Fiber Brokers International LLC 3/2/2021

F'i ICE R BROKERS 289 Cooper Ave. Brent, AL 35034 I N T E R N A"I'I O N A I,' I,I,C, Phone: 205-413-4499 Fax: 205-316-0001 MMIMMMMMMMMMNIMNNMMMNimimmimmMmimi ENROLLMENT,RECEIPT AND DESTRUCTION RECORD("ERD") City of Everett Agency Name: Agency Address: 2930 Wetmore Ave Agency City/State: Everett,Washington Agency Contact: Jenny Chang Phone#: 425-257-8904 E-mail Address: jchang@everettwa.gov Date: Thank,you for participating in our Secure Ballistic Disposal and Recycling Program. Your participation is subject to the attached terms and conditions. By signing this record,you affirm your acceptance of those terms. In order to assist us in maintaining a chain of custody over the products until they are properly destroyed,please fill in the information below and return a copy to us with your shipment. Number of vest panels: (Note here only if removed from carriers) Number of complete vests: 2 (Note here only if still in carriers) Number of Boxes: 1 (Complete for all shipments) At your discretion,you can include a manifest of the vest panels included with the shipment, but note that Fiber Brokers will complete an independent assessment of the material to track serial numbers once it arrives to ensure all material is received and destroyed properly. Please note the method of shipment that has been arranged for this shipment on the form. Include relevant tracking numbers prior to faxing a copy of this document to our office. UPS Carrier Name: (ex.FedEx,Old Dominion,etc.) Shipment Date: 3 / 11 / 2021 Tracking Number: 128541750396413781 Agency Contact: (Signature) G Print Name: (Name) ti( (Title) Office of the City Attorney �+ APPROVED AS TO FORM AT ST: David C.Hall,City Attorney City Clerk Proudly serving those that serve the people of the United States, Canada, and Mexico.