AGR-6988.77 - SAMIDA MEDICAL GROUP - SMALL BUSINESS RELIEF GRANT; COVID-19 PANDEMICI-- s 8'• 7
CITY OF ORANGE
SMALL BUSINESS ASSISTANCE PROGRAM
BUSINESS RELIEF GRANT AGREEMENT
This SMALI, BUSINESS ASSISTANCE PROGRAM BUSINESS RELIEF GRANT
AGREEMENT ("Grant Agreement")is made and entered into as of the a + day of u,
2020 ("Effective Date") by and between the CITY OF ORANGE, a municipal corporation
City"),and SAMIDA MEDICAL GROUP("Recipient"),a California corporation with reference
to the following:
RECITALS
WHEREAS, the novel coronavirus (COVID-19) has become a world-wide pandemic, in
which the federal, state, county and city governments, including the City of Orange, have all
declared a state of emergency; and
WHEREAS, the efforts to minimize the spread of COVID-19 have, among other things,
created for many Orange businesses the loss of income as a result of a significant reduction of
hours and operations,hindering the ability to keep up with payrolls,rents,mortgages,utility bills,
business operations and other related expenses; and
WHEREAS, the City has determined that encouraging and promoting stability among
commercial businesses and their employees is conducive to the public health and welfare of the
City; and
WHEREAS,the Coronavirus Aid,Relief, and Economic Security Act has made available
to the City, funds to be used for certain specific purposes related to small businesses; and
WHEREAS, the City wishes to grant to Recipient, and Recipient wishes to receive said
grant funds.
NOW, THEREFORE, both the City and Recipient, in consideration of the mutual
promises, covenants and conditions contained herein and the substantial public benefits to be
derived therefrom, do hereby agree as follows:
AGREEMENT
1. Purpose of Grant. This Small Business Assistance Program Business Relief Grant
Grant") is awarded by the City to Recipient for the sole purpose of providing relief during the
economic emergency caused by the COVID-19 pandemic.
2. Total Amount of Grant. The Grant awarded to Recipient shall be in the amount
of TWENTY FNE THOUSAND DOLLARS and 00/100($25,000.00),payable in one lump sum,
and subject to the terms and conditions contained herein.
3. Recipient Obli ations.
A. Recipient acknowledges the certifications and promises contained in the
Small Business Assistance Program Participant Certification, attached as Exhibit "A" and
incorporated herein, and agrees to abide by them during the term of this Grant Agreement.
B. Recipient shall remain in business not less than ninety(90)days after receipt
of the Grant.
C. Recipient shall submit to the City the Certification of Compliance letter that
is attached hereto as Exhibit"B"and provide any additional documentation requested by the City.
City shall review said records for compliance with the terms and conditions of this Crrant
Agreement.
4. Review of Compliance Documentation bv Citv. After review of the Certification
of Compliance letter and any other documentation submitted by Recipient; City will either:
A. Approve said records, in which case Recipient will not incur any obligation
to repay the Grant and this Grant Agreement will terminate; or
B. Disapprove said records, in which case Recipient will be obligated to repay
to City those amounts determined by City to have been not used for the intended purpose of this
Grant Agreement.
5. Repayment of Grant. If Recipient is required to repay all or part of the Grant,
said repayment to City shall be made according to a schedule as determined by the City.
6. Governing Law and Venue. This Grant Agreement shall be construed in
accordance with and governed by the laws of the State of California and Recipient agrees to submit
to the jurisdiction of California courts. Venue for any dispute arising under this Grant Agreement
shall be in Orange County, California.
7. Inte ration. This Grant Agreement constitutes the entire agreement of the parties.
No other agreement, oral or written, pertaining to the duties and obligations of each party under
this Grant Agreement shall be of any force or effect unless it is in writing and signed by both
parties.
8. Notice. Except as otherwise provided herein, all notices required under this Grant
Agreement shall be in writing and delivered personally, by e-mail, or by first class U.S. mail,
postage prepaid, to each party at the address listed below. Either party may change the notice
address by notifying the other party in writing. Notices shall be deemed received upon receipt of
same or within three (3) days of deposit in the U.S. Mail, whichever is earlier. Notices sent by e-
mail shall be deemed received on the date of the e-mail transmission.
RECIPIENT" CITY"
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Samida Medical Group City of Orange
392 South Glassell St 100/101 300 E. Chapman Avenue
Orange,CA 92866 Orange,CA 92866-1591
Attn.: David A. Sami,MD Attn.: Aaron Schulze
Telephone: 310-966-0420 Telephone: 714-7442202
E-Mail: dlsami@yahoo.com E-Mail: aschulze@cityoforange.org
9. Counternarts. This Grant Agreement may be executed in one or more
counterparts,each of which shall be deemed an original, but all of which together shall constitute
one and the same instrument. Signatures transmitted via facsimile and electronic mail shall have
the same effect as original signatures.
IN WITNESS of this Grant Agreement,the parties have entered into this Grant Agreement
as of the year and day first above written.
