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Cooperative Member contact information: <br />ORIGINAL <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: ahambridgeci.everett.wa.us <br />Secondary Contact: Name: Clark Langstraat Email: clangstraa@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 <br />expenditures <br />of more than <br />Annual <br />expenditures of <br />Tess than <br />Two -Year <br />Membershi <br />p Fee <br />Verified <br />Fee Level <br />$0.00 <br />$3,000,000 <br />$400 <br />$3,000,001 <br />$7,500,000 <br />$1,000 <br />$7,500,001 <br />$30,000,000 <br />$2,000 <br />$30,000,001 <br />$68,000,000 <br />$4,000 <br />$68,000,001 <br />$90,000,000 <br />$6,000 <br />$90,000,001 <br />$150,000,000 <br />$8,000 <br />$150,000,001 <br />and over <br />$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 > er Aut + ri ed Si • ature: / <br />Signature: �/ Date Signed: 12i'-01 <br />Print Name: Rav St:iil=nson <br />Title: Mayor <br />Address (if not the same as above): 2930 Wetmore, Everett, WA 98201 <br />Phone Number(s): <br />APPROVED AS TO FORM: <br />ames D. Iles, CiAttorney <br />Sharon Marks, City Cler <br />Date: ,z/!re/o? <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 SIGN URE <br />Verification Used: <br />IDlatsL,ng <br />