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15-001 Phil Lenihan t CITY OF SHORT FORM AGREEMENT (Less than$5,000) CITY OF CUPERTINO . [I - 10300 Torre Avenue CUPERTINO Cupertino,CA 95014 p 408-777-3200. NO. This Agreement,made and entered into this Tuesday,May 26,2015 (the"Effective Date")is by and between the City of Cupertino(hereinafter"City")and Phil Lenihan (hereinafter"Contractor"),in consideration of their mutual covenants,the parties agree as follows: A. SCOPE OF SERVICES. Contractor shall provide or furnish the following specified services and/or materials:Inline Skating Classes. Services are further described in Exhibit"A". B. TERM. The services and/or materials furnished under this Agreement shall commence on Wednesday, July 1,2015,and shall be completed no later than Thursday,June 30,2016. C. COMPENSATION. For the full performance of this Agreement,CITY shall pay Contractor a total amount not to exceed five hundred dollars($500). Consisting of the following:$20 per participant. D. EXHIBITS. The following attached exhibits hereby are made part of this Agreement: ®Exhibit"A"- Scope of Services ®Exhibit`B"-Acknowledgement of Mandated Reporting Requirements,Receipt of Training,and Receipt of Penal Code Statutes Exhibits`B"and"C"are for anyone working with minors N Exhibit"C"-City of Cupertino,Consultant Declaration GENERAL TERMS AND CONDITIONS 1. Hold Harmless. Contractor shall,to the fullest extent allowed by law and without limitation of the provisions of this Agreement related to insurance, 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 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 Contractor's 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. The acceptance of the Services by City shall not operate as a waiver of the right of indemnification.The provisions of this Section survive the completion of the Services or termination of this Contract. 2.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. 3.Assignment. Contractor may not assign,transfer, or subcontract this Agreement or any portions thereof,without prior written consent of City. 4. Insurance. Contractor shall maintain the following insurance coverage, with the City as an additional named insured, and provide a Certificate of Insurance and Additional Insured Endorsement consistent with the following requirements: (a)Workers'Compensation: Statutory coverage as required by the State of California. (b)Liability: Commercial general liability coverage,without an exclusion for sexual abuse and molestation, 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. (c)Automotive: Comprehensive automotive liability coverage in the following minimum limits: Page 1 of 7 City of Cupertino—Short Form Agreement—4/2015 1 Bodily Injury: $500,000 each occurrence Property Damage: .$100,000 each occurrence or Combined Single Limit: $500,000 each occurrence 5.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 insurance, Contractor shall look solely to its 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. 6.Termination of Agreement. 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 Contractor fails to cure the default within the time specified and according to the requirements set forth in City's written notice of default,and in addition to any other remedy available to the City by law,the City Manager may terminate the Agreement by giving Contractor written notice thereof,which shall be effective immediately.The City Manager shall also have the option, at its sole discretion and without cause, of terminating this Agreement by giving seven(7) calendar days'prior written notice to Contractor as provided herein. Upon receipt of any notice,of termination,Contractor shall immediately discontinue performance. 7. Non-Discrimination. Contractor shall not discriminate against a job applicant, employee, City employee, or a citizen on the basis of race,color,national origin,ancestry,religion,gender,sexual orientation or other protected class of such person. 8. Interest of Contractor. It is understood and agreed that this Agreement is not a contract of employment and, 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. 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. 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. 9. Permits and Licenses. Contractor, at his/her own expense, shall obtain and maintain during the term of this Agreement,all appropriate permits,licenses,and certificates including but not limited to a City business license,that may be required in connection with the performance of services under this Agreement. 10.Reports and Records.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 Contractor pursuant to or in connection with 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 Agreement 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. 