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18-001 Skyhawks Sports Academy CITY OF No. FY2018-21 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 SKYHAWKS SPORTS ACADEMY, "Contractor'), a CORPORATION for MULTI-SPORTS CAMPS AND 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 6/30/2021 ("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$150,000("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 Recreation Services Agreement/Rev.3-27-2018 Page 2 of 6 discretion may purchase insurance and deduct the costs from payments to Contractor,or terminate the contract. 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, https://www.cdc.gov/headsup/index.html�. 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): Recreation.Services Agreement/Rev.3-27-2018 Page 3 of 6 ® This contract requires services for children. ❑ 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:Jeff Ordway Name:Matt Perham Position:Recreation Coordinator Position:Area Manager Contact:jeffo@cuperfino.org 408-777-3327 Contact: 1s. 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. Recreation.Services Agreementl Rev.3-27-2018 Page 4 of 6 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 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 Recreation Services Agreenientl Rev.3-27-2018 Page 5 of 6 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. IN WITNESS WHEREOF,the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO SKYH KS SPORTS ACADEMY A Municipal Corporation By By Na e l0isoh Fraz-iPX NameL-,f r),� N Title PhP6 Cleri+ Title i ✓!c C� � Date 51 l0 $' Date �3"� Tax I.D.No.:Refer to W9 AP OVED AS TO FORM: ATTEST: CO� GRACE SCHMIDT ue5rtino Ci�Attorney City Clerk :5, Fiscal Year 2018-19 ContractlEncumbered Amount:$50,000 Account No.:580-63-620 700-702 Fiscal Year 2019-20 ContractlEncumbered Amount:$50,000 Account No.:580-63-620 700-702 Fiscal Year 2020-21 ContractlEncumbered Amount:$50,000 Account No.:580-63-620 700-702 Recreation.Services Agreement/Rev.3-27-2018 Page 6 of 6 EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide MULTI-SPORTS CAMPS AND CLASSES in,but not limited to, the following: BASEBALL CAMP, BASKETBALL CAMP, CHEERLEADING CAMP, LACROSSE CAMP, MINI- HAWK:MULTI-SPORT CAMP, MULTI-SPORT CAMP, SOCCER CAMP, VOLLEYBALL CAMP, TRACK AND FIELD CAMP, FLAG-FOOTBALL CAMP. Location and Time of CONTRACTOR Services: Refer to the Recreation Schedule dated SUMMER 2018 THROUGH SPRING 2021 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: 63% OF THE RESIDENT REGISTRATION FEE.The total compensation to the Contractor shall not exceed$150,000. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: VARIES (8-15) Maximum: VARIES (12-60) 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"): hDvnas �hovt ori{-E►�P,u �yloscleNAifti Mchebce Au54-tn Ciolelman KU Urnnh tl pwouh CIrAnu lla 5,}t ph y, Ems. Ghris•hWA VLA K4-He sh orf _1�1AL N��G ttn, Torn Knit Sher Kcn Tri vu� TQR M x-fha. Scan C05tn AMSC)h welch mo."Vccr bu.lai A� i+" KAmar Ntqan Vital CA'56fdg f20s5 6jM6ellt FNIXs A4s50 C-ior,zale5 D Sir c- ena Nat lGc i3ruc c J`l r�mn 'Pedd cord 'Travu�w► Ntorvoh< J�hv�nN T.fit~ �lan� �i I l Krt15�e-n Sci.las .Alen MaRgk Ka,-l-In64yw. DOan Mol-cyan Rq,nCUCK Ko6saMr, le- AouA M�uire- Ka�Ian Joh► N�1Viu�n iQ(�de�r Dh�muh 8t)��OVyi►n Keil O l i vi a Ct-Ct�fi' 30rda+n kZ e n her Zt�c,h a+� Schur z_ �eXgi 0 �u.rgUCx1D 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: I. 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. ❑ 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. X Required if Contractor has employees. ❑ 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 Iimit. Required 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 oflnsurers: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 D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of SKYHAWKS SPORTS ACADEMY;that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that SKYHAWKS SPORTS ACADEMY 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. 1 declare that each coach and administrator shall be required to successfully complete concussion and head injury education at least once,either online or in person,before supervising a participant, as required by California Health and Safety Code Section 124235,et seq. 4. On a yearly basis, all participants shall be required to sign and return a concussion and head injury information sheet in compliance with California Health and Safety Code Section 124235, which may be in the form attached as 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"): "f�lomc�S Shork �i�hr`c.