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18-001 Michele Westlaken CITY OF No. FY2018-21 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties. Tl1is contract is made a�1d entered uzto as of 7/6/2018 ("Effective Date"),by aizd between the City of Cupertino, a municipal corporation ("City"), and wit11 MICHELE WESTLAKEN, SAN JOSE, CA 95129 ("ConEractor"), a SOLE PROPRIETOR for FELDENKRAIS. 2. Services. Contractor agrees to provide t11e Services uzcluded in the Scope of Work and in accordance with the Schedule of Performance attached u1 Exhibit A. 3. Terrn. This contract begvzs on t11e Effective Date and ends on 6/30/2021 ("Contract Tiine"), unless extended or terinuzated as provided 1-iereul. Tune is of the essence and Contractor must have sufficient tiine, resources, and qualified staff to deliver t11e Services as required. Contractor must prornptly notify Cify of any actual or potential delays to afford the Parties adequate opportunify 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$4,000 BETWEEN 7/6/2018 AND 6/30/2019, $4,000 SETWEEN 7/1/2019 AND 6/30/2020, AND $4,000 BET'WEEN 7/1/2020 AND 6/30/2021 ("Contract Price"), based upon the Scope of Services, budget, performance sclledule, and rates included u1 Exhibit A. Tlze inaximuin compensation includes all costs, expenses and reimbursements and will remaitl in place even if Contractor's actual costs exceed the capped amount. Contractor must submit uzvoices and t11e uzformation required uz Exhibit A in order to receive payment. City will coinpensate Contractor within 30 days after approval of written ulvoices. Invoices are subject to review and audit by City durulg regular business 1lours upon 24-1lours' notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disburseinents and other cost items charged to City or establishuzg fl1e basis for a�� ulvoice, for a minimum of four (4) years from t11e date of final payment. 5. Independent Contractor.Contractor is an independent Contractor and not an einployee, partner, or joint venture of City. Contractor is solely responsible for the inea�ls and inefllods of performuZg the Services a�1d for the persons 1lired to worl<under t11is Agreeinent.No civil service status or other right of elnployinent will be acquired by virtue of Contractor's performance of tlle Services. Contractor is not entitled to City's 1lealth benefits, worker's compensation or atly other benefit. Contractor must have the skills and qualifications to perforin the Services in a cornpetent and professional manner. Contractor will supply all tools, materials and equipment required to perform t11e Services under this Contract. Contractor is responsible for obtauling permits and licenses required by law and must obtain a City business license. Recreation Services Agree�nent/Rev. 3-27-2018 Page 1 of 6 6. Proprietary/Confidential Information. To the extent Contractor may 11ave access to private or corLfidential information owned or controlled by the City, Contractor agiees to treat it confidential atld use it solely to perforin this Agreeinent. Contractor inust exercise fl1e saine statldard of care to protect City uzforination as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Ownership of Materials.To tlle extent Contractor prepares written material, drawuzgs or data in coi�ulection with this contract, City wiIl 11ave the property rights to those materials and all copyrights,if any, to such work product will constitute City property. 8. Records. Conhactor inust maintain complete,accurate, and detailed accotultulg records relating to its performance uz accorda7lce with generally accepted accounting principles and procedures. The records must include detailed ulforination about Contractor's services, bencllinarks, deliverables and costs/fees,and inust be made reasonably available to City.T11e records and supporting documents must be kept separate froin otller files and maultauzed for four years from fl1e date of City's final payinent. 9. Assignmenf. This Contract is not assignable. Contractor inay not substitute another or transfer a�zy rights or obligations under this Contract wifllout prior written approval of City.Only those persons whose names are uzcluded i�1 Exhibit A may perform the Services. 