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25-001 John Casibang for Fitness InstructionCITY OF CUPERTINO RECREATION SERVICES AGREEMENT No. FY2024 - 2026 1. Parties. This contract is made by and between the City of Cupertino, a municipal corporation ("City"), and John Casibang ("Contractor"), a Sole Proprietorship/Individual for Fitness Instruction and is effective on the last date signed below ("Effective Date"). 2. Services. Contractor agrees to provide the Services included in the Scope of Work and in accordance with the Schedule of Performance attached in Exhibit A. 3. Term. This contract begins on the Effective Date and ends on 06/30/2026 ("Contract Time"), unless extended or terminated as provided herein. Time is of the essence and Contractor must have sufficient time, resources, and qualified staff to deliver the Services as required. Contractor must promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to address or mitigate such delays. The City's appropriate department head or the City Manager may extend the Contract Time through a written amendment to this Agreement, provided such extension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City's purchasing policy. 4. Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will be based upon actual costs but that will be capped so as not to exceed $45,000.00 ("Contract Price"), based upon the Scope of Services, budget, performance schedule, and rates included in Exhibit A. The maximum compensation includes all costs, expenses, and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount. Contractor must submit invoices and the information required in Exhibit A in order to receive payment. City will compensate Contractor within thirty (30) days after approval of written invoices. Invoices are subject to review and audit by City during regular business hours upon 24 hours' notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disbursements and other cost items charged to City or establishing the basis for an invoice, for a minimum of four (4) years from the date of the final 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 Services and for the persons hired to work under this Agreement. No civil service status or other right of employment will be acquired by virtue of Contractor's performance of the Services. Contractor is not entitled to City's health benefits, worker's compensation or any other benefit. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner. Recreation Services Agreement/ Rev. April 2024 Page 1 of 7 Contractor will supply all tools, materials, and equipment required to perform the Services under this Contract. Contractor is responsible for obtaining permits and licenses required by law and must obtain a City business license, if required by the Cupertino Municipal Code. 5.2 Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees, agents, and subcontractors shall 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 employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor's business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement is determined by a court of competent jurisdiction, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERs) to be eligible for enrollment in PERS as an employee of City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City, and actual attorney's fees incurred by City in connection with the above. 6. Proprietary/Confidential Information. To the extent Contractor may have access to private or confidential information owned or controlled by the City, Contractor agrees to treat it as confidential and use it solely to perform this Agreement. Contractor must exercise the same standard of care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Ownership of Materials. To the extent Contractor prepares written material, drawings, or data in connection with this contract, City will have the property rights to those materials and all copyrights, if any, to such work product will, to the extent requested by City, constitute City property upon completion of the work to be performed hereunder or upon termination of this Agreement. 8. Records. Contractor must maintain complete, accurate, and detailed accounting records relating to its performance in accordance with generally accepted accounting principles and procedures. The records must include detailed information about Contractor's services, benchmarks, deliverables, and costs/fees, and must be made reasonably available to City. The records and supporting documents must be kept separate from other files and maintained for four (4) years from the date of City's final payment. Recreation Services Agreement/ Rev. April 2024 Page 2 of 7 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 persons whose names are included in Exhibit A may perform the Services. 10. Publicity and Signs. Any publicity generated by Contractor related to this contract or the Services during the Contract Time and for one (1) year thereafter must reference City contributions. The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews, and newspaper articles. No signs may be posted, exhibited, or displayed on or about City property, except signage required by law or under this Agreement, without prior written approval from City. 11. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor agrees to 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 acceptable to City, from and against any liability for damages, claims, actions, causes of action, demands, charges, losses, costs, and expenses (including attorney fees, legal costs, and expenses related to litigation, arbitrations, administrative, and regulatory proceedings), of every nature, arising out of or in any way related to Contractor's or Contractor's agents performance of this contract or the Services. This includes but is not limited to Liability resulting in personal injury, death, property damage, or economic losses. Contractor must pay any costs City may incur in enforcing this provision and must accept a tender of defense upon receiving notice from City. Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract. This Section 11 shall survive termination of the Agreement. 12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City will not execute the Agreement until it has received and approved satisfactory certificates of insurance and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole discretion, may purchase insurance and deduct the costs from payments to Contractor, or terminate the Agreement. 13. Compliance with Laws and Other 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 Practices Act, 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 documentation to the City on request necessary to monitor compliance with 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 does not have employees, it must sign the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying employment eligibility of employees pursuant to the Immigration Reform and Control Act of 1986. Contractor must comply with conflict of interest laws and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in governmental decisions or serving in a staff Recreation Services Agreement/ Rev. April 2024 Page 3 of 7 capacity, and is hereby advised to review the requirements of California Political Reform Act and the California Code of Regulations. Services may only be performed by persons who are not employed by City and who do not have a contractual relationship with City other than this contract. Contractor agrees to abide by City policies and administrative rules prohibiting gifts to City officials and employees. Additional Requirements for Services Provided to Minors. Contractor and its employees who provide services under this Agreement must comply with these additional requirements: A. Undergo fingerprints and a criminal background and verify all employees providing services under this contract have met this requirement. B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training required under California Health and Safety Code Section 124235, AB 2007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, htti2s://www.cdc.gov/headsul2/index.html). D. Submit required forms and acknowledgments included in Exhibit D, and ensure its each participant is provided with a concussion information sheet, signs and returns the forms to the City as required by Health and Safety Code Section 124235. Require coaches and administrators to successfully complete the concussion and 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 administrator on a yearly basis. (Training resources are available at the Center for Disease Control & Prevention (link cited above). E. If providing instruction, Contractor must acknowledge and comply with all requirements set forth in the Parks & Recreation Services Instructor Manual. This contract requires services for children. 14. 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: For Contractor: Name: Colleen Ferris Name: John Casibang Position: Recreation Coordinator 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 Services rendered through the date of abandonment upon submission of final invoices approved by City. 16. Termination. City may terminate this contract for cause or without cause at any time and will notify Contractor as soon as possible. Contractor will be paid for satisfactory services rendered through the date of termination upon submission of final invoices approved by City. Recreation Services Agreement/ Rev. April 2024 Page 4 of 7 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 contract must comply with the government claims filing requirements and must be filed with the Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is required to continue to provide Services pending 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 is required to pursue litigation, arbitration or other administrative or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. This Section 18 survives this Agreement. 19. Third Party Beneficiaries. There are no third party beneficiaries under this Contract. 20. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall not constitute waiver of another term, provision, covenant, or condition, or a subsequent breach, whether the same or a different character. 