RecreationServicesAgreement/ Rev. Nov. 2020
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No. ___________
FY2022 - 2024
RECREATION SERVICES AGREEMENT
1. Parties. This contract is made by and between the City of Cupertino, a municipal corporation (“City”), and DAN GERTMENIAN (“Contractor”), a SoleProprietorship/Individual for EducationalClassesand EducationalEventsand is effectiveon the last datesignedbelow (Effective Date”).
2. Services. Contractor agreesto provide the Servicesincluded in the Scopeof Work and in accordancewith theScheduleof Performanceattachedin Exhibit A.
3. Term. This contract begins on the Effective Date and ends on 08/ 31/2024 (“Contract Time”), unless extended or terminated asprovided herein. Time is of the essenceand Contractor must have sufficient time, resources, and qualified staff to deliver the Servicesasrequired. Contractor must promptly notify City of any actualor potential delaysto afford the Partiesadequateopportunity to addressor mitigate suchdelays. TheCity’s appropriatedepartmentheador the City Managermay extendthe ContractTimethrough a written amendmentto this Agreement, provided suchextension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City’s purchasing policy.
4. Compensation. City will payContractorfor satisfactoryperformanceof theServicesan amount that will be based upon actual costs but that will be capped so as not to exceed $773,043.00 Contract Price”), basedupon the Scopeof Services, budget, performance schedule, and ratesincluded in Exhibit A. The maximum compensation includes all costs, expenses, and reimbursements and will remainin placeevenif Contractor’s actualcostsexceedthe cappedamount. Contractormust submit invoicesand theinformation requiredin Exhibit A in orderto receivepayment. City will compensate Contractor within thirty ( 30) days after approval of written invoices.
Invoices are subject to review and audit by City during regular businesshours upon 24hours’ notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disbursementsand other cost items chargedto City or establishingthe basisfor an invoice, for a minimum of four (4) yearsfrom thedateof thefinal payment.
5. Independent Contractor.
5.1 Contractor is an independent Contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Servicesand for the personshired to work under this Agreement. No civil service status or other right of employment will be acquired by virtue of Contractor’s performanceof the Services. Contractoris not entitledto City’s health benefits, worker’scompensation or any other benefit. Contractor must have the skills
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and qualifications to perform the Servicesin a competent and professional manner.
Contractor will supply all tools, materials, and equipment required to perform the Servicesunder this Contract. Contractoris responsiblefor obtaining permits and licensesrequiredby law and mustobtaina City businesslicense, if requiredby the Cupertino Municipal Code.
5.2 Contractor is solely responsiblefor the payment of employmenttaxesincurred under this Agreementandany similar federalor statetaxes. Contractorand any of its employees, agents, and subcontractorsshall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employeebenefitsof anykind. Contractorshallbesolelyliablefor andobligated to pay directly all applicabletaxes, fees, contributions, or chargesapplicableto Contractor’s businessincluding, but not limited to, federaland stateincometaxes.
City shall have no obligation whatsoever to pay or withhold any taxesor benefits on behalf of Contractor. Should any court, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System PERS), the Internal RevenueServiceor the State Employment Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is an employee for any purpose, then Contractor agreesto a reduction in amounts payable under this Agreement, or to promptly remit to City any payments due by the City as a result of such determination, so that the City’s total expensesunder this Agreement are not greater than they would have beenhad thedeterminationnot beenmade.
6. Proprietary/ Confidential Information. To the extent Contractor may have accessto private or confidential information owned or controlled by the City, Contractor agreesto treat it as confidentialanduseit solelyto perform this Agreement. Contractormustexercisethe samestandard of careto protectCity information asa reasonablyprudent Contractorwould useto protectits own proprietarydata.
7. Ownership of Materials. To the extent Contractor prepares written material, drawings, or datain connectionwith this contract, City will havethe property rights to thosematerialsand all copyrights, if any, to such work product will, to the extent requested by City, constitute City property uponcompletionof thework to beperformedhereunderor upon terminationof this Agreement.
8. Records. Contractor must maintain complete, accurate, and detailed accounting records relating to its performance in accordancewith generally acceptedaccounting principles and procedures. Therecordsmust include detailedinformation aboutContractor’s services, benchmarks, deliverables, and costs/fees, and must be made reasonably available to City. The records and supporting documents must be kept separatefrom other files and maintained for four ( 4) years from the date of City’s final payment.
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9. Assignment. This Contract is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Contract without prior written approval of City. Only those personswhosenamesareincludedin Exhibit A mayperformtheServices.
10. Publicity and Signs. Any publicity generated by Contractor related to this contract or the Servicesduring the Contract Time and for one (1) year thereafter must referenceCity contributions.
