16-001 Twisters Sports Center'UeJ'f-~qP NO. ______ ~(J-
FY 16-17
AGREEMENT BETWEEN THE CITY OF CUPERTINO AND
TWISTERS SPORTS CENTER
FOR GYMNASTICS AND SPORTS CAMPS AND CLASSES
THIS AGREEMENT, for reference dated WEDNESDAY, JUNE 8, 2016, is by and
between CITY OF CUPERTINO, a mw1icipal corporation (hereinafter referred to as "City"), and
TWISTERS SPORTS CENTER, a CALIFORNIA CORPORATION, whose address is
(hereinafter referred to as
"Consultant"), and is made with reference to the following:
RECITALS:
A. City is a mw1icipal corporation duly organized and validly existing w1der 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
Mw1icipal Code.
B. Consultant is specially trained, experienced and competent to perform the
special services which will be required by this Agreement; and
C. Consultant possesses the skill, experience, ability, backgrow1d, certification and
knowledge to provide the services described in this Agreement on the terms and conditions
described herein.
D. City and Consultant desire to enter into an agreement for GYMNASTICS AND
SPORTS CAMPS AND CLASSES upon the terms and conditions herein.
NOW, THEREFORE, it is mutually agreed b y and between the undersigned parties as
follows:
1. TERM:
The term of this Agreement shall c01runence on FRIDAY, JULY 1, 2016, and shall
terminate on FRIDAY, JUNE 30, 2017, wuess terminated earlier as set forth herein.
2. SERVICES TO BE PERFORMED:
Consultant shall perform each and every service set forth in Exhibit "A" which is
attached hereto and incorporated herein by this reference.
3. COMPENSATION TO CONSULTANT:
Consultant shall be compensated for services performed pursuant to this Agreement in
the amow1t set forth below and as described in Exhibit "A" which is attached hereto and
incorporated herein by this reference.
FY 2016/2017 1
Classes:
Camps:
30 Min Private Lesson:
40 Min Group Lesson
55 Min Group Lesson
90 Min Group Lesson
3 Hour Camps:
.5 Hour Camps:
7 Hour Camps
$22.50 per participant per class meeting
$7.25 per participant per class meeting
$7.75 per participant per class meeting
$9.00 per participant per class meeting
$110 per participant*
$155 per participant*
$170 per participant*
*Compensation is based on five camp ineetings and vvill be prorated for programs that
meet less than five times.
The City will issue no more than two pay1nents per quarter and, if needed, one final
payment at the end of this agreement to close the account.
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
perfonned by Contractor, City may cancel and withdraw from this Agreement. The total
cmnpensation to the Consultant shail not exceed ONE HUNDRED TWENTY-FIVE
THOUSAND DOLLARS ($125,000).
4. &_~_15:NQ_~y~~-Qg_~M-~NTQI .MANQ,1\II.:'.P.~tl:'.PQKCIN•G····~t ·~o~rm~~rnNI:S.:
Consultant shall comply with the requirements of California Penal Code 11164-111 7•1 .3
and as set forth in Exhibit "B" which is attached hereto and incorporated herein by this
reference .
::i. FINGERPRINT & TUBERCULOSIS {TB) CONSULTANT DECLARATION:
Consultant agrees that all individuals covered under this Agreement shall provide
fingerprints for crirninal background test purposes and results of TB screening, pursuant to the
requirements as set forth in Exhibit "C' \.vhich is attached hereto and incorporated herein by
this reference.
6. TIME IS OF THE ESSENCE:
Consultant and City agree that time is of the essence regarding the performance of this
Agreement.
7. STANDARD OF CARE:
Consultant agrees to perform all services hereunder in a manner commensurate with the
prevailing standards of specially trained 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.
