any changes in location within
ten (10)working days of any such relocation.
11. RIGHT TO INSPECT
King County reserves the right to review and approve the performance of Agency with regard
to this Agreement,and, at its sole discretion,to inspect or audit the Agency's records regarding
this Agreement and the Project upon reasonable notice during normal business hours.
12. COMPLIANCE WITH ALL LAWS AND REGULATIONS
The Agency, in cooperation and agreement with the owners of the Premises, shall comply with
all applicable laws, ordinances and regulations in using funds provided by the County,
including, without limitation, those relating to providing a safe working environment to
employees and, specifically, the requirements of the Washington Industrial Safety and Health
Act (W1SHA); and, to the extent applicable, those related to "public works," payment of
prevailing wages, and competitive bidding of contracts. The Agency specifically agrees to
comply and pay all costs associated with achieving such compliance without notice from King
County; and further agrees that King County, does not waive this Section by giving notice of
demand for compliance in any instance. The Agency shall indemnify and defend the County
should it be sued or made the subject of an administrative investigation or hearing for a violation
of such laws related to this Agreement.
13. CORRECTIVE ACTION
A. If the County determines that a breach of contract has occurred or does not approve of the
Agency's performance, it will give the Agency written notification of unacceptable
performance. The Agency will then take corrective action within a reasonable period of
time, as may be defined by King County in its sole discretion in its written notification to
the Agency.
B. The County may withhold any payment owed the Agency until the County is satisfied that
corrective action has been taken or completed.
14. TERMINATION
A. The County may terminate this Agreement in whole or in part,with or without cause,at any
time during the Term of this Agreement, by providing the Agency ten (10) days advance
written notice of the termination.
B. If the termination results from acts or omissions of the Agency, including but not limited to
misappropriation, nonperformance of required services, or fiscal mismanagement, the
Agency shall return to the County immediately any funds, misappropriated or unexpended,
which have been paid to the Agency by the County.
C. Any King County obligations under this Agreement beyond the current appropriation year
are conditioned upon the County Council's appropriation of sufficient funds to support such
obligations. If the Council does not approve such appropriation, then this Agreement will
terminate automatically at the close of the current appropriation year.
15. FUTURE_SUPPORT
;-!L 11,111ES AND SERVICE
The County makes no commitment to support the services contracted for herein and assumes
no obligation for future support of the activity contracted for herein except as expressly set forth
in this Agreement. The Agency understands, acknowledges, and agrees that the County shall
not be liable to pay for or to provide any utilities or services in connection with the Project
contemplated herein.
16. )jq lD FIA ;S " ND 1NDIiMNIN 1CA'l'➢C}
The Agency agrees for itself, its successors, and assigns, to defend, indemnify, and hold
harmless King County, its appointed and elected officials, and employees from and against
liability for all claims, demands, suits, and judgments, including costs of defense thereof, for
injury to persons, death, or property damage which is caused by, arises out of, or is incidental
to any use of or occurrence on the Project that is the subject of this Agreement,or the Agency's
exercise of rights and privileges granted by this Agreement,except to the extent of the County's
sole negligence. The Agency's obligations under this Section shall include:
A. The duty to promptly accept tender of defense and provide defense to the County at the
Agency's own expense;
B. Indemnification of claims made by the Agency's employees or agents;and
C. Waiver of the Agency's immunity under the industrial insurance provisions of Title 51
RCW, but only to the extent necessary to indemnify King County, which waiver has been
mutually negotiated by the parties.
In the event it is necessary for the County to incur attorney's fees, legal expenses or other costs
to enforce the provisions of this Section, all such fees, expenses and costs shall be recoverable
from the Agency.
In the event it is determined that RCW 4.24.115 applies to this Agreement, the Agency agrees
to protect,defend, indemnify and save the County, its officers,officials, employees and agents
from any and all claims, demands, suits, penalties, losses damages judgments, or costs of any
kind whatsoever for bodily injury to persons or damage to property (hereinafter "claims"),
arising out of or in any way resulting from the Agency's officers, employees, agents and/or
subcontractors of all tiers, acts or omissions, performance of failure to perform the rights and
privileges granted under this Agreement,to the maximum extent permitted by law or as defined
by RCW 4.24.115, as now enacted or hereafter amended.
A hold harmless provision to protect King County similar to this provision shall be included in
all Agreements or subcontractor Agreements entered into by Agency in conjunction with this
Agreement. The Agency's duties under this Section will survive the expiration or earlier
termination of this Agreement.
17. INSURANCE
A. Liability Insurance Itush4cments. Notwithstanding any other provision within this
Agreement,the Agency and it subcontractors shall procure and maintain coverage and limits
for no less than the following:
1. Commercial Oencral Liability. Insurance Service"occurrence"form CG 00 01 (current
edition), to include Products-Completed Operations, insurance against claims for
injuries to persons or damages to property that may arise from or in connection with
activities under this Agreement. The insurance coverage shall be no less than One
Million Dollars ($1,000,000) combined single limit per occurrence, and Two Million
Dollars($2,000,000) in the aggregate.
