17-001 Kenyatta Ali CITY OF
SHORT FORM AGREEMENT
CITY OF CUPERTINO
10300 Torre Avenue
� Cupertino, CA95014 .v�,,.�
CUPERTINO 408-777-3200 NO. �(/v�� �yDy
This Agreement,made and entered into this 20th day of January,2017,(the"Effective Date") is by and
ben�een the City of Cupertino (hereinafter"Ciry")and Kenyatta Ali
(hereinafter"Contractor"),in consideration of their mutual covenants,the parties agree as follows:
A. SCOPE OF SERVICES. Contractor shall provide or furnish the follo���ing specified services and/or
materials: Youth Dance Instruction Services are further described ui Exhibit"A".
B. TERIVI. The services and/or materials fuinished under this Agreement shall commence on January 23,
2017 and shall be completed no later than June 30,2017.
C. C01�ZPENSATION. For the full performance of this Agreemeilt, CITY shall pay Contractor a total
amount not to exceed two thousand dollars($2000.00). Consisting of the following: 70%of residei�t fees-$5
adn7inistration fee per participant
D. EXHIBITS. The follo���ing attached exhibits hereby are made part of this Agreement:
bE�ubit"A"- Scope of Services
I�l Exhibit"B"-Acknowledgement of Mandated Reportuig Requirements,Receipt of Training,and Receipt of Penal
Code Statutes Exhibits`B"and"C"are for anyone working with ininors
f�J Exhibit"C"-City of Cupertino,Consultant Declaration
GENERAL TERIVIS Al\TD 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 perfonned in connection with the Agreement,
inderrulify, defend, and hold harniless 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 aeainst any of thenl, including
any injury to or death of any person or damage to property ar other liability of any nature, whether physical,
emotional, consequential or otherwise, arising out,pertaining to, or related to the perfornlance of this Agreeilient 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 terniination of this Contract.
2. Subcontractui�. Contractar has been retained due to theu unique skills and Contractor nlay not substitute
another, assign or transfer any rights or obligations under this Agreement. Unless prior written consent fi-om City is
obtained, only those people whose names are listed on fliis Agreement shall be used in the performance of this
Agreement.
3. Assi�iiment. Contractor may not assign, transfer, or subcontract this Agreement or any portions thereof, without
prior written consent of City.
4. Insui•ance. Contractor shall n7aintain 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)VVorkers' Compensation: Statutory coverage as required by the State of Califoniia.
(b)Liability: Coimnercial general liability coverage,uicluding se�ual abuse and molestation coverage, in
the following miniinum limits:
Bodily Injury: $SOO,OOOeach occurrence; $1,000,OOOaggregate-all other
Property Damage: $100,000 each occurrence; $250,000 aggregate
If subn7itted, combined single limit policy with aggregate limits ui the amounts of$1,000,000 will be
considered equivalent to the required minimum limits shown above.
Cih�of Cupertino—Shon Fonn Agreemen[—43015
a
(c)Automotive: Comprehensive autoinotive liability coverage in the following minimum limits:
Bodily Injury: $500,000 each occurrence
Property Damage: $100,000 each occurrence
or
Combuied Single Limit: $500,000 each occurrence
5.SubroQation 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 fl1e 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 fl1e event Contractor fails or refuses to perform any of the provisions hereof at �
the time and in the mamier required hereunder, Contractor shall be deeined in default in the perfoinlance of this
A�reement. If Contractor fails to cure the default within the time specified and according to the requirements set
forth in City's ��ritten notice of default, and in addition to any other remedy available to the Ciry by law, the City
Manager may ternlinate the Agreeii�ent by giving Contractor written ilotice thereof, ���hich shall be effective
irnrnediately. The City Manager shall also have the option, at its sole discretion and without cause, of tenninating
this Agreement by giving seveil (7) calendar days' prior written notice to Contractor as provided herein. Upon
receipt of any notice of termination,Contractor shall iulmediately discontinue performance.