F\i ?m 1.:;nn17
City and Consultant intend that the relationship between them created by this
Agreement is that of an independent contractor. The maimer and means of conducting the
work are under the control of Consultant, 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 \'V'ill be acquired by virtue of Consultant's services. None of the benefits provided
by City to its employees, indw:ling but not limited to, unemployment insurance, workers'
compensation plans, vacation and sick leave are available from City to Consultant, its
ernployees or agents. Deductions shall not be made for any state or federal taxes, FICA
payments, PERS payments, or other purposes norrnally associated wtth an employer-employee
relationship from any fees due Consultant. Payments 0£ the above items, if required, are the
responsibility 0£ Consultant.
9. IMI\HGRATION REFORM AND CONTROL ACT (IRCA):
Consultant assumes any and all responsibility for verifying the identity and
empioyment authorization of all of his/her employees performing work hereunder, pursuant to
all applicable lRCA or other federal, or state rules and regulations . Consultant shall indemnify
and hold City hannless from and against any loss, darnage, liability, costs or expenses arising
from any noncompliance of this provision by Consultant.
Consistent \Vi th City's policy that harassment and discrimination arc unacceptable
employer/employee conduct .. Consultant agrees that harassment or discrimination directed
toward a job applicant, a City employee, or a citizen by Consultant or Consultant's employee or
subcontractor on the basis of race, religious creed, color, national origin, ancestry, handicap,
disability, marital status/ pregnancy, sex, age, or sexual orientation \·vill not be tolerated.
Consultant agrees that any and all violations of this provision shall constitute a material breach
of this Agreement.
Consultant shall, to the fullest extent allowed by Ia-w , with respect to all services performed in
connection vvith 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 liabiiity of any nature, whether physical, emotional,
consequential or otherwise, arising out, pertaining to, or related to the performance of this
Agreement by Consultant or Consultant'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.
In addition to the obligations set forth above, Consultant 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 Consultant's
negligence, recklessness or willful misconduct under this Agreement. Such costs and expenses
shall include reasonable attorneys' fees of counsel of City's choice, expert fees and all other cos ts
a.nd fees of litigation.
12. INSURANCE:
On or before the commencement of the term of this Agreement, Consultant shall furnish
City with certificates showing the type, amount, class of operations covered, effective dates and
dates of expiration of insurance coverage in cornpliance with the paragraphs below. Such
certificates .. which do not limit Consultan t's indenmification, shall also contain substantially the
following statement: "Shouid any of the above insurance covered by this cert ificate be canceled
or coverage reduced before the expiration date thereof, the insurer affording coverage shall
provide thirty (30) days' advance 1Nritten notice to the City of Cupertino by certified mail,
Attention: City Manager." It is agreed that Consultant 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 Californi a . Endorsements naming the City as additional insured shall be
submitted with the insurance certificates.
A. COVERAGE:
Consultant shaJl maintain the folfowing insurance coverage:
(1) Workers ' Compensation:
Statutory coverage as required by the State of California.
(2) Liabilitv:
Commercial general liability coverage, including sexual abuse and
molestation coverage, in the follow ing minimum limits:
Bodily Inju.ry:
Property Damage:
$.500,000 each occurrence
$1,000,000 aggregate -all other
$100,000 each occurrence
$250,000 aggregate
If submitted, combined single limit policy 'Vvith aggregate limits in the
amounts of $1,000,000 wiil 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:
Consultant agrees that in the event of Joss due to any of the perils for \·vhich he/she has
agreed to prov ide comprehensive genera[ and automotive l iab.ility insurance, Consu ltant shall
T<V ·)()11'f?nl 7 4
look solely to his/her insurance for recovery. Consul tant hereby grants to City .. on behalf of any
insurer providing comprehensive general and automotive liability insurance to either
Consultant or City with respect to the services of Consultant herein, a waiver of any right to
subrogation which any such insurer of said Consultant may acquire against City by virtue of
the payment of any loss under such insurance.
C. FAILURE TO SECURE:
If Consultant at any time du.ring the term h ereof should fail to secure or maintain the
foregoing insurance, City shall be perrnitted to obtain such insurance in th e Consultant's narne
or as an agen t of tbe Consultant and shall be compensated by the Consultant 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 p remiums have not been paid.
