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CAG2023-385 - Original - George Perrins - Settlement, Warranty Deed & Temporary Easement - 07/06/2023
FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form DirAsst: • For Approvals,Signatures and Records Management Dir/Dep: KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover (optional) WASHINGTON Sheet forms. (Print on pink or cherry colored paper) Originator: Department: Cheryl Rolcik-Wilcox Public Works Date Sent: Date Required: c 07/05/2023 7/12/2023 QAuthorized to Sign: Date of Council Approval: Q �✓ Mayor or Designee 7/6/2021 Budget Account Number: Grant? Yes No�✓ Budget? Yes E]No Type: N/A Vendor Name: Category: George W. Perrins Other Vendor Number: Sub-Category: Other 0 Project Name: S. 218th St./98th Ave. S. (from 94th PI. S. to S. 216th St.) oProject Details: Settlement Agreement, Statutory Warranty Deed and Temporary c Construction Easement 40 c Agreement Amount: $44,557.00 Basis for Selection of Contractor: E *Memo to Mayor must be attached i Start Date: Termination Date: a Local Business? Yes F—]No*If meets requirements per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace. Business License Verification: ❑Yes In-Process F1 Exempt(KCC 5.01.045) FlAuthorized Signer Verified Notice required prior to disclosure? Contract Number: Yes ✓❑No CAG2023-385 Comments: Mayor Ralph - Please sign the attached Settlement Agreement (4th page of this packet) and the approval for the attached Warranty Deed (7th page of c this packet) and Temporary Construction Easement (13th page of this as *, packet). Thx! Cheryl R-W 3 0 N a Date Received:City Attorney: 7/5/23 Date Routed:Mayor's Offic 7/5/23 'ty Clerk's Office 7/6/23 adccW22373_7_20 Visit Documents.KentWA.gov to obtain copies of all agreements ovk �� rev.20221201 SETTLEMENT AGREEMENT KEN-50 S. 218th St./981h Ave. S. from 94th Pl. S. to S. 216th St. Project City of Kent Project Number: 17-3010 Owner: George W. Perrins King County Tax Parcel Number: 889500-0130 Address: 21642 98th Avenue S. This Settlement Agreement ('Settlement Agreement") is between the City of Kent, a Washington municipal corporation ("City") and George W. Perrins ("Mr. Perrins"). Background A. Mr. Perrins owns real property located at 21642 981h Avenue S. (the "Property"). B. To accommodate the City's S. 218th Street/98th Avenue S. from 94th Place S. to S. 216th Street Project ("Project"), the City must acquire from Mr. Perrins the following property and/or property rights: 675 square feet of right-of-way in fee, as legally described in Exhibit A and depicted in Exhibit B to Attachment A to this Agreement (the "Warranty Deed"), and a temporary easement over a 1,442 square foot portion of the property, as legally described in Exhibit A and depicted in Exhibit B to Attachment B to this Agreement (the "Temporary Easement"). C. Construction of the Project requires removal of trees ("Improvements") from the Property as depicted in Attachment C to this Settlement Agreement. D. The City offered to compensate Mr. Perrins the amount of $12,525.00 for the value of the Improvements to be displaced as part of the Project, in addition to compensation for the acquisition of right-of-way in fee and Temporary Easement described above. E. Mr. Perrins provided a counteroffer to the City in the amount of $34,407 as compensation for the value of the Improvements to be displaced by the Project, in addition to the compensation for the acquisition of right-of-way in fee and Temporary Easement. F. The City has agreed to Mr. Perrins counteroffer and would like to document its terms in this Settlement Agreement. Perrins Settlement Agreement - Page 1 of 4 The parties therefore agree as follows: Agreement 1. Settlement of Claims. The parties agree on the following as full and final settlement of all claims for just compensation and any other causes of action related in any way to the City's acquisition of property rights and its use of the Property for its Project. 2. Preparation and Execution of the Easement. 2.1 Mr. Perrins will execute the Warranty Deed, attached as Attachment A, within 5 business days after the Effective Date of this Settlement Agreement. 2.2 Mr. Perrins will execute the Temporary Easement, attached as Attachment B, within 5 business days after the Effective Date of this Settlement Agreement. 3. City Payment. 3.1 The City will pay Mr. Perrins the amount of $8,100.00 (eight thousand, one hundred dollars) as total just compensation for the right-of-way conveyed by the Warranty Deed. 3.2 The City will pay Mr. Perrins the amount of $2,050.00 (two thousand fifty dollars) as total just compensation for the Temporary Easement. 3.2 Having reviewed the information provided by Mr. Perrins, the City will pay Mr. Perrins the amount of $34,407.00 (thirty-four thousand four hundred seven dollars) as total just compensation for the value of the Improvements that will be displaced during construction of the Project. 3.4 The City will make all payments set forth in this Section 3 no later than 20 business days after the Effective Date of this Agreement, except that the City is not obligated to make these payments if Mr. Perrins have not fulfilled the obligations within Section 2 and this Section 3.4. To facilitate the City's payments, Mr. Perrins will deliver to the City, no later than 5 business days after the Effective Date of this Settlement Agreement, a completed Vendor Set-up Form and W-9 in the forms attached as Attachment D, and the Acknowledgment attached as Attachment E. Perrins Settlement Agreement - Page 2 of 4 4. Landscaping and Fencing. The City will remove six large trees and 25 laurel shrubs from the Property as depicted in Attachment C. The City may trim branches on the trees that will remain on the Property as needed for the Project. Replacement and future maintenance of Improvements shall be the responsibility and expense of Mr. Perrins. The City may remove a portion of the fence located on the Property as depicted in Attachment C but will replace any portion that is removed for the Project. Future maintenance of any portion of the fence replaced by the City shall be the responsibility and expense of Mr. Perrins. 5. Successors and Assigns. This Settlement Agreement shall bind and inure to the benefit of the parties and their respective successors and assigns. 6. Amendments. This Settlement Agreement may only be amended in writing, signed by all parties. 7. Severability. If any term, covenant, condition, or provision contained in this Settlement Agreement is determined to be invalid, voided or otherwise unenforceable, by any court of competent jurisdiction, such determination shall in no way affect the validity or enforceability of any other term, covenant, condition, or provision contained in this Settlement Agreement. 8. Execution in Counterparts. This Settlement Agreement may be executed in counterparts and/or transmitted electronically, and copies so executed or transmitted will be deemed originals. 