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10-001 Philip Lenihan CITY OF AGREEMENT 31!" CITY OF CUPERTINO 10300 Torre Avenue 4, St. + 9, us Cupertino, CA ! 5014 ‘977-1-77 (408) 777 -3200 NO. CUPERTINO V � Fiscal Year 20010 -2011 BY THIS AGREEMENT made and entered into on the 12th day of February, 2010 by and between the CITY OF CUPERTINO (Hereinafter referred to as CITY) and (1) Philip Lenihan Address: Hereinafter referred to as CONTRACTOR), in consideration of their mutual covenants, the parties hereto agree as follows: CONTRACTOR shall provide or furnish the following specified services and /or materials: Inline Skating Instruction EXHIBITS: The following attached exhibits hereby are made part of this Agreement: Exhibit A TERMS: The services and /or materials furnished under this Agreement shall commence on July 1, 2010 and shall be completed by June 30, 2011. COMPENSATION: For the full performance of this Agreement, CITY shall pay CONTRACTOR: $17.50 Per Participant GENERAL TERMS AND CONDITIONS: Hold Harmless. CONTRACTOR agrees to save and hold harmless the CITY, its officers, agents, and employees from any and all damage and liability of every nature, including all costs of defending any claim, caused by or arising out of the performance of this Agreement. CITY shall not be liable for acts of CONTRACTOR in performing services described herein. Insurance. Should the CITY require evidence of insurability, CONTRACTOR shall file with CITY a Certificate of Insurance before commencing any services under this Agreement. Said Certificate shall be subject to the approval of CITY'S Director of Administrative Services. Non - Discrimination. It is understood and agreed that this Agreement is not a contract of employment in the sense that the relation of master and servant exists between CITY and undersigned. At all times, CONTRACTOR shall be deemed to be an independent contractor and CONTRACTOR is not authorized to bind the CITY to any contracts or other obligations in executing this Agreement. CONTRACTOR certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of CITY. Changes. This Agreement shall not be assigned or transferred without the written consent of the CITY. No changes or variations of any kind are authorized without the written consent of the CITY. CONTRACT COORDINATOR and representative for CITY shall be: NAME: Jeff Ordway DEPARTMENT: Parks & Recreation J O ENTERED This Agreement shall become effective upon its execution by CITY. In witness thereof, the parties have executed this Agreement the day and year first written above. CITY OF C)JPERTINO: By: `- - (__./ Title: / /U 'S i t., I G'Q Title: Recreatio Coordinator Social Security/Tax ID #: APPROVALS EXPENDITURE DISTRIBUTION DEPARTMEN o' DATE ACCOUNT NUMBER AMOUNT 1/2- ! 0 580 - 6449 -7014 $400 CITY CL RK D E —_/,962//6) 4/1/i EXHIBIT A 1. The City reserves the right to terminate this Agreement with a 30 -day notice. The contractor may terminate this Agreement with a 30 -day written notice. 2. In the event that the Contractor has employees who will assist in the performance of this Agreement, Contractor shall file with City a Certificate of Worker's Compensation Insurance and for those instructing persons 18 years and younger, provide fingerprint clearance and current TB test. 3. In the event that less than the required minimum number of participant shall request and pay for services prior to the agreed upon time for the commencement of services to be preformed by Contractor, City may cancel and withdraw from this Agreement. 4. City shall have no right of control as to the manner Contractor performs the services to be performed. Nevertheless, City may, at any time, observe the manner in which such services are being performed by the contractor. 5. The Contractor shall comply with all applicable Federal, State, and local laws and ordinances including, but not limited to, unemployment insurance benefits, FICA laws, and the City business license ordinance. 6. The Contractor shall not promote his /her business to participants registered in the City's programs. Revised 9/23/07 \ fp; CUPERTINO City of Cupertino Contractor Affidavit The undersigned does hereby certify that: ?At I am a representative of Li Q L- :4, r N P,t.i (contract or company name); that I am familiar with the fact herein certified and am authorized and qualified to execute this certificate. 2. I verify that Pt -1.t,.( � -�= ' ( contract or company name) 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 Contract, 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. That a complete and accurate list of Contractor's employees who may come in contract with minors during the course and scope of the contract is included below 4. All of the below mentioned employees have tested negative for TB, or X -ray results for TB, and have current documentation on file with Contrac:or. A List of all Contractor Employees Working for the City of Cupertino: p L.E /4J 5. The City of Cupertino will be notified by Contractor of any new employees and will be added to the above list prior to beginning work for the City of Cupertino. Contractor Signatur 4(-7 '4.4 7 -1/8/ { Date: /i8� Z3 F Staff Title: I Ai WV C CJ ' ACORD. CERTIFICATE OF LIABILITY INSURANCE 3 /1/2010 ' PRODUCER (317) 844 -0273 FAX: (317) 972 -7142 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE City Securities Corp. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8900 Keystone Crossing ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 300 Indianapolis IN 46240 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Starr Indemnity & Skate Instructors Association Inc INSURER B: AND PHILIP LENIHAN INSURER C: 6832 27th Avenue NE INSURER D: Seattle WA 98115 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YY) DATE (MM /DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED X COMMERCIAL GENERAL LIABILITY PREM SES occurrence) $ 300,000 A CLAIMS MADE X OCCUR P2GL10000002 /P2GL10808002 1 /:L /2010 1/1/2011 MED EXP (Any one person) $ 5,000 X INCLUDES ATHLETIC PERSONAL & ADV INJURY $ 1,000,000 PARTICIPANTS GENERAL AGGREGATE $ 2 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 PRO - POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ , WORKERS COMPENSATION AND WC ST OTH- EMPLOYERS' LIABILITY TORY LIMIT MITS ER ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPE :IAL PROVISIONS CERTIFICATE HOLDER IS ADDED AS AN ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR BUT ONLY WITH RESPECT TO LIABILITY ARISING FROM THE OPERATIONS OF THE NAMED INSURED DURING THE POLICY PERIOD CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF CUPERTINO EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL CUPERTINO CITY HALL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 10300 TORRE AVENUE FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE CUPERTINO, CA 90514 -3202 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Patrick O'Connor /MJL ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IAIQn /c /nlnv, no.. 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