06. Kaboom playground at Sterling ParkDEPARTMENT OF'PARKS AND RECREATION
CUPERTINO
CITY HALL
10300 TORRE AVEIVUE • CUPERTINO, CA 95014-3255
TELEPHONE: (408) 777-3110 • FAX: {408) 777-3366
STAFF REPORT
Agenda Item No.
SUBJECT AND LSSUE
MEETING DATE: February 16, 2010
Authorize the City Manager to negotiate and execute a contract with KaBOOM!, Inc. in the amount
of $76,800 for the construction of a playground at Sterling Park.
BACKGROUND
The new park on Sterling Boulevard in Cupertirio's Rancho Rinconada neighborhood will be under
construction soon. Anew playground is includf;d in the new park.
KaBOOM!, Inc. is anon-profit organization that works with communities to build playgrounds.
The KaBOOM! process involves hundreds of cc-mmunity members who build a playground in one
day. KaBOOM! has helped build over 1500 playgrounds throughout the United States. City of
Cupertino partnered with KaBOOM!, Cupertino Rotary, and De Anza College to build the Captain
Stephens Playground at Blackberry Farm Park.
The Captain Stephens Playground Build was a very successful community building project
involving over 300 volunteers. Many who participated on Build Day asked that we have another
project with Rotary and KaBOOM! and suggested Sterling Park as candidate. Building this
playground will have a similar positive impact c-n the Rancho Rinconada neighborhood.
DISCUSSION
Working with KaBOOM!, provides Cupertino vrith a unique opportunity to strengthen community
relationships within the Rancho Rinconada neighborhood and make the Cupertino community more
aware of the neighborhood and the new park.
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The Cupertino Rotary is also a partner with this project and provides volunteer leaders who helped
with the Captain Stephens Playground at Blackberry Farm Park in June 2009. The City will invite
other service clubs to participate.
The work for the site preparation by the contractor, as well as the scheduling of the build day at
Sterling Park, will be determined through coordination with KaBOOM! and by a Contract Change
Order with the construction contractor. It is planned to occur sometime during the month of May
2010.
We anticipate approximately 200 volunteers working under the direction of KaBOOM! to construct
this new playground. The playground will be in the same location that was planned for a
playground constructed by the contractor. Build day will include food, music, and activities for
children.
Through our Leadership and Learning Partnership with De Anza College, two classes are
considering making the KaBOOM! build their service learning project. Two De Anza classes
previously worked with Cupertino Block Leaders to help with the Captain Stephens Playground
Build. Under the guidance of Block Leaders Tom Dyer and David Greenstein, the students
canvassed the neighborhood around Blackberry Farm to invite the neighbors to participate on Build
Day and to come to the Grand Opening on July 4, 2009. If the students decide to assist with the
Sterling Park playground build, they would work with Block Leaders in the neighborhood to
implement similar actions, including inviting the neighborhood to attend the Grand Opening in the
summer of 2010.
The contract with KaBOOM! has the City assuming all of the liability. KaBOOM! will not change
the contract language. Staff believes the community benefit of the project overrides the potential
liability. KaBOOM! has not experienced claims or lawsuits at its 1500 other sites. The City has
assumed full liability with other recreation contracts such as the pool lease agreement with the
Fremont Union High School District, to use the Cupertino High School swimming pool.
The draft contract with KaBOOM! is attached (Attachment A)'.
SCHEDULE AND FISCAL IMPACT
The project budget in account 420-9126 of the approved 2009-2010 Capital Improvement Program
is $700,000.00. The total cost for the KaBOOM! component is $76,800. The funding required for
design and construction is $589,345.00. The project funding required with the addition of the
KaBOOM! playground is as follows:
Project Design and Administration $125,000
Construction Management 45,000
Construction {Low Bid Awarded 11-30-09) 364,345
Construction Contingency 55,000
KaBOOM! Contract 76,800
Total Project with KaBOOM! $66b,145
Budget Balance Remaining $ 33,855
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The cost of building a playground with KaBOOM! is roughly $20,000 more than having the
contractor build it without community involvement. KaBOOM! brings staff with experience in
organizing community volunteers to build the playground in one day. The result of a City, Rotary,
and KaBOOM! partnership is a stronger and mare united community. Further, the community in
the immediate area tends to take personal responsibility for the playground.
