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18-001 North American Youth Activities CITY OF
No. �I
III 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 NORTH AMERICAN
YOUTH ACTIVITIES, ("Contractor"), a CORPORATION
for SOCCER 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$174,000("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,
ha2s://www.cdc.goy/headsui2/index.h!mD.
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.
Recreation Services Agreement/Rev.3-27-2018
Page 3 of 6
Check one (if applicable):
® 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: 011y Bayliss
Position:Recreation Coordinator Position:Territory Manager
Contact:jeffo@cupertino.org;408-777-3327 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.
Recreation Services Agreement/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
10300 Torre Ave.,Cupertino CA 95014 cc:Representative/Coordinator:
cc:Representative/Coordinator: 011y Bayliss
Jeff Ordway Email:
Email: jeffo@cupertino.org
Recreation Services Agreement/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
NORTH AMERICAN YOUTH ACTIVITIES A Municipal Corporation
By By //
Name OLLY 3AYc.ySS NameO—,kV
Title I eV4v N Man a D Q"' Title A /►—6jw—
Date /ne S 2AD l$ Date
Tax I.D. No.:Refer to W9
APPROVED AS TO FORM: ATTEST:
t B�
RAND LPH STEVENSON HOM GRACE SCHMIDT
Cupertino City Attorney City Clerk 6r"
Fiscal Year 2018-19
ContractlEncumbered Amount:$56,000
Account No.:580-63-620 700-702
Fiscal Year 2 019-2 0
ContractlEncumbered Amount:$58,000
Account No.:580-63-620 700-702
Fiscal Year 2020-21
ContractlEncumbered Amount:$60,000
Account No.:580-63-620 700-702
Recreation Services Agreement/Rev.3-27-2018
Page 6 of 6
i
EXHIBIT A
SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide SOCCER CAMPS AND CLASSES in,but not limited to,the
following:
MOMMY/DADDY AND ME SOCCER, PRE SOCCER, SOCCER 1, SOCCER 2, KIDZ LOVE SOCCER
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: 61%OF THE RESIDENT REGISTRATION FEE. The total compensation
to the Contractor shall not exceed$174,000.
Eligible Participant Minimum and Maximums for CONTRACTOR Services:
Minimum: 6
Maximum: VARIES
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'):
O II.Sc,�,a. �cw�.N,n. 5 ►�lo�`
Yow.q
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.
❑ 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 limit.
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 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 shalt be primary insurance coverage at least as broad as ISO CG 20 01 04
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 NORTH AMERICAN YOUTH ACTIVITIES;that I am familiar with the
facts herein and am authorized and qualified to execute this declaration.
2. I declare that NORTH AMERICAN YOUTH ACTIVITIES 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'):
0�Sw�o,, gcacw� Sc,ob�, Sc�o\F�►c�
:Sww, Cervtkzs.
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.
NORTH AMERICAN YOUTH ACTIVITIES
sy
Name IUTGI S A os�,p r-c�
Title
Date 5� ��
�Q r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
- 04/12/2018
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
Van Beurden Ina. Serv, Inc. - Woodland NAME: Casey Kolb
PO Box 2053 CNNo Ext: (530) 661-0666 A
aNo):(530) 661-9032
E-MAIL
Woodland CA 95776-2053 ADDRESS: ckolb@vanbeurden.com
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:Nationwide Mutual Ins Cc 23787
INSURED (408) 252-1894
INSURER B:Colony Ins Company 39993
North American Youth Activities LLC DBA Kidz
Love Soccer INSURERC:Lloyds of London
P.O. Box 337 INSURER D:State Compensation Ins Fund of 35076
Corte Madera CA 94976 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:cert ID 28667 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 NUMBER MM DDLICY EFF POLICY EXP LIMITS
LTR
C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000
CLAIMS-MADE a OCCUR Y Y IOIPKGO03704303 10/31/2017 10/31/2018 PREM SES Ea occuE encs $ 100,000
X Sexual Abuse Liab MED EXP(Any one person) $ 5,000
X $250K Clm/$500K Agg PERSONAL&ADV INJURY $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
POLICY 11PRO ❑LOC PRODUCTS-COMP/OPAGG $ 4,000,000
PRO-
OTHER: $
MBINED SINGLE LIMIT 1,000,000
AUTOMOBILE LIABILITY CO $
Ea accident
B X ANY AUTO Y ACP3046389370 10/30/2017 10/30/2018 BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
D
WORKERS EMPLOY EMPLOYERS'
Y/N 90354252017 12/01/2017 12/01/2018 X STATUTE EERH
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 11000,000
OFFICERIMEMBEREXCLUDED? N/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
D Sexual Abuse Excess Liab. PFDBC1702538 10/31/2017 10/31/2018Aggregate/Claim $ 750,000
Retention $ 25,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
Sexual Abuse or Molestation Coverage is included per attached from U013-0511.
City of Cupertino, its City council, boards & commission, officers, officials, employees, agents,
servants & volunteers are named Additional Insured as respects General Liability on primary
non-contributory basis per attached form # U156A-0313 only when required by written contract. A
Waiver of Subrogation applies with respects to the General Liability policy per attached form #
U047 0310 only when required by written contract.