RECIPIENT"i°CITY"
SAMIDA MEDICAL GROUP, CITY OF ORANGE,a municipal corporation
a California corporation
By: By:
Printed Name:David A. Sami,MD ick O , City Manager
Title:Owner
APPROVED AS TO FORM:
Mary E.Bi mg
Senior Assistant City Attorney
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EXHISIT "A"
CITY OF ORANGE
SMALL BUSINESS ASSISTANCE PROGRAM
BUSINESS RELIEF GRANT
PARTICIPANT CERTIFICATION
Beneath this sheet]
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Ci y c f
City of Orange
Small Business
Assistance Program
BUSINESS RELIEF GRAIVT APPLICATI N
Applications accepted beginning June 3, 2Q20
The purpose of this g rant program is to assist small business owners in Orange that have been adversely
affected by COVID-19. Funds will be provided to assist with payroll, capital, equipment, and operating
costs to allow businesses to continue to operate for at least 90 days.
Who can qualify?
1. The business is physically located in Orange, has been in the City for a minimum of one year and
is not a franchise or part of a chain of more than three locations.
2. The business is a for profit business with at least 1, but not more than 50 employees.
3. The business has gross annual revenues of at least $100,000, but no more than $5 million.
4. The business has experienced at least a 25% reduction in revenue due to COVID-19 and is
able to provide documentation showing the loss in revenue.
5. The business continues to operate legally during the COVID-19 crisis. ,
6. The business has had no major code violations in the last twelve months.
7. Adult businesses, massage parlors, and largely cash-based businesses are not eligible.
8. Individuals that own or have interest in more than one business may be limited to one grant total
i.e., if a person has ownership interest in three businesses, only one of those businesses may
receive a grant under this program).
9. Businesses that have not received funding through the CARES Act, such as Payroll Protection
Program loans,will be given first priority.
How much 1s the grant?
The grant is up to a maximum of $25,OQ0.
How do I appl?
Complete the Grant Application and Participation Cert'rfication online at www.cityoforange.orq and
attach all the required information on the Document Checklist. You will receive an email advising you
that your application has been received. An incomplete application will delay the review of your
application. Listed documentation is a minimum requirement and staff may request additional
documentation to determine eligibility.
If you have any questions, please email Aaron Schulze, Senior Administrative Analyst at
aschulze@citvoforanae.orq, or call (714) 744-2202. Funding is limited and will be disbursed on a first
come, first served basis.
Small Business Assistance Program Application
BUSINESS INFORMAl10N
Name of Business
amida Medical Group
7ype of Business(e.g.,LLC,corporation,sole proprietorship)
Cor oration
Address of Business
92 South Glassell St 100/101
Business Employer ldentification Number(EIN) Years in BusinQCC
5
of Employees of Employees Meeting LowlMod Incane City Business License Number
Requirement
4 179230
owNER
s
INFORMATION
a.__. .__ _ ____w__t____.___,____.__._ ___._ ____._._ _ ____._. ._______ ----z ---__ ___ _n ,.___________
OWNER CO-OWNER
Name Name
David A. Sami MD
Social Security Number Contact Phone(area code) Social Security Number Contact Phone(area code)
3109660420
Present Address(street,city,state,zip)Present Address(street,city,state,zip)
180 Ridge Dr, LA CA 90049
Email Address Email Address
d1 sami yahoo.com
BUSINESS INCOME INFORMATION
20191NCOME 2020 INCOM E(USE THE SAME MONTHS AS 2019)
Month#1 Gross Sales Q,4 Month#1 Gross Sales 16,463.77
Month of April Month of qpril
Month#2 Gross Sales 34.798.54 Month#2 Gross Sales 21,036.60
Month of May Month of Mav
Please provide a brief explanation of the adverse economic effects COVID-19 has had on your business:
have experienced a significant loss of revenue to to Covid 19 pandemic restrictions.This is a continuing issue due
o persistent long term need to social distance our patients by limiting the schedule and having to keep the reception/
aiting area free of traffic.
REQUIRED DOCUMENTS—SEE DOCUMENT CHECKLIST FOR DOCUMENTS ACCEPTED FOR VERIFlCATION
1. Revenue statements for 2 months in 2020 verifying 25% less revenue than the same months in 2019
2. Revenue statements for the same two months in 2019
3. Annual revenue statement for 2019
4. Payroll reports documerrting the number of employees
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Small Business Assistance Program Application
ACKNQWLECIGMENT AND CERTIFICATI N
Acknowledgement: INVe understand that this grant is being provided by the City of Qrange based solely upon
the information that Ilwe have provided in this application. I/We also cert'rfy that there are no outstanding tax
liens or legal judgements against the business.
Certification: I/We certify that the information provided in this application is true and complete to the best of
my/our knowledge as of the date set forth opposite my/our signature(s) in this application and acknowledge
my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this
application may result in civil liability and/or criminal penalties.
By signing below, I/we certify that the above statements are true and correct to the best of my/our knowledge.
I/We understand that a false statement may disqualify me/us from benefits.