RECOMMENDATION
Staff recommends that the City Manager be aut}iorized to negotiate and execute a contract with
KaBOOM!, Inc. in the amount of $76,800 for tb.e construction of a playground at Sterling Park.
SUBMITTED BY:
ark index
Director, Parks and Recreation
APPROVED FOR SUBMISSION BY:
David W. Knapp
City Manager
Attachment A
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At#~~chment A
~` ~~ , --
~~ ~ DRAFT FUNDING PARTNER PLAYGROUND CONTRACT
° ~ ~ ° ~ ,2010
.~- ~~ ~~ ~
KaB00M!, Inc. ("KaB00M!") is pleased tha# City of Cupet#ino ("Funding Partner's has agreed to collaborate with KaB00M! and a
Community Partner (the "Community Partner"} on the creation of a new playground in Cupertino, Cal'rfomia (the "Project"}. This Funding
Partner Playground Contract ("Agreement"), which se#s forth the Funding Partner's obligations in connection with the Project and certain
matters on which the parties have agreed, will, when executed by the duly authorized representatives of each party, supersede any prior
agreements and represent the complete legally binding agreement between the parties.
Obligations of KaB00M!.
Project Management. KaB00M! shall manage the overall execution of fhe Project on behalf of the Funding Partner. KaB00M! shall
assign a project manager who shall supervise the planning and installation of the playground, including overseeing a "Design Day"
event, presenting playground designs, convening committee conference calls, assuring that the necessary materials, tools and
equipment are on hand and managing the one-day playground installation event, which is referred to as the "Build Day" and which is
scheduled to occur on May 15, 2010.
Vendors. KaB00M! shall select and manage vendors that will provide necessary equipment for the playground (e.g., surfacing,
playground equipment, peripheral projec#s, landscaping, etc,). KaB00M! shall use commercially reasonable efforts to guard
against any loss #o the Funding Partner through the failure of suppliers to properly honor their commitments, but KaB00M! shall not
be held responsible for any such failure on their part.
Inspection. KaB00M!, in collaboration with the Funding Partner, will secure a Certified Playground Safety Inspector to review the
playground structure at fhe conclusion of the Build Day (or, if KaB00M! assumes responsibility for the playground construction
going beyond one day, at the conclusion of the installation) fo ensure that the structure is safe and built fo all appropriate standards
and guidelines, unless the Project is not completed an the Build Day due to failure of the Funding Partner, in which case the
Funding Partnershall secure the Certified Playground Safety Inspector.
Warran KaB00M! will obtain a warranty from the playground equipment manufacturers that all equipment meets or exceeds current
government-approved safety standards. Obtaining such warranty shall be the total extent of the liability of KaB00M! to the Funding
Partner with respect to the playground equipment, and the Funding Partner agrees that KaB00M! has not made nor is if in any
manner responsible or liable for any warranty, representation, or guarantee, express or implied, in fact or in law, rela#ive to any
playground equipment, including without limitation the quality, mechanical condition or fitness for a particular purpose of the
playground equipment. Any and all warranties andlor guarantees on playground equipment are subject to the respective
manufacturers' terms and therefore, the Funding Partner agrees to look solely to such manu#acturers for any such warranty andlor
guarantee,
Insurance. KaB00M! represents and warrants it has, and, upon request, shall provide evidence of, the following insurance coverage:
Commercial General Liability with a limit of $1,000,000 per occurrence with a general aggregate limit of $2,000,000 and umbrella
coverage of at least $1,000,000 per occurrence; Workers' Compensation with statutory limits for the state in which the work is
performed and employers liability insurance with a minimum of $500,000 per accidenf; and Automobile Liability for owned, hired and
non-owned autos with a combined single limit of $1,000,000. KaB00MI shall require that any subcontractor hold and maintain
insurance coverage that includes Commercial General Liability and Worker's Compensation coverage of at least the levels held by
KaB00M!.
