AG 20-733 - Kosnoski Eye CareTURN TO: Tim Johnson EXT: 2412
CITY OF FEDERAL WAY LAW DEPARTMENT TING FORM
1. ORIGINATING DEPT./DIV. ECONOMIC DEVELOPMENT
2. ORIGINATING STAFF PERSON: TIM JOHNSON w EXT: 2412 3. DATE REQ. BY; ASAP
4. TYPE OF DOCUMENT (CHECK ONE):
0 CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
11 PUBLIC WORKS CONTRACT 0 SMALL OR LIMITED PUBLIC WORKS CONTRACT
• PROFESSIONAL SERVICE AGREEMENT 0 MAINTENANCE AGREEMENT
• GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CDBG
• REAL ESTATE DOCUMENT El SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
1:3 ORDINANCE El RESOLUTION
El CONTRACT AMENDMENT (AGA):_ DINTERLOCAL
X OTHER CARES ACT RJNDS BUSINESS SUPPORT GRANT AGREEMENT
S. PROJECTNAMl CARES ACT O ROUND 2
6. NAME OF CONTRACTOR: KOSNOSKIEYECARE
ADDRESS: 10002 SE 240TH ST, FEDERAL WAY WA 98023-2848 T ELEPHONE: (253) 852-2020
E-MAIL: EDW ARD@KOSNOSK]EYF-.COM
SIGNATURENAME: EDWARD KOSNOSKI TITLE: SEE ATTACHED
7. EXHIBITS AND ATTACHMENTS: 0 SCOPE, WORK OR SERVICES El COMPENSATION 0 INSURANCE REQUIREMENTS/CERTIFICATE 0 ALL
OTHER REFERENCED EXHIBITS 11 PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS
9. TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) TWO THOUSAND AND NO/100
(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 0 YES X NO IF YES, $PAU) BY: 0 CONTRACTOR 11 CITY
RETAINAGE: RETAINAGE AMOUNT: Ei RETAiNAGE AGREEMENT (SEE CONTRACT) OR El RETAINAGE BOND
PROVIDED
10. DOCUMENT/CONTRACT REVIENJ
El P.,QJECT MANAGER
0,151RECTOR
0 RISK MANAGEMENT (iF APPLicABL
11 LAW
#
INITIAL / DATE REVIEWED
. . . ... ........
SCHEDULED COMNUTTEE DATE:
SCHEDULED CouNciL DATE:
INITIAL / DATE_APPROVED
CONMTrEE APPRovAL D.
CouNcm APPRovAL D-
1
12. CONTRACT SIGNATURE ROUTING
El SENT TO VENDOWCONT RACTOR DATE SENT:DATE RECD:
Ej ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
El 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
0 LAW , EPR ENT --N/A
PNXTORY (MAYOR OR DIRECTOR)
1:1 CITY CLERK
El ASSIGNED AG # AG,
COMMENTS:
CITY Y OF,
FederalWray
rs e.
pxr
CITY HALL
33325 ath Avenue South
Federal Way, VVA 98003-6329
(253) 835-7000
;G'34'6b"a"ra" s .°t.°tda"aS't; $"G°am
CARES ACT FUNDSSUPPORT NT C ENS"
,
KOSNOSIU
This Grant Agreement ("A reemenf') is rrrade between the City sof Federal Way, a Washy Stora municipal
corporation ("City"), and Kosnoski Eye Care, a Washington corporation ("Grantee"). tee's). re City and Grantee
(together "Parties") e located and do business at the below addresses which shall be valid fear any notice required
under this Agree east:
KOSNOSKI EYE :
I CITY OF FE DERAL WAY:
°The, parties agree as follows-,
® TERM. This agreement contemplates a one-time grant of funds to the _ Grantee under the conditions
described herein.
® CONDITIONS _OF GRANT.
dl Warranties: The Grantee waiTants the following, which arelyre-requisites for grant eligibility:
a) Grantee operates a business physically located within the political boLmda ies of the City
of Federal ay;
) Grantee maintains a current. City of Federal Way business license-,
c) Grantee has paid all taxes and govermnent fees due rfla to the date ofexecution ofthis gnuit
2.2 Use of Funds: Grantee affirms that grant funds will be used for the following pfu ses
a) Mortgage or Rent
la) Personal Protection Equipment
"7/2020
CITY OF
Federal Way
CITY HALL
33325 Sth Avenue SOUth
Federal Way, WA 98003-6325
(253) 835-7000
www cityoftedershw3y 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 City may
recover all disbursed grant Rinds 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 ($2,000.00).