The words “City of Cupertino” shall be displayedin all piecesof publicity, including flyers, press releases, posters, brochures, public serviceannouncements, interviews, and newspaperarticles. No signsmaybeposted, exhibited, or displayedonor aboutCity property, exceptsignagerequiredby law or under this Agreement, without prior written approval from City.
11. Indemnification. To the fullest extentallowed by law and exceptfor lossescausedby thesoleandactivenegligenceor willful misconductof City personnel, Contractoragreesto indemnify, defend, and hold harmless the City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers, and contractors (collectively, “ Indemnitees”), through legal counsel acceptableto City, from and against any liability for damages, claims, actions, causesof action, demands, charges, losses, costs, andexpenses (including attorneyfees, legalcosts, andexpensesrelated to litigation, arbitrations, administrative, and regulatoryproceedings), of everynature, arisingout of or in anyway relatedto Contractor’sor Contractor’sagentsperformanceof thiscontractor theServices.
This includes but is not limited to Liability resulting in personal injury, death, property damage, or economic losses. Contractor must pay any costsCity may incur in enforcing this provision and must accepta tender of defenseupon receiving notice from City. Contractor’s payments may be deducted or offsetto coveranymoneytheCity lostdueto aclaimor counterclaimarisingout of this Contract. This Section11shallsurviveterminationof theAgreement.
12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City will not executethe Agreement until it hasreceived and approved satisfactory certificates of insurance and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole discretion, maypurchaseinsuranceanddeductthecostsfrom paymentsto Contractor, or terminatethe Agreement.
13. Compliancewith LawsandOther City Requirements.
Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prohibiting discrimination, including Title VII of the Civil Rights Act of 1964, the California Fair Employment PracticesAct, the Americans with Disabilities Act of 1990, and other laws that pertain to fair employment and anti-discrimination practices. Contractor agrees to provide records and documentationto theCity on requestnecessaryto monitor compliancewith this provision.
Contractor must comply with labor laws pertaining to prevailing wages, working hours, overtime, payroll records, and other requirements imposed by the Department of Industrial Relations.
If Contractor doesnot have employees, it must sign the Affidavit of No Employees, attachedasExhibit C. Contractor is responsible for verifying employment eligibility of employees pursuant to the Immigration Reformand Control Act of 1986. Contractormust comply with conflict of interestlaws and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be requiredto file a conflict of interestform for engagingin governmentaldecisionsor servingin a staff RecreationServicesAgreement/ Rev. Nov. 2020
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capacity, and is hereby advised to review the requirements of California Political Reform Act and the California Code of Regulations. Servicesmay only be performed by persons who are not employed by City and who do not havea contractualrelationshipwith City other than this contract. Contractor agreesto abide by City policies and administrative rules prohibiting gifts to City officials and employees.
Additional Requirementsfor ServicesProvidedto Minors. Contractorandits employeeswho provide servicesunder this Agreementmustcomplywith theseadditionalrequirements:
A. Undergo fingerprints and a criminal background and verify all employees providing servicesunderthis contracthavemetthis requirement.
B. Completea Tuberculosisscreeningtestasrequiredby law andassetforth in Exhibit D.
C. Complywith theMandatoryReportingunderCaliforniaPenalCode11164-11174.3andwith the protocols, reporting, and training required under California Health and Safety Code Section124235, AB 2007, and other laws pertaining to concussionevaluation, removal from play, and return to play protocols. ( Refer to Center for Disease Control & Prevention, https://www.cdc.gov/headsup/index.html).
D. Submitrequiredforms and acknowledgmentsincluded in Exhibit D, and ensureits each participantis providedwith aconcussioninformationsheet, signsandreturnstheformsto the City asrequired by Health and SafetyCode Section124235.
Require coachesand administrators to successfullycomplete the concussionand head injury education at least once either online or in person, before supervising a participant.
Contractor shall offer training, educational materials, or both to each Contractor administratoron a yearlybasis. (Training resourcesareavailableat the Centerfor Disease Control & Prevention (link citedabove).
E. If providing instruction, Contractor must acknowledge and comply with all requirements set forth in the Parks & RecreationServicesInstructor Manual.
Thiscontractrequiresservicesfor children.
14. Coordination of Services. The Parties designate the following persons as Services Coordinatorswith theresponsibilityto overseethedeliveryof Servicesin accordancewith thetermsof this Agreement. Contractor’sdesignationandanysubstitutionaresubjectto City approval.
