13-001 Fremont Union High School District for contract servicesOFFICE OF THE CITY CLERK
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366
WEBSITE: www.cupertino.org
CUPERTINO
January 13, 2015
Fremont Union High School District
589 West Fremont Avenue
Sunnyvale, CA 94087
Re: First Amendment to Agreement
Enclosed is an original copy of the first amendment to your agreement with the City of
Cupertino. If you have any questions or need additional information, please contact the
Parks and Recreation Department at 408-777-3120.
Sincerely,
Dorothy Steenfott
Senior Office Assistant
Enclosure
cc: Parks & Recreation
No: 58303
FY 14-15
FIRST AMENDMENT TO AGREEMENT BETWEEN THE CITY OF CUPERTINO AND
FREMONT UNION HIGH SCHOOL DISTRICT FOR CONTRACT SERVICES
This First Amendment to the Agreement between the City of Cupertino and Fremont Union High
School District, for reference dated December 17, 2014, is by and between the CITY OF CUPERTINO, a
municipal corporation (hereinafter "City") and FREMONT UNION HIGH SCHOOL DISTRICT, a
California Corporation, whose address is 589 West Fremont Avenue, Sunnyvale, CA 94087 (hereinafter
"referred to as Contractor"), and is made with reference to the following:
RECITALS:
A. On December 2, 2013, the City and Contractor entered into an Agreement for Contract Services
(Agreement); and
B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein.
NOW, THEREFORE, it is mutually agreed by and between and undersigned parties as follows:
I . The term of the Agreement as set forth in Paragraph 1 shall be extended six months,
from January 1, 2015 until June 30, 2015, unless terminated earlier as set forth in the
Agreement; and
2. On or before the term of this First Amendment, Contractor shall provide the City with a
certificate of insurance and additional insured endorsement demonstrating Contractor's
ongoing compliance with the Agreement's insurance obligations and naming the City as
an additional named insured; and
3. Contractor represents, warrants, and declares that the Agreement Exhibit "C" the "City
of Cupertino Consultant Declaration" remains accurate and current.
4. Except as expressly modified herein, all other terms, covenants and conditions set forth
in the Agreement shall remain the same and shall be in full force and effect.
IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed
FREMONT UNION FIGH S HOOL DISTRICT CITY OF CUPERTINO
A Municipal Corporation
By By Dave Jahns
Title: 18W6Z i' Title: Recreation Coordinator
Date: %
APPROVAL:
7!ir0MMFND-EDLEQR
Senior Recreation Supervisor
Date: i
APRRQYED AS TO 1~ Ol:
Date: A =��f
CUPERTINO
January 7, 2014
OFFICE OF THE CITY CLERK
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366
WEBSITE: www.cupertiro.org
Fremont Union High School District
Re: - Agreement for Contract Services
0
Enclosed is a fully executed copy of the above stated agreement with the City of Cupertino. If
you have any questions or need additional information, please contact the Parks and
Recreation department at 408-777-3120.
Sincerely,
Kirsten Squarcia
Deputy City Clerk
Enclosure
cc: Parks & Recreation
FY 13-14
AG MENT BETWEEN THE CITY OF CUPERTINO AND THE FREMONT UNION
HIGH SCHOOL DISTRICT FOR CONTRACT SERVICES
dated December2', 2013 is b and between City
his Agreement, for referenced , Y
of Cupertino, a municipal corporation (hereinafter referred to as "City"), and Fremont
Union High School District, a California State corporation, whose address is
(hereinafter referred to as "Contractor"), and is
made with reference to the following:
RECITALS:
A. City is a municipal corporation duly organized and validly existing under
the laws of the State of California with the power to carry on its business as it is now
being conducted under the Constitution and the statutes of the State of California and
the Cupertino Municipal Code.
B. Contractor is specially trained, experienced and competent to perform the
special services which will be required by this. Agreement; and
C. Contractor possesses the skill, experience, ability, background,
certification and knowledge to provide the services described in this Agreement on the
terms and conditions described herein.
