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17-001 The Wilfred Jarvis Institute
NO. � r 1 -7,' c( FY 17-18 AGREEMENT BETWEEN THE CITY OF CUPERTINO AND THE WILFRED JARVIS INSTITUTE FOR LEADERSHIP CONSULTANT SERVICES THIS AGREEMENT,for reference dated WEDNESDAY,AUGUST 30,2017,is by and between CITY OF CUPERTINO,a municipal corporation(hereinafter referred to as"City"),and THE WILFRED JARVIS INSTITUE,a CALIFORNIA CORPORATION,whose address is (hereinafter referred to as"Consultant"),and is made with reference to the following: RECITALS: A. City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the Constitution and the statutes of the State of California and the Cupertino Municipal Code. B. Consultant is specially trained,experienced and competent to perform the special services which will be required by this Agreement;and C. Consultant possesses the skill,experience,ability,background,certification and knowledge to provide the services described in this Agreement on the terms and conditions described herein. D. City and Consultant desire to enter into an agreement for LEADERSHIP CONSULTANT SERVICES upon the terms and conditions herein. NOW,THEREFORE,it is mutually agreed by and between the undersigned parties as follows: 1. TERM: The term of this Agreement shall commence on WEDNESDAY,SEPTEMBER 13,2017,and shall terminate on THURSDAY,MAY 31,2018,unless terminated earlier as set forth herein. 2. SERVICES TO BE PERFORMED: Consultant shall perform each and every service set forth in Exhibit"A"which is attached hereto and incorporated herein by this reference. 3. COMPENSATION TO CONSULTANT: 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:$250.00 per hour. In the event that less than the required minimum 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. The total compensation to the Consultant shall not exceed$16,000. 4. ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS AND CONCUSSION PROTOCOL 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. R C .. n__i _,_t. r_„ .1+ + 1��11 1 .;+h ,11 - _c n n Y1L1Z'...]�_ ' mr J 1 V FY 2017/2018 Standard Consultant Agreement 1 e C „giAltai#s4alt r vide eaek par- ;eipa,,t w44-encsheet-,..,kie ffiay be ift the form ets aftaehed as Exhibit e-1. C=onsultant shatt ensure 17A7 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. httj2s:Hwww.cdc.gov/headsul2/index.html) 6. TIME IS OF THE ESSENCE: Consultant and City agree that time is of the essence regarding the performance of this Agreement. 7. STANDARD OF CARE: Consultant agrees to perform all services hereunder in a manner commensurate with the prevailing standards of specially trained professionals in the San Francisco Bay Area and agrees that all services shall be performed by qualified and experienced personnel who are not employed by the City nor have any contractual relationship with City. 8. INDEPENDENT PARTIES: City and Consultant intend that the relationship between them created by this Agreement is that of an independent Consultant. The manner and means of conducting the work are under the control of Consultant,except to the extent they are limited by statute,rule or regulation and the express terms of this Agreement. No civil service status or other right of employment will be acquired by virtue of Consultant's services. None of the benefits provided by City to its employees,including but not limited to,unemployment insurance,workers'compensation plans,vacation and sick leave are available from City to Consultant,its employees or agents. Deductions shall not be made for any state or federal taxes, FICA payments,PERS payments,or other purposes normally associated with an employer-employee relationship from any fees due Consultant. Payments of the above items, if required,are the responsibility of Consultant. 9. IMMIGRATION REFORM AND CONTROL ACT CIRCA): Consultant assumes any and all responsibility for verifying the identity and employment authorization of all of his/her employees performing work hereunder,pursuant to all applicable IRCA or other federal,or state rules and regulations. Consultant shall indemnify and hold City harmless from and against any loss, damage,liability, costs or expenses arising from any noncompliance of this provision by Consultant. 10. NON-DISCRIMINATION: FY 2017/2018 Standard Consultant Agreement 2 I i i Consistent with City's policy that harassment and discrimination are unacceptable I employer/employee conduct,Consultant agrees that harassment or discrimination directed toward a job applicant,a City employee,or a citizen by Consultant or Consultant's employee or subcontractor on the basis of race,religious creed,color,national origin,ancestry,handicap, disability,marital status, pregnancy,sex,age,or sexual orientation will not be tolerated. Consultant agrees that any and all violations of this provision shall constitute a material breach of this Agreement. 