18-001 Mad Science of the Bay Area CIYY iD�
No.
FY2018-20
CUPERTINO
RECIZEATION SERVICES AGREEMENT
1. Parties. This contract is inade and entered into as of 7/1/2018 ("Effective Date"),by and
between the City of Cupertino, a municipal corporation ("City"), aild with MAD SCIENCE OF THE
BAY AREA, FREMONT, CA ("Contractor"), a CALIFORNIA
CORPORATION for YOUTH SCIENCE CLASSES AND CAMPS.
2. Services.Contractor agrees to provide the Services included in the Scope of Worlc 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"),unless extended or terininated 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. Cornpensation. 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$50,000("Contract
Price"),based upon the Scope of Services,budget,performance schedule,and rates included in Exhibit
A. T'he inaximum compensation includes all costs, expenses and reimbursements and will remain in
place even if Contractor's actual costs exceed the capped amount.Contractor inust 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 inust maintain complete and accurate records of payrolls, expenditures,
disbursements and other cost items charged to City or establishing the basis for an ulvoice, 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,
partrler, 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 Inforrnation.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 saine standard
of care to protect City uiformation 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, benchmarlcs,
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.T'his 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 uljury, 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 inoney the City lost due to a claim or counterclaim arising out of this Contract.
12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City
will not execute the Agreement until it has received and approved satisfactory certificates of insurance
and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole
discretion may purchase insurance and deduct the costs from payments to Contractor,or terminate the
contract.
Recreation Services Agreement/Rev. 3-27-2018
Page 2 of 6
13. Cornpliance with Laws and Other City Requirernents.
Requirements for all Contracts. This contract is subject to local, state and federal laws and
regulations prohibitulg discrimination,includulg Title VII of the Civil Rights Act of 1964,the California
Fair Em�loyment Practices Act,the Ainericans with Disabilities Act of 1990,and other laws that pertain
to fair employment and anti-discrimination practices. Coiltractor must comply with labor laws
pertain'v1g to prevailing wages, working hours, overtiine, 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 ulterest. Contractor may be required to file a conflict of interest form for engagulg 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 inay only be
perforined 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 Agreeinent must comply with these additional requirements:
A. Undergo fulgerprinting and a criminal backgrouild 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,
htt�s://www.cdc.gov/head su�/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 ack�lowledge and comply with all requirements
set forth in the Recreation&Coirununity Services Instructor Manual.
Check one (if applicable):
� This contract requires services for children.
Recreation Services Agreement/Rev. 3-27-2018
Page 3 of 6
❑ This contract currently does not require services for children. If in the future, services
for children are required,the contract will require a'written amendment'to include the
appropriate insurance coverages as required in`Exhibit B—I�Zsurance 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 ul accordance with the terms of
this Agreement. Contractor's designation and any substitution are subject to City approval.
For City: For Contractor:
Name:Daniel Mestizo Name:Kate Golueke
Position:RECREATION COORDINATOR Position:BUSINESS DIRECTOR
Contact: danielm@cu�ertino.or� I 408-777-3134 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. Terrnination. City may terminate this contract for cause or without cause at any time
and will notify Contractor as soon as possible.Contractor will be paid for satisfactory services rendered
through the date of termination upon submission of final invoices approved by City.
17. Governing Law,Venue and Dispute Resolution.This contract is governed by the laws
of the State of California. Any legal actions or proceedings filed against City in connection with this
contract must comply with the government claims filing requirements and must be filed with the
Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is
required to continue to provide Services pending resolution of any dispute. If the Parties elect
arbitration, the arbitrator's award must be supported by law and substantial evidence and include
detailed written findings of law and fact.
18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative
or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will
be entitled to reasonable attorney fees and costs.This Section survives this Agreement.
19. Third Party Beneficiaries.There are no third party beneficiaries under this Contract.
20. Waiver.Neither acceptance of Services nor payment thereof constitutes a waiver of any
contract provision. City waiver of a breach shall ilot constitute waiver of another term, provision,
covenant or condition, or a subsequent breach,whether of the same or a different character.
