14-001 Heidi Merry Henn-ecker OFFICE OF THE CITY CLERK
CITY HALL
10300 TORRE AVENUE:-CUPERTINO, CA 95014-3255
TELEPHONE:(408)777-3223-FAX: (408)777-3366
C U P E RT 1 N O WEBSITE:www.cupertino.org
July 15, 2014
Re: Agreement for contract services.
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 Christine Hanel in
the Parks and Recreation department at 408-777-3120.
Sincerely,
Andrea Sanders
Senior Office Assistant
City Clerk's Office
Enclosure
cc: Parks & Recreation
NO. C�'
FY 14-15
AGREEMENT BETWEEN THE CITY 01= CUPERTINO AND HEID
ECKER FOR CONTRACT SERVICES MERRY HENN-
This Agreement, for reference dated June 19, 2014 is by and between Cit o
Cupertino,,.-a* municipal corporation (hereinafter referred-to as y
a sole proprietor whose address is
(hereinafter referred to as "Consultant"), and is made with reference.to the following:
. ng.
RECITALS:
A. City is.a municipal corporation duly organized and validly existing
the Laws of the State of California with the power to car on its busi under
-being conducted under the Constitution and the statutes of the State o as it is now
f
the Cupertino Municipal Code. of California and
B. Consultant is specially trained, experienced-and competent
special services which will be required by this Agreement; and _ p . to perform the .
C. Consultant possesses the skill, experience, ability, ba kground,
certification and knowledge to provide the services described in.this
terms and conditions described herein. Agreement on the
D.. City a.nd.Consultant desire to Enter into an agreement for youth
cooking program services upon the terms and conditions herein'.
art and
NOW, THEREFORE, it is mutually agreed by and between the undersi ned
parties as follows: g
1. TERM:
The term of this Agreement shall comi-nence on July 1 201
on June 30; 2015,,unless terminated earlier as, set forth herein. 4, and shall terminate
2. SERVICES TO BE PERFORMED:
Consultant shall perform each and evE�ry service set forth in Exhibit
attached hereto and incorporated herein by this reference:. "A" which is
3. COMPENSATION TO.CONSULTANT:
Consultant shall be compensated for services performed pursuant to this-
Agreement in the amount set forth below. ThE! total compensation under the A r
is not to exceed $25,000.00' g Bement
Compensation: z
1-Day Program: $17 per participant
2-Day Program: $25.50 per participant
Series and Camp programs: 70% of resident fee for each-participant, based on
class roster, minus
nus a $10 administrative fee per participnt. the final
1-Day or
II issue pay ment one w
2-Day p ro g eek following the completion of.each series, the
The City wi
ram. Payment for camps during the summer months will be issued after
completion of every 2 camps.
4. ACKNOWLEDGEM
ENT OF MANDATED REPORTING REQUIREMENTS:.
Consultant shall comply with the requirements of California Penal Code 1116
11174.3
and as set forth in Exhibit "B"which is attached hereto and incorporated herein
by this reference.
5. �FINGER�RINT AND
TUBERCULOSIS TB CONSULTANT DECLARATION:
Consultant agrees that all individuals covered under this Agreement shall provide
Consul g
fingerprints for criminal background test purposes and results of 713 scree
to orated
to the requirements as set forth in Exhibit C which is attach-hereto an p
herein by this reference.
6. - TIME IS OF THE ESSENCE:
Consultant and g
nd City agree that time is of the essence regarding the performance of this
Agreement.
7. 'STANDARD OF CARE:
rm all services h
to erfoereunder in a manner commensurate
Consultant agree s p
prevailing standards of like professionals in the San Francisco Bay Area and
ho .
with the pr g is lified and experienced personnel
agrees that all services shall be performed by q
are not employed by the City nor have any contractual relationship with City.. .
g. INDEPENDENT PARTIES:
City and Consultant intend that the relationship between them created by this.
Ci y
Agreement is that of an independent contractor. The manner and means of conducting
by
Ag .
the work are under the control of Consultant, except to the extent they are it service
statute, rule or regulation and the express terms of this Agreement. uJ civil services.
status or other right of employment will,be acquired by virtue of Con not limited vi
None of the benefits provided by City to its employees, inclu action and sick leave are
unemployment insurance, workers compensation plans,ntsa Deductions shall not be
available from City to Consultant, its employees or ag
made for any state or federal taxes, FICA payments,
PERS payments, or other
Y
purposes
normal) associated with an employer.-employee relationship from any fees
due
Consultant. Payments of.the above items, if required, are the responsibility o
Consultant.
g. IMMIGRATION REFORM AND CONTROL ACT (IRC the identit and
Consultant assumes any and all responsibility for verifying Y
employment authorization of all of his/her employees performing work hereunder,
pursuant to all applicable IRCA or other federal, or state rules and regulations.i damage,
Consultant shall indemnify and hold City harmless from andofgthiss rov sion by .
