18-001 Rupa Narayanan CITY OF
No.
FY2018-21
CUPERTINO
RECREATION SERVICES AGREEMENT
1. Parties. This contract is made and entered into as of 8/1/2018 ("Effective Date"),by and
between the City of Cupertino, a mulzicipal corporation ("City"), and with RUPA NARAYANAN,
CAMPBELL, CA 95008 ("Contractor"), a SOLE PROPRIETOR for YOGA
INSTRUCTION.
2. Services. Contractor agrees to provide the Services included in the Scope of Work a11d
uz accordance wit11 the Sclledule of Performance attached in Exhibit A.
3. Term. This contract beguzs on the Effective Date and ends on 6/30/2021 ("Contract
Tirne"),unless extended or terminated as provided herein. Tune is of the essence atld 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
amoluzt that will based upon actual costs but that will be capped so as not to exceed$5,000 SETWEEN
7/1/18 AND 6/30/19,$5,000 BETWEEN 7/1/19 AND 6/30/20,AND$5,000 BETWEEN 7/1/20 AND 6/30/21
("Contract Price"),based upon the Scope of Services,budget,performance schedule,and rates included
u1 Exhibit A. The inaximum compensation ulcludes all costs, expenses and reimburseinents and will
remain in place even if Contractor's actual costs exceed the capped amount. Contractor must subinit
invoices a�1d the ulformation required in Exhibit A in order to receive payment. City will cornpensate
Contractor within 30 days after approval of written ulvoices.
Invoices are subject to review and audit by City durulg regular business hours upon 24-hours'
notice. Contractor must maintain complete and accurate records of payrolls, expealditures,
disbursements and other cost iteins charged to City or establislling the basis for an invoice, for a
minimum of four(4) years froin the date of final payment.
5. Independent Contractor.Contractor is an uzdependent Contractor and not an employee,
partner, or jouzt venture of City. Colltractor is solely responsible for tlle means and inethods of
perforinuzg t11e 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 performatice of the Services.
Contractor is not entitled to City's health benefits, worker's compensation or aizy otller benefit.
Contractor must 11ave the sl<ills and qualificatioils to perforin t11e Services in a competent and
professional manner. Contractor will supply all tools, rnaterials and equipment required to perform
tlle Services under this Contract. Contractor is responsible for obtaining permits and licenses required
by law and must obtauz a City busuless license.
RecNecztion Services Ag�^eement/Rev. 3-27-2018
Page 1 of 6
6. Proprietary/Confidential Information. To the extent Contractor may 11ave access to
private or confidential ulforination owned ar confirolled by t11e City, Contractor agrees to treat it
confidential and use it solely to perform t11is Agreeinent. Cont��actor inust exercise tlze same standard
af care to protect City ulformation as a reasonably prudent Contractor would use to protect its own
proprietary data.
7. Ownership of Materials. To the extent Contractor prepares written material, drawmgs
or data in connection with this contract, City will have the property rights to those inaterials and all
copyrights, if any, to such work praduct will constitute City property.
8. Records. Contractor must maultain complete, accurate, aild detailed accounting records
relating to its performance in accordance with generally accepted accounting principles and
procedures. The records rnust i�lclude detailed ulformation about Contractor's services, benchmarks,
deliverables and costs/fees,and must be made reasonably available to City.The records and supporting
docuinents must be kept separate from other files and maintained for four years from the date of City's
final payment.
9. Assignment. This Contract is not assignable. Contractor may not substitute anoth.er or
transfer any rigllts or obligation.s 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 Contr.act Time and for one year thereafter musfi reference City contribufiions.
The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press
releases, posters, brochures, public service announcements, interviews alzd newspaper articles. No
signs rnay be posted, exhibited or displayed on or about City property,except signage required by law
or under this Agreenlent witlzout 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 inisconduct of City personnel, Contractor agrees fio indemnify, defend,
and hold harinless 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 againsfi 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 perfarmance of this contract or the Services.
