AG 20-305 - Washington Jaw and Facial SurgeryEmi RETURN TO: TIM JOHNSON
ME
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
, ORIGINATING DEPT./DIV- EC,ONOMICDEVELOPMENT
01WGINATING STAFF PERSON: _IRA �QnSON � EXT: 2412 1 DATE REQBY.' ASAP
Ei PUBLIC WORKS CONTRACT 'Ei SMALL OR LIMITED PUBLIC WORKS CONTRACT
• PROFESSIONAL SERVICE AGREEMENT Ei MAINTENANCE AGREEMENT
• GOODS AND SERVICE AGREEMENT Cl HUMAN SERVICES/ CDBG
Ei REAL ESTATE DOCUMENT 11 SECURITY DOCUMENT (E.G BOND RELATED DOCUMENTS)
o ORDINANCE El RESOLUTION
[3 CONTRACTAMENDMENT(AG#): 0 E%ITERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
PROJECTNAME: CARESAcrGRANr—RouNDI
NAME OF CONTRACTOR: JAW AND DENTAL IMPLANT CENTER
ADDRESS: 33801 1 STAVES, #311, FEDERALWAY, WA, 98003 TELEPHONE: (425)301-9609 450#0ky
E-MAIL: 33801WA@GMAIL,COM
SIGNATURE NAME: Guo Guo TITLE: SEE ACHED
EXHD31TS AND ATTACHMENTS: 11 SCOPE, WORK OR SERVICES El COMPENSATION C1 INSURANCE REQUIREMENTS/CERTIFICATE 11 ALL
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN D REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS
COMMENCEMENT DATE: SEE ATTACHED AGREEMENT COMPLETIONDATE:
TOTAL CO (INCLUDE EXPENSES AND SALES TAX, IF ANY) Two THOUSAND AND NOII 00 ($2,00000)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: El YES XNO IF YES, MAXIMUM DOLLAR AMOUNT:$____,_
IS SALES TAX OWED El YES X NO IF YES, $ PAID Br El CONTRACTOR El CITY
RETAINAGE: RETAfNAGF AMOUNT: RETAINAGE AGREEMENT (SEE CONTRACT) OR [I RETAINAGE BOND PROVIDE
El PURCHASING: PLEASE CHARGE TO. 001-1800-990-518-10-490 Project Code# 267662-25060
0. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL/ DATE APPROVED
0P JECT MANAGER
l!]ZIROECTOR
11 RISKMANAGEMENT (IFAPPLICABLE)
11 LAW
1. COUNCIL APPROVA-L (IF APPLICABLE) SCHEDULED COMMITTEE DATE: Comm= APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
0 SENT TO VENDOR/CONTRACTOR DATE SENT: DATE
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
El CREATE ELECTRONIC REMINDER/NOTIFICATION 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.)
INITIAL/ DATE SIGNED
0 LAW DEPARTMENT NED BYLAW 0148�io
ORY (MAYOR OR DIRECTOR)
11 CITY CLERK
El ASSIGNED
MIM -5,00-14
1/2020
CITY OF
,A, F;6dem I
CITY HALL
33325 8th Avenue South
�11 T�F
UMV-7MY 71n,
WITH
WASHINGTON JAW AND FACIAL SURGERY
This Grant Agreement C'Agreemenf) is made between the City of Federal Way, a Washington municip
corporation ("Cityand Washington Jaw and Facial Surgery, a professional linuted liability comp
C'Grantee"). The City and Grantee (together 'Tarties") are located and do business at the below address
which shall be valid for any notice required under this Agreement:
Wei Guo,
33801 IST AVE S,#311
EFITIF"a 4,L_W141y,1U11,&1"__1
(425) 301-9609 (telephone)
33801wa@gmail.com
The Parties agree as follows:
to) _C1_TY OF FEDERAL WAY:
Ade Ariwoola
33 325 8th Ave. S.
Federal Way, WA 98003-6322'
(253) 835-2520 (telephone)
(253) 835-2509 (facsiraile)
ade.afiwoola@cityoffederalway.com
---------- -
1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions
Lescribed herein.