21. Entire Agreement.This Agreement and all referenced Exhibits are hereby attached and
incorporated into the Agreement by this reference and represent the full and complete understanding
as to those matters contained herein, and supersede any other contract or understanding,either oral or
Recreation Services Agreement/Rev. 3-27-2018
Page 4 of 6
written,between the Parties.This Agreement may not be modified or amended except u1 writing sig�led
by both Parties.If there is any inconsistency between the inain contract and any attachments or e�ibits
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 ilot 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 terin 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 remaul 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 b� 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 48834 Kato Rd.,Suite 110A,Fremont,CA
10300 Torre Ave., Cupertino CA 95014 cc:Representative/Coordinator:
cc:Representative/Coordinator: I<ate Golueke
Daniel Mestizo Email:
Email: danielmC�cupertino,org
27. Validity of Contract. This contract is valid and enforceable only if it complies with the
provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or
authorized designee,and is approved for form by the City Attorney's Office.
28. Execution. The person executing this contract on behalf of Contractor represents and
warrants that Contractor has full right, power, and authority to execute this contract and to carry out
all actions and services required. This contract constitutes a legally binding obligation of Contractor,
and may be executed in counterparts, each one of which is deemed an original and all of which,taken
together, constitute a single binding instrument.
Recreation Services Agreement/Rev. 3-27-2018
Page 5 of 6
IN WITNESS WHEREOF,the parties have caused this contract to be executed.
CONTRACTOR CITY OF CUPEIZTINO
Mad Science of the Bay Area A Municipal Corporation
gy r By C. 's��%�` �
N e .�ii�i--�{e.- Ca�(u��e- Nam� !/����7�- ���C''
'� �
Title �+�inesc �i2ec-k'� Title��° dJ/�C"��/�"'
Date lZI J�l� Date �P""�"`��
Tax I.D. No.:��efer to W-9 on ile
APPROVED AS TO FORM: ATTEST:
� c�� / ¢;,Q,�,�� ���i b�l� .
.;� �� 7��'� � �f ��;��
DOLPH STEVENSON HOM GRACE SCHMIDT S ��
Cu ertino City Attorney City Clerk �`
�.�,�,�� �%�--•-� ��---��,�'
��.,���, `.��-�.��-.�- ��
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ContractlEncunibered Amount:$50,000
Acc�unt No.:580-62-613 700-702
Recreation Services Agree�nent/Rev. 3-27-2018
Page 6 of 6
EXHIBIT A
SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide YOUTH SCIENCE INSTRUCTION in,but not limited to,the
following:
SCIENCE PROGRAMS, CLASSES, AND CAMPS
Location and Time of CONTRACTOR Services:
Refer to the Recreation Schedule dated SUMMER 2018-SUMMER 2020 for agreed upon dates,
times, and class locations. The City, at its sole discretion,may change the agreed terins.
Cornpensation for CONTRACTOR Services:
Contractor shall be coinpensated for services performed pursuant to this Agreement. Compensation
s11a11 consist of the following: 65% of the resident fee based on final class rosters. The total
coinpensation to the Contractor shall not exceed$50,000.
Eligible Participant Minirnum and Maximums for CONTRACTOR Services:
Minimum: 10
Maximum: 20 FOR CLASS 30 FOR SUMMER CAMPS
If less than the required miniinum 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 Ernployees working for the City of Cupertino (if no Employees,identify
"selY'):
�f� �EtM��� ':�t(lA�(T> �4�x� '�Ft�'-I-�YY� �����hid'"�
�(1c:��1(�rl�- ��A�� �►ti,�N't�� �irv�na,e-�cnr.t�!► �rna-- .µe.lc�
N f 1 t�U-�3F�i�- �1rN(`��'`�Prt� �nt1.,.q ��c9�c�i S
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N i�E�� rv���c��s gwd�i�a cs�c��et t �si�.�. 5eu�w
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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 coinplete an Incident Report in the forin approved by the City. The Incident Report inust be
submitted to the City within 24 hours of the injury occurring.
8. The Contractor will notify the City of Cupertino uz writing of any new einployees 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.
MAD SCIENCE OF THE BAY AREA
,R--'�.�-
By: I<A E-�-G LUEKE
Title: BUSINESS DIRECTOR
Date: (�1�211�%�'t�'
EX�III�IT D
Contrac�r�r's M�.ndateci Reporter Declaxaiio�
Thr uz�dersi�;nec� ctc�c5 hez•eby ce�~ti:Ey t1�at.
