16-001 Omei Academy CITY OF
SHORT FORM AGREEMENT
� � CITY OF CUPERTINO
� 10300 Ton-e Avenue
«'� Cupertino,CA95014
Ct�E��F�`�`It�o 408-777-3200 I�TO. �L���-2���—"
This Agreement,made and entered uito this 9th day of September,2016,(the"Effective Date")is by and
between the City of Cupertino (hereulafter"City") and Omei Academy
(hereinafter"Contractor"),in consideration of their mutual covenants,the parties agree as follo���s:
A. SCOPE OF SERVICES. Contractor shall provide or funiish the follo���ing specified sen�ices and/or
materials: Youth Fitness Instruction Services are further described ui Exhibit"A".
B. TERl�'I. The sen�ices and/or materials funiished under this AQreeinent shall commence on Septeinber 10;
2016 and shall be completed no later than June 30,2017. y
C. CO:�ZPENSATION. For the full perfornlance of tlus Agreement, CITY shall pay Contractor a total
amount not to exceed t���o thousand dollars(�?000.00). Consisting of the following:
80% of resident fees- $5 adnunistration fee per participant
D EXHIBITS. The following attached exlubits hereby are made part of tlus Agreement:
�Exlubit"A"- Scope of Services
�Exhibit"B"-Acl;no���ledgement of Mandated Reporting Requirements,Receipt of Training, and Receipt of Penal
�Co e Statutes Exhibits"B"and"C"are for anyone���orking«�ith minors
xhibit"C"-City of Cupertino, Consultant Declaration
GENERAI,TERl�ZS A:'�D CONDITIO�S
1. Hold Harniless. Contractor shall, to the fullest extent allo���ed by law and widiout limitatioii of the provisions of
this Agreement related to insurance, ���ith respect to all sen�ices perfonned in connection ���ith the Agreement,
indenuufy, defend, and hold hannless the City and its officers; officials; agents, employees and volunteers from and
aQainst any and all liability; claims, actions, causes of action or demands���hatsoever against any of them, includulg
any injury to or death of any person or damage to property or other liability of any nature, ��hether physical,
emotional, consequential or othei-��ise, arising out;pertainin�to, or related to the perfoi7nance of tlus Agreement by
Contractor or Contractor's employees; officers, officials, agents or uldependent 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 flie riQht of indenmification.
The provisions of this Section sun�ive the completion of the Services or tennination of this Contract.
2. SubcontractinQ. Contractor has been retained due to their unique skills and Contractor rnay not suUstitute
another, assiQn or transfer any riQhts or obligations under this Agreement. Unless prior��-7itten consent from City is
obtained, only those people whose names are listed on this Agreement shall be used in the perfornlance of this
Agreement.
3. Assianment. Contractar may not assign, transfer; or subcontract this AQreenlent or any portions thereof; ���ithout
prior«�ritten conseilt of City. �
4. Insurance. Contractar shall maintain the follo���uig insurance coverage, �a�ith the City as an additional named
insured, and provide a Certificate of Insurance and Additional Insured Endorsement consistent ���ith the follo���ing
requirenlents:
(a)«'orkers' Coinpensation: Statutory coverage as required by the State of Califoniia.
(b)Liability: Conuiiercial general liability coaerage, uicludina se�ual abuse and molestation coverage,in
the follo«�ing n7inimum linlits: �
Bodily Injury: �SOO;OOOeach occui7•ence; $1,000;OOOagare;ate-all other
PropertyDamage: �100;000 each occuiYence; $2�0,000 aggregate
If submitted,coinbined snlgle linlit�olicy with a�gregate limits in the amounts of�1,000,000«�ill be
considea-ed equivalent to the required nunimunz limits sho���n above.
i
(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«'ai�•ec•. Contractor a�rees that in the event of loss due to any of the perils for���hich 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
automoti��e liability ulsurance to either Contractor or City with respect to the services of Contractor herein, a���ai��er
of any right to subroQation ���hich any such insurer of said Contractor may acquire against City by virtue of the
payment of any loss under such insurance.
6. Termination of AQreement. In the event Contractor fails or refuses to perforni any of the provisions hereof at
the titne and in the mamier required hereunder, Contractor shall be deemed in default in the perfornlance of this
Agreement. If Contractor fails to cure the default ���ithin 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 la���, the City
Manager may terniinate the Aareement by giving Contractor «�ritten notice thereof, ��-1uch shall be effective
iuunediately. i he C:ity 1Vlanagervsiiaii also nave tne option, at iis soie discretion and «�i'tiiout cause, oi terminaiuig
this Agreement by giving seven (7) calendar days' prior written notice to Contractor as pro��ided herein. Upon
receipt of any notice of termination, Contractor shall immediately discontinue perfonnance.