21. Entire Agreement. This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this reference and represent the full and complete understanding as to those matters contained herein, and supersede any other contract or understanding, either oral or written, between the Parties. This Agreement may not be modified or amended except in 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 attachments or exhibits thereto, the terms of the main contract shall prevail and be controlling. 22. Inserted Provisions. Each provision or clause required by law or this contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure any mistaken insertion or omission of a required provision. 23. Headings. The headings are for convenience only and are not a part of the contract or 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 provision shall remain in force and effect to the extent allowed by such ruling. All other contract terms and provisions and their application to specific situations will remain in full force and effect. 25. Survival. All provisions which by their nature must continue after the Agreement ends, including without limitation Indemnification, Insurance, Ownership of Materials, Records, Governing Law, and Attorney Fees, will survive the expiration or termination of this Agreement. 26. 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 personal delivery or the Recreation Services Agreement/ Rev. April 2024 Page 5 of 7 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: John Casibang 27. Execution. The person executing this contract on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to execute this contract and to carry out all actions and services required. This contract constitutes a legally binding obligation of Contractor, and may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. SIGNATURES CONTINUE ON THE FOLLOWING PAGE Recreation Services Agreement/ Rev. April 2024 Page 6 of 7 IN WITNESS WHEREOF, the parties have caused this contract to be executed. CITY OF CUPERTINO A Municipal Corporation By '�"CS° Name Rachelle Sander Title Director of Parks and Recreation Date Feb 10, 2025 APPROVED AS TO FORM: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date Feb 10) 2025 CONTRACTOR By O Name John "Lexi" Casibang Title Personal Trainer/ Grouo Fitness Instructor Date Feb 7, 2025 Tax I.D. No.: Refer to W9 Recreation Services Agreement/ Rev. April 2024 Page 7 of 7 EXHIBIT A SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide Fitness Instruction in, but not limited to, the following: Personal Training, Classes, Subbing Services Location and Time of CONTRACTOR Services: Refer to the City's Publications for agreed upon dates, times, and locations of a class, camp, activity, program, or service ("class"). The City, at its sole discretion, may change the agreed dates, times and locations of a class, or may cancel a class. Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. For a class taught in person, $42/hour. City and Contractor may mutually agree for Contractor to teach a class online rather than in person, provided that City and Contractor reach agreement for compensation for that online class. Compensation for that online class shall be specified in writing in a separate side agreement before online instruction for a class begins. The total compensation to the Contractor shall not exceed $45,000.00. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: 10 Maximum: 40 If less than the required minimum number of participants enroll in and pay for a particular class as identified in the schedule before the class is scheduled to start, the City may cancel the particular class and/or terminate this Agreement without additional notice or payment to Contractor. List of all Contractor Employees working for the City of Cupertino (if no Employees, identify "self"): Self Performance of CONTRACTOR Services: Class Cancellation Updated 06123121 Contractor will only receive compensation for a class that is performed. If performance of a class is cancelled by the City or Contractor before instruction begins, Contactor will not receive compensation for the class. If the City or Contractor cancels performance of certain meetings of a class, Contractor will only receive compensation for those meetings of the class that are performed. In the case Contractor unilaterally cancels performance of a class without City approval, City reserves the right to immediately and without notice cancel the remainder of classes offered and or performed by Contractor. COVID-19 Health Order Compliance Contractor acknowledges that its duty to comply with Laws, as stated in Section 13 of the Agreement, includes compliance by Contractor with any restrictions on travel or social distancing or other requirements set forth in any health order issued by any local, state, or federal authority, and any other local, state, or federal laws or policies that have been or may be enacted in response to the COVID-19 pandemic (collectively, "Health Laws"). Contractor shall comply with all applicable Health Laws when preforming work under this Agreement. If this Agreement specifies work that cannot be performed in compliance with the Health Laws, Contractor shall refrain from conducting the work and immediately inform the City. Contractor shall likewise comply with any City protocols designed to help prevent the spread of COVID-19. Contractor acknowledges that the need to comply with the Health Laws may result in the City