This includes but is not limited to Liability resulting in personal injury, death, property darnage, or
economic losses. Contractor must pay any costs City may ulcur in enfarcitlg this provision and must
accept a tender of defense upon receiving notice from City. Contractor's pay�ents may be deducted or
offset to cover any inaney tlze City lost due to a claiin or counterclaim arising oufi of this Contract.
12. Insurance. Contractor shall comply witll the insurance requirements in Exhibit B. City
will not execute the Agreement until it has received and approved satisfacfiory certificates of insur�ince
and endorsernents evidencing the type, amount, and dates of coverage. Alternatively, City in its sole
discretion may purcllase insurance arld 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.
Requirernents for all Contracts. This contracfi is subject to local, state and federal laws and
regulations prollibiting discriinulatic.xl,including Title VII of the Civil Rigllts Act of 1964,the California
Fair Ernployment Practices Act,the Ainericans wit11 Disabilities Act of 1990,and other laws that pertain
to fair einployinent �zd anti-discrimination practices. Contractor rnust comply with labor laws
pertaining to prevailing wages, working hours, overtirne, payroll recorc�s, and other requirements
imposed by the Department of Industrial Relations.If Contractor does not have einployees,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 musfi coinply with colzflict of in.terest laws and regulations applicabl.e fo this Agreement and
avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in
goverrunental decisialls or serving in a staff capacity, and is hereby advised to review the requirements
of California Political Reform Act ai-�d the California Code of Regulations. Services may onl.y be
performed by pexsons 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 coinply with these additional requirements:
A. Undergo fingerprinting and a criminal background check and verify all employees
providing services under this contract have met this requirement.
B. Coinplete a Tuberculosis screenulg test as required by law and as set fortll in Exhibit D.
C. Coinply with the Mandatory Reporting under Ca.lifornnia Penal Code 11164-11174.3 and with
the protocols, reporting, and training required tulder Californil Heal�h and Safety Code
Section 124235, AB2007, and other laws pertaining to concussion evaluatioll, removal from
play, and return to play protocols. (Refer to Center for Disease Control & Preventi.on,
l.ztl: s: www.cdc. ov l��ac�su index.l.-�tml .
D. Subrnit required forms and acl<nowledgments included in Exhibit D, �u1d ensure its each
participant is provided with a concussion inforrnation sheefi, signs and returns the forins to
the City as required by Health and Safety Code Section 124235.
Require coaches and administrators to successfully complete the concussion and head injury
educatio�z at least once eitller online or in person, before supervising a participant.
Coxltractor shall offer training, educ�tional materials, or both to each Contractor
adini�iiskratar on a yearly basis. (Training resources are available at the Center for Disease
Control&Prevention(link cited above).
E. If providing instruction, Contractor must aclalowledge and comply with all requirements
set fortll in the Recreation&Cornmunity Services Instructor Manual.
Check ane (if applicable):
❑ This contract requires services for children,
Recreatdon 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 cllildren are required, the contract will require a`written amendment' to include the
appropriate u�surance coverages as required in`Exhibit B—Insurance Requirements for
Recreation Contracts', proof of finger printing and additional requi.rements under
Paragraph 13. The contract amendment wi11 also require t11e approval of the Director of
Recreation�r1d Community Services and City Attorney.
14, Coordination of Services. The Parties designate the following persons as Services
Caordinators with t11e responsibility to oversee the delivery of Services in accordance with the terins of
this Agreement. Contractor's designation and any substitution are subject to City approval.
For City; For Contractor:
Name:Jason Bisely Name: Rupa Narayanan
Position: Recreation Coordinator Position: Instructor
Contact;�a�;c�n.���?�cuperti:�lo.ai� 408.777.3150 Contact:
15. Abandonment. City may abandon or postpone the Activity or Pragram and will notify
Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the
date of abandonmenfi upon submission of final invoices approved by City.