Liability, costs or expenses arising from any noncompliance p
Consultant.
7
10. NON-DISCRIMINATION:
Consistent with City's policy that harassment and discrimination
unacceptable employer/employee conducl:, Consultant agrees that harass
discrimination directed toward a job applic'3nt, a City employee, mentor
Consultant or Consultant's employee or subcontractor on the basis a citizen by
creed, color, national origin, ancestry, handicap, disabilit , marital s a race, religious
sex, age, or sexual orientation will not be tolerated. Consultant test pregnancy,
violations of this provision shall constitute a material breach of this Agr that any and all
is Agreement.
11. HOLD HARMLESS:
A. Consultant shall, to the fullest extent allowed by' law, with
services performed in connection vvith the Agreement,Yi demn f respect to all
hold harmless the City and its officers, officials Y, defend, and
volunteers from and against any and all liability, claims, actions employees and
or demands whatsoever against any of them, including n • ' causes of action
any person or damage- to g Y Injury to or death of
g property or other liability of any nature, whether
physical, emotional, consequential or otherwise, arising out
related to the g , pertaining to, or
performance of this Agreement by Consultant or Consultant's
employees, officers, officials, agents or independent contractors.
expenses shall include reasonable ,attorneys' fees of counsel of Cit costs and
expert fees and all other costs and fees of litigation. City's choice,
B. Claims for Other Liability. Consultant shall, to the fullest extent
by law, with respect to all services Performed in connection wi g allowed
indemnify, defend-, and hold harmless the City and its officers, the Agreement,
employees and volunteers against any and all liability, � officials, agents,
action or demands whatsoever from and against any of them including' causes of
to or death of any person or damage to property or � eluding any injury .
that apse out of, pertain to, or relate to Thenegligence,er liability. of any nature,
recklessness, or willful
misconduct of Consultant or Consultant's employees officer, officials,
independent contractors. Such cost,, and expenses shall include r or
inc de r agents le
attorneys' fees of counsel of City's choice, expert fees and all agents
fees of litigation. Consultant shall not be obligated under other costs and
thi
indemnify City to the extent that the damage is caused b s Agreement to
negligence or willful misconduct of City, its agents or employees..he sole r active
C. Claims involving intellectual property. In addition to the obligations
(A) and (B) above, Consultant shall indemnify, defend, and hold City,set forth in
elected and a d the City, its
appointed officers, employees, and volunteers, harmless from and
against any Claim in which a violation of intellectual property
not limited to co p pertY rights, including but
copyright or patent rights, is alleged that arises out of, pertains to
or relates to Consultant's*negligence, recklessness or willful misconduct
this Agreement. Such costs and expenses shall include reasonable attorneys'
under
fees of counsel of City's choice, expert fees and all other co ble attorneys'
litigation. costs,and fees of
12. INSURANCE:
On or before the commencement of the term of this A reement
g , Consultant shall
i
a
furnish City with certificates showing the type, amount, class of operations covered,
effective dates
and dates of expiration of insurance coverage in compliance with
12 A, B, C, D and E. Such certificates, which do not Ilment:o Should any of
paragraphs
indemnification, shall also contain substantially the following os�coverage reduced before
the above insurance covered by this certificate be canceled or
provide thirty (30) days'
the expiration date thereof, the insurer affording coverage mail, Attention: City
advance written notice to the City of Cupertino by certified in force at all times during the
Manager." It is agreed that Consultant shall maintain
e of insurance required by this
performance of this Agreement all appropriate c g
insurance company that is acceptable to City and licensed to do
i
Agreement with an
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) Liabilit
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.
B. SUBROGATION WAIVER: an of the perils for which
Consultant agrees that in the event of loss due ao d automotive liability insurance,
he/she has agreed to provide comprehensive genera Consultant hereby grants
Consultant shall look solely,to his/her insurance for e general and automotive
to City, on behalf of any insurer providing comprehensive res respect to the services of Consultant .