D. City and Contractor desire to enter into an agreement for summer
enrichment program services upon the terms and conditions herein.
NOW, THEREFORE, it is mutually agreed by and between the undersigned
parties as follows:
1. TERM:
The term of this Agreement shall commence on January 1, 2,014 and shall
terminate on December 31, 2014 unless terminated earlier as set forth herein.
2. SERVICES TO BEPERFORMED:
Contractor shall perform each and every service set forth in Exhibit "A" which is
attached hereto and incorporated herein by this reference.
3. COMPENSATION TO CONTRACTOR:
Consultant shall be compensated for services performed pursuant to this
Agreement in the amount set forth below. The total compensation under the Agreement
is not to exceed $120,000.00.
Compensation:
The City shall pay the Contractor 80% of the revenue received from participants
enrolled in classes listed in the Scope of Services.
The City will issue no more than two payments per quarter and, if needed, one final
payment at the end of this agreement to close the account.
4. ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS:
Contractor shall comply with the requireiments of California Penal Code 11164-
11174.3 and as set forth in Exhibit "B" which is attached hereto and incorporated herein
by this reference.
5. FINGERPRINT AND TUBERCULOSIS; (TB) CONTRACTOR DECLARATION:
Contractor agrees that all individuals covered under this Agreement shall provide
fingerprints for criminal background test purposes and results of TB screening, pursuant
to the requirements as set forth in Exhibit "C" which is attach hereto and incorporated
herein by this reference.
6. TIME IS OF THE ESSENCE:
Contractor and City agree that time is of the essence regarding the performance of this
Agreement.
7. STANDARD OF CARE:
Contractor agrees to perform all services hereunder in a manner commensurate
with'the prevailing standards of like professionals in the San Francisco Bay Area and
agrees that all services shall be performed by ,qualified and experienced personnel who
are not employed by the City nor have any contractual relationship with City.
8. INDEPENDENT PARTIES:
City and Contractor intend that the relationship between them created by this
Agreement is that of and independent contractor. The manner and means of conducting
the work are under the control of Contractor except to the extent they are limited by
statute, rule or regulation and the express terms of this Agreement. No civil service
status or other right of employment will be acquired by virtue of Contractor's services.
None of the benefits provided by City to its employees, including but not limited to,
unemployment insurance, workers' compensation plans, vacation and sick leave are
available from City to Contractors, its employE�es or agents. Deductions shall not be
made for any state or federal taxes, FICA payments, PERS payments, or other
purposes normally associated with an employer-employee relationship from any fees
due. Contractor. Payments of the above items, if required, are the responsibility of
Contractor.
9. IMMIGRATION REFORM AND CONTROL ACT (IRCA):
Contractor assumes any and all resporisibility for verifying the identity and
employment authorization of all of his/her employees performing work hereunder,
pursuant to all applicable IRCA or other federal, or state rules and regulations.
Contractor shall indemnify and hold City harmless from and against any loss, damage,
liability, costs or expenses arising from any noncompliance of this provision by
Contractor.
10. NON-DISCRIMINATION:
Consistent with City's policy that harassment and discrimination are
unacceptable employer/employee conduct, Contractor agrees that harassment or
discrimination'directed toward a job applicant; a City employee, or a citizen by
Contractor or Contractors' employee or subcontractor on the basis of race, religious
creed, color, national origin, ancestry, handicap, disability, marital status, pregnancy,
sex, age, or sexual orientation will not be tolerated. Contractor agrees that any and all
violations of this provision shall constitute a material breach of this Agreement.
11. HOLD HARMLESS:
A. Contractor shall, to the fullest extent allowed by law, with respect to all
services performed in connection with the Agreement, indemnify, defend, and
hold harmless the City and its ofl*icers, officials, agents, employees and
volunteers from and against any and all liability, claims, actions, causes of action
or demands whatsoever against any of them, including any injury to or death of
any person or damage to property or other liability of any nature, whether
physical, emotional, consequential or otherwise, arising out, pertaining to, or
related to the performance of this Agreement by Contractor or Contractors'
employees, officers, officials, agents or independent contractors. Such costs and
expenses shall include reasonable attorneys' fees of counsel of City's choice,
expert fees and all other costs and fees of litigation.