16. Ternnination. City may terminate this coiltract for cause or withaut cause at any time
and will notify Contractor as soon as possible.Contractor will be plid for satisfactory services rendered
througll the date of termination upon submission of final invoices approved by City.
17, Governing�,aw,Venue and Dispute Resolution.This contract is governed by the Iaws
of t11e State of California. Any legal actions or proceedings filed against City in connection wit11 i11is
contract must coinply with fl1e government claims filing requirexnents 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 inust be supported by 11w and substantial evidence and include
detailed written findulgs of law and fact.
18. AtEorney Fees. If City is required to pursue litigation,arbi.firation or other administrative
or regulatory proceeding to enforce its rights or the terms of this Agreement, t�ze prevailuzg party will
be entitl.ed to reasonabl.e attorney fees and cosfis. This Section survives this Agreement.
19. Third Party Beneficiaries. There are no third party beneficiaries under this Contract.
20. Waiver. Neither acceptance of Services n�r payment thereof constitutes a waiver of any
coi�tract provision. City waiver of a breach shall n.ot coi�stitute waiver of another term, provision,
covenant or condition, or a subsequent breach,whether of the same or a different character.
21. Entire Agreernent. T11is Agreernent and all referenced Exhibits are hereby attached and
incorporated into the Agreement by this ref.erence and represent the full and complete understanding
as to those matters contained herein, and supersede any other contract or understanding, either oral or
Recreation Servdces Agreement/Rev. 3-27-2018
Page 4 of 6
written,between the Parties.This Agreement inay not be modified or amended except in writing signed
by both Paxties, If tllere is any inconsistency between the main contract and any attachments or exhibits
thereto, the inain cantracfi s11all prevail.
22. Inserted Provisions.Each provision or clause required by law or t11is contract is deemed
to be ulcluded and will Ue inferred 1lerein. Either party may request an ainendment to cure any
inistaken insertion or omission of a required provision.
23. Headings. The headings are for convenience only and are not a part of the contract or
intended to affect, liinit or amplify the terrns or provisions of this Agresment.
24. Severability/Partial Invalidity. If any contract term or provision, or their application to
a particular situation, is found by t1le.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 u1 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 t11e expiration or termination of this Agree.ment.
26. Notices.All notices and instruments pertaining to material provisions of this contract or
significant disputes w11ic11 are required by law or under this confract to be in writing must be sent to
the per.sons Iisted below. The notices will be deemed effective on the date of personal delivery or the
date confirined by a reputable overnight delivery service, on the fiftl� calendar day after deposit in t11e
United States Mail, postage prepaid, registered or certified, or tYte next business day followulg
electrorzic submission.
To City of Cupertino: To Contractor:
Office of t�1e City Manager 408 DARRYL DR. CAMPBELL, CA 95008
10300 Torre Ave., Cupertino CA 95014 cc: Representative/Coordinator:
cc: Representative/Coordinafior: Rupa Narayanan
Jason Bisely Email:
Email: jasonbC�cupertino.org
27. Validity of Contract. This contracfi is valid and enforceable only if it complies with the
provisions of Cupertino Municipal Code Chapters 3.22 1nd 3.23, is signed by tlle City Manager or
authorized designee, and is approved for forrn by the City Attorney's Office.
28. Execution. The person executing this contract on behalf of Contractor represents and
warrants that Contractor h1s full right, power, a�1d authority to execute this contract and to carry out
al.l 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 sulgle buzding instrument.
Recreation SeNvdces Agree�nent/Rev. 3-27-2018
Page 5 of 6
IN WITNESS WHEREOF, the parties have c�used this confrlct to be executed.
CONTRACTOR CITY OF CUPERTINO
Rupa arayanan A Municipal Corporation
By By � z�'--�-�-..��
Name�V l�I�r I�1�Rlk`-1 PsN Pci`I. Name��l�'J�'�'I✓)e� �"c'��-/
Title �{0 Cx A 11�SZ RV C�o f't Title i'�'�,�'� s/ !�' ���.a-'
�
Date ��'h �u�tt= 20 t Q Date ��/�
Tax I.D. No.: Refer to W-9
APPROVED AS TO FORM: � ATTEST:
�-� � � �� ���/�
` ��
�l� �,,�, �'/�--/i� �
RA DOLPH STEVENSON HOM GRACE SCHMIDT � , �"'�l�'
Cu ertino City Attorney City Clerk
ContractlEncumbered Amount: $15,000
Account No.: 100-62-623 700-702
Recreation Servaces Agreement/Reu 3-27-2018
Page 6 of 6
EXHIBIT A
SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide YOGA INSTRUCTION in,but not limited to,the following:
YOGA FOUNDATIONS
Location and Tirne of CONTRACTOR Services:
Refer to t11e Senior Center Newsletters dated JULY/AUGUST 2018, SEPTEMSER/OCTOBER 2018,
NOVEMBER/DECEMBER 2018,JANUARY/FEBRUARY 2019, MARCH/APRIL 2019,MAY/JUNE
2019,JULY/AUGUST 2019, SEPTEMBER/OCTOBER 2019, NOVEMBER/DECEMBER 2019,
JANUARY/FESRUARY 2020, MARCH/APRIL 2020, MAY/JUNE 2020,JCTLY/AUGUST 2020,
SEPTEMBER/OCTOBER 2020, NOVEMBER/DECEMBER 2020,JANUARY/FEBRUARY 2021,
MARCH/APRIL 2021,AND MAY/JUNE 2021 for agreed upon dates,times, and class locations. The
City, at its sole discretion,inay change the agreed terms.
Cornpensation for CONTRACTOR Services:
Contractor s11a11 be compensated for services perforined pursuant to this Agreeinent. Coinpensation
s11all consist of the following: EIGHT'Y PERCENT(80%) OF REVENUE GENERATED PER SESSION
BASED ON FINAL CLASS ROSTER. 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 EIZASE MARKERS, ERASERS,AND
HANDOUTS. CONSULTANT PAYS FOR COPY SERVICE AT THE SENIOR CENTER AT$0.10 PER
PAGE.The total compensation to the Contractor shall not exceed$15,000.
Eligible Participant Minimurn and Maxirnums for CONTRACTOR Services:
Muliinuin: 5
Maxiinum: 20
If less than fl1e required ininimuin nuinber of participants enroll u1 and pay for a particular class as
identified u1 the schedule before t11e class is scheduled to start, the City may cancel t11e particular class
and/or terminate this Agreement without additional notice or payment fo Contractor.
List of all Contractor Ernployees working for the City of Cupertino (if no Ernployees,identify
"self"):
SELF
Performance of CONTRACTOR Services:
In t11e case Conh actor unilaterally ca�lcels performance of a c11ss, carnp, activity or service without
City approval., City reserves the right to iinmediately 1nd without noti.ce cancel the remaulder of
progr.ams/services o£fered and or perforrned by Contractor.
The Contractor shall follow all guidelines pertaining to registration procedures as Iisted in the
quarterly recreation schedule. Participants inay not take part in the program unless they are listed on
the class roster or can show praof of enrollment. AIl participants and volunteers need to coinplete the
City's Waiver of Li.ability form prior to tal<ing part u1 the program. If applicable, contractors who are
responsible for supervising minors must rem�in with the class until a parent of legal gu.ardian 11as
arrived and all lninors are released to thein.
In the event of an injury occurring to a participant, the Contractor will notify t11e City within 1 hour
and complete an Incident Report in the form approved by t11e City. The Incident Report�rnust be
submitted to the City within 2411aurs of the injury occurring.
