ARLINGTON COUNTY, VIRGINIA OFFICE OF THE PURCHASING AGENT 2100 CLARENDON BOULEVARD, SUITE 500 ARLINGTON, VIRGINIA 22201 NOTICE OF CONTRACT AWARD She-£0 DATE ISSUED: January 2, 2019 4031 University Dr., Suite 100, Fairfax VA 22030 CONTRACT NO: _19-016-RFP Attn: DeShawn Robinson-Chew Provision of Summer Camp Services for Department of CONTRACT TITLE: _Parks and Recreation Your firm is awarded the above referenced contract. By signing belov., She-EO ("Contractor"), a Limited Liability Company authorized to do business in Virginia, accepts the terms of the Agreement No. 19-016-RFP. The contract documents consist of the terms and conditions of AGREEMENT No. 19-016-RFP including any attachments or amendments thereto. EFFECTIVE DATE: Upon date of signature by the Contractor on the bottom of this page EXPIRES: September 14, 2019 RENEWALS: Four (4) ONE (1) YEAR RENEWAL OPTIONS FROM INSERT DATES COUNTY CONTAC: CONTRACTOR CONTACT: Kathryn (Katie) Salyers (DPR) DeShawn Robinson-Chew, Owner/Founder (703) 228-1856 866.697.4: THE COUNTY BOARD OF ‘SHE-EO tie ete ew See ba D> NAME Igor Scherbakov NAME (Print) DeSaaun filnasar bo DATE January 2, 2019 DATE Anuar & Gq Arlington County Agreement 19-016-RFP Notice of Award and Contractor's AcceptanceRoquest for Taxpayer we W-9 ive Form to the (foe Novena 2017) Identification Number and Certification requester. Do not Sees” > ooo wea gorFamW9 fico sd te et normeton =ee [SRA RO aS Se SS i 2 She- as SS OE novammcnpeprare Ce Dscopmen Cee we copra nee i ' ——— Bb) rence eo er et men corre $8 cpm i i inet anette trate sean mer cara Sa7 | empentom PATCA NG Set one ewe rs Bas frome Sars a =H ST Terrace: meentreuille VA A019 rou actin Fr Seat eps: sauna repo raat rum (EN Hous tha ea. ee oH at tee acrut nere ance anes net fe te, Aso St What Name ant ‘Simon To cee Rags usin on wos nant Car (per epee 4 Typnateupst csp ely nese een nbsp wots have ese rig ear Ree Eh aan byes bean wg a arent ot tare ropa a laa mon, oy Be PS hes td mPa a rorgy sxe buan wEPOOre oe lamas. ctemer omer US. pose tes Dow: ans {LIne eaToA coon etre eno any otng hat a xan um FATCA epring come Purpose of Form {Fam 080 fear card anu ay rete arcs) Rreeecememsersegwrnramtome — igyimagenneeereet nc maena, "nef rut cya cree aoe ‘se paso ‘Gomeeronranow (way or yrs secay tavew + FON 1886 mode eo Tawa pay Sosa haw {ram tom» Sequin or sbamaonert ot nas0 ps se fom wer yous US. peren rewang areca sort prow ya eorerT 1 yo ot ae Far W-3 e aqetar wa TN og ahi ep mtracny oo oar so HONSInstructions: This form should be used to provide bank account addition/modification requests for the Supplier account. This information will be used to make payments to the supplier via ACH. B® creation C Modification (If modification, provide Supplier Number) Supplier Name: She - ED A (Supplier name should match with Form W9 if accompanied by one.) EIN/Taxpayer ID#/SSN (No Dashes): S(, D3 FO49S Bank Account Informatio! Name of the Banking Institution: PN Account Holder's Name: Shy ED LLC. ewe DeShawn Rebinson-Cherd Routing Number: 054000020 Account Number: 53 (4109 Jil Type of Account: Checking CHOOSE ONE Submitted Comments:All Supplier Account requests except for Refund/Reimbursement payments must be accompanied by a ‘completed Form W-9. DMF AP does not accept a handwritten supplier request form and all the drop down menu have to be selected D1 Creation L. Modification (If modification, provide Supplier Number) ‘Supplier Name: (Should match with Form Wa) EINTaxpayer IDISSN (No Dashes): 5(VQS ¥OUWS Please indicate the Supplier type (Required): CHOOSE ONE Description of Payment: CHOOSE ONE If OTHER, please describe: Does the supp! sr have a contract with the County CHOOSE ONE I yes, what is current contract number number? Section |: Tax Reporting Information: Is the supplier 1099 reportable? CHOOSE ONE tyes, 1099 reportable name: 1099 reportable EIN/Taxpayer ID/SSN Taxpayer Type: CHOOSE ONE. IF OTHER, please describe: Section Il: Supplier Site (Address): Site Street: 405] Univeraity Dr. #100 city: Fairfax state: J A~ Zip Code: ADOSO itional Site Address (if! i site street: (6747 Stone Maple Terrace city: Centreville state: | VA ZipCode: 2O\S-( Section Ill: Supplier Contact: (Required for all GENERAL Suppliers) FirstName: DESiauuy\ Last Name: (20191 Sen -Chew Phone Number (no dashes): Email: Ceo@ SEASHEEO: Com 8666914336 ‘To submit Supplier's Bank Information for payments, please use the Supplier Direct Deposit Form ‘Submitted by: Phone number: