AG 20-809 - St Therese Adult Family Home LLCRETURN TO: Tim Johnson
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: ECONOMIC DEVELOPMENT
2. ORIGINATING STAFF PERSON: TIM JOHNSON p EXT: 2412 3. DATE REQ.13Y. ASAP
4. TYPE OF DOCUMENT (CHECK ONE):
11 CONTRACTOR SELECTION DOCUMENT (E.G., R -FB, RFT, RFQ)
0 PUBLIC WORKS CONTRACT 0 SMALL OR LE\41TED PUBLIC WORKS CONTRACT
[I PROFESSIONAL SERVICE AGREEMENT 0 MAINTENANCE AGREEMENT
El GOODS AND SERVICE AGREEMENT El HUMAN SERVICES/ CDG
0 REAL ESTATE DOCUMENT 0 SECURITY DOC NT (E.G. BOND RELATED DOCUMENTS)
El ORDINANCE El RESOLUTION
Ei CONTRACTA NT (AG#):_ 0 INTERLOCAL
X OTHER CARES ACT FUNDS BUSINESS SUPPOM'Cr. ANTAGREEMENT
5. PROJECT NAME: CARES ACT GRANT
6. NAME OF CONTRACTOR: ST THE SE ADULT FAMILY HOME LLC
ADDRESS: 2715 SW 337TH ST, FEDERAL WAY WA 98023-7758 T ELEPHONE: (206) 595-0768
E-MAIL: ST.THERESE AFH@YAHOO.COM
SIGNATURE NAME: TERESITA GALVEZ TITLE: SEE ATTACHED
7. EXHIBITS AND ATTACHMENTS: El SCOPE, WORK OR SERVICES El COMPENSATION 1:1 INSURANCE REQUIRENIENTS/CERTIFICATE 0 ALL
OTHER REFERENCED EXHIBITS El PROOF OF AUTHORITY TO SIGN El REQUIRED LICENSES El PRIOR CONTRACT/AMENDMENTS
9. TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX, IF ANY) ONE THOUSAND AND NO/100
(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 D YES X NO IF YES, $-,- PAID BY: El CONTRACTOR E3 CITY
0 PURCHASING: PLEASE CHARGE TO: 001-1800-990-518-10-490 Project Code #267662-25060
10. DOCUMENT/CONTRACT REVIEW INITIAL DATE REVIEWED INITIAL DATE APPROVED
2 0 PR TECT MANAGER
I PR
7) C'j
11 RISKMANAGEMENT (IF APPLICABLE)
0 LAW
11. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
El SENT TO VENDOR/CONTRACTOR DATE SENT:
F&MN119=4013
• ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
• CREATE ELECTRONIC REMINDERINOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE
(Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.)
INITIALL DATE SIGNED
El LAW DEPARTMENT NI/
P,KGNATORY (MAYOR OR DIRECTOR)
0 CITY CLE
11 RK
%A
ASSIGNED AG# G
COMMENTS:
1/2020
LORENW483E
it OF CITY HALL
33325 8th Avenue South
Federal Way Federal V%Jay. WA 95003-6325
(253) 835-7000
wlwvdfaffederalwa.v cow
CARES ACT FUNDS BUSINESS SUPPORT GRANT AGREEMENT
WITH
ST THERE$E ADULT FAMILY IEIOMIE LLC
Q I*
VW I
61MINIM.11 1 •.i
Ade •s
33325 8th Ave. S.
Federal Way, WA 93003-6325
835-2414 (telephone)
835-2509 (facsimile)
This agreement contemplates a one-time grant of funds to the Grantee under the conditions
describedNePeln.
CARES ACT BUSINESS GRANT AGREEMENT - I -
Oct 13 20 10:23a Galvez 2535173488 P.3
Q1r1V OF
P�6deral VVOy
CITY HALL
33325 8th Avenue South
Federal Way. *VVA 98003-6325
(253) 835-7000
i*%Kv.c�1y0*LYeraAViqJv cat r,
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 fimds and will provide them to the City or ita
tesignee, upon request
3. !�INATWN. Should any of the conditions described in section 2.1 above, not be e City
may recover all disbursed grant funds and terminate this agreement.
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 COWP,!.9 a« 4%
Oki 2FOL"is- z
not to exceed One Thousand and NO/100 Dollars (S 1,000.00).
4.2 &�Azuronriation of F--- ". if suAdicht &n& are not appropriated or allocated for p4yWO
under this AgNemperiod, the Cit� Will hot be oblig4* to make paymerets undtt this
agreement.
those. tovoAms
CARES ACT BUSINESS GRANT AGREEMENT -2-
Oct 13 20 10:23a Galvez 2535173488 p.4
Akk COV 04;
4�W F6deral My
Cr TY HALL
33325 8th Avenue Soutt-t
Federal Way, WA 98003-6325
(253) 835-7000
VAVwC11Y0"Tef1eT1hVZVcutin
5.3 City jndemnifi=666. Ac JOY agees to release, indemnify, defend and hold the GTantee, i
officers, direc�,: s�bWers alvents renresentatives. and &TIbio tractfir-q V
11 J
X
licensees, or representatives, arising from, resulting from or connerted with this Agreement to the e ent so el
caused by [he 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.
nts W01 11 1-aw
such other provisions shal-1 remain in full force and lwAsion, of ftk Agreement; including il�s�
provision, may be amended, waived, or modified except by written agreement signcd by duly authorized
representatives of the Parties.
1� cill 1
I IF 1
■
CARES ACT BUSINESS GRANT AGREEMENT -3-
Oct 13 20 10:23a Galvez 2535173488 P.5
ciry of;
Fedem I Woy
CITY HALL
33325 Sth Avenue South
Federal IlVay� VVA 98003-6325
(253-1 835-7000
a4m.cityafferferalli'aYcom
6.3 hx-wution. Each individual executing this Agreement on behalf of the City and Grantee
XV� and vlarraot$� thatsuch individual is duly autliorized to execute and deliver this A ent- THS
A be
into
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
By:
PrintedName:
Title:
DATE: CD
CARES • BUSINESS GRANT AGREEMBNT .4-
10/5/2020 Washington State Department of Revenue
< Business Lookup
License Information:
Entity name:
ST. THERESE ADULT FAMILY HOME LLC
Business name:
ST. THERESE ADULT FAMILY HOME LLC
Entity type:
Limited Liability Company
UBI :r
602-760-528
Business ID:
001
Location ID:
0001
Location:
Active
Location address:
2715 SW 337TH ST
FEDERAL WAY WA 98023-7758
Mailing address:
2715 SW 337TH ST
FEDERAL WAY WA 98023-7758
Excise tax and reseller permit status:
Secretary of State status:
Endorsements
Endorsements held at this location Li cp . r s e Count
Federal Way General Business 07 -105702 -00 -BL
Governing PeopleNdy 1.dude gol. —f Wbtemd .1th 5-9ay ®fStaft
Governing people
GALVEZ, DENNIS
GALVEZ, TERESITA
Registered Trade Names
Registered trade names Status
ST. THERESE AFH LLC Active
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SP a t Us Expiration date First 'ssuance dat
Active Sep -30-2021 Apr -18-2008
The Business Lookup information is updated nightly. Search date and time: 10/5/2020 11:02:57 AM
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First issued
Nov -18-2019
a