For City:
Name: Daniel Mestizo
Position: RecreationCoordinator
Contact: [email protected]
For Contractor:
Name: Dan Gertmenian
Position: Instructor
Contact:
15. Abandonment. City may abandon or postpone the Activity or Program and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Servicesrendered through the dateof abandonmentupon submissionof final invoicesapprovedby City.
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16. Termination. City may terminate this contract for causeor without causeat any time and will notify Contractor assoon aspossible. Contractor will bepaid for satisfactory servicesrendered throughthedateof terminationupon submissionof final invoicesapprovedby City.
17. Governing Law, Venue, and Dispute Resolution. This contract is governed by the laws of the State of California. Any legal actions or proceedings filed against City in connection with this contractmust comply with the governmentclaims filing requirementsand must be filed with the SuperiorCourt for the County of SantaClara, Stateof California. At City’s request, Contractoris required to continue to provide Servicespending resolution of any dispute. If the Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and include detailed written findings of law and fact.
18. Attorney Fees. If City isrequiredto pursuelitigation, arbitrationor otheradministrative or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will be entitled to reasonableattorney feesand costs. This Section18 survives this Agreement.
19. Third PartyBeneficiaries. Thereareno third party beneficiariesunderthis Contract.
20. Waiver. Neither acceptanceof Servicesnor payment thereof constitutes a waiver of any contractprovision. City waiver of a breachshall not constitutewaiver of anotherterm, provision, covenant, or condition, or asubsequentbreach, whetherthesameor a differentcharacter.
21. Entire Agreement. This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this referenceand represent the full and complete understanding asto thosematterscontainedherein, andsupersedeanyothercontractor understanding, eitheroralor written, betweentheParties. ThisAgreementmaynotbemodifiedor amendedexceptin writing signed by both Parties. If there is any inconsistency between any term, clause, or provision of the main contract and any term, clause, or provision of the attachmentsor exhibits thereto, the terms of the main contract shall prevail and be controlling.
22. InsertedProvisions. Eachprovisionor clauserequiredby law or thiscontractisdeemed to be included and will be inferred herein. Either party may requestan amendmentto cure any mistaken insertion or omission of a required provision.
23. Headings. Theheadingsarefor convenienceonly and arenot a part of the contractor intended to affect, limit, or amplify the terms or provisions of this Agreement.
24. Severability/ Partial Invalidity. If any contract term or provision, or their application to a particular situation, is found by the court to be void, invalid, illegal, or unenforceable, such term or provisionshallremainin forceandeffectto theextentallowedby suchruling. All othercontractterms andprovisionsandtheir applicationto specificsituationswill remainin full forceandeffect.
25. Survival. All provisions which by their nature must continue after the Agreement ends, including without limitation Indemnification, Insurance, Ownershipof Materials, Records, Governing Law, and Attorney Fees, will survive the expiration or termination of this Agreement.
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26. Notices. All noticesand instruments pertaining to material provisions of this contract or significant disputes which are required by law or under this contract to be in writing must be sent to thepersonslistedbelow. Thenoticeswill bedeemedeffectiveon thedateof personaldelivery or the dateconfirmedby a reputableovernightdelivery service, on thefifth (5th) calendarday afterdeposit in the United StatesMail, postage prepaid, registered or certified, or the next businessday following electronic submission.
ToCity of Cupertino:
Officeof theCity Manager
10300Torre Ave., Cupertino, CA 95014
Cc: Representative/Coordinator: Daniel Mestizo
Email: [email protected]
ToContractor: DAN GERTMENIAN
Cc: Representative/Coordinator: Dan
Gertmenian
Email:
27. Validity of Contract. This contract is valid and enforceableonly if it complies with the provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or authorizeddesignee, andis approvedfor form by theCity Attorney’sOffice.
28. Execution. The person executing this contract on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to executethis contract and to carry out all actions and services required. This contract constitutes a legally binding obligation of Contractor, andmaybeexecutedin counterparts, eachoneof which is deemedanoriginal and all of which, taken together, constitute a single binding instrument.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
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IN WITNESS WHEREOF, the parties have causedthis contract to be executed.
