HomeMy WebLinkAboutCAG2024-057 - Original - GEP X West Hill, LLC - Reith Road Roundabout Project - 02/08/2024 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 02/07/2024 2/12/2024
QAuthorized to Sign: Date of Council Approval:
Q �✓ Mayor or Designee 7/18/23
Budget Account Number: Grant? Yes NoF—]
Budget? Yes E]No Type: N/A
Vendor Name: Category: i
GEP X West Hill, LLC Contract
Vendor Number: Sub-Category:
Original
0
Project Name: Reith Road Roundabout Project
3- Project Details: Settlement Agreement for acquisition of right of way and a temporary
0 9 q 9 Y P Y
C easement from the Avana West Hill Apartments property to construct the
*, roundabout project.
C
(11.111
E Agreement Amount: $15 850
Basis for Selection of Contractor:
*Memo to Mayor must be attached
i Start Date: 08/2024 Termination Date:
lm
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) Authorized Signer Verified
Notice required prior to disclosure? Contract Number:
Yes ✓❑No CAG2024-057
Comments:
Mayor Ralph - Please sign the Settlement Agreement on the 5th page of this
packet, then sign the acceptance on the Special Warranty Deed on the 7th
c page of the packet, and the acceptance on the Temporary Easement on the
as *, 12th page of the packet. Thank you! Cheryl R-W
3 0
a
Date Received:City Attorney: 2/7/24 Date Routed:Mayor's Office 2/8/24 L
ty Clerk's Office 2/9/24
adccW22373_7_20 Visit Documents.KentWA.gov to obtain copies of all agreements
rev.20221201
SETTLEMENT AGREEMENT
Reith Road Roundabout Project
City of Kent Project Number: 22-3005
Owner: GEP X West Hill, LLC
King County Tax Parcel Number: 222204-9018
Address: 24849 46th Ave. S., Kent, WA 98032
This Settlement Agreement ("Settlement Agreement") is between the City of Kent,
a Washington municipal corporation ("City") and GEP X West Hill, LLC ("Owner").
Background
A. The Owner owns real property located at 24849 46th Ave. S., Kent, WA 98032,
commonly known as the Avana West Hill Apartments (the "Property").
B. To accommodate the City's Reith Road Roundabout Project ("Project"), the City
must acquire from the Owner the following property and/or property rights:
196.64 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 4,839.70 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 regrading of a portion of Owner's
landscaping, replacement of Owner's irrigation pipes and relocation of the
irrigation control box. The monument sign identifying the complex as the
Avana Apartments ("Avana Sign") will not be moved but may be obscured
during construction. The location of the sign and the irrigation control box are
depicted in Attachment C to this Settlement Agreement.
D. The Owner would like assurance that the irrigation pipes and sprinkler heads
will be replaced, and the irrigation control box location adjusted as part of the
Project. The Owner would also like assurance that the City will protect the
Avana Sign during construction and, in the event it is damaged, replace it. The
Owner has also requested that temporary fencing be placed along the
Temporary Easement boundary to separate the Property from the Project
during construction and that residents have access to the Property during
construction.
GEP X West Hill LLC Settlement Agreement - Page 1 of 4
E. The City would like to accommodate the Owners' requests as part of the
settlement for acquisition of the above-referenced property rights.
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 Deed and Easement.
2.1 The Owners will execute the Special Warranty Deed, attached as
Attachment A, within 5 business days after the Effective Date of this
Settlement Agreement.
2.2 The Owners 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 the Owners the amount of $2,200.00 (two thousand,
two hundred dollars) as total just compensation for the right-of-way
conveyed by the Warranty Deed.
3.2 The City will pay the Owners the amount of $4,300.00 (four thousand,
three hundred dollars) as total just compensation for the Temporary
Easement.
3.3 The City will pay the Owners the amount of $9,350.00 (nine thousand,
three hundred fifty dollars) as total just compensation for the value of
improvements that will be displaced during construction of the Project,
including lawn, river rocks, shrubs, plants, and trees. This does not
include compensation for the irrigation piping and sprinkler heads
addressed in Section 4.
