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18-001 Kae Montgomery ciTv oF No. t'�� ! �� FY2018-20 Ct1PERTl1�o 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 rnunicipal corporation ("City"), and wit11 KAE MONTGOMERY, PALO ALTO, CA 94303 ("Contractor"), a FITNESS INSTRUCTOR for DYNAMIC STRETCHING AND YOGA. 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. Terrn. This contract begins on the Effective Date and ends on 6/30/2020 ("Contract Time"),urtless extended or terminated as provided herein. Time is of the essence and Contractor rnust 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$9,000.00("Contract Price"),based upon the Scope of Services,budget,performance schedule,and rates included in Exhibit A. The maximum compensation includes all costs, expenses and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount.Contractor must submit invoices and the information required in Exhibit A in order to receive payment. City will compensate Contractor within 30 days after approval of written invoices. Invoices are subject to review and audit by City during regular business hours upon 24-hours' notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disbursernents and other cost items charged to City or establishing the basis for an invoice, for a rninirnum 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 employxnent 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 perforrn the Services under this Contract. Contractor is responsible for obtaining permits and licenses required by law and must obtain a City business license. 6. Proprietary/Confidential Information.To the extent Contractor.may have access to private or confidential information owned or controlled by the City, Contractor agrees to treat it confidential and use it solely to perform this Agreement. Contractor must exercise the same standard Recreation Services Ag�eement/Rev. 3-27-2018 Page 1 of 6 of care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Ownership of Materials.To the extent Contractor prepares written material, drawings or data in connection with this contract, City will have the property rights to those materials and all copyrights,if any, to such work product will constittxte 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 mixst include detailed information about Contractor's services, benchmarks, deliverables and costs/fees,and must be made reasonably available to City.T'he records and supporting documents rnust be kept separate frorn other files and maintained for four years from the date of City's final payrnent. 9. Assignment. This Contract is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Contract withaut 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 Agreernent without prior written approval from City. 11. Indernnificatian.To the fullest extent allowed by law and except for losses caixsed by the sole negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend, and hold harrnless the City, its City Council, boards and cornmissioris, officers, of£icials, 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, dernands, 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 pe�formance of this contract or the Services. This includes but is not limited to Liability resulting in persanal injury, death, property damage, or economic losses. Contractor must pay any casts City may inctxr in enforcing this provision and must accept a tender of defense upon receiving notice from City.Contractor's payrnents 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, arnount, and dates of coverage. Alternatively, City in its sole discretion may purchase insurance and deduct the costs frorn payments to Contractor,or terminate the contract. Recreation Set^vices Agreement/Rev. 3-27-2018 Page 2 of 6 13. Compliance with Laws and Other City Requirements. Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prohibiting discrimination,including Title VII af 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 ernployment and anti-discrimination pxactices. Contractor must comply with labor laws pertaining to prevailing wages, working ho�rs, overtime, payroll records, and other requirernents 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 Imrnigration 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 rnay 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 Requirernents for Services Provided to Mino�s: 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 verifq alI ernployees providing services under this contract have met this requirement. B. Cornplete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Cornply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training xequired under California Health and Safety Code Section 124235, AS2007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, htt�s://www.cdc.gov/headsu�/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 rnust acknowledge and comply with all requirements set