AG 20-674 - Family Medicine Clinic of Federal WayEXT: 2412
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: ECONOMIC DEVELOPMENT
2. ORIGINATING STAFF PERSON:
_,Lim joHNsoN EXT: __ 2412 3. DATE REQ. BY ASAP
4. TYPE OF DOCUMENT (CHECK ONE):
El CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
El PUBLIC WORKS CONTRACT El SMALL OR LIMITED PUBLIC WORKS CONTRACT
• PROFESSIONAL SERVICE AGREEMENT El MAINTENANCE AGREEMENT
• GOODS AND SERVICE AGREEMENT 0 HUMAN SERVICES/ CG
• REAL ESTATE DOCUMENT 0 SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
• ORDINANCE 0 RESOLUTION
• CONTRACT AMENDMENT (AG#): El INTERLOCAL
• OTHER CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
5. PROJECTNAW:- CARES ACT GRANT— ROUND 2
6. NAME OF CONTRACTOR: FAMILY MEDICINE CLINIC OF FEDERAL WAY, LLC
ADDRESS: PO BOX 6015, FEDERAL WAY WA 98003 TELEPHONE: (206) 214-6007
E-MAIL: DOCTORLENG@YAHOO.COM
SIGNATURENAME: VUTHY LENG TITLE: SEE ATTACHED
EXHIBITS AND ATTACHMENTS: 11 SCOPE, WORK OR SERVICES 0 COMPENSATION 13 INSURANCE REQUIREMENTS/CERTIFICATE 0 ALL
OTHER REFERENCED EXHIU31TS 11 PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES 0 PRIOR CONTRACT/AMENDMENTS
9. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND NO/100 ($2,00 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 El YES X NO IF YES, $-- PAID BY: El CONTRACTOR D CITY
RETAINAGE: RETAiNAGE AMOUNT: RETAINAGE AGREEMENT (SEE CONTRACT) OR EIRETAINAGEBOND
0 PURCHASING: PLEASE CHARGE TO: 001-1800-990-518-10 490 Pro'ect Code #267662-25060
10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIALJ DATE APPROVED
0 P JECT MANAGER
2,
=1RECTOR &L
11 RISK MANAGEMENT (wAppucABLE)
El LAW
11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED CONBeTTEE DATE: CoNmTTEE APPRovAL DATE:
SCHEDULED CouNaL DATE: CouNaL APPRovAL DArE:
El SENT TO VENDOR/CONTRACTOR DATE SENT: I DATE REC'D--
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
0 CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE
(Include dept. supports if necessary and feel free to set notification more than a month in advance if council approval is needed.)
INITIAL / DATE SIGNED
❑1-,A DEPAR,rMENT N/A
GNATO RY (NLAYOR OR DIRECTOR)
• CITY CLERK
• ASSIGNED AG# AG
CO NTS:
1/2020
tily of
Fbderal M10y
CfTY HALL
33325 3th Avenue outh
Federal Way, A/A 98003-6325
(253) 335-7000
www atyodfederalway corm
CARES ACT FUNDS SUPPORT GRANT AGREEMENT
WITH
FAMILY MEDICINE OF 1 '.
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation and Family
Federal Y limited liability1 I
("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:
WAY, LLC:
VUTHY LENG
34618 11th PI S, Federal Way, WA 98063
Mailing address: PO Box 6015,
Federal Way, WA 98063
(206) 214-6007 (telephone)
octorleiznvaoo. co
F.Ir.me l
Federal33325 Sth Ave. S.
.. • 98003-6325
(253) 835-2414 (telephone)
r1
11- Y' i♦ Y J '1' . �
TERM.1. This agreement conte plates a one-time grant of funds to the Grantee under the conditions
described herein.
FederalFt. I 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 ,
grantb) 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
agreement;
d) Grantee's business employs no more than the equivalent of ten (10) full-time employees
(20,800 -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 C VI -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
IN Incurred over $1,000 in C VI -19 related expenses
Experienced 10-50% lost revenue
Experienced over 50% lost revenue
2.2 Use of s: Grantee affirms that grant funds will be used for the following purposes:
a) Mortgage or Rent
b) Personal Protection Equipment
c) Insurance
d) Utilities
e) Marketirfg,
f) Payroll
CITY HALL
33325 8th Avenue South
Federal Way., WA 98003-6325
(253) 835-7000
wwUv cityoffederalway coo
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. if
4.2 Non -Appropriation 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 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
litieation ex) -tenses to or p anvi and all Goersons or wtities, including, without limitation- their res!�#wctive agents,
licensees, or representatives, anising 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 acts or any other benefits acts or programs. The Parties further
acknowledge that they have mutually negotiated this waiver.
CITY OF
d. °c vvay
CITY HALL
33325 Sth Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www Wyoffederalway com
5.3 Ojy W&�flgfi�pl. 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 rocresentatives- ansing from.-rcsultinZ from or connected with this Agnir4=.-nt 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 Interpretation 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.
6.3 Execution. Each individual executing this Agreement on behalf of the City and Grantee
c7epresents 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
AVII MOHR= �0_ MOM IMMITRUMMUSIMM
)CITY of
d x' Ml�y
CITY HALL
33325 Sth Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederaAvay coo
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 execution" hereof.
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY:
DATE:
By:
Title:
L7_
DATE, 67
< Business Lookup
License Information:
New search Back to rmuIts
Entity name: FAMILY MEDICINE CLINIC OF FEDERAL WAY, LLC
Business name: FAMILY MEDICINE CLINIC OF FEDERAL WAY, LLC
Entity type, Limited Liability Company
UBI 602-513-211
Business ID: 001
Location ID: 0001
Location: Active
Location address: 34618 11TH PL S STE 100
FEDERAL WAY WA 98003
Mailing address: PO BOX 6015
FEDERAL WAY WA 98063
Excise tax and reseller permit status:
Click here
Secretary of State status:
Click here
Endorsements
Endorsements held at this location License ti Count
Details Status
Expiration date First issuance date
Federal Way General Business
Active
Aug -31-2021 Aug -13-2020
Governing People
Governing people
Title
LENG,VUTHY
Registered Trade Names
Registered trade names Status
First issued
FAMILY MEDICINE CLINIC OF FEDERAL WAY, LLC Active
Jun -24-2005
The Business Lookup information is updated nightly. Search date and time: 9/29/2020 *46.30 PM
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