Build Guild. KaB00M! will place the playground on the roster of KaB00M! Build Guild and KaB00M1 will send information to the
Funding Partner on playground maintenance programming and enhancements.
Obligations of the Funding Partner,
Project Site.
(i) Ownership. At the time of execution of this agreement, the Funding Partner shall provide KaB00M! with proof of land
ownership evidenced by either a deed granting title to the property to the Funding Partner or a letter from the property owner
showing approval for the Project. Funding Partner will allow the playground to be constructed on its property, vvifl participate in
the organization and planning process and will be the owner of the playground in its entirety, including the equipment and
safety surfacing, and subsequent maintenance. The Funding Partner is the owner of the playground in its entirety, for the
lifetime of fhe playground, including the equipment andlor safety surfacing purchased by KaB00M! andlor its funding partners.
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{ii) Permits. The Funding Partner shall obtain all necessary hermits and licenses regarding the installation, possession and use of
the playground prior to Build Day in compliance with local and state laws, regulations and guidelines.
(iii) Preparation. The Funding Partner shall ensure that the playground site is safe far volunteers and children, which responsibility
includes, without limitation: (1 }preparing the site for the installation of the new playground at least two weeks before Build
Day, which includes but is not limited to removing existing playground equipment, footers and safety surfacing, grading the
land, removing fencing and performing soil tests; (2} concluding up to two utility checks as reasonably requested by KaBOOMt
with fhe appropriate ufility companies with the first test being completed within two weeks of Design Day and with all utility
check documentation provided to the KaBOOM! Project ~4anager upon completion; and (3}conducting up to two soil site tests
as reasonably requested by KaBOOMl, with the first fest being completed within two weeks of Design Day and with a{I soil
check documentation provided to the KaBOOM! Project A9anager upon completion. The Funding Partner is responsible far
undertaking any necessary risk mitigation should the soil be deemed unsafe for children and volunteers.
(iv} Safety and Security. The Funding Partner together with ttie Community Partner is responsible for ensuring the security of
equipment, tools, supplies and well being of the adults and children from the beginning of the preparation activities un#il the
conclusion of Build Day, including any postponement.
(v} Maintenance. The Funding Partner shall collaborate with Ka8O0Ml during the Project planning process to develop a
maintenance program for the playground and shall maintain the playground and the property before and after the build #o
ensure a safe and attractive play space. In addition, the Funding Partner shall accept and maintain engineered wood fiber as
playground safety surfacing, meefing standards established by Consumer Product Safety Commission guidelines, for the
lifetime of the playground. Maintenance of the playgroun~j facility and supervision of its use is the sole responsibility of the
Funding Partner. Upon request, the playground equipment and safety surfacing manufacturers, including Playworld Systems,
Inc, will provide guidance and materials for the purpose of developing a maintenance plan for the playground.
Build Dav. The Funding Partner shall recruit $0 adult volunteers from the community to participate in a one-day installation event for the
Project, which is scheduled to occur on May 15, 2090 and which is referred to herein as the Build Day, On the Build Day, The
Funding Partner shall provide food, water, tools, power, and re:;troom facilities for all volunteers.
Playground Costs. The Funding Partner is solely responsible for and shall hold KaBOOM! and its Community Partner harmless from any
costs beyond the proposed Project budget, including costs incurred by the Community Partner for any prior site preparation,
upgrades or improvements or any equipment or materials purchased to supplement those secured by KaBOOM!.
Warran .The playground equipment and the safety-surfacing related to the Project may be covered under warranty by the applicable
manufacturers; a copy of which warranty may be obtained, upon reques#, from such manufacturers. The Funding Partner
acknowledges that any warranties andlor guarantees on any equipment or material are subject to fhe respective manufacturer's
ferms thereof, and the Funding Partner agrees to look solely to such manufacturers for any such warranty andlor guarantee.
