AG 20-654 - Douglas Sheetsa W-11110111
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV. ECONOMIC DEVELOPMEN.T,
ORIGINATING STAFF PERSON: TIM JOH.N.SON m�mmyEXT: 2412 3. DATE REQ.BY: ASAP
TYPE OF DOCUMENT (CHECK ONE):
El CONTRACTOR SELECTION DOC NT (E.G., RIB, RFR RFQ)
El PUBLIC WORKS CONTRACT 0 SMALL OR Ll3\4ITED PUBLIC WORKS CONTRACT
El PROFESSIONAL SERVICE AGREEMENT El MAINTENANCE AGREEMENT
0 GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CDBG
El REAL ESTATE DOCUMENT 0 SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
1-1 ORDINANCE El RESOLUTION
0 CONTRACTA NT (AG): El INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
. PROJECT NAME: CARES ACT GRANT -ROUND 2
NAME OF CONTRACTOR: DOUGLAS M SHEETS, P.S.
ADDRESS: 3032116TH AVE S, FEDERAL WAY WA 98003-4124 T ELEPHONE: (253) 376-3694
E-MAIL: DOUGDDSSHEETS@HOTMAIL.COM
SIGNATURE NAME: DOUGLAS SHEETS TITLE: SEE ATTACHED
EXHIBITS AND ATTACHMENTS: 0 SCOPE, WORK OR SERVICES El COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE El ALL
OTHER REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS
TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND NO/100 ($2,000.00)
(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 BY: El CONTRACTOR 0 CITY
RETAINAGE: RETAINAGE AMOUNT:
ROVIDED
El PURCHASING: PLEASE CHARGE TO: 001-1800-990-518-10-490 Rrqjg2.gt Code #267662-25060
0, DOCUMENTICONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL..../DATE APPROVED
ED PROJECT NLkNAGER
.2
Lq`DI RECTOR
L'
El RISK MANAGEMENT (IFAPPLICABLE)
El LAW
1. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
ral N # 2-411Y96- "10
D ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
El CREATE ELECTRONIC REMINDERJNOTIFICATION 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.)
rNITIAL DATE SIGNED
11 LAW DEPARTMENT
GiOgTGTATO RY (MAYOR OR DIRECTOR) u V
1:1 CITY CLERK
11 ASSIGNED AG# AG#
;OE S:
CITY Of
.A., Fodera Way
CAl-CKS
WITH
DOUGLAS M SHEETS, P.S.
CITY HALL
33325 6th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoftederalway com
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Douglas M Sheets, P.S., 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 required
under this Agreement:
DOUGLAS M SHEETS, P.S.: CITY OF FEDERAL WAY:
DOUGLAS SHEETS - Ade Ariwoola
30321 16th Ave S, Federal Way, WA 98003 33325 8th Ave. S.
Mailing address: 30321 16th Ave S, Federal Way, WA 98003-6325
Federal Way, WA 98003 (253) 835-2414 (telephone)
(253) 376-3694 (telephone) (253) 835-2509 (facsimile)
dou :ddssheets@,hotmail.com I ade.ariwoola@cit.yoffederalwky.com
1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions
described herein.
9 Lei Aj, 1
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 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-19, Grantee business (check all that apply):
'?T 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
E] 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
TOURISM GRANT AGREEMENT - I - 312017
c) Insurance
d) Utilities
e) Marketing
f) Payroll
CITY HALL
33325 5th Aveme South
Federal Way. WA 98003-6325
(253) 835-7000
www, cityoffederalway com
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 Cill
may recover all disbursed grant funds and terminate this agreement.
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I
riot to exceed Two Thousand and NO/100 Dollars ($2,000.00).
4.2 Non-Aimropriation 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.
i I I
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 covenants of indemnification.
5.2 Industrial hisuraftee Ad 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
wa-W bo anw, limitation on the amount of damages. comfignsation or be fits i�tagLable to or bg n- third partr
La .yj _A
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 Cily4fidemilifitdtib . The City agrees to release, indemnify, defend and hold the Grantee, its
I
IN-53yr-aym E 9M
CITY OF
Fbderal My
CITY HALL
33325 8th Avenue South
Federal Way, VIA 98003-6325
(253) 835-7000
w atyorfederilwaycorn
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 Agreement shallbehe "date of mutualexecution" hereof.
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
RTVIKVMRMr
By: r
ATE: `. —
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OR MIUVNAXGJIFMIR��
1 3 R �.
911812020 Washington State Department of Revenue
( Business Lookup
License Information:
First issuance and
Entity name: DOUGLAS M. SHEETS, P.S.
Nov -07-2007
Business name: DOUGLAS M. SHEETS, P.S.
Jun -29-2000
Entity type: Professional Service Corporation
Nov -07-2007
UBI #: 602-013-108
Business ID: 001
Location ID: 0001
Location: Active
Location address: 30321 16TH AVE S
FEDERAL WAY WA 98003-4124
Mailing address: 30321 16TH AVE S
FEDERAL WAY WA 98003-4124
Excise tax and reseller permit status: Click here
Secretary of State status, Click here
Endorsements
Endorsements held at this location License # Count Details
Status
Dental X-Ray/CT/ Pan/Ceph 01758 4
Active
Federal Way General Business 00 -103426 -00 -BL
Active
X -Ray: 01758
Active
Denta I/Pod iatric/Veteri nary
Governing People May lwiud..qwnfq le—t rad with se—ftwor afStaft
Governing people Title
SHEETS, DOUGLAS
New search Back to results
Expiration date
First issuance and
Feb -28-2021
Nov -07-2007
Feb -28-2021
Jun -29-2000
Feb -28-2021
Nov -07-2007
Registered trade names Status
DOUGLAS M SHEETS, P.S. Active
The Business Lookup information is updated nightly. Search date and time: 9/18/202010:23:05 AM
https://secure.dor.wa.gov/gteunauth/,/#4
First issued
Mar -23-2018
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