Owner q dar p,
o,s Date Co-Owner Signature Date
6/26/2020
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City of Orange
Small Business Assistance Program
Qwner Participant Certification
Business Name
Business Address
In order to participate in the City of Orange Small Business Assistance Program ("Program")
and receive a grant, the City of Orange ("City") requires that you ("Recipient") and your staff,
if applicable, certify the following:
You own a small business that employs between 1 and 50 employees.
Your business is legally operating during the COVID-19 crisis.
Your business has been in operation in Orange for at least one year.
Your business has experienced a revenue decrease of at least 25% compared to 2019,
because of the impact of COVID-19.
Your business is not a franchise and is not a chain of four or more locations.
You commit to continue operating for a minimum of three months after receipt of the
grant funds.
Notwithstanding any other rights of the City under other Sections of this Certification or applicable
law, if the Recipient violates any of the terms, covenants or provisions of the Certification, or if
any representation or warranty made by the Recipient in this Certification or in any document
or application submitted in connection with this Certification or the Program shall prove false or
misleading, or if, in the sole judgment of the City, the conduct of the Recipient is such that the
interests of the City have been or are likely to be impaired or prejudiced, the City shall thereupon
have the right to terminate any grant or withhold payments due under the Program and/or demand
and obtain the return of payments already made which are equal to the damages the City may
have already suffered due to a breach by the Recipient. Any such action by the City shall not give
rise to any cause of action for damages against the City.
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CERTIFICATIONS ,
1) I certify that my business has been in operation for at least one year.
2) I certify that I currently employ a total of 4
employees.
3) I certify that as a result of COVID-19, my business experienced at least a 25%
decrease in revenue for two consecutive months after January 1 st, 2020, compared
to the average revenue for the same two-month period in calendar year 2019 (or
average monthly revenue based on total 2019 sales).
4) I certify that my business is continuing to operate during the COVID-19 crisis.
5) I certify that my business will continue to operate for a three-month period
commencing on the date of receiving the grant funds.
6) I certify that my business will comply with all laws and rules applicable to the
program, including City, state and federal laws.
7) I certify that I have not misrepresented the eligibility of my business for the Program.
By signing below, I certify that the above statements are true and correct to the best of
my knowledge and belief. I understand that willful or fraudulent submission of a materially
false statement in connection with this certification may disqualify my business from
eligibility for the Program benefits and may subject my business or myself to criminal
charges.
This certification shall be deemed executed in the City of Orange and State of California
and shall be governed and construed in accordance with the laws of the State of
California and the laws of the United States.
e=,a oa.,.=a,m,e„s.om
a e rea e • a 06/26/2020
Business Owner Signature) Date)
Business Owner Signature) Date)
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City of Orange
Small Business Assistance Program—Document Checklist
Document Why we need this Documertts accepted
Signed participation Verification that the business employs between 1 and
certification 50 employees and has experienced a loss of revenue.
Revenue statements for pocumentation of revenue foilowing COVID-19 impact One or more of the following for the entire impacted period:point-of-
two consecutiVe months in sales reports, sales reports(demonstrating fees cotlected or earned
2020 income), bank statements, quarterly sales tax filings, or CPA-
certified profit&loss statements for two consecutive months in 2020
Revenue statements for Comparison of typical operating revenue to verify One or more of the fol(owing for the same two months in 2019:
the same two consecutive loss of revenue as a result of COVID-19 point-of-sales reports,sales reports(demonstrating fees collected
months in 2019 or earned income),bank statements,quarterly sales tax filings,r
CPA-certified profit&loss statements for two consecutive months
in 2019
Annual revenue statements Comparison of typical operating revenue to verify One or more of the following for totaf 2019 sales:point-of-sales
for 2019 loss of revenue as a result of COVID-19 reports,sales reports (demonstrating fees collected or earned
income}, bank statements,quarterly sales tax filings, 2019 tax
returns, CPA-certified profit & loss statements, 2019 Tax
Returns(atl pages),or Federa1990
Payroll report showing To determine eligibility for the grant Payroll records.
number of employees
Proof of Orange location To verify that the business is located in the City City of Orange business license number on application, signed
federal tax forms,signed copy of lease agreement,or 3 months
of operational bills
f you do not have a CIty buslnessllcense you w1I!L e requlred to obtaln
one prlor to fund dlstrJbutJon
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Date:
Hannah Haase
City of Orange
300 East Chapman Avenue
Orange, California 92866
Re: Certification of Compliance Pursuant to City of Orange Small Business
Assistance Program Business Relief Grant Agreement
Dear Ms. Haase:
This Certification is submitted to the City of Orange in accordance with the Small
Business Assistance Program Business Relief Grant Agreement ("Agreement"), and
constitutes the Final Compliance Report. The undersigned authorized representative of
Samida Medical Group, hereby certifies each of the following statements:
1. The 90-day compliance period for this Agreement began on June 13, 2020, and
ended on October 15, 2020.
2. During the compliance period, the business continued to operate legally.
3. Grant funds were used in accordance with the Small Business Assistance
Program.
DATED:
M
Title: