AG 20-553 - Mo Mahoutchi DMDRETURN TO: TIM JOHNSON EXT: 2412
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPTADIV: ECONOMIC DEVELOPMENT
ORIGINATING STAFF PERSON: TIM 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 0 SMALL OR LIMITED PUBLIC WORKS CONTRACT
El PROFESSIONAL SERVICE AGREEMENT 0 MAINTENANCE AGREEMENT
El GOODS AND SERVICE AGREEMENT El HUMAN SERVICES / CDBG
El REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE El RESOLUTION
El CONTRACTA NT (AG#).-- El INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
PROJECT NAME: —CARES ACT GRANT - ROUND I
NAME OF CONTRACTOR: Mo MAHOUTCHI DMD PLLC
ADDRESS: 2345 SW 320TH STT, FEDERAL WAY, WA, 98023 TELEPHONE: (206) 778-0399
E-MAIL: mm34@uw.EDU
SIGNATURE NAME: MAHOUTCHI MAHOUTCHI TITLE: SEE ATTACHED
TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) Two THOUSAND AND N01100 ($2,000.00)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: 11 YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED El YES X NO IF YES, $ PAID BY: El CONTRACTOR El CITY
RETAINAGE: RETAINAGE AmoUNT: �LLRETAINAGE AGREEMENT (SEE CONTRACT) OR El RETAINAGE BOND
ROVIDED
a PURCHASING: PLEASE CHARGETO: _001-1800-990-518-1�499 PM*t Code #20662-25060
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INITIAL / DATE APPROVED
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SCHEDULED COMMITTEE DATE: COMNUTTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
El SENT TO VENDOR/CONTRACTOR DATE SENT: DATE RECD:
0 ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
El CREATE ELECTRONIC REMINDER/NOTIFICATICIN 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.)
INITIALl DATE SIGNED
0 LA , EPARTMENT
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(MAYOR OR DIRECTOR) 4.0
El CITY CLERK
0 ASSIGNED AG# A
'OMMENTS:
"SIftCITY OF
F6deral � y
CARES ACT FUNDS BUSINESS SUPPORT
WITH
MO MAHOUTCHI DMD PLLC
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway cern
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and MO MAHOUTCHI DMD PLLC, a professional 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:
Dr. Mo Mahoutchi Ade Ariwoola
2345 SW 320' St, Federal Way, WA 98023 33325 8th Ave. S.
Mailing address: Federal Way, WA 98003-6325
12515 NE 132n' CT, #A208, Kirkland, WA 98034
(253) 835-2520 (telephone)
(206) 778-0399 (telephone) (253) 835-2509 (facsimile)
nun34@uw.edu ade.ariwoola@cityoffederalway.com
123
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 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) DuetoC0 ID -19, Grantee business (check all that apply):
Wy 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 purposel
CITY OF CITY HALL
33325 Sth Avenue South
,4! Federal Way, WA 98003-6325
Federal Way (253) 835-7000
www cityoffederalutay 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 Two Thousand and NO/ 100 Dollars ($2,000.00).
4.2 Non -Appropriation of Funds. If sufficient funds are not appropriated or allocated for paymeni
under this Agreement for any fiscal period,- the City will not be obligated to make payments under this
agreement.
5.1 Grantee Indemnification. 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
these coven
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.
cily OF
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CITY HALL
33325 Sth Avenue South
Federal Way. WA 98003-6325
(253) 835-7000
wAYwcjtyoffederahvqycom
5.3 C_�__. 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.
U150,141M
6.1 IntWretation 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.
6.2 Enforcement. Any notices required to be given by the Parties shall be delivered at the addresses
set forth at the beginning of this Agreement. Any notices may be delivered personally to the addressee of the
notice or may be deposited in the United States mail, postage prepaid, to the address set forth above. Any notice
so posted in the United States mail shall be deemed received three (3) days after the date of mailing. Any
remedies provided for under the terms of this Agreement are not intended to be exclusive, but shall be
cumulative with all other remedies available to the City at law, in equity or by statute. The failure of the City to
insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to
exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver
"41 �Jtjfffjflft�* J ifiJilijiS, J -_ egigig jjtJj , i jami shall be and remain in full force and
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such breach or default. Failure of the City to declare one breach or default does not act as a waiver of the City5s
right to declare another breach or default. This Agreement shall be made in, governed by, and interpreted in
accordance with the laws of the State of Washington. If the Parties are unable to settle any dispute, difference or
claim arising from this Agreement, the exclusive means of resolving that dispute, difference, or claim, shall be
by filing suit under the venue, rules and jurisdiction of the King County Superior Court, King County,
Washington, unless the parties agree in writing to an alternative process. If the King County Superior Court
does not have jurisdiction over such a suit, then suit may be filed in any other appropriate court in King County,
Washington. Each party consents to the personal jurisdiction of the state and federal courts in King County,
Washington and waives any objection that such courts are an inconvenient forum. If either Party brings any
claim or lawsuit arising from this Agreement, each Party shall pay all its legal costs and attorney's fees and
expenses incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other
a3h shall be construed to
limit the Parties' rights to indemnification under Section 5 of this Agreement.
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
roderat
.
CITY OF
CITY HALL
33325 8th Avenue South
Federal Way, WA 98503-5325
(253) 335-7003
wmv. cityoffederalwayC017r)
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 and acknowledgment pages. The date upon which the last of all of the Parties have executed R
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.
DATE: D
i. ! P� , 1 1
Services Business Lookup FEDERAL WAY FAMILY DENTAL CARE
License Information:
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Entity name: MO MAHOUTCHI DMD PLLC
Business name: FEDERAL WAY FAMILY DENTAL CARE
Entity type: Professional Limited Liability Company
UI #: 604-155-905
Business ID: 001
Location ID: 0001
Location: Active
Location address: 2345 SW 320TH ST
FEDERAL WAY WA 98023-2568
Mailing address: 12515 NE 132ND CT
APT A208
KIRKLAND WA 98034-3117
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 3
Active
Dec -31-2020
Dec -10-2019
Federal Way General Business 18 -100174 -00 -BL
Active
Aug -31-2020
Jan -26-2018
X -Ray: Dental/Podiatric/Veterinary
Active
Dec -31-2020
Dec -10-2019
Governing People May include governing people not registered with Secretary of State
Governing people Title
MAHOUTCHI, MO
Registered Trade Names
Registered trade names Status
First issued
FEDERAL WAY FAMILY DENTAL CARE Active
Oct -16-2017
The Business Lookup information is updated nightly. Search date and time: 7/26/2020 1:50:34 PM
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