Exhibit B
Insu��ccnce Requit•einents fo� Rec�etction Contracts
As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurauce
for the dLiration of the conti�act agavist claims arising fi•om or in connection witli Cont�•actor, its agents,
representatives, employees or subcontractors Selvices under this Agreeinent.
Minimum Seope and Limit of Insurance. Coverage s11a11 be at least as broad as:
1. Commercial General Liability (CGL): Insurazice Services Office Foi�m CG 00 O1 covering CGL on an
"occurrence" basis, including property damage, bodily injury and personal & advertising injuiy 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 tlze rec�uired occui�rence limit.
2. Automobile Liability: ISO CA 0001 covering Cocle 1 (any auto), or if Contractor l�as no owned autos,
Code 8 (hi�ed) asld 9 (non-owned), with limits no less t11�1 $1,000,000 per accident for bodily injury a71d �
property damage.
❑ Required if c�uto»�obile is used to perforrn��o�^k under this contracl.
� Othel^wise, p�^oof of ContractoN's pe�^sonal auto insurance with limits required by state lcrn�
suf�ces, Contrc�ctor shall not transport or use zts personal vehzcle to tNansport pa�ticipants o�^
peNfo�nz woNk under this contract.
3. Workers' Compensation: As required by the State of California, with Statutory and Employer's
Liability Insurance limits of no less thau$1,000,000 per accident for bodily injury ot•disease.
❑ Required if Co��t�actor has enzployees.
� If no enzployees, ContNactor must sign Affidavit of No Enaployees.
� Sexual Abuse/Molestation: Insurance or tl�e equ.ivalent as required for activities/services involving
minors, (i.e., after school activities, recreational programs, athletics, study/training events and
transportation of minors). Coverage may be included under General Liability or be obtained in a separate
policy, such as Edueators Lega1 Liability (ELL) poli�y,�with a ]vnit of no less than $1,000,000 per
occtiu•rence. If a general aggregate limit applies, it must apply separately to this contract or be twice the
required occurrence limit. ^
❑ Reqzrired if Contract involves se�vices to childre�.
Insurance cover�ge required may be s2tisfied by a combination of Primary and Excess/Umbrella insui�ance.
Self-Insurecl Retentions: Self-insured retentions must be approved by City. City may require Contractor to
provide proof of ability to pay losses and related investigations, claim administ�•ation, and defense
expenses within the rete�ltion. The policy language �71ust pi�ovide, or be endorsed to provide, that the self-
instiu�ed rete�rtion ivay be s�.tisfiecl by either the nan�ed insiu•ed ol•City.
Acceptcrbility oflnsurers: Instu•ance must be issued by insurers acceptable to City and licei�sed to do b�tsiness
in the Sta.te of C1lifornia,with an A.M. Best's financial strength rating of"A" or better and a�nancial size
ratiug of"VII"or better.
OTH�R INSUIZANCE PROVISIONS: The CGL policy must contain, or be endo�•sed to contain, the
following provisions:
1. The City, its City Council, boards and commissions, officers, officials, employees, agents, seivants
and volunteers are to be covered as additiona] insureds with respect to liability arising out of worl<oi�
Exh. I3 Insurance for Recreatton Contracts Updated 3-26-18
1
operations performed by or on behalf of the Conh•actor incltiiding matei�ials, parts or equipment
fiunished in conuection«�ith such wor]<or operations.
2. Contractor's insurance shall be primary insurance coverage at ]east as broad as ISO CG 20 O1 04
13 as respects the City, its officers, of�cials, employees, agents, and volunteers,
3. The Insurance Company agrees to waive all rights of subrogation against the City, its elacted or
appointed of�cers, officials, agents, and empl�yees for losses paid under the terms of any policy
whicl� arise from woil<performed by Contractor foi City. This provisiozl also applies to the
Contractor's Workei•s' Compensation policy. �
4. Each insurance policy required by this contract shall provide that coverage shall not be canceled,
except with notice to tl�e City.