forth in the Recreation&Comrnunity Services Instructor Manual. Check one (if applicable): � This contract requires services for children. Recreatron Services Agreement/Rev. 3-27-2018 Page 3 of 6 ❑ This contract currently does not require services for children. If in the future, services for children are required,the contract will require a'written amendment' to include the appropriate insurance coverages as required in`Exhibit B—Insurance Requirernents for Recreation Contracts', proof of finger printing and additional requirements under Paragraph 13. The contract arnendment will also require the approval of the Director of Recreation and Cornmunity 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.Confiractor's designation and any substitution are subject to City approval. For City: For Contractor: Name: Colleen Ferris Name:KAE MONTGOMERY Position:Recreation Coordinator Position: FITNESS INSTRUCTQR Contact:colleenf@cu�ertino.org 408-777-3160 Contact: 15. Abandonrnent. City may abandon or postpone the Activity or Prograrn and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the date of abandonment upon subrnission 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 subrnission of final invoices approved by City. 17. Governing Law,Venue and Uispute 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 rnust 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. 9.8. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative or regulatory proceeding to enforce its rights or the terrns of this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs.T'his Section survives this Agreernent. 19. Third Party Beneficiaries.There are no third party beneficiaries under this Contract. 20. Waiver.Neither accep�ance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall not constitute waiver of another term, provision, covenant or condition, or a subsequent breach,whether of the same or a different character. 21. Entire Agreement.This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this reference and represent the full and complete understanding as to those matters contained herein,and supersede any other contract or understanding,either oral or Recreation Services Agreement/Rev. 3-27-2018 Page 4 of 6 written,beiween the Parties.This Agreement may not be modified or amended except in writing signed by both Parties.If there is any inconsistency between the rnain contract and any atfiachments 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 ornission of a required provision. � 23. Headings. T'he headings are for convenience only and are not a part of the contract or intended to affect,lirnit 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 Agreernent 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 fio rnaterial 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 confirrned 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 PALO ALTO, CA 94303 10300 Torre Ave., Cupertino CA 95014 cc:Representative/Coordinator: cc:Representative/Coordinator: KAE MONTGOMERY Colleen Ferris Email: Ernail: colleenfC cupertino.org 27. Validity of Contract. This contract is valid and enforceable only if it cornplies 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 instrurnent. Recreation Services Agreement/Rev. 3-27-2018 Page 5 of 6 IN WITNESS WHEREOF,the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO KAE MONTGOMERY A Municipal Corporation � . By :=�`°�.-c��-� By �..e � __� Namey . - �� Name Christine Hanel Title ��'1 'l v1 C.� Tltle Assistant Director of Recreation&Communitv Services Date � � � `�� Date �'`"<�"�`��C Tax I.D. No.: ��I J� �i APPROVED AS TO FOR • � ��0�� {p ATTEST: � � � � � �� N OLPH STEVENSON M GRACE SCHMIDT � �d .�� Cup rtino City Attorney City Clerk Fiscal Year 2018-19 Fiscal Year 2019-20 ContractlEncumbered Amount:$4,500.00 ContractlEncumbered Amount:$4,500.00 Account No.:570 63 621 700 702 Account No.:570 63 621 700 702 Recreation Services Agreement/Rev. 3-27-2018 Page 6 of 6 EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide FITNESS INSTRUCTION in,but not limited to,the following: DYNAMIC STRETCHING AND YOGA. Location and Time of CONTIZACTOR Services: Refer to the MONTHLY FITNESS CLASS SCHEDULE for agreed upon dates,times, and class locations. The City, at its sole discretion,may change the agreed terms. Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. Compensation shall consist of the following: $42/class. T'he total compensation to the Contractor shall not exceed $9,000.00. Eligible Participant Minimum and Maxirnums for CONTRACTOR Services Minimum: 10 Maximum: 50 If less than the required rninimum 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 Agreernent without additional notice or payment to Contractor. List of all Contractor Employees working for the City of Cupertino (i#no Employees,identify "self"): self Performance of CONTRACTOR Services: In the case Contractor unilaterally cancels performance of a class, carnp, activity or service without City approval, City reserves the right to immediately and wifhout notice cancel the remaincler 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 rnust remain with the class until a parent of legal guardian has arrived and all rninors 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. Ex3��it� Ins�crunce .1�ec��tire�neni�fo� 1�ecr,eatior� Cantrrrcts 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. 