� �ose.leH ��cu McL��he� .,Aus�-t:h C�olclman Kv11� Cc�wt�bell YLuar� Circ+. ut1A _-AgbW 511is Un�hti V" K0.-ki C_ 5lnork 'M.tG NAuHttn-P�i��anntni� 'Fightr Kun '1'rax�A AliW\ K.watr V, e " ReAA Ck"505id4 V_0vs ClAweLk Fyrbrs ALNssc4 6oty a 4s be<,irce- CfiAwA I- Itm bruCt- Jusfib I CD rd TrGtvG,wn MDraw -Titm Ja e- 'itt K.rmto salas cK Maur�A KaWi6nA boom Mowan HmcocK Kaysandm Le- o Michael mo,(A,txre -Alf)(a t<ac�l John. N u��r, �avetna p1n� Pbcniaxmin K6 ONia Chr+Utb 3oWan ktovicr 2acham�3 �ch�lfiz 5"\,Q 'burqutcy10 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. SKYHAWKS SPORTS ACADEMY By 1, 0- Naa�=Irc-Z�5-1b—v\ FYG�ziC►' Title ` fmti dc. VVI Date 5� 11 U 1 I$ CONCUSSION Information Sheet Rol This sheet has information to help protect your children or teens from CONCUSSION concussion or other serious brain injury. Use this information at your children's or teens'games and practices to learn how to spot a concussion and what to do if a concussion occurs. What Is a Concussion? Ian ahead.What do you ,nt . ur A concussion is a type of traumatic brain injury—or TBI—caused • • • • about • • by a bump,blow,or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth.This fast movement can cause the brain to bounce around or twist in the skull,creating chemical changes in the brain and sometimes stretching and damaging the brain cells. How Can I Spot a Possible Concussion? Children and teens who show or report one or more of the signs How Can I Help Keep fly Children or and symptoms listed below—or simply say they just"don't feel right"after a burnp,blow,or jolt to the head or body—may have Teens Safe? a concussion or other serious brain injury. Sports are a great way for children and teens to stay healthy and Signs Observed by Parents or CoacheF, can help them do well in school.To help lower your children's or teens'chances of getting a concussion or other serious brain Appears dazed or stunned. injury,you should: Forgets an instruction,is confused about an assignment of • Help create a culture of safety for the team. position,or is unsure of the game,score,or opponent. 3 Work with their coach to teach ways to lower the chances Moves clumsily. of getting a concussion. Answers questions slowly. > Talk with your children or teens about concussion and Loses consciousness(even briefly). ask if they have concerns about reporting a concussion. ff Shows mood,behavior,or personality changes. Talk with them about their concerns;emphasize the Can't recall events prior to or after a hit or fall. importance of reporting concussions and taking time to recover from one. Symptoms Reported by Children,and Teens Ensure that they follow their coach's rules for safety and < Headache or"pressure"in head. the rules of the sport. • Nausea or vomiting. Tell your children or teens that you expect them to Balance problems or dizziness,or double or blurry vision. practice good sportsmanship at all times. > - When appropriate for the spur t or activity,teach your Bothered by light or noise. children or teens that they must wear a helmet to lower the Feeling sluggish,hazy,foggy,or groggy. chances of the most serious types of brain or head injury. Confusion,or concentration or memory problems. However,there is no"concussion-proof'helmet.So,even Just not"feeling right,"or"feeling down." with a helmet,it is important for children and teens to avoid hits to the head. Talk with your children and teens about concussion.Tell them to report their concussion symptoms to you and their coach right away.Some children and teens think concussions aren't serious or worry that if they report a concussion they will lose their position on the tearn or look weak. Be sure to remind them that it's better to miss one game than the whole season. — -------- --- ... - -— - — ------ Centers for Disease i Control and Prevention NationalCenterfor Injury LITo learn more, go to www.edc.gov/HEADSUP Prevention and Control Concussions affect each child and teen differently.While most children and teens with a concussion feel better within a couple of weeks,some will have symptoms for • months or longer.Talk with your children's or teens'health care provider if their concussion CONCUSSION] symptoms do not go away or if they get worse after they return to their regular activities. What Are Some More Serious Danger What Should I Do If My Child Signs to Look Out For? or Teen Has a Possible Concussion? In rare cases,a dangerous collection of blood(hematoma)may As a parent,if you think your child or teen may have a form on the