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HomeMy WebLinkAboutAG 20-369 - Mark Sebastian, DMDCITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM ORIGINATING DEPT./DIV: —ECONOMIC DEVELOPMENT ORIGINATING STAFF PERSON:,_TIM JOHNSON EXT: 2412 3. DATE Q. BY.—ASAP -,,,,-- E] PUBLIC WORKS CONTRACT El SMALL OR LIMITED PUBLIC WORKS CONTRACT El PROFESSIONAL SERVICE AGREEMENT El MAINTENANCE AGREEMENT El GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CDBG 0 REAL ESTATE DOCUMENT 0 SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) El ORDINANCE 0 RESOLUTION * CONTRACT AMENDMENT (AG#):_ IIINTERLOCAL * OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT PROJECT NAME: CARES ACT GRANT — ROUND I NAME OF CONTRACTOR: MARK SEBASTIAN, DMD, PLLC ADDRESS: 33516 9TH AVE S, #2, FEDERAL WAY, WA, 98003 TELEPHONE: (253) 941-6242 E-MAIL: MARKSEBASTIANDMD@AOL.COM SIGNATURE NAME: SEBASTIAN SEBASTIAN TITLE: SEEATTACHED EXHIBITS AND ATTACHMENTS: El SCOPE, WORK OR SERVICES 0 COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE 0 ALL OTHER REFERENCED EXHIBITS L1 PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS TERM: COMMENCEMENT DATE: SEE ATTACYIE.D.A MMENT COMPLETION DATE: P1 Is A'li i* IS SALES TAX OWED DYES X NO IF YES, $ PAID BY: 11 CONTRACTOR 0 CITY RETAINAGE: RETAINAGEAmoUNT: -0 RETAINAGE AGREEMENT (SEE CONTRACT) OR 11 RETAINAGE BOND PROVIDE 0 PURCHASING: PLEASE CHARGE TO: 001-1800-990-518-10-490 Prp ect Code # 267662-25060 0. DOCUMENT/CONTRACT REVIEW 11 PROJECT MANAGER 11 DIRECTOR El RISKMANAGE MENT (IF APPLICABLE) 0 LAW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED SCHEDULED COMMITTEE DATE: CommmrEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: 2. CONTRACT SIGNATURE ROUTING L1 SENT TO VENDOR/CONTRACTOR DATE SENT: I 11 ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS El CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL / DATE SIGNED D LAW DEPARTMENT SIGN D By LAw.07-28-20 S SIGNATORY (MAYOR OR DIRECTOR)ERK '_' CITYCLj ASSIGNED 4 �D AG 'OMMENTS: 1/2020 This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Mark Sebastian, DMD, PLLC, a professional limited liability company ("Grantee"). The City and Grantee (together "Parties") are located and do business at the below addresses which shall bc IN "•+ �11 M 33516 9TH AVE Ade Ariwoola 33325 8th Ave. S. Federal Way, WA 98003-6325 (253) 835-2520 (telephone) (253) 835-2509 (facsimile) 1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions described herein. 2. CONDITIONS OF GRANT 2.1 Warranties. The Grantee warrants the following, which are pre -requisites for grant eligibility: a) Grantee operates a business physically located within the political boundaries of the City of Federal Way; b) Grantee maintains a current City of Federal Way business license c) Grantee has paid all taxes and government fees due up to the date of execution of this grant agreement d) Grantee is not the recipient of other state or federal funding made available as a response to the COVID-19 pandernic e) Grantee's business employees no more than the equivalent of ten (10) full-time employees (20,800 man-hours total for all employees per year). Grantee's net revenues do not exceed more than $1.5 million per year g) Grantee does not operate as a tax-exempt business as defined by the Internal Revenue Service h) Due to COVID-19, Grantee business (check all that apply): Was required by state or local order to close Was forced to lay off employees due to reduced patronage Incurred over $1,000 in 'OVI-19 related expenses Ej Experienced 10-50% lost revenue ffKExperienced over50% lost revenue CITY OF CITY HALL 4 33325 8th Avenue South Aw* Fe d le ra I Wa y Federal Way., WA 98003-6325 (253) 835-7000 m4w cifyoffederalway coo a) Mortgage or Rent b) Personal Protection Equipment c) Insurance d) Utilities e) Marketing F) Payroll Grantee agrees to retain receipts documenting use of grant ftinds and will provide them to the City or its designee upon request. 3. TERMINATION. Should any of the conditions described in section 2.1, above, not be met, the City may recover all disbursed grant funds and terminate this agreement. 4.1 Amount. In order to promote healthy economic activity in the City and in response to the losses i nriJ dui to SY7.11 _#)revidozara-it t4i Vie Gr.2--ttee i -t an aw,*irtit 4.2 Non -Appropriation of Funds. If sufficient funds are not appropriated or allocated for payment under this Agreement for any fiscal period, the City will not be obligated to make payments under this agreement. E � 1910 910 10 1 a 5.1 Grantee hideninifi cation. The Grantee agrees to release indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives, arising from, resulting from, or in connection with this Agreement or the performance of this Agreement, except for that portion of the claims caused by the City's sole negligence. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Grantee and the City, the Grantee's liability hereunder shall be only to the extent of the Grantee's negligence. Grantee shall ensure that each sub -Grantee shall agree to defend and indemnify the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers to the extent and on the same terms and conditions as the Grantee pursuant to this paragraph. The City's inspection or acceptance of any of Grantee's work when completed shall not be grounds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Grantee waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51 RCW, solely for the purposes of this indemnification. Grantee's indeninification shall not be limited in any way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. The Parties further acknowledge that they have mutually negotiated this waiver. CITY Ot F6deral My CITY HALL 33325 8th Avenue South Federal Way, VVA 98003-6325 (253) 835-7000 www cityoffederahvaV coma 5.3 City Indemnification. The City agrees to release, indemnify, defend and hold the Grantee, its officers, directors, shareholders, partners, employees, agents, representatives, and sub- contractors harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons or entities, including without limitation, their respective agents, licensees, or representatives, arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent acts, errors, or omissions of the City. 5.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement with respect to any event occurring prior to such expiration or ten-nination. 6.1 Intftmatioli and, Modification. This Agreement contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior statements or agreements, whether oral or written, shall be effective for any purpose. Any provision of this Agreement that is declared invalid, inoperative, null and void, or illegal shall in no way affect or invalidate any other provision hereof awi such other provisions shall remain in full force and effect. No provision of this Agreement, including this provision, may be amended, waived, or modified except by written agreement signed by duly authorized representatives of the Parties. R "I UTieff 0I Mill it milig,111 SLU11 uJillin in a lion o recovery or award provided by law; provided, however, however nothing in this paragraph shall be construed to limit the Parties' rights to indemnification under Section 5 of this Agreement. 6.3 Execution. Each individual executing this Agreement on behalf of the City and Grantee represents and warrants that such individual is duly authorized to execute and deliver this Agreement. This � � � �- �, .1 1r Fbdera 3 Woy CITY OF CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 s cifyoffederalway coma Agreement be executed in any number of _, i ar deemed a and with the same effect as if all Parties hereto .a -a - ydocument. All i ` a. be construed together and shall constitute one instrument, but in making proof hereof it shall only be necessary to produeR one such counterpart. The signature and acknowledgment pages from such counterparts may be assembled together to form a single instrument comprised of all pages of this Agreement and a complete set of all signature and acknowledgment pages. The date upon which the last of all of the Parties have executed a counterpart of this Agreement IN WITNESS, the Parties execute this Agreement below, effective the last date written below. Jim Ferrell, Mayor m ATE: $44 hozo SEBASTIAN,MARK • PrintedName: Title: ATE: -114 uv 3 d - - T- r ♦ : ` * . , , 7/26/2020 Services Business Lookup MARK SEBASTIAN, DMD, PLLC License Information: eServices New search Back to results Entity name: MARK SEBASTIAN, DMD, P.L.L.C. Business name: MARK SEBASTIAN, DMD, PLLC Entity type: Professional Limited Liability Company UBI #: 603-114-033 Business ID: 001 Location ID: 0001 Location: Active Location address: 33516 9TH AVE S STE 2 FEDERAL WAY WA 98003-6322 Mailing address: 33516 9TH AVE S STE 2 FEDERAL WAY WA 98003-6322 Excise tax and reseller permit status: Click here Secretary of State status: Click here Endorsements Endorsements held at this location License # Count Details Status Expiration date First issuancE Dental X-ray/CT/ Pan/Ceph 10316 2 Active May -31-2021 Aug -25-2011 Federal Way General Business 00 -101321 -00 -BL Active May -31-2021 Jan -08-2000 X -Ray: Dental/Podiatric/Veterinary 10316 Active May -31-2021 Aug -25-2011 Governing People May include governing people not registered with Secretary of state Governing people Title SEBASTIAN DMD, MARK Registered Trade Names Registered trade names Status First issued MARK SEBASTIAN, DMD, PLLC Active Jul -28-20111 Working together to fund Washington's future hftps://secure.dor.wa.gov/gteunauth/­/#1 0 111