10. Publicity and Signs.Any publicity generated by Contractor related to this contract or the Services duruzg the Contract Tirne and for one year tllereafter inust reference City contributions. The words "City of Cuperfino" shall be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announceinents, 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 witllout prior written approval froin City. 1L Indernnification. To the fullest extent allowed by law a�1d except for losses caused by the sole negligence or willful misconduct of City persorulel, Confi�actor agrees to indeinnify, defend, and hold harinless the City, its City Couiuil, boards �Zd commissions, officers, officials, employees, agents, servants, volunteers a�1d Contractors (collectively, "�ildemilitees"), througll legal counsel acceptable to City, froin and against any liability for damages, claims, actions, causes of action, delnatlds, charges, losses, costs and expenses (including attorney fees,legal costs and expenses related to litigation, arbitrations, administiative and regulatory proceedings), of every nature, arisulg out of or uz any way related to Cont�actor's or Contractor's agents perforinance of this contract or the Services. Tl1is includes but is not limited to Liability resulting uz personal injury, death, property damage, or economic Iosses. Contractor must pay any costs City may incur in enforcing this provision and inust accept a tender of defense upon receivulg notice from City. Contractor's payinents inay be deducted or offset to cover any inoney the City lost due to a claim or counterclaim arisuzg out of this Contract. 12. Insurance. Contractor shall comply with the insurance requireinents in Exhibit B. City will not execute the Agreement until if has received and approved satisfactory certificates of uzsurance and endorsements evidenculg the type, amowzt, and dates of coverage. Alternatively, City uz its sole discretion inay purchase insurance and deduct the costs froin payinents to Contractor, or terinuzate the contract. � Recreation Services Agreement/Rev. 3-27-2018 Page 2 of 6 13. Cornpliance with Laws and Other City Requirements. Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prollibiting discriinulatioll,includitzg Title VII of the Civil Rights Act of 1964,�11e California Fair Einployment Practices Act,the Ainericans with Disabilities Act of 1990,and other laws that pertaul to fair einployinent a�zd anti-discrunulation practices. Contractor must comply witll labor laws pertauzuzg to prevailuzg wages, workuzg hours, overti�ne, payroll records, and otller requirements imposed by the Department of I�Zdustrial Relations.If Colltractor does not have einployees,it lnust sign the Affidavit of No Employees, attached as Exhibit C. Contractor is respoYlsible for verifying einployment eligibility of einployees pursuant to the Immigration Reforin and Control Act of 1986. Contracfor must coinply wit11 conflict of ulterest laws and regulations applicable to this Agreeinent a�1d avoid conflicts of i�lterest. Contractor may be required to file a cor�flict of interest forin for engaging in governmental decisions or serving u1 a staff capacity, and is hereby advised to review the requirements of California Political Reforin Act atzd the California Code of Regulations. Services may only be performed by persons w110 are not einployed by City and who do not have a contzactual relationship with City other t11an this contract. Contractor agrees to abide by City policies and admulistrative rules prohibiting gifts to City officials and employees. Additional Requirernents for Services Provided to Minors: Contractor and its einployees who provide services under this Agreeinent inust comply with these additional requireinents: A. Undergo fulgerprintvlg and a critninal background check a�1d verify all employees providulg services wzder this contract have met tllis requirement. B. Colnplete a Tuberculosis screening test as required by law and as set fortll u1 Exhibit D. C. Coinply with the Matldatory Reporting under California Penal Code 11164-11174.3 alzd with the protocols, reportuzg, and trainuzg required utlder California Health aizd Safety Code Section 124235, AS2007, and other laws pertauzvzg to concussion evaluation, removal froin play, and retur�l to play protocols. (Refer to Center for Disease Coni�ol & Prevelltion, htt�s://www.cdc.gov/hea dsu�/index.11tml�. D. Submit required forms and acicnowledgments uzcluded u1 Exhibit D, and ensure its eac11 participant is provided wit11 a concussion ulformation sheet, signs aizd returns the forms to the City as required by Healtll and Safety Code Section 124235. Require coaclles and administrators to successfully complete the concussion and 11ead uljury education at least once either online or in person, before supervising a participant. Contractor s11a11 offer frainulg, educational inaterials, or both to each Contractor admu�istrator on a yearly basis. (Traululg resources are available at tl�e Center for Disease Control&Prevelltion(link cited above). E. If providuzg instruction, Contractor must acknowledge atld comply with all requirements set forth uz the Recreation&Cominunity Services Insfructor Manual. Checic one (if applicable): ❑ Tl1is contract requires services for children. Recreation Services Ag�^eement/Rev. 3-27-2018 Page 3 of 6 � This contract currently does not requue services for cllildren. If in the future, services for childrelz are required, the conhact will require a'written amendinent' to vzclude the appropriate uzsurance coverages as requued 'u1`Exhibit B-I�lsurance Requirements for Recreation Contracts', proof of fulger prultuzg and additional requireinents tulder Paragrap1113. The contract ainendinent will also require t11e approval of the Director of Recreation and CoiYununity Services and City Attorney. 14. Coordination of Services. The Parties designate the followulg persons as Services Coordulators wit11 t11e responsibility to oversee fl1e delivery of Services u1 accordance with fl1e terins of this Agreeinenf. Contractor's designation and atly substitution are subject to City approval. For City: For Contractor: Naine:Jason Bisely Naine:Midlele Westlaken Position: Recreatiolz Coord'uzator Position: Instructor Contact:jasonb@cut�ertino.org;408.777.3150 Contact: 15. Abandonment. City inay abandon or postpone the Activity or Program and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through t11e date of aba�zdoiunent upon subinission of fuzal uzvoices approved by City. 16. Terrnination. City inay terinulate tl-iis 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 subinission of fvzal uzvoices approved by City. 17. Governing Law,Venue and Dispute Resolution.T11is contract is governed by the laws of t11e State of California. Any legal actions or proceeduzgs filed againsf City u1 corulection with this contract must comply with the governinent claims filulg requireinents and inust be filed witll t11e Superior Court for fl1e County of Santa Clara, State of California. At City's request, Contractor is required to contulue to provide Services pending resolution of aily dispute. If tlle Parties elect arbitration, the arbitrator's award inust be supported by law and substantial evidence and include detailed written fuldulgs of law and fact. 18. Attorney Fees. If City is required to pursue litigation,arbitration or other admuzistrative or regulatory proceedulg to enforce its rights or fl1e terins of this Agreement, the prevailulg party will be entitled to reasonable attorney fees and costs. This Section survives t11is Agreeinent. 19. Third Party Beneficiaries.There are no third party beneficiaries wzder this Contract. 20. Waiver. Neither acceptance of Services nor payinent thereof constitutes a waiver of a�1y contract provision. City waiver of a breach shall not constitute waiver of anotller term, provision, covenant or condition, or a subsequent breach,whether of the saine or a different character. 21. Entire Agreement. This Agreelnent and all referenced Exhibits are hereby attached and incorporated into the Agreeinent by this reference aild represent the full and complete understanding as to fhose matters contauled herevl, and supersede any other contract or wzderstandulg, eitller oral or Rec��eation Se�^vices Agi^eement/Rev. 3-27-2018 Page 4 of 6 written,between t11e Parties.This Agreeinent inay not be rnodified or ainended except u1 writulg signed by both Parties.If tllere is any vzconsistency between the inaul conh act and any attaclunents or e�ibits thereto, the maul confract shall prevail. 