AG 20-303 - Jac EnterprisesRETURN TO: TIM JOHNSON EXT: 2412
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: —ECONOMIC DEVELOPMENT
ORIGINATING STAFF PERSON: TIM JOHNSON EXT: 2412 3. DATE REQ, BY,, AskP
TYPE OF DOCUMENT (CHECK ONE):
Ei CONTRACTOR SELECTION DOCUMENT (E.Ci, RFB, RFP, RFQ)
0 PUBLIC WORKS CONTRACT o SMALL OR LIMITED PUBLIC WORKS CONTRACT
Ei PROFESSIONAL SERVICE AGREEMENT Ei MAINTENANCE AGREEMENT
• GOODS AND SERVICE AGREEMENT o HUMAN SERVICES/ CDG
• REAL ESTATE DOCUMENT o SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
Ei ORDINANCE o RESOLUTION
El CONTRACT AMENDMENT (AG):_ DINTERLOCAL
X OTHER CANT SACT FU', SBUSTNESSStJPPORTOi'RANT AOR14ENII; ,',rl'
PROJECT NAME: CARES ACT GRANT —ROUND t
NAME OF CONTRACTOR: JAC ENTERPRISES
ADDRESS: 4630SW329THWAY, FEDERAJ-WAY, WA,98023 TELEPHONE: (206) 372-4866
E-MAIL: GIXS(RJEFF@GMAIL.COM
SIGNATURE NAME: JE"Dgy QA"FORD TITLE: SEEA'jTACHED
EXHIBITS AND ATrACHMENTS: El SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE 13 ALL
OTHER REFERENCED EXHfB ITS U PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES C1 PRIOR CONTRACT/AMENDMENTS
I TERM: COMMENCEMENT DATE: SEE ATTACHED AAktEMkNT COMPLETION DATE -
TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NO1100 ($1,000.00)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: 0 YES XNO IF YES, MAXIMUM DOLLAR AMOUNT:
IS SALES TAX OWED 0 YES X NO IF YES, $ PAID BY: El CONTRACTOR 0 CITY
RETAINAGE: RETAfNAGEAmoUNT: ..—DRETAfNAGEAGRFEMFNT (SEE CONTRACT) OR oRETAINAGE BOND PROVID]
1:1 PURCHASING: PLEASE CHARGETO: 001-1800-990-518-10-490 'Project Code #267662-25060
0. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL/ DATE APPROVED
0 PROJECT MANAGER
004IRECTOR
0 RISKMANAGEMENT (IFAPPLICABLE)
El LAW
1. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
L1 SENT TO VENDOR/CONTRACTOR DATESENT: DATE tEC'D:
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
El CREATE ELECTRONIC REMINDER/NCITIFICATION FOR 1 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.)
11*41TIAL /DATE SIGNED
0 LAW EPARTMtNT
jio�! M� (MAYOR OR DIRECTOR) tt
L1 CITY CLERK
0 ASSIGNED AG#
1 /2020
CITY HALL
33325 Sth Avenue SmM
etW FqderN Woy, WA 98003-6325
io (253 83-5--foop
wwnv4o���Vm
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WVFH
JAC ENTERPRIS" NW LLC
This Grant Agreement C'Agrccmcnt` ') is rnade betw= dw City of Fcdvral Way. a Washington municipal
corporation (City"), 3nd JAC Enterprises NW LLC, a limited liability company ('Vffantee"). The City and
Grantee (together -Parti&') are located and do business at the below addresses which "I be valid for any
noAice requirod unda this Ag(e"c:
JAC ENTERPIUSES NW LLC:
Jeffrey Cmwfbrd
4630 SW 329TH WAY
rEDERAL WAY, WA 98023
Ade Ariwoola
3 3 325 M
(253) 835-2520 (telepiwne)
(253) 835-2509 (facsimile)
1. TERM I . This agrement conionplates a one-6me grantof fintds to tbu Grantee undw tl�e comitiom
described herein.
14141MIX)TV1 11TWIR 0
2. 1 . The Gmtee warranu the following, which am pre -requisites for grant eligibility.
9.) Grantee operates a businew physically Imted within thcpolitical boundaries of the City
of Federal Way;
b) Omwee maintairn a c=vnt City of Fed" Way business license
Omntue Jw paid all taxes and goventment fees due up to the date of execution of this
grant asrwrnerA
d) Grantee is not the redpient of othcT state or federal fUnding made aysUable as a mponse
to r 9 pandemic
e) Grantee's business employem no mom than the equivalent of ten 0 0) fidl-time
employea (20,800 mOR-hours total for all employees per year).
