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18-001 Natasha Austin CITY OF No. 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 NATASHA AUSTIN, ("Contractor"), a SOLE PROPRIETOR for YOUTH EDUCATION CAMPS/CLASSES. 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$35,000 FOR FY18- 19, $35,000 FOR FY 19-20 ("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. Recreation Services Agreement/Rev. 3-27-2018 Page 1 of 6 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 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, httl2s://www.cdc.gov/headsul2/index.htmij. 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 (if applicable): ® This contract requires services for children. Recreation Services Agreement/Rev. 3-27-2018 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:Marilu Mejia Name: Natasha Austin Position: Recreation Coordinator Position:Instructor Contact:marilum@cupertino.org, 408-777-3124 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 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 Email: marilum@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. Recreation Services Agreement/Rev. 3-27-2018 Page 5 of 6 IN WITNESS WHEREOF,the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO NATASHA AUSTIN A Municipal Corporation By( �mw 5haSih ��. � By 4-0�� Ar A Name AAfy sh& Ayt, !7 Name Yl�, ytc�i Title T-0 5*V cfW Title DateOS`�3dll�' Date Tax I.D. No.: RPff-J' �o 0 APPROVED AS TO FORM: ATTEST: GRACE SCHMIDT Cupertino City Attorney City Clerk ContractlEncumbered Amount: $35,000 FOR FY18-19 $35,000 FOR FY19-20 Account No.:580-62-613-700-702 Recreation Services Agreement/Rev. 3-27-2018 i Page 6 of 6 i EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide YOUTH EDUCATION CAMPS/CLASSES in, but not limited to,the following: LET'S READ, SCIENCE CAMPS, MATH CAMPS, SAT PREP Location and Time of CONTRACTOR Services: Refer to the Recreation Schedule dated SUMMER 2018—SPRING 2020 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: 70%OF RESIDENT FEE PER PARTICIPANT,BASED ON FINAL ROSTER, MINUS$10 ADMINISTRATION FEE PER PARTICIPANT.The total compensation to the Contractor shall not exceed$35,000 FOR FY18-19,$35,000 FOR FY 19-20. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: 4 Maximum: 12 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'): ,ya+rt&ka A-145ji s 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. 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 B Insurance Requirements for Recreation Contracts As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurance for the duration of the contract against claims arising from or in connection with Contractor, its agents, representatives, employees or subcontractors Services under this Agreement. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this project/location(CG 25 03 or 25 04) or be twice the required occurrence limit. 2. Automobile Liability: ISO CA 0001 covering Code 1 (any auto), or if Contractor has no owned autos, Code 8 (hired) and 9 (non-owned), with limits no less than$1,000,000 per accident for bodily injury and property damage. ❑ Required if automobile is used to perform work under this contract. 1K Otherwise, proof of Contractor's personal auto insurance with limits required by state law suffices. Contractor shall not transport or use its personal vehicle to transport participants or perform work under this contract. 3. Workers' Compensation: As required by the State of California, with Statutory and Employer's Liability Insurance limits of no less than$1,000,000 per accident for bodily injury or disease. ❑ Required if Contractor has employees. JK If no employees, Contractor must sign Affidavit of No Employees. 4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving minors, (i.e., after school activities, recreational programs, athletics, study/training events and transportation of minors). Coverage may be included under General Liability or be obtained in a separate policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the required occurrence limit. kRequired if Contract involves services to children. Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance. Self-Insured Retentions: Self-insured retentions must be approved by City. City may require Contractor to provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language must provide, or be endorsed to provide, that the self- insured retention may be satisfied by either the named insured or City. Acceptability of Insurers:Insurance must be issued by insurers acceptable to City and licensed to do business in the State of California,with an A.M. Best's financial strength rating of"A"or better and a financial size rating of"VII"or better. OTHER INSURANCE PROVISIONS: The CGL policy must contain, or be endorsed to contain, the following provisions: 1. The City, its City Council, boards and commissions, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds with respect to liability arising out of work or Exh.B Insurance for Recreation Contracts Updated 3-26-18 1 operations performed by or on behalf of the Contractor including materials, parts or equipment furnished in connection with such work or operations. 