22. Inserted Provisions.Eac11 provision or clause required by law or this contract is deeined to be ulcluded and will be inferred hereul. Either party inay request a�1 amendinent to cure any inistaken uzsertion or oinission of a required provision. 23. Headings. Tl1e 1leadulgs are for convenience only and are not a part of the contract or ultended to affect, liinit or atnplify tlle terms or provisions of tliis Agreeinent. 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, uzvalid, illegal or unelzforceable, suc11 term or provisioiz shall remaul u1 force a�1d effect to the extent allowed by suc11 ruling. All otller contract terins and provisions and their application to specific situations will remain i�z full force and effect. 25. Survival.All provisions whicll by their nature inust contuzue after t11e Agreement ends, including without limitation Tizdeiruzification, I�zsurance, Ownership of Materials,Records, Governulg Law a�zd Attoi�ney Fees,will survive the expiration or terinulation of this Agreeinent. 26. Notices.A11 notices and it�isfruments pertauzuzg to inaterial provisions of this contract or significant disputes w11icI1 are required by law or under this contract to be u1 writulg must be sent to t11e persons lisfed below. T11e notices will be deeined effective on the date of personal delivery or t11e date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit u1 t11e United States Mail, postage prepaid, registered or certified, or the next busuless day following electronic subinissioil. To City of Cupertuzo: To Contractor: Office of the City Ma�zager 1158 Hwztuzgdon Drive,San jose, CA 95129 10300 Torre Ave., Cupertino CA 95014 cc: Represerltative/Coordulator: cc: Representative/Coordinator: Michele Westlaken jason Bisely Email: Email: jasonb@cupertulo.org 27. Validity of Contract. T12is contract is valid and enforceable only if it coinplies with t11e provisions of Cupertuzo Mwlrcipal Code Chapters 3.22 and 3.23, is signed by the City Ma�zager or autl�orized 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 fllat Contractor 11as full right, power, and authority to execute t11is contract and to carry out all actions and services required. Tl1is contract constitutes a legally buzding obligation of Contractor, alzd may be executed in cowlterparts, each one of which is deemed an origulal and all of which, taken together, constitute a single bulding instruinent. Recreation Se�^vices Agreement/Rev. 3-27-2018 Page 5 of 6 IN WITNESS WHEREOF,the parties have caused this confi�act to be executed. CONTRACTOR CITY OF CUPERTINO Michele Westlaken A Municipal Corporation B �'_— By ..,,� Naine Ch�,R Q �' Naine��JC/J���1Co �i�/ Title ����ct,lS �?�i�� Title ���-I /��'C-C:�Z1r' Date �l L�.a., (2-��� Date `d' �c���t� Tax I.D. No.: Re{er to W-9 . ��I� �- APPROVED AS TO FO�� � � � �f� ��' ATTEST: � ��- �J � �`�, �/ �1 . _�� ,�ND�H---�T�-�P�SC-�-��0� GRACE SCHMIDT ,.� �--;�� pertuzo City Attorney � City Clerk / � Cont��actlEncumbered A�nount:$12,000 Account No.: 100-G2-623 700-702 RecT^eation Services Agreen�ent/Rev. 3-27-2 DI S Page 6 of 6 EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide FELDENKRAIS INSTRUCTION in,but not lirnited to,the following: FELDENKRAIS METHOD Location and Tirne of CONTRACTOR Services: Refer to the Senior Center Newsletters dated jULY/AUGUST 2018,SEPTEMSER/OCTOBER 2018, NOVEMBER/DECEMSER 2018,JANUARY/FEBRUARY 2019, MARCH/APRIL 2019, MAY/JUNE 2019,JULY/AUGUST 2019, SEPTEMBER/OCTOBER 2019, NOVEMSER/DECEMSER 2019, JANUARY/FEBRUARY 2020, MARCH/APRIL 2020, MAY/JUNE 2020,JULY/AUGUST 2020, SEPTEMBER/OCTOSER 2020, NOVEMBER/DECEMBER 2020,JANUARY/FEBRUARY 2021, MARCH/APRIL 2021,AND MAY/JUNE 2021 for agreed upon dates, tiines, and class locations. The City, at its sole discretion,inay cllange t11e agreed terins. Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. Compensation shall consist of t11e followitlg: EIGHTY-SEVEN AND A HALF PERCENT(87.5%) OF REVENUE GENERATED PER SESSION PLUS SIXTY PERCENT(60%) OF THE REVENUE FOR DROP IN PASSES.A TWENTY-FIVE($25)DOLLAR ADMINISTRATION FEE WILL BE DEDUCTED FROM THE FIRST PAYMENT. CONSULTANT SHALL PROVIDE ALL TEACHING SUPPLIES SUCH AS,BUT NOT LIMITED TO, DRY ERASE MARI<ERS,ERASERS,AND HANDOUTS.COPY SERVICE AT THE SENIOR CENTER IS$0.10 PER PAGE. T11e total coinpensation to the Contractor s11a11 not exceed$12,000. Eligible Participant Minirnum and Maximurns for CONTRACTOR Services: Mulunuin: 3 Maxiinum: 15 If less tha�z the required mulimum number of participailts eruoll u1 and pay for a particular class as identified in the schedule before the class is scheduled to start, the City inay cancel the particular class and/oi terrninate this Agreement without additional notice or paylnent to Contractor. List of all Contractor Employees worlcing for the City of Cupertino (if no Employees,identify "self"): SELF Performance of CONTRACTOR Services: I�Z fl1e case Contractor wzilaterally cancels performance of a class, cainp, activity or service without City approval, City reserves the right to iinmediately alzd without notice cancel the reinauzder of programs/services offered and or performed by Contractor. The Contractor shall follow all guidelules pertaulvlg to registration procedures as listed u1 t11e quarterly recreation schedule. Participants lnay not take part in the prograin unless they are listed on t11e class roster or can s11ow proof of enrollment. All participants and volwzteers need to complete the City's Waiver of Liability forin prior to takulg part u1 t11e program. If applicable, contractors who are responsible for supervisulg ininors inust rema'v1 with the class until a parent of legal guardian 11as arrived and all inuzors are released to them. In the event of an uzjury occurrulg to a participant, t11e Contractor will notify t11e City wi�lluz 1 hour and coinplete an Incident Report in t11e form approved by the City. T11e I�lcident Report must be subinitted to fhe City with"vz 24 hours of the uzjury occurring. ` Exhibit B i Insut�a»ce Requi��et�aents fot�Rec�eation Co�atf°acts As required by Section 12 of the Agreement, Contractor shall prociue and maintain the following insurance for the duration of the contract against claims arising from or in coiu7ection with Contractor, its agents, representatives, employees or subcontractors Sei-vices under this Agreement. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: l. Commercial General Liability (CGL): Insurance Services Office Form CG 00 O1 covering CGL on an "occunence" basis, including property damage, Uodily injury and personal & advertising injury with liinits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to tivs project/location(CG 25 03 or 25 04) or be twice the required occui�ence 1u11it. 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 linuts no less than$1,000,000 per accident for bodily injury and property damage. ❑ Requi�ed if automobile is used to perfo�^T�2 woriz ui�de�this cont�act. ;°� Otlze�wise, �roof of Contractor's pev�sonal auto insura��ce with limits requi�ed by stczte law suffices. Cont�acto�^shall not trans�ov�t oN use its personal vehicle to tra�zsport pa�^ticipa��ts o�^ �e�foNm wo�Iz 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 injuiy or disease. ❑ Requi�ed if Cont�actor has einployees. � If no e�n�loyees, Contractor rsaust sign Affidavit of No Einployees. 4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/sei-vices involving minors, (i.e., after school activities, recreational programs, atl�letics, study/training events and transportation of minors). Coverage inay 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. ❑ Requi�ed if Conti�act involves services to childr�en. Insurance coverage required inay ve satisfied by a combination of Priinary and Excess/LTmbrella insurance. Self-b2su��ed Rete�itio�is: Self-insured retentions must be approved by City. City may require Contractor to provide proof of aUility to pay losses and related investigations, claim adiniiustration, and defense expenses within the retention. The policy language must provide, or be endorsed to provide, that the self- insured retention may Ue satisfied by either the named insured or City. Acceptability of Insur^ers:Insurance must be issued by insurers acceptaUle 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 ratiilg 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 InsuYal2ce for Recreation Contracts Updated 3-26-18 1 operations perfonned by or on Uehalf of the Contractor including materials, parts or equipment fui7lished in comlection with such work or operations. 