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Home My WebLink AboutGrant Related - BOCC (004)GRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT: gOCC REQUEST SUBMITTED BY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Karrie Stockton CONFIDENTIAL INFORMATION: ❑YES 70 NO DATE:2/1 3/2024 PHONE:ext. 2937 DATE OF ACTION: a - 2t ?k1( APP DENIED ABSTAIN D1: )ja D2: D3: V " DEFERRED OR CONTINUED TO: --- - - -----palp ❑Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ABPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled [:]Boards / Committees ❑ Budget ❑Computer Related El County Code ❑Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders ® Grants — Fed/State/County ❑ Leases ❑ MOA / MOU ❑ Minutes ❑ Ordinances ❑Out of State Travel ❑ Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution El Recommendation ❑Professional Sery/Consultant ❑Support Letter ❑Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB A Reimbursement request from New Hope on the Dept. of Commerce Consolidated Homeless Grant (CHG) grant # 24-46108-10 in the amount of $5,034.06. DATE OF ACTION: a - 2t ?k1( APP DENIED ABSTAIN D1: )ja D2: D3: V " DEFERRED OR CONTINUED TO: STATE- 0, r WASHIN(510N DEPART ENT OF COtIAMERCE 1011 Plum StreSE -0, P-0 Box 42525 -Olympia, VVaShbIWI-cm, 98504-2525 -(3-BET) 725-10 Form 19-1A VOUCHER DISTRIBUTION AGENCY Short Code Commerce Contract Number NUMBER. CMS Invoice ID: DEPARMENT OF 1030 24-46108-10 386876 COMMERCE VENDOR OR CLAIMANT (Warrant payable to:) INSTRUCTION TO VENDOR OR CLAIMANT: Grant County Board of Commission Submit this form to claim payment for materials, merchandise or PO BOX 37 services. Show complete detail for each item. EPHRATA, WA98823-0037 Vendor's Certificate: The individual signing this voucher below warrants they have the authority to do so as authorized and on behalf Janice Flynn of the entity identified in the Vendor/Claimant section. The individual (Vendor Contact Person) signing below certifies under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or (509) 754-2011 ext 2937 (Vendor Contact Phone) services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, iflynn(@.grantcountywa.gpov (Vendor Contact Email) national origin, handicap, religion or Vietnam era or disabled veterans status. 07/01/23 - 06/30/25 (Contract Period) Karrie Stockton (Kstockton21 2/13/2024 2:39:33 PM 12/01/23 - 12/31/23 (REPORT PERIOD) (SUBMITTED BY) (SUBMIT DATE) DESCRIPTION BUDGET REQUESTED EXPENDED TO AMOUNT THIS AWARD AMOUNT DATE INVOICE REMAINING Unassigned - Unassigned $.00 $.00 $.00 $.00 $.00 Admin - Unassigned $28,680.00 $.00 $2,670.18 $.00 $267009.82 Rent - Unassigned $210,275.00 $.00 $47,045.43 $.00 $163,229.57 Facility Support - Unassigned $27,902.27 $.00 $27,902.27 $.00 $.00 Operations - Unassigned $189,417.73 $.00 $44,299.32 $.00 $145,118.41 HEN Admin 2024 - Unassigned $2,000.00 $.00 $991.85 $.00 $1 ,008.15 HEN Rent/Fac Support 2024 - Unassigned $184,345.00 $.00 $95,091.73 $.00 $89,253.27 HEN Operations 2024 - Unassigned $42,000.00 $.00 $18,407.43 I $.00 $23,592.57 HEN Admin 2025 - Unassigned $5,000.00 $.00 $.00 $.00 $5,000.00 HEN Rent/Fac Support 2025 - Unassigned $173,345.00 $.00 $.00 $.00 $173,345.00 HEN Operations 2025 - Unassigned $50,000.00 $.00 I $.00 $.00 $50,000.00 Eviction Prevention Admin - Unassigned $10,000.00 $.00 $.00 $.00 $10,000.00 Eviction Prevention Rent - Unassigned $1,132,655.00 $.00 $.00 $.00 $1,132,655.00 Eviction Prevention Operations - Unassigned $3502000.00 $.00 $.00 $.00 $350,000.00 Inflation Increase 2024 - Unassigned $110,242.00 $.00 $.00 $.001 $110,242.00 Inflation Increase 2025 - Unassigned $110,242.00 $.00 $.00 I $.00 $110,242.001 I Local DRF Support 2024 - Unassigned $71,609.00 $5,034.06 $17,591.69 $.00 $54,017.31 Local DRF Support 2025 - Unassigned I $71,609.00 I $.00 I $.00 I $.00 $717609.00 I I Non - Match Total: $21769,322.00 $5,034.06 $253,999.90 $.00 $27515,322.10 PROGRAM APPROVAL - (The individual signing this voucher warrants they have the authority to sign this voucher.) Short Code Date DOC DATE CURRENT REFERENCE DOC NO. DOC. NO. VENDOR NUMBER and SUFFIX SWV0002426 03 ACCOUNT NO. ASD NUMBER 45705 VENDOR MESSAGE - TRANS REV MASTER SUB SUB' MG MS GL ACCT CODE CODE INDEX OBJ SUB OBJ SUB AMOUNT PROGRAM SID INDEX 46A70111 NZ 46155 46A70212 NZ 46155 46A20111 NZ 46151 46A20212 NZ 46151 465C1211 NZ 46114 465C2212 NZ 46114 465DO250 NZ 46108 46AK0210 NZ 46108 Paid to Org Type Expense Type READY to BATCH PREPARER DATE WARRANT TOTAL CREATED BY Karrie Stockton (Kstockton2) DATE 2/13/2024 2:35:37 PM `Form 19-1A VOUCHER DISTRIBUTION AGENCY Short Code Commerce Contract Number NUMBER CMS Invoice ID: DEPARMENT OF 1030 24-46'108-10 386876 COMMERCE Cl All Expenses under $1,000 Paid by U131 Paid Paid by Organization NameType Paid to Paid to Paid to U131Amount Organization Name Paid to Org Type Expense Type Subcontractor Total Sub Subcontractor Total . . Name.,. ::List S ub .Grantee Names;'. ,: �, ,: , _: Grantee, _ . Invoice Month/Year _ � ; New Hope Dec -23 Signature County of Grant 35 C ST NW P.O. Box 37 Ephrata WA 98823 Vendor: Baird Springs Apt 1120 3rd Ave NE Apt 108 Ephrata WA 98823 Purchase 6rder Number Document Number 12062023-B108 Description: .... ........... Client EFA BSAPT Page 1 /1 Invoice 0404811 Date 12/20/2023 'vendor ID Shipping Method Payment Terms ID 30 --- ------___...,.r. ---- Amount $856.00 Subtotal $856.00 Mise $0.00 Tax $0.00 Freight $0.00 Trade Discount $0.00 Payment $0.00 Total Due $856.00/ County of Grant 35 C ST NW P.O. Box 37 Ephrata WA 98823 Vendor: RAFAEL MORENO PO BOX 1118 QUINCC WA 98848 Document Number Purchase Order Number I 11272023 -AT -AF Description: Client EFA - Rent VendorlD Invoice Page 1 /1 Invoice 0402779 Date 11 /28/2023 Shipping Method Subtotal Misc Tax Freight Trade Discount Payment Total Due Payment Terms ID Amount $500,00 $500.