17-001 Anita Yee NO.-It\17 bbd 60 10
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FY 17-18
AGREEMENT BETWEEN THE CITY OF CUPERTINO AND
ANITA YEE
FOR FITNESS INSTRUCTOR
THIS AGREEMENT,for reference dated THURSDAY,JUNE 1,2017,is by and between CITY OF
CUPERTINO,a municipal corporation(hereinafter referred to as"City"),and ANITA YEE, a CA SOLE
PROPRIETORSHIP,whose address is hereinafter
referred to as"Consultant"),and is made with reference to the following:
A. SCOPE OF SERVICES. Contractor shall provide or furnish the following specified
services and/or materials:FITNESS INSTRUCTOR.Services are further described in Exhibit"A".
B. TERM. The term of this Agreement shall commence on 7/1/2017,and shall terminate on
6/30/2018,unless terminated earlier as set forth herein.
C. COMPENSATION.. Consultant shall be compensated for services performed pursuant
to this Agreement in the amount set forth below and as described in Exhibit"A"which is attached hereto
and incorporated herein by this reference.Compensation shall consist of the following:$38 per 60 minute
class.The total compensation to the Consultant shall not exceed$2,500.00.
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.Required for any
consultant working with minors.
® EXHIBIT C-City of Cupertino,Consultant Declaration.Required for any
consultant working with minors.
GENERAL TERMS AND CONDITIONS,
1. HOLD HARMLESS;
Consultant shall,to the fullest extent allowed by law,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 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 costs and fees of litigation.
2. SUBCONTRACTING;
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1
Consultant has been retained due to their unique skills and Consultant 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 this Agreement shall be used in the
performance of this Agreement.
3. ASSIGNMENT:
Consultant may not assign,transfer,or subcontract this Agreement or any portions thereof,
without prior written consent of City.
4. ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS AND,
CONCUSSION PROTOCOLS AND TRAINING:
A. Mandatory Reporting and Fingerprinting,and Consultant shall comply with the
requirements of California Penal Code 11164-11174.3 and as set forth in Exhibit'B"which is
attached hereto and incorporated herein by this reference.
B. Concussion Protocol: Consultant shall comply with all requirements of AB2007,including
those outlined in Health and Safety Code Section 124235,et seq.including concussion
evaluation,removal from play,and return to play protocols. (Resources are available at the
Center for Disease Control&Prevention.htt-os://www.cdc.aov/headsuv/index.html)
1. Consultant shall provide each participant with a concussion information sheet,which
may be in the form as attached as Exhibit C-1. Consultant shall ensure each
participant signs and returns the form as required by Health and Safety Code Section
124235;and
2. Consultant shall require all coaches and administrators to successfully complete the
concussion and head injury education at least once either online or in person,before
supervising a participant. Consultant shall offer training,educational materials,or
both to each consultant administrator on a yearly basis. (Training resources are
available at the Center for Disease Control&Prevention.
https://www.cdc.izov/headsut)/l*ndex.html)
5. FINGERPRINT&TUBERCULOSIS (TB) CONSULTANT DECLARATION
Consultant agrees that all individuals covered under this Agreement shall provide fingerprints
for criminal background test purposes and results of TB screening,pursuant to the requirements as set
forth in Exhibit"C"which is attached hereto and incorporated herein by this reference.
6. 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 compliance with the paragraphs below. Such certificates,which do
not limit Consultant's indemnification,shall also contain substantially the following statement: "Should
any of the above insurance covered by this certificate be canceled or coverage reduced before the
expiration date thereof,the insurer affording coverage shall provide thirty(30)days'advance written
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 California. Endorsements naming the City as additional insured
shall be submitted with the insurance certificates.
A. COVERAGE:
Consultant shall maintain the following insurance coverage:
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i. Workers' Compensation:Statutory coverage as required by the State of
California.
ii. Liability: Commercial general liability coverage,including sexual abuse and
molestation coverage,in the following minimum limits:
1. Bodily Injury: $500,000 each occurrence
$1,000,000 aggregate-all other
2. 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.
iii. Automotive:Proof of automobile insurance required at the California statutory
minimums.
7. SUBROGATION WAIVER:
Consultant agrees that in the event of loss due to any of the perils for which he/she has agreed to
provide comprehensive general and automotive liability insurance,Consultant shall look solely to his/her
insurance for recovery. Consultant 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.