11. 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. 12. 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: 1. Workers'Compensation:Statutory coverage as required by the State of California. 2. 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 FY 2017/2018 Standard Consultant Agreement 3 i 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. 3. Automotive:Proof of automobile insurance required at the California statutory minimums. B. 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. C. FAILURE TO SECURE: If Consultant at any time during the term hereof should fail to secure or maintain the foregoing insurance,City shall be permitted to obtain such insurance in the Consultant's name or as an agent of the Consultant and shall be compensated by the Consultant for the costs of the insurance premiums at the maximum rate permitted by law and computed from the date written notice is received that the premiums have not been paid. D. ADDITIONAL INSURED: City,its City Council,boards and commissions,officers,employees and volunteers shall be named as an additional insured under all insurance coverages,except any professional liability insurance, required by this Agreement. The naming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible portion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured shall not be required to contribute anything toward any loss or expense covered by the insurance provided by this policy. E. SUFFICIENCY OF INSURANCE: The insurance limits required by City are not represented as being sufficient to protect Consultant. Consultant is advised to confer with Consultant's insurance broker to determine adequate coverage for Consultant. 13. CONFLICT OF INTEREST: Consultant warrants that it is not a conflict of interest for Consultant to perform the services required by this Agreement. Consultant may be required to fill out a conflict of interest form if the services provided under this Agreement require Consultant to make certain governmental decisions or serve in a staff capacity as defined in Title 2,Division 6,Section 18700 of the California Code of Regulations. 14. PROHIBITION AGAINST TRANSFERS: Consultant shall not assign, sublease,hypothecate,or transfer this Agreement, or any interest therein, directly or indirectly,by operation of law or otherwise,without prior written consent of City. Any attempt to do so without said consent shall be null and void,and any assignee,sublessee, hypothecate or transferee shall acquire no right or interest by reason of such attempted assignment, FY 2017/2018 Standard Consultant Agreement 4 i i I hypothecation or transfer. However, claims for money by Consultant from City under this Agreement may be assigned to a bank,trust company or other financial institution without prior written consent. Written notice of such assignment shall be promptly furnished to City by Consultant. The sale,assignment,transfer or other disposition of any of the issued and outstanding capital stock of Consultant,or of the interest of any general partner or joint venturer or syndicate member or cotenant,if Consultant is a partnership or joint venture or syndicate or cotenancy,which shall result in changing the control of Consultant,shall be construed as an assignment of this Agreement. Control means fifty percent(50%)or more of the voting power of the corporation. 15. SUBCONTRACTOR APPROVAL: Unless prior written consent from City is obtained,only those people and subcontractors whose names and resumes are attached to this Agreement shall be used in the performance of this Agreement. In the event that Consultant employs subcontractors,such subcontractors shall be required to furnish proof of workers'compensation insurance and shall also be required to carry general,and professional liability insurance in reasonable conformity to the insurance carried by Consultant. In addition,any work or services subcontracted hereunder shall be subject to each provision of this Agreement. 16. 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. 17. REPORTS: A. 