. liability insurance to either Consultant or City with
any such ins.urer of said Consultant
herein, a waiver of any right to subrogation which
of any loss under such insurance.
may acquire against City by virtue of the pay
C. FAILURE TO SECURE:
If Consultant at a n y time during the term hereof should fail to secure or maintain
the foregoing in
surance, City shall be perm ppermitted to obtain such insurance in the
b the
Consultant's name or as an agent of the Con s sultant and shall be um rate permitted by
Consultant for the costs of the insurance premiums at that he premiums have not
law and computed from the date written notice is rece ived
been paid.
D. ADDITIONAL INSURED: to ees and
City, its City Council, boards and commissions, officers, emp y
71 yi
volunteers shall be named.as an additional insured
.except any professional liability insurance, required under all insurance coverages,
an additional insured shall not affect an r,� by this Agreement. The naming of
would be entitled under this policy if not nz'Imed s to which such additional insured such additional insured. An . .
additional insured named herein shall not I've held liable
portion of any loss., or expense of any nature on this oli or any premium, deductible
Any other..insurance held by an additional iinsured shall of or any extension thereof.
anything toward any loss or expense covered by the insurancerequired to contribute
E. SUFFICIENCY OF INSURANCE: provided by this policy.
The insurance limits required by City are not re rese
protect Consultant. Consultant is advised i:o confer with Consul
to as being sufficient to
to determine adequate coverage for Consultant. tant's insurance broker
13. CONFLICT OF INTEREST.
Consultant warrants that it is not a conflict of interest for Cons
. the services required by this Agreement. Consultant may ultant to perform
of interest form if the services p .,r provided under this Agree y be require to fill out a conflict
ment require Consultant to
make certain governmental decisions or serve in a staff capacity
Division 6, Section 18700 of the California Code of Re u P y as defined in Title 2,
g lation.s.
14. PROHIBITION AGAINST TRANSFERS:
. Consultant shall not assign, sublease, hypothecate, or transfer
or any interest therein, directly or indirectly, by operation of law or otherwise,this Agreement,
prior written consent of City. Any attempt to do so without said consent sat without
void, and any assignee, sub-Lessee, hypothecate or transferee shall ac shall be null and
interest by reason of such attempted assignment, hypothecation hall acquire no right or
claims for money by Consultant from City under this Agreement or transfer. However,
bank, trust company.or other financial institution without prior written may be assigned to a
notice of such assignment shall be promptly.-Furnished to City b Consultant.consent. Written
The sale, assignment, transfer or other disposition of any of thissued
outstanding capital stock of Consultant, or of the interest of any e he issued and
venture or syndicate member or cotenant, if(;onsultant is a partnership y general partner,or joint
or syndicate or co-tenancy, which shall result in changing the control l o or joint venture
shall be construed as an assignment of this Agreement. Conti trol of Consultant,
(50%) or more of the voting f means fifty percent
g power of the corporation.
15. SUBCONTRACTOR APPROVAL:
Unless prior written consent from City is obtained, only those
subcontractors whose names and resumes are attached to this people and
used in the performance of this Agreement. Agreement shall be
In the event that Consultant employs subcontractors, such subcontractors
be required to furnish proof of workers' compensation insurance l also shall
required to carry general, and professional liability insurance a and shall also be
the insurance carried by Consultant. .In addition, an work or!n reasonable conformity to .
hereunder shall be subject to each provision o.11 this Agreement.
ervrces subcontracted
16. PERMITS AND LICENSES:
Consultant, at his/her sole expense, shell obtain and maintain
this Agreement, all appropriate permits, certificates and that m during the term of
may be required in
+. 4
connection with the performance of services hereunder.
17. REPORTS: , and other.
A. Each and every repo rt, draft, work product, map, re ared or
document,
hereinafter collectively referred to as "Report", reproduced, prepared
Agreement,
used to be prepared by Consultant.pursuant to or in connection with
ca copyright an Report
the exclusive property of City. Consultant shall not copy g any
'Report
be appropriate documents to assign to City
required by this Agreement and shall execute app ro p
the copyright to Reports created pursuant to this Agreement. Any Report, information nd
required by this Agreement shall become the property of City, a
and data acquired or q of any report
all publication rights are reserved to City. Consultant may retain a copy
furnished to the City pursuant to this Agreement.nt ma. be used by City in execution or
B. All Reports prepared by Consul Y
implementation of:
O 1 The original Project for which Consultant was.hired;
Completion of the original Project by others;
(2) Completion
additions to the original project; and/or
(3)
(4) Other City projects as appropriate.
