HomeMy WebLinkAboutPierce Cnty Dept Community SvcsPIERCE COUNTY DEPARTMENT OF COMMUNITY SERVICES
PROJECT AGREEMENT
JANUARY, 2003 THROUGH DECEMBER, 2004
The Pierce County Department of Community Services (PCDCS) and the City of Auburn -- Sunset Park
Project (Sunset Park is located within Pierce County at 1306 69th St SE, Auburn, WA 98002) at City Flail, 25 West
Main St. Auburn, 98001-4998 (phone number: ) Tax ID # 91-600-1228 the Organization and Fiscal Agent, agree to
engage in a working partnership for the purpose of implementing the project entitled Schools Out to Li~;hts Out. The
Agreement will begin 01/01/03 and end 12/31/04 and be identified with BARS Code: 001.134.0000.57680.50.0055,
when billing.
PCDCS will provide from the Pierce County General Fund up to $7,500 to the organization for expenditures
identified by County Council. A budget is attached. The organization will submit invoices for reimbursement expenses
with receipts to the PCDCS on the attached Reimbursement Request Form. The funds for this Agreement will be on a
cost reimbursable status and all receipts should be mailed to Pierce County Department of Community Services, 8815
South Tacoma Way, St 202, Lakewood, WA 98499 Attention: Mary Ellen Pahner, Contract Compliance Specialist.
City of Anburn -- Sunset Park Project will contract to have fencing placed in Sunset Park on the bail fields to be
used by Youth Baseball teams. The City of Auburn will attach their fencing agreement with the contractor to their first
reimbursement request. If other funds are used for this fence, reimbursement requests to Pierce County will clearly
request only the percentage utilizing Pierce County funds. City of Auburn will attach a geographical map to this
Agreement, showing the park's location within Pierce County.
The project will commence on 01/01/03 and be completed by 12/31/04.
Our signatures indicate our commitment to this working agreement and fulfillment of the obligations and
completion of the tasks described above. The Organization will submit any changes in activities, goals, or budget needed
in writing and wait upon approval from PCDCS before implementation of those changes. This Agreement is null and
void if any of the stipulations are not met.
Mailing Address and Contact name for fiscal agent if different
Name
Federal ID/ETN __91-600-1228
Phone:
Address
BARS: .' ....
PIERCE COUNTY
CONTRACT SIGNATURE PAGE
Contract
IN WITNESS WHEREOF, the parties have executed this Agreement this day of
,2004
CONTRACTOR:
Contractor Sig ~ature Date
Title of Signatory Authorized by Firm Bylaws
Name: Pete Lewis
UBI No.
Address:
Mailing
Address:
City Hail, 25 West Main St.
Auburn, WA 98002
Contact Name: Darrel Faber
Phone: 253-931-3043
Fax:
PIERCE ~iT~
Com mu ni:t'y Development
P~osecuting A~orney (as t~ f~ only)
dget and Finance
Date
Date
Date
Approved: _
Department Director f,.,)
County Executive (if over $250,000) Date
CONTRACTOR-
Complete the tax status information for once of the following business entity types, Individual or Corporate name must exactly match that which is registered with
either Social Security Administration or Internal Revenue Service.
SOLE PROPRIETOR:
Business Owner's Name
Business Owneds Social Secudty Number
DBA/Business or Trade Name (if applicable)
Name of Partnership
PARTNERSHIP:
CORPORATION:
Name of Corporation
Partnership's Employer ID Number
Corporation's identification Number
Community Development Division
City of Auburn ~- Sunset Park Project
January, 2003 through December, 2004
Reimbursement Request
Project: Schools Out to Lights Out
Date submitted:
TAX ID
BARS Code: 001.134.0000.57680.50.0055
Mail To:
Mary Ellen Palmer, Contract Compliance Specialist
Pierce County Department of Community Services
8815 S. Tacoma Way, Suite 202
Tacoma, WA 98499-4588
Please reimburse City of Auburn -- Sunset Park Prqject for expense incurred for the month(s) of
~e,~ o ~,x--x. ,2003-04 in the amount of $ ~ 500
January Activities
February Activities
March Activities
April Activities
May Activities
June Activities
July Activities
August Activities
September Activities
October Activities
November Activities
December Activities
Budgeted Amount
Current Request
Year to Date Balance
TOTAL __$7,500_ "/~ffl:~o -> ~.~ ~ ~-
Attach Receipts for the items listed in the Current Request column above.
Signature of D~rector of F~nance or eqmvalent:
Print Name of Director of Finance or equivalent: ~-~'/~ ~-' ~'~2/
Phone Number: c>~.~ ~.~-;(:t~ ~; I'~ Date' ~-/c~