Neither KaBOOM! nor its funding partners nor any of their resp~:ctive affiliates, directors, officers, managers, partners, members,
shareholders, employees, agents or representatives, have made nor are in any manner responsible or liable far any representation,
warranty or guarantee, express or implied, in fad or in law, relative to any equipment or material, including, without limitation, its
quality, mechanical condition or fitness for a particular purpose.
(b) Insurance. The Funding Partner shall obtain and maintain from the dale of this agreement and far a minimum of one (1 }year
thereafter worker's compensa#ion insurance policies and commercial general liabillty insurance (providing coverage against liability
for bodily injury, death and property damage that may arise out of or be based upon the use of the playground), in each casein
amounts not less than one million dollars {$1,000,000). At the lime of execution of this agreement, the Funding Partner shall
provide #o KaBOOM! a copy of a certificate from its insurer indic;afing the nature, scope, duration and amount of insurance coverage,
and naming KaBOOM! and its funding partners as additional in:~ureds under such policy, which insurance shall be primary over any
other insurance covering KaBOOM! and its funding partners and which policy shall provide that KaBOOM! and its funding partners
be given at least thirty {30) days' prior written notice of any change or cancellation of coverage.
(c) Indemnification. The Funding Partner shall indemnify and hold harmless KaBOOMt, its community partners and their respective
affiliates, directors, officers, managers, partners, members, shareholders, employees, agents and representatives from any and all
losses, liabilities, claims, actions, fees and expenses (including interest and penalties due and payable with respect thereto and
reasonable attorneys' and accountants' fees and any other reasonable out-of-pocket expenses. incurred in investigating, preparing,
defending or settling any action}, expenses {including attomey';~ fees and disbursements} in each case that are due and payable,
including any of the foregoing arising under, out of or in connection with any actions associated with this Projector resulting from the
use of any playground property and equipment, including (hose for personal injury, death, or property damage, except to the extent
resulting from the willful misconduct of such indemnified person, This provision shall survive any termination or expiration of this
agreement.
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Comnensation.~ In consideration for KaB00M! management of the Project, the Funding Partner agrees to compensate KaB00M! the
amount of $76,800 according to the following schedule:
Twenty-five percent (25%) or the total ($19,200) shall be due within 30 days of signing of this Agreement.
Seventy percent (70%) of the total ($53,760) shall be due 45 days prior to the Build Day date.
Five (5%) of the total ($3,840) shall be due within 15 days of the completion of fhe playground installation.
The total of any additional fees and expenses incurred pursuant hereto will be due within 30 days of invoicing.
Past-due accounts shall be assessed a monthly finance charge of 1'/s % or the maximum rate allowed by law, whichever is greater.
Timeline. The Funding Partner will respond fo KaB00M! on fhe dates and fimes reasonably set forth #or the Project.
The Funding Partner will identify its Project market to KaB00M! at least six mon#hs in advance of the Build Day,
Following the confirmation of the Community Partner by the Funding Partner, the Funding Partner and KaB00M! will identify a Build
Day date which shall occur on a mutually agreeable date no later than December 31, 2010.
Additional Materials. If the Funding Partner decides to purchase additional equipment to supplement materials secured by KaB00M!
through the Project budget, then the Funding Partner is responsible for paying for the materials directly. Funding Partner will hold
KaB00M! harmless of any paymen#s or liability with respect to the additional items ordered.
Grant of Promotional Rights. KaB00M! will provide an opportunity for the Funding Partner and Community Partner names and logos to
appear on fhe permanent playground site sign and on certain materials developed jointly by KaB00M! and the Community Partner
pertaining to the Project Funding Partner and Community Partner may create and promote Design day and Build Day events including
posting banner{s) with Funding and Community Partners name and logo a# the Project site.,
Intellectual Property.
