AG 20-765 - Northwest Dental PLLCCITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV- —ECONOMIC DEVELOPMENT
1 ORIGINATING STAFF PERSON. TIM JOHNSON EXT: -- 2412 3. DATE Q. BY.- ASAP
4. TYPE OF DOCUMENT (CHECK ONE):
El CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
El PUBLIC WORKS CONTRACT 0 SMALL OR LIMITED PUBLIC WORKS CONTRACT
0 PROFESSIONAL SERVICE AGREEMENT El MAINTENANCE AGREEMENT
I] GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CG
0 REAL ESTATE DOCUMENT 11 SECURITY DOC NT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE 1:1 RESOLUTION
13 CONTRACTA NT (AG#):_ El INTERLOCAL
X OTHER-, CARES ACT FUNDS BUSIIINIiSS SUPPORT GRANT AGREEMENT
5. PROJECT NAME; CARES ACT GRANT— ROUND 2
6. NAME OF CONTRACTOR: NORTHWEST DENTAL PLLC
ADDRESS: 720 S 348TH ST # AI -A, FEDERAL WAY WA 98003-7000 TELEPHONE: (253) 517-9065
E-MAIL: NWDENTAL98003@GMAIL.COM
SIGNATURENAME: Y LIU TITLE: SEE ATTACHED
7. EXHIBITS AND ATTACHMENTS: El SCOPE, WORK OR SERVICES 11 COMPENSATION El INSURANCE REQUIREMENTS/CERTIFICATE 0 ALL
OTHER REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN DREQUIRED LICENSES F-1 PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT D. SEE ATTACHED AGREEMENT-—— COMPLETION DATS
P. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND NO/100 ($2,00000)
(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: $
TS SALES TAX OWED El YES X NO IF YES,$
RETAINAGE: RETAINAGE AMOUNT: —_0 RETAINAGE AGREEMENT (SEE CONTRACT) OR DRETAINAGE BOND
PROVIDED
El PURCHASING: PLEASE CHARGE TO: 001-1800-990-518-10-490, Project Code #267662-25060
10. CU /C REVIEW INITIAL DATE REVIEWED INITIAL.:;/ DATEAPPROVEP
�0 P OJECT MANAGER
21RECTOR
El RISKMANAGEMENT (IF APPLICABLE)
El LAW
11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
El 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
1:1 LAW DEPARTMENT eA
POSIGNATORY (MAYOR OR DIRECTOR)
F-1 CITY CLERK
El ASSIGNED AG# AG #
COMMENTS:
QTY OF CITY HALL
33325 8th Avenue SouM
Federal Way Federal Way VVA 98003-6325
(253) 835-7000
s N
35-7000AVIN
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
NORTHWEST DENTAL PLLC
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Northwest Dental PLLC, a professional limited liability company ("Grantee"). The
City and Grantee (together "Parties") are located and do business at the below addresses which shall be valid for
zny notice required under this Agreement:
NORTHWEST DENTAL PLLC.
YAKO LIU
720 S 348th
FEDERAL WAY, WA 98003
CITY OF FEDERAL WAY:
Ade Ariwoola
33325 8th Ave. S.
Federal Way, WA 98003-6325
(253) 835-2414 (telephone)
(253) 835-2509 (facsimile)
k9* i]
1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditio
described herein. i
2. CONDrriONS OF GRANT.
. The Grantee warrants the following, which are pre -requisites for grant eligibility:
2.1)jarranti -:'es. W
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 employees 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 Intemal Revenue
Service,
g)
Due to COVID-19, Grantee business (check all thiLAM_1_y):
E3 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
CARES ACT BUSINESS GRANT AGREEMENT - I - 7/?0?0
CITY OF
6�deml Way
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway com
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
c) Insurance
d) Utilities
e) Marketing
f) Payroll
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 flinds and terminate this agreement.
uln§��M
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 ($2,000.00).
4.2 Non-AppEo icient funds are not appropriated or allocated for paymenl
priation of Funds. If suff
under this Agreement for any fiscal period, the City will not be obligated to make payments under this
agreement.
5.1 Grantee 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 acts or any other benefits acts or programs. The Parties further
acknowledge that they have mutually negotiated this waiver.
CARES 1CT BUSINESS GRANT AGREEMENT -2- 7/2020
CITY OF
,;*S� Federal My
Cr7Y HALL
33325 Sth Avenue South
Fede I W WA 98003-6325
1 5.3 CLty Indeumilkation. The City agrees to release, indemnify, defend and hold the Grantee, its
officers, directors, shareholders, partners, employees, agents, representatives, and subcontractors 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 �D*UN:q�on and Modifigati . 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 fall 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.
CARES ACT BUSINESS GRANT AGREEMENT -3- 7/2020
CITV OF
fWjiewal VOy
CITY HALL
33325 Bth Avenje South
FederN Way, AIA 98003-63125
;253) 835-7000
t,ou�
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 he 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 forni a single instrument com ' prised 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.
IMP
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NORTHWEST DENTAL PLLC:
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CARES ACT R1 JSINESS GRANT AGRFFMFNT -4- 7/*?0?0
Services Business Lookup NORTHWEST DENTAL PLLC
License Information:
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Entity name: NORTHWEST DENTAL PLLC
Business name: NORTHWEST DENTAL PLLC
Entity type: Professional Limited Liability Company
U #: 602-939-258
Business ID: 001
Location ID: 0001
Location: Active
Location address: 720 S 348TH ST # Al -A
FEDERAL WAY WA 98003-7000
Mailing address: 720 S 348TH ST # All -A
FEDERAL WAY WA 98003-7000
Excise tax and reseller permit status: Click here
Secretary of State status: Click here
Endorsements
Endorsements held at this location License # Count Details
Status
Expiration date
First issuance
Dental X-ray/CT/ Pan/Ceph 09372 3
Active
Jul -31-2021
Nov -04-2009
Federal Way General Buginess 09 -103991 -00 -BL
Active
Jul -31-2021
Nov -06-2009
X -Ray: Dental/PodiatricNeterinary 09372
Active
Jul -31-2021
Nov -04-2009
Governing People May Include governing people not registered with Secretary of State
Governing people Title
LIU, YAKO
NIEH, MEITING
Registered Trade Names
Registered trade names Status
First issued
NORTHWEST DENTAL Active
Jun -22-2016
Working together to fund Washington's future