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 Consultant pursuant to or in connection with this Agreement, shall be the exclusive property of City. Consultant 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. Consultant may retain a copy of any report furnished to the City pursuant to this Agreement. B. All Reports prepared by Consultant may be used by City in execution or implementation of: 1. The original Project for which Consultant was hired; 2. Completion of the original Project by others; 3. Subsequent additions to the original project;and/or 4. Other City projects as appropriate. C. Consultant shall,at such time and in such form as City may require,furnish reports concerning the status of services required under this Agreement. D. All Reports required to be provided by this Agreement shall be printed on recycled paper. All Reports shall be copied on both sides of the paper except for one original,which shall be single sided. E. No Report,information or other data given to or prepared or assembled by Consultant pursuant to this Agreement shall be made available to any individual or organization by Consultant without prior approval by City. 18. RECORDS: FY 2017/2018 Standard Consultant Agreement 5 Consultant 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. Consultant shall maintain adequate records of services provided 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. Consultant 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 receipt of final payment. If supplemental examination or audit of the records is necessary due to concerns raised by City's preliminary examination or audit of records,and the City's supplemental examination or audit of the records discloses a failure to adhere to appropriate internal financial controls,or other breach of contract or failure to act in good faith,then Consultant shall reimburse City for all reasonable costs and expenses associated with the supplemental examination or audit. 19. NOTICES: All notices,demands,requests or approvals to be given under this Agreement shall be given in writing and conclusively shall be deemed served when delivered personally or on the second business day after the deposit thereof in the United States Mail,postage prepaid,registered or certified,addressed as hereinafter provided. All notices,demands,requests,or approvals from the Consultant to the City shall be addressed to the City at:10300 Torre Ave.,Cupertino,CA,95014,Attention:Director of Recreation and Community Services. All notices,demands,requests,or approvals from City to Consultant shall be addressed to Consultant at: 20. TERMINATION: 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. 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 classes,the number of classes and the assigned instructor. 21. COMPLIANCES: Consultant shall comply with all state or federal laws and all ordinances,rules and regulations enacted or issued by City. Consultant 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. FY 2017/2018 Standard Consultant Agreement 6 i I 22. CONFLICT OF LAW: This Agreement shall be interpreted under,and enforced by the laws of the State of California excepting any choice of law rules which may direct the application of laws of another jurisdiction. The Agreement and obligations of the parties are subject to all valid laws,orders,rules,and regulations of the authorities having jurisdiction over this Agreement(or the successors of those authorities.) Any suits brought pursuant to this Agreement shall be filed with the courts of the County of Santa Clara,State of California. 23. ADVERTISEMENT: Consultant shall not post,exhibit,display or allow to be posted,exhibited, displayed any signs, advertising,show bills,lithographs,posters or cards of any kind pertaining to the services performed under this Agreement unless prior written approval has been secured from City to do otherwise. 24. WAIVER: A waiver by City of any breach of any term, covenant,or condition contained herein shall not be deemed to be a waiver of any subsequent breach of the same or any other term,covenant,or condition contained herein,whether of the same or a different character. 25. INTEGRATED CONTRACT: This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties hereto,and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions hereof. Any modification of this Agreement will be effective only by written execution signed by both City and Consultant. 26. INSERTED PROVISIONS: Each provision and clause required by law to be inserted into the Agreement shall be deemed to be enacted herein,and the Agreement shall be read and enforced as though each were included herein. If through mistake or otherwise,any such provision is not inserted or is not correctly inserted,the Agreement shall be amended to make such insertion on application by either party. 27. CAPTIONS: The captions in this Agreement are for convenience only,are not a part of the Agreement and in no way affect,limit or amplify the terms or provisions of this Agreement. 