2. Autprne>bfltb_lab�ijty. If activities require vehicle usage. Insurance Services form
number CA 00 01 (current edition),covering BUSINESS AUTO COVERAGE,Symbol
l "any auto".If the grant includes the use of automobiles,the Limit of Liability shall be
no less than One Million Dollars($1,000,000)per occurrence.
3. Workers Compensation/Sipp (iap. If the recipient or its contractor(s) has/have
employees.Statutory Workers Compensation coverage and Stop Gap Liability for a limit
no less than One Million Dollars($1,000,000)per occurrence.
4. PtofeisAilnalLiabilityt..lfthe grant includes the use ofProfessional Services.Professional
Liability coverage shall be no less than One Million Dollars ($1,000,000)per claim and
in the aggregate.
B. If the grant involves the construction of a capital project or involves the purchase of
equipment greater than Five Thousand ($5,000) in value, the Agency shall provide "All
Risk" Builders Risk or Property coverage for the full replacement value of the
project/property built/purchased. King County shall be listed as an additional Loss payee
as our interests may appear.
C. King County and its officers,officials,employees and agents shall be covered as additional
insured on Agency's and its contractor(s') commercial general liability insurance and, if
applicable, commercial auto liability insurance, with respect to liability arising out of
activities performed by the Agency and its contractors. Additional Insured status shall
include Products-Completed Operations.
D. To the extent of the Agency's or its contractor's negligence, their insurance respectively
shall be primary insurance with respect to the County, its officers, employees and agents.
Any insurance or self-insurance maintained by the County, and its officers, officials,
employees or agents shall not be subjected to contribution in favor of the Agency or its
contractors insurance, and shall not benefit either in any way.
The Agency's and its contractors' insurance shall apply separately to each insured against
whom a claim is made or a lawsuit is brought, subject to the limits of the insurer's liability.
E. Coverage shall not be suspended, voided,canceled, reduced in coverage or in limits except
by the reduction of the applicable aggregate limit by claims paid, until after thirty (30)days'
prior written notice has been given to and change in coverage accepted by King County.
F. The insurance provider must be licensed to do business in the State of Washington and
maintain a Best's rating of no less than A-VIII. Within five (5) business days of County's
request, Agency must provide a Certificate of Insurance and Additional Insured
Endorsement(s) (CG 20 10 11/85 or its equivalent) to the County. The Agency shall be
responsible for the maintenance of their contractors' insurance documentation.
G. If the Agency is a municipal corporation or an agency of the State of Washington and is
self-insured for any of the above insurance requirements, a certification of self-insurance
shall be attached hereto and be incorporated by reference and shall constitute compliance
with this Section.
H. The Agency's duties under this Section shall survive the expiration or earlier
termination of this Agreement. The Agency understands, acknowledges and agrees that
for the relevant period of public use set forth in Section 8, the Agency shall maintain
insurance and name the County as an additional insured, all of which shall be consistent
with the requirements of this Section.
18, ANTi-f11SCRtNt1NAT'It3N
King County Code chapters 12.16, 12.17 through 12.18 apply to this Agreement and are
incorporated by this reference as if fully set forth herein. In all hiring or employment made
possible or resulting from this Agreement,there shall be no discrimination against any employee
or applicant for employment because of seat, age, race, color, creed, religion, national origin,
sexual orientation, gender identity or expression, marital status or the presence of any sensory,
mental,or physical disability unless based upon a bonaiide occupational qualification, or age
except by minimum age and retirement provisions, and this requirement shall apply to but not
be limited to the following: employment, advertising, lay-off, or termination, rates of pay or
other harms of compensation, and selection for training, including apprenticeship. No person
shall be denied or subjected to discrimination in receipt of the benefit of any services or activities
made possible by or resulting from this Agreement on the grounds of sex, race, color, creed,
national origin,religion,sexual orientation,gender identity or expression,age(except minimum
age and retirement provisions),marital status,or the presence of any sensory,mental,or physical
handicap. Any violation of this provision shall he considered a violation of a material provision
of this Agreement and shall be grounds for cancellation, termination or suspension in whole or
in part of this Agreement by King County and may result in ineligibility for further King County
agreements. [Community Partner Name] shall also comply with all applicable anti-
discrimination laws or requirements of any and all jurisdictions having authority.
19. C NF1.pC'I't7FiNi&;I2ES"I"
KCC Chapter 3.04 (Employee Code of Ethics) is incorporated by reference as if fully set forth
hence,and the Agency agrees to abide by all conditions of said chapter. Failure by the Agency
to comply with any requirement of said KCC Chapter shall be a material breach of contract.