2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 0104 13 as respects the City, its officers,officials, employees, agents, and volunteers. 3. The Insurance Company agrees to waive all rights of subrogation against the City, its elected or appointed officers, officials, agents, and employees for losses paid under the terms of any policy which arise from work performed by Contractor for City. This provision also applies to the Contractor's Workers' Compensation policy. 4. Each insurance policy required by this contract shall provide that coverage shall not be canceled, except with notice to the City. Primary Coverage: The Additional Insured coverage under Contractor's policy shall be primary non- contributory and at least as broad as ISO CG 20 01 04 13 as respects the City and all the insureds/indemnitees. If the limits of insurance required are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a "primary and non-contributory"basis for the benefit of the Additional Insureds before City's own insurance is triggered. Notice of Cancellation: Each insurance policy shall provide that coverage shall not be canceled or allowed to expire without written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Such notice must be sent to City via email or certified mail to the attention of the City Manager. Waiver of Subrogation:Contractor grants City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City by virtue of payment of any loss under such insurance. Contractor will obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Verification of Coverage:Contractor shall furnish the City with original certificates and amendatory endorsements effecting coverage required by this clause. All certificates and endorsements are to be received and approved by the City before work commences.The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications, at any time.At a minimum Contractor must provide acceptable copies of the policy declarations and endorsement page verifying the required insurance coverages. Homeowner's Insurance:Contractor's homeowner's liability insurance may provide coverage sufficient to meet these requirements. Contractor should provide these requirements to his or her agent to confirm and provide verification to City. Special Events Coverage:Insurers may provide special events coverage for a reduced fee, or City may be able to offer this coverage. Contractor should contact the City Manager's Office for information or assistance. Special Risks or Circumstances:City reserves the right to modify these requirements based on the nature of the risk,prior experience,insurer,coverage,or other special circumstances. Exh.B Insurance for Recreation Contracts Updated 3-26-18 2 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 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 2018, at L(,0.6r-.. i wC California. A)efaS tla- AuVin PRINT NAME 12. & L SIGNATURE EXHIBIT D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of NATASHA AUSTIN; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that NATASHA AUSTIN 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"): 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. NATASHA AUSTIN fi. (")z By: NATASHA AUSTIN Title: INSTRUCTOR Date: 5- .�n�a20/8 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 636637092394635886 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED) Alliant Insurance Services,Inc.in conjunction with City of Cupertino Apex Insurance Services P.O.Box 6450 Newport Beach,CA 92658 License No:OC 36861 NAMED INSURED(EVENT HOLDER): EVENT INFORMATION: Natasha Austin TYPE: Academic LOCATION: Monte Vista Recreation Center,22601 Voss Ave,Cupertino,CA 95014 *Liquor Liability Yes No **Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless amended as described in Special Conditions. INSURANCE CARRIER:Evanston Insurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: January 01,2018 EXPIRATION: January 01, 2019 COMMERCIAL GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $2,000,000 Products&Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal&Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance: Medical Payments(Any One Person) 5,000 MEGL1643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased 0 $1,000,00053,000,000 ❑ $2,000,00052,000,000 Property Damage(If purchased) No Property Damage Coverage