22-001 Amendment #2 dated 2-6-25 Raj Goel (Amit Goel) for Fitness Instruction1
SECOND AMENDMENT TO AGREEMENT 22-001
BETWEEN THE CITY OF CUPERTINO AND RAJ GOEL
(FORMERLY KNOWN AS AMIT GOEL) FOR FITNESS
INSTRUCTOR
This Second Amendment to Agreement 22-001 is by and between the City of Cupertino, a
municipal corporation (hereinafter "City") and RAJ GOEL (formerly known as AMIT GOEL), a Sole
Proprietorship/Individual (“Contractor”) whose address is CUPERTINO,
CA 95014, and is made with reference to the following:
RECITALS:
A. On July 12, 2022, Agreement 530 (“Agreement”) was entered into by and between
City and Contractor for Fitness Instructor.
B. On June 20, 2024, City and Contractor agreed to the First Amendment for Fitness
Instructor.
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. Paragraph 1 of the Agreement is modified to read as follows:
Parties. This contract is made by and between the City of Cupertino, a municipal
corporation (“City”), and RAJ GOEL (“Contractor”), a Sole Proprietorship/Individual for
Fitness Instructor and is effective on the last date signed below (“Effective Date”).
2. Paragraph 14 of the Agreement is modified to read as follows:
Coordination of Services. The Parties designate the following persons as Services
Coordinators with the responsibility to oversee the delivery of Services in accordance with
the terms of this Agreement. Contractor’s designation and any substitution are subject to
City approval.
For City:
Name: Colleen Ferris
Position: Recreation Coordinator
Contact: colleenf@cupertino.org
For Contractor:
3. Paragraph 26 of the Agreement is modified to read as follows:
Notices. All notices and 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 the persons listed below. The notices will be deemed effective on the date of
2
personal delivery or the date confirmed by a reputable overnight delivery service, on the
fifth (5th) calendar day after deposit in the United States Mail, postage prepaid, registered
or certified, or the next business day following electronic submission.
To City of Cupertino:
Office of the City Manager
10300 Torre Ave., Cupertino, CA 95014
Cc: Representative/Coordinator: Colleen Ferris
Email: colleenf@cupertino.org
To Contractor: RAJ GOEL
4. Exhibit C and D are replaced with a new Exhibit C and D attached hereto.
5. 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.
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
RAJ GOEL
By
Title
Date
Fitness Instructor
Feb 5, 2025
Christopher D. Jensen
Director of Parks and Recreation
Feb 5, 2025
Feb 6, 2025
3
EXPENDITURE DISTRIBUTION
Item PO Number Amount
Base Amount 2023-74, 2024-110 12,000.00
Amendment 1 5,000.00
Amendment 2 0.00
- - 17,000.00
Updated 06/23/21
EXHIBIT C
AFFIDAVIT OF NO EMPLOYEES
State of California
County of Santa Clara
City of Cupertino
I, the undersigned, declare as follows:
I am an independent contractor and the owner of RAJ GOEL.
I wish to enter into a services contract with the City of Cupertino. I am fully aware of the
provisions of section 3700 of the California Labor Code, which requires every employer to
provide Workers' Compensation coverage for employees in accordance with 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 Section 12 of 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 business during the term of any service contract 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 State of California that the foregoing
is true and correct.
Executed on this ____day of ____________, 2025, at , California.
______________________________
PRINT NAME
______________________________
SIGNATURE
5th February Cupertino
Raj Goel
Updated 6/23/21
EXHIBIT D
Contractor’s Mandated Reporter Declaration
The undersigned does hereby certify that:
1. I am a representative of RAJ GOEL; that I am familiar with the facts herein and am authorized
and qualified to execute this declaration.
2. I declare that RAJ GOEL has complied with fingerprinting and criminal background
investigation requirements with respect to all Contractor’s employees who may have contact with
minors in the course of providing services pursuant to the Agreement, and the California Department
of Justice has determined that none of those employees has been convicted of a felony, as that term is
defined in California Penal Code Section 11105.3.
3. I declare that each coach and administrator shall be required to successfully complete
concussion and head injury education at least once, either online or in person, before supervising a
participant, as required by California Health and Safety Code Section 124235, et seq.
4. On a yearly basis, all participants shall be required to sign and return a concussion and head
injury information sheet in compliance with California Health and Safety Code Section 124235, which
may be in the form attached as D-1.
5. That a complete and accurate list of Contractor’s employees, who may come in contact with
minors during the course and scope of 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 Contractor Employees working 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
1386923.1
Raj Goel
Raj Goel
Fitness Instructor
Feb 5, 2025
Fitness Instructor
Final Audit Report 2025-02-06
Created:2025-02-05
By:Webmaster Admin (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAA-CRv2STE3M754pco_eze3Trd4bXPHOhA
"Fitness Instructor" History
Document created by Webmaster Admin (webmaster@cupertino.org)
2025-02-05 - 10:37:14 PM GMT- IP address: 35.229.54.2
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2025-02-05 - 10:39:31 PM GMT
Email viewed by Araceli Alejandre (aracelia@cupertino.org)
2025-02-05 - 10:39:39 PM GMT- IP address: 52.202.236.132
Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Date: 2025-02-05 - 11:30:01 PM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to for signature
2025-02-05 - 11:30:04 PM GMT
Email viewed by
2025-02-05 - 11:56:37 PM GMT- IP address: 74.125.209.7
Signer entered name at signing as Raj Goel
2025-02-06 - 0:01:52 AM GMT- IP address: 73.231.92.214
Document e-signed by Raj Goel (
Signature Date: 2025-02-06 - 0:01:54 AM GMT - Time Source: server- IP address: 73.231.92.214
Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature
2025-02-06 - 0:01:56 AM GMT
Email viewed by Christopher Jensen (christopherj@cupertino.org)
2025-02-06 - 0:02:15 AM GMT- IP address: 3.232.50.116
Signer Christopher Jensen (christopherj@cupertino.org) entered name at signing as Christopher D. Jensen
2025-02-06 - 0:02:46 AM GMT- IP address: 104.1.88.56
Document e-signed by Christopher D. Jensen (christopherj@cupertino.org)
Signature Date: 2025-02-06 - 0:02:48 AM GMT - Time Source: server- IP address: 104.1.88.56
Document emailed to Rachelle Sander (rachelles@cupertino.org) for signature
2025-02-06 - 0:02:50 AM GMT
Email viewed by Rachelle Sander (rachelles@cupertino.org)
2025-02-06 - 0:03:14 AM GMT- IP address: 52.202.236.132
Document e-signed by Rachelle Sander (rachelles@cupertino.org)
Signature Date: 2025-02-06 - 0:08:07 AM GMT - Time Source: server- IP address: 98.51.212.207
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2025-02-06 - 0:08:10 AM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2025-02-06 - 0:08:18 AM GMT- IP address: 52.202.236.132
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2025-02-06 - 5:33:54 PM GMT - Time Source: server- IP address: 73.241.178.249
Agreement completed.
2025-02-06 - 5:33:54 PM GMT