17-001 Celeste Repasky i
CITY OF
SHORT FORM AGREEMENT
CITY OF CUPERTINO
10300 Torre Avenue
Cupertino,CA95014 �
C U P E RT C N O 408-777-3200 NO.
This Agreement,made and entered into this 24th day of April,2017,(the"Effective Date")is by and between
the City of Cupertino(hereinafter"City")and Celeste Repasky621
(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:Adult Fitness Instruction Services are further described in Exhibit"A".
B. TERM.The services and/or materials furnished under this Agreement shall commence on April 29,2017
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 seven hundred dollars($700.00). Consisting of the following: $39 per 60 minute class
D. EXHIBITS. The following attached exhibits hereby are made part of this Agreement:
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
❑Exhibit"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 performed in connection with 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 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 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 performance of this Agreement.
3.Assignment. Contractor may not assign, transfer, or 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)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 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 Agreement. In the event Contractor fails or refuses to perform any of the provisions hereof at the
time and in the manner required hereunder, Contractor shall 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 available 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 terminating this Agreement by
giving seven(7) calendar days'prior written notice to Contractor as provided herein. Upon receipt of any notice of
termination,Contractor shall immediately discontinue performance.
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.
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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.Reports 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 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 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 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.Chances. No changes or variations of any kind are authorized without the written consent of the City.
CONTRACT CO-ORDINATOR and representative for CITY shall be: Karen Levy, Recreation and Community
Services
I
In witness thereof,the parties have executed this Agreement the day and year first written above.
CONTRACTOR: CITY OF CUPERTINO:
By: ��'-�7 � By: Karen Lew
Title: Fitness Instructor Title: Recreation Coordinator
APPRO S EXPENDITURE DISTRIBUTION
REC �T ' M �� DAyTE� � ACCOUNT NUMBER � AMOUNT
b`Jj 580-63-620 700-702 $700.00
CI ATTO Y-M—ROVED AS TO FORM DATE
6AA 4 1 L�-j I—+
CITY CLERK: ATTEST DATE
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EXHIBIT A
CONSULTANT SERVICES TO BE PERFORMED
The CONSULTANT will provide instruction in,but not limited to,the following programs:
Zumba
Location and Time of CONSULTANT 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: 20
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 Agreement without additional notice or payment to Consultant.
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 City'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 Incident Report in the form approved by the City. The Incident Report must be submitted to
the City within 24 hours of the injury occurring.
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 636256405270335524
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED)
Alliant Insurance Services,Inc.in conjunction with City of Cupertino
I Apex Insurance Services
P.O.Box 6450
Newport Beach,CA 92658
License No:OC 36861
NAMED INSURED(EVENT HOLDER): EVENT INFORMATION:
Celeste Repasky TYPE: Aerobics
LOCATION: Quinlan Community Center-Dance&Activity Room
*Liquor Liability Yes o No G)
**Liquor Liability after 12 am ends before 2 am ❑
This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy
period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless
amended as described in Special Conditions.
INSURANCE CARRIER:Evanston Insurance Company
MASTER POLICY NUMBER: SEP41023
MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2017 EXPIRATION:JANUARY 1,2018
COMMERCIAL GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE
Aggregate Limit $2,000,000
Products&Completed Operations 1,000,000 SPECIAL CONDITIONS:
Personal&Advertising Injury 1,000,000 The following endorsements attached to
Each Occurrence Limit 1,000,000 the Master Policy do not apply to this
Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance:
Medical Payments(Any One Person) 5,000 MEGL1643
Liquor Liability (If purchased) 1,000,000
Optional Limits Purchased
❑ $1,000,00053,000,000
❑ $2,000,00052,000,000
Property Damage(If purchased)
No Property Damage Coverage
The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event.
OTHER ADDITIONAL INSUREDS
City of Cupertino, It's City Council, Boards and
Commissions, Officers, Employees, & Volunteers
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy
provisions.
AUTHORIZED REPRESENTATIVE-
DATE ISSUED: 04/24/2017