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17-001 Kae Montgomery CITY OF SHORT FORM AGREEMENT CTTY OF CUPERTINO 10300 Torre Avenue C U P E RT I N O Cupertin o, CA95014 408-777-3200 NO. ������� This Agreement, for reference dated January 20, 2017, is by and between the City of Cupertino (hereinafter "City") and Kae Montgomery, an individual,whose address (hereinafter "Contractar"), in consideration of their mutual covenants, the parties agree as follows: A. SCOPE OF SERVICES. Contractor shall provide the services further described in Exhibit"A."All class materials must be provided by contractors. This includes but is not limited to, photocopies, stationery, and office supplies. If a class requires an additional fee that is separate from the registration fee, the contract instructor is responsible for collecting these fees. B. TERM. The services and/or materials furnished under this Agreement shall commence on February 1, 2017 and shall be completed no later than June 30, 2017. C. COMPENSATION. For the full performance of this Agreement, CITY shall pay Contractor a total amount not to exceed three thousand dollars($3,000.00). Classes: $40 per 60 minute class.EXHIBITS.The following attached exhibits hereby are made part of this Agreement: ❑Exhibit"A"-Consultant Services to be Performed ❑Exhibit"B"-Mandated Reporting ❑Exhibit"C"- 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, indexnnify, 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 trar►sfer 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 performance of this Agreement. � 3. Assignment. Contractor may not assign, transfer, ar 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)(b)Liability: Commercial general liability coverage,including sexual abuse and molestation coverage in the following minimum limits: Bodily Injury: $500,OOOeach occurrence;$1,000,OOOaggregate -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 shownabove. (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. Subro�ation 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 Asreement. 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 within 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. If Consultant fails to attend scheduled classes or does not start classes at the scheduled time, such default is not curable, and the City shall have the option,at its sole discretion, to immediately terminate this Agreement. City shall have the option, at its sole discretion and without cause, of terminating this Agreement by giving thirty (30) days' prior written 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 dasses, the number of classes and the assigned instructor. 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. Revorts 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 thisAgreement. 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 there from 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 doci.iments 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. Chan�es.No changes or variations of any kind are authorized without the written consent of the City. CONTRACT COORDINATOR and representative for CITY shall be: Colleen Ferris, Recreation &Community Services In witness thereof,the parties have executed this Agreement the day and year first written above. CONTRACTOR: CITY OF CUPERTINO: By.��_ �ti�(��(, �'�'`� By: Colleen Ferr� C - � � Title: Fitness Instructor Title: Recreation Coordinator APPROVALS EXPENDITURE DISTRIBUTION DEPARTMENT HEAD DATE ACCOUNT NUIvIBER AMOUNT I ;.•'� � I,� �� -� 570-63-621-700-702 $3000.00 �,�� � / 1 r �.� �f l./�� �\:i''�✓ � :� . � IL"i�4` �'i_✓ CITY ATTORNEY APPROVED AS TO FOR1�I DATE � 2,� �b (� (�' CI�"Y CLERK: ATTES T DA"TE G�w�,� �� �� r�� ' i EXHIBIT A CONSULTANT SERVICES TO BE PERFORMED The CONSULTANT will provide Fitness Instruction in but not limited to,the following programs: Yoga, Aerobics Location and Time of CONSULTANT Services: Refer to the monthly CSC fitness schedule (s)for agreed upon dates, times, and class locations. By Mutual agreement of both parties, class schedule may change Eligible Participant Minimum and M�imums for CONSULTANT Services: Minimum: 15 Maximum: 50 In the event that less than the required ininimum number of participants shall request and pay for services prior to the agreed upon time for the commencement of services to be performed by Consultant, City may cancel and withdraw from this Agreement. Performance of CONSULTANT Services: City shall have no right of control as to the manner Consultant performs the services to be performed. Nevertheless,City may, at any time, 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 need to complete the Cit�s Waiver of Liability form 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 occurring to a participant, the Consultant will notify the City within 1 hour and complete an ABAG Incident Report. The ABAG Incident Report must be submitted to the City within 24 hours of the injury occurring. � ' • � EXHIBIT B ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS,RECEIPT OF TRAINING,AND RECEIPT OF PENAL CODES STAT`UTES A mandated reporter is an individual who is obligated by law to report suspected cases of child abuse and neglect.In general, any individual who, in the ardinary 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.�. If your job duties as an employee or an independent contractor as Kae Montgomery include contact with children, you are a Mandated Reporter.Prior to commencing employment and j as a prerequisite of that employment, California 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 responsibilities under California law. You are also being provided with 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 Clara.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 contact the Recreation Supervisor at 408-777-3120. ' I understand that: • By virtue of my employment or independent contractor status as Kae Montgomery and because my employment requires me to have contact with children, I am a Mandated Reporter as defined by California Penal Code 11165.7. • The following situations trigger mandatory reports: a) Physical Abuse (willful harming 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 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 immediately make a telephone report. I must follow up with a written report within 36 hours. This report may be made to local law enforcement, or County Sheriff's Department, Probation Department or Child Welfare Agency. (Cal Pen. Code ll166(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 report, 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 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 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 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. , , � 2/r l �f� Na�1�',���`a ate � � L�� �c��—��,���. � / Name (Print) I ! � EXHIBIT C City of Cupertino Consultant Declaration The undersigned does hereby certify that: 1. I arn a representative of Kae Mon��omery that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare Kae Montgomery_that has complied with fingerprinting and crim.inal 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. List of Consultant's employees assigned to perform services under this agreement: N A 6. Consultant agrees to complete background check, TB testing and mandated reporter training and notify City in writing in advance of assigning any new employees to perform services under this agreement. I declare under penalty of perjury that the foregoin is true and correct: � I l I�� CSC - L,���'—� Date Place l Consu�t 'gnature Staff Title: