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18-001 Jennifer Hill CITY OF No. III FY2018-20 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties. This contract is made and entered into as of 7/1/2018 ("Effective Date"),by and between the City of Cupertino, a municipal corporation ("City'), and with JENNIFER HILL, "Contractor"),a FITNESS INSTRUCTOR for ZUMBA. 2. Services.Contractor agrees to provide the Services included in the Scope of Work and in accordance with the Schedule of Performance attached in Exhibit A. 3. Term. This contract begins on the Effective Date and ends on 6/30/2020 ("Contract Time"), unless extended or terminated as provided herein.Time is of the essence and Contractor must have sufficient time, resources, and qualified staff to deliver the Services as required.Contractor must promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to address or mitigate such delays. 4. Compensation.City will pay Contractor for satisfactory performance of the Services an amount that will based upon actual costs but that will be capped so as not to exceed$5,000.00("Contract Price"),based upon the Scope of Services,budget,performance schedule,and rates included in Exhibit A. The maximum compensation includes all costs, expenses and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount.Contractor must submit invoices and the information required in Exhibit A in order to receive payment. City will compensate Contractor within 30 days after approval of written invoices. Invoices are subject to review and audit by City during regular business hours upon 24-hours' notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disbursements and other cost items charged to City or establishing the basis for an invoice, for a minimum of four(4)years from the date of final payment. 5. Independent Contractor.Contractor is an independent Contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement. No civil service status or other right of employment will be acquired by virtue of Contractor's performance of the Services. Contractor is not entitled to City's health benefits, worker's compensation or any other benefit. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner. Contractor will supply all tools, materials and equipment required to perform the Services under this Contract.Contractor is responsible for obtaining permits and licenses required by law and must obtain a City business license. 6. Proprietary/Confidential Information.To the extent Contractor may have access to private or confidential information owned or controlled by the City, Contractor agrees to treat it confidential and use it solely to perform this Agreement. Contractor must exercise the same standard Recreation ServicesAgreement/Rev. 3-27-2018 Page 1 of 6 of care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Ownership of Materials.To the extent Contractor prepares written material, drawings or data in connection with this contract, City will have the property rights to those materials and all copyrights,if any,to such work product will constitute City property. 8. Records.Contractor must maintain complete,accurate,and detailed accounting records relating to its performance in accordance with generally accepted accounting principles and procedures. The records must include detailed information about Contractor's services, benchmarks, deliverables and costs/fees,and must be made reasonably available to City.The records and supporting documents must be kept separate from other files and maintained for four years from the date of City's final payment. 9. Assignment.This Contract is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Contract without prior written approval of City.Only those persons whose names are included in Exhibit A may perform the Services. 10. Publicity and Signs.Any publicity generated by Contractor related to this contract or the Services during the Contract Time and for one year thereafter must reference City contributions. The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews and newspaper articles. No signs may be posted,exhibited or displayed on or about City property,except signage required by law or under this Agreement without prior written approval from City. 11. Indemnification.To the fullest extent allowed by law and except for losses caused by the sole negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend, and hold harmless the City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and Contractors (collectively, "Indemnitees"), through legal counsel acceptable to City, from and against any liability for damages, claims, actions, causes of action, demands,charges,losses,costs and expenses (including attorney fees,legal costs and expenses related to litigation,arbitrations,administrative and regulatory proceedings),of every nature,arising out of or in any way related to Contractor's or Contractor's agents performance of this contract or the Services. This includes but is not limited to Liability resulting in personal injury, death, property damage, or economic losses. Contractor must pay any costs City may incur in enforcing this provision and must accept a tender of defense upon receiving notice from City.Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract. 12. Insurance.Contractor shall comply with the insurance requirements in Exhibit B.City will not execute the Agreement until it has received and approved satisfactory certificates of insurance and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole discretion may purchase insurance and deduct the costs from payments to Contractor,or terminate the contract. Recreation Services Agreement/Rev. 3-27-2018 Page 2 of 6 13. Compliance with Laws and Other City Requirements. Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prohibiting discrimination,including Title VII of the Civil Rights Act of 1964,the California Fair Employment Practices Act,the Americans with Disabilities Act of 1990,and other laws that pertain to fair employment and anti-discrimination practices. Contractor must comply with labor laws pertaining to prevailing wages, working hours, overtime, payroll records, and other requirements imposed by the Department of Industrial Relations.If Contractor does not have employees,it must sign the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying employment eligibility of employees pursuant to the Immigration Reform and Control Act of 1986. Contractor must comply with conflict of interest laws and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in governmental decisions or serving in a staff capacity,and is hereby advised to review the requirements of California Political Reform Act and the California Code of Regulations. Services may only be performed by persons who are not employed by City and who do not have a contractual relationship with City other than this contract.Contractor agrees to abide by City policies and administrative rules prohibiting gifts to City officials and employees. Additional Requirements for Services Provided to Minors: Contractor and its employees who provide services under this Agreement must comply with these additional requirements: A. Undergo fingerprinting and a criminal background check and verify all employees providing services under this contract have met this requirement. B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training required under California Health and Safety Code Section 124235, AB2007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, htWs://www.cdc.goviheadsW/index.htmo. D. Submit required forms and acknowledgments included in Exhibit D, and ensure its each participant is provided with a concussion information sheet,signs and returns the forms to the City as required by Health and Safety Code Section 124235. Require coaches and administrators to successfully complete the concussion and head injury education at least once either online or in person, before supervising a participant. Contractor shall offer training, educational materials, or both to each Contractor administrator on a yearly basis. (Training resources are available at the Center for Disease Control&Prevention(link cited above). E. If providing instruction, Contractor must acknowledge and comply with all requirements set forth in the Recreation&Community Services Instructor Manual. Check one @ applicable): ® This contract requires services for children. i Recreation ServicesAgreement/Rev. 3-27-2018 j Page 3 of 6 ❑ This contract currently does not require services for children. If in the future, services for children are required,the contract will require a'written amendment'to include the appropriate insurance coverages as required in'Exhibit B-Insurance Requirements for Recreation Contracts', proof of finger printing and additional requirements under Paragraph 13. The contract amendment will also require the approval of the Director of Recreation and Community Services and City Attorney. 14. Coordination of Services. The Parties designate the following persons as Services Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of this Agreement. Contractor's designation and any substitution are subject to City approval. For City: For Contractor: Name: Colleen Ferris Name:JENNIFER HILL Position: Recreation Coordinator Position: Fitness Instructor Contact: colleenf@cupertino.or 408-777-3160 Contact: 15. Abandonment.City may abandon or postpone the Activity or Program and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the date of abandonment upon submission of final invoices approved by City. 16. Termination. City may terminate this contract for cause or without cause at any time and will notify Contractor as soon as possible.Contractor will be paid for satisfactory services rendered through the date of termination upon submission of final invoices approved by City. 17. Governing Law,Venue and Dispute Resolution.This contract is governed by the laws of the State of California. Any legal actions or proceedings filed against City in connection with this contract must comply with the government claims filing requirements and must be filed with the Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is required to continue to provide Services pending resolution of any dispute. If the Parties elect arbitration, the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. 