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 the Owners have
not fulfilled the obligations within Section 2 and this Section 3.4. To
facilitate the City's payments, the Owners will deliver to the City, no
GEP X West Hill LLC Settlement Agreement - Page 2 of 4
later than 5 business days after the Effective Date of this Settlement
Agreement, a completed Vendor Set-up Form and in the form attached
as Attachment D, and the Acknowledgment attached as Attachment
E.
4. Landscaping and Irrigation. As part of the Project, the City will remove a
portion of landscaping in the Temporary Easement area, and will regrade the
area to meet the new grades of the right-of-way. The City will also replace
any irrigation pipes and sprinkler heads removed as part of the Project and will
protect and relocate the irrigation control box. The control box will be raised
to the new grade level and any electrical and water components of the
irrigation system that are damaged or abandoned during construction will be
replaced as part of the Project.
5. Avana Sign and Fencing. The City will protect the Avana Sign during
construction and, in the event it is damaged, the City will replace it. For the
time that the existing Avana sign will be obscured by construction activities,
the City will install up to 2 temporary 4-feet high by 6-feet wide laminated
vinyl face Avana signs mounted on plywood and 4" x 4" wooden posts. The
Owner will provide the City with the electronic vector graphics design files
required for printing the temporary Avana signs. Temporary fencing will be
placed along the Temporary Easement boundary to separate the Property from
the Project.
6. Access. The City will ensure vehicle and pedestrian access to the Property
during construction of the Project.
7. Successors and Assigns. This Settlement Agreement shall bind and inure to
the benefit of the parties and their respective successors and assigns.
8. Amendments. This Settlement Agreement may only be amended in writing,
signed by all parties.
9. 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.
10.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.
GEP X West Hill LLC Settlement Agreement - Page 3 of 4
11.Entire Agreement. This Settlement Agreement, together with all exhibits
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.
12.Effective Date. The effective date of this Agreement is the last date signed
below.
CITY OF KENT GEP X West Hill, LLC
By: Dana Ralph Bv:James O'Brien
Title: Mayor Title: Authorized Representative
Date: 02/08/2024 Date: 2/7/24
Attachment List
A - Special Warranty Deed
B - Temporary Easement
C - Depiction of Improvements
D - Vendor Set-Up Form
E - Acknowledgment
GEP X West Hill LLC Settlement Agreement - Page 4 of 4
Instrument Number:20240212000444 Document:WD Rec: S306.50 Page-1 of 4
Excise Docs:3269723 Selling Price: S0.00 Tax Amount: S10.00 Record Date:2/12/2024 11:11 AM
Electronically Recorded King County,WA
WHEN REC'O DE RETURN N TO:
City Clerk
City of'Kent.
22,0 Fourth avenue South
Dent,Washington 98032
Grantor:—_,GEP West hill LI,C ...._-_
Grantee: Cit dent
Abbreviated Legal Description:— �Ptn.N 1/2 SE 1/4 See. 22,,1 2N,P 4E.W.M..
Additional Legal Description on: ,Exhibit"A„
Assessor's Tax Parcel ID No.: 222204-901 STP.: 22-22N-4:
Project:Name: Reith„Road Roundabogt
SPECIAL WARRANTY DEED
THE GRANTOR,CEP X West dill,LLC,a Delaware limited liability company, for
and in consideration of Teti Dollars and No/100 ( 10.00) and/or other valuable consideration i
band paid, conveys to the City of Kent, a Washington municipal corporation ("Grantee"), for
right-of-way purposes, all its interest, in the real property described and depicted in the attached
and incorporated Exhibits A and B, situated in ding County, Washington, under the imminent
threat of the Grantee's exercise of its rights of Eminent Domain.
Grantor,for itself,and its successors and assigns,does hereby covenant,promise and agree,
to and with Grantee,its successors and assigns,that it has not done or suffered to be done,anything
whereby the property hereby granted is,or may be,in any manner encumbered or charged, except.
as herein recited; that Grantor is lawfully seised of said property in fee simple; that Grantor has
good right and lawful authority to grant and convey said real property and hereby warrants the title
to said property;and that said property against all persons lawfully claiming,or to claim the sane,
y, through and under Grantor, but not otherwise, Grantor will WARRANT" .AND DEFEND,
subject to the conditions listed on Fidelity National Title Insurance Company Certificate No.
611325748, Schedule 1 ,Part ll-Exceptions,Paragraphs 1-1.1, as set forth in Exhibit C,attached
and incorporated,or other matters of record or to which reference is made in the public record.
(Signature onfollowingpt�ge)
WARRANTY DEED--Page 1 of
ACVVE 689184780
Instrument Number:20240212000444 Document:WD Rec: $306.50 Page-2 of 4
Record Date:2/12/2024 11:11 AM King County,WA
IN WITNESS REOF,Grantor has executed this Special Warranty feed as of the
7_. ay of WFebruary 2021.4
ESQ HILL,LLC,
a Dela are limited liability company
Na r ( .'Ze _-
Date. t.11,
ATE OF �
CC:It.TNTY CAP',Ljlj,j ,,LLj.i-. ,I'l
Personally appeared before me, the undersigned authority in and for the said county and
stag,on the day of; rY'F "TM ,2024,withinmy jurisdiction,the within named
ofGEP X West dill,LLC, a Delaware limited liability
company who proved to nee on the basis of satisfactory evidence to be the person whose name i
subscribed in the above and foregoing instrument and acknowledged that he/she execrated the
same in his/her representative capacity of CEP X West Hill, Lf.C,a Delaware limited liability
company, and that by his/her signature on the instrument,and as the act and deed of the person
or entity upon behalf of which he/she acted,executed the above and foregoing instrument, after
first having been duly authorized so to do.
,ew• `" ''r5kd"J'Cl�' °^� d �� /2 P gy�pp!! F I� fn 9
My Commission Expires:
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ACCEPTED:
E :
CITY OF KENT
y:. C_a dal h
Title:_Mgyor
Date: 02/08/2024
WARRANTY DEED Page 2 of
ACTIVE 68 184780
Instrument Number:20240212000444 Document:WD Rec: $306.50 Page-3 of 4
Record Date:2/12/2024 11:11 AM King County,WA
EIIII3IT A.
TAB LOT 222204901
THAT PORTION OF PARCEL,A DESCRIBED BELOW,LYING NORTHWESTERLY OF
THE FOLLOWING DESCRIBED DINE:
COMMENCING ING A.T THE NORTHEASTERLY CORNER.NE OF SAID PARCEL A.,THENCE
ALONG THE EASTERLY LINE THEREOF, S5"44'06"E 20.70 FEET TO THE POINT OF
BEGINNING;THENCE N35°05'32"W 28.70 FEET TO A 406.74 FC C>T RAD J S,NON-
TANGENT CIRCULAR CURVE TO THE LEFT,FROM"ICH T14E CENTER OF SAID
CURVE BEARS S 14"1 0'2 "W, THENCE ALONG SAID CURVE, THR.OIJ`GH A CENTRAL,
ANGLE OF 06"02'42",AN ARC LENGTH OF 42,91 FEET, THENCE,N08°07'47"E I.00
FEET TO THE NORTHERLY LINE OF SAID PARCEL A AND THE TERMINUS CIE THE
HEREIN DESCRIBED LINE.
PARCEL,A.
THAT PORTION OF THE NORTH HALF OF THE SOUTHEAST QUARTER OF SECTION
22, TOWNSHIP 22 NORTH, RANGE 4 EAST,WILLAMET"TE MERIDIAN, CITY OF DENT,
IN KING COUNTY,TY,WASHINGTON,LYING EASTERLY AND SOUTHERLY OF THE
ROAD"A„RIGHT-CIF"-WAY AS CONVEYED TO THE CITY OF KENT BY DEED
RECORDED UNDER RECORDING NUMBER 7110060365, RECORDS OF ICING
COUNTY, WASH NGTON,AND WESTERLY OF THE WESTERLY MARG N OF LAKE
FENWICK ROAD(J.L. REITH ROAD NO, 2266),AND WESTERLY OF ROAD"B" RIGHT-
OF-WAY AS CONVEYED TO THE CITY OF DENT BY SAID DEED.