1. I an1 � re�z•�se�itative of MAD S�IEN�'E O�Tl lE BAY Al2EA; tlzat I ar.n fa�i�ila.�r wit�-� Etie
facts l-��r�f�ia� �ncl am�utltoriz�d �nd q�.��lilia�c� l-o execute t1�zs �ecla�-�tic�r�.
2. I c.�ecl�re tllat MAD S�'IENC.:E t�r THE 13AY AREA h�s con�pli�d Z�vitl�.fi��,�er�rJi�t��g�7�rc�
c�imii�al 1�ack,�round iz�tvcsi:i�atic�n�•e.c��.sirern��-�ts witl�resJa�ct tc�aIl�ox-�tx-actor's
ei�n�lc�yees�vl�to xr►�y havP coi�t�ct witl.�n�izzoz°s i�� the co���-se oE�rc�v�dir��;services
pursuaxlt tc�t1�e l-�greeia�c��t, a��c� tl�e C7lifcari�ia De��rta�-�e��t of Justice l��s e�eterxni��ed f1�at
n�3ze c�f thc�se erxip�.oy�es I��s beel� cc��-�victeci c�f� felc�ily, as th�t ter�-� is c�efi��ec� ir-�
CaIifr�rnia Penal C.ode Sectzoz� 11 T 0�.3,
3. I ciecl�.re tl�at���h coacl7 aT�d ad�n��istx�tor sl�all be r�c�uir�� tc�succc�ssEully con��lete
ca�zrussic��� ���� head injury ed�tcatic�r�a at Se7st oa�ce, c�a.ther c��zlir�c�c�r•it� �ersc�n, l�efore
s�.ipervisu-�g� 7�artici}����t, as re�ziixed 1�}� C�lii�o���i� He�ltl-i �ne� S��fety Code�ectio�-�
124235, �t sec�.
4. Oi-t a y�arTy basi,s, a1l�r�rtzcip�a�ts sl��ll bc� requir�d to si�;a1 �7�d returx� a �c�:�-►�:Lzssia�� a��d
h��d injur�y iszfc��°matiop� sl�c�et i�.� cc�7n�-�).i.ai�ce�+,Titl-�Califc�rnia l Ie1if}.1 �rnd Satet}%C:c�de
S�chic�r� 124�35,wTiich n-�ay L�e in the farm atlacl-�e� ns L1-1.
5. That a cc,m�lete G�nci accu..iate list of Co�-�tr���ctvi's e�r�.�1.c�ye���, �vi1c�nz7y cc�Yn�in contact
Yvitl�rr�i��c�rs cturirl�tl�e cours� ar���3 sco�e of tl�e A.gree�s7cazzt, ��•e iricluc�ec,� b�l.o��v.
6. ,�II c�l k���bele�w n�e�2tiorted c�iriplo�Tees h��e test�c�t�aL�;atzv� foz�TB, c>r X-r�y restzlts faa�
Tli, a��d l��ve cux�re��t c.-�c>cum�ntation c�n file�.vith Cr�rltr�ctc�a-
7. Alt ot t17e Eaelow s�tentic�i��ct eii��lc�ye�s 2��rPe z•�ceivcd tra7nin� �nci u7��Iexsta�lc.l their
res�o��sibilitie�ua�dea•tl�e M�r�dateci R�po7~ter Iaws of this sfiate a��.cl a��e wi1li��,��1�c� ���le to
cr�ix��ly. .