brain after a bump,blow,orjolt to the head or body concussion,you should: and can squeeze the brain against the skull.Call 9-1-1 or take your child or teen to the emergency department right away if, Remove your child or teen From play. after a bump,blow,or jolt to the head or body,he or she has 2. Keep your child or teen out of play the day of the injury. one or more of these danger signs: Your child or teen should be seen by a health care provider • One pupil larger than the other. and only return to play with permission from a health care provider who is experienced in evaluating for concussion. Drowsiness or inability to wake up. ;. Ask your child's or teen's health care provider for written • A headache that gets worse and does not go away. instructions on helping your child or teen return to school. > Slurred speech,weakness,numbness,or decreased You can give the instructions to your child's or teen's school coordination. nurse and teacher(s)and return-to-play instructions to the n Repeated vomiting or nausea,convulsions or seizures coach and/or athletic trainer. (shaking or twitching). Do not try to judge the severity of the injury yourself.Only a Unusual behavior,increased confusion,restlessness, health care provider should assess a child or teen for a possible • concussion.Concussion signs and symptoms often show up soon or agitation. after the injury.But you may not know how serious the concussion • Loss of consciousness(passed out/knocked out).Even a is at first,and some symptoms may not show up for hours or days. brief loss of consciousness should be taken seriously. The brain needs time to heal after a concussion.A child's or teen's return to school and sports should be a gradual process that is Children • teens who continue to play while carefully managed and monitored by a health care provider. having concussion Symptomsor • return to chanceplay too soon—while the brain is still healing— have a greater of getting another . . To learn more, go to concussion.A repeat concussion that occurs while �► : : www,cdc.gov/HEADSUP the brain is still healingfrom the first injury can You can also download the CDC HEADS UP be - - • • . • - . app to get concussion information at your lifetime. It can even be fingertips.Just scan the QR code pictured at left with your smartphone. Revised 5/2015 Discuss the risks of concussion and other serious brain injury with your child or teen and have each person sign below. Detach the section below and keep this information sheet to use of your children's or teens'games and practices to help protect them from concussion or other serious brain injury. ------------------------------------------------------------------------------- O 1 learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury. Athlete Name Printed: Date: Athlete Signature: O 1 have read this fact sheet for parents on concussion with my child or teen and talked about what to do if they have a concussion or other serious brain injury. Parent or Legal Guardian Name Printed: Date: Parent or Legal Guardian Signature: A4C R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) V 04/05/2018 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 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 Roach, Howard, Smith and Barton PHOE NAME: Jo Watson 8750 N. Central Expressway, Suite 500 A/CNNo, Ext: (972) 231-1300 FAX No:(972) 231-1368 E-MAIL hatson@rhsb.com Dallas TX 75231 ADDRESS: jwatson@rhsb.com AFFORDING COVERAGE NAIC# INSURERA:Chubb Indemnity CO 12777 INSURED INSURER B:Philadelphia Indemnity 18058 Skyhawks Sports Academy LLC INSURER C: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 41323 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 OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR VD POLICYNUMBER MMIDD/YYYY MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA E TO REENTE-D CLAIMS-MADE OCCUR PHPK1731918 09/23/2017 09/23/2018 PREM IS Eaoccurrrence $ 100,000 MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT F-]LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: Abuse/Molestation $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANYAUTO PHPK1731918 09/23/2017 09/23/2018 BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ $ B X UMBRELLA LIAB X OCCUR PHUB605509 09/23/2017 09/23/2018 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 51000,000 DED I I RETENTION$ $ - WORKERS COMPENSATION PER OTH- A AND EMPLOYERS'LIABILITY Y/N 71754023 03/31/2018 03/31/2019 X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? � N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 $ $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General liability and Automobile liability policies include a blanket automatic additional insured endorsement or provision that provides additional insured status to the certificate holder when required by written contract or agreement. General liability and Automobile liability policies contains a special endorsement or provision with "primary additional insured" wording. General liability, Automobile Liability and workers compensation policies include a blanket automatic waiver of subrogation endorsement or provision that provides this feature only when there is a written contract between named insured and certificate holder that requires it. Certificate holder is extended to include: City of Cupertino, its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS. 10300 Torre Ave. AUTHORIZED REPRESENTATIVE Cupertino CA 95014 t I '( C P 1� I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 2 DESCRIPTION OF OPERATIONS SECTION CONTINUED DATE 04/05/2018 CERTIFICATE HOLDER: INSURED: City of Cupertino Skyhawks Sports Academy LLC 10300 Torre Ave. 9425 N. Nevada St., Suite 210 Spokane WA 99218 Cupertino CA 95014 DESCRIPTION OF OPERATIONS CONTINUED: Sexual Abuse/Molestation Liability: $1,000,000 Each Occurrence, $2,000,000 Aggregate DOC(10/2003) Page 2 of 2 POLICY CHANGE DOCUMENT POLICY NO.: PHPK1731918 Philadelphia Indemnity Insurance Company 443 Moloney O'Neill, an Alliant Insurance Se NAMED INSURED Skyhawks Sports Academy, Inc. MAILING ADDRESS POLICY PERIOD: FROM 09/23/2017 TO 09/23/2018 at 12:01 A.M. Standard Time at your mailing address shown above. CHANGE EFFECTIVE 09/23/2017 CHANGE# 2 REVISION# 2 DESCRIPTION In consideration of the premium reflected, the policy is amended as indicated below: Added: Blanket Additional Insured Per the attached Path ID 11558062 Total Annual Total Prorate Additional/Return Premium $ 0.00 Additional/Return Premium$ 0.00 NO CHANGE NO CHANGE COUNTERSIGNED BY (Date) (Authorized Representative) 04/06/2018 Issue Date Insurance Policy Page 1 of 1 POLICY NUMBER: PHPK1731918 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): Blanket Additional Insured 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. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations,- rented eclarations;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 PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CG2026 Blanket Additional Insured "Any person or organization where required by a written contract that was executed prior to the occurrence of a loss, but only for liability arising out of the negligence of the named insured." All other terms and conditions of this Policy remain unchanged. Page 1 of 1 PI-AS-009 (04/04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY GENERAL LIABILITY DELUXE ENDORSEMENT It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words "you" and "your" refer to the Named Insured shown in the Declarations. The words"we,""us"and "our' refer to the Company providing this insurance. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE The following is a summary of the Limits of Insurance and additional coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. A. Supplementary Payments—Bail bonds increased to$2,500/Loss of earnings increased to$500 each day; B. Tenant's Legal Liability—for Fire, Lightning, Explosion, Smoke and Leaks from Sprinklers—Limit increased to$300,000; C. Broadened Definition of Who Is An Insured; D. Amended Duties In the Event Of Occurrence, Claim Or Suit; E. Broadened definition of Advertising Injury—includes Televised Or Videotaped Publication; F. Amended definition of Bodily Injury to include Mental Anguish,- G. nguish;G. Broadened definition of Personal Injury—includes Abuse Of Process/Discrimination; H. Amended Unintentional Failure To Disclose Hazards; L Amended Liberalization Clause J. Added Employee Indemnification Defense Coverage— We will pay up to$25,000 in defense costs for an "employee"in a criminal proceeding(subject to established criteria); K. "Property Damage"-Removed exclusion for"Property damage"resulting from the use of reasonable force to protect persons or property; L. Added blanket Additional Insured—Funding Source; M. Added blanket Additional Insured—Managers or Lessors of Premises; N. Non-owned Watercraft—coverage length is increased to 58 ft. Page 1 of 5 PHILADELPHIA INDEMNITY INSURANCE COMPANY Includes copyright material of the Insurance Services Office, Inc., used with its permission. PI-AS-009 (04/04) A. Supplementary Payments In the Supplementary Payments—Coverages A. and B. provision: 1. The limit for the cost of bail bonds is changed from $250 to$2,500; and 2. The limit for loss of earnings is changed from $250 a day to$500 a day. B. Fire, Lightning, Explosion, Smoke and Leaks from Sprinklers If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word "fire" is changed to"fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: 1. The Limits of Insurance section of the Declarations as the Fire Damage Limit. That limit: a. Is changed subject to all the terms of Limit of Insurance (Section III) to the greater of.