CONTAINING 197 SQUARE FEET,MORE OR LESS.
WARRANTY DEED...-Page 3 of 3
ACTIVE 689184780
Instrument Number:20240212000444 Document:WD Rec: $306.50 Page-4 of 4
Record Date:2/12/2024 11:11 AM King County,WA
ROTH
197 Sa FT
1, 1- Z,
rM
P t �
i
N
TWS M NO T A SURVEY,tlT t�
FURMV4ED AS A COMSMENCE TO PORT�ON OF RIGHT OF WAY
LOCATE THE LAIC INDICATEO HEREON THEN V2 CW THE SE 114 liQtft R1 M4
a"ATH REFERENCE TO$TREETS AND OP$EC 22 7r;vNS14,F 22 w,OTHER LAP4?NO LCEUrY G ASSUMED 4`RESP OF N T SCtM CEW PEA SON F RED RANGE a E W YKEWT T
EXH01
LAND S IM' SZCT"ION E3 TE.DO N r24T25 B
WARRANTY"DEED,_-Page 4 of
ACTIVE 689184780
Instrument Number:20240212000316 Document:EAS Rec: 5307.50 Page-1 of 5
Record Date:2/12/2024 9:03 AM
Electronically Recorded King County,WA EXCISE TAX NOT REQUIRED BY HOLLY FERGUSON,DEPUTY
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: /A
Grantor(s): GEP X Nest Hill,LLC
Grantee(s): City of Kent
Legal Description: Ptn.N % S /4 Sec.22, p 22N.R .4E,W.M.
Additional Legal Description is on Exhibit A of Document.
Assessor's Tax Marcel lumber: 04- 0I.
TEMPORARY ASp NT
Peith Road Roundabout Project
Grantor, GEP X West bill, CLC, a. Delaware limited liability company, for and in
consideration of TEN AND NCB/10 ($10.00) DOLLARS, and other valuable consideration,
conveys and grants unto the City of Dent, 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 sole purpose of constructing a
roundabout at the intersection of Reith Road and Rake lroenwick Road(the"project")for the Term
(as hereinafter defined).
Said lands being situated in Ding County,State ofWashington,and described in Exhibit A
and depicted in Exhibit 13,attached hereto and made a part hereof(the"Easement Area").
The term of this Temporary Easement shall commence on the date of entry by Grantee for
construction in the Easement Area and shall expire one (1) year from that date (the "Term").
").
Provided,however,that Grantee's use and occupancy of the easement area shall tenninate no later
than May 31, 2025 (the"Expiration hate").
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 any 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
and upon delivery of such extension notice, Grantee shall pay to Grantor such extension fee.
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.
Grantee shall indemnify, protect and save harmless Grantor from and against any and all
claims, demands, loss, damage, expense, and liability of every kind and description and for any
LPA-325 Page l (3)Pages FA No.
Rev.512021ACTIVE 689/84794 Parcel Dumber: 222204-9 1 S
Instrument Number:20240212000316 Document:EAS Rec: S307.50 Page-2 of 5
Record Date:2/12/2024 9:03 AM King County,WA
damage to or loss or destruction of property suffered by Grantor, arising out of or relating to the
Project.
Nothing contained herein shall authorize Grantee or any person or entity acting through,
with, or on behalf of Grantee (as used in this paragraph, a "Lienor"), to subject the Grantor's
property(including,without limitation,the Easement Area)to any lien or encumbrance,including,
without limitation,any mechanic's or materialmen's lien, If any such lien is tiled,the Lienor shall.
cause the lien to be discharged. If the Lienor does not discharge the lien.within 20 days after receipt
of written notice of the lien, Grantor, at its option and at the reasonable cost and expense of the
Lienor, may enter into, defend, prosecute or pursue any effort or action(whether or not litigation
is involved) which Grantor deems reasonably necessary to defend its property from and against.
the lien.