canceling performance of any class or meetings of a class referenced in this Agreement. Registration, Enrollment, and Supervision The Contractor shall follow all guidelines pertaining to registration procedures as listed in the quarterly recreation schedule. Participants may not take part in the program unless they are listed on the class roster 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 responsible for supervising minors must remain with the class until a parent of legal guardian has arrived and all minors are released to them. Injury of a Class Participant In the event of an injury occurring to a participant, the Contractor will notify the City within 1 hour and complete an Incident Report in the form approved by the City. The Incident Report must be submitted to the City within 24 hours of the injury occurring. Updated 06123121 Exhibit B Insurance Requirements for Recreation Contracts As required by the Agreement, Contractor shall procure prior to commencement of Services and maintain the following insurance for the duration of the Agreement against claims arising from or in connection with Contractor, its agents, representatives, employees or subcontractors Services under this Agreement. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this project/location (CG 25 03 or 25 04) or be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Consultant's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City's own insurance or self- insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: Proof of Contractor's personal auto insurance with limits required by state law. (Contractor shall not transport or use its personal vehicle to transport participants or perform work under this contract.) 3. Workers' Compensation: Contractor Must Sign Affidavit of No Employees 4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving minors, (i.e., after school activities, recreational programs, athletics, study/training events and transportation of minors). Coverage may be included under General Liability or be obtained in a separate policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the required occurrence limit. Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance. OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Additional Insured Status 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. General Liability coverage can be provided in the form of an endorsement to Consultant's insurance (at least as broad as ISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later editions are used). Exh. B Insurance for Recreation Contracts Updated August 2024 Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant's insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Waiver of Subrogation Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically, the Workers' Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self -Insured Retentions Any deductible or self -insured retention must be declared to and approved by the City. At City's option, either: the insurer must reduce or eliminate the deductible or self -insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurance shall be placed with insurers admitted in the State of California and with an AM Best rating of A- VII or higher. Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements (or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior to commencement of the Contract. City retains the right to demand verification of compliance at any time during the Contract term. Subconsultants Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant's insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City shall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice. Exh. B Insurance for Recreation Contracts Updated August 2024 2 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Cupertino Apex Insurance Services P.O. Box 6450 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: John Casibang TYPE: Weightlifting (Machines Only) LOCATION: Cuperl- Sports Censer. 21111 Stevens Creek SNd, Cupertino, CA 95014 *Liquor Liability Yes 0 No "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ics) unless amended as described in Special Conditions. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: MKLV7PBC0o 1969 MASTER POLICY DATES: EFFECTIVE: January 01, 2025 EXPIRATION: January 01, 2026 COMMERCIAL. GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal & Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not applyto this Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance: Medical Payments (Any One Person) 5,000 MEGLI643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,0001$3,000,000 ❑ $2,000,0001$2,000,000 Property Damage (If purchased) No Property Damage Coverage 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 City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the polio• pro -visions, AUTHORIZED REPRESENTATIVE: DATE ISSUED: 02/01/2025 POLICY NUMBER: MKLV7PBC001969 COMMERCIAL GENERAL LIABILITY CG20260413 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 Name Of Additional Insured Person(s) Or Organ ization(s): City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, and Volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG20260413 oil POLICY NUMBER: MKLV7PBC001969 MARKEL