Gramm's net reymues do not exceud `I1wre than S 15 mi Ilion per you
g) Cirmtee does not operate as a tax-exempt business as defined by the Internal Revenue
Service
b) Due to pty),
6 Was requifed� by stato or " order to dw
E] Was fbrved to lay off employees due to reduced patronage
C] Incurred over$ 1, 000 in COVID- 19 Mated expenses
Experienced I 0-500/a lost mvimue
Experietwed over 50% lost revenue
Akk C31TY OF
4ML
�� 1�40*eral Vft
2.2 Use ofd . Grantee affinns that grant funds will be used forthe following purposes:
mo�gasc or Punt
b) Personal Protection Equipmeat
0 Lnsurarice
d) Utilities
C) Maketing
F) Payroll
Cirantee agrees to rotain receipts documenting use of grant MM's and will provide them to the City or its
dcsignm upon request,
3. URMINATI Should any of the conditiorts described in section 2.1, above, not be met, ffie City
may rcoDver all disbursed grant ftmda and terminate this agreer".
In order In pfdhi6te healthy aeonomic. A&M;Y in the city " in rcspo,!*
AMwiw;'Wa 10, �iii4"W" �
■ LEJ I I�ff 4 1 ( 110 "1 11'- - - I " - — - V - I C I - P� 0) 11 " 11m
4.2 NdaAwmpn'ationof Funds. If sufficient funds we not appropriated or allocated for payment
under this Agreement for any fiscal period, the City will not be obligated (o make papnents under this
agreement.
.................
ik
volunteers to the extent andon the same Wrrns and conditions as the Grant= pursuant to this poograph. Th
5,2 jW&gWjdJns;=a-cc 69 Waj,=. It is specifically and expressly understood that the Grantsc
waives any immunity thAt may be granted to it undeT the Washington State industrial inmmmce act, Tifle 51
by any limitation 1n the attwunt of damages, empewation or benefits payable to 1r by any r party under
MY Of
vai� F6delral Oy
41 1 io 0 � �Ii
6.3 Ex=fion Each individual executing this Agreement on behalf Df the City and Gmtee
n. ,+ warrants that such individual is duty authorized to execute and dclivcr US Agrwwunt11is
`UD-W-"A)jWj:3.! A, j VVA
one sucb counterpart. The signature and acknowledgment pages from such countcqxuU may be assanbled
togethcr to forin a single insWmant comprised of all peges of this Agroement and a complete set of all
signattire and ackmowledyment pagm Thc date upon which the Last of all of the Panics have executed a
vountcparl of this Agreement shall be the `date of mutual execution" hereof.
IN WrrNESS, the Parties execute this Agreement below, effi�cfivc the last date written Mow.
JAC ENTERPIUSES NV LLC:
BY,
Printed Name- -Te,4YR--i A C-4AW4'rok
Title.
CARES ACT BUSINESS GRANT AGREEMENT -4-
Services Business Lookup JAC ENTERPRISES
License Information:
Entity name: JAC ENTERPRISES NW LLC
Business name: JAC ENTERPRISES
Entity type: Limited Liability Company
UBI #: 604-309-416
Business ID: 001
Location ID: 0002
Location: Active
Location address: 4630 SW 329TH WAY
FEDERAL WAY WA 98023-3214
Mailing address: 4630 SW 329TH WAY
FEDERAL WAY WA 98023-3214
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
CRAWFORD, JEFF
Registered Trade Names
New search Back to results
Status Expiration date
Active May -31-2021
Registered trade names Status
JAC ENTERPRISES Active
View Additional Locations
The Business Lookup information is updated nightly. Search date and time: 7125/20201:47:33 PM
MEB=
First issuance
May -20-2020
First issued
ay -11-2020
https://secure.dor.wa.gov/gteunauth/,/#320 111
Ls� .-
1-31MIUMNI
Business Name:
JAC ENTERPRISES NW LLC
UBI Number:
604309416
Business Type:
WA LIMITED LIABILITY COMPANY
Business Status:
ACTIVE
Principal Office Street Address:
3261 SW AVALON WAY, APT 213, SEATTLE, WA, 98126-2883, UNITED STATES
Principal Office Mailing Address:
Expiration Date:
07/31/2021
Jurisdiction:
UNITED STATES, WASHINGTON
Formation/ Registration Date:
07/13/2018
Period of Duration:
PERPETUAL
Inactive Date:
Nature of Business:
OTHER SERVICES
Registered Agent Name:
OLDHAM & FRANCIS PS, INC.
Street Address:
33400 9TH AVE S, SUITE 118, FEDERAL WAY, WA, 98003-2607, UNITED STATES
Mailing Address:
Title Governors Type
GOVERNOR INDIVIDUAL
https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation
Entity Name First Name
"M