- (1) f:(1) $300,000; or (2) The amount shown in the Declarations as the Fire Damage Limit. b. Subject to a. above is the most we will pay to all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof. 2. The last paragraph of Coverage A. (Section 1) after the Exclusions; 3. Paragraph 6. of Limits of Insurance (Section III); 4. Paragraph b.(1)(b) of the Other Insurance Condition (Section IV); and 5. Paragraph a. of the definition of"insured contract." C. Who Is An Insured Who Is An Insured (Section 11) is changed as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Coverage Part, paragraph 3.a. is changed to read: a. Coverage under this provision is afforded until the end of the policy period. D. Duties In The Event Of Occurrence, Claim Or Suit 1. The requirement in Condition 2.a. (Conditions, Section IV) that you must see to it that we are notified as soon as practicable of an "occurrence" or an offense, applies only when the "occurrence" or offense is known to.- (a) o:(a) You, if you are an individual; (b) A partner, if you are a partnership; or (c) An executive officer or insurance manager, if you are a corporation. Page 2 of 5 PHILADELPHIA INDEMNITY INSURANCE COMPANY Includes copyright material of the Insurance Services Office, Inc., used with its permission. PI-AS-009 (04/04) 2. The requirement in Condition 2.b. that you must see to it that we receive notice of a claim or "suit" as soon as practicable will not be considered breached unless the breach occurs after such claim or"suit" is known to: (a) You, if you are an individual; (b) A partner, if you are a partnership; or (c) An executive officer or insurance manager, if you are a corporation. E. Advertising Injury—Televised Or Videotaped Publication 1. The definition of"Personal and Advertising Injury' items 14. d., e., f. and g. is changed to read: "Personal and Advertising Injury" means injury arising out of one or more of the following offenses: d. Oral, written, televised or videotaped publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Oral, written, televised or videotaped publication of material that violates a person's right of privacy; f. Misappropriation of advertising ideas or style of doing business; or g. Infringement of copyright, title or slogan. 2. 2. Exclusions b. and c. of Coverage B., Personal And Advertising Injury Liability, are changed to read: b. (2)Arising out of oral, written, televised or videotaped publication of material, if done by or at the direction of the insured with knowledge of its falsity; C. (3)Arising out of oral, written, televised or videotaped publication of material whose first publication took place before the beginning of the policy period. F. Bodily Injury—Mental Anguish The definition of"bodily injury" is changed to read: "Bodily injury": a. Means bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. G. Personal Injury—Abuse Of Process/Discrimination If Personal and Advertising Injury Liability Coverage (Coverage B.) is not otherwise excluded from this Coverage Part: 1. The definition of"Personal and Advertising Injury" is changed by: Page 3 of 5 PHILADELPHIA INDEMNITY INSURANCE COMPANY Includes copyright material of the Insurance Services Office, Inc., used with its permission. PI-AS-009 (04/04) a. Revising Item b. of that definition to read: Malicious prosecution or abuse of process; b. Adding the following: "Personal Injury" also means discrimination based on race, color, religion, sex, age or national origin, except when: (1) Done intentionally by or at the direction of, or with the knowledge or consent of: (a) Any insured; or (b) Any executive officer, director, stockholder, partner or member of the insured; or (2) Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; or (3) Directly or indirectly related to the sale, rental, lease or sub-lease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or (4) Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The insurance