28. AGREEMENT COORDINATOR: The Agreement Coordinator and representative for CITY shall be:MOLLY JAMES, RECREATION COORDINATOR,Recreation&Community Service Department FY 2017/2018 Standard Consultant Agreement 7 i I IN WITNESS,WHEREOF,the parties have caused the Agreement to be executed. THE WILFRED JARVIS INSTITUTE CITY OF CUPERTINO A Mu Corporati By: MINH LE By: MOLLY JAMES Title: PRESIDENT Title: RECREATION COORDf INAT Date: /f`�/ �'�� Date: RECOMMENDED FOR APPROVAL: By: CHRISTINE ANEL Title: ASSISTANT DIRECTOR APPROVED AS TO FO . AN�OLPH STEVENSON HOM CITY ATTORNEY ATTEST: GRACE SCHMIDT CITY CLERK EXPENDITURE DISTRIBUTION: Account No: 100-62-608-700-702 Amount: $16,000.00 FY 2017/2018 Standard Consultant Agreement 8 EXHIBIT A CONSULTANT SERVICES TO BE PERFORMED The CONSULTANT will provide LEADERSHIP CONSULTANT SERVICES in,but not limited to,the following programs: LEADERSHIP 95014 Consultant shall complete the tasks described in this exhibit for the Leadership 95014 program as directed by City's Recreation Coordinator,Molly James,and consistent with the project schedule set forth in Exhibit B. 1. Prepare and facilitate the two-day kick-off session for Leadership 95014 program. 2. Supply the program participants with licensed material in a format that they can use on their laptop or tablet computer. 3. Attend at least the final hour of each of the monthly sessions to provide additional training, facilitation and reinforcement of learning. 4. At the final program session,Consultant will bring the interactive group technology to conduct a two-hour brainstorming meeting to: - Collect for each participant Keep Stop Start feedback/recommendations from his/her classmates(from 9 months of time together) 5. In coordination with the City,facilitate the program graduation ceremony,participate in program committee meetings,and assist with enrollment activities free of charge,and provide one on one coaching and consultation for program participants free of charge. 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. FY 2017/2018 Standard Consultant Agreement 9 EXHIBIT B SCHEDULE OF PERFORMANCE Consultant shall perform the Services within a timeframe mutually agreed by the program supervisor for Consultant and City,so long as all work is completed within the term of the Agreement. Scheduled dates for 2017/18 program are: Program Schedule-2017/18 Wed.Sept. 13,2017 Kick-Off Retreat—Day 1 Thurs.Sept.14,2017 Kick-Off Retreat/Bus Tour-Day 2 Thurs.Oct.12,2017 Getting Involved In Cupertino Thurs.Nov.9,2017 Role of First Responders in our Community Thurs.Dec. 14,2017 Will Cupertino Always Be at the Head of the Class? Thurs.Jan. 11,2018 Business in Cupertino/Supervision with Minh Thurs.Feb.8,2018 Healthcare at El Camino Hospital Thurs.March 8,2018 Cost of Going Green Thurs.April 12,2018 Ethical Leadership/Social Sector Thurs.May 10,2018 Graduation and Group Presentations FY 2017/2018 Standard Consultant Agreement 10 I PAAF87� (b1NLDRYYYY) ACORN CERTIFICATE OF LIABILITY INSURANCE 8054 6/2016 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: STRATTON AGENCY/PHS -P-HONE (866) 467-8730 is.No>: (888) 443-6112 151631 P: (866) 467-8730 F: (888) 443-6112 ADDRESS PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURERA: Sentinel Ins Co LTD 11000 INSURED INSURER B INSURER C: THE WILFRED JARVIS INSTITUTE INSURER INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OFL\SURANCE ADDL SUBR POLICYNUtIBER POLICYEFF POLICYEXP LLVITS 0111I/DD/YYY1 1 5 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1, 000, OO0 CLAIMS-MADEFx1 OCCUR DAMAGE TO RENTED $1 000, 000 PREMISES(Ea occurrence) I A X General Liab X 57 SBA AZ5747 09/19/2016 09/19/2017 MED EXP(Any one person) $10, 000 PERSONAL&ADV INJURY $1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2, 000, 000 ❑ X LOC PRODUCTS-COMP/OP AGG 5 2, 0 0 0, 000 POLICY El PE OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) s ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) HIREDNON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA LAB HOCCUR EACH OCCURRENCE S EXCESS LAB CLAIMS-MADE AGGREGATE 5 DED RETENTION S 5 WORKERS COUPE.SATIOA PER OTH- 4NDEMPLOYERS'LL.IBILITY STATUTE I JER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) El E.L.DISEASE-EA EMPLOYEE If yes,describe under S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. Re: Leadership and Organizational Development - 10300 Torre Avenue, Cupertino, CA. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Cupertino AUTHORIZED REPRESENTATIVE 10300 TORRE AVE CUPERTINO, CA 95014 ��/� �GLr✓C+%� �� ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ..''