La Hacienda Family Mexican Restaurant 12/28/2020

u� aidu Everet �W d Grant Program CONTACT If you have any questions or need technical assistance with completing the form,please contact Tyler Chism by email :chisnn@everettwa.gov and include a phone number. INSTRUCTIONS This Report Form is a fillable Adobe Acrobat PDF document. Please fill out each field shown below,marked in yellow. If the information requested is not applicable,please enter"none" in the field.Add sheets or duplicate sections as necessary. Read each component in full and provide the accurate information. Prior to entering into an agreement,the City will require that you submit the attachments listed in Part 4 of the Duplication of Benefits Reporting Form on page 11. Please upload this completed packet here. NI RECITALS This Agreement is entered into upon the basis of the following facts and circumstances: 1. City(herein referred to as "City"or"Grantor"): The City of Everett 2, Business name(herein referred to as "Business"or"Grantee"): 3. Address: " ekt t 4. Phone: ...3 c' �; ) .) 5. Contact Person: 3 €1-('.) { 6. DUNS Number 7. Title of Program being Funded: Everett CARES Round 3 Small Business Grant 8. Time of Performance-Beginning: August 1,2020 Ending: July 31,2021 _ 9. Amount of Agreement/Grant Award: $10,000.00 10. This Agreement/grant award and the rights and obligations of both parties hereto shall be subject to and governed by the following, incorporated by reference herein as is fully set forth: (1)Grant Budget attached hereto or Exhibit"A" (2)Expense Reporting Form attached hereto or Exhibit"B" The City has funds available,authorized by the City Council for helping businesses respond to the negative economic impact of the Coronavirus;and " EVERETT Everett CARES Small Business Grant Program Round 3 page 1 YtASHINGTON