9. Entire Agreement. This Settlement Agreement, together with all attachments constitutes the entire agreement between the parties with respect to the subject matter of this Settlement Agreement. This Settlement Agreement is specifically intended by the parties to supersede all prior agreements whether written or oral. 10.Effective Date. The effective date of this Agreement is the last date signed below. CITY OF KENT By: Dana Ralph By: Ge rae W. Perrins Title: Mayor Date: 40 Date: 07/06/2023 Perrins Settlement Agreement - Page 3 of 4 Attachment List A - Warranty Deed B - Temporary Easement C - Depiction of Improvements D - Vendor Set-Up Form and W-9 E - Acknowledgment Perrins Settlement Agreement - Page 4 of 4 8/7/23, 10:55 AM Landmark Web Official Records Search Instrument Number:20230714000013 Document:EAS Rec:$207.50 Page-1 of 5 Record Datc:7/14/2023 8:11 AM Electronically Recorded King County,"EXCISE TAX NOT REQUIRED By PAUL JUNG,DEPUTY After recording return document to: City Clerk City of Kent 220 41'Avenue South Kent,WA 98032 Document Title:Temporary Easement Reference Number of Related Document: N/A Gmntor(s):George W.Perrins Grantee(s):City of Kent Legal Description: Ptn.Lot 13,Verde Mesa,Vol.79 of Plats,Pg.86 Additional Legal Description is on Exhibit A of Document. Assessor's Tax Parcel Number:889500-0130 TEMPORARY EASEMENT KEN-50 South 2181h Street/98"' Avenue South from 94'h Place South to South 216'h Street Project The Grantor(s), George W. Perrins, for and in consideration of TEN AND NO/100 ($10.00) DOLLARS, and other valuable consideration, conveys and grants unto the City of Kent,and its assigns,Grantee,under the imminent threat of the Grantee's exercise of its right of Eminent Domain, the right, privilege and casement over, upon, through and across the hereinafter described lands for the purpose of widening South 218th Street and 98th Avenue South(from 94th PL S to 99th Ave S)to three lanes and including paving, concrete curbs& gutters,sidewalks,paved shoulders,street lighting,storm drainage,sanitary sewer,water mains replacement,landscaping,and channelization.This project will also include undergrounding all the overhead utilities to a Joint Utility Trench. Said lands being situated in King County,State of Washington,and described in Exhibit A and depicted in Exhibit B,attached hereto and made a part hereof. The term of this Temporary Easement shall commence on the date of acceptance of this Temporary Easement by Grantee and shall terminate on October 31, 2024, hereinafter the FA No. LPA-325 Page I of(3)Pages Parcel Number:989500•0130 Rcv.5/2021 https://recordsearch.kingeounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 1/5 8/7/23, 10:55 AM Landmark Web Official Records Search Instrument Number:20230714000013 Document:EAS Rec: $207.50 Page-2 of 5 Record Date:7/14/2023 8:11 AM King County,WA ...................... ................ .......... ....................... TEMPORARY EASEMENT "Term". Provided.however,that Grantee's use and occupancy of the easement area is limited to between August 1,2023 and October 31,2024. It is further agreed that this Temporary Easement may be extended by up to six months at the Grantee's option.The rate associated with this extension shall be at the same rate as the original Temporary Easement, or at the newly established rate determined by an updated administrative offer; whichever is higher. Grantee shall notify Grantor in writing prior to exercising this option. Grantee shall provide Grantor written notice no less than three days in advance of Grantee's intent to exercise its rights under this Temporary Easement. It is understood and agreed that delivery of this temporary easement is hereby tendered and that the terms and obligations hereof shall not become binding upon the City of Kent unless and until accepted and approved hereon in writing for the City of Kent,by its authorized agent. Dated. .01-jy-2? Grantor: 9 George Vf Perrins Accepted and Approved City of Kent By: Dana Ralph.. Mayor Date: 07/0,6/2023 Notary acknowledgments on following page LPA-325 Page 2 of(3)Pages Rev.5/2021 https://recordsearch.kingcounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 2/5 8/7/23, 10:55 AM Landmark Web Official Records Search Instrument Number:20230714000013 Document:EAS Rec: $207.50 Page-3 of 5 Record Date:7/14/2023 8:11 AM King County,WA TEMPORARY EASEMENT STATE OF WASHINGTON ) )ss. COUNTY OF KING ) I certify that I know or have satisfactory evidence that George W.Perrins is the person who appeared before me,and said person acknowledged that he signed this instrument and acknowledged it to be his free and voluntary act for the uses and purposes mentioned in the instrume Dated: 0 -Notary,Vad;t?ust.ppear Within Mis Box- written. Wl� w,Ufill REOF,t have here�u set my h d d official at7dayd year first above wriCten. �!�Itey t'tr16 s a„ ,4e'Ftp+ ®t+t►a (Printed Name) _ 4 $ 1� � NOTARY PUBLIC:,in and,for the S to r -4 of Washington,residing at A ►r�b` 11ttc 2 = My appointment expires fjrr0% 0#41% -24 w LPA•325 Page 3 of(3)Pages Rev.5/207 t https://recordsearch.kingeounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 3/5 8/7/23, 10:55 AM Landmark Web Official Records Search Instrument Number:20230714000013 Document:EAS Rec: $207.50 Page-4 of 5 -Record, Date:7/111.41/2-02131181:1 11-AM.,King_.County,.WA EXHIBIT—A TAX LOT 8895000130 TEMPORARY CONSTRUCTION EASEMENT THAT PORTION OF LOT 13, VERDE MESA, ACCORDING TO THE PLAT THEREOF, RECORDED IN VOLUME 79 OF PLATS, PAGE 86, RECORDS OF KING COUNTY, WASHINGTON, IN THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 7, TOWNSHIP 22 NORTH, RANGE 5 EAST, WILLAMETTE MERIDIAN, CITY OF KENT, IN KING COUNTY, WASHINGTON, LYING WESTERLY OF THE FOLLOWING DESCRIBED LINE: COMMENCING AT THE NORTHWEST CORNER OF SAID LOT 13; THENCE ALONG THE NORTH LINE THEREOF, N89-57'07-E 14.50 FEET TO THE POINT OF BEGINNING; THENCE S1009'23"W 124.03 FEET; THENCE N89057'07"E 14.50 FEET, CFI ENCE S1009'23"W 11.00 FEET TO THE SOUTHERLY LINE OF SAID LOT 13 AND THE TERMINUS OF THE HEREIN DESCRIBED LINE. EXCEPT THE WEST 5.00 FEET OF SAID LOT 13. CONTAINING 1,442 SQUARE FEET, MORE OR LESS. �wr me 41 https://recordsearch.kingeounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParcelld&quickSearchSelection=# 4/5 8/7/23, 10:55 AM Landmark Web Official Records Search Instrument Number:20230714000013 Document:EAS Rec: $207.50 Page-5 of 5 Record Date:7/14/2023 8:11 AM King County,WA EXH11,41T B or �wimx x .. '�q f. 9 T HAVE m 00 va < 0 7 } MQCO m l m 41- O c> 124.03 a� X M lX1 r' rs 1 ID nQO wa Z' ira 0 w -T .r A -� 7j ,c�a 7 6 M U, 0 , .. < " ti i ar <t M 4 T F0 --i 0 R https://recordsearch.kingeounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 5/5 8/7/23, 10:56 AM Landmark Web Official Records Search Instrument Number:20230720000659 Document:WD Rec: S208.50 Page-1 of 6 Excise Does:3246519 Selling Price:$0.00 Tax Amount:$10.00 Record Date:7/20/2023 3:03 PM Electronically Recorded King County,WA WHEN RECORDED RETURN TO: City Clerk City of Kent 220 Fourth Avenue South Kent, Washington 98032 Grantor:_____Georae W. Perrin Grantee: Citv of Kent_ Abbreviated Legal Description: e n Le 13_Verb ���..Vca{,79 l�f�.P��� Additional Legal Description on:. Exhibit`•A"_ _.� �� � __,.�__ Assessor's Tax parcel ID No.: — .89500-013 , STR:__Q_7- 2-05 w Project Dame:_ KEN- 0 ' SLR'&ve afL= 4.h�PI 5 . 16ti"St WARRANTY DEED THE GRANTOR, George W. Perrins, for and in consideration of Ten Dollars and No/100 ($10.00) and/or other valuable consideration in hand paid, conveys and warrants to the City of Kent, a Washington municipal corporation ("Grantee"), for right-of-way purposes, all its interest, including any after acquired title, in the real property described and depicted in the attached and incorporated Exhibits A and 6, situated in King County, Washington, under the imminent threat of the Grantee's exercise of its rights of Eminent Domain, and subject to the conditions listed on CT Title and Escrow, File No, 50005328-103, Schedule B, Part 1i, Paragraphs 3-4, as set forth in Exhibit C, attached and incorporated. (Signatures on fallowing page) WARRANTY DEED - Page 1 of 2 4 i https://recordsearch.kingcounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParcelld&quickSearchSelection=# 1/6 8/7/23, 10:56 AM Landmark Web Official Records Search Instrument Number:20230720000659 Document:WD Rec: $208.50 Page-2 of 6 Record Date:7/20/2023 3:03 PM King County,WA GRANTOR: 'A Name: orce Vrr'rn _. Date: M STATE OF WA HINGTON � ) ss. COUNTY OF KING ) I certify that I know or have satisfactory evidence that George W. Perrin is the person who appeared before rite, and said person acknowledged that he signed this instrument and acknowledged it to be his free and voluntary act for the uses and purposes mentioned in the instrument. UJ;0 1 [dated: .n__..._.)_. -Notary Serf must Appear 4y7tfiln'rhts Box- IN WITNESS WHEREOF, I hav hereu o set nd and fficial seal the day and year fis ,s}above written ES (Signature) NOTARY PUBLIC, in and fir the Sta u of Washington, residing at "us » "' My appointment a expires ACCENTED: CITY OF KENT By: Title:_Mavor Gate:, QZ C Z 2 ____ WARRANTY DEED •- Page 2 of 2 https://recordsearch.kingcounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 2/6 8/7/23, 10:56 AM Landmark Web Official Records Search Instrument Number:20230720000659 Document:WD Rec: $208.50 Page-3 of 6 Record Date:7/20/2023 3:03 PM King County,WA EXHIBIT—A TAX LOT 8895000130 RIGHT OF WAY DEDICATION THE WEST 5.00 FEE OF LOT 13, VERDE MESA, ACCORDING TO THE PLAT THEREOF, RECORDED IN VOLUME 70 OF FLATS, PAGE 86, RECORDS OF KING COUNTY, WASHINGTON, IN THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 7, TOWNSHIP 22 NORTH, RANGE 5 EAST, WILLAME`ITE MERIDIAN, CITY OF KENT, IN KING COUNTY, WASHINGTON. CONTAINING 675 SQUARE FEET, MORE OR LESS. 4�*� KK iiM MYMW 4YY risr.*p�a a a r�. b r �• °iArerleMA.fA�M�t i i I t https://recordsearch.kingeounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 3/6 8/7/23, 10:56 AM Landmark Web Official Records Search Instrument Number:20230720000659 Document:WD Rec: $208.50 Page-4 of 6 Record Date 7/20/2023 3 03 PM King County,WA s w z ill: I � CY US SV tea'% I ox n i �6tt � t r,z 't saa C"J f3 z Eli Cl Ct_z UJ r7- e(CY. LL!4J fM._r C3 >a z < -- -i � ¢ zzx toy o > 0<: https://recordsearch.kingcounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParceIId&quickSearchSelection=# 4/6 8/7/23, 10:56 AM Landmark Web Official Records Search Instrument Number:20230720000659 Document:WD Rec: $208.50 Page-5 of 6 Record Date 7/20/2023 3 03 PM King County,WA (EXHIBIT C SCHEDULE B, PART II EXCEPTIONS SPECIAL EXCEPTIONS 3, All covenants, conditions, restrictions, reservations,easements or ether servitudes,if any,disclosed by the recorded plat of Verde Mesa recorded in Book 79 of plats, Page 86, This policy does not insure that the land described in schedule a is benefited by easements,covenants or other appurtenances shown on the plat or survey to benefit or burden real property outside the boundaries of said land. https://recordsearch.kingeounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParcelld&quickSearchSelection=# 5/6 8/7/23, 10:56 AM Landmark Web Official Records Search Instrument Number:20230720000659 Document:WD Rec: S208.50 Page-6 of 6 Record Date:7/20/2023 3:03 PM King County,WA 4. Right to make necessary Mopes for cuts or fills upon;the land herein described as granted to King county by deed recorded as Instrument##5030891. https://recordsearch.kingcounty.gov/LandmarkWeb/search/index?theme=.blue§ion=searchCriteriaParcelld&quickSearchSelection=# 6/6 ATTACHMENT B After recording return document to: City Clerk City of Kent 220 4th Avenue South Kent, WA 98032 Document Title: Temporary Easement Reference Number of Related Document: N/A Grantor(s): George W. Perrins Grantee(s): City of Kent Legal Description: Ptn. Lot 13,Verde Mesa, Vol. 79 of Plats, Pg. 86 Additional Legal Description is on Exhibit A of Document. Assessor's Tax Parcel Number: 889500-0130 TEMPORARY EASEMENT KEN-50 South 218th Street/98th Avenue South from 94th Place South to South 216th Street Project The Grantor(s), George W. Perrins, for and in consideration of TEN AND NO/100 ($10.00) DOLLARS, and other valuable consideration, conveys and grants unto the City of Kent, and its assigns, Grantee, under the imminent threat of the Grantee's exercise of its right of Eminent Domain, the right, privilege and easement over, upon, through and across the hereinafter described lands for the purpose of widening South 218th Street and 98th Avenue South (from 94th PL S to 99th Ave S) to three lanes and including paving, concrete curbs & gutters,sidewalks,paved shoulders, street lighting,storm drainage, sanitary sewer,water mains replacement, landscaping,and channelization.This project will also include undergrounding all the overhead utilities to a Joint Utility Trench. Said lands being situated in King County, State of Washington, and described in Exhibit A and depicted in Exhibit B, attached hereto and made a part hereof. The term of this Temporary Easement shall commence on the date of acceptance of this Temporary Easement by Grantee and shall terminate on October 31, 2024, hereinafter the FA No. LPA-325 Page 1 of(3)Pages Parcel Number:889500-0130 Rev.5/2021 TEMPORARY EASEMENT "Term". Provided. however, that Grantee's use and occupancy of the easement area is limited to between August 1, 2023 and October 31, 2024. It is further agreed that this Temporary Easement may be extended by up to six months at the Grantee's option. The rate associated with this extension shall be at the same rate as the original Temporary Easement, or at the newly established rate determined by an updated administrative offer; whichever is higher. Grantee shall notify Grantor in writing prior to exercising this option. Grantee shall provide Grantor written notice no less than three days in advance of Grantee's intent to exercise its rights under this Temporary Easement. It is understood and agreed that delivery of this temporary easement is hereby tendered and that the terms and obligations hereof shall not become binding upon the City of Kent unless and until accepted and approved hereon in writing for the City of Kent, by its authorized agent. Dated: 4 Grantor: George Werrins Accepted and Approved City of Kent By -' Dana Ralph Mayor Date: 07/06/2023 Notary acknowledgments on following page