AG 20-720 - Kenneth L BrosselCITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV. ECONOMIC DEVELOPMENT
2. ORIGINATING STAFF PERSON: TIM JOHNSON — EXT: 2412 3. DATE REQ. BY. ASAP
TYPE OF DOCUMENT (CHECK ONE):
El CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RF -P, RFQ)
El PUBLIC WORKS CONTRACT El SMALL OR LIMITED PUBLIC WORKS CONTRACT
El PROFESSIONAL SERVICE AGREEMENT El 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 CONTRACT AMENDMENT(AG#):— El INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
5. PROJECT NAME: CARES ACT GRANT — ROUND 2
6. NAME OF CONTRACTOR: KENNETSSEL, DDS, PS
ADDRESS: 2335 SW 320TH ST # 2, FEDERAL WAY WA 98023-2569 T ELEPHONE: (253) 925-2171
E-MAIL: OFFICE@BROSSELSMILES.COM
SIGNATURE NAME: KENNETH BROSSEL TITLE: SEE ATTACHED
7. EXHIBITS AND ATTACHMENTS: 11 SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE El ALL
OTHER REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES 0 PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT DATE: SEE ATTACHED AGREEMENT COMPLETION DATE:
9. 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: El YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED El YES X NO IF YES, $ PAID BY: L1 CONTRACTOR El CITY
RETAINAGE: RETAINAGE AMOUNT: m El RETAINAGE AGREEMENT (SEE CONTRACT) OR El RETAINAGE BOND
PROVIDED
El PURCHASING: PLEASE CHARGE TO: — 001-1800-990-518-19-490 Project Code #267662-25060
10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
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1:1 P OJECT MANAGER
--Z R' E CT 0 R
0 RISK MANAGEMENT (IFAPPLICABLE)
El LAW
11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
E] SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
El 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
US4'6&ATORY (MAYOR OR DIRECTOR)
El CITY CLERK
El ASSIGNED AG# AG#
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61 ky,
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1/2020
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Kenneth L Brossel, DDS, a professional services corporation ("Grantee"). The City and
required is this Agreement:
I'mMan a I . I a an -3.6i to B 13 M
KENNETH BROSSEL
2335 SW 320th St # 2, Federal Way, WA 98023-2569
Mailing address: 2335 SW, 320TH ST # 2,
Federal Way, WA 98023-2569
(253) 925-2171 (telephone)
officeabrosselsmiles.com
Ade Ariwoola
5«t,. S.
Uederal Way, WA 98003-6325
(253) 835-2414 (telephone)
(253) 835-2509 (facsimile)
Ria #w& , OAikiw�W.Axmwlom
1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions
described herein.
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's business employs no more than the equivalent of ten (10) full-time employees
(20,800 man-hours to for all employees per year);
e) Grantee's net revenues do not exceed more than $1.5 million per year;
f) Grantee does not operate as a tax-exempt business as defined by the Internal Revenue
Service;
g) Due to COVID-19, Grantee business (check all that apply):
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 purposes:
a) Mortgage or Rent
b) Personal Protection Equipment
- 1 -
CITY OF CFTY HALL
33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
(253) 835-7000
kvww cityoffederalway cam
c) Insurance
d) Utilities
e) Marketing
f) Payroll
Grantee agrees to retain receipts documenting use of grant Rinds 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. GRANT AMOUNT.
4.1 Amount. In order to promote healthy economic activity in the City and in response to the losses
not to exceed Two Thousand and NO/ 100 Dollars ($2,000.00).
4.2 Non -A ri or pa e
pprgpriation of Funds. If sufficient funds are not approp ated or allocated f ym nt
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 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
loyees, agents re-
, ,iresentatives insurers &Q=a 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, 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.
5.3 Citv hdounifloation. The City agrees to release, indemnify, defend and hold the Grantee, its
VKV,
CITY OF
Fe'des` at Way
CFT-Y HALL
33325 8th Avenue $outh
Federal Way WA 98003-6325
(253) 835-7000
mvw cityoffederalway com
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.
6.1 !��Wtdafi6ft and Uo"cation. 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
represents and warrants that such individual is duly authorized to execute and deliver this Agreement. This
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 construei
CARES ACT BUSINESS GRANT AGREEMENT -3-
CrFY HALL
33325 8th Avenue South
Federal Way., WA 98003-6325
(253) 835-7000
www cityoffederalway cam
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 z
I
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.
11 1�
By:
Printed Name:
-A 13, o s,,7
Title: -6-K-
DATE: 9 —1 S- - U
Services Business Lookup KENNETH BROSSEL DDS PS
License Information-.
New search Back to results
Entity name:
KENNETH L. BROSSEL, D.D.S., P.S.
Business name:
KENNETH BRSL DDS PS
Entity type.
Professional Service Corporation
UBI #:
600-393-842
Business ID,
001
LocationID:
0002
Location:
Active
Location address:
2335 SW 320TH ST
ST E 2
FEDERAL WAY WA 98023-2569
Mailing address:
2335 SW 320TH ST
STE 2
FEDERAL WAY WA 98023-2569
Excise tax and reseller permit status: Click here
Secretary of State status-
Click here
Endorsements held at this location License # Count Details
Status
Expiration date
First issuance
Dental X-ray/CTI Pan/Ceph 4
Active
Mar -31-2021
Sep -13-2018
Federal Way General Business 07 -101725 -00 -BL
Active
Mar -31-2021
Apr -06-2007
X -Ray: Dental/Pocliatric.Neterinary
Active
Mar -31-2021
Sep -13-2018
Governing People May include governing people not registered with Secretary of State
Governing people Title
BROSSEL, KENNETH
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0 6 . -1 . a -. 1 6. - .16 1 - : I III
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