AG 20-190 - Copper Leaf Home CareCITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
I ORIGINATING DEPT./DIV: ECONOMIC DEVELOPMENT
ORIGINATING STAFF PERSON:
_X[m joHNsq EXT: _2412_ 3. DATE REQ. BY., ASAP
0 PUBLIC WORKS CONTRACT 0 SMALL OR LIMITED PLJ13LIC WORKS CONTRACT
El PROFESSIONAL SERVICE AGREEMENT Ei MAINTENANCE AGREEMENT
o GOODS AND SERVICE AGREEMENT 0 HUMAN SERVICES/ CDBG
El REAL ESTATE DOCUMENT 0 SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
Ei ORDINANCE 0 RESOLUTION
El CONTRACT AMENDMENT(AG#): El INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
PROJECT NAME: CARES ACT GRANT — ROUND I
NAME OF CONTRACTOR: COPPER LEAF HOME CARE, LLC
ADDRESS: 2919 SW 312TH PL, FEDERAL WAY, WA, 99023 TELEPHONE: (206) 351-0615
E-MAIL: COPPERLEAFAFHCIG MAIL.COM
SIGNATURE NAME: BIDES BIDES TITLE: SEEATv\cHED
EXHIBITS AND ATTACHMENTS: L1 SCOPE, WORK OR SERVICES 171 COMPENSATION 0 INSURANCE REQUIREMENTS/CERTIFICATE 13 A TM
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS
TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NO/100 ($1,000.00)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: 0 YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED El YES X NO IF YES, $--, PAID BY: 0 CONTRACTOR 0 CITY
RETAINAGE: R-ETAINAGE AMOUNT: RETAINAGE AGREEMENT (SEE CONTRACT) OR Ei RETAINAGE BOND PROVIDA
0. DOCUMENT/CONTRACT REVIEW
0 PROJECT MANAGER
6RECTOR
11 RISKMANAGEMENT (IF APPLICABLE)
El LAW
ommaw MORMONgm
INITI I /,DATE REVtEWEQQ
SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: CouNciL APPROVAL DATE -
REV
IFS,*T,M-
L1 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 —NI -G-
0 SIGNATORY (MAYOR OR DIRECTOR)
El CITY CLERK
El ASSIGNED AG#
172020
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CITY OF
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CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway coo
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
COPPER LEAF HOME CARE, LLC
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("Cityand Copper Leaf Home Care, LLC, a limited liability company ("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:
Nerio Bides
2919 SW 312TH PL
FEDERAL WAY, WA 9801
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CITY OF FEDERAL WAY:
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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).
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):
E] 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-
CITY OF CITY HALL
33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
(253) 835-7000
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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
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
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 -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.
5.1 Grantee 1hdbfhrii&atiOn. 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
perfortnance 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
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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 ternis 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.
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CITY OF CITY HALL.
33325 8th AvenUe SOUth
Federal Way Federal Way WA 98003-6325
(253) 835-7000
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5.3 City Jhde1miifiic�ifiou. 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, as 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 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 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
cepresents and warrants that such individual is duly authorized to execute and deliver this Agreement. This
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CITY HALL
33325 8th Avenue South
Federal Way„ WA 98003-6325
(253) 835-7000
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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 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 comprised of all pages of this Agreement and a complete set of all
signature i acknowledgment pages. The date uponthe last of all of _ Parties have executed <;
counterpart of this Agreement shall be the "date of mutual execution" hereof.
IN WITNESS, the Parties execute this Agreement below,date written below.
ATE:
COPPER LEAF HOME CARE, LLC:;
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Printed Name:
Title 1
ATE: "..
7/24/2020 eServices
Washington State Department of Revenue
Services Business Lookup COPPER LEAF HOME CARE, U C
Entity name:
COPPER LEAF HOME CARE, LLC
Business name:
COPPER LEAF HOME CARE, LLC
Entity type:
Limited Liability Company
UBI #:
604-539-607
Business ID:
001
Location ID:
0001
Location:
Active
Location address:
2919 SW 312TH PL
FEDERAL WAY WA 98023-7860
Mailing address:
2919 SW 312TH PL
FEDERAL WAY WA 98023-7860
Excise tax and reseller permit status: Click here
Secretary of State status:
Click here
Endorsements
Endorsements held at this location License # Count Details
Federal Way Home Occupation
Business
Governing People May Include governing people not registered with Secretary of state
Governing people Title
Status Expiration date First issuanCE
Active Nov -30-2020 Jan -30-2020
BIDES, ERIO
The Business Lookup information is updated nightly. Search date and time: 7/24/2020 4:00:37 PM
https://secure.dor.wa.gov/gteunauth/—/#271 1/1
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BUSINESS INFORMATION
Business Name:
COPPER LEAF ROME CARE, LLC
U Number:
604539607
Business Type:
WA LIMITED LIABILITY COMPANY
Business Status:
ACTIVE
Principal Office Street Address:
2919 SW 312TH PL, FEDERAL WAY, WA, 98023-7860, UNITED STATES
Principal Office Mailing Address:
2919 SW 312TH PL, FEDERAL WAY, WA, 98023-7860, UNITED STATES
Expiration Date:
11/30/2021
Jurisdiction:
UNITED STATES, WASHINGTON
Formation/ Registration Date:
11/12/2019
Period of Duration:
PERPETUAL
Inactive Date:
Nature of Business:
HEALTH CARE, SOCIAL ASSISTANCE & SERVICE ORGANIZATION
01610190:1091 UAC01 M A�k
Registered Agent Name:
NERIO BIDES
Street Address:
2919 SW 312TH PL, FEDERAL WAY, WA, 98023-7860, UNITED STATES
Mailing Address:
2919 SW 312TH PL, FEDERAL WAY, WA, 98023-7860, UNITED STATES
GOVERNORS
Title Governors Type Entity Name it Name Last Name
GOVERNOR INDIVIDUAL NERIO BIDES
https://ccfs.sos.wa.gov/#/BusinessSearch/BusinessInformation 1/1