During the Term, Grantee shall maintain, and shall cause all contractors and any
subcontractors to mainLiin commercial general liability insurance insuring against their respective
liability arising out of the construction of the project. The commercial general liability insurance
shall cover liability arising from premises, operations, independent contractors, products-
completed operations, personal injury, property damage, liability assumed under an insured
contract coverage and contractual indemnity coverage. The insurance shall be on an occurrence
basis providing single-limit coverage in an amount not less than One Million Dollars
( 1,000,000,00) per occurrence. Grantee shall also carry a policy of builders risk insurance
covering the construction of Project, Grantee shall ensure that any contractor or subcontract
completing all or any portion of the construction work maintains a commercial general liability
insurance as set forth herein, fnsurance required to be maintained hereunder shall be with
companies rated.A-X or better in Best's Insurance Guide,which are authorized to transact business
in the State of Washington, A certificate of insurance evidencing such coverage shall be provided
to Grantor prior to any entrance by Grantee or its contractors or subcontractors onto the Grantor's
property. Grantee shall cause Grantor to be designated as an additional insured on the foregoing
insurance. The applicable insurance carrier shall notify Grantor at least 30 days in advance of the
cancellation or reduction in coverage of any policy.
Capon completion of the Project and prior to the expiration of the Term, Grantee shall
remove all debris and restore the surface of the Easement Area and restore the Easement Area and
adjacent property to substantially,the saute condition,as existed prior to the commencement of the
Project.
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 parties unless and until
accepted and approved hereon in writing for the City of dent by its authorized agent..
[Signature Page Follows]
LPA-325 Page 2(3)Pages FA No.
Rw 512021ACTIfiE 689184794 Parcel Number: 2222 4- 01.8
Instrument Number:20240212000316 Document:EAS Rec: S307.50 Page-3 of 5
Record Date:2/12/2024 9:03 AM King County,WA
IN WITNESS WHEREOF,Grantor has executed this"Temporary Easement as of the 7_
day of.Fib _,2023.
GRANTOR:
G P X WIEST . .ILL,LLC,
a Delaware limited liability company
Na
"Title; "w " L C,�.�.d—ILI
STATE OF
ss.
COUNTY T, OF . i"2. L4.L"IIL- (TI �
Personally appeared before me,the undersigned authority in and for the said county and
state,on this " day o �b�� (1 ' ,202. within asyjurisdiction,th within named
^N 't ` ` `, .as N I. C _. k P X West Hill,LLC,a Delaware are limited liability
company who Proved to me on the basis of satisfactory evidence to be the Person whose name is
subscribed in the above and foregoing instrument and acknowledged that he/she executed the
same in his/her representative capacity of C EP X West Hill,LLC, a Delaware limited liability
company, and that;by his/her signature on the instrument, and as the act and deed of the person
or entity upon behalf of which he/she acted,executed the above and foregoing instrument, after
first having been duly authorized so to do.
OTARY PlAkIC
My Commission Expires: C>���g
,U T
ACCEPTED:
CITY OF KENT
E ankh
Title: M
Date: 02/08/2024
ACTIVE 689184794
Instrument Number:20240212000316 Document:EAS Rec: S307.50 Page-4 of 5
Record Date:2/12/2024 9:03 AM King County,WA
EXHIBIT A
TyL"4.r^1a LOT 222204901
THAT PORTION OF PARCEL A DESCRIBED BELOW,LYING NORTHWESTERLY OF
THE FOLLOWING DESCRIBED LINE:
COMMENCING AT THE NORTHEASTERLY CORNER E OF SAID PARCEL A; THENCE
ALONG THE EASTERLY LINE THEREOF, S05044'06"E 75.64 FEET TO THE POINT OF
BEGINNING; THENCE S 4°I5'54"W 15.00 FEET;THENCE N05'44'06"W 28.67 FEET TO
A 55.01 FOOT RADIUS,CIRCULAR CURVE TO THE L.,EL"T"; HE CE ALONG SAID
CURVE, THROUGH A CENTRAL ANGLE OF 75009'23",AN ARC DISTANCE OF 72.16
FEET TO A 392.74 FOOT RADIUS,COMPOUND CURVE TO THE LEFT", THENCE
ALONG SAID CURVE, THROUGH A CENTRAL ANGLE OF 27°22'45", AN ARC
DISTANCE OF 187.67 FEET; THENCE ICI 18057'40" '" 15.00 FEET TO THE NORTHERLY
LINE OF SAID PARCEL.A AND THE TERMINUS OF THE HEREIN DESCRIBED LINE.
PARCEL.A.
THAT PORTION OF THE NORTH HALF OF THE SOUTHEAST QUARTER OF SECTION
22„ TOWNSHIP 22 NORTH,RANGE 4 EAST",WIL,L.aAMET'TE MERIDIAN,CITY OF L E T,
IN KING COUNTY,WASHINGTON,LYING EASTERLY AND SOUTHERLY OF THE
ROADS"A"RIGHT—CIF—WAY AS CONVEYED TO THE CITY OF I EN T'BY DEED
RECORDED UNDER RECORDING NUMBER 7110060365,RECORDS OF KING
COUNTY,T'Y, WASI-INGT O ,AND WE,ST'ERLY OF THE WESTERLY MARGIN OF LAKE
FEN WICK ROAD(.I.L:. REIT T ROAD NO, 2266),AND WESTERLY OF ROAD"II"RIG14T—
OF-WAY AS CONVEYED TO THE CITY C.1F KENT BY SAID DEED..
CONTAINING 4840 SQUARE FEET,MORE CAR LESS,
ACTIVE 689184794
Instrument Number:20240212000316 Document:EAS Rec: S307.50 Page-5 of 5
Record Date:2/12/2024 9:03 AM King County,WA
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ATTACHMENT D
❑ New Vendor
❑ Reactivate Vendor
�KlNT Vendor Set-up Form ❑ Address Change
W A S H I N G T O N 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 sub-ect to the IRS required back-up withholding.
Name, as it will appear on check (NO ABBREVIATIONS) Doing Business As(If different than name on check)
Payment Address Business Address
City State Zip City State Zip
Phone Number Accounts Receivable Contact
• • - check the aPpropriate box
❑ Corporation ❑ Government Agency ❑ Individual/Sole Proprietor ❑ Non-Profit ❑ Partnership
gig EM 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 exem t 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):
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 It, Date ►
[Ic52727 indd•2XI4
ATTACHMENT E
Project Name/Number: Reith Road Roundabout
Property Owner: GEP X West Hill, LLC
Address: 24849 46t" Ave. S., Kent, WA 98032
Tax Parcel Number: 222204-9018
ACKNOWLEDGEMENT
I, the undersigned, am the authorized signer for the owner of the property
described in Exhibit ""A" attached.
I acknowledge and understand
• That the City of Kent will not be contacting the owner's lender and requesting
a partial re-conveyance for the acquired property;
• That the owner's lender may have a right to the proceeds from the
acquisition. The owner hereby holds the City of Kent harmless, if the lender
requires any portion or all of the proceeds after this transaction has closed
and disbursed. The owner will pay the lender directly;
• That payment for the acquisition of the described property will be made
directly to the owner, or at the owner's option initialed below, the City of
Kent will make payment directly to the owner's lender.
GEP X West Hill LLC
By:
Title:
Date:
Make payment directly to the Grantor at the following address:
Make payment directly to the lender at the following address and loan
Number
Loan #:
EXHIBIT A
That portion of the North half of the Southeast quarter of Section 22,Township 22 North, Range 4 East,Willa melte
Meridian, in King County,Washington,lying Easterly and Southerly of the Road'A'right of way as conveyed to the City of
Kent by deed recorded under recording number 711OM(1365,and Y4esterly of the Westerly margin of Lake Fenwick Road
(J.L. Reith Road No.22M),and Westerly of the Road'B'right of way as conveyed to the C ity of lent by deed recorded
under recording number7110UB0365.
Situate in the County of King, State of Washington.