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500.00 Page 1 /1 Invoice 0402838 Date 11/28/2023 County of Grant 35 C TW P.O. Box 37 Ephrata WA 98823 Vendor,-. Cot welt Banker 1000 S Pioneer Way Moses Lake WA 98837 Payment Terms ID Document Number Purchase Order Number Vendor[D Shipping Method I T f 6-20,2-,-3- — --------- . ...... CLDBK NET 30 Description: Client EFA - Rent Amounil $900.00 j Subtotal $900.00 fisc $0.00 Tax $0.00 Freight $0,00 Trade Discount $0.00 Payment $0.00 Total Due $900.00%/ THE LAKES APARTMENTS Logged *inas: Oneft�Time Payment R/ Your payment is being processed! A confirmation email will be sent to @gmail.com when processings complete. Processing can take up to two hrO Payment Details Reference Number: Print 329869796 Payment Date,jj5* 11/312023 12001 PM (PST) Payment Account: Visa XXXX-8493 Payment Amount: $2.378.06.,,-, The Lakes Apartments 1 1050 S Division Moses Lake, WA 98837 1 (haps://maps.app.goo.gl/967enN4aV17RCWSD7) (509--) 360-8868 (fiel:(S09) 350-8860 JS1 Oc "IlResidential Inc 2023 All Rights Reserved I Website Design by RentCafe (0 2023 Yardi Systems Inc, All Rights Reserved.) 16%.- Accessibility S,tatementibilit -(access- -y-as —P--�O- 1146 LWG 3 7 1 231201 0 PAGE I OF 2 1 0 4833 0030 CX48 01AC1 146 Payment Due Date :.,....-Transadflons Cardholder Name and Account Number VISA Page 1 oft Trans Date NEW HOPE SHELTER ADVOCATE S M T W T F S Amount 11103 GRANT COUNTY 24137469K0I I TE04S USPS PO 6456420837 MOSES LADE WA WWWon TISt Banc .ACX X-XXXXXX XX -8493 15 24445009LOOMXNBDV VCS *GRANTCOSHERIFFCTR EPHRATA WA Due back to 6Sct12.1.2by 1 ,a 80234 2pm 11105 11/03 24692169K32MQ6VW9 WALMART.COM 800-966-6546 AR $127,27P' ciouot AcS 11103 kCCOUtit Information Statement Closing Date 12/0112023 Previous Balance $0.00 Credit Limit $20,000.00 Payments and Credits $0.00 Available Credit $19,699.00 Finance Charge(net) $0.00 Cash Credit Limit $0.00 + Purchases $0.00 Available Cash $0.00 + Cash Advances $0.00 SQ *MASON?S PLACE MOSES LAKE WA $5.50 + Other Chafge's $0.00 24692169S2Y7D2E64 MOSES LAKE 509-764-3717 WA Now Balance $0.00 -------- :ftym n tinfdr.mation..."' STAPLES 00113019 MOSES LAKE WA $40.10 Payment Pue Date. 12/27/2023 Minimum Payment Due: $0.00 New Balance: $0.00 Remit Payment to. - WASHINGTON TRUST BANK PO BOX 2127 SPOKAN e, WA99210- 127 WASHINGTON TRUST BANK PO BOX 2127 SPOKANE, WA 99210-2127 Please include your account number on your check. F1New address, phone number or e-mail? Check the box to the left and print changes on back. WASHINGTON TRUST BANK PO BOX 2127 SPOKANE, WA 99210-2127 Mail Inquiries To: P.O. BOX 2127 SPOKANE, WA 99210-2127 We appreciate your business! Questions? Call Customer Service: 800-788-4578 Lost or Stolen Card: 800-788-4578 Payment Due Date :.,....-Transadflons Post Date Trans Date ReferenceDescription I S M T W T F S Amount 11103 11/02 24137469K0I I TE04S USPS PO 6456420837 MOSES LADE WA $8M5V 11105 11103 24445009LOOMXNBDV VCS *GRANTCOSHERIFFCTR EPHRATA WA 11105 11/03 24692169K32MQ6VW9 WALMART.COM 800-966-6546 AR $127,27P' 11I05 11103 24906419K5DJSFAMG YSI*The Lakes 509-3508868 WA $2,77&06W 1 IM 111,107 24431069P2DZ50VMZ GRANT PUD1k- 509-754-0600 WA $150.00 - 11110 11/09 24431069T2DZPEXY1 GRANTPUD 509-758250011A WA - $132.68---"- 11/10 11/09 24455019T447Y57ZM WAL-MART#2007 MOSES LAKE WA $3333 11/10 11/09 2469:2169T2XYTVVMWK SQ *MASON?S PLACE MOSES LAKE WA $5.50 11110 11/10 24692169S2Y7D2E64 MOSES LAKE 509-764-3717 WA 11/12 11/09 24164079S31T8YK6D STAPLES 00113019 MOSES LAKE WA $40.10 11/12 11/09 24164079S31T8YK65 STAPLES 00113019 MOSES LAKE WA 11/12 11/11 24427339VMHE08MGD MCDONALD'S E4100 MOSES LAKE WA $0.43 11.115 11/14 24455019Y447Y5DV1= WAL-MART*2007 MO$ESLADE WA 11117 11/15 2423168AORBGJ5PM6 SAFEWAY #325.211 MOSES LAKE WA U2.54 11/19 11/17 244450OA2BLLSLGQK WM SUPERCENTER #2007 MOSES LAKE WA $9.28--o-' 11/19 11/17 2444500A2BLLSLG77 WM SUPERCENTER #2007 MOSES LAKE WA $21.6° `11121 11/20 2443105A5RQEF3G30 0'REILLY 2517 MOSES LAKE WA $149.58 Remit Payment to. - WASHINGTON TRUST BANK PO BOX 2127 SPOKAN e, WA99210- 127 WASHINGTON TRUST BANK PO BOX 2127 SPOKANE, WA 99210-2127 Please include your account number on your check. F1New address, phone number or e-mail? Check the box to the left and print changes on back. WASHINGTON TRUST BANK PO BOX 2127 SPOKANE, WA 99210-2127 Mail Inquiries To: P.O. BOX 2127 SPOKANE, WA 99210-2127 We appreciate your business! Questions? Call Customer Service: 800-788-4578 Lost or Stolen Card: 800-788-4578 NEW HOPE SHELTER ADVOCATE GRANT COUNTY ATTN MICHELE JADERLUND PO BOX 37 EPHRATA WA 98823-0037 000000000000000041295700310084937 Payment Due Date December Account Number XXXX-XX-XXXX-8493 XX S M T W T F S 11 12 NewBalance $0.00 L3 81 4 5 6 7 9 10 Al 12 13 14 '15 16, 17 18 1S=21 22 231 Minimum Payment Due NONE 241.25t MZ8 'znI 30 4 Amount Enclosed NEW HOPE SHELTER ADVOCATE GRANT COUNTY ATTN MICHELE JADERLUND PO BOX 37 EPHRATA WA 98823-0037 000000000000000041295700310084937 EMERGENCY FINANCIAL, ASSISTANCE REQUEST FORM iW ! new ronin, better tomorrows, Type of client: xDV XSA EICVSC YHDP * Background check for housing # Children's needs * Debt assistance * Driver's license * Education training # Bus fare e to return home I * Cell phone to seek work/housing * Family well being Staff,* Buena Sanchez Amount requested $ Client's Home City: Ephrata, WA -- - -- --------- - ------------ r= r7l a s is- ance ncial A . . ..... ----- Explain: Client is seeking assistance with rent.. She is behind and is - no - t working currently. Client struggling with her mental health anri riruo nn+ * Mortgage have a strong support system. 'The client is grateful for any help she can * Service DVPO this bills get in her time of need. * U * Security Assist * Rental Assist * Car payments * Food/Necessities Updated: 2/11/2020 12/18/202-3 12:06PM 15097540117 1 BA I RDBEAKEY GRANT COUNTY New Hope/Kids Hope PROMISE TO PAY Date . 