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<br /> Grant Program
<br /> CONTACT
<br /> If you have any questions or need technical assistance with completing the form, please contact Tyler Chism by email
<br /> chi_rgileverettwa.gov and include a phone number.
<br /> INSTRUCTIONS
<br /> This Report Form is a fillable Adobe Acrobat PDF document. Please fill out each field shown below, marked in yellow. If the
<br /> information requested is not applicable, please enter"none” in the field.Add sheets or duplicate sections as necessary. Read each
<br /> component in full and provide the accurate information. Prior to entering into an agreement,the City will require that you submit the
<br /> attachments listed in Part 4 of the Duplication of Benefits Reporting Form on page 11.
<br /> Please upload this completed packet here.
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<br /> RECITALS
<br /> This Agreement is entered into upon the basis of the following facts and circumstances:
<br /> 1. i City(herein referred to as"City" or"Grantor"): The City of Everett
<br /> 2. Business name(herein referred to as k4e1 O.AP-k V€ i-cuL,tit(,,
<br /> "Business"or"Grantee"):
<br /> 3. Address: {1 :L ...1 ' ` r.
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<br /> 4. Phone: [ t-7 q / 2,,, 7
<br /> 5. Contact Person: v1.1 Am, ""Cr O. ,'
<br /> 6. DUNS Number
<br /> 7. Title of Program being Funded: Everett CARES Round 3 Small Business Grant
<br /> 8. Time of Performance-Beginning: August 1,2020 `��
<br /> i I
<br /> Ending: July 31, 2021
<br /> 9. Amount of Agreement/Grant Award: $10,000.00
<br /> 10. This Agreement/grant award and the rights and obligations of both parties hereto shall be subject to
<br /> and governed by the following,incorporated by reference herein as is fully set forth:
<br /> (1)Grant Budget attached hereto or Exhibit"A"
<br /> 1 (2) Expense Reporting Form attached hereto or Exhibit "B"
<br /> The City has funds available,authorized by the City Council for helping businesses respond to the negative economic impact of the
<br /> Coronavirus;and
<br /> EVE R E T T Everett CARES Small Business Grant Program Round 3 page 1
<br /> 1111112 WASHINGTON
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