LPA-325 Page 2 of(3)Pages Rev.5/2021 TEMPORARY EASEMENT STATE OF WASHINGTON ) )ss. COUNTY OF KING ) I certify that I know or have satisfactory evidence that George W. Perrins is the person who appeared before me, and said person acknowledged that he signed this instrument and acknowledged it to be his free and voluntary act for the uses and purposes mentioned in the instrument. Q 1 Dated: p I ®I yJ �7 -Notary Seal Must Appear Within This Box- IN WIgQ*$%WIEREOF,I have hereunt set Ahdfficial al the day and year first above written. ���"p,REYEs I1I11� � *014+ � 6 (Z-4 ,� to (Printed Name) AVl 1 {S— t 16t-0-1 N 189 _ NOTARY PUBLIC,in and for the State d63 a� of Washington residing at t ilf-Al _AAA - 7F LAC-��V' 6; B �;r M appointment expires L/— "' 09.24 �s t� LPA-325 Page 3 of(3)Pages Rev.5/2021 EXHIBIT_A TAX LOT 8895000130 TEMPORARY CONSTRUCTION EASEMENT THAT PORTION OF LOT 13, VERDE MESA, ACCORDING TO THE PLAT THEREOF, RECORDED IN VOLUME 79 OF PLATS, PAGE 86, RECORDS OF KING COUNTY, WASHINGTON, IN THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 7, TOWNSHIP 22 NORTH, RANGE 5 EAST, WILLAMETTE MERIDIAN, CITY OF KENT, IN KING COUNTY, WASHINGTON, LYING WESTERLY OF THE FOLLOWING DESCRIBED LINE: COMMENCING AT THE NORTHWEST CORNER OF SAID LOT 13; THENCE ALONG THE NORTH LINE THEREOF, N89°57'07"E 14.50 FEET TO THE POINT OF BEGINNING; THENCE S1009'23"W 124.03 FEET; THENCE N89157'07"E 14.50 FEET; THENCE S1009'23"W 11.00 FEET TO THE SOUTHERLY LINE OF SAID LOT 13 AND THE TERMINUS OF THE HEREIN DESCRIBED LINE. EXCEPT THE WEST 5.00 FEET OF SAID LOT 13. CONTAINING 1,442 SQUARE FEET, MORE OR LESS. a a f a a i a t 1 a tittl..',.t'+..,' : 1Ib016A7 i t ttttlt#ttta/laffaiff q/ZZ/zo22 £&HmI s m w m 0 c -0 m@= > 0= mEm = > z 7_0 % oK � x ) F, m § 7co & M ® m /k ® §��� AVE S = § § $ � w9 �� Xzz \ mooz > c o ƒ- moo = m g ifcn§k \ \ 9 o« \e \ 2 0 m ® I > z ® = 3m ) mf m m q = z ————————= o —— ———— w \ / \� \ 12.0` § ) � R $ M @ \ \ n K p /& ®\ \\jk k$ $\ 45« U2 Z 4 © / ƒ \\ \ f \\ � y M \ E � 2 o ■ o w .. § 9 e \ � o k 6 " Goo C) mn 22 / - - / , Z q y � m c x q ` % O 2 ATTACHMENT C ro ev f: ` r --s a c';�' � ,! ,�• CA � ^ j. N —O •• Mi ;u pD N Z 00 � 00 O 00 O . �+1 �— j�4 r' 'r�.�c.�.L'•_s 1. Al k t .. rr ,f J • 1�� •A/. %1 • ' ,S ATTACHMENT D dNew Vendor \ ! ❑ Reactivate Vendor TKE N T Vendor Set-up Form ❑ Address Change WASHINGTON To be filled out by Vendor ONLY Vendor Number FINANCE 220 Fourth Avenue South • Kent,WA 98032-5895 • Phone: (253) 856-5235 • Fax: (253)856-6200 • • • An incomplete form will create a delay in our payment(s)to you and your payment(s) could be subject to the IRS required back-up withholding. C'15:0"2 pe'CA4 A f Name,as it will appear on check (NOABBREVIATIONS) Doing Business As(If different than name on check) 21 G '-1// L FT" AVr rQ Payment Address Business Address 1<ENT- vJPr M? I City State Zip City State Zip ( .2S'? ) 95-Z-SG 7 Phone Number Accounts Receivable Contact •• • check the appropriate box ❑ Corporation ❑ Government Agency Individual/Sole Proprietor ❑ Non-Profit ❑ Partnership This business is ❑ Minority Owned ❑ Women Owned ❑ Both Minority and Women Owned ❑ Neither Will you provide medical services to the City of Kent? ................................................................Yes No Will you provide legal services to the City of Kent? ....................................................................Yes No Will you provide services other than medical or legal to the City of Kent?....................................Yes No Will you provide parts, supplies or materials to the City of Kent?..................................................Yes No Do you pay sales tax to the State of Washington?.................................................................. .Yes No if exempt from Form 1099 reporting, and check your qualifying exemption reason below: ❑ 1. Corporation, except there is no exemption for medical and healthcare payments or payments for legal services ❑ 2. Tax Exempt Charity under 501(a), or IRA ❑ 3. The United States or any of its agencies or instrumentalities ❑ 4. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions ❑ 5. A foreign government or any of its political subdivisions Name(Owner of the Tax Payer Identification Number(EIN or SSN) as name appears on IRS or Social Security Administration Records): m____ �s`-sa2GA •P0rtrLr Social Security#: _ _ or Federal TIN: Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me)and, 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or(b) I have not been notified by the Internal Revenue Service (IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends, or(c)the IRS has notified me that I am no longer subject to backup withholding, • Signature ► Date ► '� firs2727 Indd-2104 Form Request for Taxpayer Give Form to the (Rev.October2018) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to ww%vJrs.gov/Form W9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. lrao2G 04zr-111 2 Business name/disregarded entity name,if different from above a) 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to rn following seven boxes. certain entities,not individuals;see r°a instructions on page 3): cp U Individual/sole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrustlestate �. c single-member LLC Exempt payee code(if any) ,� 2 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)No p « Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting w LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that code if any) 0. is disregarded from the owner should check the appropriate box for the tax classification of its owner. o ❑ Other(see instructions)► (Applies to s=ounts mWnrelned outside the U.S.) N5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) CD a- B City,state,and ZIP code KEAj T LAf Aq 8G.3 I 7 List account number(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN, later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. EMUF Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later. Sign Signature of Here U.S.person► w Date► 6—,?O —23 General Instructiod a Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments .Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption o Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9(Rev.10-2018) Form W-9(Rev.10-2018) Page 2 By signing the filled-out form,you: Example.Article 20 of the U.S.-China income tax treaty allows an 1.Certify that the TIN you are giving is correct(or you are waiting for a exemption from tax for scholarship income received by a Chinese number to be issued), student temporarily present in the United States.Under U.S.law,this student will become a resident alien for tax purposes if his or her stay in 2.Certify that you are not subject to backup withholding,or the United States exceeds 5 calendar years.However,paragraph 2 of 3.Claim exemption from backup withholding if you are a U.S.exempt the first Protocol to the U.S.