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, 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 designees at all proper times, and gives City the right to examine and audit same, and to make transcripts 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 Contractor receives final payment from City for all services required under this agreement. Page 2 of 7 City of Cupertino.—Short Form Agreement—4/2015 J 11.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: Jeff Ordway, Recreation and Community Services In witness thereof,the parties have executed this Agreement the day and year first written above. Title:Recreation Coordinator Title: Owner Tax I.D:. CITY OF CUPERTINO: [ 1 APPROVALS EXPENDITURE DISTRIBUTION LA DEPARTMENT HEAD DATE ACCOUNT NUMBER AMOUNT ./ 580-63-620-700-702 . $500 CITY A ORNEY PROV D AS'TO FORM DATE CITY CLERK: A E DATE c- &4-1�f b 3D—i s� Page 3 of 7 City of Cupertino—Short Form Agreement—4/2015 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) • 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 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 be kept in my personnel file. Date Name (Print) Page 4 of 7 City of Cupertino—Short Form Agreement—4/2015 - EXHIBIT C • City of Cupertino Consultant Declaration The undersigned does hereby certify that: 1. I am a representative of Phil Lenihan; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. 1 declare that Phil Lenihan 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 11105.3. 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 Consultan/t�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 at the City of Cupertino. I declare under penalty of perju t the foregoing ise and correct: Date Place h Page 5 of 7 City of Cupertino—Short Form Agreement—4/2015 V , . � , 6/22/201155 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jennifer Heath NAME: City. Securities Insurance, LLC PHONE (317)844-0273 FA� (317)972-7142 8900 'Keystone Crossing E-MAIL .jheath@citysecurities.com Suite 300 INSURERS AFFORDING COVERAGE NAIC# Indianapolis IN 46240 INSURERA:United States Fire Insurance 21113 INSURED INSURER B: Skate Instructors Association Inc INSURERC: 6832 27th Avenue NE INSURER D: INSURER E: Seattle WA 98115 INSURER F: COVERAGES CERTIFICATE NUMBER:CL151214024 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR JUM POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE r—xl OCCUR USPI68912 1/1/2015 1/1/2016 MED EXP(Any one person) $ 5,000 X Includes Participant PERSONAL&ADV INJURY $ 1,000,000 Accident GENERAL AGGREGATE $ 2,000,000 . HGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JFrT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea .,dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS (. ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes;describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Phil Lenihan (Individual Member) ACCORDANCE WITH THE POLICY PROVISIONS. 21841 Almaden Ave Cupertino, CA 95014-2855 AUTHORIZED REPRESENTATIVE Patrick O'Connor/JEN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 fgnlnnr,)ni Tho Ar`ni2n nnma and Inn^ara ranie4ararl m2rke of Af`npn ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/22/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jennifer Heath NAME: City Securities Insurance, LLC PHONE (317)844-0273 AICFAX (317)972-7142 8900 Keystone Crossing E-MAILS .jheath@citysecurities.com Suite 30.0 INSURERS AFFORDING COVERAGE NAIC# Indianapolis IN 46240 INSURERA:United States Fire Insurance 21113 INSURED INSURER B: Skate Instructors Association Inc INSURER C: 6832 27th Avenue NE INSURER D: INSURER E: Seattle WA 98115 INSURER F: COVERAGES CERTIFICATE NUMBER-CL151214024 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF MM/LDDY/Y� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r A CLAIMS-MADE FXI OCCUR USP168912 1/1/2015 1/1/2016 MED EXP(Any one person) $ 5,000 X Includes Participant PERSONAL BADV INJURY $ 1,000,000 Accident GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ r-tDED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ F1OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Cupertino, its City Council, ACCORDANCE WITH THE POLICY PROVISIONS. Commissions, officers, employees and volu. AUTHORIZED REPRESENTATIVE 10300 Torre Avenue Cupertino, CA 90514-3202 Patrick O'Connor/JEN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgninnsi nt Tho AnnPi 1 n2mn=nrl Inn^am rnnletnrrarl mark*of Ad nl2 l EVIDENCE OF INSURANCE-STATE OF CALIFORNIA -' FARMERS Named insured FARMERS INSURANCE EXCHANGE, LOS ANGELI'S, CALIFORNIA ,an authorized California Insurer, in compliance with the California Financial Responsibility Act, certifies that it has issued a policy in an,unount not less than that required by the California Financial Responsibility Law for the described motor vehicle(s). Vehide description: Registered kner: 200+ SIIBARU FORES'CER 4D 4WD 2. 5X PHILIP LENIHAN ilgentn;ime:LIAR Y FORM{ICO BARNARD Phoneno: (408) 286-1334 25-6408 4-13 Keep this certificate in your vehicle at all times. A6408511