City of Cupertino, its City council, boards & commission, officers, officials, employees, agents,
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 95014r
©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
04/12/2018
CERTIFICATE HOLDER: INSURED:
City of Cupertino North American Youth Activities LLC DBA Kidz
Love Soccer
10300 Torre Ave. P.O. Box 337
Corte Madera CA 94976
Cupertino CA 95014
DESCRIPTION OF OPERATIONS CONTINUED:
servants & volunteers are named as Additional Insured on the Auto policy per attached form CA2048
02-99 only when required by written contract. A Waiver of Subrogation also applies on the Auto
policy per attached form CA0444 0310.
DOC(10/2003)
Page 2 of 2
101 PKG 0037043-03
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - BLANKET COVERAGE
INCLUDING PRIMARY / NON-CONTRIBUTORY
AND WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s)or Organization(s)
Additional Insured): Locations of Covered Operations:
All persons or organizations as required by a written Locations as required by a written contract or
contract or agreement with the named insured. agreement with the named insured.
A. SECTION 11 —WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule for whom you are performing operations when you and such
person or organization have agreed in writing in a contract or agreement that such person or
organization be added as an additional insured on your policy. Such person or organization is an
additional insured only with respect to liability for "bodily injury', "property damage" or "personal and
advertising injury"caused, in whole or in part, by:
1. your acts or omissions; or
2. the acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s)
designated above.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
Additional Insured Contractual Liability
"bodily injury"or "property damage" for which the additional insured(s) are obligated to pay damages
by reason of the assumption of liability in a contract or agreement.
Finished Operations at Work
"bodily injury" or "property damage" occurring after:
1. all work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
2. that portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization.
Negligence of Additional Insured
"bodily injury"or "property damage"arising directly or indirectly out of the negligence of the additional
insured(s).
U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2
with its permission.
101 PKG 0037043-03
C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is
amended and the following added:
The insurance afforded by this Coverage Part for the additional insured required by a written contract
or agreement with the named insured is primary insurance and we will not seek contribution from any
other insurance available to that additional insured.
D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of
Recovery Against Others To Us is amended and the following added:
We waive any rights of recovery we may have against any person or organization because of
payments we make for injury or damage resulting from your ongoing operations or'your work" done
under a contract with that person or organization and included in the "products-completed operations
hazard" if:
a. you agreed to such waiver;
b. the waiver is included as part of a written contract or lease; and
c. such written contract or lease was executed prior to any loss to which this insurance applies.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2
with its permission.
101 PKG 0037043-03
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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
The following is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section
IV—Conditions:
We waive any rights of recovery we may have against any person or organization because of payments we
make for injury or damage resulting from your ongoing operations or"your work"done under a contract with
that person or organization and included in the "products-completed operations hazard"if:
a. you agreed to such waiver;
b. the waiver is included as part of a written contract or lease; and
c. such written contractor lease was executed prior to any loss to which this insurance applies.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1
with its permission.
101 PKG 0037043-03
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SEXUAL ABUSE OR MOLESTATION
COVERAGE LIMITATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions and SECTION I — COVERAGES, COVERAGE B PERSONAL AND
ADVERTISING INJURY LIABILITY, 2. Exclusions are amended to include the following:
Sexual Abuse or Molestation—Employees, Volunteers or Temporary Workers
This insurance does not apply to:
(1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the actual or
threatened sexual abuse or molestation:
(a) by anyone of any"employee", "volunteer worker"or"temporary worker"; or
(b) of any person by any cleric, elder or officer of any religious institution that owns, operates or
directs the operation of the insured.
B. SECTION III —LIMITS OF INSURANCE is amended and the following added:
The most we will pay under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY, and COVERAGE B PERSONAL AND ADVERTISING INJURY
LIABILITY for claims and/or "suits" made against you resulting from actual or threatened sexual
abuse or molestation by anyone of any person while in the care, custody or control of the Named
Insured, is shown below for this coverage:
$250,000 Each Claim/$500,000 Aggregate
The Each Claim Lint is the most we will pay as damages because of sexual abuse or molestation
sustained and expenses incurred in the defense and adjustment of claims and/or "suits" asserted in
any one claim and/or "suit". All claims for damages made by one or more persons because of any
one act or series of acts of sexual abuse or molestation shall be deemed to be one claim.
The Aggregate Limit is the most, subject to the Each Claim Limit, we will pay as damages because of
sexual abuse or molestation sustained and expenses incurred in the defense and adjustment of such
claims and/or"suits" regardless of how many persons assert such claims and/or"suits".
The Each Claim and Aggregate Limits described above are the most we will pay regardless of the
number of insureds. These Lints of Insurance are subject to and not in addition to the General
Aggregate Limit shown in the Declarations of the policy. Payments under these Limits of Insurance
are part of and erode the policy General Aggregate Limit of Insurance shown in the Declarations.
C. For the purposes of the Limits of Insurance provided under this endorsement, the following applies:
For any coverage for actual or threatened sexual abuse or molestation that may also be provided
under an "Assault", "Battery' or "Assault and Battery" Coverage Sub-Limited Endorsement made a
part of this policy, such coverage will be limited to the highest limit applicable. This single highest
limit will be the most we will pay for any one claim for any covered actual or threatened sexual abuse
or molestation.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U013-0511 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1
with its permission.