CONTRACTOR
By ________________________
Name______________________
Title ______________________
Date_______________________
TaxI.D. No.: Referto W9
CITY OFCUPERTINO
A Municipal Corporation
By ________________________
Name______________________
Title ______________________
Date_______________________
APPROVEDAS TO FORM:
HEATHERM. MINNER
CupertinoCity Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
Date_______________________
Heather M. Minner
City Manager
Deb Feng
Jun 25, 2021
Jun 25, 2021
Updated04/15/20
EXHIBIT A
SCOPEOF WORK, PERFORMANCE AND PAYMENT SCHEDULES
TheCONTRACTORwill provide EducationalClassesandEducationalEventsin, but not limited to, the following:
Math Olympiads, Math Olympiads Honors, Math Olympiad Accelerated, Chess, Math Themed Events, ChessEvents, InformationNights, Trial Math Classes, OptionalParticipantEvents, Parent- Child Math Olympiad Classes, AMC-8PreparatoryClasses
Location and Time of CONTRACTOR Services:
Referto theCity’sPublicationsfor agreedupon dates, times, andlocationsof aclass, camp, activity, program, or service (“class”). The City, at its solediscretion, may changethe agreed dates, times and locations of a class, or may cancela class.
Compensationfor CONTRACTORServices:
Contractor shall be compensatedfor servicesperformed pursuant to this Agreement.
Foraclasstaughtin person, 65% of theresidentfeebasedon final classrosters, minuscopierusefees.
City and Contractor may mutually agreefor Contractor to teacha classonline rather than in person, provided that City and Contractor reach agreementfor compensation for that online class.
Compensation for that online classshall be specified in writing in a separateside agreement before online instruction for a classbegins.
The total compensation to the Contractor shall not exceed $773,043.00.
Eligible ParticipantMinimum andMaximumsfor CONTRACTORServices:
Minimum: 10
Maximum: 40
If lessthan the required minimum number of participants enroll in and pay for a particular classas identified in the schedule before the classis scheduled to start, the City may cancelthe particular class and/or terminatethis Agreementwithout additionalnoticeor paymentto Contractor.
List of all Contractor Employees working for the City of Cupertino ( if no Employees, identify self”):
Self
Performanceof CONTRACTORServices:
Updated04/15/20
ClassCancellation
Contractorwill only receivecompensationfor a classthatis performed. If performanceof a classis cancelledby theCity or Contractorbeforeinstructionbegins, Contactorwill not receivecompensation for the class. If the City or Contractor cancelsperformance of certain meetings of a class, Contractor will only receive compensation for those meetings of the classthat are performed.
In thecaseContractorunilaterallycancelsperformanceof aclasswithout City approval, City reserves theright to immediatelyandwithout noticecanceltheremainderof classesofferedandor performed by Contractor.
COVID-19HealthOrder Compliance
Contractor acknowledges that its duty to comply with Laws, asstated in Section13of the Agreement, includescomplianceby Contractorwith therestrictionsontravelandtheSocialDistancing Requirementssetforth in Section13.k of thehealthorderissuedby theCountyof SantaClaraPublic HealthDepartmenton March31, 2020, in responseto theCOVID-19pandemic, andanysubsequent amendments or superseding orders thereto (the “Health Order”), and any other local, state, or federal laws or policies that have been or may be enactedin responseto the COVID- 19 pandemic collectively, “Health Laws”). Contractor shall comply with theserestrictions on travel and Social DistancingRequirementswhenpreformingwork underthis Agreement. If this Agreementspecifies work that cannotbeperformedin compliancewith theHealthOrderor HealthLaws, Contractorshall refrainfrom conductingthework andimmediatelyinform theCity. Contractorshalllikewisecomply with any City protocols designed to help prevent the spread of COVID- 19. Contractor acknowledges that the need to comply with the Health Order and Health Laws may result in the City canceling performance of any classor meetings of a classreferencedin this Agreement.
Registration, Enrollment, andSupervision
TheContractorshallfollow all guidelinespertainingto registrationproceduresaslistedin the quarterly recreation schedule. Participants may not take part in the program unless they are listed on the classroster or can show proof of enrollment. All participants and volunteers need to complete the City’s Waiver of Liability form prior to taking part in the program. If applicable, contractors who are responsiblefor supervisingminorsmustremainwith theclassuntil aparentof legalguardianhas arrivedandall minorsarereleasedto them.
Injury ofa ClassParticipant
In theeventof aninjury occurringto a participant, theContractorwill notify theCity within 1hour andcompleteanIncidentReportin theform approvedby theCity. TheIncidentReportmustbe submitted to the City within 24hours of the injury occurring.
Exh. B Insurancefor RecreationContracts UpdatedMay 2020 1 Exhibit B
Insurance Requirements for Recreation Contracts
As required by the Agreement, Contractor shall procure prior to commencementof Servicesand maintain the following insurancefor theduration of the Agreementagainstclaimsarising from or in connectionwith Contractor, its agents, representatives, employeesor subcontractorsServicesunder this Agreement.