8. TERMINATION OF AGREEMENT:
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 Consultant 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 Consultant 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 Consultant as provided herein. Upon receipt of any notice of termination,Consultant
shall immediately discontinue performance.
9. 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.
10. INTEREST OF CONSULTANT:
It is understood and agreed that this Agreement is not a contract of employment and,at all times,
Consultant shall be deemed to be an independent Consultant and Consultant 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 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. Consultant 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.
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11. PERMITS AND LICENSES:
Consultant,at his/her sole expense,shall obtain and maintain during the term of this Agreement,
all appropriate permits,certificates,and licenses including,but not limited to,a City Business License,
that may be required in connection with the performance of services hereunder.
12. 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 therefrom 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.
13. CHANGES:
No changes or variations of any kind are authorized without the written consent of the City.
14. COMPLIANCES:
Consultant shall comply with all state or federal laws and all ordinances,rules and regulations
enacted or issued by City. Contractor shall obtain a Cupertino Business License and further comply with
the City's Minimum Wage Ordinance as set forth in Cupertino Municipal Code Chapter 3.37.
15. AGREEMENT COORDINATOR:
The Agreement Coordinator and representative for CITY shall be:Colleen Ferris,Recreation
Coordinator,Recreation&Community Service Department.
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IN WITNESS,WHEREOF,the parties have caused the Agreement to be executed.
ANITA YEE CITY OF CUPERTINO
A Municipal Corporation
By: ANI YEE By: COLLEEN FERRIS
Title: FITN/ESS INSTRUCTOR Title: RECREATION COORDINATOR
Date: �/ 7111 Date: 61M
17
RECOMMENDED FOR APPROVAL:
(� By JE KOVERMAN
tle: RE REATION SUPERVISOR
APPROVED AS TO FORM:
RANDOLPH STEVENSON HOM
CITY ATTORNEY
ATTEST:
U, -
GRACE SCHMIDT J ��
CITY CLERK (S�
EXPENDITURE DISTRIBUTION:
Account No: 570-63-621-700-702
Amount: $2,500.00
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i
EXHIBIT A
CONSULTANT SERVICES TO BE PERFORMED
The CONSULTANT will provide FITNESS INSTRUCTOR in,but not limited to,the following
programs:
AERBOICS,TRX
Location and Time of CONSULTANT Services:
Refer to the monthly Cupertino Sports Center fitness schedule for agreed upon dates,times,and class
locations. By the mutual agreement of both parties,class schedule may change.
Eligible Participant Minimum and Maximums for CONSULTANT Services:
Minimum: 15
Maximum: 50
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. Consultants 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.
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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 law 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 ANITA YEE include contact with
children,you are a Mandated Reporter. Prior to commencing employment and 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 with ANITA YEE,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 Sheriffs Department,Probation Department or
Child Welfare Agency. (Cal Pen. Code 11166(a)).
• 1 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)).
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• 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. I
i
• 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.
ANITA YEE
By: ANITA&EE
Title: FITNESS INSTRUCTOR
Date:
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EXHIBIT C
CITY OF CUPERTINO CONSULTANT DECLARATION
The undersigned does hereby certify that:
1. I am a representative of ANITA YEE;that I am familiar with the facts herein and am authorized
and qualified to execute this declaration.
2. I declare that ANITA YEE has complied with 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 convicted of a
felony, as that term is defined in California Penal Code Section 11105.3.
3. 1 declare that each coach and administrator shall be required to successfully complete concussion
and head injury education at least once,either online or in person,before supervising a
participant,as required by California Health and Safety Code Section 124235,et seq.
4. On a yearly basis,all participants shall be required to sign and return a concussion and head
injury information sheet in compliance with California Health and Safety Code Section 124235,
which may be in the form attached as C-1.
5. 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.
6. 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.
7. 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 all Consultant Employees working for the City of Cupertino(if no Employees,identify"self'):
self
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8. The Consultant will notify the City of Cupertino 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.
ANITA YEE
By: ANITA&E
Title: FITNESS INSTRUCTOR
Date: '
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Fort Wayne, IN 46804
Emz Phone 1-800-506-4856
Fax 1-260-459-5590
Insuring the world's fun! Claims 1-800-237-2917
Date :06/08/2017
Final Summary
Fitness Instructors
Insured Information
Are you an insurance agent or No
broker?