1Vlinimurn Seope and I.irnit of Insuranee. Coverage shall be at least as broad as: l. Corainn�rcial Ge�neral Liability (CGL): Insurance Services Office Form CG 00 O1 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. Aa�tomobile Liabilitye 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. 0 Required if automobile is used to perform work under this contr°act. �Otherwise, proof of Contractor's personal auto insuNance with limzts required by state law su�ces. Contractor shall not transport or use its personal vehicle to transport participants or psrform work 2�n.�'er t�is c�nirc�c#. 3. Wm�kers' C�mp��sa�ion: As requirzd by t�ie �tate of California, vvith Statutory a�i� Enlpl�ye�'s Liability Insurance limits of no less than$1,000,000 per accident for bodily injury or disease. ❑ Required if Contractor has employees. t�If no employees, Contractor must sign A�davif of No Employees. 4. Se��al Aba��e/1@�Io�es4��no �nsurance 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 iricluded under General Liability or be obtained in a separate policy, such as Educators Legal Liability (�LL) 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/L7mbrella insurance. S'elf-Insured l�eteratio�as: 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. flccepPabality oflizsurers:Insurance must be issued by insurers acceptable to City and licensed to do business in the State of California,with an A.M.�est's financial strength rating of"A"or better and a financial size rating of"VII"or better. OTI-IEIt II�TSITY�AI�TCE PItOVISIOI�TSe The CGL policy must contain, or be endorsed to contain, the following provisions: L 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. C�eatractor's insuraan��sflna9l�e primary insurance coverage at least as broad as ISO CG 20 O1 04 13 as respects the City, its officers, officials, employees, agents, and volunteers. 3. The Insurance Company agrees to waive all righ�s of subrogati�n against the City, its elected or appointed officers, of�cials, agents, and employees for losses paid under the terms of any policy which arise from work performed by Contractor for City. This provision also applias 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. 1'ra�nary Coverage: The Additional Insured coverage under Contractor's policy shall be primary non- contributory and at least as broad as ISO CG 20 Ol 04 13 as respects the City and all the insureds/indemnitees. If the limits of insurance required are satisfied in part by Urnbrella/Exce�s I�nsuramce, the UmbrellalExcess 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. N�tice of Caracellatio�: 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 rnust be sent to Cbty via email or certified mail to the attention of the City Manager. bYaiver of,S'ubro�ataon: 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 ibe 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. �erifacation of C"overage;Contractor shall furnish the City with original certificates and amendatory endorsements eff'ecting 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, certi�ied copies of all required insurance policies, including endorsements affecting the coverage required by these speci�'ications, at any time.At a minimum Contractor must provide accepta.ble copies of the policy declarations and endorsement page verifying the required insurance coverages. �loBrzeowreer's Irasurance: 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 rnay provide special events coverage for a reduced fee, or City may be able to offer this coverage. Contractor should contact the City 1Vlanager's Office for information or assistance. Specialllisks oa�Circufrasta�ces: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-I8 2 . EXHIBIT C AFFIDAVIT OF NO EMPLOYEES� State af California County of Santa Clara City of Cupertino I, the undersigned, declare as follows: I am an independent contractor and the owner of KAE MONTGOMERY_ I wish to enter into a services contract with the City of Cupertino. I am fully aware of the provisions of section 3700 of the California Labor Code, which requires every employer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that I must provide proof of workers' compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. � q Executed on this�day of�l � 2018, at_��!��'.�'�d��c� _, California. �'l� , ��_��.Q �(�:�(�1/L%�'.�1�- PRINT NAME � ____.__.� . . __-_ !