�. DATE(MM/DD/YYYY) �1 o� CERTIFICATE OF LIABILITY INSURANCE 8/26/2017 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT N,VAE STRATTON AGENCY/PHS PHONE STRATTON (866) 467-8730 -----TF—AX (888) 443-6112 151631 P: (866) 467-8730 F: (888) 443-6112 �o ESS; PO BOX 3.3015 INSURER(S)AFFORDING COVERAGE NAICR I SAN ANTONIO TX 78265 INSURERA: Sent_ne_ Ins G-� LTD INSURED INSURER 6; INSURER C: THE WILFRED JARVIS INSTITUTE INSURER D: ( INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LNISR 7'1PB0FLNSLTANCE ADDI SLG POZIC5:3Ti3L8ER POLICf'EFF POLICYEiP LMTS S R?, i}DYLDDh'F'FY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ', � 1 OCCUR I DAMAGE TO RENTED S1,000,000 PREMISES(Ea occurrence) A X General Liab X 57 SBA AZ5747 09/19/20 7 09/19/2013 MED EXP(Any one person) ,10, 000 I PERSONAL&ADV INJURY $1,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2, 000,000 POLICY a PRO FXJ LOC PRODUCTS-COMP/OP AGG $2,0 0 0, 0 0 0 JECT OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accidentl $ ANYAUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY JAUTOS HIRED NON-OWNED i PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) 1 _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I I AGGREGATE $ I Q RETENTIONS F $ WORKEW COILPFVS.4 TION SPER OTH- ANDEMPLOFERS'LL98ILnT TATUTE Eft ANY PROPRIETORIPARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F-1NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTIONOFOPERATIONSI LOCATIONSI VEHIC?AMRD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. Re: Leadership and Organizational Development - 10300 Torre Avenue, Cupertino, CA. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to i this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of C up e L t i I i o AflTHOR,ZED REPRESEArrAT,YE 4 10300 TORRE AVE , , CUPERTINO, CA 95014 CJ 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Progressive PROGRfUlYf P.O.Box 94739 COMMERC14L Cleveland,OH 44101 1-800-895-2886 Policy number: 03523354-7 Underwritten by: PROGRESSIVE EXPRESS INS September 7,2017 Pagel of 2 Certificate of Insurance Certificate Holder ................................................................................................................................................................................................... THE WILFRED JARVIS Insured Agent ................................................................................................................................................................................................... THE WILFRED JARVIS PROG COMMERCIAL INSTITUTE PO BOX 94739 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify,or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements,and conditions of these policies. ............................................................................................................................................................................. Policy Effective Date: May 16,2017 Policy Expiration Date: May 16,2018 Insurance coverage(s) Limits ............................................................................................................................................................................. BODILY INJURY/PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT ............................................................................................................................................................................. UNINSURED/UNDERINSURED MOTORIST $1,000,000 COMBINED SINGLE LIMIT Description of LocationNehicles/Special Items Scheduled autos only ............................................................................................................................................................................. 2012 TOYOTA CAMRY HYBRID 4T1 BD1 FK6CU012254 MEDICAL PAYMENTS $5,000 COMPREHENSIVE $1,000 DED COLLISION $1,000 DED ............................................................................................................................................................................. 2013 MINI COOPER S WMWSV3C57DT390793 MEDICAL PAYMENTS $5,000 COMPREHENSIVE $1,000 DED COLLISION $1,000 DED ............................................................................................................................................................................. 2013 TOYOTA SIENNA 5TDKK3DC4DS319946 Stated Amount $59,000 MEDICAL PAYMENTS $5,000 COMPREHENSIVE $1,000 DED COLLISION $1,000 DED Is Continued Policy number: 03523354-7 Page 2 of 2 Certificate number 25017NET354 Form 5241(10/02) Contractor/Consultant Affidavit of No Employees State of California County of Santa Clara City of'Cupertino I,the undersigned, declare as follows: I am an independent contractor and the owner of The Wilfred Jarvis Institute_ ' I wish to enter into a services contract with the City of Cupertino. I am fully aware of the provisions of section 3700 of the California Labor Code, which requires every employer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that I must provide proof of workers' compensation insurance to the City of Cupertino for any and all employees I may have,pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this 12th day of September , 2017,at Cupertino , California. MINH LE, PRESIDENT SIGNATURE I I