AG 20-605 - Andrea Becker DDS PSmwtrlqlq,,�,�
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
*RIGINATING DEPT./DIV: ECONOMIC DEVELOPMENT
. ORIGINATING STAFF PERSON: TIM JOHNSON EXT: 2412 3. DATE REQ. BY— AS AP
TYPE OF DOCUMENT (CHECK ONE):
El CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
0 PUBLIC WORKS CONTRACT 11 SMALL OR LIMITED PUBLIC WORKS CONTRACT
El PROFESSIONAL SERVICE AGREEMENT El MAINTENANCE AGREEMENT
El GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CDBG
E] REAL ESTATE DOCUMENT Ei SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE F-1 RESOLUTION
El CONTRACTA NT (AG#):_ El INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT NGREEMENT
.
PROJECT NAME:—' CARES ACT GRANT—ROUND 2
NAME OF CONTRACTOR: ANDREA BECKER DDS PS
ADDRESS: 118SW330THST#205,FEDERALWAY
E-MAIL: ABECKFRDDS@LIVE.COM
SIGNATURE NAME: ANDREA BECKER
WA 98023-6185 T ELEPHONE: (253) 517-3477
TITLE: SEE ATTACHED
EXHIBITS AND ATTACHMENTS: Ll SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE El A
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS I
COMMENCEMENT D. SEEATTACHEDAGREEMENT COMPLETION DATE -
TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NO/100 ($1000.00)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: 1:1 YES X NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED El YES X NO IF YES, $ — PAID BY: 0 CONTRACTOR 0 CITY
RETAINAGE: RETAINAGE AMOUNT: 1:1 RETAINAGE AGREEMENT (SEE CONTRACT) OR [I RETAINAGE BOND
ROVIDED
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
0
PROJECT MANAGER
DZIRECTOR
0 RISKMANAGEMENT (IFAPPLICABLE)
El LAW
1. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
2. CONTRACT SIGNATURE ROUTING
11 SENT TO VENDOR/CONTRACTOR DATE SENT: DATE C'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
D LAW DEPARTMENT A
&RG<ATORY (MAYOR OR DIRECTOR)
El CITY CLERK
0 ASSIGNED AG# AG
:OMMENTS: 'Ile
1/2020
CITY OF CrTY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
Federal Way (253) 835-7000
urww cityoffederalway com
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
ANDREA BECKER DDS PS
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Andrea Becker DDS PS, a Washington corporation ("Grantee"). The City and Grantee
(together "Parties") are located and do business at the below addresses which shall be valid for any notice
ANDREA BECKER
118 SW 330th St # 205
FEDERAL WAY, WA 98023-6185
CITY OF FEDERAL WAY:
asymalm
Federal Way, WA 98003-6325
(253) 835-2414(telephone)
(253) 835-2509 (facsimile)
1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions
described herein.
X" tAll-le"
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 F-•-
•. •
depaid 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 total 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-1 , Grantee business (check all that apply):
XWas required by state or local order to close
E] Was forced to lay off employees due to reduced patronage
Incurred over $1,000 in COVID-19 related expenses
El Experienced 10-50% lost revenue
9 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
CARES ACT BUSINESS GRANT AGREEMENT - I -
CITY OF
Fedeml VWty
c) Insurance
d) Utilities
e) MarketinV
f) Payroll
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
wwwatyoffedei-alwaycom
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
rnay 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
V
4,krvtn_�cmount
not to exceed One Thousand and NO/100 Dollars ($1,000.00).
4.2 Non -A unds are not appropriated or allocated for payment
pprgpriation of Funds. If sufficient f
under this Agreement for any fiscal period, the City will not be obligated to make payments under this
agreement.
5.1 Grantee hidenwifidation. 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 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 a&s or any other benefits acts or programs. The Parties further
acknowledge that they have mutually negotiated this waiver.
5.3 CM ItiddippAcation. The City agrees to release, indemnify, defend and hold the Grantee, its
C17Y HALL
33325 9th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
msw cityoffederalway corn
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,
-2
agents, licensees, or representatives, arising from, resulting from or connected with this Agreement to the exten!
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.
1 0 1 11 1
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6.1 hiteWrdtation and Modificatin. 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.
I ir! 111 It -g -M 1 11 m us I I (A U.) I I I I to a [W. I I uJ I a I I I tom 6"r.1% I to) I ywu E 18 1 116
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 construed
CARES ACT BUSINESS GRANT AGREEMENT -3-
CITY HALL
33325 Sth Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
w cityoffederalway coo
together i shall constituteone instrument, but . • proof . _i.'. it shallonly 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 execution" hereof.
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
ANDREA ECKER DDS PS:
By: �.
Printed e:
Title.
ATE: ry «�
W Ps
License Information:
Expiration date
Entity name:
ANDREA BECKER DDS PS
Business name:
ANDREA BECKER DDS PS
Entity type:
Professional Service Corporation
UI #:
604-127-738
Business ID:
001
Location ID:
0002
Location:
Active
Location address:
118 SW 330TH ST
STE 205
FEDERAL WAY WA 98023-6185
Mailing address:
118 SW 330TH ST
STE 205
FEDERAL WAY WA 98023-6185
Excise tax and reseller permit status: Click here
Secretary of State status:
Click here
Endorsements
Endorsements held at this location License # Count
Dental X-ray/CT/ Pan/Ceph
Federal Way General Business 00 -101345 -00 -BL
X -Ray: Dental/Podiatric[Veterinary
Governing People May include governing people not registered with Secretary of State
Governing people Title
BECKER,ANDREA
Registered Trade Names
Registered trade names
0,
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Status
Expiration date
First issuanCE
Active
May -31-2021
Sep -29-2017
Active
I
May -31-2021
Jan -14-2000
Active
May -31-2021
Sep -29-2017
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Working together to fund Washington's future
First issued
Sep -21-2017