20. Pf)L1'I"CfAI, AGTEVIT'Y F'ftC}HIE3t'I;ET)
None of the funds, materials, property, or services provided directly or indirectly under this
Agreement shall be used for any partisan political activity or to further the election or defeat of
any candidate for public office.
21, PI(O&( 1" MAIM]1I ANCf?; PMFNT )URCHASI:. MAfN11,N,tr117LG. AND
OWNERSHIP
A. As between the County and the Agency, the Agency shall be responsible to operate and
maintain the completed project at its own sole expense and risk. The Agency shalt maintain
the completed project in good working condition consistent with applicable standards and
guidelines. The Agency understands, acknowledges, and agrees that the County is not
responsible to operate or to maintain the project in any way.
B. The Agency shall be responsible for all property purchased pursuant to this Agreement,
including the proper care and maintenance of any equipment,
C. The Agency shall establish and maintain inventory records and transaction documents
(purchase requisitions, packing slips, invoices, receipts) of equipment and materials
purchased with Agreement funds. The Agency's duties under this Section shall survive
the expiration of this Agreement.
22. NOTICES
Whenever this Agreement provides for notice to be provided by one party to another,such notice
shall be in writing, and directed to the person specified in Section 4 of this Agreement. Any
such notice shall be deemed to have been given on the date of delivery, if mailed, on the third
(3rd) business day following the date of mailing; or, if sent by fax, on the first (1 st) business
day following the day of delivery thereof by fax.Notice sent solely by e-mail shall be deemed
to have been given on the date of transmission.Either party may change its address,fax number,
email address, or the name of the person indicated as the recipient by notice to the other in the
manner aforesaid.
23. ASSIGNMENT
The Agency shall not assign any portion of rights and obligations under this Agreement or
transfer or assign any claim arising pursuant to this Agreement without the written consent of
the County. The Agency must seek such consent in writing not less than fifteen(15)days prior
to the date of any proposed assignment.
24, CONTRACT AMENDMENTS
This Agreement together with the attached exhibits expressly incorporated herein by reference
and attached hereto shall constitute the whole Agreement between the Parties. Either party may
request changes to this Agreement. No modifications or amendment of this Agreement shall be
valid or effective unless evidenced by an Agreement in writing signed by the Parties.
25. WAIVER OF DEFAULT
Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or
breach of any provision of the Agreement shall not be deemed to be a waiver of any other or
subsequent breach and shall not be construed to he a modification ofthe terms ofthe Agreement
unless stated to be such through written approval by the County, which shall be attached to the
original Agreement.
26. TAXES
The Agency agrees to pay on a current basis all taxes or assessments levied on its activities and
property, including, without limitation, any leasehold excise tax due under RCW Chapter
82.29A; PROVIDED, however, that nothing contained herein will modify the right of the
Agency to contest any such tax, and the Agency will not be deemed to be in default as long as
it will, in good faith, be contesting the validity or amount of any such taxes.
27. WASMNC;[Q1N t AW P`C➢9V'1"ROLI,CNGLA E xf ACTI_11t95 [3'R{1IIC1:H'9'
This Agreement is made in and will be in accordance with the laws of the State of Washington,
which will be controlling in any dispute that arises hereunder. Actions pertaining to this
Agreement will be brought in King County Superior Court, King County, Washington.
28. PARAGRAPH HEADINGS
The paragraph headings contained herein are only for convenience and reference and are not
intended to be a part of this Agreement or in any manner to define, limit, or describe the scope
or intent of this Agreement or the particular paragraphs to which they refer.
29. PUBLIC DOCUMENT
This Agreement will be considered a public document and will be available for inspection and
copying by the public.
30. LEGAL RELATIONS,
Nothing contained herein will make,or be deemed to make,the County and the Agency a partner
of one another, and this Agreement will not be construed as creating a partnership or joint
venture. Nothing in this Agreement will create, or be deemed to create, any right, duty or
obligation in any person or entity not a party to it.
31. SINGULAR AND PLURAL
Wherever the context will so require, the singular will include the plural and plural will include
the singular.
32. PERMITS AND LICENSES
The Agency shall design, develop and construct the Project in accordance will all applicable
laws and regulatory requirements including environmental considerations, permitting
determinations, and other legal requirements. All activities and improvements shall be
performed by Agency at its sole expense and liability. The Agency shall, at its sole cost and
expense, apply for, obtain and comply with all necessary permits, licenses and approvals
required for the Project,
33. INTERPRETATION OF COUNTY RULES AND REGULATIONS
If there is any question regarding the interpretation of any County rule or regulation, the County
decision will govern and will be binding upon the Agency.
34. POLICE POWERS OF THE COUNTY
Nothing contained in this Agreement will diminish, or be deemed to diminish,the governmental
or police powers of the County.