2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 Ol 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 tei7ns of any policy which arise from worlc perfonned by Contractor for City. Tlus 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. Pr�inaary Cove�^age: The Additional Insured coverage under Contractor's policy shall Ue primary non- contributory and at least as broad as ISO CG 20 O1 04 13 as respects the City and all the insureds/indenuutees. If the limits of insurance required are satisfied in part by Umbrella/Excess Insurance, the UmUrellaBxcess 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 Caricellatio�z: 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 premiuins. Such notice must be sent to City via email or cei-tified inail to the attention of the City Manager. Waive��of Sub��ogatio�z: Contractor grants City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City Uy virtue of payinent of any loss under such insurance. Contractor will obtain any endorsement that may Ue necessary to effect tlus waiver of suUrogation, Uut this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Yerification of Cove�^age:Contractor shall furnish the City with origulal certificates and amendatory endorseinents effecting coverage required by this clause. All certificates and endorseinents are to be received and approved Uy the City Uefore work conunences. 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 �ld endorsement page verifying the required ulsurance coverages. Ho»Zeowner's bZsu�^a�2ce: Contractor's homeowner's liability insurance may provide coverage sufficient to meet these requirements. Contractar should provide these requirements to lus or her agent to confirm and provide veri�ication to City. � Special Eve�zts Coverage:Insurers inay 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 Circunzstce�zces:City reserves the right to modify these requirements based on the nature of the rislc,prior experience, insurer, coverage, or other special circumstances. Exlz.B Insurance for Recreation Co�at�acts Updated 3-26-18 2 EXHIBIT C AFFIDAVIT OF NO EMPLOYEES State of California County of Santa Cla��a . City of Cupertino I, the undersigned, declare as follows: I am an independent contractor and t11e owner of_ �IG►�i�,W�s'���(�v�— I wish to enter into a services contract with the City of Cupertino. I ain 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 piovisions of that Code. I am also awaie that I inust provide proof of workeis' compensation insurance to the Cify of Cupertino for any and all employees I may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify t11at I do not have any employees nor will I have any employees worl<ing for me or iny business duiing the term of any service contract with the City of Cupertino. I am not required to have Worl<ers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this 4Lday of J�w-- , 2018, at U �✓��� California. �U� W�'�`f 1 G�+�.e-- PRINT NAME (�e6�/� SIGNAT RE '�h� �+��den�rai� t�ui�d of 1'�or�i� .�meri�� Ger�ificate c�f Insuran�e 1t��mb�r���: 13�9�34 Mc�b�r Cl�sssi�c�t�crn: �`ederatic�n Nlichel� W�stla�en �nrolled Mennber Effe�tive Ilate; � �an 7i�s�;,�A 9�12:�-�12� 0��`tllJ2tl18 i �(7 ��«.������ Caver��e�fc�r es�rnllec��nei7zt7er's busi�ess i�li�nitc�d to claz:m.��risixi�frt�n�enrnlled ane����r's prafess�ua�a2 s�r��acc:s. �t�si����n���e; _ _ __ _ ___ _ �.drr�iraister�d 8��, �nsuran+�e Cornpa��: :�3e�t�caare �rc�vzd.er����vi�� t�r�at�i�.t��an +Cc�tumbi���sua.It�X+�Csmpany r�`i�ity��s�rance a��vvic�s,�c. A C�,7���,mpa.n� l T{�t� '�ir�i�zia�ri��, ��aiit� x 2�t7��rt't�'ashir�gtor� . � , , ,. �::T� e:�F Tnsr�i�a�t� , ; h�ast�r�'oli��°Numl�er ". ... �L�m�ts( er enr�olted.iu�mbei�:; :� ProF�ssic���I JLi�tali3t� t3�89�35�5��r �2,Qt�CI;U(3�e�ch ci�im!$(i,t)�Jt},(��0 aggkegate (�CCurreqCG�v�et'ic e �u�j�cf to th�Mnster Pc�licy'�,��'e�at� ���j�ge��aff�rdect tt�r�u�l�t��AMTA S�+�a�ter�'��cy to the L�srolled:l�ez��b�r�f'�'��Federation a�The�ap�ut�c��ssa�e, Bc��-���ri�.���znatic P�ct�c�C}r�;�iz.�ti��ad��ati�ed�t the i:o�c�f tl��s�e���ate c�f in�r,�z�zi�e fnr a period�F�2 z�nnf��s canc�ent X�ith tta�E�rroll��'Ie���er�f��c�av�D�te r�ar�t��t��tnberslu�is tern�i�t�d nr�xpires. �th�A:I�IT�.Ivlaster Potic� is r�c�n-re�ear��d�rr c�cel��,the Enrcriled.�vle�rat�er's�rr��rag�u�}d�r�his pnl�����ill ter�nin��e upt�n the e�pir�ti�n of t�ie �nrc�lt�d lv�ezrzhe;r�.f�ecti��c I3��t.�:;�r�ct�a�il no�la�rerie���d.