C. Consu
ltant shall, at such time and in such form as City may require,
furnish reports concerning the status of services required under this Ahall bee tinted on .
D. All Reports required to be provided by this Agreement paper except for one
recycled paper. All Reports shall be copied on both sides of the p p
p p
original, which shall be single sided.
E. No Report, information or'other data given to or prepared or assembled by
to this Agreement shall be made available to any individual or
Consultant pursuant g royal b Cit Y•
organization by Consultant without prior app Y
18. RECORDS:
maintain complete and accurate records with.respect to sales,
e
Consultant shall City that relate t
expenses, receipts and other such information required by Y
costs, p
performance of services under this Agreem ecords of services provided in sufficient
Consultant shall maintain adequate r
valuation of services. All such records shall be maintained dentified
detail to permit an e rinci les and shall be clearly i
accordance with generally accepted accounting principles
tee access to such books and records
and readily accessible. Consultant shall provide free
all roper times, and gives City the
to the representatives of City or its de-signees transcpripts therefrom as necessary, and
right to examine and audit same, and to ma
I work data, documents, proceedings and activities related to
to allow inspection of al � supporting documents, shall be kept
this Agreement. Such records, together with supp 9
re
and
ments cords and shall be maintained for a period of
separate.from other docu ment.
three (3) years after receipt of final pay
If supplemental examination or audit of the records is necessary due to concerns
reliminary examination or audit of records, and the City,s supplemental
tinternal
raised by City's p
examination or audit of the records discloses a failure to adhere to a faith, then
financial controls, or other breach of contract or failur is and expenses associated with
Consultant shall reimburse City for all reasonable cos
the supplemental examination or audit.
19. NOTICES:
r
All notices, demands, requests or Ei
shall be given in writing.and conclusive) Shall be to be given under this Agreement
deemed served when delivered
personally or on the second business day after the
Mail, postage prepaid., registered or certified, addressed thereof in the United States .
. � . esued as hereinafter provided.
All notices, demands, requests, or approvals from Con
addressed to City at: sultant to City shall be
City of Cupertino
10300 Torre Ave.
Cupertino CA 95014
Attention: Director of Parks and Recreation
All notices, demands, requests, or a� royals
addressed to'Consultant at: I p from City to Consultant shall be
20. TERMINATION:
In the event Consultant fails or refuses to perform an of
the time and in the manner required �hereuncier, Consultants the provisions hereof at
�in the performance of this Agreement. If such default i hall be deemed in default
specified after receipt by Consultant from City of written notic ured within the time
nature of such default and the steps necessary to cure such default,f default, specifying the
the Agreement forthwith by giving to the Consultant written City may terminate
City shall have the option, at its sole discretion and without notice thereof.
this Agreement by giving thirty (30) days' prior written notice C cause, of terminating
herein. Upon termination.of this Agreement, each art shall to Consultant as provided
portion of compensation specified in this AgrE)emenpt that is e pay to the other party that
the effective date of termination. earned and unpaid prior to
City has no obligation to offer any of Consultant's services
unless minimum enrollment for a particular class identified in t to participants, a'
nd,
met, City may cancel that class without further notice to he Scope of Services is
this Agreement. The City in its sole discretion may determine' or payment under
number of classes, and any assigned instructor.. Consultant the type of classes, the
non-exclusive agreement. understands that this is an
21. COMPLIANCES:
Consultant shall comply with all state or,federal laws and a
and regulations enacted or issued by City. II ordinances, rules
22. . CONFLICT OF LAW:
This Agreement shall be interpreted'unoler., and enforced b
of California excepting any choice of law rules which ma Y the laws of the State
of another jurisdiction. The Agreement.and obligations.of direct the application of laws
valid laws, orders, rules, and regulations of the authorities h e parties are subject to all
aving�unsdiction over this
4
Agreement or the successors of those authorities.) filed with the courts of the
Any suits brought pursuant to this Agreement shah be
County of Santa Clara, State of California.
23. ADVERTISEMENT:
not ost-, exhibit, display or allow to be posted, exhibited kind
Consultant shat p posters or cards of any
displayed any signs, advertising, show bills, lithographs,ent unless prior written approval
pertaining to the services performed under this Agree
has been-secured from City.-to do otherwise.
24. WAIVER: an term, covenant, or condition contained
of an breach of y
A waiver by City Y
herein shall not be deemed to be a waiver of any subsequent breach of the same ifferent
other term.,
covenant, or condition contained herein, whether of the same or a
character.