7. Non-Discrimination. Contractor shall not discrunii7ate 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, Contractar shall be deemed to be an independent contractor and Contractor is not aufliorized to bnid the
b City to any contracts or other obligations in executing this Agreement Contractor certifies that no one ���ho has or
will have any financial uiterest under this Agreenzent is an officer or en�ployee of City. City shall have no right of
control as to the manner Contractor perfornis the services to be performed. Nevertheless, City may, at any tin7e,
observe the nzanner in which such services are Ueing performed by the conri•actor. Contractor shall comply with all
applicable Federal, State, and local la���s 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 obtani and maiutain during the term of this
Agreement, all appropriate pern7its,licenses, and certificates including but not limited to a City business license,that
may be required in connection with the perfonnance of services under this Agreement.
10.Renorts 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 airy 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 Agreenzent 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 Agreen�ent.
Contractor shall maintain complete and accurate records with respect to sales, costs, expei7ses, receipts and other
such information required by City that relate to the perforniance of services under this Agreement, in sufficient
detail to pernlit an evaluation of services. All such records shall be maintained ui 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 examiue and audit same, and to make transcripts there from as necessary, and to allow inspection of all
���ork, data, documents,proceedings and activities related to this Agreement. Such records, together with supporting
Cit��of Cupenino-Shon Fonn.�lcreement-A'_O15
docuinents, shall be kept separate from other documents and records and shall be maintained for a period of tlu-ee(3)
years after Contractor receives final payment fi-om City for all services required under this agreeznent.
11. Chanaes. No chan�es or variations of any kind are authorized without the���ritten consent of the City.
CONTRACT CO-ORDI�vATOR and representative for CITY shall be: Karen Levy, Recreation and Communiry
Sen�ices
In witness thereof,the parties have executed this A�reement the day and year first written above.
CONTRACTOR: CITY OF CUPERTINO:
.
B •—, � ����__ By: Karen Levy ��
Title: Yo t i nce Instructor Title: Recreation Coordinator
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APPROVALS.� EIPENDITURE DISTRIBUTION
RECREA � � AG AT � ACCOUNT N[JMBER AMOUNT �
��{�, �(;�,��,� 580-63-620 700-702 $Z000.00
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CI AT�EY�P�ED AS TO FORM DATE � I
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CITY CLERI�,ATTEST DATE
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City of Cupertino—Short Fomi Aercement—4 201�
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EXHIBIT A
CONSULTANT SERVICES TO BE PERFORMED
The CONSLTLTANT will provide instruction in,but not limited to,the following programs:
Youth hip hop and break dance class
Location and Time of CONSULTANT Services:
Refer to the Recreation Schedule for agreed upon dates, times, and class locations. By Mutual ab eement of both
parties, class schedule may change.
Eligible Participant Minimum and Maximums for CONSiTLTANT Services:
Miiumum: 6
Maximum: 12
If less than the required nuniulum 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 tenlunate this Ab eement
without additional notice or payment to Consultant.
Performance of CONSULTANT Services:
City shall have no right of control as to the maimer Consultant performs the seivices to be perfoi711ed.Nevertheless,
City may, at any time, observe the manner in wluch such sei-��ices are being perfonned by the consultant.
The Consultant shall follow all guidelines pertaining to registration procedures as listed in the quartei-ly recreation
schedule. Participants may not take part in the pro��ain 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 b ardian has arrived.
In the event of an injury occurring to a participant, the Consultant will notify the City witlun 1 hour and coinplete an
I�icideilt Report ui the foi7li approved by the City. The I�Zcident Report must be subiiutted to the City within 24 hours
of the injury occurring.
City of Cupzrtino-Short Fomi Agreement-�3 201�
EXHIBIT B
ACKNOWI,EDGEMENT 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 aUuse and neglect I�I
general, any individual who, in the ordinaiy course of their employment, has contact with cluldren is a mandated
reporter. Mandated reporters include child care workeis,teachers and coaches. (Califoi7lia Penal Code 11165.7).
