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Cooperative Member contact information: <br /> Contact Person to whom contract documents and related communications are to be mailed or faxed. <br /> Cooperative Member Agency Name: City of Everett <br /> Agency Federal TIN#: <br /> Contact Name: Hope Hambridge <br /> Address: 3200 Cedar Street <br /> City, St.Zip Everett,WA 98201 <br /> Phone Number: 425-257-8905 Fax Number: 425-257-8864 <br /> Email Address: ahambridoe@ci.everett.wa.us <br /> Secondary Contact: Name: Clark Lanostraat Email: clanostraa(cr�ci.everett.wa.us <br /> Two-Year Membership Fee Schedule <br /> Note: Total expenditures listed below are minus of debt service and inter-fund transfers <br /> Annual Annual Two-Year Verified <br /> expenditures expenditures of Membershi Fee Level <br /> of more than less than p Fee <br /> $0.00 $3,000,000 $400 <br /> $3,000,001 $7,500,000 $1,000 <br /> $7,500,001 $30,000,000 $2,000 <br /> $30,000,001 $68,000,000 $4,000 <br /> $68,000,001 $90,000,000 $6,000 <br /> $90,000,001 $150,000,000 $8,000 <br /> $150,000,001 and over $10,000 <br /> According to the most recent authoritative information; EVERETT CITY OF,your annual operating <br /> expenditures were$222199833 making your two-year fee$10000. <br /> The undersigned has read, understands and agrees to the terms and conditions of this Agreement, certifies <br /> that he/she is the Authorized Signatory for the Cooperative Member, and certifies under penalty of perjury <br /> under the laws of Washington State that the verified expenditure in the Membership Fee Schedule above is <br /> true and correct. <br /> Cooperative Member Authorized Signature: <br /> Signature: Date Signed: <br /> Print Name: Ray Stephanson Title: Mayor <br /> Address (if not the same as above): 2930 Wetmore, Everett,WA 98201 <br /> Phone Number(s): <br /> APPROVED AS TO FORM: ATTEST: <br /> James D. Iles, City Attorney Sharon Marks, City Clerk <br /> Date: Date: <br /> FOR OSP USE ONLY(Completed by OSP,this page will be returned to you in executed copy) <br /> Approved as to form: AAG Date: 10/16/2009(signature on file) <br /> Your assigned Co-op member number is . Please provide this number to vendors when ordering from <br /> contracts or communicating with OSP. <br /> OSP AUTHORIZED SIGNATURE <br /> Verification Used: <br /> Name Title Date <br /> 12 <br />