12/06/2023 vendor: Bal'422igs Apartments Post OfficeAddress.., 1120 3rd Ave N E APT B 108, Ephrata, WA 98823 %11- PAGE 01/01 Total Amount AIJ bills must be icenlized in detail on this blank or itemized His attached herewith. When submittling claims for rent be sure to specify dates claim is intended to cover, for 5 ubm iss! o n for Raym ent - ISSUED., Return Voucher To-, Braila Santiago Sanchez Grant County New Hope/Kids Hope New Hope/Kids Hope Advocate 3 It W Third Avenue Moses Lake, WA 98837 I hereby Certify on lionor, that the goods, merchandise, material or service charged for In the above bill have been furnisbed as herein charged, 0 AM,,' 12/06/2023 CANNOT BE USED `OR ALCOHOL, TOBACCO, PRE -PAID OR GIFT CARDS,, Printed Vendor lame SignatUre hecone: I Ma -l -pa g1meat -t2 above address Gl� 0 Claimant will ick UP R93MLq_nta_t New. Hoj2l Voticbers received by 12* -00 pm Wednesday will have payment available the following Thtirsday. EM�RGENCY FINANCIAL ASSISTANCE FORM SIGNED? YESb NO[] FUNDING: 0 Serve MUQuincy 0 QS 0 CPS 0 Family contribution # Friend contribution Updated: 08/31/2023 Staff: A a 4W Date Submitted: Amount requested �$ 00 ---- new beginnings, beer tomorrows, # of Children: Client's HomeA City: ti IIAJ Type of client, CID V OSA CV El CAC Client ID: 6b K� NCA ID: C . -7 7. -w: me e n n nce-�I.EFA e T Explain: Background check for housing Children's needs ore * Mtgag Q ext 4 k O%A is Vq (i 1 Wor Debt assistancer ver's license * Service DVPO 0 Utilities billst * Security Assist t ) ��f fA fybry) kt,"C. Y1,I) LLP V9Dri• kv,�j (A) A 4 A I I.. # Education training P Bus fare to return home Rental Assist C a ar payments 1C)OQ11) D U I 51 no + pa--� ke # Cell phone to seek work/housing # Family well being a Food/Necessities < JA f, C3 0 Serve MUQuincy 0 QS 0 CPS 0 Family contribution # Friend contribution Updated: 08/31/2023 % 111" #_ GRANT COUNTY *ds Hope 'ids flope New Hope/Ki PROMISE TO PAY Vendor : iAflol- Post OfficeAddress:_ V, a Date 11/27/2023 �c:�t , �J�1 `1 Total Amount $500.00 All bills Must be itemizedIs in detail on tll*, blank or itemized list attached herewith. Wb en submtkunry claims for rent be sti re to specif� 0 .1 dates claim is intended to cover, For Submission for Payment - ISSUED: Rettj rn Voucher To: Abraham Tapia Grant County New Hope/Kids Hope New Hope/KidsHope Advocate 311, W Third Avenue Moses Lake, WA 98837 1 hereby Certify on Honor, that the goods, mer chandise, material or service charged for in the above bill have been furnished as herehi charged. DKIT: 11/27/2023 CANNOT BE USED FOR ALCOHOL, TOBACCO, Check one: IN–la-11 Payment to above address PRE - PAID OR GIFT CARDS. Claimant will pic rX k up Pa merit at New H2pe Votichers received by 12.00 pm Wednesday wilt have payment available the following Thursday. — - -------- - ---- EMERGENCY MAI CIAL, SISTA FORM SIGNED? YES )K NO[] FUNDING, - 170tMW=9 Recluest for Taxpayer Section references aye to the Intern al Revenue Code unless othenvise noted. October 2018) Identification Number and Certification Give Form to the "e after they were published, go to VfwwJrs.gov1Form'M, re nester,, Do not a 0" r 00 to Wwwi0V/F0""W9 for 1rMttu0t10nS and the latest Informatlon. send to the IRS. I Narns (as shown on yovr k-oo-or-ne taX retum). Name Is required on this One, do not leave ft -a One bWv*. An Individual or entity (Fom, W-9 requoex-ter)who is requirod to foie an Information return with the IRS must obtain your correct taxpayer * Form 1098 (home mortgage Interest), 1098-E (studont loan Interest), 1098-T (tuition) Rafael Moreno * Form 1099-0 (canceted debt) taxpw/er Identification number Tlls (A�, or employer Identification number 2 Business namediaregarded WILY riarne, If dIfferent frmi above (EIN)t to report on an information return the arnount paid to you, or other V) 3 Checkapptopriate box for federal tax eta ....... . (0110wiN W.,en boxes. saffillation of the pen;on whose nam Is erste erod on line i. Che-ok on one of the 4 Exemptiorls (des apply only to CL ff you do not return Form W-9 tO the requester with a TIN, you mtVht ceftin entities, rsot Individualal 0 lndMduWso6 proprIefor cr 0 Corporation 0 S Corpomflon C1 Partriershfp 0 Trust/wAte If lnel=tlons an page sIngla-memb-ar LLC Exempt 0 mo I 0 Umitod liability compwy. Enter the tax classtricatio n (0=0 corporation, 6--$ payao code Of wy) Lv 09 corporation, P=PartnershlpJ)-* Note: Chock the appmpdata box In tie Inc above for the tax classification V the si of single -member` owner, Do not chaok LLC If tho LLC Is classifled as a singla-membor LLC that Is disreWded trom to ovyllor urles$ the ownef of the LLC *a awther LLC that Is not d1sregmded from the ovMer for U.S. fe-dbrat tax purposos. Oftrw !so, a LLO EXOMPtion from FATCA reporting code at any) Is disrogardad from ffis wvm-w shy &=k ft approp.dato box for the tax oil"* flmdo . single -member that n of Its ovmar. 2iz (-%e z'S AddrO." (nuMber, street, and apt. or Wte no.) Soo.. lnstnx-fJons, Reoes nye and e�dd s qu W --6 '01tY, stat%arid ZIP code -7rV <Y -U$t a=unt numbeds) here (optlomi) i Pxpayer liceninication NUMber (TIN) - ----- Enter your TIN In the VPMPdate box, The TIN proMed must match the mme giver, on line I to avoid backup withholding. For IndWiduals.. this is ganerathy your social sawribi number (SSN). Holmevqr'. for a resident alien, sole proprietor, -or disregarded entity, see the instructions for Part- 1, tater. For other 6nfitlesx It Is your employer Wentfficatlon number (M4. If you do not have a number, see How to got a TYV ., later., Notw. If the account Is In more than one name, seo the Im.tmotfons for line 1. Mo See What Name and Number To Give Ute Regumter for guidelines on hose number to enter. or IdemMeatian nurnb4 CeMficatlon L16der penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer Identifloation number (or I am voting for a number to be* issued to me)- and 2. 