�. �, ;-';''� SIGNATURE EXHIBIT D Contractor's Mandated Reporter Declaratian T'he undersigned does hereby certify that: 1. I am a representative of KAE MONTGOMERY;that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that KAE MONTGOMERY has cornplied with fingerprinting and criminal background investigation requirements with respect to all Contractor's employees who may have contact with minors in the course of providing services pursuant to the Agreement, and the California Department of Justice has determined that none of those employees has been convicted of a felony, as that term is defined in California Penal Code Section 11105.3. 3. I declare that each coach and administrator shall be required to successfully complete concussion and head injury education at least once, either online or in person, befare 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, whi.ch 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 docurnentation on file with Contractor. 7. All of the below mentioned employees have received training and understand their responsibilifiies under the Mandated Reporter laws of this state and are willing and able to comply. L,ist of all Contractor Employees working for the City (if no Employees,identify "self"): self 8. The Contractor will notify the City of Cupertino in writing of any new employees and will be added to the above list prior to beginning work at the City of Cupertino. I declare under penalty of perjury that the foregoing is true and correct. KAE MONTGOMERY _��._ � - ,/" ..-::--" i ,.�r By: KAE MON OMERY Title: FITNESS INSTRUCTOR Date: � � l " EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 636639645025537304 CERTIFICATE OF INSIJI2ANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY(ADDITIONAL INSiJRED) Alliant Insurance Seivices,Inc.in conjunction with City of Cupertino Apex Insurance Services P.O.Box 6450 Newport Beach,CA 92658 License No: OC 36861 N�MED INSi.7RED(EVENT HOLDER): EVENT 1NFORMATION: Kae Montgomery TYPE: Yoga DaTE(s): 06�0��2o�a-�z�3�i2o�a East Palo Alto, CA 94303 LOCATION. CupeAlnoSpodsCenter,217715tevensCreekBlvd,Cupedino,CA95014 *Liquor Liability Yes� No� **Liquor Liability after 12 ain ends before 2 am ❑ This is to certify that the insurance policy listed Uelow has been issued to the above insured named(event holder)for the policy period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless ainended as desci•ibed in Special Conditions. INSURANCE CARRIER:Evanston I�lsurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: January 01,2018 EXPIRATION: January 01, 2019 COMMERCIAL GENERAL LIABILITY General OCCi JRRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $2,000,000 Products&Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal&Advertising Injtuy 1,OOQ000 The following endorsements attached to Each Occmrence Lunit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Instuance: Medical Plyinents(Any One Person) 5,000 MEGL1643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,000/$3,000,000 ❑ $2,000,000/$2,000,000 Property Damage(If purchased) No Property Damage Coverage The lunits of insm•ance apply separately to each event insured Uy this policy as iF a separate policy oP insurance has been issued for that event. OTHER ADDITIONAL INSUREDS City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants CANCELLATION: Should the aUove descriUed policy be cancelled before the expiration date thereof,notice will Ue delivered in accordance with the policy provisions. �� - ¢ AUTHORIZED REPRESENTATIVE: DATE ISSiIED: 06/07/2018 PP� 6 .�/� USAA GENERAL INDEMNITY COMPANY ADDL INFO ON NEXT PAGE MAIL MCH-M-I '�� RENEWAL OF � �' (A Stock Insurance Company) State 01 0 2 ven POIJCYNUMBER (j$�° 9800 Fredericksburg-San Antonio,Texas 78288 CA 14 14 ��r 0 2 2 8 9 2 7 6 3 G 7101 8 CALIFORNIA AUTO POLICY POLICYPERIOD: (12:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE MAY 16 2018 TO NOV 16 2018 OPERATORS Named Insured and Address 02 KAE MONTGOMERY PALO ALTO CA 94303-0704 Descri tion of Vehicle s VEHUSE� VE}i TR,4DE NAME MODB_ BODYTYPE MILEAGE IDENTIFICATION NUMBER SYM �5 � O1 P The Vehicle(s)described herein is princi�pally gara ed at the above address unless otherwise stated.*W��=W��ooi;B=Business;�F�,,,;P=Pleasure VEH 01 E PALO ALTO CA 94303—�014 VEH 02 E PALO ALTO CA 94303-2014 hi� policy provi es those coverages where a premium is shown elow. The limits shown may, be reduced by policy provisions and may .not be combined regardless of the number of vehicles for which a remium is listed unless s ecificail authoriaed elsewhere in this olic . COVERAGES LIMITS OF LIABILITY VEH VEH VEH VEH O1 6—MONTH 02 6—MONTH �°ACV��MEANSACTUALCASHVALUE) D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $ MOUNT $ MOUNT $ MOUNT $ PART A — LIABILITY BODILY INJURY EA PER $ 25, 00 EA ACC $ 50, 00 75.49 68 . 73 PROPERTY DAMAGE EA ACC $ 25, 00 93 . 91 83 . 19 PART C — UNINSURED MOTORISTS BODILY INJURY EA PER $ 25, 00 EA ACC $ 50, 00 21.44 21 . 86 WAIVER OF COLL DEDUCTIBLE 2 .09 2 . 