EVANSTON INSURANCE COMPANY FORMS SCHEDULE FORM NUMBER FORM NAME MJIL 1000 08 10 Policy Jacket/Signature Page MPIL 1007 01 20 Privacy Notice MPIL 1039-CA 01 20 California Surplus Lines Notice (D-2) MPIL 1041 02 20 How To Report A Claim MPIL 1083 04 15 U.S. Treasury Department's Office Of Foreign Assets Control ("OFAC") Advisory Notice To Policyholders MDIL 1001 08 11 Forms Schedule IL 00 21 09 08 Nuclear Energy Liability Exclusion Endorsement GD MEIL 1231 10 13 Minimum Earned Premium And Minimum Retained Premium MDGL 1008 08 11 BC Commercial General Liability Coverage Part Declarations CG 00 01 04 13 Commercial General Liability Coverage Form CG 02 24 10 93 Earlier Notices of Cancellation Provided By Us CG 20 01 04 13 Primary & Noncontributory - Other Ins Condition CG 20 11 0413 Additional Insured -Managers or Lessors of Premises CG 20 26 04 13 Additional Insured - Desg Person or Organization CG 21 3311 85 Exclusion - Designated Products CG 21 47 12 07 Employment Related Practices Exclusion CG 21 58 04 13 Exclusion - Professional Veterinarian Services CG 21 7001 15 Cap on Losses From Certified Acts of Terrorism CG 21 7601 15 Exclusion Of Punitive Damages Related To A Certified Act Of Terrorism CG 21 96 03 05 Silica Or Silica -Related Dust Exclusion IL 00 17 11 98 Common Policy Conditions ESX MEGL 0241 05 16 Waiver Of Transfer of Rights Against Others to Us MEGL 1639 08 14 Excl - Aircraft and Hot Air Balloon Rides, Demos & MEGL 2300 11 19 Exclusion - Marijuana MEGL 2322 05 21 Exclusion - Communicable Disease MEGL 5300 05 16 Exclusion -Organic Pathogen And Legionellae MEGL 5302 05 16 Exclusion - Asbestos MEGL 5303 05 16 Exclusion - Lead MEIL 1200-CA 02 23 Service Of Suit - California MEIL 1225 10 11 Changes - Civil Union MEIL 1251 10 21 Two Or More Coverage Forms or Policies MGL 1319 01 16 Exclusion - Unmanned Aircraft MGL 1356 10 20 Exclusion - Cyber Incident, Data Compromise, And Violation Of Statutes Related To Personal Data MIL 1214 09 17 Trade or Economic Sanctions IL 12 01 11 85 Policy Changes - for CA MDIL 1000-CA 08 11 Common Policy Declarations MDIL 1001 08 11 Page 1 of 2 MEGL 0205 01 24 Abuse, Molestation, Or Exploitation Coverage -Defense Costs Within Limits MEGL 163811 19 Concert or Performance Exclusions and Limitations MEGL 1640 08 14 Exclusion - Aircraft and Watercraft Liability Assumed Under An Insured Contract MEGL 1641 05 16 Exclusion - Amusement Devices and Rides MEGL 1642 10 14 Exclusion - Boxing, Wrestling and Contact Martial Arts MEGL 164308 14 Exclusion - Entertainers, Participants and Equipment MEGL 1644 08 14 Exclusion - Fireworks, Pyrotechnics and Flashboxes MEGL 1645 08 14 Exclusion - Motorized Sporting Events MEGL 1646 08 14 Exclusion - Professional Sporting Events MEGL 1647 08 14 Exclusion - Rodeos and Roping Events MEGL 1664 08 15 Exclusion - Obstacle Course Races and Mud Runs MEGL 1851 08 14 Additional Insured - Concessionaires, Exhibitors and vendors MEGL 1852 08 14 Aggregate Limit of Insurance MEGL 1853 10 14 Broadened Insurance MEGL 1854 08 14 Damage to Property Coverage MEGL 1855 08 14 Liquor Liability Coverage MEGL 1856 10 14 Premium Reporting MEGL 1857 11 17 Primary and Noncontributing Insurance MEGL 2632 01 24 Exclusion -Abuse, Molestation, Or Exploitation MAIL 1001 08 11 Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and t2y You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG2001 0413 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rats. If the first Named Insured cancels, the refund may be less than pro rats. The cancellation will be effective even if we have not made or offered a refund. S. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; INTERLINE IL OD 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. E. Premiums The first Named Insured shown in the Declarations: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay- F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 1198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 GEICO Tel: 1-800-841-3000 GEICO General Insurance Company P.O. Box 509090 San Diego, CA 92150-9090 Date Issued: August 25, 2024 Email Address: Named Insured Vehicles Occurrence State Minimum $15,000/$30,000 .............................................................I-- ............ Property Damage Liability State Minimum $5,000 ................................................................................ Uninsured & Underinsured Motorists Each Person/Each Occurrence ................................................................................ Comprehensive (Excluding Collision) ................................................................................ Collision ................................................................................ Rental Reimbursement ............................................................................ Six Month Premium Per Vehicle Limits and/or Deductibles $300,0001$300,000 $100,000 ......................... $30,000/$60,000 .................... I ..................... $500 Ded .......................................... $1,000 Ded/Waiver .......................................... $50 Per Day $1,500 Max Vehicle 1 Vehicle 2 Vehicle 3 $276.60 $99.40 $177.90 -................................................................. $173.50 $122.70 $103.20 .................................................................... $62.40 $26.30 $42.10 ................................................................. $75.10 $43.30 I ....... - $64.00 ............................................................ $434.30 ........................................................................... $145.00 I . - ........... $221.30 $32.60 ........................................................................... $32.60 $32.60 $1,054.50 $469.30 $641.10 Continued on Back DEC —PAGE (03-14) (Page 1 of 4) Renewal Page 9 of 48 ............................................................ Total Six Month Premium ...................... $2,164.90 *Coverage applies where a premium or $0.00 is shown for a vehicle. If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee amount will be shown on your billing statements and is subject to change. Discounts and Surcharges Discounts Anti -Theft Device (All Vehicles) Multi -Car (Veh 1, 3) California Good Driver (All Vehicles) Loyalty Persistency (All Vehicles) Subclass Factor (Veh 2, 3) Surcharges Accident and/or Conviction (Veh 1) Group Insurance Plan: Professional Group Insurance Plan Contract Type: A30CA Contract Amendments: ALL VEHICLES - A30CA SIGPGCW Unit Endorsements: UE315C(VEH 2,3) Class: 0 -N -14SM - T (VEH 1); A -N -34MF - T (VEH 2); A -N -09SF - T (VEH 3) Important Policy Information - You have elected to receive your insurance documents via electronic delivery at the electronic mail address displayed on this Declarations Page. To change the address where you receive your policy documents, visit geico.com or call 1-800-841-3000. - No coverage is provided in Mexico. - Reminder - Physical damage coverage will not cover loss for custom options on an owned automobile, including equipment, furnishings or finishings including paint, if the existence of those options has not been previously reported to us. This reminder does NOT apply in VIRGINIA, however, in Virginia coverage is limited for custom furnishings or equipment on pick-up trucks and vans but you may purchase coverage for this equipment. Please call us at 1-800-841-3000 or visit us at geico.com if you have any questions. - Congratulations! Your policy qualifies for the Professional Group Insurance Plan and includes a savings of $785.00. - Subject to the policy carrying Comprehensive and/or Collision Coverage, if a non -owned auto, in operation while leased or rented for a fee, has a Manufacturer Suggested Retail Price above $100,000, the limits of liability for loss to the non -owned auto is the highest of the actual cash value of any owned auto shown on the declarations page. Continued on Next Page DEC —PAGE (03-14) (Page 2 of 4) Renewal Page 10 of 48 Important Policy Information - For your protection, California law requires the following to appear on this form: "Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison." - Confirmation of coverage has been sent to your lienholder and/or additional insured. - In California, you have the right to designate one person to receive notices from GEICQ if your policy is about to cancel or expire for non-payment. Your designee will not have any rights or benefits under your policy other than the right to receive the notice or make a payment. You can change or remove the designee at any time. If you would like to add, change or remove a designee from your policy, simply log into your account at geico.com or call us at 1-800-841-3000. - Claims incurred while an insured vehicle is being used to carry passengers for hire may not be covered by this contract. Please review the contract for a full list of exclusions and contact us if you plan to use any of your insured vehicles for this purpose. - Please verify that the coverages you requested are accurately reflected on your Declarations Page. Visit geico.com to review additional coverages and/or limits available to you. - In accordance with Section 1872.87 of the California Insurance Code, in addition to your premium, a $0.88 charge per vehicle is assessed to fund auto insurance fraud reduction initiatives. This charge is applied once per policy term per vehicle. - The annual mileage figures applicable to the vehicles on your policy for the current and upcoming policy periods are: Vehicle Current Mileage Upcoming Mileage 2016 Nissan Altima I2,000 12,000 2014 Toyota RAV4 I2,000 12,000 2015 Honda Accord I2,000 12,000 DEC_PAGE (03-14) (Page 3 of 4) Renewal Page 11 of 48 TYSERS 71 Fenchurch Street London FC3M 4BS Telephone: +44 M20 3037 8000 Fax: +44 (0Z 3037 8010 www.tysers.com CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE Form: Tysers SafeGuard 2021 - primary Policy Number: MR244153 Unique Market Reference: B0572MR244153 Renewal of: MR234153 Named Insured: Name: City of Cupertino — Parks and Recreation Department, Public Works Department Address: 10300 Torre Avenue, Cupertino, CA 95014 Policy Period: From: 1st July 2024 To: I" July 2025 Both days at 12:01 a.m. Local Time at the Address specified above Limit of Liability: a) USD 5,000,000 in the aggregate during the policy period for all claims brought by or on behalf of each victim, and b) USD 5,000,000 in the aggregate during the policy period for all claims brought by or on behalf