If your job duties as an employee or an independent contractor of Kenyatta Ali include contact with children,you are a
Mandated Reporter. Prior to conunencirig employment and as a prerequisite of that employment, Califonua 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 resparisibilities under California law. You are also being provided with a
separate iufoi7zZational docun�ent wluch includes the text of the Califoinia Mandated Reporter Law and contact
infornlation for Cluld Abuse and Neglect Reporting for the County of Santa Clara.Please review this infoimation
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 ernployment or independent contractor status with Kenyatta Ali, and because my
employment requires me to have contact with cluldren, I ani a Mandated Reporter as defined by
Califoi7ua Penal Code 11165.7.
• The following situations trigger mai7datory reports: a)Physical Abuse(willful hai7iung of a child); b)
Sexual abuse including sexual assault, child exploitation,pornob aphy, and trafficking; c) Severe or
General Neglect; and d) Extreme Corporal Punislmlent(resultuig in injuiy). (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 inuilediately make a telephone report. I
must follow up with a written report within 36 hours. Tlus report may be inade to local law
enforcement, or County Sheriff s Departnzent, Probation Department or Child Welfare Agency. (Cal
Pen. Code 1ll66(a)).
• I am not required to,but I may, share infornlation about suspected abuse with iny supervisor or
management or the parents of the alleged victim.
• Wheri I make a mandated report, I will be required to give my name. However,my identity will be
kept coufideiitial unless I either consent to disclosure or if the disclosure is made pursuant to a court
order. Further, agencies investigating the mandated report inay disclose my identity to one another,
(Cal Pen. Code 11167(d)).
• The following agencies and individuals receiving or investigating inandated reports inay disclose zny
identity to one another:
o Prosecutors in a criil�inal prosecuting or in an action initiated under section 602 of the Welfare
and Institutions Code arising from alleged cluld abuse;
o Counsel appouited 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 1ll67.5)
City of Cupertino-Short Fonn A�a�ezmznt-a?015
• I may not be disciplined, disnussed, retaliated against, discrinunated a�ainst or harassed for making a
mandated report of reasonaUly suspected cluld abuse.
• As a Mandated Reporter, I have civil and crinunal inmzunity 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 inonths 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
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 a��vare of and understand my responsibilities under
the Mandated Reporter la`��s of this state and am«�illing and able to comply. I understand that a copy of this
Ackno«�ledgement�vill be kept in my personnel file.
� il � ll�-
Name i t re Date
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Name (P�rr1t)
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Ciry�of Cupertino—Short Porni Acreement—4'_Oli
EXHIBIT C
City of Cupertino Consultant Declaration
The undersi�led does hereUy certify that:
1. I am a representative of Kenyatta Ali; that I am fanuliar with tl�e facts herein and am authorized and qualified
to execute this declaration.
2. I declare that Kenyatta Ali has complied with fingeipriuting and criininal background im�estigation
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 California Department of Justice has deternuned that
none of those employees has been convicted of a felony, as that tei7il is defined in Califoinia Penal Code
Section 11105.3.
3. That a complete and accurate list of Consultant's employees, who may come in contact with miizors 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 cui-�-ent
documentation on file with Consultant.
5. All of the below mentioi7ed employees have received trailung and understand their responsibilities under the
Mandated Reporter laws of this state and are willing and able to coinply.
A List of all Consultant Employees working for the City of Cupertino:
N/A
6. The City of Cupertii7o will be notified by Consultant in writing of any new employees and will be added to the
above list prior to begiiuung work at the City of Cupertino.
I declare under penalty of eijury that the foregoing is true,and coi7�ect:
//�� �_� dance instructor
Date Con�l�nt Signature Title
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City of Cupertino—Shon Fonn.A!;reement—4201