18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs.This Section survives this Agreement. 19. Third Party Beneficiaries. There are no third party beneficiaries under this Contract. 20. Waiver.Neither acceptance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall not constitute waiver of another term, provision, covenant or condition,or a subsequent breach,whether of the same or a different character. 21. Entire Agreement.This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this reference and represent the full and complete understanding as to those matters contained herein,and supersede any other contract or understanding,either oral or Recreation Services Agreement/Rev. 3-27-2018 Page 4 of 6 I written,between the Parties.This Agreement may not be modified or amended except in writing signed by both Parties.If there is any inconsistency between the main contract and any attachments or exhibits thereto, the main contract shall prevail. 22. Inserted Provisions.Each provision or clause required by law or this contract is deemed to be included and will be inferred herein Either party may request an amendment to cure any mistaken insertion or omission of a required provision. 23. Headings. The headings are for convenience only and are not a part of the contract or intended to affect,limit or amplify the terms or provisions of this Agreement. 24. Severability/Partial Invalidity.If any contract term or provision,or their application to a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such ruling. All other contract terms and provisions and their application to specific situations will remain in full force and effect. 25. Survival.All provisions which by their nature must continue after the Agreement ends, including without limitation Indemnification, Insurance, Ownership of Materials,Records,Governing Law and Attorney Fees, will survive the expiration or termination of this Agreement. 26. Notices.All notices and instruments pertaining to material provisions of this contract or significant disputes which are required by law or under this contract to be in writing must be sent to the persons listed below. The notices will be deemed effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission. To City of Cupertino: To Contractor: Office of the City Manager 10300 Torre Ave.,Cupertino CA 95014 cc:Representative/Coordinator: cc: Representative/Coordinator: JENNIFER HILL Colleen Ferris Email: Email: colleenf@cupertino.org 27. Validity of Contract. This contract is valid and enforceable only if it complies with the provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or authorized designee, and is approved for form by the City Attorney's Office. 28. Execution. The person executing this contract on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to execute this contract and to carry out all actions and services required. This contract constitutes a legally binding obligation of Contractor, and may be executed in counterparts,each one of which is deemed an original and all of which,taken together,constitute a single binding instrument. I i Recreation ServicesAgreement/Rev. 3-27-2018 Page 5 of 6 IN WITNESS WHEREOF,the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO JENNIFER HILL A Municipal Corporation By By Name t n ax�� to \ Name Christine Hanel Title I I 1 l .I—��� Title Assistant Director of Recreation&Community Services Date Tax I.D. No.: �P hjjq APPROVED AS TO FORM: ATTEST: E OM (:W,-GRACE SCHMIDT Cupertino City Attorney City Clerk Fiscal Year.2018-19 Fiscal Year.2019-20 Contract/Encumbered Amount.$2,500.00 Contract/Encumbered Amount:$2,500.00 Account No.:570 63 621 700 702 Account No..-570 63 621 700 702 l i I Recreation ServicesAgreement/Rev. 3-27-2018 Page 6 of 6 I i EXHIBIT A SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide FITNESS INSTRUCTION in,but not limited to,the following: ZUMBA Location and Time of CONTRACTOR Services: Refer to the MONTHLY FITNESS CLASS SCHEDULE for agreed upon dates, times, and class locations. The City, at its sole discretion, may change the agreed terms. Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. Compensation shall consist of the following: $37/class. The total compensation to the Contractor shall not exceed $5,000.00. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: 10 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 Contractor. List of all Contractor Employees working for the City of Cupertino (if no Employees, identify "self'): self Performance of CONTRACTOR Services: In the case Contractor unilaterally cancels performance of a class, camp, activity or service without City approval, City reserves the right to immediately and without notice cancel the remainder of programs/services offered and or performed by Contractor. EXHIBIT C 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 Jennifer Hill. 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 day of -11U 2018, at I rl fV-3 , California. PRINT NAME I i I I The Contractor 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. If applicable,contractors who are responsible for supervising minors must remain with the class until a parent of legal guardian has arrived and all minors are released to them. In the event of an injury occurring to a participant, the Contractor 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. EXHIBIT D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of JENNIFER HILL;that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that JENNIFER HILL has complied with fingerprinting and criminal background investigation requirements with respect to all Contractor'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. I 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 D-1. 5. That a complete and accurate list of Contractor'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 Contractor. 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 Contractor Employees working for the City (if no Employees, identify "self"): self 8. The Contractor 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. JENNIFER HILL B RH Title: FITNESS INSTRUCTOR Date: I U �1 A`�o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/16/2017 THIS CERTIFICATE IS 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 certi Icate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. I 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: Mass Merch Underwriting K&K Insurance Group,Inc. HONE "A A/C N0 Ext): 888-580-8041 A/c,No: 260-459-5995 1712 Magnavox Way info@fitnessinsurance-kk.com Fort Wayne Indiana 46804 ADDRESS: P D R CUSTOMER to: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Nationwide Mutual Insurance Company 23787 Jennifer R Hill INSURER B: INSURER C: A Member of the Sports,Leisure&Entertainment RPG INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W01049932 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/D E F MWDD/Y LIMITS A X COMMERCIAL GENERAL LIABILITY 6BRPG0000005987800 06/30/2017 06/30/2018 EACH OCCURRENCE $1,000,000 CLAIMS- X OCCUR 12:01 AM EDT 12:01 AM DAMAGE RENTED MADE _ PREMISES Ea Occurrence $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $1,000,000 PRO- POLICY JECT LOC PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITYCOMBINED L Ea accident ANY AUTO BODILY INJURY(Per person) OWNED AUTOS SCHEDULED BODILY INJURY Per accident ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY A A AUTOS ONLY AUTOS ONLY Per accident NOT PROVIDED WHILE IN HAWAII UMBRELLALIABOCCUR EACH OCCURRENCE EXCESS LIAB H CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION ANDPER EMPLOYERS'LIABILITY N/A STATUTE OTHER ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT EXECUTIVE OFFIC(Mandatory i ER ❑ E.L DISEASE—EA EMPLOYEE EXCLUDED?(Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000005987800 06/30/2017 06/30/2018 PRIMARY MEDICAL 12:01 AM EDT 12:01 AM EXCESS MEDICAL $5000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certified Instructor of:Aerobics,Dance,Exercise,ZUMBAO Sexual Abuse or Sexual Molestation Liability-$100,000 each occurrence(included above)/$300,000 aggregate(included above) CERTIFICATE HOLDER CANCELLATION Evidence of Coverage SH ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Coverage is only extended to U.S.events and activities. `*NOTICE TO TEXAS INSUREDS:The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6BRPG0000005987800 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of Cupertino, its City Council, boards and commissions, officers, employees, agents, servants, volunteer and consultants 10300 Torre Avenue Cupertino, CA 95014 Ref:Jennifer R Hill Ref: CP#2429 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to Section organization(s) shown in the Schedule, but only with 111—Limits Of Insurance: respect to liability for 'bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" caused, required by a contract or agreement, the most we will in whole or in part, by your acts or omissions or the pay on behalf of the additional insured is the amount acts or omissions of those acting on your behalf: of