13 PART D — PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 500 25 . 83 500 28 . 81 COLLISION LOSS ACV LESS D 500 155 .56 500 182 .43 VEHICLE TOTAL PREMIUM 374 .32 387 . 15 6 MONTH PREMIUM $ 761 . 47 PREMIUM DUE AT INCEPTION. THIS I NOT BILL, STAT MENT 0 FO LOW. ADDITIONA MESS GE(S) — SEE FOLLO ING GE(S) LOSS PAYEE VEH O1 TOYOTA MOTOR CREDIT CORP, ATLANTA GA VEH 02 TOYOTA MOTOR CREDIT CORP, ATLANTA GA ENDORSEMENTS: ADDED 05-16-18 — 5100CA( 02) REMAIN IN EFFECT(REFER TO PREVIOUS POLICY)— RSGPCW( O1 ) INFORMATION FORMS: NIPFCA( 05) 320CA(05) 50CA( 03 ) CADS(04) 40CA(01) 13580( 03) 999CA( 18) HO1 RMM22 00 H 2 RMF23 00 H H IN WITNESS WHEREOF,we have caused this policy to be signed by our President and Secretary at San Antonio,Texas, on this date APRIL 10, 2018 �� s000 G 05-1 2 Deneen Donnle y y , 53384-p5-12 y,Seaeta� S.Wa ne Peacock Prssident PA�E 7 ,1� USAA GENERAL INDEMNITY COMPANY RENEWAL OF ~ �' (A Stock Insurance Company) State vdi POLICYNUMBER U$�° 9800 Fredericksburg-San Antonio,Texas 78288 CA ��r 0 2 2 8 9 2 7 6 3 G 7101 8 CALIFORNIA AUTO POLICY POLICYPERIUD: 12:01 A.M.standard time) RENEWAL DECLARATIONS EFFECTIVE MAY 1� 2018 TO NOV 16 2018 Named Insured and Address PALO ALTO CA 94303-0704 Descri tion of Vehicle s vEH usE• ��- `�5 �� VH-I TRADE NAME A/IODEL BODYIYPE MILEAGE IDENTIFICATION NUMBER SYM � The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated.*wic=worwsonoor B=aUs�ne��r��,,,;P=Pleasure This policy provides ONLY those coverages where a premium is shown below. The limits shown may be reduced by policy provisions and may .not be combined regardless of the number of vehicles for which a remium is listed unless s ecificall authorized elsewhere in this ol6c . COVERAGES LIMITS OF LIABILITY VEH VEH VEH VEH ��ACV��MEANSACTUALCASHVALUE) D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT MOUNT MOUNT MOUNT THE FOLLOWING COVERAGE(S) DEFINED N THTS POLIC ARE NOT P OVID D FOR: VEH O1 — MEDICAL PAYMENTS, EXTEN ED B NEFITS OVE GE, R TAL REIMBU SEME T, TOWING AND LABOR VEH 02 — MEDICAL PAYMENTS, EXTEN ED B EFITS OVE GE, R TAL REIMBU SEME T, TOWING AND LABOR E E E E H H H H In WITNESS WHEREOF,we have caused this policy to be signed by our President and Secretary at San Antonio,Texas, on this date APRIL 10, 2018 ,r�� G��.� s000 G 05-12 Deneen Donnley,Secretaiy S.Wayne Peacock,Presidenfi 53384-05-12 ARC H � INTERMEDIARIES CLAIMS MADE SEXUAL MISCONDUC'�AND MOLESTATION INSURANCE Fonzz: SML Safe�uard Wordinp- 623AFB00213 Policy Number: TBA Renewal of: N/A Named Insured: City of Cupertino—Dept of Recreation&Community Services Principal Address: 10185 N Stelling Road, Cupertino, CA, 95014 Policy Period: From: 1 St July 2018 To: 1 St July 2019 Both dates at 12:01 a.m. Local Time at the Principal Address stated in Item 1. Limit of Liability: a) USD 5,000,000 for all Claims for Wrongful Acts against any one Victim b) USD 5,000,000 for all Claims for Wrongful Acts against all Victims,but sub-linuted to: c) USD 50,000 for all Safeguard Costs resulting froin all Circumstances Such Sub-liinit of Liability shall be part of, and not in addition to,the overall Limit of Liability stated in 3.U) above. Retention: USD 35,000 any one Victim Premium: USD 27,000 to be paid within 25 days of attachment Notification pursuant to Clause IX. shall be given to: Claims Department Beazley 30 Batterson Park Road, Farmington, CT 06032. claims e beazle_ .y coin (860) 677 3765 (phone) (860) 679 0247 (fax) Retroactive Date: 1 St July 2018 Pending or Prior I.itigation Date: 1 St July 2018 Service of Suit: Eileen Ridley,FLWA Service Coip., c/o Foley&Lardner LLP, 555 Califonua Street, Suite 1700, San Francisco, CA 94104-1520 Choice of Law: New York Conditions: Application Dated: TBA California Surplus Lines Notice 1-LMA9098A Small Additional or Retuni Premiums Clause(U.S.A.)—NMA 1168 Nuclear Incident Exclusion Clause-Liability-Direct—NMA 1256 Radioactive Contamination Exclusion Clause-Liability-NMA 1477 War and Terrorism Exclusion—NMA 2918 Sanctions Limits Clause-LMA 3100 Beazle�Safe�uard Education Document Arch Safepuard Enhancenzent Endorsement U.S Classification: Surplus Lines Brolcer and State filed in: TBA License Number: TBA Subject to: 1) Satisfactoiy re-signed and dated SML application within 30 days of ulception 2) Confirmation of the Surplus Lines Broker. Including name of individual, company name, address and license number All subj ectivities to be received within 7 working days of binding otherwise Underwriters reserve the right to amend terms or cancel ab initio. Brokerage: 22.5%or same net equivalent downwards,plus taxes as applicable Information: Einployees—36 full time+250 part time+63 IC's Exposure Units—97,000 Nature of Business—Municipality Cancellation by an Insured may result in a short rate calculation to deternline the retunl premium, suUj ect to 5%minimum earned of the total premium. Underwriting Security: 100%Lloyd's(Infoi7nation about Llovds)