T.,ist of aIl Ce�ntractar�rn.ploye�s warlcin�for tl��+C�fy(if z�o k�m�xTayees, i�ex�tify "sel.£"):
�-�� �t+���!n�...�-r, G�k�y=s srnt��-t `� -r� �z���;ti-� ��.�ri� t�m-c-T�:s
'V e�'��.�i� 1't"P�'�c�� ':.�-yqc,�i C� ���.� �-l-ck-�Yi.v� N c:.t_�
l�ti.os��'"`£�. "=a tT--€�,lkt�fE�Pri) �►'�� �.cvtni'L��4zaln�i;" �ct��tv�'tk-�,c�� •
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�,c.q���` Y+�G-��aics�y �n�>)r� ��c`�t��1E p��s2�� �CR..a:�,
'� � DATE(MMIDDlYYYY) �
AcoR'o CERTIFICATE OF LIABILITY INSURANCE
�,,,�- 6/12/2018
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 CQNTRACT 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 certiticate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT �
NAME:
Hylant-Toledo PHONE FAx
811 Madison Ave. ac No ex :419-255-1020 a�c r,o:419-255-7557
Toledo OH 43604 ADDR�Ess: toledo hmi h lant.com
INSURER 5 AFFORDING COVERAGE NAIC#
iNsuReRa:Philadel hia lndemnit Ins Co 18058
INSURED � NANOSCI-01 INSURER B: HBfIfOfCI CaSUBIf Insurance Co 29424
Nanogan Science&Services LLC dba
Mad Science of the Bay Area INSURER C:
INSURERD:
Newark CA 94560 wsuReR e:
INSURER F:
COVERAGES CERTIFICATE NUMBER:541949134 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 LIMITS
LTR IN D VD POLICYNUMBER MM/DDlYYYY MM/DD/YYYY
A X COMMERCIALGENERALLIABILITY Y PHPK1779034 3/1/2016 3/1/2019 EACHOCCURRENCE $1,OOD,000
DAMAGE TO RENTED
CLAIMS-MADE �OCCUR PREMISES Ea occurrence $300,D00
MED EXP(Any one person) $15,000
PERSONAL&ADV INJURY $1,00O,OOp
GEN'L AGGREGATE LIMIT APPLIES PER: . GENERAL AGGREGATE $2,000,000
POLICY PR� X LOC PRODUCTS-COMP/OP AGG $2,000,000
�JECT �
$
OTHER:
A AUTOMOBILE LIABIUTY PHPK1779D34 3/1/2018 3/1/2019 COMBINED SINGLE LIMIT $1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHE�ULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED Pe�acadenDAMAGE $
AUTOS ONLY AUTOS ONLY .
$
A X UMBRELLA LIAB X OCCUR PHUB618192 3/1l2018 3/1/2019 EACH OCCURRENCE $3,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000
DED X RETENTION$ $
g WORKERSCOMPENSATION 45WECAB20CKD 3/1/2018 3/1/2019 X STATUTE �RH �
AND EMPLOYERS'LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N�A E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED7
(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
A Abuse/Molestation PHPK1779034 3/1/2018 3/1/2019 PerOcc/Agg $1,000,000
DESCRIPTION OF OPERATIONS/LOCATION5/VEHICLES(ACORD 701,Additional Remarks Schedule,may be attached if more apace is required)
Policy includes blanket Additional Insured per written contract,subject to policy provisions.
City of Cupertino,its City Council,Boards&Commissions,Officers,Officials, Employees,Agents,Servants,Volunteers&Gonsultants are included as an
Additional Insured's per form CG2026.Waiver of Subrogation is included under the Transfer of Rights of Recovery Against Other to Us see form PI-GLD-VS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Cupertino, its City Council, Boards&Commissions, ACCORDANCE WITH THE POLIGY PROVISIONS.
Officers, Officials, Employees,Agents, Srvnts,Volunteers
&Consulnt AUTHORIZEDREPRESENTATIVE
10300 Torre Ave
Cupertino CA 95014 �,�'�����'°���'
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER:PHPK1779034 COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)Or Organization(s):
City of Cupertino, its City Council, Boards & Commissions, Officers, Officials, Employees, Agents, Srvnts,
Volunteers & Consulnt
10300 Tarre Ave
Cupertino CA 95014
Information re uired to com lete 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 contrack or agreemenk, the most we
caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the
omissions or the acts or omissions of those acting amount of insurance:
on your behalf:
1. Required by the contract or agreement; or
1. In the performance of your ongoing operations;
or 2. Available under the applicable Limits of
2. In connection with your premises owned by or Insurance shown in the Declarations;
rented to you. whichever is less.
However: This endorsemen# 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 O Insurance Services Office, Inc., 2012 Page 1 of 1
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