2.1 MLarranties. The Grantee warrants the following, wbich 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).
0 Grantee's net revenues do not exceed more than $1.5 mon per year
g) Grantee does not operate as a tax-exempt business as defined by the Internal Revenue
Service
h) Due to COVID-1 9, Grantee business (check all that apply):
�:roqulrIxf by state or local order to close
s hfd6d to �# o#*Oloyees due to reduced patronage
Incurred over S 1�000 'in COVID- 19 related expenses
li4crienadI:l 10.60% lost revenue
EXpetiddded over 50% lost revenue
VMITXAFTTQ�� �
0" OF CITY HALL
33325 Sth Y Avenue South
Federai Way, WA 98003-6325 (253) 836-7000
2.2
Us of funds: Granteeaffirms that grant fbnds 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 funds and will provide them to the City or its
designee upon request.
3. Tt9M1tjAJM. 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.
p
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 amount
not to exceed Two Thousand and NO/100 Dollars ($2,000.00).
4.2 Nbgt4ppophatiwn of Funds. If sufficient fimds are not appropriated or allocated for payment
under this Agrepment for any fiscal period, the City will not be obligated to make payments under this
agreement.
kJ!
5.1 GfAftteelq&19�60_ 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 liabty fbr 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
ts elected officials officers. M
0_�10��fMtWu;cTie.
volunteers to the extent and on the same terms and conditions as the Grantee pursuant to this pa0grapit. The
City's inspection or acceptance of any of Grantee's work when comoWe4 shall not be grounds to avoid any of
these covenants of indemnification.
5.2 Industrial LV_uL4go Agt_]MA�� It ii specifically and expressly understood that the Grantee
I
waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51
All, AA, i PT f
% 0
1114. for
•
4A�CITY, OF 'CITY HALL
OPM a 33325 Sth Avenue South
veaeml vl��Y Federal Way, WA 98003-6325
(253) 835-7000
wmk000do"** corn
represents and warrants that such individual is duly authorized to executeand deliver this Agreement.
Agreement may be executed in any number of counterparts, each of which shall be deemed an original and wi
the same eff�ct as if all Parties hereto had signed the same document. All such counterparts shall be constru
tog4er AM A4 constitute 666 instrum04 Wt in making proof hereof it shall •® be necessary to pr*
one such counterpart. The signature and acknowledgment •a®^ fromi such counterparts may be ass , "I
together to form a single instrument comprised of all pages of this Agreement and a complete set of
signature and acknowledgment pages. i upon which the last of t: the Parties have executed
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.
By:
Printed Name:
Title:
DATE:
Services Business Lookup JAW AND DENTAL IMPLANT CENTER
License Information:
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Entity name: WEI GUO, D.M.D., M.D., PLLC
Business name: JAW AND DENTAL IMPLANT CENTER
Entity type: Professional Limited Liability Company
UI #: 602-993-321
Business ID: 001
Location ID: 0001
Location: Active
Location address: 33801 1 ST WAY S STE 311
FEDERAL WAY WA 98003-4548
Mailing address: 33801 1 ST WAY S STE 311
FEDERAL WAY WA 98003-4548
Excise tax and reseller permit status: Click here
Secretary of State status: Click here
Endorsements
Endorsements held at this location License # Count Details
Status
Expiration date
First issuance
Dental X-ray/CT/ Pan/Ceph 1
Active
Feb -28-2021
Nov -15-2017
Federal Way General Business 10 -104151 -00 -BL
Active
Feb -28-2021
Oct -01-2010
X -Ray: Dental/Podiatric/Veterinary
Active
Feb -28-2021
Nov -15-2017
Governing People may include governing people not registered with Secretary of State
Governing people Title
GUO, WEI
Registered Trade Names
Registered trade names Status First issued
JAW AND DENTAL IMPLANT CENTER Active Feb -22-2012
WASHINGTON JAW AND FACIAL SURGERY Active Feb -22-2012
WOODINVILLE ORAL & MAXILLOFICIAL SURGERY Active May -08-2018
View Additional Locations
The Business Lookup information is updated nightly. Search date and time: 7/25/2020 1:48:32 PM
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