The URL can be used to link to this page

Home My WebLink AboutAG 20-720 - Kenneth L BrosselCITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM ORIGINATING DEPT./DIV. ECONOMIC DEVELOPMENT 2. ORIGINATING STAFF PERSON: TIM JOHNSON — EXT: 2412 3. DATE REQ. BY. ASAP TYPE OF DOCUMENT (CHECK ONE): El CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RF -P, RFQ) El 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 El REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) El ORDINANCE El RESOLUTION El CONTRACT AMENDMENT(AG#):— El INTERLOCAL X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT 5. PROJECT NAME: CARES ACT GRANT — ROUND 2 6. NAME OF CONTRACTOR: KENNETSSEL, DDS, PS ADDRESS: 2335 SW 320TH ST # 2, FEDERAL WAY WA 98023-2569 T ELEPHONE: (253) 925-2171 E-MAIL: OFFICE@BROSSELSMILES.COM SIGNATURE NAME: KENNETH BROSSEL TITLE: SEE ATTACHED 7. EXHIBITS AND ATTACHMENTS: 11 SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE El ALL OTHER REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES 0 PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: SEE ATTACHED AGREEMENT COMPLETION DATE: 9. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND N01100 ($2,000.00) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: El YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED El YES X NO IF YES, $ PAID BY: L1 CONTRACTOR El CITY RETAINAGE: RETAINAGE AMOUNT: m El RETAINAGE AGREEMENT (SEE CONTRACT) OR El RETAINAGE BOND PROVIDED El PURCHASING: PLEASE CHARGE TO: — 001-1800-990-518-19-490 Project Code #267662-25060 10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED z 1:1 P OJECT MANAGER --Z R' E CT 0 R 0 RISK MANAGEMENT (IFAPPLICABLE) El LAW 11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING E] SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: El 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 El LAW DEPARTMENT US4'6&ATORY (MAYOR OR DIRECTOR) El CITY CLERK El ASSIGNED AG# AG# *I 61 ky, ZI 1/2020 This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Kenneth L Brossel, DDS, a professional services corporation ("Grantee"). The City and required is this Agreement: I'mMan a I . I a an -3.6i to B 13 M KENNETH BROSSEL 2335 SW 320th St # 2, Federal Way, WA 98023-2569 Mailing address: 2335 SW, 320TH ST # 2, Federal Way, WA 98023-2569 (253) 925-2171 (telephone) officeabrosselsmiles.com Ade Ariwoola 5«t,. S. Uederal Way, WA 98003-6325 (253) 835-2414 (telephone) (253) 835-2509 (facsimile) Ria #w& , OAikiw�W.Axmwlom 1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions described herein. 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's business employs no more than the equivalent of ten (10) full-time employees (20,800 man-hours to for all employees per year); e) Grantee's net revenues do not exceed more than $1.5 million per year; f) Grantee does not operate as a tax-exempt business as defined by the Internal Revenue Service; g) 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 COVID-19 related expenses Experienced 10-50% lost revenue Experienced over 50% lost revenue 2.2 Use of Funds: Grantee affirms that grant funds will be used for the following purposes: a) Mortgage or Rent b) Personal Protection Equipment - 1 - CITY OF CFTY HALL 33325 8th Avenue South Federal Way Federal Way, WA 98003-6325 (253) 835-7000 kvww cityoffederalway cam c) Insurance d) Utilities e) Marketing f) Payroll Grantee agrees to retain receipts documenting use of grant Rinds 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. GRANT AMOUNT. 4.1 Amount. In order to promote healthy economic activity in the City and in response to the losses not to exceed Two Thousand and NO/ 100 Dollars ($2,000.00). 4.2 Non -A ri or pa e pprgpriation of Funds. If sufficient funds are not approp ated or allocated f ym nt under this Agreement for any fiscal period, the City will not be obligated to make payments under this agreement. 5.1 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 loyees, agents re- , ,iresentatives insurers &Q=a 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 indemnification 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. 5.3 Citv hdounifloation. The City agrees to release, indemnify, defend and hold the Grantee, its VKV, CITY OF Fe'des` at Way CFT-Y HALL 33325 8th Avenue $outh Federal Way WA 98003-6325 (253) 835-7000 mvw cityoffederalway com 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 termination. 6.1 !��Wtdafi6ft and Uo"cation. 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 and 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. 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 Agreement may be executed in any number of counterparts, each of which shall be deemed an original and with the same effect as if all Parties hereto had signed the same document. All such counterparts shall be construei CARES ACT BUSINESS GRANT AGREEMENT -3- CrFY HALL 33325 8th Avenue South Federal Way., WA 98003-6325 (253) 835-7000 www cityoffederalway cam together and shall constitute one instrument, but in making proof hereof it shall only be necessary to produce 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 z I counterpart of this Agreement shall be the "date of mutual execution" hereof. IN WITNESS, the Parties execute this Agreement below, effective the last date written below. 11 1� By: Printed Name: -A 13, o s,,7 Title: -6-K- DATE: 9 —1 S- - U Services Business Lookup KENNETH BROSSEL DDS PS License Information-. New search Back to results Entity name: KENNETH L. BROSSEL, D.D.S., P.S. Business name: KENNETH BRSL DDS PS Entity type. Professional Service Corporation UBI #: 600-393-842 Business ID, 001 LocationID: 0002 Location: Active Location address: 2335 SW 320TH ST ST E 2 FEDERAL WAY WA 98023-2569 Mailing address: 2335 SW 320TH ST STE 2 FEDERAL WAY WA 98023-2569 Excise tax and reseller permit status: Click here Secretary of State status- Click here Endorsements held at this location License # Count Details Status Expiration date First issuance Dental X-ray/CTI Pan/Ceph 4 Active Mar -31-2021 Sep -13-2018 Federal Way General Business 07 -101725 -00 -BL Active Mar -31-2021 Apr -06-2007 X -Ray: Dental/Pocliatric.Neterinary Active Mar -31-2021 Sep -13-2018 Governing People May include governing people not registered with Secretary of State Governing people Title BROSSEL, KENNETH View Additional Locations 0 6 . -1 . a -. 1 6. - .16 1 - : I III Working together to fund Washington's future