AG 20-197 - D&B Adult Family Home. ........... .. .....
RETURN TO: TIM JOHNSON EXT: 2412
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: ECONOMIC DEVELOPMENT
. ORIGINATING STAFF PERSON: _ju\4 joHNsoN_ EXT: 2412 3. DATE REQ. BY. ASAP
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
0 PROFESSIONAL SERVICE AGREEMENT Ei MAINTENANCE AGREEMENT
El GOODS AND SERVICE AGREEMENT El HUMAN SERVICES / CDG
El REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE El RESOLUTION
El CONTRACT AMENDMENT ;wm0 INTERLOCAL
X OTHER CARF' A(,"['FL�NT)Sfi(JStNl--S-SS[IPPOWI'(iR,�,N,rAGREEMEN'F
_CARES AC[ FL_._
I
PROJECT NAME:1-- CARES ACT GRANT— ROUND I
NAME OF CONTRACTOR: D&B ADULT FAMILY HOME
ADDRESS: 34229 34TH AVE SW, FEDERAL WAY, WA, 98023 TELEPHONE: (808) 639-4277
E-MAIL: BAMBADOLINO@GMAIL.COM
SIGNATURE NAME: APUI-HN APUHIN TITLE: SEEATTACHED
EXHIBITS AND ATTACHMENTS: 1:1 SCOPE, WORK OR SERVICES El COMPENSATION E] INSURANCE REQUIREMENTS/CERTIFICATE 0 Ali
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS 0
TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NO/I 00 ($ 1,000.00)
(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 E]YES X NO IF YES, PAID BY: 0 CONTRACTORD CITY
RETAINAGE: RETAINAGE AMOUNT: ___ ___—El RETAINAGE AGREEMENT (SEE CONTRACT) OR El RETAINAGE BOND PROVII
0 PURCHASING: PLEASE CHARGE TO.em:
001-1800-990-518-10-490 Proiect Code# 267662-25060
0. DOCUMENT/CONTRACT REVIEW
INITIAL / DATE REVIEWED
INITIAL / DATE APPROVED
0 PROJECT MANAGER
El DIRECTOR
El RISKMANAGEMENT (IF APPLICABLE)
El LAW
1. COUNCIL APPROVAL (IF APPLICABLE)
SCHEDULED COMMITTEE DATE:.--
COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE:
COUNCIL APPROVAL DATE:
2. CONTRACT SIGNATURE ROUTING
El SENT TO VENDOR/CONTRACTOR
DATE SENT:
DATE C'D:
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
* 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
* LAW DEPARTMENT SIGNED By LAW 07-28-20
SIGNATORY (MAYOR OR DIRECTOR)
CITY CLE RK
ASSIGNED AG# Oc,
1/2020
4 PO OF
P6deral VVOY
CITY HALL
33325 Sth Avenue South
Federal Way. VVA 98003-6325
(253) 835-7000
www_ cityON"der a4vay C0171
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
D&B ADULT FAMILY HOME
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and D&B Adult Family Home, 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:
Barbara Apuhin
34229 34TH AVE SW
FEDERAL WAY, WA 98023
NOW -51,00 =__
1 fro 1111 fro I a Lou 1,11 jkgo,0414 I rg I I rmyj I I=
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 pandemic
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) Due to COVID- 19, Grantee business (check all that apply):
Was required by state or local order to close
E] 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
CITY OF CITY HALL
33325 8th Avenue South
Fe d e ra I Wa y Federal Way, VVA 98003-6325
(253) 635-7000
www cjtyoffederahvqv corns
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 the 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
mYy 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 amoun)
not to exceed One Thousand and NO/100 Dollars ($1,000.00).
4.2 Non-A-p-promiation 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
Ygreement.
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5.1 Grantee Wernnification. 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 condons 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 covena-tts 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.
tITY OP
FLmderal MW
CITY HALL
33325 8th Avenue South
Federal Way. WA 98003-6325
(253) 835-7000
wvvw cityoffederahvqy cern
5.3 Cify Wembificafion. 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, drors, 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 IfiteroretAtion md 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 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
0TV OF
A:%
F6deml
Y"Y
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 335-7000
www cityoffederalway. corn
Agreement may be executed in any number of counterparts, each of which shall be deemed an original and with
the -effect as if all Partiesi had signed the same document. ` All i _ r. be construed
together i shall constituteone but • proof hereof
only be necessary to produce
Agreementone 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 and . 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 executethisAgreement below,effective the last date written below.
Jim Ferrell, Mayor
ATE: qla
By:
Printed Name:--b-0-1&V—A--
Title: '9011110V 100JAV/ "46
ATE: 00 0 1 oelo to
7/24/2020
WasAiing L
,ton State Departnient of RevetlLje,
17ervices Business Lookup D&B ADULT FAKLY HOME
S
eServices
License Information:
Entity name:
APUHIN, BARBARA DOLINO
Business name:
D&B ADULT FAMILY HOME
Entity type:
Sole Proprietor
UBI #:
603-067-753
Business ID:
001
Location ID:
0001
Location:
Active
Location address:
34229 34TH AVE SW
FEDERAL WAY WA 98023-7641
Mailing address:
34229 34TH AVE SW
FEDERAL WAY WA 98023-7641
Excise tax and reseller
permit status: Click here
Endorsements
Endorsements held at this location License # Count Details Status
Federal Way General Business 11 -100107 -00 -BL Active
Governing PeOP18 May include governing people not registered with Secretary of State
Governing people Title
APUHIN, BARBARA DOLINO
APUHIN, DANTE TURA
New search Back to results
Expiration date First issuance
Dec -31-2020 Jan -14-2011
Registered Trade Names
Registered trade names Status First issued
D&B ADULT FAMILY HOME Active Dec -07-2010
The Business Lookup information is updated nightly. Search date and time: 7/24/2020 4:03:37 PM
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