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19-001 Huichen Lin, Adult Fitness Instruction CITY OF No. ► vo l 0 FY2018-20 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties.This contract is made and entered into as of 3/12/2019("Effective Date"),by and between the City of Cupertino, a municipal corporation ("City"), and with HUICHEN LIN, ("Contractor"), a SOLE PROPRIETOR for ADULT FITNESS INSTRUCTION. 2. Services. Contractor agrees to provide the Services included in the Scope of Work and in accordance with the Schedule of Performance attached in Exhibit A. 3. Term. This contract begins on the Effective Date and ends on 6/30/2020 ("Contract Time"),unless extended or terminated as provided herein. Time is of the essence and Contractor must have sufficient time,resources, and qualified staff to deliver the Services as required. Contractor must promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to address or mitigate such delays. i 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$3000.00("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, disbursements and other cost items charged to City or establishing the basis for an invoice, for a minimum of four (4)years from the date of final payment. 5. Independent Contractor.Contractor is an independent Contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement.No civil service status or other right of employment will be acquired by virtue of Contractor's performance of the Services. Contractor is not entitled to City's health benefits, worker's compensation or any other benefit. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner. Contractor will supply all tools, materials and equipment required to perform the Services under this Contract. Contractor is responsible for obtaining permits and licenses required by law and must obtain a City business license. j I i Recreation Services Agreement/Rev. 3-27-2018 Page 1 of 6 6. Proprietary/Confidential Information.To the extent Contractor may have access to private or confidential information owned or controlled by the City, Contractor agrees to treat it confidential and use it solely to perform this Agreement. Contractor must exercise the same standard of care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Ownership of Materials. To the extent Contractor prepares written material, drawings or data in connection with this contract, City will have the property rights to those materials and all copyrights,if any, to such work product will constitute City property. 8. Records.Contractor must maintain complete,accurate, and detailed accounting records relating to its performance in accordance with generally accepted accounting principles and procedures. The records must include detailed information about Contractor's services, benchmarks, deliverables and costs/fees,and must be made reasonably available to City.The records and supporting documents must be kept separate from other files and maintained for four years from the date of City's final payment. i I 9. Assignment.This Contract is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Contract without prior written approval of City.Only those persons whose names are included in Exhibit A may perform the Services. 10. Publicity and Signs.Any publicity generated by Contractor related to this contract or the Services during the Contract Time and for one year thereafter must reference City contributions. The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews and newspaper articles. No signs may be posted, exhibited or displayed on or about City property, except signage required by law or under this Agreement without prior written approval from City. 11. Indemnification.To the fullest extent allowed by law and except for losses caused by the sole negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend, and hold harmless the City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and Contractors (collectively, "Indemnitees"), through legal counsel acceptable to City, from and against any liability for damages, claims, actions, causes of action, demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses related to litigation, arbitrations, administrative and regulatory proceedings), of every nature,arising out of or in any way related to Contractor's or Contractor's agents performance of this contract or the Services. This includes but is not limited to Liability resulting in personal injury, death, property damage, or economic losses. Contractor must pay any costs City may incur in enforcing this provision and must accept a tender of defense upon receiving notice from City. Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract. 12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City will not execute the Agreement until it has received and approved satisfactory certificates of insurance and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole 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. Compliance with Laws and Other City Requirements. Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prohibiting discrimination,including Title VII of the Civil Rights Act of 1964,the California Fair Employment Practices Act,the Americans with Disabilities Act of 1990,and other laws that pertain to fair employment and anti-discrimination practices. Contractor must comply with labor laws pertaining to prevailing wages, working hours, overtime, payroll records, and other requirements imposed by the Department of Industrial Relations.If Contractor does not have employees,it must sign the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying employment eligibility of employees pursuant to the Immigration Reform and Control Act of 1986. Contractor must comply with conflict of interest laws and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in governmental decisions or serving in a staff capacity,and is hereby advised to review the requirements of California Political Reform Act and the California Code of Regulations. Services may only be performed by persons who are not employed by City and who do not have a contractual relationship with City other than this