insurance: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement;or or 2. In connection with your premises owned by or 2. Available under the applicable Limits of rented to you. Insurance shown in the Declarations; However: whichever is less. 1. The insurance afforded to such additional This endorsement shall not increase the applicable insured only applies to the extent permitted by Limits of Insurance shown in the Declarations. law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 ©Insurance Services Office, Inc.,2012 Page 1 of 1 CSAR Insurance Exchange Automobile Policy Declarations P.O.Box 22221 7 Oakland,CA 94623-2221 Please keep with your policy.See Important Notice on reverse. /nSul a/1C@ For questions or changes call:(800)922-8228 Page 1 of 1 1.Name and Address of Insured Declarations Process 'IIII�II'lll�'Il.ll�l��l�l'�I'll"1�'III1111'�'I�'I111����'III'II O Type Renewal Certificate Date 01-26-2018 WME Z Named Insured,but not prior to the time applied } Your 03-03-2018 for or,if this is a replacement declarations,not V Policy prior to the time coverage change was requested. J Period TO 0 12:01 A.M.Standard Time at the address of the CL 03-03-2019 Named Insured. Alternate Address Occupation Alternate Number Telephone Number Manager (408)559-3410 Item Make Model Yr Body Type Vehicle Identification No. Name in 1 LU necessarily JENNIFER _ 9 correspond LU I= to principally > a operated vehicles. Coverage .................Liability Limits ...........................Item 1.........................Item 2 - Each Person Each Occurrence Deductible Premium Deductible Premium Deductible Premium Deductible Premium Bodily Injury 500,000 500,000 $275 $196 .......-----•------------------------------- ---------------------- ---------•................ Medical Payments 10,000 $71 $41 ............................................ .........................• Uninsured Motorists 100,000 300,000 $62 $48 ..... Property Damage 100,000 $350 $330 ..............•----------------------................ . ............. .. .................... Comprehensive Actual Cash Value Less Deductible 250 $140 250 $102 Full Comprehensive Safety Glass Endorsement ($0 deductible) NO COV: NO COV:: .. ......-•-----------------•----........---------------•--...---•----•-------- Collision Actual Cash Value Less Deductible 500 E $818 500 ; $431 ....................................................................................................... Enhanced Transportation Expense $25 per day/$750 aggregate $28 $28 All Risks Actual Cash Value Less Deductible No Cov4rage No Coverage Vehicle Loan/Lease Protection Endorsement No Cov4rage No Coverage New Car Added Protection Endorsement No Cov4rage No Coverage Original Equipment Manufacturer Parts(OEM)Endorsement No Cov4rage No Coverage Ride-sharing Coverage Endorsement No Cov4rage No Coverage TOTAL PREMIUM PER VEHICLE➢ $1,744 $1,176 *Automobile Death Benefits $15,000 per deceased insured person Premium Premium Summary This is not a bill. CA Surcharge:$0 CA Special Fraud Assessment Fee:$3.52 Total Premium: $2,929.52 Total Premium shown is for the Member AdvantageTM Program. EXCLUSIONS There is no coverage provided by this Policy while the following individual(s)operate a motor vehicle: None Schedule of Changes LA W ID Z Q v 55 1500 a 15 01-26-2018 08632 0210 (Continued on back) Item Rated Driver Driv Safety Record Yrs Driv Exp Prior Ann Miles Future Ann Miles Veh Garage Zip Vehicle Usage Gender Marital 1 See final page for explanation Ln of codes. UJ 2 CA z Discounts: uMature Driver:None. Multi Car:Item(s) 1,2. Good Driver:Item(s) 1,2. New Driver:None. C Multi Policy:None. Good Student:None. MERCEDES BENZ FINANCIAL MARI WEST CU You may qualify for other products tw `;m PO BOX 685 `z 5615 CHESBRO AVE and discounts. For more info call a ROANOKE TX 76262 SAN JOSE CA 95123 your Insurance Agent a N House Agent San Jose Oakridge 0 J IMPORTANT NOTICE:THIS IS A PART OF YOUR DECLARATIONS The insurance afforded is only with respect to such of the preceding coverages as are indicated by specific premium charge or charges. The limit of the Exchange's liability under each such coverage shall be as stated herein, subject to all the terms of the policy.The purpose for which the automobile is to be used is pleasure or business, subject to the exclusions in the policy, including the exclusion for wholesale and retail delivery. RENEWAL CERTIFICATE -Extends this policy for the period shown under Policy Period upon payment of the premium. AMENDED DECLARATIONS-In consideration of the premium adjustment indicated herein this policy is hereby amended only with respect to such changes as are indicated in the schedule of changes. The limit of the Exchange's liability under such amended coverage shall be as stated herein. LOSS PAYEE(S)-Any loss under Physical Damage coverages is payable as interest may appear to the named