14-001 Haideh Shariffi (2) 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 ITT I N O W EBSITE:www.cupertino,org
June 26, 2014
Re: Agreement for consultant services.
Enclosed is a fully executed copy of the above s1_ated 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,
Andrea Sanders
Senior Office Assistant
City Clerk's Office
Enclosure
cc: Parks & Recreation
F
CITY OF
AGREE=MENT
CITY OF CUPERTINO
10300 Torre Avenue
Cupertino, CA 95014
CUPERTINO 408-77'7-3200 NO.
FY 14-15
THIS AGREEMENT, made and entered into this 12�day o une is by and between the
CITY OF CUPERTINO (Hereinafter "CITY") and a California State, SOLE
PROPRIETORSHIP whose address is
sole proprietor whose address is Hereinafter "CONTRACTOR"), in consideration of
their mutual covenants, the parties agree as follows:
'CONTRACTOR shall provide or furnish the following specified services and/or
materials: Fitness Instructor.
Check box if services are further described in an Exhibit.
EXHIBITS: The following attached exhibits hereby are made part of this Agreement:
A,B,C..
TERM: The services and/or materials furnished under this Agreement shall commence
on-7/1/14 and shall be completed no later than 6/30/15.
COMPENSATION: For the full performance-of this Agreement, CITY shall pay
CONTRACTOR:
$35 per.55 minute class taught.
California Labor Code, Section 1771 requires the payment of prevailing wages to all
workers employed on a Public Works contract in excess of$1,000.00.
GENERAL TERMS AND CONDITIONS
Hold Harmless. Contractor shall, to the fullest extent allowed by law, indemnify,
defend, and hold harmless the City and its officers, .officials, agents, employees'and
volunteers against any and all liability, claims, stop-notices, 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, arising out of,
pertaining to, or related to the performance of this 'Agreement by Contractor or
Contractor's employees, officers, officials, .. agents or independent contractors.
Contractor shall"not•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. 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.
Subcontracting. Contractor has been retained due to their unique skills and
Contractor may not substitute another, assign or transfer any rights or obligations under
this Agreement. Unless prior written consent from City is obtained, only those people
whose names are listed this Agreement shall) be used in the performance of this
Agreement.
Assignment. Contractor may not assign or transfer this Agreement, without prior
written consent of CITY.
Insurance. Contractor shall file with City a ('-",'ertificate of Insurance consistent.with the
following requirements .
Coverage: ;
Contractor 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:
Comprehensive automotive: liability coverage in the following minimum
limits:
Bodily Injury: $500,000 each occurrence
Property Damage: $100,000 each occurrence
or
Combined Single Limit: $500,000 each occurrence
Subrogation Waiver. Contractor agrees that in the event of loss due to any of the perils
for which it has agreed to provide comprehensive general and automotive liability
in Contractor shall look solely to its insurance for recovery. Contractor hereby
grants to City, on behalf of any insurE!r 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.
d
Termination of Agreement. The City reserves the right to terminate this Agreement
with or without cause with a seven (7)-day notice. The.Contractor may terminate this
Agreement with or without cause with a sevE!.n (7)-day written notice.
Non-Discrimination. No discrimination,shall be made in the employment of persons.
under this Agreement because of the race, color, national origin, ancestry, religion,
gender or sexual orientation of such person
Interest of Contractor. It is understood and agreed that this Agreement is not a
contract of employment in the sense that the relationship 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 intE�rest under this Agreement -is an officer or
employee of City. City shall have no right of control as to the manner Contractor
performs the services to be performed. NeVfftheless, City may, at any time,.observe the
manner in which such services are being performed by the contractor.
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.
Changes. . No changes or variations of any kind are authorized without the written
consent of the City.
CONTRACT CO-ORDINATOR and representative for CITY shall be:
NAME: Colleen Ferris DEPARTMENT :Parks and Recreation
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.
CONTRACTOR: CITY OF CUPERTINO:
' _ By: Colleen Ferris
Title J;' S h-CA-G K Title: Recreation Coordinator
APPROVALS _ EXPENDITURE DISTRIBUTION
DEPABIMENT HEAD D TE ACC LINT NUMBER AMOUNT
i 6 1jd 570 6450 7014 $4,000.00
CITY RNE APP OVED S TGEORM DAT
�Li Q�
CI RK: ATTES DATE
EXHIBIT A
CONSULTANT SERVICES TO BE PERFORMED
The CONSULTANT will provide Group Fitness Instruction in but not limited to, the
following programs:
Fitness Instructor
Location and Time of CONSULTANT Services:
Cupertino Sports Center
Eligible Participant Minimum and Maximums for CONSULTANT Services:
Minimum: 10
Maximum: 50
In the event that less than the required minimum number of participants shall request and pay for
services prior to the agreed upon time for the commencement of services to be performed by
Consultant, City may cancel and withdraw from this Agreement.
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 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 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 Haideh Sharifi include
contact with children, you are a Mandated Reporter. Prior to commencing employment.and'
mployment.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 Haideh
Sharifi, 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) 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 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 WeIfare Agency. (Cal Pen. Code 11166(a)).
• I 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
mandated report may disclose my identity to one another. (Cal Pen. Code
111.67(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 Cabuse or neglect in out-of-home care is
reasonably suspected. (Cali Pen. Code 11167.5)
• I 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 Californivi: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 be kept in my personnel
file.
Date
Name (Print)
EXHIBIT C
City of Cupertino Consultant Declaration
The undersigned does hereby certify that:
.l. I am a representative of Haideh Sharifi (��onsultant or company name); that I am
familiar with the facts herein and am authorized and qualified to execute this declaration.
2. 1 declare that Haideh Sharifi (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-is
defined in California Penal Code Section 1 1105.3.
3. That a complete and accurate list of Consultant's 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 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:
N/A
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.
I .declare under penalty of perjury that
Contractor Title: Fitness Instructor