Named insured (as it should appear Anita Catherine Yee
on the policy):
Doing business as (DBA): City of Cupertino, City Council, boards,
Contact first name: Anita
Contact last name: Yee
Mailing address:
City: State: California Zip:
Phone: Fax: Cell:
E-mail:
Website:
This is a renewal of coverage
Commercial General Liability
Eligibility
Aerobics, Ballet,
Cardio kickboxing,
Children's fitness
programs,
Selected operation(s): Cultural/ethnic,
Exercise, Fitness
bootcamp, Hip
Hop, Pilates,
Strength, Yoga,
ZUMBA (R)
Coverage effective date(s): 06/09/2017 to06/09/2019
In which state does the insured reside? California
Does the insured employ other people? No
Is the insured under the age of 18? No
Is the insured currently certified? Yes
Who is the insured certified by?
ACE, AFAA, Les Mills Cert, NASM, Jullian Michaels BODYSHRED, bbarreless
Coverage & Limits
Each Occurrence: $ 500,000
General Aggregate (other than Products-completed Operations): $ 5,000,000
(per year)
Products-completed Operations Aggregate: $ 500,000
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Damage to Premises Rented to You: $ 300,000
Medical Expense (other than participants): $ 5,000
Abuse, Molestation, Harassment or Sexual Conduct Defense Cost $ 100,000
Reimbursement
Certification Information
Certification organization Certification number (if Expiration date (if any)
ACE
AFAA
11-es Mills Cert
INASM I IJ
hullian Michaels BODYSHRED, bbarreless
Total Commercial General Liability Premium: $288.00
Notable Exclusions:
The following exclusions are contained in the commercial general liability coverage provided by this
program. Abuse, molestation, harassment or sexual conduct; Aircraft/hot air balloon; Airport; Amusement
devices (the ownership, operation, maintenance or use of: any mechanical or non-mechanical ride, slide,
or water slide, any inflatable recreational device, any bungee operation or equipment, any vertical device
or equipment used for climbing-either permanently affixed or temporarily erected, or dunk tank.
Amusement devices do not include any video or computer games or any device that is specifically
designed for the training or instruction of the activity for which you are enrolled); Animals (injury or death
to, or injury, death or property damage caused by any animal owned, rented or hired by you); Any adult-
themed parties/meetings/trips, including but not limited to parties/meetings/trips during which
demonstration of products and/or services used in the adult entertainment industry takes place; Asbestos;
Commercial general liability standard exclusions (CG0001 04/13 edition); Cryogenic chambers/therapy;
Cycling (other than stationary); Employment-related practices; Fireworks; Fitness/exercise operations
related, in whole or in part, to performance as an exotic dancer or any similar occupation in the adult
entertainment industry; Fungi or bacteria; Haunted attractions; Instruction/activities held on or in open
water; Lead; Medical, therapy or health care services; Nuclear energy liability; Operation, ownership or
management of a fitness, dance or sports facility; Performers; Physicals/stress testing; Physical therapy,
massage or salon services; Rodeos; Saddle animals; Sale or distribution of medicinal, herbal and/or
nutritional products; Snowmobile; Training programs for law enforcement, public safety and military
personnel; Violation of statutes that govern e-mails, faxes, phone calls or other methods of sending
material or information; Those operations listed as ineligible: Certified athletic trainers, Coaching of
organized competitive athletic teams,Instructors under the age of 18, Instruction of sports skills activities,
Instructor's employment as an exempt or non-exempt employee of a school, university or college.
Terms & Conditions:
1. Premiums are 100% fully earned when coverage begins and non-refundable.
2. Any exposure changes that deviate from the original enrollment form must be reported in writing.
3. Acceptance of this quote confirms your desire to obtain liability insurance through the Sports,
Leisure and Entertainment Risk Purchasing Group. K&K reserves the right to decline any request
for coverage.
4. Coverage is contingent upon receipt of premium payment. No coverage will be deemed in effect
until premium is received by the company or their representative.
5. This program only provides coverage for your individual operations as an instructor. The policy
does not extend coverage for activities conducted by employees or anyone else assisting or
performing on your behalf, nor does it apply to the operation of a studio/facility.
6. Commercial General Liability Broadening Endorsement:
• Expected or intended bodily injury or property damage resulting from the use ofreasonable
force to protect persons or property.
• Non-owned Watercraft - extended to 58 feet.
• Supplementary Payments - $2,500 bail bonds, $500 a day loss of earnings.
• Waiver of Right of Recovery.