afforded by G.1.b. above does not apply to fines or penalties imposed because of discrimination. H. Unintentional Failure To Disclose Hazards It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. I. Liberalization If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. J. Employee Indemnification Defense Coverage Under SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: 3. We will pay on your behalf defense costs incurred by an "employee" in a criminal proceeding. However, you must have a prior written agreement with such "employee"whereby you agree to indemnify the"employee"for such defense costs and the agreement includes a provision for repayment of defense costs in the event of an adverse judgment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is $25,000 regardless of the number of employees, claims or"suits" brought or persons or organizations making claims or bringing "suits." Page 4 of 5 PHILADELPHIA INDEMNITY INSURANCE COMPANY Includes copyright material of the Insurance Services Office, Inc., used with its permission. PI-AS-009 (04/04) K. Extended "Property Damage" SECTION I—COVERAGES, COVERAGE A, 2. Exclusions a. is deleted and replaced by the following: a. Expected or Intended Injury "Bodily Injury" or"Property Damage" expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury" or"property damage" resulting from the use of reasonable force to protect persons or property. L. Additional Insured—Funding Source Under SECTION II—WHO IS AN INSURED the following is added: Any person or organization with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. M. Additional Insured—Managers or Lessors of Premises Under SECTION II—WHO IS AN INSURED the following is added: Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased to you subject to the following additional exclusions: This insurance does not apply to.- a. o:a. Any"occurrence"which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. N. Non-owned Watercraft SECTION I—COVERAGES, 2. Exclusions, paragraph g. (2) is amended to read as follows: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. Page 5 of 5 PHILADELPHIA INDEMNITY INSURANCE COMPANY Includes copyright material of the Insurance Services Office, Inc., used with its permission. PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: 10/15/2017 Name of Person or Organization (Additional Insured): Any person or entity where required by written contract executed prior to a loss or claim SECTION II —WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for"bodily injury," "property damage" or"personal and advertising injury" arising out of or relating to your negligence in the performance of"your work"for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III— LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: PHPK1731918 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or entity where required by written contract executed prior to a los Any person or entity where required by written contract executed prior to a los Any person or entity where required by written contract executed prior to a los Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ POLICY CHANGE DOCUMENT POLICY NO.: PHPK1731918 Philadelphia Indemnity Insurance Company 443 Moloney O'Neill, an Alliant Insurance Se NAMED INSURED Skyhawks Sports Academy, Inc. MAILING ADDRESS POLICY PERIOD: FROM 09/23/2017 TO 09/23/2018 at 12:01 A.M. Standard Time at your mailing address shown above. CHANGE EFFECTIVE 09/23/2017 CHANGE# 3 REVISION # 3 DESCRIPTION In consideration of the premium reflected, the policy is amended as indicated below: Added: Blanket Additional Insured, Manuscript Endorsement: Primary and Non-Contributory Clause Endorsement and Waiver of Subrogation Per attached Path ID 11687205 Total Annual Total Prorate Additional/Return Premium $ 0.00 Additional/Return Premium $ 0.00 NO CHANGE NO CHANGE COUNTERSIGNED BY (Date) (Authorized Representative) 05/01/2018 Issue Date Insurance Policy Page 1 of 1 POLICY NUMBER: PHPK1731918 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following.