B. Claims for Other Liability. Contractor shall, to the fullest extent allowed
by law, with respect to all services performed in connection with the Agreement,
indemnify, defend, and hold harmless the City and its officers, officials, agents,
employees and volunteers against any, and all liability, claims, actions, causes of
action or demands whatsoever from and against any of them, including any injury
to or death of any person or damage to property or other liability of any nature,
that arise out of, pertain to, or relate to the negligence, recklessness, or willful
misconduct of Contractor or Contractors' employees, officers, officials, agents or
independent contractors. Such costs and expenses shall include reasonable
attorneys' fees of counsel of City's choice, expert fees and all other costs and
fees of :litigation. Contractors shall riot be obligated under this Agreement to
indemnify City to the extent that the damage is caused by the sole or active
negligence or willful misconduct of City, its agents or employees.
C. Claims involving intellectual properly. In addition to the obligations set forth in
(A) and (B) above, Contractor shall indemnify, defend, and hold the City, its
elected and appointed officers, employees, and volunteers, harmless from and
against any Claim in which a violation of intellectual property rights, including but
not limited to copyright or patent rights, is alleged that arises out of, pertains to,
or relates to Contractor's negligence, recklessness or willful misconduct under
this Agreement. Such costs and experises shall include reasonable attorneys'
fees of counsel of City's choice, expert fees and all other costs and fees of
litigation.
12.: INSURANCE:
On or before the commencement of the term of this Agreement, Contractor -shall
furnish City with certificates showing the type, amount, class of operations covered,
effective dates and dates of expiration of insurance coverage in compliance with
paragraphs 12 A, B, C, D and E. Such certificates, which do not limit Contractor's
indemnification, shall also contain substantially the following statement: "Should any of
the above insurance covered by this certificate be canceled or coverage reduced before
the expiration date thereof, the insurer affording coverage shall provide thirty (30) days'
advance written notice to the City of Cupertino by certified mail, Attention: City
Manager." It is agreed that Contractor shall maintain in force at all times during the
performance of this Agreement all appropriatE! coverage of insurance required by this
Agreement with an insurance company that is acceptable to City and licensed to do
insurance business in the State of California. Endorsements naming the City as
additional insured shall be submitted with the insurance certificates.
A. COVERAGE:
Consultant shall maintain the following insurance coverage:
(1) Workers' Compensation:
Statutory coverage as required by the State of California.
(2) Liability:
Commercial general liability coverage in the following minimum
limits:
Bodily Injury: $500,000 each occurrence
$1,000,000 aggregate - all other
Property Damage: $100,000 each occurrence
$250„000 aggregate
If submitted, combined single limit policy with aggregate limits in the
amounts of $1,000,000 will be considered equivalent to the
required minimum limits :shown above.
(3) Automotive:.
Proof of automobile insurance required at the California statutory
minimums.
(4) Professional Liability:
Professional liability insurance which includes coverage for the
professional acts, errors and omissions of Contractor in the amount
of at least $1,000,000.
B. SUBROGATION WAIVER:
Contractor agrees that in the event of loss due to any of the perils for which
he/she has agreed to provide comprehensive general and automotive liability insurance,
Contractor shall look solely to his/her insurance for recovery. Contractor hereby grants
to City, on behalf of any insurer providing comprehensive general and automotive
liability insurance to either Contractor or City with respect to the services of Contractor
herein,. a waiver of any right to subrogation which any such insurer of said Contractor
may.acquire against City by virtue of the payment of any loss under such insurance.
C. FAILURE TO SECURE:
If Contractor at any time during the term hereof should fail to secure or maintain
the foregoing insurance, City.shall be permittE�d to obtain such insurance in the
Contractors' name or as an agent of the Contractor and shall be compensated by the
Contractors for the costs of the insurance premiums at the maximum rate permitted by
law and computed from the date written notice is received that the premiums have not
been paid.
