AG 20-497 - Three Angels Dental LabI Zq an An ows tw9 1011
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: —ggqNqNuc DEVELOPMENT
ORIGINATING STAFF PERSON: _1[m jOHNsoN
EXT: 2412 1 DATEREQBY. ASAP
TYPE OF DOCUMENT (CHECK ONE):
X CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RF -P, RFQ,)
El PUBLIC WORKS CONTRACT El SMALL OR LIMITED PUBLIC WORKS CONTRACT
11 PROFESSIONAL SERVICE AGREEMENT El MAINTENANCEAGREEMENT
11 GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CDBG
D REAL ESTATE DOCUMENT D SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
11 ORDINANCE El RESOLUTION
0 CON TRACTAMENDMENT(AG#):____ El INTERLOCAL
X OTHER - CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
. PROJECT NAME:.- CARES ACT GRANT -ROUND
NAME OF CONTRACTOR: THREE ANGELS DENTAL LAB
ADDRESS: 1635 SW 330 PL, FEDERAL WAY, WA, 98023 TELEPHONE: (253) 335-4991
E-MAIL: JEONG6314@HOTMAIL.COM
SIGNATURE NAME: JEONG JEONG TITLE: SEE ATTACHED
M
EXHIBITS AND ATTACHMENTS: El SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE 0 ALL
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS
COMMENCEMENT DATE: SEE ATTACHED ;PLETION DATE:
TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NOII 00 ($1,000.00)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: D YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED DYES X NO IF YES, $ mA,PAID BY: 0 CONTRACTOR El CITY
RETAINAGE: RETAINAGE AMOUNT: — TMEl RETAINAGE AGREEMENT (SEE CONTRACT) OR El RETAINAGE BOND PROVIDE
El PURCHASING: PLEASE CHARGETO: -
001-1800-990-518-10,490 Pr pie_qt Code # 267662-25060
0. DOCUMENT/CONTRACT REVIEW
INIT1AL / DATE REVIEWED rw'TI
L AL/ DATE APP RO�LED
• PROJECT MANAGER
• DIRECTOR
E:l RISKMANAGEMENT (IF APPLICABLE}
El LAW
1. COUNCIL APPROVAL (IF APPLICABLE)
SC RULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
2. CONTRACT SIGNATURE ROUTING
El SENT TO VENDOR/CONTRACTOR
DATE SENT: DATE
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
• CREATE ELECTRONIC REMINDERINOTIFICATION 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.)
!MTIAL L]2tkTE SIGNED
• LAW DEPARTMENT
SIGNED Ew LAW 07-28-20
• SIGNATORY (MAYOR OR DIRECTOR)
• CITY CLERK
g M K2 Z:
El ASSIGNED AG#
AG# A-141), 041
1/2020
CITY OF
FOderal YVpy
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
miwatyoffedeialwaycorn
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
THREE ANGELS DENTAL LAB
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Three Angels Dental Lab, a sole proprietor ("Grantee"). The City and Grantee
(together "Parties") are located and do business at the below addresses which shall be valid for any notice
required under this Agreement:
MUMS 1.01401 DW.1101111114 01 mivolaltz
Hyeon-Sik Jeong
1635 SW 330 PL
FEDERAL WAY, WA 98023
Or-11j1j_!!j=CjgMP IL61414
a
ANIM
A#] a 21 of 11 oil
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.
2.1 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 ane is
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).
f) 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) DuetoC VIII- 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 $1,000 in COVID-19 related expenses
Experienced 10-50% lost revenue
Experienced over 50% lost revenue
2.2 Use of Funds: Grantee affirms that grant funds will be used for the following purposes:
CITY OF CrTY HALL
33325 8th Avenue South
Federal Way WA 98003-6325
AN
Federal Way (253) 835-7000
www ntyoffPdera1wqy com
a) Mortgage or Rent
b) Personal Protection Equipment
c) Insurance
d) Utilities
e) Marketing
F) Payroll
Grantee agrees to retain receipts documenting use of grant funds and will provide them to the City or its
designee upon request.
3. TERMINATION. Should any of the conditions described in section 2.1, above, not be met, the City
may recover all disbursed grant funds and terminate this agreement.
4.1 Amount. In order to promote healthy economic activity in the City and in response to the losses
Grantee has incurred due to the COVID- 19 pandemic, the City shall provide a grant to the Grantee in an amount
not to exceed One Thousand and NO/I 00 Dollars ($ 1,000.00).
4.2 Non -Appropriation of Funds. If sufficient funds are not appropriated or allocated for paymen)
under this Agreement for any fiscal period, the City will not be obligated to make payments under this
agreement.
.J.�Afflfflnl
5.1 Grantee lhdtmnifie4bn. 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
Viese cove-ta-its 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.
VIM � �312
crry op
Fderal My
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(2 a3) 835-7000
w1m. CityOffederahl'ayr COP7
5.3 City lfidtumi&a�h. 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 termination.
6.1 lntqOtdati6ii and, Modification. This Agreement contains all of the agreements of theParties
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.
I VMM a I I INION II to M I I I I I I I taro I I M IMq I ILI IMM -17-01 I M I MKOJEW! -WM_MJK7-IM I 14,7d I
6.3 Execution. Each individual executing this Agreement on behalf of the City and Grante,�
represents and warrants that such individual is duly authorized to execute and deliver this Agreement. This
MO #132NUMM
1CITY OF
FOdelral
CITY HALL
33325 3th Avenue South
Federal Way, WA 98003--5325
(253) 835-7000
www cityoftederalwaycram
Agreement may be executed in any number of counterparts, each of which shall be deemed an E
togetherinal and with
the same effect as if all Parties hereto had signed the same document. All such counterparts shall be construed
and shall constitute• _ instrument, but • • proof - .• 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 a
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.
Jim Ferrell, Mayor 1
ATE:
THREE ANGELS DENTAL L
Printed Name: ZrIE
Title:
ATE: .._...
.• ,
7125/2020
Washin,
gton State Depwarbnent of Revenue
Services Business Lookup THREE ANGELS DENTAL LAB
License Information:
eServices
Entity name:
JEONG, HYEON SIK
Business name:
THREE ANGELS DENTAL LAB
Entity type:
Sole Proprietor
UBI #:
602-274-414
Business ID:
001
Location ID:
0001
Location.
Active
Location address:
1635 SW 330TH PL
Registered trade names Status
FEDERAL WAY WA 98023
Mailing address:
1635 SW 330TH PL
The Business Lookup information is updated nightly. Search date and time: 7/25/2020 5:20:25 PM
FEDERAL WAY WA 98023
Excise tax and reseller
permit status: Click here
Endorsements
Endorsements held at this location License # Count Details Status Expiration date
First issuancE
Federal Way Home Occupation 03 -100831 -00 -BL Active Mar -31-2021
Mar -07-2003
Business
Governing People May Include governing people not registered with Secretary of State
Governing people Title
JEONG, EUN SILL
JEONG, HYO N SIK
Registered Trade Names
Registered trade names Status
First issued
THREE ANGELS DENTAL LAB Active
Feb -26-2003
The Business Lookup information is updated nightly. Search date and time: 7/25/2020 5:20:25 PM
https://secure.dor.wa.gov/gteunauth/,/#496 1/1