The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 06/04/2018 POLICY NUMBER: SEP41026 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Person(s) Or Organization(s): City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants For Certificate No.: 636637092394635886 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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 organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing operations; or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by 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 -,.w '--- �✓ ffM ` LJI�Pi iiislil aIllC LRllfplit� Ys# / PO Box 22221 Automobile Policy Declarations �lnsuranre Oakland,CA 94623-2221 Please keep with your policy.See Important Notice on reverse. For questions or changes call:(800)922-8228 Page 1 of 1 1-Nana and Address of haired I Z I ixcioreiitnu Rene%e.al Ci ertfi„ate r"ruce�s !17_17-7(117 'llllliiill'llli'il'll'ilii'Illl�lliil��l�i�ill�l�lll"i"1111111 g Type Dare Q Policy insured NATASHA AUSTIN W Number Since 1981 ? Named Insured,but not prior to the time applied } Your 08-21-2017 for or,if this is a replacement declarations,not lJ Palky prior to the time coverage change was requested. Period I T` 12:01 A.M.Standard Time at the address of the a I 08-21-2018 Named Insured Alternate Address Occupation A/temate Number Telephone Number Engineer/Scientist (408)446-0506 hem Make i°LC necessan`y ob not conesoond NATASHA I I ion.�;.- p operated vehicles. Coverage LiabifityLimi� hem 7 ttem2 ............................................... ..................................................................... Each Person Each Occurrence Deductible Premium Deductible Premium Deductible Premium Deductible Premium Bodily Injury 100,000 300,000 $118 .$127 i -............... ...........•---•---.... ......................... Piled Co.�t- i I . 'u.m..,-, 6r..!•..,....age A1..l'oye,.ag. • I y I ..��.vvc.ayc I ivv wvcrayc I I. Uninsured Motorists 100,000 300,000 $17 :` $24 ............ .. .................... -- Property Damage 100,000 ` $169 $293 ...... ................................. ...................• ...... -----•-- omprehensive Actual Cash Value Less Deductible 100 $32 100 $122 Full Comprehensive Safety Glass Endorsement -(30 deductible)-------------------------- - ---- NO COV:: NO COV Collision Actual Cash Value Less Deductible I 500 $193 I 500 ; $521 I I .................................................................................................... Enhanced Transportation Expense $25 per day/$750 aggregate $28 $28 II Risks Actual Cash Value Less Deductible No Coverage No Coverage ehicle Loan/Lease Protection Endorsement No Coverage No Coverage New Car Added Protection Endorsement No Coverage No Coverage Original Equipment Manufacturer Parts(OEM)Endorsement No Coverage No Coverage Ride-sharing Coverage Endorsement No Coverage No Coverage TOTAL PREMIUM PER VEHICLE ➢ $557 $1,115 Automobile death Benefits $15,000 per deceased in Premium- Premium person $6 Premium Summary This is not a bill. CA Surcharge: $0 CA Special Fraud Assessment Fee:$3.52 Total Premium: $1,681.52 1 Tatar Premium shown-i'a sat ill€Mle^ibe Ad antage`rm.Arogr$..n. EXCLUSIONS There is no coverage provided by this Policy while the following individual(s)operate a motor vehicle: None Schedule of Changes LU W AI V 55 1500 12 15 07-17-2017 01454 0210 (Gontinued on hack) Item explanation N CA of codes. iu IA i—I _ z viscounts: :) Mature Driver:None. Multi Car:Item(s) 1,2. uGood Driver:Item(s) 1,2. New Driver:None. Multi Policy condo:Item(s) 1,2. Good Student:None. your Insurance Agent tA Kevin Lee Edelberg p (408)725-4316 J ,IMPORTANT NOTICE_THLS.IS-A_P_ART OF YOUR-IECLARATIIIMS i I 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.Ttie 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 DECLARAT iONS-in consideration of the premium adjustment indicated 'herein this policy is hereby amended only with respect I 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 ctatic), n..c..e..r..l to develnrn the nemillm r. ­........ 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 • 4'i ono nrthp arrlclent rPSUItPd in_dp;;th fnr lnssPsnrrnlrrinn 13/1101111 nr 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 forpion r-ouritry driving pxnQrienrp ran Inip 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. wFHiCFF 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 1500 12 15 07-17-2017 01454 0210 ARCH 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. claims@beazley.com (860) 677 3765 (phone) (860)679 0247(fax) Retroactive Date: 1St 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 Beazle�Safeguard 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 subjectivities 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)