AG 20-830 - Todd G Yoshino DDSRETURNTO: TirnJohnson EXT: 2412
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV: --ECONOMIC DEVELOPMENT
2. ORIGINATING STAFF PERSON: -TIM JOHNSON EXT: 2412 3. DATE REQ.BY' ASAP
4. TYPE OF DOCUMENT (CHECK ONE):
• CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
• PUBLIC WORKS CONTRACT El SMALL OR LIN41TED PUBLIC WORKS CONTRACT
• PROFESSIONAL SERVICE AGREEMENT 11 MAINTENANCE AGREEMENT
11 GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CBG
0 REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE El RESOLUTION
El CONTRACT AMT-NDMENT(AG#): El INTERLOCAL
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6. NAME OF CONTRACTOR: TODD G YOSHINO, D.D.S.
ADDRESS: 33516 9TH AVE S # 3, FEDERAL WAY WA 98003-6322 T ELEPHONE: (253) 815-0441
E-MAIL: YOSHINODDS@COMCAST.NET
SIGNATURE NAME: TODD YOSHINO TITLE: SEE ATTACHED
7. EXHIBITS AND ATTACHMENTS: 0 SCOPE, WORK OR SERVICES El COMPENSATION D INSURANCE REQUIREMENTS/CERTIFICATE 0 ALL
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS,
8. TERM: COMMENCEMENT DATE: SEE ATTACHED AGREEMENT COMPLETION DATE:
9. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AVD NO/100 ($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 0 YES X NO IF YES, I
PAID BY: El CONTRACTOR 11 CITY
RETAINAGE AGREEMENT (SEE CONTRACT) OR o RETAfNAGE BOND
El PURCHASING: PLEASE CHARGE TO: —001-1800-990-518-10-490111 1[gigpt Code #267662-25060
10. DOCUMENT/CONTRACT REVIEW INITIAL DATE REVIEWED INITIAL / DATE APPROVED
El PR dECT MANAGER
RECTOR
* RISKMANAGEMENT (IF APPLICABLE)
* LAW
11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
Inc II fill!" �_14 112 I
El SENT TO VENDOWCONTRACTO R DATE SENT: DATE C'D:
El ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
11 CREATE ELECTRONIC REMINDERfNOTIFICATION 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 N/A
iNATORY (MAYOR OR DIRECTOR)
1:1 CITY CLERK
El ASSIGNED AG# AG#
COMMENTS:
11 V FAM 1�
CITY OF CITY HALL
33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
(253) 835-7000
wwwo"#969ralwaycorn
WITH
TODD G YOSHINO, D.D.S.
This Grant Agreement ("Agreement") is made between the City of Federal Way, a Washington municip
corporation ("City"), and Todd G Yoshino, D.D.S., a sole proprietor CGrantee"). The City and Grant
(together "Parties") are located and do business at the •below addresses which shall be valid l for any noti
required under this Agreement:
TODD YOSHINO
33516 9th Ave S # 3
FEDERAL WAY,
L41-4 3 DI 11 A "AN IM
Ade Ariwoola
33325 8th Ave. S.
Federal WaX, RUERR
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1. TERM. This agreement contemplates a one-time grant of funds to the Grantee under the conditions
described herein.
t, I Warranties: The Grantee wan -ants the following, which are pre -requisites for grant eligibility: —
a) Grantee operates is 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 mon per year;
Grantee does not operate as a tax-exempt business as defined by the Internal Revenue
Service;
g) Due to COVID- 19, Grantee business
Was required by state or local order to close
Was forced to lay off employees due to reduced patronage
Incurred over S 1,000 in COVID- 19 related expenses
Experienced 10-501/6 lost revenue
Experienced over 50% lost revenue
CARES ACT BUSINESS GRANT AGREEMENT7/2020
CITY 09
Fbideiml My
CITY HALL
33325 Sth Avenue South
(253) 835-7000
,*ww. ciooffedetahviny 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. 1EMNATIOX 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. qGRANT AMOUNT.
4.1 Amount. In order to promote healthy economic activity in the City and in response to the losses
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4.2 -�f r► .fi�Ln ofFujids. 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 The Grantee agrees to release, indemnify, defend, and hold the City, i
elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless fro
any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgment
awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties expenses, attorney's fees, costs, and/
litigation expenses to or by any and all persons or entities, including, without limitations their resvective a ent
a WM[Crr-Ms MUMMM FrT47o#TM-9 =re MrAWE1 IFERITI-M Rn MUMMER P-M-MR1
Implexect snall not Ge grV
these covenants of
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AcU4 dis"ity benefit or Any other benefits acts or programs. The Parties further
acknowledge that they have mutually negotiated this waiver.
CARES ACT BUSINESS GRANT AGREEMENT -2- 7/2021
CITY OF
F6deral VWky
CITY HALL
33325 Sth Avenue South
Federal W•
(253) 835- 1i0
www 01yoffederalway com
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
the same effect as if all Parties hereto had signed the same document- All such counterparts shall be construed
together and shall coimfitute 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.
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CA.1-4S ACT BUSINESS GRANT AGREEMENT -4-- 7/202%
Services Business Lookup TODD G YOSHINO, D.D.S,
License Information:
Entity name: YOSHINO, TODD G
Business name: TODD G YOSHINO, D.D.S.
Entity type: Sole Proprietor
UI #: 601-561-929
Business ID: 001
Location ID: 0001
Location: Active
Location address: 33516 9TH AVE S STE 3
FEDERAL WAY WA 98003-6322
Mailing address: 33516 9TH AVE S STE 3
FEDERAL WAY WA 98003-6322
Excise tax and reseller permit status: Click here
Endorsements
Endorsements held at this location License # Count
Dental X-ray/CT/ Pan/Ceph 02964 4
Federal Way General Business 95 -104061 -00 -BL
X -Ray: Dental/Pod iatdc/Veteri nary 02964
Details Status
Expiration date
First issuanCE
Active
Mar -31-2021
Nov -07-2007
Active
Mar -31-2021
Dec -10-1999
Active
Mar -31-2021
Nov -07-2007
Governing People May include governing people not registered with Secretary of State
Governing people Title
YOSHINO, TODD G
6 a . -6 6
Working together to fund Washington's future