35. ENTIRE AGREEMENT
This Agreement, including its attachments, constitutes the entire Agreement between the
County and the Agency. It supersedes all other agreements and understandings between them,
whether written, oral or otherwise.
KING COUN"FY Cit ofXe t Parks and Recreation
a
FOR
King County Executive ,nature
- -- tJJUCie- Z1rAIr nd0 /4l .Pf ?° of Plnr✓ws�/2ec_,
Date NAME (Pleasetype or print), Title q- Co tM m uHi
Dat __.
29. PUBLIC DOCUMENT
This Agreement will be considered a public document and will be available for inspection and
copying by the public.
30. LEGAL RELATIONS
Nothing contained herein will make,or be deemed to make,the County and the Agency a partner
of one another, and this Agreement will not be construed as creating a partnership or joint
venture. Nothing in this Agreement will create, or be deemed to create, any right, duty or
obligation in any person or entity not a party to it.
31. SINGULAR AND PLURAL
Wherever the context will so require,the singular will include the plural and plural will include
the singular.
32. PERMITS AND LICENSES
'The Agency shall design, develop and construct the Project in accordance will all applicable
laws and regulatory requirements including environmental considerations, permitting
determinations, and other legal requirements. All activities and improvements shall be
performed by Agency at its sole expense and liability. The Agency shall, at its sole cost and
expense, apply for, obtain and comply with all necessary permits, licenses and approvals
required for the Project,
33. I�tTI, RETATION OF COUNTY RUI ES AND RP" ,( LA"f1 Nq
If there is any question regarding the interpretation of any County rule or regulation,the County
decision will govern and will be binding upon the Agency.
34. POLICE POWERS OF THE COUNTY
Nothing contained in this Agreement will diminish,or be deemed to diminish,the governmental
or police powers of the County.
35. ENTIRE AGREEMENT
This Agreement, including its attachments, constitutes the entire Agreement between the
County and the Agency. It supersedes all other agreements and understandings between them,
whether written,oral or otherwise.
KING COUNT Ckk t Parks and Recreation
FOR rt®
King County Executi e nature
Date NAME(Please type or print),Title } Co im 4,vo; <y Silas,
Dn
City of Kent—Lake Meridian Dock - Exhlbil I
lM King County
Your}iglitt igard
Youth and Amateur Sports Grant
Scope of Services
'This project replaced the existing floating concrete dock at Lake Meridian Park. The original
dock was installed in the early 1980's and had reached the end of its useful life. All sections of
the existing dock were removed and disposed of New concrete floats were fabricated and
installed in the same footprint as the existing dock. New piers were installed where necessary.
Railing was installed around the swimming and fishing sections of the dock. Construction
occurred during May and June of 2017 with a grand opening on July 4, 2017.
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wM Request for Taxpayer Identification number and Give form to King County.
KING COUNTY Certification Do not send to IRS.
SUBSTITUTE W-9
Name(as shown on Invoice)
City of Kent
Business Type
❑Association ❑ C-Corporation ❑ S-Corporation ❑ Disregarded Entity
❑Division 0 Government ❑ Individual
❑ Limited Liability Company', Enlartax classification(C-C-Corporation,8-8-Corporation,P=PahnershipM►-
❑ Non Profit [] Partnership ❑Sole Proprietor ❑Trust/Estate
Business Registration Information
Enter where you are registered to do business and the corresponding State Registration Number
State, Washington Registration Number: 173-000-002
Purchasing Location Information
Physical Address
220 Fourth Avenue South
City State,and Zip
Kent WA 98032
Remittance Information
Remit Address (if different than above)
Same
City, State,and Zip
Tax Reporting Name and Tax Identification Number or Social Security Number
Enter your Tax reporting Name and address. The Tax Identification number provided must match the name
given on the"Tax Reporting Name" line. For individuals,this is your social security number
Tax Reporting Name
City of Kent
Tax Reporting Address
220 Fourth Ave S
Tax Reporting City, State, and Zip
Kent WA 98032
fax Idantlficadlon Number. Emolo er Identification Number or Social Security Number;
9 1 1 6 1 0 1 0 1 1 1 2 1 5 1 4
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct tax reporting name and identification number
2. 1 am a U.S. citizen, U.S. person or U.S. Business Entity,
3. 1 am not subject to backup withholding due to failure to report interest and dividend income.
4. 1 am exempt from FATCA reporting.
Certification Instructions. If you are not a U.S. citizen, U.S. person or U.S. Business Entity, you must cross
out item 2 abo o will n toy provide a completed King County W9 form as well as a copy of your W-8.
Sign Here
Print Name of Signer Q r?D$ 09, D Date Signed
Version: 2 King County Substitute W9 Dated 2/2 312 0 1 5