Minimum Scopeand Limit of Insurance. Coverageshall beat leastasbroad as:
1. Commercial General Liability ( CGL): InsuranceServicesOffice Form CG 00 01 covering CGL on an occurrence” basis, including property damage, bodily injury and personal & advertising injury with limits no lessthan $1,000,000per occurrence. If ageneralaggregatelimit applies, it must apply separately to this project/location (CG2503or 2504) or betwice the required occurrencelimit. a. It shall be a requirement that any available insuranceproceedsbroader than or in excessof the specified minimum insurancecoveragerequirementsand/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specifiedin this agreement; or (ii) thebroadercoverageand maximum limits of coverageof anyinsurancepolicy, whichever is greater. b. Additional Insured coverageunder Consultant's policy shall be "primary and non-contributory," will not seekcontribution from City’sinsurance/self-insurance, and shall beat leastasbroad asISO Form CG2001 (04/13).
c. Thelimits of insurancerequired may besatisfiedby acombinationof primary andumbrella or excess insurance, provided eachpolicy complies with the requirements set forth in this Contract. Any umbrella or excessinsuranceshall containor beendorsedto containa provision that suchcoverage shall also apply on a primary basisfor the benefit of City beforethe City’s own insuranceor self- insuranceshall becalledupon to protect City asa namedinsured.
2. Automobile Liability: Proof of Contractor’s personalauto insurancewith limits required by statelaw suffices. Contractor shall not transport or useits personalvehicle to transport participants or perform work under this contract.
3. Workers’ Compensation: ContractorMust SignAffidavit of No Employees
4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/servicesinvolving minors, ( i.e., after school activities, recreational programs, athletics, study/training events and transportation of minors). Coveragemay be included under General Liability or be obtained in a separatepolicy, such asEducatorsLegal Liability ( ELL) policy, with a limit of no lessthan $1,000,000 per occurrence. If a generalaggregatelimit applies, it must apply separatelyto this contractor betwice the required occurrencelimit.
Insurancecoveragerequired may besatisfiedby a combinationof Primary and Excess/Umbrella insurance.
OTHER INSURANCE PROVISIONS
Theaforementionedinsuranceshall beendorsedand haveall the following conditions and provisions:
Additional InsuredStatus
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers Additional Insureds”) are to be covered as additional insureds on Consultant’s CGL and automobile liability policies. GeneralLiability coveragecanbeprovided in the form of an endorsementto Consultant’s insurance (at leastasbroad asISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later editions areused).
Exh. B Insurancefor RecreationContracts UpdatedMay 2020 2 Primary Coverage
Coverageafforded to City/Additional Insuredsshall beprimary insurance. Any insuranceor self-insurance maintained by City, its officers, officials, employees, or volunteersshall beexcessof Consultant’s insurance and shall not contribute to it.
Notice of Cancellation
Eachinsurancepolicy shallstatethat coverageshallnot becanceledor allowed to expire, exceptwith written noticeto City 30daysin advanceor 10daysin advanceif due to non-payment of premiums.
Waiver of Subrogation
Consultantwaivesany right to subrogationagainstCity/Additional Insuredsfor recoveryof damagesto the extent said losses are covered by the insurance policies required herein. Specifically, the Workers’ Compensationpolicy shall beendorsedwith awaiver of subrogationin favor of City for all work performed by Consultant, its employees, agentsand subconsultants. This provision applies regardlessof whether or not the City hasreceiveda waiver of subrogationendorsementfrom the insurer.
Deductiblesand Self-InsuredRetentions
Any deductible or self-insured retention must be declaredto and approved by the City. At City’s option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respectsthe City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defenseexpenses. The policy shall provide, or be endorsed to provide, that the self-insured retention may besatisfiedby either the insured or the City.
Acceptability of Insurers
Insurersmust belicensedto do businessin California with an A.M. BestRatingof A-VII, or better.
Verification of Coverage
Consultant must furnish acceptableinsurancecertificatesand mandatory endorsements (or copiesof the policieseffectingthe coveragerequired by this Contract), and a copy of the Declarationsand Endorsement Pageof the CGL policy listing all policy endorsementsprior to commencementof the Contract. City retains the right to demandverification of complianceat any time during the Contractterm.
Subconsultants
Consultant shall require and verify that all subconsultantsmaintain insurancethat meetthe requirements of this Contract, including naming the City asan additional insured on subconsultant’sinsurancepolicies.
Higher InsuranceLimits
If Consultantmaintains broadercoverageand/or higher limits than the minimums shown above, City shall beentitled to coveragefor the higher insurancelimits maintained by Consultant.
Adequacyof Coverage
City reservesthe right to modify theseinsurancerequirements/coveragebasedon the nature of the risk, prior experience, insurer or other specialcircumstances, with not lessthan ninety (90) days prior written notice.