D. ADDITIONAL INSURED:
City of Cupertino, 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 n amin g of an additional
insured sha ll not affec t any recovery to \Nhich such additional insured would b e entitled under
this policy if not narned as such additional insured. An additional insured nam.ed herein shall
not be held liable for any p remium, <led uctible 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 requi re d lo contribute anything tm'\rard any loss or expense covered by the insurance
provided by this policy .
E . SUFFICIENCY OF INSURANCE:
The insurance limits required by City are not represented as being sufficient to protect
Consultant. Consultant is advised to confer with Consultant's insurance broker to determine
adequate cover age for Consultant.
13 . CONFLICT OF INTEREST:
Consultant warrants that it is not a conflict of interest for Consultant to perform the
services re quired by this Agreernent. Consultant may b e required to fill out a conflict of interest
form if the services provided under this Agreement require Consultant to make certain
governmental decis ions or serve in a staff capacity as defined in Titie 2, Division 6, Section
18700 of the California Code oi H.egulations .
14. PRQtIHHIIQN AG.A:INS.TIRAJ'.ll:?.J:<~Rf?:
Consultant shall not assign, sublease, hypothccate, or transfer tl1is Agreement, or any
interest therein, directly or indirectly .. by operation of la'w or otherwise, vdthout prior written
consent of City. Any attempt to do so without said consent s hall be null and void, and any
assignee, sublessee .. hypothecate or transferee shall acquire no right or interest by reason of such
attempted assignment, hypothecation or transfer. However, claims for money by Consultant
FV ·)()I 1.;1?n17
from City under this Agreement may be assigned to a bank, trust company or other financial
instihrtion ·without prior v\Titten consent. \Nritten notice of such assignment shall be promptly
furnished to City by Consultant.
The sale, assignment, transfer or other disposition of any of the issued and outstanding
capital stock of Consultant, or of the interest of any general partner or joint venturer or
syndicate member or cotenant, if Consultant is a partnership or joint venture or sy ndicate or
cotenancy, vvhich shall result in changing the control of Consultant, shall be construed as an
assignment of this Agreement. Control means fi fty pe rcent (50 %) or rnore of the voting po\·ver
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 ol
this Agreement.
In the event that Consultant employs subcontractors, such subcontractors shall be required to
furnish proof of workers' compensation insurance and shall also be required to carry general,
and profes s ional liability insurance in reasonable conformity to the insurance carried by
Consultant. In addition, any work or services subcontracted hereunder shall be subject to each
provision of this Agreement.
16 . PERMITS AND LICENSES:
Consultant, al: hisiher sole expense, shall o btain and maintain during the term of this
Agreement, a ll appropriate permit s, certificate s and license s including, but not limited to, a City
Business License, that may be requi red in connection with the performance of services
hereunder.
17. K~YQJ~I$:
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 connection with this Agreement, shall be the exclusive property
of City. Consultant 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 ri g hts are reserved to City. Consultant
may retain a copy of any report furnished to the City pursuant to this Agreement .
B. All Reports prepared by Consultant rn a y be used by City in execution o r
implementation of:
F'{ )()1r.;f?nl7
(1)
(2)
(3)
(-1)
The original Project for v,rhich Consultant was hired;
Completion of the ori ginal Project by others.:
Subsequent additions to the original project; and/or
Other City projects as appropriate .
C. Consultant 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
Consultant pursuant to this Agreement shall be made available to any individual or
organization by Consultant without prior approval by City.
18. RECORDS:
Consultant shall maintain complete and accurate records vvith respect to sales, costs,
expenses, receipts and other such information required by City that relate to the perforrnance of
services under this Agreement.
Consultant shall maintain adequate reco rds 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.
Consultant 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 allovv inspection of all vvork, data, documents,
proceedings and activities related to this Agreement. Such records, together \'Vith supporting
documents, shall be kept separate from other documents and records and shall be rnaintained
for a period of three (3) years after receipt of final payment.
If supplemental exarnination or audit of the records is necessary due to co ncerns raised by
City's preliminary exan:rination 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 Consultant shall reimburse City for
all reasonable costs and expenses associated with the supplemental exarn.ination or audit.
