16-001 Geetha KuppuswamyCITY OF
II SHORT FORM AGREEMENT
CUPERTINO
CITY OF CUPERTINO
10300 Torre Avenue
Cupertino, CA95014
408-777-3200 NO . 1-011-{, '
This Agreement, made and entered into this 16th day of June, 2016 ,(the "Effective Date") is by and between
the City of Cupertino (hereinafter "City") and Geetha Kuppuswamy
(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: Fitness Instruction Services are further described in Exhibit "A".
B. TERM. The services and/or materials furnished under this Agreement shall commence on July 1, 2016 and
shall be completed no later than June 30 , 2017.
C. COMPENSATION. For the full perfomrnnce of this Agreement, CITY shall pay Contractor a total
amount not to exceed four thousand dollars ($4000.00). Consisting of the following:
70% of resident fees -$5 administration fee per participant
D. EXHIBITS. The following attached exhibits hereby are made part of this Agreement:
tj 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
Qtxhibit "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 perfom1ed in connection with the Agreement ,
indemnify, defend, and hold hannless 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 peifomrnnce 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 tem1ination 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 on this Agreement shall be used in the perfonnance of this
Agreement.
3. Assignment. Contractor may not assign, transfer, or subcontract this Agreement or any po1iions 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, including sexual abuse and molestation coverage, in
the following minimum limits:
Bodily Injury: $500 ,000each occurrence; $1 ,000 ,000aggregate -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:
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 ofloss 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 und er such insurance.
6. Termination of Agreement. In the event Contractor fails or refuses to perfonn any of the provisions hereof at
the time an d in the maimer required hereunder, Contractor sha ll 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 availab le 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 tenninating
this Agreement by givin g seven (7) ca lend ar days' prior written notice to Contractor as provided herein. Upon
receipt of any notice of termination, Contractor shall immediately discontinue performance.
7. No n-Discrimination. Contractor sha ll 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 suc h 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 perfom1ed . Nevertheless, City may, at any time,
observe the manner in which such services are being perfom1ed 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 an d maintain during the tenn of this
Agreement , all appropriate permits , licenses , and ce1iificates including but not limited to a City business license, that
may be required in connection with the perfom1ance of services und er this Agreement.
10. Reports and Records. Each and every report, draft, work product, map , record and other document, hereinafter
co ll ective ly referred to as "Report", reproduced , prepared or caused to be prepared by Contractor pursuant to or in
com1ection 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, infomrntion 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
repori 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 perfonnance of services under this Agreement, in sufficient
detail to pennit 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.
11. Changes. No changes or variations of any kind are authorized without the written consent of th e City.
CONTRACT CO-ORDINATOR and representative for CITY shall be: Karen Levy, Recreation and Community
Services
In witness thereof, the parties have executed this Agreement the day and year fast written above.
CONTRACTOR: CITY OF CUPERTINO:
By: __ K=-==a=--'re=n'-"'L=e=-vv'-'--~-+--------
Title:_~D~an~c~e~I~n~s~tru~ct~o_r _________ _ Title : _ _,R=e=c=r=ea=t=io""'n"'"--"'C=o=o=--'rd=i=na=t=o:...r ___ _
EXPENDITURE DISTRIBUTION
ACCOUNT NUMBER AMOUNT
580-63-620 700-702 $4000.00
EXHIBIT A
CONSULT ANT SERVICES TO BE PERFORMED
The CONSULTANT will provide instruction in, but not limited to, the following programs:
Yoga for kids
Location and Time of CONSULT ANT Services:
Refer to the Recreation Schedule for agreed upon dates, times , and class locations. By Mutual agreement
of both parties, class schedule may change.
Eligible Participant Minimum and Maximums for CONSULTANT Services:
Minimum: 5
Maximum: 12
If less than the required minimum number of paiiicipants 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 p ayment to Consultant.
Performance of CONSULTANT Services:
City shall have no iight of control as to the manner Consultant performs the services to be perfonned.
Nevertheless , City may, at any time, observe the manner in which such services are being perfonned by
the consultant.
The Consultant shall follow all guidelines pe1iaining to registration procedures as listed in the quaiierly
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 fonn 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 occuning to a participant, the Consultant will notify the City within 1 hour and
complete an Incident Report in the fonn approved by the City. The Incident Report must be submitted to
the City within 24 hours of the injury occuning.
EXHIBITB
ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS, RECEIPT OF
TRAINING, AND RECEIPT OF PENAL CODES STATUTES
A mandated rep01ter 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 Geetha Kuppuswamy include contact
with children, you are a Mandated Rep01ter. Prior to commencing employment and as a prerequisite of
that employment, California law requires that you sign a statement to the effect that you ha ve 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 Repo1ter responsibilities under California law. You are also being
provided with a separate informational document which includes the text of the California Mandated
Repo1ter Law and contact infonnation for Child Abuse and Neglect Reporting for the County of Santa
Clara. Please review this infonnation carefully and acknowledge your receipt and understanding where
indicated . If you have questions or concerns about this fonn or your Mandated Repo1ter responsibilities,
please contact the Recreation Supervisor at 408-777-3120 .
I understand that:
• B y virtue of my employment or independent contractor status with Geetha Kuppuswamy,
and because my employment requires me to ha ve contact with children, I am a Mandated
Reporter as defined by California Penal Code 11165 . 7 .
• The following situations trigger mandatory repo1ts: a) Physical Abuse (willful hanning
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 futther understand that I may, but am not
required to, repo1t 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 repo1t may be made
to local law enforcement, or County Sheriffs Depaitment, Probation Department or
Child Welfare 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 repo1t , 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 comt order. Fmther, agencies investigating the mandated 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 a1ising from alleged child abuse;
o Counsel appointed pursuant to subdivision ( c) of Section 31 7 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 Cow1ty jail, a fine of not more than
$1000 , or both. I fu1iher understand I could be civilly liable for failure to report. (Cal.
Pen. Codell 166(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.
Name (Signature)
CE CT HA 'K v rPusw f\T!J
Name (Print)
Datd
EXHIBITC
City of Cupertino Consultant Declaration
The undersigned does hereby certify that:
1. I am a representative of Geetha Kuppuswamy; that I am familiar with the facts herein and am
authorized and qualified to execute this declaration.
2. I declare that Geetha Kuppuswamy has complied with fingerprinting and criminal background
investigation requirements with respect to all Consultant 's employees who may ha ve contact with
minors in the course of providing services pursuant to the Agreement, and the California
Department of Justice has detennined that none of those employees has been convicted of a
felony, as that tennis 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 cu1Tent 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:
self
6. The City of Cupe1iino 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 Cupe1iino .
I declare under penalty of perjury that the foregoing is true and coITect:
6/;)5/~o1b
Date Consultant Signature
fitness instructor
Title