1223215.2
EXHIBIT C
AFFIDAVIT OF NO EMPLOYEES
StateofCalifornia
CountyofSantaClara
City ofCupertino
I, the undersigned, declare asfollows:
I am an independent contractor and the owner of DAN GERTMENIAN.
I wish to enter into a servicescontract with the City of Cupertino. I am fully aware of the provisions of section 3700of the California Labor Code, which requires every employer to provide Workers' Compensation coveragefor employees in accordancewith the provisions of that Code. I am also aware that I must provide proof of workers’ compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section12of the City of Cupertino’s contract.
I hereby certify that I do not have any employees nor will I have any employees working for me or my businessduring the term of any servicecontract with the City of Cupertino. I am not required to have Workers’ Compensation insurance.
I declare under penalty of perjury under the laws of the Stateof California that the foregoing is true and correct.
Executedon this ____day of ____________, 2021, at , California.
PRINT NAME
SIGNATURE
Updated4/15/20
EXHIBIT D
Contractor’s Mandated Reporter Declaration
Theundersigneddoesherebycertify that:
1. I ama representativeof DAN GERTMENIAN; that I am familiar with thefactshereinandam authorized and qualified to executethis declaration.
2. I declarethat DAN GERTMENIANhascompliedwith fingerprinting andcriminal background investigation requirements with respect to all Contractor’s employees who may have contact with minors in the course of providing servicespursuant to the Agreement, and the California Department of Justicehas determined that none of those employees has been convicted of a felony, as that term is definedin CaliforniaPenalCodeSection11105.3.
3. I declare that each coach and administrator shall be required to successfullycomplete concussionand headinjury educationat leastonce, either online or in person, beforesupervisinga participant, asrequiredby CaliforniaHealthandSafetyCodeSection124235, etseq.
4. On a yearly basis, all participantsshall berequiredto sign and return a concussionand head injury information sheetin compliance with California Health and Safety Code Section124235, which may be in the form attached asD-1.
5. That a complete and accurate list of Contractor’s employees, who may come in contact with minors during the course and scopeof the Agreement, are included below.
6. All of the below mentioned employees have tested negative for TB, or X-ray results for TB, and have current documentation on file with Contractor.
7. All of the below mentioned employees have received training and understand their responsibilities under the Mandated Reporter laws of this state and are willing and able to comply.
List of all ContractorEmployeesworking for the City (if no Employees, identify “self”):
Self
8. The Contractor will notify the City of Cupertino in writing of any new employees and will be added to the above list prior to beginning work at the City of Cupertino.
I declare under penalty of perjury that the foregoing is true and correct.
CONTRACTOR
By ________________________
Name ______________________
Title ______________________
Date _______________________
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: -
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY ( ADDITIONAL INSURED)
Alliant Insurance Services, Inc. in conjunction with
Apex Insurance Services
P. O. Box 6450
Newport Beach, CA 92658
License No: OC 36861
NAMED INSURED ( EVENT HOLDER): EVENT INFORMATION:
TYPE:
DATE( S):
LOCATION:
Liquor Liability Yes No
Liquor Liability after 12 am ends before 2 am
This is to certify thattheinsurancepolicy listedbelowhasbeenissuedto theaboveinsurednamed (eventholder) for thepolicy periodindicated. Theinsurancedescribedhereinis subjectto all theterms, exclusionsandconditionsof suchpolicy(ies) unless amendedasdescribedin SpecialConditions.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER:
MASTER POLICY DATES: EFFECTIVE: EXPIRATION:
COMMERCIAL GENERAL LIABILITY General
Aggregate Limit
Products & Completed Operations
Personal & Advertising Injury
Each Occurrence Limit
DamageTo PremisesRentedTo You (Any OnePremises)
Medical Payments (Any One Person)
Liquor Liability ( If purchased)
Optional Limits Purchased
1,000,000/$3,000,000
2,000,000/$2,000,000
Property Damage ( If purchased)
2,000,000
1,000,000
1,000,000
1,000,000
100,000
5,000
1,000,000
OCCURRENCE FORM DEDUCTIBLE: NONE
The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
SPECIALCONDITIONS:
Thefollowingendorsementsattachedto
theMasterPolicydo not applyto this
CertificateOf Insurance:
MEGL1643
January 01, 2021
Academic
Creekside Park Building, 10455 Miller Ave, Cupertino, CA 95014, Quinlan Community Center, 10185 North Stelling Road, Cupertino, CA 95014, Portal Park Building, 10225 North Portal Ave, Cupertino, CA 95014 City of Cupertino
City of Cupertino, Its City Council, Boards and
Commissions, Officers, Officials, Employees,
Agents, Servants, Volunteers and Consultants
l
No Property Damage Coverage
01/ 12/ 2021
Dan Gertmenian
01/ 11/ 2021 - 12/ 31/ 2021
MKLV7PBC000569
January 01, 2022
MPIL 1039- CA 01 20 Page 1 of 2
EVANSTON INSURANCE COMPANY
IMPORTANT NOTICE
CALIFORNIA SURPLUS LINES NOTICE ( D- 2)
1. The insurance policy that you have purchased is being issued by an insurer that is not licensed by the State of California. These companies are called “ nonadmitted” or “ surplus lines” insurers.