19. NOTICES:
All notices, demands, requests or approvals to be given under this Agreement shall be
given in 1.vriting and conclusively shall be deemed served when delivered personally or on the
second business day after the deposit thereof in the United States l\fail, postage prepaid,
registered or certifi e d, addressed as hereinafter
provided.
All notices, demands, requests, or approvals from Consultant to City shall be addressed
to City at:
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014
Attention: Director of Recreation and Community Services
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All notices, demands, requests, or approvals from City to Consultant shall be addressed
to Consultant at: , Attention: ALLAN
FUSILEl{O.
20 . TERMINATION: ·····-··········-·-·····--·-·······-···············-···-·····-···-·-···
In the event Consultant fails or refuses to perform any of the provisions hereof at the
time and in the manner required hereunder, Consultant shall be deemed in default in the
performance of this Agreement. If such default is not cured \Vithin the time specified after
receipt by Consultant 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 Consultant written notice thereof.
City shall have the option, at its sole discretion and vvithout cause, of terrn.inating this
Agreement by giving thirty (30) days' prior \>\Titten notice to Consultant 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 Consultant'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 Consultant or payment under this Agreement. The
City in its sole discretion may determine the type of classes, the number of classes and the
assigned instructor.
21 . COMPLIANCES:
Consultant 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 sub:iect 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. ARYJ.m :ns.~M~NI:
Consultant 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 vvritten approval has been secured from
City to do otherwise.
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24. \YAIY J:m:
A waiver by City of any breach of any term, covenant, or condition contained herein
shall not be deemed to be a '""'aiver of any subsequent breach of the same or any other term,
covenant, or condition contained herein, whether of the same or a different character.
25. INTEGRATED CONTRACT:
This Agreement represents the full and complet e understanding of every kind or nature
whatsoever between the parties hereto, and all preliminary negotiations and agreements of
vvhatsoever kind or nahue are merged herein. No verbal agreement or implied covenant shall
be held to vary the provisions hereof. .Any modification of this Agreement 'Nill be effective only
by written execution signed by both City and Consultant.
26. INSERTED PROVISIONS :
Each provision and clause required by law to be inserted into the Agreement shall be
deemed to be enacted herein, and the Agreernent shati be read and enforced as tl10ugh each
vvere 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 appfication
by eilher party.
27. ~AP_UQNS'
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.
q
IN WITNESS WHEREOF, the parties have caused the Agreement to be executed.
~ ~
By : ALLAN FUSILERO
T itle : OWNER
Da t e :
CITY OF CUPERTINO
A Municip al Cor poration rL--C,r
>
Bv: JEFF ORDWAY
Title: RF.CREATION COO RD IN ATOR
Date: ••••••••Ce :25 ... : ... ~.~ •••••••••••••••••••••••••••••••••••••••••mm •••••••••••••••••
RECOMMENDED FOR APPROVAL:
By: CHRISTINE HANEL
Title: DIRECTOR OF RECREATION &
crnvrMU NITY SEHV ICES
APP RO VED AS TO FORM:
~)if
GRACE SCHMIDT f ~17-( b
CITY CLEEK
EXPENDTTURE DISTRIBUTION:
A ccoun t N o: 580-63-620 -700 -702
Amou nt: $125,000
EXHIBIT A
CONSULTANT SERVICES TO BE PERI;ORMED
The CONSULTANT will provide GYMNASTICS AND SPORTS CAMPS AND CLASSES in,
but not limited to, the following programs:
PRESCHOOL LEVEL l: LEAPING LIONS, PRESCHOOL LEVEL 2: JUMPING GIRAFFES,
PRESCHOOL LEVEL 3: CAl\TVv'HEEL KANGAROOS, PRESCHOOL LEVEL 4: BOUNCING
BEARS, RECREATIONAL Gl:'MNASTICS LEVEL 1, RECREATIONAL GYMNASTICS LEVEL
2, RECREATIONAL G'r'lvfNASTICS LEVEL 3, PRIVATE GYMNASTICS LESSONS,
GYMNASTICS CAMP, GYMNA.STICS PRESCHOOL CAMP, GYMNASTICS AND DANCE
CO~v1BO CAMP GYMNASTICS AND TAEKWONDO COMBO CAMP
Location and Time of CONSULTANT Services:
Refer to the Recreation Schedule dated 2016 SUl\tf:\-1ER (JULY I AUGUST CAMPS), 2016 FALL,
2017 WINTER, 2017 SPRING (JUNE CAMPS) 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: 2
Maximum: 6-8
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 Agreernent vvithout additional notice or payment to
Consultant.