The Funding Partner acknowledges and agrees that KaB00M! is the sole owner of all right, title and interest in and to the name and
mark KaB00M! {the "Mark") and the tagline "It Starts with a Playground." (the "Tagline"), each in any form or embodiment, as well
as the designs and logos as specified on fhe KaB00M! website at www.kaboom.orglstyle (the "Logos", and together with the Mark
and the Tagline (and any successor marks, #aglines, or logos), the "KaB00M! Marks°}, as well as all goodwill attached or which
shall become attached to any of the foregoing. The Lago is comprised of the Mark and Tagline in a starburst design. On occasion,
the Logo may be used wi#hout the Tagline; however, prior written approval of KaB00M! is required for such use. Guidelines for the
usage of fhe Logo are available from KaB00M? or via the Intemet at www.kaboom.org/style. The Funding Partnerfurther
acknowledges and agrees that, as between the parties, KaB00M! is fhe sole owner of all label designs, product identifications,
artwork, symbols, devices, manuals, guides, inventions, and publications produced as part of Ka600M! operations, services, and
programs. The parties acknowledge that KaB00M! may take all steps to protect the KaB00M! Marks and its other property as
KaB00M! deems appropriate.
During the term of this contract, KaB00M! hereby grants to the Funding Partner a limited, non-exclusive, non-transferable, non-
sublicensable, worldwide, royalty-free license to use the KaB00M! Marks, and the Funding Partner hereby grants to KaB00M! a
limited, non-exclusive, non-transferable, non-sublicensable, worldwide, royalty-free license to use the Funding Partner's name,
trademarks, service marks, and logos, solely to promote the Project, including, without limitation, in broadcast, print, and Intemet
media and advertising, press releases, and other media materials, internal communications materials, and promotional materials,
but only as provided below. Other than in connection with the materials jointly developed as provided in Section 3, each party will
obtain the prior written approval of the other before using the o#her party's name, marks, or logos in connection with any publicly
distributed materials, provided That the party whose approval is being sought will not unreasonably withhold or delay its approval.
KaB00M?shall have the right to review and approve the type, manner, location, and duration of any advertisements or promotions
in which the Funding Partner references the KaB00M! Marks, the Project, or its participation in the Project. All such advetisements.
and promotions, inclusive of merchandising, sampling and special events, shall be at the expense and liability of fhe Funding
Partner.
The Funding Partner shall not manufacture, sell, or distribute, or license or otherwise permit the manufacture, sale or distribution of, any
merchandise that incorporates or includes the KaB00M? Marks, without prior written consent of KaB00M!.
Any use of the Ka800M! Marks by the Funding Partner will inure to the sole benefit of KaB00M!. The Funding Partner shall not use the
KaB00M! Marks in any manner that would hams fhe reputation of KaB00M! or disparage or negatively reflect upon the KaB00M!
Marks, Upon expiration of or termination of #his contract for any reason, the Funding Partner shall cease all use of the KaB00M!
Marks.
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Build Day Postoonemen#. A Build Day shat! not be postponed except when weatl~er ar other conditions jeopardize the safety of the
volun#eers or threaten the structural integrity of the playground. Thc? decision to postpone a Build Day will be made by majority
agreement of the representatives of KaBOOMl, the Funding Partner and the Community Partner, except where such decision must be
made by KaBOOM! on the construction site and representatives of ~;he Funding Partner and the Community Partner are not available for
consultation. In the event that a Build Day !s postponed, KaBOOM!, the Funding Partner and the Community Partner shall develop a
plan for rescheduling the Build Day at the next earliest date possible; for each party and for allocating additional expenses related to the
rescheduled Build Day, In the event that the date of a Build Day is ~;anceiled or changed solely by the Community Partner, the
Community Partner shall be liable to KaBOOM! and the Funding Partner for any equipment costs, labor, and materials and any additional
expenses related to the Project, such as travel expenses and general supplies.