1 am not subject to baakup Wbholding because',' (a) I am ioxampt from backup withholding, or (b) I have not been no ed by the Intemal Revenue Service (IRS) that I am sAect to backup withholding as a result of a falture to report all interest or dividands, or (c) the JPIS has not1fied me that I am no Wger sublaot to bad(up withholding, and 3.1 am a U h& eltizen or other USI. person ideflned Wow), and 4. The FAT CA code(s) antared on this form (Vany) Indicating that I am exempt frorn FCA reporting is correct. Cortifficaton Instructlons. You must cross out Item 2 above if you have been notified 4y the IRS that you are currantsubject to backLq3 WlthhMng because you have failed to report all Interest and dIvIdends on your tax return.. For real estate transactiGns, ftom 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement IAS aril and generally, payments other than Interest and dh4dends, you are not required to sign the certiftatrop, but you must provide your correct TIN.. See the instrxtiorts for Part 11, later. to Here General Instructions Fomi 1109 DIV (dMd ends, Including those from stocks or mutual Section references aye to the Intern al Revenue Code unless othenvise noted. funds) # Form 1099-MISC (vadOus Wes Of Income, pdzes, award% or gross Future developments. For the latest Inforniation a�oout C19velopmgnts related to Form W-9 and ita instructions. such as legislation enacted proceeds) e Form 1099-B (stock or mutual fund sales and certain other after they were published, go to VfwwJrs.gov1Form'M, trawactions by brokers) Purpose of Form * Form 1099-S (proceeds from real estate transactions) * Form 1099-K (merchant card and third Party network transactions) An Individual or entity (Fom, W-9 requoex-ter)who is requirod to foie an Information return with the IRS must obtain your correct taxpayer * Form 1098 (home mortgage Interest), 1098-E (studont loan Interest), 1098-T (tuition) Idei,tifloation number (TIN) which may be your social security number (88N), Individual taxpayer Identification number PTIN), adoption * Form 1099-0 (canceted debt) taxpw/er Identification number Tlls (A�, or employer Identification number s Form 1099-A (acquislition or abandonment of secured property) (EIN)t to report on an information return the arnount paid to you, or other Use Fofm W-9 only if you are a U.S. person (including a resident amount reportable on gninforration return. Examples of Information alien), to provide your correct TtN. returns Include, but are not limited to, the follovilngx ff you do not return Form W-9 tO the requester with a TIN, you mtVht • Ponn 1999 -INT (Interest earned or poll) be subject to backup withholding. See Mat Is backup withholding, later. Cat, No. 1023 1 X Fatal W-9 (Rev. 10-2018) 49 P nN new beginnings. 6etter tomorrows, ype of client-, DV SA CVSC X El YFIDP What is the Background check for housing Children's needs Debt assistance Drivers license Education training Bus fare to return home Cell phone to seek work/housing Family well being - # Mortgage a Service DPO o Utilities bills * Security Assist # Rental Assist * Car payments * Food/Necessities Client's Home Ci�y: Moses Lake --- ----- -- Explain: Rent Updated: 2/11/2020 EMERGENCY FINANCIAL ASSISTANCE REQUEST FORM Include back up documentation: Receipt Copy of check Mt 'if applicable Updated: 2/11/2020 zzwz� 14 Ir Preverty Manage-M01"t TOMLINSON BLACK RANCH & HOME LLCI PROPERTY MANAGEMENT RESIDENTIAL REN Ifs E SE AGREEMENT Bus. (509) 766-0300 THIS AGREEMENT, executed this day of Lg,3 between LANDLORDi BROKERJAGENTas Agent for the erg assigns, a nd the followi*liq TENANT(S) hereby leases to: and THE F0110WING PROPERTY IN Ck commonly known as J�N Nior vJ On tile follo'win RENTAL AMOUNT: The rent is the sum of ql)& op per month payablein advance on or before thefirst day of each month. Prorated rent from to Number of days times $ C per day se m--"--,M0NTF1 RENT , TENANT'S SECURITY/DAMAGE DEPOSIT, PET XP 1T / PET FEE NO PETS ALI-.,OWED. circle one) Refundable Non -re un OTHER TOTAL DIJE BEFORE OCCUPANCY Tenant Initials TERAI: The Premises are rented for a term begi and ending mid niabt on 2. RESTRICTIONS ON PAYMjENT: All amounts due must be made by certified funds (cashiers click or money ordei-) or personal check, except after an NSF check 'is recAe-wed, If any check is NSF, late charges will be immediately incurred, retroactive to the beginning of the rental period, and an NSF fee of $48.00, will be charged. All daily accruing late charges, NSF fees, and legal evi'dion fees -which have been accumulated to the date of redemption, must be Paid in certified funds to re-establish tenancy, and stop further charges. All payments thereafter must be by certified funds for a mA .4 Injillum of one vear, LAN.] LORD OR AGENT acknowledges receipt of the sum of dollars Daid by TENANT(S) as a dqp X agahist faithful perforinance for after the tenant vacates—th'-e-- p-r-emises., damage, clean up - late. rent, late .ebarges, or utility char Res. Said amount shall be d)osited into a trust account ill 4' which monies may be co -mingled with other tenant rnonies, with Banner Bank,-, Moses Lake, WA, This sianed document shall be considered receipt for said deposit and TENANT(S) sha'11 t::� P I be notified of ansot future changes in the depository. This secupit v deDOSI*t is ABSOLUIELY NOT to be construed as the last month's rent, 4. LATE, ARGES.- A S65,00 late fee will be. charged for rent paid after 5:00 p.m. the, 5t" day of the month, plug for each. day thereafter until rent is paid in full. Payments by mai I shall be current so long as the envelope i's Postmarked on or before the 3'd of the nionth, Late payments shall be charged until LANDLORD OR AGENT has actually received funds, Monies received shall always be applied to the oldest owing debt. No failure to enforce any terra herein shall be deemed a waiver of the right to collect the full amount thereof W Rtgtis.