of all victims and separately: c) USD 75,000 in the aggregate during the policy period for all safeguard costs resulting from all circumstances Such Limit of Liability shall be in addition to the overall Limit of Liability stated in a) and b) above. Retention: USD 35,000 each Victim Optional Extension Period: 12 months Additional premium of 100% of the annual premium plus applicable taxes, provided no claims and/or circumstances have been reported to the insurance company. In the event any claims and/or circumstances have been reported to the insurance company, the additional premium for the 12 month optional extension period will be determined by the insurance company at the time this Policy is not renewed or replaced by the insurance company Premium: USD 34,650 to be paid within 30 days of inception Notification pursuant to Clause IX. Shall be given to: Beazley Group Attn: Claims Group 30 Batterson Park Road Farmington, CT 06032 claims ,beazley.com or Other Notices: To report a circumstance under the Safeguard Additional Coverage, Call +1 844 285 4700 where a service representative will be available 24 hours a day, seven days a week Retroactive Date: V July 2018 Pending or Prior Litigation Date: 1 st July 2018 Service of Suit: Service of process in any suit shall be made upon: Lloyd's America, Inc. Attention: Legal Department 280 Park Avenue, East Tower, 25th Floor New York, NY 10017 Governing Law: New York Conditions: Application Dated: 25" June 2024 California Surplus Lines Notice California Complaints Notice Nuclear Incident Exclusion Clause -Liability -Direct — NMA 1256 Radioactive Contamination Exclusion Clause -Liability - NMA 1477 War and Terrorism Exclusion — NMA 2919 US Terrorism Risk Insurance Act of 2002 as amended New & Renewal Business Endorsement — LMA5389 Several Liability Notice— LMA5096 Sanctions Limits Clause - LMA3100A Tysers SafeGuard 2021 - Risk Management & Response Solutions Cyber Acts Clarification U.S Classification: Surplus Lines Broker and State filed in: Risk Placement Services, 2850 Golf Road, Rolling Meadows, IL 60008 License Number: OC66724 State of Filing: CA Brokerage: 20% or same net equivalent downwards, plus taxes as applicable Information: Employees — 235 Contractors — 90 Exposure Units — 70,000 Nature of Business --- Municipality Cancellation by an Insured may result in a short rate calculation to determine the return premium, subject to 5% minimum earned of the total premium. Underwriting Security: 100% Lloyd's (Information About Lloyd's) 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 John Casibang. 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 7 day of February 2025, at Cupertino , California. John "Lexi" Casibang PRINT NAME 0 SIGNATURE Updated 06123121 EXHIBIT D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of John Casibang; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that John Casibang 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 NameJohn "Lexi" Casibang Title Personal Trainer/ Grouo Fitness Instructor Date Feb 7, 2025 1386923.1 Updated 6123121 Fitness Instruction Final Audit Report 2025-02-10 Created: 2025-02-07 By: Webmaster Admin (webmaster@cupertino.org) Status: Signed Transaction ID: CBJCHBCAABAAR5hxhr6oegsMWMhNE5NMFZouHBst1TvW "Fitness Instruction" History Document created by Webmaster Admin (webmaster@cupertino.org) 2025-02-07 - 8:18:06 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2025-02-07 - 8:23:12 PM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2025-02-07 - 8:23:21 PM GMT- IP address: 52.202.236.132 dp Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2025-02-07 - 10:04:41 PM GMT - Time Source: server- IP address: 71.202.76.156 Document emailed to for signature 2025-02-07 - 10:04:44 PM GMT Email viewed by 2025-02-07 - 10:04:50 PM GMT- IP address: 74.125.209.7 d Signer entered name at signing as John "Lexi" Casibang 2025-02-08 - 2:11:28 AM GMT- IP address: 172.59.161.230 d4 Document e-signed by John "Lexi" Casibang ( Signature Date: 2025-02-08 - 2:11:30 AM GMT - Time Source: server- IP address: 172.59.161.230 Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature 2025-02-08 - 2:11:33 AM GMT Email viewed by Christopher Jensen (christopherj@cupertino.org) 2025-02-08 - 2:11:40 AM GMT- IP address: 52.202.236.132 Document e-signed by Christopher Jensen (christopherj@cupertino.org) Signature Date: 2025-02-08 - 3:03:31 AM GMT - Time Source: server- IP address: 104.1.88.56 Powered by Q I � Adobe cvrLr Ihv Acrobat Sign Document emailed to Rachelle Sander (rachelles@cupertino.org) for signature 2025-02-08 - 3:03:33 AM GMT Email viewed by Rachelle Sander (rachelles@cupertino.org) 2025-02-08 - 3:03:43 AM GMT- IP address: 52.202.236.132 Document e-signed by Rachelle Sander (rachelles@cupertino.org) Signature Date: 2025-02-10 - 3:33:24 PM GMT - Time Source: server- IP address: 98.51.212.207 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-02-10 - 3:33:27 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-02-10 - 3:33:36 PM GMT- IP address: 3.232.50.116 d4 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-02-10 - 5:19:53 PM GMT - Time Source: server- IP address: 174.194.128.81 Agreement completed. 2025-02-10 - 5:19:53 PM GMT Powered by Adobe c�rerrrinv Acrobat Sign