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Home My WebLink AboutAG 20-775 - Patricia Kho DDSEXT: 2412 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM *RIGINATING DEPT./DIV: *RIGINATING STAFF PERSON: TIM JOHNSON, — EXT: 2412 3. DATE REQ. BY. ASAP 4. TYPE OF DOCUMENT (CHECK ONE): El CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) El PUBLIC WORKS CONTRACT El SMALL OR LIMITED PUBLIC WORKS CONTRACT El PROFESSIONAL SERVICE AGREEMENT 0 MAINTENANCE AGREEMENT • GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CBG • REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) FSKeyagEff-IM14111 FEW1=1910111910 * CONTRACTA NT (AG#): El INTERLOCAL * OTHER CARES ACT FUNDS BUSINESS SUPP014GRANT AGREEMENT 5. PROJECT NAME: CARESACT GRANT ROUND2 6. NAME OF CONTRACTOR: PATRICIA KHO DDS PLLC ADDRESS: 33915 1 ST VVY S # 201, FEDERAL WAY WA 98003-6396 T ELEPHONE: (253) 927-6411 E-MAIL: PATRICIAKHO@YAHOO.COM SIGNATURE NAME: PATRICIA KHO TITLE: SEE ATTACHED 7. EXHIBITS AND ATTACHMENTS: Ej SCOPE, WORK OR SERVICES El COMPENSATION 0 INSURANCE PEQUIREMENTS/CERTIFICATE El ALL OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN 13 REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: SEE ATTACHED AGREEMENT COMPLETIONDATE: 9. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND NO/ 100 (S2,000AO) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLMM� REIMBURSABLE EXPENSE: El YES X NO IF YES, MAXE\4UM DOLLAR AMOUNT: $__ -- IS SALES TAX OWED El YES X NO IF YES, RETA1NAGE: RETAINAGE AMOUNT: PAID BY: 0 CONTRACTOR 0 CITY RETAINAGE AGREEMENT (SEE CONTRACT) OR 0 RETAINAGE BOND 0 PURCHASING: PLEASE CHARGE TO: .001-1800-990-518-10-490 Project (Lqde #267662-25060 10. DOCUMENT/CONTRACT REVIEW INITIAL DATE REVIEWED INITIAL / DATE APPROVED =F-1 PR JECT MANAGER RE, CTOR 0 RISKMANAGEMENT (IF APPLICABLE) El LAW 11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: Moto—IMIJOULOXTAN 00191 Lill El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS 0 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 ATORY (MAYOR OR DIRECTOR) 0 CITY CLERK I 11 ASSIGNED AG# AG# COMMENTS: 1/2020 This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Patricia Kho DDS PLLC, a professional limited liability company ("Grantee"). The WiVI& &r - any notice required under this Agreement. PATRICIA Kit HO 33915 1 st Way S # 201 FEDERAL WAY, WA 98003 Ade Ariwoola 33325 8th Ave. S. Federal Way, WA 98003-6325 (253) 835-2414 (telephone) (253) 835-2509 (facsimile) 1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions described herein. Mnnpp�, �#mLt "Im 11 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 employees no more than the equivalent of ten (10) fill -time employees (20,800 man-hours total for all employees per year); e) Grantee's net revenues do not exceed more than $1.5 million per year; Grantee does not operate as a tax-exempt business as defined by the Internal Revenue Service; g) Due to COVID- 19, Grantee business (Slh�eck all �that ably): % 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 AML OF CITY V.NLL --E 33325 Sth Avenue South 1�606ml Vft Federal Way. WA 98003-6325 V;A�(253),835-1000 www�4�4*com 2.2 JL§eoLFunds- Grantee affirms that grant fimds will be used for the following purposes: 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 fLmds and will provide them to the City or its designee upon request. 3. TEMNATICIN., Should any of the conditions described in section 2.1 above, not be mc4 the City may recover all disbursed grant funds and terminate this agreement. 4. GRANTAMOUNT. 4.1 Amount. In order to promote healthy economic activity in the City and in response to the losses x-mt not to exceed Two Tbousand and NO/l 00 Dollars ($2,000.00). 4.2 i * ipMpdation 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. event of liabty for damages ansing out of bodily injury to persons or damages to property caused by or RA-02AA14-N-WA I K'A I WALIM unas EO av01 —rapartyund i n acts� disaNilfty benefit act or any other benefits acts or programs. The Parties fin-ther acknowledge that they have mutually negotiated this waiver. ITT F COCITY HALL 4% 33325 8th Avenue South Federal Way, WA 98003-6325 Federal Way (253) 835-7000 ar com 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 AW-MR701ar-TWe executed "anp 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 construed 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 compnised 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 shall be the "date of mutual execution" hereof. v 12i I . i 111FIRI'lir mr1111111:111111 III By: Printed Name: K Title: DATE: "-ARES ACT BUSINESS GRANT AGREEMENT -4- 10/512020 Washington State Department of Revenue z cj,no Side Depai.-ieill- of r Pe, < Business Lookup Entity name: PATRICIA KHO, DDS, PLLC Business name: PATRICIA KHO DDS PLLC Entity type- Professional Limited Liability Company UBI #. 602-808-551 Business ID: 001 Location ID: 0002 Location: Active Location address: 33915 1ST WAY S STE 201 FEDERAL WAY WA 93003-6396 Mailing address: 33915 1ST WAY S STE 201 FEDERAL WAY WA 98003-6396 Excise tax and reseller permit status* Click here Secretary of State status., Click here Endorsements Ucqnw,�, count Detaiiis Dentat X-R-a,,,=/CT/ PanXeph 4 Federal Way GenerA Business 08--10132S-00-BL X -Ray Dentia l/Pod wnc/Vetennarte Governing People Govvrnnig peqjh, Title KHO, PATRICIA Registered Trade Names Rsgistt,red trade names Status - FEDERAL WAY ENDODONTICS' Active PATRICIA KHO DDS PLLC Active https://secure.dor.wa.gov/gteunauth/,/#1 3 New search Back to results Status Explra6on date First issuance dat Active Feb -28-2021 Feb -27-2013 Active Feb -28-2021 Apr -04-2008 Active Feb -28-2021 Feb -27-2013 First issued Sep -17-2012 Feb -20-2013 1/2