Pri�iary Coverage: The Additianal Insured coverage undei• Contractor's policy shall be primary non-
contributory and at least as broad as ISO CG 20 O1 04 13 as respects the City and all the
insureds/indelnnitees, If the limits of insuranca rec�uired are satisfed in part Uy Umbrella/Excess Insurance,
t11e Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall
also apply on a "primary and non-contributary" basis for the benefit of the Additional Insureds before City's
own insurance is triggered.
Notice of Cancellation: Each insurance policy shall provide that coverage shall not be canceled or allowed to
expire without written notice to City 30 days in advance or 10 days in advance if due to non-payment of
premiuuls. Sl�ch notice must be sent to City via email or cei�tified mail to the attei�tion of the City Manager.
Wcriver of Suhrogation: Contractor grants City a waiver of any right to subrogation wliicl� any insurer of said
Contractor may acc�uire against City by virtue of payment of any loss under such insurance. Contractor will
obta.in any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies
regardless of whether or not the City l�as raceived a waiver of subrogation endorsement from the insurer.
Verr�cation of Coverage: Contractor shall fiirnish tl�e City with original certificates a�1d amendatory
endorseinents effecting coverage i•equired by this clause. All certi�cates and endorsements are to be received
and ap�roved by t11e City before work commences.The City reserves tl�e right to rec�uire complete, certified
copies of all required insurance policies, including endorsements affecting the coverage required by these
specifications, at any time. At a.miniuituz� Contractor must p�rovide acceptable copies of the policy
declarations and endorsement page verifying the required insurance coverages.
Homeowner's Insurcznce: Contractor's homeowner's liability insurance may provide coverage sufficient to
meet these requirenlents. Contractor should provide these requirements to his or her agent to confirm and
provide verification to City.
Special Events Coverage: Insurers may provide special events coverage for a reduced fee, or City may be
able to offer this coverage. Contractor should contact tlie City Mauager's Of�ce for information or assistance.
Special Risks or Circumstances: City reserves the right to modify tllese requirements based on the nature of
the risl<, prior experience, insurer, coverage, or other special circumstances.
Exh. B Inst�ranc,e.for Recreation Co�tracts Updated 3-26-18
2
EXHII3IT C
AFFIDAVIT OF NO EMPLOYE�S
State of California
Count� of Santa Clara
City of Cupe��tino
I, the undersigned, declare as follows:
I am an independent contractor and the awner of ►`�U P A ��A�C`�P�N�N
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 Worl<ers' Compensation coverage for employees in accordance with the provisions
of that Code. I am also aware that I musfi provide proof of workers' compensation insurance
to the City of Cupertino for any and all ernployees I may have, pursuant to Section 12 of the
City of Cupertrno's contract.
I hereby certify that I do not have any employees nor will I have any employees worl<ing for
me or my business during 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 th�t the foregoing
is true and correct.
Executed on this�day of Jc7 f�(�, , 2018, at C U P�t2T1 N O , California.
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDOlaSEMENT
Tlus endorsement inodi�es insurance provided under the following:
COMMERCIAL GENERAL LIABILITY POLICY OCCURRENCE
HEALTH,WELLNESS&BEAUTY PROVIDERS PROFESSIONAL LIABILITY INSURANCE POLICY
In consideration of the premium charged, it is agreed that the defined term `7nsured" is hereby amended to include the following
person(s)and/or entity(ies):
1. The City of Cupertino, its City Council, boards and commissions, officers, officials, employees,
agents,servants and volunteers
ALL OTHER TERMS,CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED.
THIS ENDORSEMENTFORMS A PART OF POLICY�INIBER. LRAFVTX17AOM
Issued by:Aspen Specialty I�isw�ance Company
Issued to:Rupa Na1•ayanan .
Effective date:2018-OS-04
ASPMT011 0118 2018 OAspen Insurance U.S. Services Inc.All rights reserved. Page 1 of 1
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