Termination. In the event that the Funding Partner fails to make the paymenfs required under this Agreement, KaBOOM! may terminate the
Agreement upon written notice to the Funding Partner of such termination. Furthermore, if either party is delayed or prevented from
fulfilling any of its obligations hereunder by any cause beyond its re~~sonable control, including acts of God, acts or omissions of civil or
military authorities, fire, strike, flood, riot, act of terrorism, war, transportation delay, or inability due to such causes fo obtain required
labor, materials or facilities, such party shall not be liable hereunder for such delay or failure and either party may terminate this
Agreement if the other is unable to perform any obligation hereundE~r for a period longer than ten calendar days due to such force
majeure event, in which case KaBOOM! shall refund to the Funding Partner any amounts paid to KaBOOM!, less expenses already
committed and/or incurred prior to the date of such termination. If, capon termination as provided herein, the sum due KaBOOM! by
Funding Partner exceeds the sum paid to KaBOOM! hereunder, Funding Partner shall pay KaBOOM! for any such additional sum due
upon presentation of appropriate documentation within 30 days of invoice. Except as set forth above, upon any termination, this
Agreement shall become void and have no effect, and no party shall have any liability to the other party, except that nothing herein will
relieve any party from liability for any intentional breach of this Agreement prior to such termination.
General Provisions. Each party has all requisite power and authority, including any necessary approval by its governing body, to execute and
deliver this Agreement, and to perform its obligations hereunder. This Agreement may not be assigned or transferred by either party
without the prior written consent of the other party hereto. This Agreement shall inure to the benefit of and be binding upon the parties
hereto, their respective successors and permitted assigns, and where expressly stated, their affiliates and representatives. This
Agreement shall be governed by and construed under the laws of the State of New York, without regard to conflicts of laws principles to
the extent that the application of the laws of another jurisdiction woti d be required thereby. This Agreement may be altered, modified or
amended only by a written document signed by both parties. This agreement may be executed in two or more counterparts, each of
which shall be an original and aq of which, when taken together, sh~rll constitute the same Agreement and may be delivered by facsimile
or electronic mail transmission with the same force and effect as if originally executed copies hereof were delivered. Any notices
required or permitted to be given hereunder shall be sent by certified or registered United States mail, postage prepaid, by personal
delivery addressed to the applicable party or by facsimile or electronic mail transmission (the receipt of which is confirmed) at the
address set forth under such party's signature below.
By executing this Funding Partner Playground Contract where indicated below, each of KaBOOM! and the Funding Partner agrees, as of the
date identified above, to be legally bound by all of the terms and provisions set forth above.
City of Cupertino KaBOOM?, Inc.
By:
Name: Mark Linder
Title: Director, Cupertino Parks and Recreation
10300 Torre Avenue
Cupertino, California 95014-3255
T; 408.777.3268
F: 408.777.3366
e-mail: rnarkl@cupertino.org
By:
Name: Bruce M. Bowman
Title: Chief Operating Officer
4455 Conner#icut Avenue, NW, Suite B100
Washington, DC 20008
T: {202} 464-6061
F: (202} 659-0210
e-mail: bbowman@kaboom,org
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2009 Playground Volunteer Build Day Waiver
KaB00M1 PLAYGROUND PROJECT -- VOLUNTEER WAIVER AND RELEASE
This form must be signed by or on behalf of each volunteer who will participate in or otherwise be involved with the
construction of the Blackberry Farm Playground Build (the "Playground Build or the "Project"), or will be on the
construction of the Playground Build, occurring the week of June 6th in Cupertino, CA. If you are unable to read this print,
please speak with the person handling volunteer registration for assistance.
The KaB00Ml project and activities will include the playground construction, side projects and play enhancemenE projects on and in the periphery of
the playground construction site including building interiors. The "playground construction site" is the physical space where the playground is being
installed; the playground construction projects are any activities directly related to the installation and placement of the playground equipment, the
mixing of concrete and moving safety surfacing onto the playground site. Volunteers under age 18 {or under 19 in AL and NE) may not work on the
"playground construction site", as defined above. Volunteers under 18 but who meet this state's minimum age for employment may work gn the side projects,
beautification and play enhancement projects, and other non-playground construction site projects and may help with preparation for the build day if they have
received written approval from a parent or legal guardian for participation. Any children under state's minimum age for employment will not be supervised by
Ka800M! in any way or be allowed to participate in playground ornon-playground construction projects managed by KaB00M!; however KaB00M! will work
with the community partner to procure supplies for use by these children and to help them plan projects that are occurring on a site that is distinctly separated
from the construction site, No children under this state's legal working age should be on the playground construction site.