• Bodily Injury definition expanded to include mental anguish, mental injury, shock,fright,
humiliation, emotional distress or death resulting from bodily injury, sickness or disease.
• Damage to Premises Rented to You - the term fire is replaced with fire, lightning,explosion,
smoke and leaks from sprinklers.
• Additional Coverage:
o Emergency Real Estate Consultant Fee - $25,000
o Identity Theft Exposure - $25,000
o Key Individual Replacement Cost - $50,000
o Lease Cancellation Moving Expense - $2,500
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Additional Certificate Request
Do you need to request any additional Certificate(s) of Insurance to present to a third Yes
party?
Entity name: City of Cupertino, its City Council, boards and commissions, officers, employees and
volun
Mailing address: 21111 Stevens Creek Blvd
City: Cupertino State: California Zip: 95014
Relationship: Owner, manager or lessor of a facility where the insured conducts instruction
Entity name: The City of Cupertino, City Council, boards, commissions, offers, employees and
volunteers
Mailing address: 21111 Stevens Creek Blvd.
City: Cupertino State: California Zip: 95014
Relationship: Owner, manager or lessor of a facility where the insured conducts instruction
r Warranty & Disclosure
I understand that the insurance company, in determining whether to provide insurance coverage, will
rely on the information contained in this form and all other information being submitted. I hereby
warrant, represent and confirm that, to the best of my knowledge, all information provided is
complete, true and correct.
I am aware that the insurance company expects accurate reporting for my premium calculation, and
should my figures exceed my estimates during the coverage term I will make arrangements to pay
the additional premium. I understand that my book and records may be examined or audited by the
insurance company at any time during the coverage period and up to three years thereafter.
Intentional misrepresentation or misreporting may jeopardize coverage, K&K reserves the right to
decline/void any ineligible coverage.
I further acknowledge that, I have reviewed all information provided with this enrollment form and
understand the exclusions which apply, as well as the activities and operations for which coverage is
not provided. The information I provided on this enrollment form becomes a part of the insurance
contract.
Compensation and Other Disclosure Information
K&K Insurance Group, Inc. ("K&K") is an insurance producer licensed in your state. Insurance
producers are authorized by their license to confer with insurance purchasers about the benefits,
terms and conditions of insurance contracts; to offer advice concerning the substantive benefits of
particular insurance contracts; to sell insurance; and to obtain insurance for purchasers. The role of
the producer in any particular transaction involves one or more of these activities. Compensation will
be paid to the producer, based on the insurance contract the producer sells. Depending on the
insurer(s) and insurance contract(s) the purchaser selects, compensation will be paid by the
insurer(s) selling the insurance contract or by another third party. Such compensation may vary
depending on a number of factors, including the insurance contract(s) and the insurer(s) the
purchaser selects. In addition, K&K may charge a fee for administrative services. Your signature on
your application, quote form, check, credit card and/or other authorization for payment of your
premium, will be deemed to signify your consent to and acceptance of the terms and conditions
including the compensation, as disclosed above, that is to be received by K&K. The insurance
purchaser may obtain information about compensation expected to be received by the producer
based in whole or in part on the sale of insurance to the purchaser, and compensation expected to be
received based in whole or in part of any alternative quotes presented to the purchaser by the
producer, by emailing a written request to warrantvCa)kandkinsurance.com.
In addition, premiums paid by clients to K&K for remittance to insurers, client refunds and claim
payments paid to K&K by insurance companies for remittance to clients are deposited into fiduciary
accounts in accordance with applicable insurance laws until they are due to be paid to the insurance
company or Client. Subject to such laws and the applicable insurance company's consent, where
required, K&K will retain the interest or investment income earned while such funds are on deposit in
such accounts.
In placing, renewing, consulting on or servicing your insurance coverages K&K and its affiliates may
participate in contingent commission arrangements with insurance companies that provide for
additional contingent compensation, if, for example, certain underwriting, profitability, volume or
retention goals are achieved. Such goals are typically based on the total amount of certain insurance
coverages placed by K&K with the insurance company or the overall performance of the policies
placed with that insurance company, not on an individual policy basis. As a result, K&K may be
when specified thresholds are achieved.
Our liability to you, in total, for the duration of our business relationship for any and all damages,
costs, and expenses (including but not limited to attorneys' fees), whether based on contract, tort
(including negligence), or otherwise, in connection with or related to our services (including a failure
to provide a service) that we provide in total shall be limited to the lesser of $2,500,000 or the
singular annual limit of the policy of insurance procured by us on your behalf from which your
damages arise.