-China treaty(dated April 30,1984)allows payee.If applicable,you are also certifying that as a U.S.person,your the provisions of Article 20 to continue to apply even after the Chinese allocable share of any partnership income from a U.S.trade or business student becomes a resident alien of the United States.A Chinese is not subject to the withholding tax on foreign partners'share of student who qualifies for this exception(under paragraph 2 of the first effectively connected income,and protocol)and is relying on this exception to claim an exemption from tax 4.Certify that FATCA code(s)entered on this form(if any)indicating on his or her scholarship or fellowship income would attach to Form that you are exempt from the FATCA reporting,is correct.See What is W-9 a statement that includes the information described above to FATCA reporting,later,for further information. support that exemption. Note:If you are a U.S.person and a requester gives you a form other If you are a nonresident alien or a foreign entity,give the requester the than Form W-9 to request your TIN,you must use the requester's form if appropriate completed Form W-8 or Form 8233. it is substantially similar to this Form W-9. Backup Withholding Definition of a U.S.person.For federal tax purposes,you are considered a U.S.person if you are: What is backup withholding?Persons making certain payments to you •An individual who is a U.S.citizen or U.S.resident alien; must under certain conditions withhold and pay to the IRS 24%of such payments.This is called"backup withholding." Payments that may be •A partnership,corporation,company,or association created or subject to backup withholding include interest,tax-exempt interest, organized in the United States or under the laws of the United States; dividends,broker and barter exchange transactions,rents,royalties, •An estate(other than a foreign estate);or nonemployee pay,payments made in settlement of payment card and •A domestic trust(as defined in Regulations section 301.7701-7). third party network transactions,and certain payments from fishing boat operators.Real estate transactions are not subject to backup Special rules for partnerships.Partnerships that conduct a trade or withholding. business in the United States are generally required to pay a withholding You will not be subject to backup withholding on payments you tax under section 1446 on any foreign partners'share of effectively receive if you give the requester your correct TIN,make the proper connected taxable income from such business.Further,in certain cases certifications,and report all your taxable interest and dividends on your where a Form W-9 has not been received,the rules under section 1446 tax return. require a partnership to presume that a partner is a foreign person,and pay the section 1446 withholding tax.Therefore,if you are a U.S.person Payments you receive will be subject to backup withholding if: that is a partner in a partnership conducting a trade or business in the 1.You do not furnish your TIN to the requester, United States,provide Form W-9 to the partnership to establish your 2.You do not certify your TIN when required(see the instructions for U.S.status and avoid section 1446 withholding on your share of Part II for details), partnership income. In the cases below,the following person must give Form W-9 to the 3.The IRS tells the requester that you furnished an incorrect TIN, partnership for purposes of establishing its U.S.status and avoiding 4.The IRS tells you that you are subject to backup withholding withholding on its allocable share of net income from the partnership because you did not report all your interest and dividends on your tax conducting a trade or business in the United States. return(for reportable interest and dividends only),or •In the case of a disregarded entity with a U.S.owner,the U.S.owner 5.You do not certify to the requester that you are not subject to of the disregarded entity and not the entity; backup withholding under 4 above(for reportable interest and dividend •In the case of a grantor trust with a U.S.grantor or other U.S.owner, accounts opened after 1983 only). generally,the U.S.grantor or other U.S.owner of the grantor trust and Certain payees and payments are exempt from backup withholding. not the trust;and See Exempt payee code,later,and the separate Instructions for the •In the case of a U.S.trust(other than a grantor trust),the U.S.trust Requester of Form W-9 for more information. (other than a grantor trust)and not the beneficiaries of the trust. Also see Special rules for partnerships,earlier. Foreign person.If you are a foreign person or the U.S.branch of a What is FATCA Reporting? foreign bank that has elected to be treated as a U.S.person,do not use Form W-9.Instead,use the appropriate Form W-8 or Form 8233(see The Foreign Account Tax Compliance Act(FATCA)requires a Pub.515,Withholding of Tax on Nonresident Aliens and Foreign participating foreign financial institution to report all United States Entities). account holders that are specified United States persons.Certain Nonresident alien who becomes a resident alien.Generally,only a payees are exempt from FATCA reporting.See Exemption from FATCA nonresident alien individual may use the terms of a tax treaty to reduce reporting code,later,and the Instructions for the Requester of Form or eliminate U.S.tax on certain types of income.However,most tax W-9 for more information. treaties contain a provision known as a"saving clause."Exceptions Updating Your Information specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise You must provide updated information to any person to whom you become a U.S.resident alien for tax purposes. claimed to be an exempt payee if you are no longer an exempt payee If you are a U.S.resident alien who is relying on an exception and anticipate receiving reportable payments in the future from this contained in the saving clause of a tax treaty to claim an exemption person.For example,you may need to provide updated information if from U.S.tax on certain types of income,you must attach a statement you are a C corporation that elects to be an S corporation,or if you no to Form W-9 that specifies the following five items. longer are tax exempt.In addition,you must furnish a new Form W-9 if 1.The treaty country.Generally,this must be the same treaty under the name or TIN changes for the account;for example,if the grantor of a which you claimed exemption from tax as a nonresident alien. grantor trust dies. 2.The treaty article addressing the income. Penalties 3.The article number(or location)in the tax treaty that contains the saving clause and its exceptions. Failure to furnish TIN.If you fail to furnish your correct TIN to a 4.The type and amount of income that qualifies for the exemption requester,you are subject to a penalty of$50 for each such failure from tax. unless your failure is due to reasonable cause and not to willful neglect. 