5.1 qtgWee ludgMAffiRgion. 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
Jout of *e cl7i-us causedky L's S*le -1 cc, SV*111
_V�e Cil
11M.
-J liere'Jil'ter snall 00--(vity * "Itec.
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
tation 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 ACT BUSINESS GRANT AGREEMENT -2-
7/2020
CITY OF CITY HALL.
A* 33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
we-nle (253) 835-7000
www. cityoffederahvey com
5.3 City Iridetubification. 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,-i4juries, damages, liabilities, losses, fines, fees, rtenalties exis.,enses, atto 's fees costs and/or litieation
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, effors, 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 01 tfn N utic
6.1 W�Atibn 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,
ino,,Qerative. null and void. or illegal shall in no way -affect or invalidate anLother provision hereof and such other
rwnRijo 11 oxtik-Akiii)n *f hithLi1wais
amended, waived, or modified except by written agreement signed by duly authorized representatives of the
Parties.
I UORV 00 D) I Omit
set torth at lie beginning ot this Agreement. Any notices may be delivered personally to the addressee Foe
notice or may be deposited in the United States mail, postage prepaid, to the address set forth above. Any notice
so posted in the United States mail shall be deemed received three (3) days after the date of mailing. Any remedies
provided for under the terms of this Agreement are not intended to be exclusive, but shall be cumulative with all
other remedies available to the City at law, in equity or by statute. The failure of the City to insist upon strict
performance of any of the covenants and agreements contained in this Agreement, or to exercise any option
conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of
-,1.2if I i 11 f r, F
-4
each Party shall pay all its legal costs and attorney's fees and expenses incurred in defending or bringing such
claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided,
however, nothing in this paragraph shall be construed to limit the Parties' rights to indemnification under Section
5 of this Agreement.
CARES ACT BUSINESS GRANT AGREEMENT -3-
7/2020
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 execution7' hereof.
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
........... ---- - -- --------
J4n ell, or
DATE:
KOSNOSKI E-fiCARE.-
tk
Printed Name-.
Title: v a) 111 -PW
DATE:
CARES ACT BUSINESS GRANT AGREEMENT -4-
7/2020
8,ffi Avenue South
FE33325
a I
Way
Federa%J 'wAVay, V"Ne,k 98 0 0 3 4151, 3 2 5
-der
(253'), 835-7f.)NOI
con"
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 execution7' hereof.
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
........... ---- - -- --------
J4n ell, or
DATE:
KOSNOSKI E-fiCARE.-
tk
Printed Name-.
Title: v a) 111 -PW
DATE:
CARES ACT BUSINESS GRANT AGREEMENT -4-
7/2020
Wasliinatoi) State Deuartment. oi Rev -✓w,!=
< Business Lookup
License Information:
Count
Entity name:
KOSNOSKI EYE CARE, INC.
Business name:
KCSNOSKI EYE CARE, FEDERAL WAY
Entity type:
Profit Corporation
UBI
602-628-623
Business ID:
001
Location 10:
0006
Location-
Active
Location address:
2314 SW 336TH ST
Active
FEDERAL WAY WA 98023-2848
Mailing address-
10002 SE 240TH ST
Active
KENT WA 98031
Excise tax and reseller permit status:
Secretary of State status -
Endorsements
Endorsements held at this location License ft
Count
Federal Way General Business 16 -105030 -00 -BL
Governing People
Governing people
KCGNOSKI, EDWARD M
Registered Trade Names
Registered trade names
Status
AUBURN VISION CLINIC
Active
FAIRWOOD VISION CLINIC
Active
KENT VISION CLINIC
Active
KCSNOSKI EYE CARE, FEDERAL WAY
Active
SOUTH HILL VISION CLINIC
Active
SUNSET VISION CLINIC
Active
Click here
Click here
M
SWUM
Active
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The Business Lookup information is updated nightly. Search date and time: 10f712020 2:21:15 PM
New seach Back tcNesulfs
Expiration date Rrst issuance date
Jun -30-2021 Oct -20-2016
First issued
Sep -27-2006
Sep -27-2006
Sep -27-2006
Oct -11-2016
Mar -27-2012
Nov -15-2010