-duc,on.the Vhe t of.each tb e. Sth falls on a weekend or a holid a, and the office is elosed,jsou need to make arra.nRpments to have the renfln h the 5t,QE-N!0U will be ch j d, late fees* 5. OCCUTIANCY & SUBLETTI G- The premises are rented for occupancy by, AdultsL Children. and Pets. Occs panev (people or pets) SHALL NOT BE M IAICRE�AS ED wit'hout the written. crinission of LANDLORD OR AGENT, The TENANTT(S) agrees no".. to sublet said prem.tses,, j *1 ne TEN ANT(S) furthc,r agrees not to assign thi's rental acrreement or any part thereof. 6. MULTIPLE OCCUPANCY: it is eXPrCsslv understood that this agreement is between LANDLORD OR AGENT mid each sigDatory and that each signatory is entirely responsible for property use andpayments. In'the event of default by one signator) each and every remaining signatoiy shall be responsible for thne1v payment of the full rent and all other provisions of th" is agreement. 7. PEI' 11N,141TATI ONS : TENAYF(S) shall have no pet on the premise unless- authorized in writing by LANDLORD OR AGENT. If authorized, pet owner agrees to keep all areas in a clears and sanitary condition, All pet waste is to be removed from unit on a daily basis and 17 Tenant Inibats disposed of in a proper matuier. All pets must be leashed or they caged if leave the unit, All pe( Z7 11 waste in common areas is to be removed immediately, Animal kennels must be cleaned d.aily and Yard reseeded if needed upon exiting the property. There may be an additional pet deposit or fee, - 8. INSPECTIONS: A property condition report xxvrill be completed solely by TENANIT(S) prior to UNANT(S) moving in, as provided by Law, and said signed report will become part (-)f this lease. TENANT(S) agrees that throughout the term- oft is lease, TENANT(S) will abide by all terms and Go. nditions of this lease and. keep. said premises ire as good order, condition and r tp epalr IF as when the lease commenced. Normal wear and tear resulting from ordinmy use is expected. 'ENA N'T(S) shall return the premises to LANDLORD OR AGENT in as neat and clean t.". conn on as be/she accepted it LANDLORD OR AGENT "1*11 solely complete prope rty co-ndItion report upon TEN.NNT(8') surrender of the prernises and will be compared to the move in form, In the everit of T ANT'S fai I tire to perform the foregoing, or to pay all rent, or to make all late payments or utility charges 'in accordance with this lease, LANDLORD OR AGENT may withhold Whatever is ixcesswir from TENANTS security deposit. 9House) Mai lbox, . KV Keys issued Garaae and Other f If TENANT(S) fails to return all keys to the office at time of vacating, TENANT(S) will pay it for another re -keying out of their security deposit. If TENANT(S) fails to turn in Utiliq keys lissued, $25.00 will b.c. charged for each 10. U11 _JITI ES: UNANIT(S) shall slan in and pay, when due. the following utilities. E-lectricity Water' Other 6� Natural Gas ewer Heating 0*11 (Y� Garbage I I SPECIFIC OBLIGATIONS OF THE TL?NANT: TENANTkS) shall pay the rental amount at such times and in such amounts as provided for in this rental agreement..., or as otherwise proyrided by law and compiv with all oblicysations imposed upon TEN.. `($ by applicable provisions of all niunicipal, county, and state codes, statutes, ordinances, and regul.-ation.s. and in addition shall: (a) Keep that part of the premiscs which he or she OCOLIPIeS and uses, as clean and sanitary as the condition of the prei rises pemia. j EN. NT(S) is responsible for all daniage to the furntshmgs or premises caused by their negligence. TENANT(S) shall report leaky or defiective faucets at once. Expense or damage caused by stoppage of waste pipes or overflow of bathtubs, toilets.., or wash baSiDS, or 'improper use of shower/tub enclosure Ind `or TENAN'l"'S shower curtain must be paid by TENANT(S) as well as any dor nage to the building or furnishings other than ordinar\,, wear and teat-, W (b) 11roperly dispose from his or her dwelling unit all rubbish- Slarbage, and other organ' I- ie 01* fiammable waste in a clean and sanitary maimer at reasonable and regular intervals and assume all costs of extermination and finnigation Cor infesLation caused by the W `I"ENANT(S). TENANT(S) shall take patlicular caution against Gigarettes and other fire hazards, TENANT(S) shall not store inflarnmable or hazardous materials. If Tenant Initials environmental damage i's done. to premises, neighboring premises,. surrounding or t_1 I a als neighboring orourids, trees, and/or waterways by TENANT(S) and/orpersons or nim in'FEVAN T'S coiitrol TENANT(S) agrees to pay all costs including but not IiiTifted to clean up, authorized disposal, repairs, restoration, legal fees, and cost of collection, (c) Properly use, and operate all electrical, gasheating, plumbing, and other fixt ur and appliances supplied by the OWNER, (d)Not intentionally or negligently destroy, deface, damage, impair, or remove any part of the structure or dwelling, with the appurtenances thereto, including the facilities, equipment, fern ittire, furnishings, and appliances, or permit any member of bis or her family, invitee. I ic. ensee., or any person acting Linder his or her control to do so. I Violationsmay be prosecuted under Chapter 9A.48 RCW if the destruction is Intentional or malicious. (e) Not permit anuisance or common waste, Not engage in drug-related activitv at the rental premises, or allow a subtenant sub lessee, resident, or anyone else to engage M drug-related activity at the rental preniises ON with the knowledge or consent of the tenant. "Drup-related activi i t�v" means that activi�y which constitutes a violation of