insured and the Loss Payee in accordance with the loss payable agreement. RATING INFORMATION DISCLOSURE EXPLANATION (From Discounts/Messages Section on Previous Page) ITEM (ITEM NUMBER): Item number is the number assigned to the vehicle shown on the Declarations. RATED DRIVER: The driver assigned to a vehicle whose attributes(e.g.,years driving experience, driving safety record, gender, and marital status)are used to develop the premium. DRIV SAFETY RECORD(DRIVING SAFETY RECORD):The total number of points assessed the driver for "principally at fault chargeable accidents" with or without injury and/or vehicle code violation convictions(tickets).A "principally at fault chargeable accident" occurs when the driver of a vehicle is at least 51% at fault for an accident and the total monetary damages(whether paid or not) in the accident exceed: • $750 or the accident resulted in death for losses occurring prior to 12/11/11 • $1,000 or the accident resulted in death for losses occurring 12/11/2011 or after Additional information on the number and types of incidents can be provided on request. Carriers use different point count systems for rating purposes.The number of points shown on your declarations would not necessarily match the number of points assigned by another carrier. YRS DRIV EXP(YEARS DRIVING EXPERIENCE): The number of years a driver has been licensed to drive a motor vehicle anywhere in the world. However,a driver must have at least 18 months current driving experience in the United States, U.S. Territories, or Canada, before foreign country driving experience can be counted. PRIOR ANN MILES(PRIOR ANNUAL MILES DRIVEN):The estimated number of total miles a vehicle was driven during the year just past. FUTURE ANN MILES(FUTURE ANNUAL MILES DRIVEN):The estimated number of total miles a vehicle will be driven in the coming year. VEH GARAGE ZIP(VEHICLE GARAGED ZIP CODE):The ZIP code of the location where the vehicle is garaged. VEHICLE USAGE:Vehicles are assigned to one of five usage designations: Business Use,Work Commute, Farm Use, Farm Business Use or Pleasure. GENDER: "M" stands for Male and "F" stands for Female. MARITAL(MARITAL STATUS): "M" stands for Married, and "S" stands for Single. DISCOUNTS:A reduced rate applies for each Discount listed. 55 150012 15 01-26-2018 08633 0210 ARCH 4 INTERMEDIARIES CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE Form: SML Safeguard Wording-623AFB00213 Policy Number: TBA Renewal of. N/A Named Insured: City of Cupertino—Dept of Recreation&Community Services Principal Address: 10185 N Stelling Road, Cupertino, CA, 95014 Policy Period: From: 1St July 2018 To: 1St July 2019 Both dates at 12:01 a.m. Local Time at the Principal Address stated in Item 1. Limit of Liability: a) USD 5,000,000 for all Claims for Wrongful Acts against any one Victim b) USD 5,000,000 for all Claims for Wrongful Acts against all Victims,but sub-limited to: c) USD 50,000 for all Safeguard Costs resulting from all Circumstances Such Sub-limit of Liability shall be part of, and not in addition to,the overall Limit of Liability stated in 3.b)above. Retention: USD 35,000 any one Victim Premium: USD 27,000 to be paid within 25 days of attachment Notification pursuant to Clause IX. shall be given to: Claims Department Beazley 30 Batterson Park Road, Farmington, CT 06032. claimsna beazle (860)677 3765 (phone) (860)679 0247(fax) Retroactive Date: 1"July 2018 Pending or Prior Litigation Date: 1St July 2018 Service of Suit: Eileen Ridley,FLWA Service Corp.,c/o Foley&Lardner LLP, 555 California Street, Suite 1700, San Francisco, CA 94104-1520 Choice of Law: New York Conditions: Application Dated: TBA California Surplus Lines Notice 1-LMA9098A Small Additional or Return Premiums Clause(U.S.A.)—NMA 1168 Nuclear Incident Exclusion Clause-Liability-Direct—NMA 1256 Radioactive Contamination Exclusion Clause-Liability-NMA 1477 War and Terrorism Exclusion—NMA 2918 Sanctions Limits Clause-LMA 3100 Beazleyafeguard Education Document Arch Safeguard Enhancement Endorsement U.S Classification: Surplus Lines Broker and State filed in: TBA License Number: TBA Subject to: 1) Satisfactory re-signed and dated SML application within 30 days of inception 2) Confirmation of the Surplus Lines Broker. Including name of individual, company name, address and license number All subj ectivities to be received within 7 working days of binding otherwise Underwriters reserve the right to amend terms or cancel ab initio. Brokerage: 22.5%or same net equivalent downwards,plus taxes as applicable Information: Employees—36 full time+250 part time+63 IC's Exposure Units—97,000 Nature of Business—Municipality Cancellation by an Insured may result in a short rate calculation to determine the return premium, subject to 5%minimum earned of the total premium. Underwriting Security: 100%Lloyd's(Information about Lloyds)