7. l�Ton-Discrimivation. Contractor shall not discriminate aQainst a job applicant, einplo}�ee, 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 tlus AQreement 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 eaecuting this Agreenlent. Contractor certifies that no one ���ho has or
���ill ha��e any financial uiterest under tlus Agreement is an officer or employee of City. City shall have no right of
control as to the maruier Contractor perfornls the sen�ices to be perfornled. Nevertheless, City may, at any time,
observe the manner in which such services are being perfonned by the contractor. Contractor shall comply�vith all
applicable Federal, State, and local la«�s and ordinances includinQ, but not limited to, unemployment insurance
benefits,FICA la«�s, and the City business license ordinance. �
9. Pei•mits and Licenses. Contractor, at his/her o���n ezpense, shall obtaiu and maintain duruig the ternl of this
Agreement, all appropriate pennits, licenses,and certificates including but not limited to a City business license,that
may be required in connection«�ith the perfornlance of seivices under tlus Agreement.
10. Reports and Reco►•ds. Each and e�ery report, draft, ���ork product, map, record and other document, hereinafter
collectively refen-ed to as "Report", reproduced, prepared or caused to be prepared by Contractor pursuant to or in
coimection���ith this Agreement, shall be the e�clusive property of City. Contractor shall not cop}�riQht any Report
required by this AQreement and shall execute appropriate documents to assign to City the copyritrht to Reports
created pursuant to this Agreement. Any Report, uifoniiation and data acquired or required by this Agreement shall
become the property of City, and all publication ri�hts are resen�ed to City. Contractor may retain a copy of any
report fiimished to the City pursuant to tlus Agreement.
Contractor shall maintain complete and accurate records «�ith respect to sales, costs, expenses, receipts arld other
such infonnation required by City that relate to the performauce of sen�ices under tl�is Aareement, in sufficient
detail to pemut an evaluation of services. All such records shall be maintained in accordance ���ith generally
accepte�d accountuig principles and shali be clearly identified and readily accessible. Contractor shall provide free
access to such books aild records to the representatives of City or its designees at all proper times,and gives City the
right to e�amine and audit same,and to make transcripts therefrom as necessary, and to allow inspection of all ���ork,
data, documents, proceedings and activities related to tlus Agreement. Such records, to�ether ���ith 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 fmal payment from Ciry for all services required under this agreement.
11. ChanQes. I�To chau�es or variations of any kind are authorized��ithout the written consent of the City.
COlVTRACT CO-ORDII�TATOR and representative far CITY shall be: Karen Levy, Recreation and Conmlunity
Services
In witness thereof,the parties have executed this Agreement flle day and year first���ritten above.
CONTRACTOR: CITY OF CUPERTINO:
��/
BY� � By: Karen Le�� ���� /
,
Title: Fitness Instructor Title: Recreatiou Coordinatar
�.PPROVAI,S E�PENDITURE DISTRIBtiTION
RECRE I N TAGER DATE ACCOUNT l���IBER AI��OUNT �
��i-� C-�-(� 580-63-620 700-702 $2000.00
`�>(` CI'`I`Y A�I'ORNEY APPROVED AS TO FORM DATE
,��( � C ��l�
CIT LERK: AT�ES DATE
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EXHIBIT A j
!
CONSULTANT SERVICES TO BE PERFOR�I'IED
The CO\TSULTANT�`�ill pro��ide instruction in, but not limited to,the follo��-ing programs:
Tai Chi for Kids
Location and Time of COIVSULTANT Services:
Refer to the Recreation Schedule for a�-eed upon dates, times; and class locations. By Mutual agreement
of Uoth parties, class schedule may change.
Eligible Participant Minimum and PZaximums for CONSiTLTANT Ser��ices:
��iiuinum: 4
Maximum: 8
If less than the required minimum number of participants eiu-oll 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 tei7iunate this Agreement���ithout additional notice or payment to Consultant.
Perforrnance of CONSULTANT Services:
City shall have no right of control as to the mamler Consultant perfor711s the services to be perfoi7ned.
Nevertheless, City may, at any time, observe the mamler in which such services are being perfonned by
the consultant.
The Consultant shall follo���all b idelines pertaiiung to re�istration procedures as listed ul the quarterly
recreation schedule. Participants may not take part in the prograin unless they are listed on the class
roster or can sho���proof of em-ollment. All participants and volunteers need to coulplete the City's
Waiver of Liability fonn prior to takin�part in the program. Contractors are responsible for supervising
nunors after class until a parent of le�al b ardian has arri��ed.
I�i the event of an injury occun-in�to a participant, the Coilsultant«-ill notify the Cit}�witlun 1 hour aild
complete an I�icident Report in the fornl approved by the City. The I�Zcident Report must be subnutted to
the City«�itlun 24 hours of the injury occuiring.
EXHIBIT B
ACKI�TO�?�'LEDGEPZENT OF PZANDATED REPORTII�TG REQUIREl�'iENTS,RECEIPT OF
TRAII�TING,A1�TD RECEIPT OF PENAL CODES STATUTES
A mandated reporter is an individual��ho is obligated by law to report suspected cases of child abuse and
neglect. In general, any individual who, in the ordinary course of tlleir employment, has contact«�ith
children is a mandated reporter. Mandated reporters iilclude cluld care«�orkers,teachers and coaches.
(Califoi7lia Penal Code 11165.7).