I understand that I will be spending the day{s) as a volunteer for the Project and
will be participating al my own risk. I acknowledge chat my participation is
voluntary and does not constitute a condition or requirement of employment. I
further acknowledge chat the Project will occur at a construction site and chat the
construction site will be a potentially dangerous place. I attest chat I am physically
fit and prepared for this event.
I will not create an unsafe situation for other individuals or myself nor will I use
any tool or engage in any task with which I am not completely comfortable. I will
abide by all applicable federal, state and local laws, as well as the rules and
directions of the sponsors and coordinators. If I see any situation that I feel is
unsafe, I will immediately call it to the attention of KaB00M! or a safety
coordinator. If I bring any children or young adults with me to participate in the
Project, I will be solely responsible for providing for their safety and will keep them
under dose supervision at all times. FOR EACH PARTICIPANT UNDER 18, THE
PARENT OR GUARDIAN MUST FILL OUT A SEPARATE WAIVER. I
understand that a vdunteer may be at the Project to provide medical treatment in
the event of an injury, and ff necessary to assist in arranging transportation to
medical facilities.
On behalf of myself, as well as my heirs, executors, administrators and assigns, I
hereby forever release, discharge, waive and agree to indemnify and hold
harmless KaB00M!, the.City of Cuperlrio, and he Rotary. Club of Cupertino;;
Playworld Systems Ina, and any additional sponsors of the Project, along with
their respective officers, directors, agents, employees, contractors, successors
and assigns, and any volunteers to whom I give my consent to provide medical
treatment to me or to any children or young adults under my supervision
("Released Parties°), from and against any and all daims, demands, actions,
causes of action, obligations. liabilities. suits. losses. damages, casts, exaenses,
and fees, induding, without limitation, court costs and attorneys' fees, of any and
every nature of character, induding, without limitation, for death, personal injury
andlor loss of property, whether antidpated or unantidpated, directly or indirectly,
whether caused, in whole or in pars, by the sole or concurrent negligence or
wrongdoings, strict liability or fault of the Released Parties or otherwise, arising
out of or connected in any way with my participation in the Project.
I acknowledge that I have read the foregoing paragraph and know and
understand the full contents and effects of it. 1 understand the full nature, extent,
and import of Section 1542 of the California Civi] Code and of the entire release
stated in the foregoing paragraph, Accordingly, I waive and relinquish, any and
all rights or benefits that I may have under the provisions of Section 1542 of the
California Civil Code, which reads as follows: °A general release does not
extend to claims which the aediior does not know or suspect to exist in its fav-
at the time of executing the release, which if known by him must have materia~.,
affected his settlement with the debtor'
I hereby grant KaB00M!, the City of Cupectlno,' and the Rotary Club of
_..
Cupe~irio: full and complete permission to use project photographs, videography
and interview footage and quotations #rom mein legitimate promotions of the
Prgect and to further the mission and vision of KaB00Ml. in any and all media
now known or hereinafter developed without restriction or compensation.
I understand that I have given up substantial rights by signing this waiver
and have signed If fteely and voluntarily without any inducement,
assurance or guarantee being made to me and I INTEND MY SIGNATURE
TO BE A COMPLETE AND UNCONDITIONAL RELEASE of all liability by
Released Parties to the Greatest extent allowed by taw.
Adult Volunteer (AGe 18+) ~ Volunteer Under Age 18
I am here to volunteer from:
_ Rotary Club of Cupertino {i am a: -staff member!-non-staff
member}
_ Local Community
City of Cupertino
Signature of Partidpant Date
Printed Name of Participant
Address
City State Zip
Email AddreSS: Providing email allows us to send you photos of today's build!
^ I would not like to receive information about KaB00M! in the future.
Please frll out a SEPAR,4TE waiver for your child--use this section ONL Y
Signature of Parent or Legal Guardian of Participant
Printed Name of Parent ar Legal Guardian
Do you affirm that your child or dependant meets this state's minimum
age requirements for employment?
^ Yes, my child may volunteer ^ No, my child cannot volunteer
Printed Name of Child Participant Date -