D. ADDITIONAL INSURED:
City, its City Council, boards and commissions, officers, employees and
-volunteers shall be named as an additional insured under all insurance coverages,
except any professional liability insurance, required by this Agreement. The naming of
an additional insured shall not affect any recovery to'which such additional insured
would be entitled under this policy if not named as such additional insured. An
additional insured named herein shall not be held liable for any premium, deductible
portion of any loss, or. expense of any nature on this policy or any extension thereof.
Any other insurance held by an additional insured shall not be required to contribute
anything toward any loss or expense covered by the insurance provided by this policy.
E. ' SUFFICIENCY OF INSURANCE . -
The
'
The insurance limits required by City are not represented as being sufficient to
protect Contractor. Contractor is advised to co 'nfer with Contractor's insurance broker to
determine adequate coverage for Contractors.
13. CONFLICT OF INTEREST:
Contractor warrants that it is not a conflict of interest for Contractor to perform the
services required by this Agreement. Contractor may be required to fill out a conflict of
interest form if the services provided under this Agreement require Contractor to make
certain governmental decisions or serve in a staff capacity as defined in Title 2, Division
6, Section 18700 of the California Code of Regulations.
14. PROHIBITION AGAINST TRANSFERS:
Contractor shall not assign, sublease, hypothecate, or transfer this Agreement,' or
any interest therein, directly or indirectly, by operation of law or otherwise, without prior
written consent of City. Any attempt to do so without said consent shall be null and
void,, and any assignee, sub -lessee, hypothecate or transferee shall acquire no right or
interest by reason of such attempted assignment, hypothecation or transfer. However,
claims for money by Contractor from City'undE�r-this Agreement may be assigned to a
bank, trust company or other financial institution without prior written consent. Written
notice of such assignment shall be promptly furnished to City by Contractor.
, The sale, assignment, transfer or other disposition of any of the issued and
outstanding capital stock of Contractor, or of the interest of any general partner or joint
venture or syndicate member or cotenant, if Contractor is a partnership or joint venture
or syndicate or co -tenancy, which shall result iin changing the control of Contractor, shall
be construed as an assignment of this Agreement. Control means fifty percent (50%) or
more of the voting power of the corporation.
15. SUBCONTRACTOR APPROVAL:
Unless prior written consent from City is obtained, only those people and
subcontractors whose names and resumes are attached to this Agreement shall be
used in the performance of this Agreement.
: In the event that Contractor employs subcontractors, such subcontractors shall
be required to furnish proof of workers' compensation insurance and shall also be
required to carry general, and professional liability insurance in reasonable conformity to
the insurance carried by Contractor. In addition, any work or services subcontracted
hereunder shall be subject to each provision of this Agreement.
16. PERMITS AND LICENSES:
Contractor, at his/her sole expense, shall obtain and maintain during the term of
this Agreement, all appropriate permits, certificates and that may be required in
connection with the performance of services Hereunder.
17. REPORTS:
A. Each and every report; draft, work product, map, record and other
document, hereinafter collectively referred to as "Report", reproduced, prepared or
caused .to be prepared by Consultant pursuant to or in connectionwith this Agreement,
shall be the exclusive property of City. Contractor shall not copyright any Report
required by this Agreement and shall execute appropriate documents to assign to City
the copyright to Reports created pursuant to this Agreement. Any Report, information
and data acquired or required by this Agreemf.nt shall become the property of City, and
all publication rights are reserved to City. Contractor may retain a copy of any report
furnished to the City pursuant to this Agreement.
B. All Reports prepared by Consultant may be used by City in execution or
implementation of:
(1) The original Project for which Contractor was hired;
(2) Completion of the original Project by others;
(3) Subsequent additions to the original project; and/or
(4) Other City projects as appropriate.
C. Contractor shall, at such time and in such form as City may require,
furnish reports concerning the status of services required under this Agreement.
D. All Reports required to be provided by this Agreement shall be printed on
recycled paper. All Reports shall be copied on both sides of the paper except for one
original, which shall be single sided.
E. No Report, information or other data given to or prepared or assembled by
Contractor pursuant to this Agreement shall bE! made available to any individual or
organization by Contractor without prior approval by City.
18. RECORDS:
Contractor shall maintain complete and accurate records with respect to sales,.
costs, expenses, receipts and other such information required by City that relate to the
performance of services under this Agreement.
Contractor shall maintain adequate records of services provided in sufficient
detail to permit an evaluation of services. All such records shall be maintained in
accordance with generally accepted accounting principles and shall be clearly identified
and readily accessible. Contractor shall provide free access to such books and records
to the representatives of City or its de-signees at all proper times, and gives City the
right to examine and audit same, and to make pranscripts therefrom as necessary, and
to allow. inspection of all work, data, documents, proceedings and activities related to
this Agreement. Such records, together with supporting documents, shall be kept
separate from other documents and records and shall be maintained for a period of
three (3) years after receipt of final payment.
If supplemental examination or audit of the records is necessary due to concerns
raised by City's preliminary examination or audit of records, and the City's supplemental
examination or, audit of the records discloses a failure to adhere to appropriate internal
financial *controls, or other breach of contract or failure to act in good faith, then
Contractor shall reimburse City for all reasonable costs and expenses associated with
the supplemental examination or audit.
19. NOTICES:
All notices, demands, requests or approvals to be given under this Agreement
shall be given in writing and conclusively shall be deemed served when delivered
personally or on the second business day after the deposit thereof in the United States
Mail, postage prepaid, registered or certified, addressed as hereinafter provided.
All notices, demands, requests, or approvals from Contractor to City shall be
addressed to City at:
City of Cupertino
10300 Torre Ave.
Cupertino CA 95014,
Attention: Director of Parks and Recreation
All notices, demands, requests, or approvals from City to Contractor shall be
addressed to Consultant at:
Fremont Union High School District
587 West Fremont Avenue
Sunnyvale, CA 94087
Attention: Superintendent
20. TERMINATION:
In the event Contractor fails or refuses to perform any of the provisions hereof at
the time and in the manner required hereunder, Contractor shall be deemed in default in
the performance of this Agreement. If such default is not cured within the time specified
after receipt by Contractor from City of written notice of default, specifying the nature of
such default and the steps necessary to cure such default, City may terminate the
Agreement forthwith by giving to the Contractor written notice thereof. .
City shall have the option, at its sole discretion and without cause, of terminating
this Agreement by giving thirty (30) days' prior'Nritten notice to Contractor as. provided
herein. Upon termination of this Agreement, each party shall pay to the other party that
portion of compensation specified in this Agreement that is earned and unpaid prior to
the effective date of termination.
. City. has no obligation to offer any of Contractor's services to participants, and,
unless minimum enrollment for a particular class identified in the Scope of Services is
met, City may cancel that class without further notice to Contractor or payment under
this agreement.
21. COMPLIANCES:
Contractor shall comply with all state or federal laws and all ordinances, rules
and regulations enacted or issued by City.
22. CONFLICT OF LAW:
This Agreement shall be interpreted under, and enforced by the laws of the State
of California excepting any choice of law rules which may direct the application of laws
of another jurisdiction. The Agreement and obligations of the parties are subject to all
valid laws, orders, rules, and regulations of the authorities having jurisdiction over this
Agreement (or the successors of those authorities)
Any suits brought pursuant to this Agreement shall be filed with the courts of the
County of Santa Clara, State of California.
23.' ADVERTISEMENT:
Contractor shall not post, exhibit, display or allow to be posted,_ exhibited,
displayed any signs, advertising, show bills, Lithographs, posters or cards of any kind
pertaining to the services performed under this Agreement unless prior written approval
has-been secured from City to do otherwise.
24. WAIVER:
A waiver by City of any breach of any term, covenant, or condition contained
herein shall not be deemed to be a waiver of any subsequent breach of the same or any
other term, covenant, or condition contained herein, whether of the same or a different
character.
22. INTEGRATED CONTRACT.
This Agreement represents .the full and complete understanding of every kind or
nature whatsoever between the parties hereto, and all preliminary negotiations and,
agreements of whatsoever kind or nature are merged herein. No verbal agreement or
implied covenant shall be held to vary the provisiohs.hereof. Any modification of this
Agreement will be effective only by written execution signed by both City and
Contractor.
25. INSERTED. PROVISIONS:
Each provision and clause required by law to be inserted into the Agreement
shall be deemed to be enacted herein, and the Agreement shall be read and enforced
as though each were included herein. If through mistake or otherwise, any such
provision is not inserted or is not correctly inserted, the Agreement shall.be amended to
make such insertion on application by either party.
26. CAPTIONS:
The captions in this Agreement are for convenience only, are not a part of the
Agreement and in no way affect, limit or amplify the terms or provisions of this
Agreement.
IN WITNESS WHEREOF, the parties hereto have caused this modification of
Agreement to be executed.
FREMONT UNION HIGH SCHOOL DISTRCT
CITY OF CUPERTINO
A Municipal Corporation
By Lauren Neff
Title: Recreation Coordinator
REGOMMENDED F R APP VAL:
(I }-J Zvi
Director of Parks and Recreation
Date:
APPROVED AS TO FORM:
(� W, AY(Y^-' City Attorney
Date: 17,
AT,TEST:
�—�
City Clerk
Date:
EXPENDITURE DISTRIBUTION:
580-6349-7014 $120,000.00
Account Number Amount
4���Pl 4-
EXHIBIT A
CONTRACTOR SERVICES TO BE' PERFORMED
The CONTRACTOR will provide ENRICHMENT COURSES in, but not limited to, the
following programs:
College Planning Workshop, College Essay Workshop, Trigonometry, Geometry, Art
Portfolio Development
Location and Time of CONTRACTOR Services:
Refer to mailings sent by Contractor to student households. By Mutual agreement of
both parties, class schedule may change.
Eligible Participant Minimum and Maximums for CONTRACTOR Services:
College Planning/ Essay Workshops
Minimum: 10
Maximum: 18
Trigonometry
Minimum: 10
Maximum: 30
Geometry
Minimum: 10
Maximum: 60
Art Portfolio Development
Minimum: 10
Maximum: 25
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.
Performance of CONTRACTOR Services:
City shall have no right of control as to the. mariner 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..
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. Contractors are responsible for supervising minors after
class until.a parent of legal guardian has arrived.
In the event of an injury occurring to a participant, the Contractor will notify the City
within 1 hour and complete an ABAG Incident Report. The ABAG Incident Report must
be submitted to the City within 24 hours of the injury occurring.
EXHIBIIT B.
ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS, RECEIPT
OF TRAINING, AND RECEIPT OF PENAL CODES STATUTES
A mandated reporter is an individual who is obligated by law to report suspected cases
of child abuse and neglect. In general, any individual who, in the ordinary course of
their employment, has contact with children is a mandated reporter. Mandated
reporters include child care workers, teachers and coaches. (California Penal Code
11165.7).
If your job duties as an.employee or an indepEindent contractor of FREMONT UNION
HIGH SCHOOL DISTRICT include contact with children, you are a Mandated Reporter.
Prior to.commencing employment and as a prerequisite of that employment, California
law requires that you sign a statement to the Effect that you have knowledge of the
provisions of the Mandated Reporter Law, and will comply with those provisions.
(California Penal Code 11166.5.).
The following are the Mandated Reporter responsibilities under California law. You are
also being provided with a separate informational document which includes the text of
the California Mandated Reporter Law and contact information for Child Abuse and
Neglect Reporting for the County of Santa Clara. Please review this information
carefully and acknowledge your receipt and understanding where indicated. If you have
questions or concerns about this form or your Mandated Reporter responsibilities,
please contact.the Recreation Supervisor at 408-777-3120.