Chapter 69.41, 69,50, or 69.52 RCW. `MNANT(S) understands that a high amount of traffic to and from this unit is reasonable cause for suspicion of drug-related activities, and eviction proceedings will be enacted for disturbing the peace of the neighborhood. (g)A battery smoke detector has been installed, To test the smoke detector (no less than twery 6 monflus) p'Ush the button on the cover. The alarm will sound if the battery is ivorking. tf no alarm sound is heard, the unit has a defective battery or other failure. It shall be the responsibillity of the TENANT(S) to test the smoke detectors at least once evety six nionths and replace the batteries. If upon testing it is determined that the smoke detector does not function and such malfunction is not corrected by the replacement of batteries, the TENANT(S) shall immediately notify the management 'in writing. It 'I's a violation of the law to remove or tamper with a properly functioning smoke detector, including removing batteries. Failure to properly maintain the smoke detecto.r(s) can result in Punishment including a fine of not raore than 5250.00 pursuant to RCW 48.48-140. VA (a)(01"he unit has a sinoking policy, as follows ------- - - - - - - - - - - - - - - - - 14" 'SM (h) Not eug-age in wi)/ activity at the rental premises that is*, (a) Imminently hazar(IOLIS to the physical. safety of other persons on the premises, and (b)(i) Extaits physical assaults upon another person which results in an arrest, or WEntai_ls the unlawful use of a fireanii or other deadly{ weapon as defined 'n RCW 9A.04.1 10 which results in an arrest, including threatening another TENANT(S) or the OWNER'S representative with a firearm or other deadly weapon under CW 59.19, Nothing in this subsection (8) shall authorize the terunnation of tenancy and evictlons of 4 "Fera rpt Initials the victim of the use or threatened use of a Firearm or other deadly weapon; and eviction proceedings will be enacted for disturbing the peace of the neighborhood. (i) Upon termination and vacation, restore the premises to their initial condition except for reasonable wear and tear or conditions caused by failure of the lwidlord to comply with his or her obligations under this chapter. Not permit any acts to be done on premises that violate any law or rule or regulation of any governin, . body including those that may be enacted by the property manager or an applicable owner's association. (k) Agrees to use the premises only as a dwelling. Disorderly conduct shall be gro-urids for notice to vacate dxvelllng and term mate this agreement. TENANT(S) shall restrict all sound or noise to a reasonable volume. TENANT(S) and TENANT'S guests shall conduct themselves in a manner that will not disturb their neighbor"s peaceful en" of the Premises. j oyment (1) Report immediately in writing all ffialfunctions of equipment, bailreof essential senlices,, or need for repair. 'FE-NANT(S) shall not tamper with the furnacel refrigerator, locks, entrance of all doors,, lights, or other appliances. 0) Any goods, chattel, motor vehicles, or other property on the premises that is considered inoperative shall be considered abandoned and may be disposed of as provided by LANDLORD OR AGENT or WASHINGTONSTATE W. 12, RECOMMENDATIONS: Doors of` ENANT'S dwelling should be kept locked. TENANT(S) shat I noti ley LANDLORD OR GENT in writing I r locks fail to operate, LANDLORD OR AGENT will not be liable or responsible in any -way for loss or damage to articles or property belonging to TENANT(S). # fo it is r red. that Tenant Ire r be acquired. before occunapq and keot current TENANT(S), Washington State Insurance does oes'nota'llow OWNER'S insuraneeto cover any damage or loss to T)EN*AN*TIS vr2perj3L. 13. LAWNS & SHR'UBS/SNOW* TENANT(S) agrees to MOW the lawn every 7 to 10 days. To keep the lawn, flowers and shrubbery thereon in good order and watered on a regular basis, to keep weeds under control, and to keep the sldevvalk surrounding said premises ftee and clear of all obstructions including snow and ice; to replace in a neat and workmanlike manner all glass and doors broken during occupancy thereof; to use due precaution against freezing of water or waste pipes and stoppage of same In and about said premises and that in the case water or waste pipes are frozen or become clogged by reason of neglect of TENANT(S), the TENANT(S) shall be responsible for the professional repair cost. In the event the lawn is not maintained, the LANDLORD OR AGENT shall have the right to hire the services out and bill the cost of said scrvicesto"FENANT(S). Said bill shall be due on the first of the month and the penalty provisions of item 4 shall apply. 5 Tenant Initials TOINIL:1:MON BLACK FANCH & fi0i'VIE 1000 S. PIONEER WAY MOMS LAKE, WA 98837 509-766.0300 `AX: 509-766-2190 pyn Northwest Wfiple L10SeMce LEASE RENTAL AGREEMENT ALL RIGHTS RESERVED RULES 159 1. Garbage". Tenant shell furnish his/hh+r own garbage can and place it where required for 160 pickup. 161 . lilasal Use. Tenant shall not use the Property for any illegal purposes. 1162 . l ep lr . Tenant shall promptly repair, at Tenant's expense, any broken glass in doors or 163 windows, 164 . Freezing. Tenant shell protect the plumbing from freezing. As a minimum, Tenant shall 165 lege the heat on low during cold heather. 166 6. Drains. Tenant shall relieve stoppage of drains at Tenant's expense unless resulting from a 167 condition existing al the time Tenant moved in. 168 . bails/Painting. Tenant shall not drive any "rails or screws ihto walls, and shall netint 169 � l• anything,"without the prier written consent of Lessor. 11170 7. Lawns & Shrubs/Snow. Tenant shall cut and* water any lawn and water any shrubs, trees 171 and landscaping so as to maintain the sane in as geed a condition as they are presently. lex 172 the event ofenow, Tenant will remove the same from any abutting sidewatks. 