2. The insurer is not subject to the financial solvency regulation and enforcement that apply to California licensed insurers.
3. The insurer does not participate in any of the insurance guarantee funds created by California law. Therefore, these funds will not pay your claims or protect your assets if the insurer becomes insolvent and is unable to make payments as promised.
4. The insurer should be licensed either as a foreign insurer in another state in the United States or as a non- United States ( alien) insurer. You should ask questions of your insurance agent, broker, or “ surplus line” broker or contact the California Department of Insurance at the toll- free number 1- 800- 927- 4357 or internet website www. insurance. ca. gov. Ask whether or not the insurer is licensed as a foreign or non- United States ( alien) insurer and for additional information about the insurer. You may also visit the NAIC’ s internet website at www. naic. org. The NAIC – the National Association of Insurance Commissioners – is the regulatory support organization created and governed by the chief insurance regulators in the United States.
5. Foreign insurers should be licensed by a state in the United States and you may contact that state’ s department of insurance to obtain MPIL 1039- CA 01 20 Page 2 of 2
more information about that insurer. You can find a link to each state from this NAIC internet website: https:// naic. org/ state_ web_ map. htm.
6. For non- United States ( alien) insurers, the insurer should be licensed by a country outside of the United States and should be on the NAIC’ s International Insurers Department ( IID) listing of approved nonadmitted non- United States insurers. Ask your agent, broker, or surplus line” broker to obtain more information about that insurer.
7. California maintains a “ List of Approved Surplus Line Insurers LASLI).” Ask your agent or broker if the insurer is on that list, or view that list at the internet website of the California Department of Insurance: www. insurance. ca. gov./ 01- consumers/ 120- company/ 07- lasli/ lasli. cfm.
8. If you, as the applicant, required that the insurance policy you have purchased be effective immediately, either because existing coverage was going to lapse within two business days or because you were required to have coverage within two business days, and you did not receive this disclosure form and a request for your signature until after coverage became effective, you have the right to cancel this policy within five days of receiving this disclosure. If you cancel coverage, the premium will be prorated and any broker’ s fee charged for this insurance will be returned to you.
Insurance Services Office, Inc., 2012 Page 1 of 1
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
A. Section II – Who Is An Insured is amended to
include as an additional insured the person( s) or
organization( s) shown in the Schedule, but only
with respect to liability for " bodily injury", " property damage" or " personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
POLICY NUMBER:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Name Of Additional Insured Person( s) Or Organization( s):
City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers, and Consultants
U33 12- 17
MAILING ADDRESS
DANIEL AVEDIS GERTMENIAN
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
GEICO INDEMNITY COMPANY
VERIFICATION OF COVERAGE
SEE BELOW UNDER CAUTIONARY NOTE)
GEICO
Washington DC
Policy Number:
Effective Date: 03- 01- 21
Expiration Date: 09- 01- 21
Registered State: CALIFORNIA
COVERAGES LIMITS DEDUCTIBLES
Bodily Injury Liability
Each Person/ Each Occurrence
State Minimum $ 15, 000/$ 30, 000 $ 15, 000/$ 30, 000
Property Damage Liability
State Minimum $ 5, 000 $ 25, 000
Uninsured & Underinsured Motorists
Each Person/ Each Occurrence $ 15, 000/$ 30, 000
Uninsured Motorists Property Damage $ 3, 500
Lienholder Additional Insured Interested Party
Additional Information:
Issue Date: 06- 04- 21
If you have any additional questions, please call 1- 800- 841- 3000.
CAUTIONARY NOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS, AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER " ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN, THE DATE OF THIS FACSIMILE OR EMAIL.
