UASI and Seattle Police Department 9/2/2017

----- CITY SEATTLE Federal Grant Equipment Hand Receipt Form 4 Agency & Project Information POLICE Grant/FFY: UASI/FFY16 Prepared By: Rebecca Clark Project No. PJ1882 Phone No. 206 684-0376 Subgrantee Name: _Everett Police Department Email Address: rebecca.clark@seattle.gov Street Address: 3002 Wetmore Ave City,State,Zip: Everett,WA 98201 CFDA No. : 97.076 Discipline Vendor Manufacturer Description Units Unit Cost Total Cost (Include Make,Model,Serial No.) LE TNVC TNVC TNVC TNV/PBVS-14 w/L3 OMNI VIII, BLK kit 6 2,799.28 16,795.68 LE TNVC TNVC Wilcox L4 three hole shroud-black 6 58.00 348.00 LE TNVC TNVC Wilcox L4 G11 Mount w/Horn interface for A 6 285.00 1,710.00 We understand this is a one-time grant and as such,the final recipient is responsible for the maintenance,training and proper storage of Shipping: 140 the equipment. Equipment lost,stolen or unrepairable will not be replaced.This grant does not mandate that your jurisdiction purchase replacement equipment if this equipment expires or is used for WMD/CBRNE purposes. If used for other purposes, the Subrecipient will Subtotal: 18,993.68 replace this equipment. We will make the above listed equipment available for audit/inspection at SPD's request. We understand that our agency must report Sales Tax this equipment in accordance with 2 CFR Part 200 and is subject to audit under 2 CFR Part 200,Subpart F. We hold the Department of Homeland Security,the Washington State Military Department and the City of Seattle Police Department @ 9.6% 1,823.39 harmless for any and all damages that may result from the acceptance of this equipment,including data loss. Grand Total: 20,817.07 Authorized Signature: 7litiliLAitaNA----- 46Date: S' N"* Print Name: ( �j S.f`e j` (,n.so Phone No.: Position Title: 6 J r I & Q er� Department/Division: cc: 1.5 System, Recipient's Fiscal 0' ce T AT ' %S t . APP'OVED 0 1`•M o YY �XXCS�� ES D.ILE ,City A torney City Clerk