173 6. Noise/Nuisance, Tenant sell keep TV, stereo, radia and musical instrument volurnes to 17 enough so that no Noise whatsoever shall escape from the Property. Tenant shall not create 1' or permit any ether nuisance on the Property. 176 S. Guests. Tenant is responsible for the conduct of all guests an the Property and shell insure 177 that guests comply with these Rules, 178 10. Feta. if Lessor has given written permission for pets an the Property, no pet nois e � 179 hat ever shall be allowed to escape from the Property. In the case' of apartments, pets 180 shall not be allowed in the halls, common spaces or surroubding Prop'erty except an a leash 181 K end accompanied by Tennt. It i's Tenant's responsibility to clean up and dispose of any pet 182 excrement anywhere on the Property and on adjacent sidewalks, Streets, alleys and 183 neighbors' properties. 184 11. Vehicles. Tenant-shall not park or stare recreation vehicles, trailers, boats and inoperable or 1 unlicensed automobiles on the Property, on or in any parking area provided for the Property, 186 or on any street or alley serving the Property. Tenant shall complete repairs to seer vehicle 187 I n these locations within 24 tours of commencement. 188 12. Hallways - Common Areas. If there are hallways or other common areas shared v lth 189 1 ether tenants, Tenant t shall keep noise to a minimurn therein and nothing may be stored, 19+0 1 even ternporanl, therein. 191 13. Fireplace insertMod Stove, Woad stoves are prohibited, unless provided b Lessor. o 192 fireplace insert may be installed without Lessor's prior Written perrn scion- if permission is 193 given, there the installation must be inspected by the applicable city or county building 194 department, at Tenant's expense, before the same is used_ 19 14. Water Beds, Pianos & Heavy Objects. No water beds, aquariums, pianos, organs, library 196 or anther unusually heavy objects are permitted in the Property without Lessor's written 197 4 ♦ y Permission. As a condition to permitting a grater bed, Lessor may rewire Tenant to provide 198 and pay for water bed insurance, 199 16. Screens, Lessor is not obligated to provide window and1or door screens, if there are any 200 { presently installed, Lessor has no obligation to maintain or repi ce therm, 201 , ;� lnitials_�knant:.... te: ::23 Lessor: bete: Tenant; Date: Lesser.--�"" Date: ach Office r � epO Yn. � d And rafe ~.. .. TENANT(S) agrees not to inake anv repairs or alterations to said premises. TENANT(S) agrees to replace (when. applicable) orwash fumace filter every month in order to facilitate good workincir order of heatin g and air conditioning. DO NOT -�,VER SET HO f WATER HF -,,ATE -R ABOVE 120 DEGREES 1*0 PREVENT BURNS, 14. MAINTENANCE BY LANDLORD OR AGENT : All rpt lnests Lor -niainti' nafte–—IR.1-US—t be delivered in writing to LANDLORD OR AGENT. Maintenance will be done in a timely niaruier xid in accordance with the Landlord "errant Law. 4! I..,ANDLORD OR AGENTshall not be liable for Janna es of any kind caused by the lack of heat., refrigeration, or other services to the premises arising out of any accident or act of G- od r) V or occurrence beyond the control of LANDLORD OR AGENT, ACCESS.- LANDLORD OR AGENT shall have the n'ght to place and maintain "for rel'it" and/or "'for sale"' signsin a cOfISPICUOLIS place on said premises dul'Ing fhe term eft s tenancy. TENANT(S) further has been adv1sed that the landlord May place these premises on the naarket and TENANT(S) aarees to allow LANDLORD OR AGENT to show the prem* C i-ses at a reasonable time after giving TENANT(S) 24 hours notice of LANDLORD OR AGENT'S intent to show.. LANDLORD OR AGEN17 further reserves the right ofaccess to the premises for the purpose oHNSP.CTI ON, RE-PAIRS,ALTERATIOVis; and AND IMPROVEMENTS; and to exhibit or display the,, premises at reasonable times, LANDLORD OR AGENT may enter the premises without'FENANT' S knowledge only if an emergency repair or emergency should occur. .15. TERMINA"FIONrfENANT BREAKING LEASE.- If TENANT(S) to inates this lease for whatever reason, prior to full term vv)hichis indicated herein, TENANT'S security depositn the amount of $300.00 may not be refunded, and TENANT(S) shall be obligated pay for the rental ments for the remainder. of the term or until the property has been e� rented, In addition, TENANT(S) shall be responsible for paying all costs necessary to secure the replacement tenant for the remaining term of the lease, This includes but is not limited to utilities that are Tenants responsibility, carpet cleaning, professional Cleaning, re -keying of locks, and LANDLORD R. AGENT'S $.250.00 placemeut fee. 1 ...... llfi-b- y -apart of �6. COSTS AND ATTORNEY FEES,. reason of any def alt or breach on the either paily in the performance of any of the provisions of thi is agreement and lepal action is b-Wl instituted, the prevailing party shall be awarded its reasonable costs and attomeyls fees in i d that the venue of any legal action brought Linder the terms of connectlon therewith. It is agreed flit's rental agreement shall be in Grant County Court, Ephrata, Washington-, It is agreed upon that for non-payment of monies will be sent -to Central Boned Collectors, Moses Lake, Washington., 17. ABANDONMENT: If theTENANT(S) defaults in the payment of rent and. reasonably Hidicates by words or actions the intention not to resume tenancy, it shall be res .nye that TENANT(S) has abandoned the property and does not intend to resume tenancy, In the event of such abandonment, LANDLORD OR AGENT nlay 111iniediatcly enter the property and take possession of any property of TENANT(S) found therein. Any SUch property shall be stored and disposed of pursuant to the provisions of RCW Chapter 58,18. A written notice will be mailed to tile, TENNAN"I""S last known address. Tenant initials .18* DISPOSITION OF DEPOSIT: Within twenty- one days after termination of th's t lease and vacating the Premises by THNIAN"F(S), LANDLORD OR AGENT agrees to give a full a.nd complete statement of the basis for retaining any amount of the security depos4t. Statement will W be addressed as EN ANT directs or in the absence thereof. to TENANT'S last known address or personally delivered to the tenant. In the event the foregoing amount i's insufficient for the purposes, TENANT(S) agrees to immediately pay LANDLORD OR AGENT any additional arnounts due. If repairs are necessary which cannot be completed within the twenty-one days, the TENAN"Y(S) will still be notified within twenty-one days of the list of repairs. In the eve -at n' NANT(S) has broken the lease agreement and is still responsible for rent on a ]eased unit, T +. 0 ENANT(S) will be notified of all the foregoing wid funds will be withheld until the disposition is completed. Carpeting has been professionally shampooed prior to T"NANNY movie in. When TENANT(S) vacates., carpeting 'is again professionally shampooed -with the resulting I # invoice paid from the TENANT'S security deposit. If a disagreement arises regarding this disposition of deposit and the .matter is referred to the Courts, TENANT(S) may be required to pay all disputed funds into a Court controlled Rent Trust Fund. The funds Will be disbursed according to the findings off` the Couil. 19. CARBON MONOXIDE ALARMS. Lessor shall equip the property with carbon monoxide alarmin accordance with the RC's 1 state building code as required by RC9.27.530,, The pa.rties (s) acknowledge that the Brokers are not responsible for ensuring that Lessor complies \,Vitb RCW 19.27.530. Lessor and Tenant shall hold the Brokers and their Finns harmless from anv claim reSLlltl'nP- from Lessor's failure to install a carbon monoxide alarm(s) in the Property, Addendum: $.tgnatUrreS Date/ ,ED at, Date Date ,Property Manager Tenant Tenant Tenwit . 7 (7\Tenant Initials- Mom and Dad are parents to a child who was victim of child abuse. Mom works odd jobs on the side if available. Parents Just got back together and it has been financially hard on mom being a single parent and not receiving child support. So helping her with November rent will help get her back on track, Mom was very appreciative of the assistance. all- X%3R . , !- A IN Staff; ------ -------- Date Submitted: I "Ob Ot) Amount requested $ 'Type of client: # of Children: OOV OSA QCVSC 0 YHDP MO Client ID: �'j lil �,,, � �? 1 j Clients Home City: • Background check for housing • Children"s needs • Debt assistance • Drivers license • Education training Bus fare to return home Cell phone to seek work/housing 1= amity well being • Mortgage • Service DVPO • Utilities bills Security Assist Rental Assist Car payments Food/Necessities WA e d SO ;)e*'r' s ana, ure pprove i. Dal a all Updated: 2/11/2020 Residential Lease Agreement Summary Not all items listed in this summary are applicable to every Unit. Persons signing Lease ("Tenane): Authorized Occupants: Guarantor(s): Landlord: The Lakes - Moses Lake 125 LLC Unit Address. 1050 S Division #D2, Moses Lake, NVA 98837 Community: The Lakes MOVE -IN CHARGES MISCELLANEOUS FEES Initial Late Cha es . . . . . . . . . . ecur epo 200.00 Rent for 21 days 951.30 Non -Refundable Admin Fee 200.00 Returned Checks -------- - - -- Taxable CharLie Tot -at Cbarees.- S-1710.30 MISCELLANEOUS FEES Initial Late Cha es $75.00 Per ,Date $5.00 Additional Late Fee' 09:00 AM to 06:00 PIM MaximumLate Ch�� e _$0.00 N/A.�_ Returned Checks $50,00 Earl Temiination Fee 52038.5 , 0 I aXable Charge ADDITIONAL FEES AND/OR CIIARGES CONTACT Property Manager: Name: Skyler Dikse'n Address: 1050 South Division, tyloses Lake, NVA 988.37 Phone* (509) 350-8868 Einall: skyler.diksen@1 iresidential.com, Emergency Mamitenance Issues-. .(509).295-9628 Please Make Payments Payable To: The Lakes - Nlost!s Lake 125 LLC Monday 09:00 AM to 06:00 PM Tuesday 09-00 AM to 06:00 PIM Wednesday 09:00 AM to 06:00 PIM Thursday 09:00 ANI to 06:00 Pm Friday 1 09:00 AM, to 06:00 PNM Saturday Closed Sunday Closed Online portal: www .thelakesatrnoseslake,com UTILITIES A Utility Vacant Cost Recovery fee of 50.00 may apply. Additional utility fees may apply depending on the locality. Please see your Utility ----------- Addenda tor Tenant responsibilities. RENTERS INSURANCE (X] Renters Insurance is Required ------ Renters Insurance- is Not Rc aired If required and Tenant falls to obtain: Landlord may purchase Landlord Placed Tenant Liability Insurance policy CIPTLI") at Tenant's expense of 5)9.00, plus any applicable administrative fees, due with monthly rent. The cost of LPTLI coverage and administrative fees are subject to clianLe upon Lease renewed or if the Lease converts to a month-to-month tenpcy- Residential Lcase Agreement Summary - Page I Document digitally signed using RENTCafe eSignature services. Document ID: 1312302 ENTRY DEVICES Vehicle I Vehicle') ------ - Key Description Quantity. Issued Replacement Charge per Key or FOB Unit Key 1 10.00 —Building Key I $50.00 Mailbox Key t $10.00 -,Keyless Entry Remote/FOB 0 $50.00 Garage Door Remote 0 $50.00 -.AUTHORIZED WHICLE INFORMATION Vehicle I Vehicle') Vehicle 3 Vehicle 4 Year: Year: Year. Year: Make.: Chrysler Make: Make: Make,, Model: Chrysler 200 Model: Model: Model: Color: Color: Color: Color: Plate: Plate, Plate., HAW 1 State: WA State'. State: _State: ANIMALS Type (Dog, Cat, etc.) Animal Name Weight Service or Support Animal Tenant, - Signature: PrInt Name: Signature: Print Name: Landlord or Landlord's Representative-, Signature: SrA Print Name� Residential Lease Agreement Summary - Page 2 Document digitally signed using RENTCafe eSignature services, Document ID: 1312302