This liability limitation applies to you, our client, and extends to our client's parent(s), affiliates,
subsidiaries, and their respective directors, officers, employees and agents (each a "Client Group
Member" of the "Client Group") wherever located that seek to assert claims against K&K, and its
parent(s), affiliates, subsidiaries and their respective directors, officers, employees and agents (each
an "K&K Group Member" of the "K&K Group"). Nothing in this liability limitation section implies that
any K&K Group Member owes or accepts any duty or responsibility to any Client Group Member.
If you or any of your Group Members asserts any claims or makes any demands against us or any
K&K Group Member for a total amount in excess of this liability limitation, then you agree to
indemnify K&K for any and all liabilities, costs, damages and expenses, including attorneys' fees,
incurred by K&K or any K&K Group Member that exceeds this liability limitation.
Aon Corporation, our ultimate parent company, and its affiliates have from time to time sponsored
and invested in insurance and reinsurance companies. While we generally undertake such activities
with a view to creating an orderly flow of capacity for our clients, we also seek an appropriate return
on our investment. These investments, for which Aon is generally at-risk for potential price loss,
typically are small and range from fixed-income to common stock transactions. In such case, the
gains or losses we make through your investments could potentially be linked, in part, to the results
of treaties or policies transacted with you. Please visit the Aon website at
http://www.aon.com/market relationships for a current listing of insurance and reinsurance carriers
in which Aon Corporate and its affiliates hold any ownership interest.
W I have agreed to all of the above terms
Name of the person completing this First name: Anita Last name: Yee
form:
Relationship to insured: Insured
Premium Summary
Total Commercial General Liability: $ 288.00
Total Premium: $ 288.00
RPG Membership Fee $15.00
iTotal Amount
* Premium subject to change if not completing purchase same day as quoting
This summary is not a contract of insurance. You must refer to the actual policy for complete information
regarding coverage terms, conditions and exclusions, as they may change from one coverage period to
the next. Please remember that you will receive evidence of coverage immediately if purchased online.
You may request a copy of the full policy by submitting a written request.
Acceptance of this quote confirms your desire to obtain liability insurance through the Sports, Leisure and
Entertainment Risk Purchasing Group (where applicable). An RPG provides group purchasing power for
similar risks resulting in potential advantageous coverage terms, competitive rates, risk management
bulletins, and rewards for favorable group loss experience.
An RPG membership fee may be charged.
Fraud Warning
ADolicable in AL. AR. DC. LA. MD. NM. RI and WV
Any person who knowingly (or willfully)* presents a false or fraudulent claim for payment of a loss or
benefit or knowingly (or willfully)* presents false information in an application for insurance is guilty of
a crime and may be subject to fines and confinement in prison. *Applies in MD Only.
ADDlicable in CO
It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance
company for the purpose of defrauding or attempting to defraud the company. Penalties may include
imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an
insurance company who knowingly provides false, incomplete, or misleading facts or information to a
policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement
of claim or an application containing any false, incomplete, or misleading information is guilty of a
felony (of the third degree)*. *Applies in FL Only.
Anulicable in KS
Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares
with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any
agent thereof, any written, electronic, electronic impulse, facsimile, magnetic, oral, or telephonic
communication or statement as part of, or in support of, an application for the issuance of, or the rating
of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit
pursuant to an insurance policy for commercial or personal insurance which such person knows to
contain materially false information concerning any fact material thereto; or conceals, for the purpose
of misleading, information concerning any fact material thereto commits a fraudulent insurance act.
Anulicable in KY, NY, OH and PA
Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals
for the purpose of misleading, information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties* (not to exceed
five thousand dollars and the stated value of the claim for each such violation)*. *Applies in NY Only.
Anulicable in ME, TN, VA and WA
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company
for the purpose of defrauding the company. Penalties (may)* include imprisonment, fines and denial of
insurance benefits. *Applies in ME Only.
Anulicable in N)
Any person who includes any false or misleading information on an application for an insurance policy
is subject to criminal and civil penalties.
ADnlicable in OR
Any person who knowingly and with intent to defraud or solicit another to defraud the insurer by
submitting an application containing a false statement as to any material fact may be violating state
law.
Copyright 2009 K&K Insurance Group Inc., California License number : 0334819; Arkansas License number:
240898.
K&K Insurance Group is a wholly-owned subsidiary of Aon