5.Sufficient facts to justify the exemption from tax under the terms of Civil penalty for false information with respect to withholding.If you the treaty article. make a false statement with no reasonable basis that results in no backup withholding,you are subject to a$500 penalty. Form W-9(Rev.10-2018) Page 3 Criminal penalty for falsifying information.Willfully falsifying IF the entity/person on line 1 is THEN check the box for... certifications or affirmations may subject you to criminal penalties a(n)... including fines and/or imprisonment. Misuse of TINs.If the requester discloses or uses TINs in violation of • Corporation Corporation federal law,the requester may be subject to civil and criminal penalties. • Individual Individual/sole proprietor or single- 9 Sole proprietorship,or member LLC Specific Instructions • Single-member limited liability company(LLC)owned by an Line 1 individual and disregarded for U.S. You must enter one of the following on this line;do not leave this line federal tax purposes. blank.The name should match the name on your tax return. . LLC treated as a partnership for Limited liability company and enter If this Form W-9 is for a joint account(other than an account U.S.federal tax purposes, the appropriate tax classification. maintained by a foreign financial institution(FFI)),list first,and then a LLC that has filed Form 8832 or (P=Partnership;C=C corporation; circle,the name of the person or entity whose number you entered in 2553 to be taxed as a corporation, or S=S corporation) Part I of Form W-9.If you are providing Form W-9 to an FFI to document or a joint account,each holder of the account that is a U.S.person must e LLC that is disregarded as an provide a Form W-9. entity separate from its owner but a. Individual.Generally,enter the name shown on your tax return.If the owner is another LLC that is you have changed your last name without informing the Social Security not disregarded for U.S.federal tax Administration(SSA)of the name change,enter your first name,the last purposes. name as shown on your social security card,and your new last name. Note:[TIN applicant:Enter your individual name as it was entered on • Partnership Partnership your Form W-7 application,line 1 a.This should also be the same as the • Trust/estate Trust/estate name you entered on the Form 1040/1040A/1040EZ you filed with your Line 4, Exemptions application. b. Sole proprietor or single-member LLC.Enter your individual If you are exempt from backup withholding and/or FATCA reporting, name as shown on your 1040/1040A/1040EZ on line 1.You may enter enter in the appropriate space on line 4 any code(s)that may apply to your business,trade,or"doing business as"(DBA)name on line 2. you. c. Partnership,LLC that is not a single-member LLC,C Exempt payee code. corporation,or S corporation.Enter the entity's name as shown on the • Generally,individuals(including sole proprietors)are not exempt from entity's tax return on line 1 and any business,trade,or DBA name on backup withholding. line 2. • Except as provided below,corporations are exempt from backup d. Other entities.Enter your name as shown on required U.S.federal withholding for certain payments,including interest and dividends. tax documents on line 1.This name should match the name shown on the . Corporations are not exempt from backup withholding for payments charter or other legal document creating the entity.You may enter any made in settlement of payment card or third party network transactions. business,trade,or DBA name on line 2. • Corporations are not exempt from backup withholding with respect to e. Disregarded entity.For U.S.federal tax purposes,an entity that is attorneys'fees or gross proceeds paid to attorneys,and corporations disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect "disregarded entity." See Regulations section 301.7701-2(c)(2)(iii).Enter to payments reportable on Form 1099-MISC. the owner's name on line 1.The name of the entity entered on line 1 should never be a disregarded entity.The name on line 1 should be the The following codes identify payees that are exempt from backup name shown on the income tax return on which the income should be withholding.Enter the appropriate code in the space in line 4. reported.For example,if a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a),any IRA,or entity for U.S.federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7)if the account satisfies the person,the U.S.owner's name is required to be provided on line 1.If requirements of section 401(%2) the direct owner of the entity is also a disregarded entity,enter the first 2—The United States or any of its agencies or instrumentalities owner that is not disregarded for federal tax purposes.Enter the disregarded entity's name on line 2,"Business name/disregarded entity 3—A state,the District of Columbia,a U.S.commonwealth or name."If the owner of the disregarded entity is a foreign person,the possession,or any of their political subdivisions or instrumentalities owner must complete an appropriate Form W-8 instead of a Form W-9. 4—A foreign government or any of its political subdivisions,agencies, This is the case even if the foreign person has a U.S.TIN. or instrumentalities Line 2 5—A corporation If you have a business name,trade name,DBA name,or disregarded 6—A dealer in securities or commodities required to register in the entity name,you may enter it on line 2. United States,the District of Columbia,or a U.S.commonwealth or possession Line 3 7—A futures commission merchant registered with the Commodity Check the appropriate box on line 3 for the U.S.federal tax Futures Trading Commission classification of the person whose name is entered on line 1.Check only 8—A real estate investment trust one box on line 3. 9—An entity registered at all times during the tax year under the Investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the investment community as a nominee or custodian 13—A trust exempt from tax under section 664 or described in section 4947 Form W-9(Rev.10-2018) Page 4 The following chart shows types of payments that may be exempt M—A tax exempt trust under a section 403(b)plan or section 457(g) from backup withholding.The chart applies to the exempt payees listed plan above,1 through 13. Note:You may wish to consult with the financial institution requesting IF the payment is for... THEN the payment is exempt this form to determine whether the FATCA code and/or exempt payee for... code should be completed. Interest and dividend payments All exempt payees except Line 5 for 7 Enter your address(number,street,and apartment or suite number). Broker transactions Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your information through 11 and all C corporations. returns.If this address differs from the one the requester already has on S corporations must not enter an file,write NEW at the top.If a new address is provided,there is still a exempt payee code because they chance the old address will be used until the payor changes your are exempt only for sales of address in their records. noncovered securities acquired Line 6 prior to 2012. Enter your city,state,and ZIP code. Barter exchange transactions and Exempt payees 1 through 4 patronage dividends Part I. Taxpayer Identification Number (TIN) Payments over$600 required to be Generally,exempt payees Enter your TIN in the appropriate box.If you are a resident alien and reported and direct sales over 1 through 52 you do not have and are not eligible to get an SSN,your TIN is your IRS $5,0001 individual taxpayer identification number(ITIN).Enter it in the social security number box.If you do not have an ITIN,see How to get a TIN Payments made in settlement of Exempt payees 1 through 4 below. payment card or third party network If you are a sole proprietor and you have an EIN,you may enter either transactions your SSN or EIN. 1 See Form 1099-MISC,Miscellaneous Income,and its instructions. If you are a single-member LLC that is disregarded as an entity separate from its owner,enter the owner's SSN(or EIN,if the owner has 2 However,the following payments made to a corporation and one).Do not enter the disregarded entity's EIN.If the LLC is classified as reportable on Form 1099-MISC are not exempt from backup a corporation or partnership,enter the entity's EIN. withholding:medical and health care payments,attorneys'fees,gross proceeds paid to an attorney reportable under section 6045(%and Note:See What Name and Number To Give the Requester, later,for payments for services paid by a federal executive agency. further clarification of name and TIN combinations. Exemption from FATCA reporting code.The following codes identify How to get a TIN.If you do not have a TIN,apply for one immediately. payees that are exempt from reporting under FATCA.These codes To apply for an SSN,get Form SS-5,Application for a Social Security apply to persons submitting this form for accounts maintained outside Card,from your local SSA office or get this form online at of the United States by certain foreign financial institutions.Therefore,if www.SSA.gov.You may also get this form by calling 1-800-772-1213. you are only submitting this form for an account you hold in the United Use Form W-7,Application for IRS Individual Taxpayer Identification States,you may leave this field blank.Consult with the person Number,to apply for an ITIN,or Form SS-4,Application for Employer requesting this form if you are uncertain if the financial institution is Identification Number,to apply for an EIN.You can apply for an EIN subject to these requirements.A requester may indicate that a code is online by accessing the IRS website at www.irs.gov/Businesses and not required by providing you with a Form W-9 with"Not Applicable"(or clicking on Employer Identification Number(EIN)under Starting a any similar indication)written or printed on the line for a FATCA Business.Go to www.irs.gov/Forms to view,download,or print Form exemption code. W-7 and/or Form SS-4. Or,you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 A—An organization exempt from tax under section 501(a)or any business days. individual retirement plan as defined in section 7701(a)(37) If you are asked to complete Form W-9 but do not have a TIN,apply B—The United States or any of its agencies or instrumentalities for a TIN and write"Applied For"in the space for the TIN,sign and date C—A state,the District of Columbia,a U.S.commonwealth or the form,and give it to the requester.For interest and dividend possession,or any of their political subdivisions or instrumentalities payments,and certain payments made with respect to readily tradable D—A corporation the stock of which is regularly traded on one or instruments,generally you will have 60 days to get a TIN and give it to more established securities markets,as described in Regulations the requester before you are subject to backup withholding on section 1.1472-1(c)(1)(i) payments.The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until E—A corporation that is a member of the same expanded affiliated you provide your TIN to the requester. group as a corporation described in Regulations section 1.1472-1(c)(1)(i) Note:Entering"Applied For"means that you have already applied for a F—A dealer in securities,commodities,or derivative financial TIN or that you intend to apply for one soon. instruments(including notional principal contracts,futures,forwards, and options)that is registered as such under the laws of the United Caution:A disregarded U.S.entity that has a foreign owner must use States or any state the appropriate Form W-8. G—A real estate investment trust Part II. Certification H—A regulated investment company as defined in section 851 or an To establish to the withholding agent that you are a U.S.person,or entity registered at all times during the tax year under the Investment resident alien,sign Form W-9.You may be requested to sign by the Company Act of 1940 withholding agent even if item 1,4,or 5 below indicates otherwise. I—A common trust fund as defined in section 584(a) For a joint account,only the person whose TIN is shown in Part I J—A bank as defined in section 581 should sign(when required).In the case of a disregarded entity,the K—A broker person identified on line 1 must sign.Exempt payees,see Exempt payee L—A trust exempt from tax under section 664 or described in section code,earlier. 4947(a)(1) Signature requirements.Complete the certification as indicated in items 1 through 5 below. Form W-9(Rev.10-2018) Page 5 1.Interest,dividend,and barter exchange accounts opened For this type of account: Give name and EIN of: before 1984 and broker accounts considered active during 1983. You must give your correct TIN,but you do not have to sign the 14.Account with the Department of The public entity Certification. Agriculture in the name of a public entity(such as a state or local 2.Interest,dividend,broker,and barter exchange accounts government,school district,or opened after 1983 and broker accounts considered inactive during prison)that receives agricultural 1983.You must sign the certification or backup withholding will apply.If program payments you are subject to backup withholding and you are merely providing your correct TIN to the requester,you must cross out item 2 in the 15.Grantor trust filing under the Form The trust certification before signing the form. 1041 Filing Method or the Optional 3.Real estate transactions.You must sign the certification.You may Form 1099 Filing Method 2(see cross out item 2 of the certification. Regulations section 1.671-4(b)(2)(i)(B)) 4.Other payments.You must give your correct TIN,but you do not List first and circle the name of the person whose number you furnish. have to sign the certification unless you have been notified that you If only one person on a joint account has an SSN,that person's number have previously given an incorrect TIN."Other payments"include must be furnished. payments made in the course of the requester's trade or business for 2 Circle the minor's name and furnish the minor's SSN. rents,royalties,goods(other than bills for merchandise),medical and health care services(including payments to corporations),payments to s You must show your individual name and you may also enter your a nonemployee for services,payments made in settlement of payment business or DBA name on the"Business name/disregarded entity" card and third party network transactions,payments to certain fishing name line.You may use either your SSN or EIN(if you have one),but the boat crew members and fishermen,and gross proceeds paid to IRS encourages you to use your SSN. attorneys(including payments to corporations). 4 List first and circle the name of the trust,estate,or pension trust.(Do S.Mortgage interest paid by you,acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the secured property,cancellation of debt,qualified tuition program legal entity itself is not designated in the account title.)Also see Special payments(under section 529),ABLE accounts(under section 529A), rules for partnerships,earlier. IRA,Coverdell ESA,Archer MSA or HSA contributions or *Note:The grantor also must provide a Form W-9 to trustee of trust. distributions,and pension distributions.You must give your correct Note:If no name is circled when more than one name is listed,the TIN,but you do not have to sign the certification. number will be considered to be that of the first name listed. What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft For this type of account: Give name and SSN of: Identity theft occurs when someone uses your personal information 1.Individual The individual such as your name,SSN,or other identifying information,without your 2.Two or more individuals Ijoint The actual owner of the account or,if permission,to commit fraud or other crimes.An identity thief may use account)other than an account combined funds,the first individual on your SSN to get a job or may file a tax return using your SSN to receive maintained by an FFI the account' a refund. 3.Two or more U.S.persons Each holder of the account To reduce your risk: Qoint account maintained by an FFI) •Protect your SSN, 4.Custodial account of a minor The minor2 •Ensure your employer is protecting your SSN,and (Uniform Gift to Minors Act) •Be careful when choosing a tax preparer. 5.a.The usual revocable savings trust The grantor-trustee' If your tax records are affected by identity theft and you receive a (grantor is also trustee) notice from the IRS,respond right away to the name and phone number b.So-called trust account that is not The actual owner printed on the IRS notice or letter. a legal or valid trust under state law If your tax records are not currently affected by identity theft but you 6.Sole proprietorship or disregarded The ownW think you are at risk due to a lost or stolen purse or wallet,questionable entity owned by an individual credit card activity or credit report,contact the IRS Identity Theft Hotline 7.Grantor trust filing under Optional The grantor* at 1-800-908-4490 or submit Form 14039. Form 1099 Filing Method 1(see For more information,see Pub.5027,Identity Theft Information for Regulations section 1.671-4(b)(2)(1) Taxpayers. (A)) Victims of identity theft who are experiencing economic harm or a For this type of account: Give name and EIN of: systemic problem,or are seeking help in resolving tax problems that 8.Disregarded entity not owned by an The owner have not been resolved through normal channels,may be eligible for individual Taxpayer Advocate Service(TAS)assistance.You can reach TAS by 9.A valid trust,estate,or pension trust Legal entity4 calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. 10.Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes. corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to Form 2553 mimic legitimate business emails and websites.The most common act 11.Association,club,religious, The organization is sending an email to a user falsely claiming to be an established charitable,educational,or other tax- legitimate enterprise in an attempt to scam the user into surrendering exempt organization private information that will be used for identity theft. 12.Partnership or multi-member LLC The partnership 13.A broker or registered nominee The broker or nominee Form W-9(Rev.10-2018) Page 6 The IRS does not initiate contacts with taxpayers via emails.Also,the privacy Act Notice IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers,passwords,or similar secret access Section 6109 of the Internal Revenue Code requires you to provide your information for their credit card,bank,or other financial accounts. correct TIN to persons(including federal agencies)who are required to file information returns with the IRS to report interest,dividends,or If you receive an unsolicited email claiming to be from the IRS, certain other income paid to you;mortgage interest you paid;the forward this message to phishing@irs.gov.You may also report misuse of the IRS name,logo,or other IRS property to the Treasury Inspector acquisition tr abandonment of secured property;the cancellation of General for Tax Administration(TIGTA)at 1-800-366-4484.You can debt;n contributions you made to in IRA,Archer the for to The forward suspicious emails to the Federal Trade Commission at person collecting this form uses the information o the form to file spam@uce.gov or report them at www.ftc.gov/complaint.You can information returns with the IRS,reporting the above information. contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT(877-438-4338). Routine uses of this information include giving it to the Department of If you have been the victim of identity theft,see www.ldentitITheft.gov Justice for civil and criminal litigation and to cities,states,the District of and Pub.5027. Columbia,and U.S.commonwealths and possessions for use in administering their laws.The information also may be disclosed to other Visit www.irs.govIldentityTheft to learn more about identity theft and countries under a treaty,to federal and state agencies to enforce civil how to reduce your risk. and criminal laws,or to federal law enforcement and intelligence agencies to combat terrorism.You must provide your TIN whether or not you are required to file a tax return.Under section 3406,payers must generally withhold a percentage of taxable interest,dividend,and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. ATTACHMENT E Project Name/Number: KEN-50 S. 218th St./98th Ave S. from 94th PI S to S 216th St Property Owner: George W. Perrins Address: 21642 98th Ave. S. Tax Parcel Number: 889500-0130 ACKNOWLEDGEMENT I, the undersigned, am the owner of the property described in Exhibit "A" attached. I acknowledge and understand • That the City of Kent will not be contacting my lender and requesting a partial re-conveyance for the acquired property; • That my lender may have a right to the proceeds from the acquisition. We hereby hold the City of Kent harmless, if the lender requires any portion or all of the proceeds after this transaction has closed and disbursed. We, the undersigned, will pay the lender directly; • That payment for the acquisition of the described property will be made directly to me, or at my option initialed below, the City of Kent will make payment directly to my lender. George W� Perrins Date: 30'23 Make payment directly to me the Grantor at the following address: 21642 98th Ave S. Kent WA Make payment directly to my lender at the following address and loan Number Loan #: Exhibit A Lot 13 of VERDE MESA, as per plat recorded in Volume 79 of Plats, on page 86, records of King County, Washington; Situate in the County of King, State of Washington. THE ADDRESS FOR THE PROPERTY DESCRIBED ABOVE IS AS FOLLOWS: 21642 98th Avenue South, Kent,WA 98031