If your job duties as an employee or an independent contractor of Omei Academy include contact«�ith
cluldren, you are a Mandated Reporter. Prior to coi�unencing employment and as a prerequisite of that
employment, Califonua law requires that you si�l a statement to the effect that you have kno���ledge of
the provisions of the Mandated Reporter Law, and will comply with those provisions. (Califoi7ua Penal
Code 11166.5).
The following are the Mandated Reporter responsibilities under Califonua law. You are also being
provided«�ith a separate izlfonnational document wluch includes the text of the Califonua Mandated
Reporter La�� and contact infonnation for Cluld Abuse and I�Teglect Reporting for the County of Santa
Clara. Please review tlus infoi-�ilation carefully and ackno«�ledge your receipt and understanding���here
indicated. If you ha��e questions or concei7ls about this foini 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 Omei Academy, and
because nry employment requires me to have contact«�ith children, I am a Mandated
Reporter as defined by Califoi7ua Penal Code 11165.7.
• The following situations trigger ivandatory reports: a)Physical Abuse(«�illful harnung
of a child); b) Sexual abuse includulg se�ual assault, child e�ploitation,poi7lob aphy, and
trafficking; c) Severe or Geizeral I�reglect; and d) Extreme Coiporal Puiuslunent (resulting
in injury). (Cal. Pen. Code 11165 et. seq.) I further uiiderstand that I may, but am iiot
required to,report suspected Einotional Abuse.
• If I reasonably suspect that a child is being abused, I must inullediately make a telephone
report. I must follow up«�ith a���ritten report«�ithin 36 hours. This report inay be made
to local law enforcement, or County Sheriff's Department, Probation Department or
Child Welfare Agency. (Cal Pen. Code 11166(a)).
� I am not required to, but I may, share infoi7ilation about suspected abuse with my
supeivisor or iilanagement or the parents of the alleged victim.
• When I make a mandated report, I���ill be required to give my nan�e. Ho���ever, my
identity���ill be kept confidential ui�less I eidler coiisent to disclosure or if the disclosure
is made pursuant to a court order. Further, agencies investigating the mandated report
may disclose my ideutity to one another. (Cal Pen. Code 11167(d)).
• The following agencies and individuals receiving or investiQating iilandated reports may
disclose my ideiltity to one another: �
o Prosecutors in a crinunal prosecuting or in an action initiated under section 602 I
of the VVelfare and I�istitutions Code arising from alleged cluld abuse;
o Counsel appointed pursuant to subdivision(c) of Section 317 of the��Jelfare and
I�lstitutions Code;
o A licensing agency���hen abuse or neglect in out-of-home care is reasonably
suspected. (Cal Pen. Code 11167.5)
• I may not be discipluied, disnussed, retaliated against, discrinunated against or harassed
for makin�a mandated report of reasonably suspected child abuse.
• As a Mandated Reporter, I have civil and crinunal immunity when making a report(Cal
Pen. Code 11172).
• As a Mandated Reporter, it is a misdemeanor to fail to comply«�ith n7audated
Reporting la�i�s and I can be held criminally liable for failing to report suspected
abuse. Tlie penalty ior this is up to six montiis in l:ounty jail, a Inle oi not more tilan
�1000, or both. I further understand I could be civilly liable for failure to report. (Cal.
Pen. Code 11166(c)).
I ha�•e been pro��ided«ith a copy of California Penal Code sections 11164-1ll74.3 (1�Iandated
Reporter La`i-).
I understand that I am a legally 1�landated Reporter. I am a�F�are of and understand my
responsibilities under the 117andated ReportPr la`r�s of this state and am�i•illing aud able to comply.
I understand that a copy of this Acl�no�i�ledgement«ill be kePt in my personnel file.
9 -� - �%�
Name(Si a�e) � Date
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I�Tame(Print) ��
EXHIBIT C
Cit3�of Cupertino Consultant Declaration
The undersi�ied does hereby certify that:
l. I am a representative of Omei Academy, that I am fanuliar with the facts herein and au1
authorized and qualified to execute this declaration.
2. I declare that Omei Academy has complied with finQerprintnig and crinunal background
iilvestigatioii requirements with respect to all Consultant's employees who inay have contact with
nunors in the course of providing seivices pursuant to the Agreement, and the Califonua
Department of Justice has detez7iuned that none of those ernployees has been convicted of a
felony, as that tenll is defined in California Penal Code Section 11105.3.
3. That a complete and accurate list of Consultant's employees, ���ho may come in contact with
nunors during the course and scope of the Ab-eeinent, are included belo���.
4. All of the belo���mentioned employees have tested netrative for TB, or X-ray results for TB, and
have cun-ent documentation on file with Consultant.
5. All of the below il�entioned employees have received traiiung and understand their
responsibilities under the Maizdated Reporter laws of this state and are willuig and able to
comply.
A List of all Consultant Emplo��ees«�orking for the City of Cupertino:
Yuniian Zou
6. The City of Cupertino«�ill be notified by Coizsultaiit in writul�of an5�iiew eizlployees and���ill be
added to the above list prior to beQimli�Ig���ork at the City of Cupertino.
I declare under penalty of perjury that the foregoing is true and con-ect:
� ���1 � � fitness insh�uctor
Date Coiisultaiit Signature Title