AG 20-565 - Pattilife InsuranceWONM,
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
. ORIGINATING DEPT./DIV: --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., RIB, REP, RFQ)
• PUBLIC WORKS CONTRACT 0 SMALL OR LIMITED PUBLIC WORKS CONTRACT
• PROFESSIONAL SERVICE AGREEMENT El MAINTENANCE AGREEMENT
El GOODS AND SERVICE AGREEMENT Ei HUMAN SERVICES/ CG
El REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE El RESOLUTION
Ej CONTRACT AMENDMENT (AG#): El INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SQPPOPT GRANT AGREEMENT
. PROJECT NAME: CARES ACT GRANT —ROUND I
NAME OF CONTRACTOR: PATTILIFE INSURANCE PLLC
ADDRESS: 3753027""PLS,FEDEPALWAY, WA98003 TELEPHONE: (206) 234-1912
E-MAIL: KimpATrl@GMAIL.COM
SIGNATURE NAME: PATTI Kim TITLE: SEE -ATTACHED
EXHIBITS AND ATTACHMENTS: 0 SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE El ALL
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES 0 PRIOR CONTRACT/AMENDMENTS
TERM: COMMENCEMENT DATE: SEEM-TACHEDAGREEMEw COMPLETIONDATE:
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 DYES X NO IF YES, $
RETAINAGE: RETAINAGE AMOUNT: El RETAINAGE AGREEMENT (SEE CONTRACT) OR E:i RETAINAGE BOND PROVIDE
0 PURCHASING: PLEASE CHARGE TO: Project Code #267662-25060
0 PROJECT MANAGER
DIRECTOR
RISK MANAGEMENT (IF APPLICABLE)
El LAW
INITIAL / DATE APPROVED
n
SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
11XV414114940
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
[I 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
LA PARTMENT OT RE IEMIED
G
11 1 -11 1 1-
3 —tl/- -
0 NATORy (MAYOR OR DIRECTOR)
• CITY CLERK
• ASSIGNED AG # AG
1141allyug1aw
CITY OF CITY HALL
33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
A%44�1
40 (253) 835-7000
www.cilyoffedei'ability.com
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
PATTILIFE INSURANCE PLLC
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Pattilife Insurance PLLC, a professional limited liability compamy ("Grantee"). The
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any notice required under this Agreement:
I- Z!, NJ IRK! I 1: 140
Patti Kim
30540 Pacific Hwy S, #13, Federal Way, WA
Mailing address:
17534 27th PI S, Federal Way, WA 98003
i
I% V V&SI a 91 all 11i of
Ade Ariwoola
33325 8th Ave. S.
Federal Way, WA 98003-6325
(253) 835-2520 (telephone)
(253) 835-2509 (facsimile)
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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).
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
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
&FedeCITY Of CITY HALL
33325 Sth Avenue South
ral Way, WA 98003-6325
Fbderal MMY (253) 835-7000
www cilyoffederatway. com
a) Mortgage or Rent
b) Personal Protection Equipment
c) Insurance
d) Utilities
c) Marketing
F) Payroll
Grantee agrees to retain receipts documenting use of grant funds and will provide them to the City or its
iesignee upon request.
3. TERMINATION. Should any of the conditions described in section 2.1, above, not be met, the Ci
may recover all disbursed grant funds and terminate this agreement. I
gim gna [gI
4.1 Amount. In order to promote healthy economic activity in the City and in response to the loss
Grantee has incurred due to the COVID- 19 pandemic, the City shall provide a grant to the Grantee in an amo
not to exceed One Thousand and NO/ 100 Dollars ($ 1,000.00). 1
4.2 N��ARptqpriation 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 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 coniiiietent �urisdiction determine that this Ayvmu t- . th L-
e
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 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 solelp fo -MU#,oses of this indemnification. Grantee's indemnification shall not be limi' J i . waVT
by any limitation on the amount of damages, compensation or benefits payable to or by any third party uni-
i ,`
eorkerscompensation acts, disability benefit acts or any other benefits acts or programs. The Parties further
acknowledge that they have mutually negotiated this waiver.
�__ �4 i�_ �, Tv�
CITY Of CITY HALL
33325 Sth Avenue South
wfi�Weral A" Federal Way, WA 98003-6325
(253) 8,35-70,00
wwwi�"6�4��CO/77
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 a
counterpart of this Agreement shall be the "date of mutual executiolf 'hereof.
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
MaNKE229§93MEM
IM
DATE:
PATTILIFE IN ,DACE PLLC.;
By:
PrintedName: A
Title:
DATE:
AM,
01; 1 �� M914812 irk
8/18/2020 eServices
s , StatUE.,
ul
Servi-es Btisiness 'Llookuip PATTI �IJFE' �NSURANC'E PLLC
License Information:
Entity name:
PATTILIFE INSURANCE PLLC
Business name:
PATTILIFE INSURANCE PLLC
Entity type:
Professional Limited Liability Company
UBI #:
604-227-315
Business ID:
001
Location ID:
0002
Location:
Active
Location address:
30640 PACIFIC HWY S
STE B
FEDERAL WAY WA 98003-4889
Mailing address:
37530 27TH PL S
FEDERAL WAY WA 98003-7516
Excise taxa reseller permit status: Click here
Secretary of State status:
Click here
Endorsements
Endorsements held at this location License # Count Details
Federal Way General Business
Governing People May include governing people not registered with Secretary ot'State
Governing people Title
KIM, PATTI
Registered Trade Names
Registered trade names Status
PATTI KIM INSURANCE Active
New search Back to results
Status Expiration date
Active Jul -31-2021
View Additional Locations
The Business Lookup information is updated nightly. Search date and time: 8/18/2020 1:46:26 PM
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https://secure.dor.wa.gov/gteunauth/—/#75 1(1