I understand that:
• By virtue of my employment or independent contractor status with
FREMOND UNION. HIGH SCHOOL DISTRICT, and because my
employment requirs me to have contact with children, I am a Mandated
Reporter as defined by California. Penal Code 11165.7.
The following situations trigger mandatory reports: a) Physical Abuse
(willful harming of a child); b) Sexual abuse including sexual assault, child
exploitation, pornography, and trafficking; c) Severe or General Neglect;
and d) Extreme Corporal Punishment (resulting in injury). (Cal. Pen. Code
11165 et. seq.) I further understand that I may, but am not required to,
report suspected Emotional Abuse.
If. I reasonably suspect that a child is being abused, I must immediately
ake a telephone report. I must follow up with a written report within 36
hours. This report may be made to. local law enforcement, or County
Sheriff's Department, Probation Department or Child Welfare Agency.
(Cal Pen. Code 11166(a)).
• 1 am not required to, but I may, share information about suspected abuse
with my supervisor or management or the parents of the alleged victim.
When I make a mandated report, I will be required to give my name.
However, my identity will be kept confidential unless I either consent to
disclosure or if the disclosure is made pursuant to a court order. Further,
agencies investigating the mancated report may disclose my identity to
one another. (Cal Pen. Code 11167(d)).
• The following agencies and individuals receiving or investigating
mandated reports may disclose my identity to one another:
o Prosecutors -in a criminal prosecuting or in an action initiated under
section 602 of the Welfare: and Institutions Code arising from
alleged child abuse;
o Counsel appointed pursuant to subdivision (c) of Section 317 of the
Welfare and Institutions Code;
o A licensing agency.when abuse or neglect in out -of -home care is
reasonably suspected. (Cal Pen. Code 11167.5)
1 may not be disciplined, dismissed, retaliated against, discriminated
against or harassed for making a mandated .report of reasonably
suspected child abuse.
• As a Mandated Reporter, I have civil and criminal immunity when making
a report (Cal Pen. Code 11172).
As a Mandated Reporter, it is a misdemeanor to fail to comply with
Mandated Reporting laws and I can be held criminally liable for
failing to report suspected abuse. The penalty for this is up to six
months in County jail, a fine of not more than $1000, or both. I further
understand I could be civilly liable for failure to report. (Cal. Pen. Code
1.1166(c)).
I have been provided with a copy of California Penal Code sections 11164-11174.3
(Mandated Reporter Law).
I understand that I am a legally Mandated Reporter. I am aware of and understand
my responsibilities under the Mandated Reloorter laws of this state and am willing
and.able to comply. I understand that a copy of this Acknowledgement will be
kept in my personnel file.
Nam4(S nature)
CHRISTINE MALLERY
CBO / ASSOCIATE SUPERINTENDENT
IiT UNION HIGH SCHOOL DISTRICT
Name (Print)
/t;-/ 13
Date
EXHIBIT C
City of Cupertino Contractor Declaration
The: undersigned does hereby certify that:
I am a representative of FREMONT UNION HIGH SCHOOL DISTRICT
(contractor or company name); that I am familiar with the facts herein and am
authorized and qualified to execute this declaration.
2. 1 declare that FREMONT UNION HIGHI SCHOOL DISTRICT (contractor or
company name) has complied with fingerprinting and criminal background .
investigation requirements with respect to all Contractors 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. That a complete and accurate list of Contractors employees, who may come in
contact with minors during the course and scope of the Agreement, are 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 Contractor.
5. All of the below mentioned employees have received training and understand
their responsibilities under the MandatE!d Reporter laws of this state and are
willing and able to comply.
A List of all Contractor Employees Working for the City of Cupertino:
6. The City of Cupertino will be notified by Contractor in writing of any new
employees and will be added to the above list prior to beginning work for the City
of Cupertino.
I declare under penalty of perjury that the foregoing is true and
1-�-11313 /t
CHRISTINE MkLE
4
CBO/ ASSOCIATE SUPERINTENDENT
fl!iDW UNION HIGH SCHOOL DISTRICT
correct:
C15-0
Title