- BUSINESS ollowing:BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Skyhawks Sports Academy, Inc. Endorsement Effective Date: 09/23/2017 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or entity where required by written contract executed prior to a loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 ©Insurance Services Office, Inc., 2009 Page 1 of 1 0 PI-CA-003 (04/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. SECTION II —COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended by adding the following: The following are also "insureds": Any person or organization for whom you are required by an "insured contract" to procure "bodily injury" or"property damage" liability insurance arising out of the operation of a covered "auto"with your permission. However, this additional insurance does not apply to: 1. The owner or anyone else from whom you hire or borrow a covered "auto." This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own; 2. Your"employee" if the covered "auto" is owned by that"employee" or a member of his or her household; 3. Anyone using a covered "auto"while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours, 4. Anyone other than your"employees," partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their"employees,"while moving property to or from a covered "auto"; or 5. A partner(if you are a partnership), or a member(if you are a limited liability company) for covered "auto"owned by him or her or a member of his or her household. B. The"insured contract" must be in effect during the policy period shown in the Declarations and must have been executed prior to the "bodily injury" or"property damage". C. This person or organization is an "insured" only to the extent you are liable due to your ongoing operations for that"insured", whether the work is performed by you or for you, and only to the extent you are held liable for an "accident"occurring while a covered "auto" is being driven by you or one of your employees. D. There is no coverage provided to this person or organization for"bodily injury" to its employees or for "property damage" to its property. E. Coverage for this person or organization shall be limited to the extent of your negligence or fault according to the applicable principles of comparative negligence or fault. F. The defense of any claim or"suit" must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or"suit". G. A person's or organization's status as an "insured" under this endorsement ends when your operations for that"insured" are completed. Page 1 of 2 PI-CA-003 (04/14) H. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any"insured,"or to procure insurance. I. The following additional exclusions apply: The insurance afforded to any person or organization as an "insured" under this endorsement does not apply to "loss": 1. Which occurs prior to the date your contract is effective with such person or organization; 2. Arising out of the sole negligence of any person or organization that would not be an "insured" except for this endorsement; or 3. Which occurs after you returned the leased or rented "auto"to the lessor or the policy period ends, whichever occurs first. Page 2 of 2 PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY PI-CA-004 PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT PI-CA-004 10/14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following is added to SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance: The insurance provided by this policy for any additional insured endorsement attached to this policy is primary when primary coverage is required in a written contract. In addition, we will not seek contribution from any insurer when insurance on a non-contributing basis is required in a written contract for any additional insured endorsement attached to this policy. For coverage to apply, the written contract must have been executed prior to the occurrence of "loss." This endorsement supersedes anything to the contrary. All other terms and conditions of this Policy remain unchanged. Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILfrY INSURANCE POLICY WC 124 (4-84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attachirxl clause'need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement.effective on 03/31/2018 at 12:01 A.M.standard time,forms a part of PATE) Policy No. (18)7175-40-23 of the CHUBB INDEMNITY INSURANCE COMPANY (NAME OF INSURANCE COMPANY) issued to S PAY INC Endorsement No. Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.` This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule IT IS UNDERSTOOD AND AGREED THAT THE COMPANY, IN THE EVENT OF ANY PAYMENT, WAIVES THE RIGHTS OF RECOVERY AGAINST ANY PRINCIPAL WHERE SUCH WAIVER HAS BEEN INCLUDED AS PART OF A CONTRACTUAL UNDERTAKING BY THE NAMED INSURED, BUT THIS WAIVER SHALL NOT APPLY IN RESPECT OF OTHER OPERATIONS OR SUCH PRINCIPAL IN WHICH THE INSURED HAS NO CONTRACTUAL INTEREST. WC 124(4-84) WC 00 03 13 Copyright 1983 National Council on Compensation Insurance. Page 1 of 1