22-001 Amendment #2 dated 8-19-24 Mei's Dance Academy Ballroom and Social Dance1
SECOND AMENDMENT TO AGREEMENT 22-001
BETWEEN THE CITY OF CUPERTINO AND MEI'S
DANCE ACADEMY FOR BALLROOM AND SOCIAL
DANCE INSTRUCTION
This Second Amendment to Agreement 22-001 is by and between the City of Cupertino, a
municipal corporation (hereinafter "City") and Mei's Dance Academy, a Sole
Proprietorship/Individual (“Contractor”) whose address is 20683 Scofield Dr, Cupertino, CA 95014,
and is made with reference to the following:
RECITALS:
A. On August 08, 2022, Agreement 22-001 (“Agreement”) was entered into by and
between City and Contractor for Ballroom and Social Dance Instruction.
B. On June 26, 2024, City and Contractor agreed to the First Amendment for Ballroom
and Social Dance Instruction.
C. The Agreement and First Amendment are collectively referred to as the “Agreement”
unless otherwise indicated.
D. City and Contractor desire to modify the Agreement on the terms and conditions set
forth herein.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as
follows:
1. Exhibit A of the Agreement is modified as follows, under the following section(s):
List of all Contractor Employees working for the City of Cupertino (if no Employees,
identify “self”):
Andray Polyvka Olena Polyvka
2. Exhibit C of the agreement is replaced with the Workers’ Compensation Insurance
documentation attached hereto.
3. Except as expressly modified herein, all other terms and covenants set forth in the
Agreement shall remain the same and shall be in full force and effect.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
2
IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement
to be executed.
CITY OF CUPERTINO
By
Title
Date
APPROVED AS TO FORM
City Attorney
ATTEST:
City Clerk
Date
MEI'S DANCE ACADEMY
By
Title
Date
EXPENDITURE DISTRIBUTION
Item PO Number Amount
Base Amount 2023-131, 2024-61 12,000.00
Amendment 1 11,000.00
Amendment 2 0.00
- - 23,000.00
Dance instructor/manager
Aug 16, 2024
Christopher D. Jensen
Director of Parks and Recreation
Aug 19, 2024
Aug 19, 2024
Ballroom and Social Dance Instruction
Final Audit Report 2024-08-19
Created:2024-08-06
By:Webmaster Admin (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAvDzHQW9j8S4GsBezNvTTp_nw6ZKtUDlk
"Ballroom and Social Dance Instruction" History
Document created by Webmaster Admin (webmaster@cupertino.org)
2024-08-06 - 7:57:38 PM GMT- IP address: 35.229.54.2
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2024-08-06 - 7:58:57 PM GMT
Email viewed by Araceli Alejandre (aracelia@cupertino.org)
2024-08-06 - 7:59:08 PM GMT- IP address: 52.202.236.132
Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Date: 2024-08-06 - 8:03:52 PM GMT - Time Source: server- IP address: 71.204.144.228
Document emailed to meiwuulee@gmail.com for signature
2024-08-06 - 8:03:54 PM GMT
Email viewed by meiwuulee@gmail.com
2024-08-06 - 9:15:23 PM GMT- IP address: 76.102.11.0
Email viewed by meiwuulee@gmail.com
2024-08-15 - 9:01:29 PM GMT- IP address: 172.226.192.42
Signer meiwuulee@gmail.com entered name at signing as Mei Lee
2024-08-15 - 11:34:14 PM GMT- IP address: 125.227.190.89
Document e-signed by Mei Lee (meiwuulee@gmail.com)
Signature Date: 2024-08-15 - 11:34:16 PM GMT - Time Source: server- IP address: 125.227.190.89
Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature
2024-08-15 - 11:34:18 PM GMT
Email viewed by Christopher Jensen (christopherj@cupertino.org)
2024-08-15 - 11:34:58 PM GMT- IP address: 52.202.236.132
Signer Christopher Jensen (christopherj@cupertino.org) entered name at signing as Christopher D. Jensen
2024-08-15 - 11:39:23 PM GMT- IP address: 64.165.34.3
Document e-signed by Christopher D. Jensen (christopherj@cupertino.org)
Signature Date: 2024-08-15 - 11:39:25 PM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to Rachelle Sander (rachelles@cupertino.org) for signature
2024-08-15 - 11:39:27 PM GMT
Email viewed by Rachelle Sander (rachelles@cupertino.org)
2024-08-15 - 11:39:45 PM GMT- IP address: 52.202.236.132
Document e-signed by Rachelle Sander (rachelles@cupertino.org)
Signature Date: 2024-08-19 - 3:02:26 PM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2024-08-19 - 3:02:28 PM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2024-08-19 - 3:03:08 PM GMT- IP address: 52.202.236.132
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2024-08-19 - 4:08:38 PM GMT - Time Source: server- IP address: 73.241.178.249
Agreement completed.
2024-08-19 - 4:08:38 PM GMT