22. INTEGRATED CONTRACT: kind or
Agreement represents the full and complete understanding °f every and
This Agree p
nature whatsoever between the parties hereto, and all preliminary negotiations
agreement or
of whatsoever kind or nature are merged herein. No modification of this
agreements rovisions hereof. Any
implied covenant shall be held to vary the execution signed by both City and
Agreement will be effective only by writ
Consultant.
25. INSERTED PROVISIONS: law to be inserted into the Agreement
Each provision and clause required by
ed herein, and the Agreement shall be read and enforced
shall be deemed to be enact a such
as though
each were included herein. If through mistake. or otherwise,
be amended to
provision is not inserted or is not correctly inserted, the Agreement
make such insertion on application by either party.
26. CAPTIONS:
Agreement are for convenience only, are not a part of the
The captions in this g
s or provisions of this
Agreement and in no way affect, limit or amplify the term
Agreement.
IN WITNESS WHEREOF, the parties herE!to have caused this modification of
Agreement to be executed.
Heidi Merry Henn-Ecker CITY OF CUPERT
INO
A Municipal Corporation
By B Dav
Ti Y e Jahns
Date: - Title: Recreation Coordinator
&15C M END D FO,7 APPROVAL:
r I
rn Senior Recreation Supervisor
Date: - t
AP ROVED AS TO FORM:
Cit t Attorney
Da e: Z
A ST:
Clerk
Date:
EXPENDITURE DISTRIBUTION:
580-63497014 25 000.00
Account Number Amount
EXHIBIT A
CONSULTANT SERVICES TO BE PERFORMED
The CONSULTANT NT will provide instruction of youth art and cooking in, but not
limited to, the following programs:
Baking and Creative Crafts
Sewing, Textiles, and Crafts
Doll Fashion
Home Arts
Kinder Kids
Sewing, Cooking, Art Camps
Holiday Camps and Workshops
Location and Time of CONSULTANT Services:
Refer to current Fall, Winter, Spring and/or Summer Recreation Brochures for agreed
upon dates, times, and class locations. By Mutual agreement of both parties, class
schedule may change.
p
Eligible
Participant Minimum and Maximums for CONSULTANT Services:
Minimum: 2
Maximum: 14
If less tha n the required or a
aired minimum number of participants enroll in and pay he
may particular class as identified in the schedule before the class is scheduled to start,the
cancel the particular class and/or terminate this Agreement without additional
notice or payment to Consultant.
Performance of CONSULTANT Services.:
City shall have no right of control as to the manner Consultant performs the services to
be performed. Nevertheless, City may, at any time, observe the manner in which such
services are being performed by the consultant.
The Consultant t shall follow all guidelines pertaining to registration procedures as listed pro
in the q uarterly recreation schedule. Participants may not take part in tnt Allgram
unless they are listed on the class roster or can show proof of enr ll form prior to
participants and volunteers need to complete the City Liability s Waiver of minors after
taking part in the program. Contractors are responsible for supervising
class until a parent of legal guardian has arrived.
In the event of a n �u ry'in occurring to a participant, the Consultant 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.
EXHIBIT 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 independent contractor of Heidi Merry Henn-
Ecker 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 haW 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 andl 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.
understand that:
• By virtue of my employment or independent contractor status with Heidi
Merry Henn-Ecker and because my employment requires 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) '-:')exual 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
make 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,eer,
agencies investigating the mandated report may disclose my identity
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;
• Counsel appointed pursuant to subdivision (c) of Section 317 of the
Welfare and Institutions Code;
• 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
11166(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 Reporter laws of this state and am willing
and able to comply. I understand that a copy of this Acknowledgement will b
ate
Name (Print)
EXHIBIT C
City of Cupertino Consultant Declaration
The undersigned does hereby certify that:
1. I am a representative of Heidi Merry Henn-Ecker (consultant or company name);
that I am familiar with the facts herein and am authorized and qualified to execute
this declaration.
2. 1 declare that Heidi Merry Henn-Ecker (consultant or company name) has
- complied with fingerprinting and criminal background investigation requirements
with respect to all Consultant'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 i1; defined in California Penal Code Section
11105.3.
3. That a complete and accurate list of Consultant's employees, who may come in
contact with minors during the coursse, 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 Consultant.
5. 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.
A List of all Consultant Employees 'Working for the City of Cupertino:
6. The City of Cupertino will be notified by Consultant in writing of any new
employees and will be added to the above list prior to beginning work for the City
of Cupertino.
declare under penalty
Title