`I'lxe S�i�sier P�lic�A�gse�a�e�:nayr be reduc�d by�cl�irns pazd an be�Zalf'�rr�atl�er insureds. Aciditivnal��s�crst�;cs�included�n I�c�fe�icaual Li�biTity S:�iz��zt�sp�c'�f'i�d abave}: * t�neral Li��i�i� � �'roducts�.,i��itit� * :�t I,i�u+qr Liabilit?,r � �'erso�al I���rv�ia�rilitiv • �d�at�tarita:n Liabilaty • Malp�atcenc�ettt�iab'rlit� • �'Ir��'r V�'�.ter Le�a1�fa�i�it�(��bject���IC�€�,�t?(�s�t�li:�.it.) �arrcrt��c Estetisic�ns Ct��°�r��e�cten�ion Lim�t�a Li�z��1'�ot��t�c��z _ _ _ �I Q;�tt}�7 p�r�r�cc.�.�in�1�2�,�t3�S�����t�, T�efend�nt�;�pense Benefit �T{},{��ag�xegate Dcpc�sitic�c�R�pz��s�nt��tiart $2,S�t�per cie�sitia�x l�S,t�tIQ�b�regate � /'L3il��4��r�nVr���Et���.rl�LtJ� a��L1Z�� �,/yA�.cJtA41.�V4.1i.}u,��w✓�.17V�./ti�j�'�SUk��+ 2���c�ic�I P��n�ents `fi'�,{�{)t}per person J$1 t�,�{�t�a�,�rc�;at� �irst Aict ��,����ggre�;�t� Daz���e la Praperty c��'{:�Thers ��U,(�������:gate This c�rver��,e is�tend�i tc,you t]imu�h the�iC�'T`A lvt�st��'alicc�,'I"�is znat�.�ria�i�intu�rid�d Ec��rrc��°ici�.�;�ner�l overrriew c�f ihe pradu�ts aur3 sz.�rnic�:s�ff���d.Cav�r.age for�nrollecl�nember s t�usin��:�is.timit�ci tcs claint:;ari�ir�g�i•orr��rarol.led rneniEser's�rc�fes.�ian�l sen�ic�s. C1n1y th��licy cun�rc�vicie tl�e a�rtu�l tersns;c�x��r���'s;�tx�crru�ts,ccsnciitzans a�d e:�clusi�tts.Pie��ccantnct�II'SQ R�t l«-�fG�162-1227 din:ctiv fsr a fre�crr z�oI`th��am Icte xsl�Gv. ����� fl�fl nSlv147A4 �C.^ntthc�art['rcmviden 5esviee 4r�anisatian` Feldenkrais Guild of North America ADDITIONAL INSURED COVERAGE VERIFICATION Insured: Enrolled Member Effective Date: American Massage Therapy Association 500 Davis Street 01/01/2018 Evanston, IL 60201 To Master Policy Number: HPG 0289955556 01/01/2019 Enrolled Member Name and Address: Administered Bv: Michele Westlaken Healthcare Providers Service Organization Affinity Insurance Services, Inc. 159 East County Line Road San Jose, CA 95129-3123 Hatboro, PA 19040 Insurance Companv: Columbia Casualty Company A CNA Compan Additional Insured: Limits City of Cupertino, its Council, Boards, and Commissions, Each Claim: $2,000,000 Aggregate: $6,000,000 officers, employees, &Volunteers Fire&Water Legal Liability sublimit:$100,000 10300 Torre Ave., Subject to the Master Policy Aggregate Cupertino,CA 95014 X Professional Liabilitv Coveraqe Extension for Additional Insureds The coverage set forth in Section I, Coverage Agreement is extended to any additional insured but only as respects such additional insured's liability arising out of a medical incident by the enrolled member, and solely to the extent that: 1. a professional liability claim is made against the enrolled member and the additional insured;and 2. in any ensuing litigation arising out of such claim, the enrolled member and the additional insured remain as co- defendants. In no event is there any coverage provided under this policy for acts, errors or omissions of the additional insured. Additional Insured means any person or entity that an enrolled member is required to add as an additional insured by written contract or agreement for professional services.The written contract or agreement must be: 1. Currently in effect or become effective during the term of the enrolled member's certificate period; and 2. Executed prior to the injury or damage. X General Liabilitv Coveraqe Extension for Additional Insureds The coverage set forth in Section I, Coverage Agreement is extended to any additional insured but only as respects such additional insured's liability arising out of premises they own, maintain or control while the enrolled member leases or occupies these premises, and solely to the extent that: 1. a general liability claim is made against the enrolled member and the additional insured; and 2. in any ensuing litigation arising out of such claim,the enrolled member and the additional insured remain as co- defendants. In no event is there any coverage provided under this policy for an occurrence that is the direct liability of the additional insured. The written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy; or 2. Executed prior to the injury or damage. Additional Insured means any person or entity that an enrolled member is required to add as an additional insured by written contract or agreement. 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