Performance of CONSUL TANT Services:
City shall have no right of control as to the manner Consultant performs the services to be
performed. Nevertheless, City may, at any tirn.e, 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 ne1~d
to complete the City's Waiver of Liability form prior to laking part in the program. Contractors
are responsible for supervising minors after class until a parent of legal guardian bas arrived.
i:;y •)()! f;/?()17 11
In the event of an injury occurring to a participant, the Consultant ·will notify the City within 1
hour and complete an Incident Report in the form approved by the City. The Incident Report
must be submitted to the City ·within 2,1 hours of the injury occurring.
i:;·v ·/n11.;nn17 1?
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 la-vv 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 TWISTERS SPORTS CENTER
include contact with children, you are a Mandated Reporter. Prior to commencing employment
and as a prerequisite of that e rnployrnent, California law requires that you s ign 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 \Vith 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 Ciara. 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 co ntact the
Recreation Supervisor at 408 -777-3120.
I understand that:
• By virtue of 111y employment or independent contractor status with TWISTERS
SPORTS CENTER, and because my employment requires me to have contact
with children1 I am a rvlandated Reporter as defined by California Penal Code
1116.5.7 .
• The follo1Ning situations trigger mandatory reports: a) Physical Abuse (willful
harming of a child); b) Sexual abuse including sexual assault, child exploitation ..
pornography, and trafficking.: c) Sever e or General Neglect; and d) Extreme
Corporal Punishment (resulting in injury). (Cal. Pen. Code 11165 ct. 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 rnust inunediately 1nake a
telephone report. l rnust follow up with a written report within 36 hours. This
FY ·)fl!1:;/?n17 l~
report may be made to local L:n"r enforcement, or County Sheriff's Department ..
Probation Department or Child Welfare Agency. (Cal Pen. Code 11166(a)}.
• I am not required to, but T 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 ,.vill be required to give my nan'te. Hmvever,
my i dentity ·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
11167(d)).
• The following agencies and individuals receiving o r investigating mandated
reports may disclose my identity t o 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
VVelfare and Institutions Code;
u A licensing agency when abuse or neglect in out-of-home care is
reasonably sus pected. (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 vvhen making a
report (Cal Pen. Code U 172).
• As a Mandated Reporte1·, it is a misdemeanor to fail to comply with Mandated
Reporting laws and l 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)).
FY ·)f11{;/?nl7 14
l have been provided with a copy of California Penal Code sections 11164-11174.3 (Mandated
Reporter Law).
l understand that I am a legally Mandated Reporter. l 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 .
~.l--....... .
Name (Signature) ~/-~---Date
Name (Print)
FV ·/1111.;1?n17 Fi
EXHIBIT C
City of Cupertino Consultant Declaration
The undersio-ned does herebv certifv that: 0 ; ;
1. I am a representative of TWISTERS SPORTS CENTER; that I arn farniliar with the facts
herein and am authorized and qualified to execute this declaration.
2. I declare that TWISTERS SPORTS CENTER has complied v11ith 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 convi cted of a felony, as that term is defined in
California Penal Code Section 1110.5.3.
3. That a complete and accurate list of Consultant's employees, vd10 may come in contact
with minors during the course and scope of the Agreement, are included below.
4. All of the belovv mentioned employees ha v e tested negative for TB, or X-ray results for
TB, and have current documentation on file tvith 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 (if no Employees, identify "self":
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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 perjury that the foregoing is true and correct:
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Date Place Consultant Signature Title
FY ·)01f;/?nl7