U33 12- 17
MAILING ADDRESS
DANIEL AVEDIS GERTMENIAN
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
GEICO INDEMNITY COMPANY
VERIFICATION OF COVERAGE
SEE BELOW UNDER CAUTIONARY NOTE)
GEICO
Washington DC
Policy Number:
Effective Date: 03- 01- 21
Expiration Date: 09- 01- 21
Registered State: CALIFORNIA
COVERAGES LIMITS DEDUCTIBLES
Bodily Injury Liability
Each Person/ Each Occurrence
State Minimum $ 15, 000/$ 30, 000 $ 15, 000/$ 30, 000
Property Damage Liability
State Minimum $ 5, 000 $ 25, 000
Uninsured & Underinsured Motorists
Each Person/ Each Occurrence $ 15, 000/$ 30, 000
Uninsured Motorists Property Damage $ 3, 500
Lienholder Additional Insured Interested Party
Additional Information:
Issue Date: 06- 04- 21
If you have any additional questions, please call 1- 800- 841- 3000.
CAUTIONARY NOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS, AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER " ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN, THE DATE OF THIS FACSIMILE OR EMAIL.
CLAIMS MADESEXUALMISCONDUCTANDMOLESTATIONINSURANCE
Form: SML SafeguardWording - 623AFB00213
Policy Number:
Renewalof:
NamedInsured: City of Cupertino – ParksandRecreationDepartment, PublicWorksDepartment
PrincipalAddress: 10300TorreAvenue, Cupertino, CA 95014 PolicyPeriod: From: 1stJuly 2020 To: 1stJuly2021
Both datesat 12:01a.m. Local Timeat thePrincipalAddressstatedin Item 1.
Limit of Liability:
a) USD5,000,000 for all Claims for Wrongful Acts againstanyoneVictim b) USD5,000,000 for all Claimsfor WrongfulActsagainstall Victims, but sub-limited to:
c) USD50,000 for all SafeguardCostsresultingfrom all Circumstances SuchSub-limit of Liability shallbepartof, andnotin additionto, theoverallLimit of Liability statedin 3.b) above.
Retention:
USD35,000 anyoneVictim
Premium:
USD30,000 to bepaidwithin 25 daysof attachment
Notification pursuant to ClauseIX. shall begiven to:
ClaimsDepartmentBeazley
30BattersonParkRoad,
Farmington,
CT 06032.
[email protected]
860) 6773765 (phone)
860) 6790247 (fax)
RetroactiveDate:
1stJuly 2018
Pendingor Prior LitigationDate:
1stJuly 2018
Serviceof Suit:
Foley & LardnerLLP, 555CaliforniaStreet, Suite1700, SanFrancisco, CA 94104- Choiceof Law:
NewYork
Conditions:
ApplicationDated: 30thJune2020
CaliforniaSurplusLinesNotice1- LMA9098A
CaliforniaComplaintsClause – LMA9136
SmallAdditional or ReturnPremiumsClause (U.S.A.) – NMA 1168 NuclearIncidentExclusionClause-Liability-Direct – NMA 1256 RadioactiveContaminationExclusionClause-Liability - NMA 1477 War andTerrorismExclusion – NMA 2918
SeveralLiability Notice – LSW1001
SanctionsLimits Clause - LMA 3100
BeazleySafeguardEducationDocument
TysersSafeguardEnhancementEndorsement
AmendedDefinition of IndependentContractorEndorsement – asattached U.S Classification:
SurplusLinesBrokerandStatefiled in: RiskPlacementServices, 2850Golf Road, Rolling Meadows, IL 60008
LicenseNumber: 0C66724
Brokerage:
Information: Employees – 296
IndependentContractors – 70
ExposureUnits – 97,000
Natureof Business – Municipality
Cancellationby anInsuredmayresultin a shortratecalculationto determine thereturnpremium, subjectto 5% minimumearnedof thetotal premium.
Underwriting
Security: 100% Lloyd’s (InformationaboutLloyds)
AMENDEDDEFINITIONOFINDEPENDENTCONTRACTORTO INCLUDESUB-
CONTRACTORSANDDELETESFULL-TIME BASIS
This endorsementmodifiesinsuranceprovidedunderthefollowing:
BEAZLEYSAFEGUARD
In considerationof the premiumchargedfor this Policy, it is herebyunderstoodandagreedthat ClauseIII. DEFINITION H. is deletedin its entiretyandreplacedwith thefollowing:
H. “ Independent Contractor” meansany natural personindependentcontractoror sub- contractorwho performslabor or servicefor the Insured Organizationpursuantto a written contractor agreement, wheresuchlaboror serviceis undertheexclusivedirection of theInsured Organization. Thestatusof anindividual asanIndependentContractor shallbedeterminedasof thedateof anallegedWrongfulAct.
All othertermsandconditionsof this Policy remainunchanged.