contract. Contractor agrees to abide by City policies and administrative rules prohibiting gifts to City officials and employees. Additional Requirements for Services Provided to Minors: Contractor and its employees w'Ro provide services under this Agreement must comply with these additional requirements: I A. Undergo fingerprinting and a criminal background check and verify all employees providing services under this contract have met this requirement. B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training required under California Health and Safety Code Section 124235, A132007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, https://www.cdc.gov/headsul2/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 acknowledge and comply with all requirements set forth in the Recreation&Community 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—Insurance Requirements for Recreation Contracts', proof of finger printing and additional requirements under Paragraph 13. The contract amendment will also require the approval of the Director of Recreation and Community Services and City Attorney. I 14. Coordination of Services. The Parties designate the following persons as Services Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of this Agreement. Contractor's designation and any substitution are subject to City approval. For City: For Contractor: Name:Karen Levy Name: Huichen Lin Position: Recreation Coordinator Position: Fitness Instructor Contact: karenl@cupertino.org;408-777-3123 Contact: 15. Abandonment. City may abandon or postpone the Activity or Program and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the date of abandonment upon submission of final invoices approved by City. 16. Termination. City may terminate this contract for cause or without cause at any time and will notify Contractor as soon as possible.Contractor will be paid for satisfactory services rendered through the date of termination upon submission of final invoices approved by City. 17. Governing Law,Venue and Dispute Resolution.This contract is governed by the laws of the State of California. Any legal actions or proceedings filed against City in connection with this contract must comply with the government claims filing requirements and must be filed with the Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is required to continue to provide Services pending resolution of any dispute. If the Parties elect arbitration, the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. I I 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. i 20. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall not constitute waiver of another term, provision, covenant or condition, or a subsequent breach, whether of the same or a different character. 21. Entire Agreement.This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this reference and represent the full and complete understanding as to those matters contained herein, and supersede any other contract or understanding, either oral or Recreation Services Agreement/Rev. 3-27-2018 Page 4 of 6 written,between the Parties.This Agreement may not be modified or amended except in writing signed by both Parties.If there is any inconsistency between the main contract and any attachments or exhibits thereto, the main contract shall prevail. 22. Inserted Provisions.Each provision or clause required by law or this contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure any mistaken insertion or omission of a required provision. 23. Headings. The headings are for convenience only and are not a part of the contract or intended to affect, limit or amplify the terms or provisions of this Agreement. 24. Severability/Partial Invalidity.If any contract term or provision, or their application to a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such ruling. All other contract terms and provisions and their application to specific situations will remain in full force and effect. 25. Survival.All provisions which by their nature must continue after the Agreement ends, including without limitation Indemnification, Insurance, Ownership of Materials, Records, Governing Law and Attorney Fees, will survive the expiration or termination of this Agreement. 26. Notices.All notices and instruments pertaining to material provisions of this contract or significant disputes which are required by law or under this contract to be in writing must be sent to the persons listed below. The notices will be deemed effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission. To City of Cupertino: To Contractor: Office of the City Manager 10300 Torre Ave., Cupertino CA 95014 cc: Representative/Coordinator: cc: Representative/Coordinator: Huichen Lin Karen Levy Email: Email: karenl@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 CUPERTINO Huichen'Lin A Municipal Corporation By Name.Ht(TC/I G11 &n Name Title Etp )q .Tt1 5�oyc eo- Title cg/ Date ����� Date Tax I.D. No.: refer to W-9 on file APPROVED AS TO FORM: ATTEST: HEATHER M. MINNER GRACE SCHMIDT Cupertino City Attorney City Clerk FY 18-19 ContractlEncumbered Amount: $1,000 Account No.:580-63-620 700-702 FY 19-20 ContractlEncumbered Amount: $2,000 Account No.:580-63-620 700-702 Recreation Services Agreement/Rev. 3-27-2018 Page 6 of 6 EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide ADULT FITNESS INSTRUCTION in,but not limited to,the following: ZUMBA, TOTAL BODY, STRETCH&SCULPT Location and Time of CONTRACTOR Services: Refer to the Recreation Schedule dated SPRING 2019-SPRING 2020 for agreed upon dates,times, and class locations.The City, at its sole discretion,may change the agreed terms. Compensation for CONTRACTOR Services: I Contractor shall be compensated for services performed pursuant to this Agreement. Compensation shall consist of the following:$40 per 60 minute class;$49 for 75 minute class.The total compensation to the Contractor shall not exceed$3,000. (FY18-19=$1000;FY19-20=$2000) i Eligible Participant Minimum and Maximums for CONTRACTOR Services: ' Minimum: 5 Maximum: 20 i If less than the required minimum number of participants enroll in and pay for a particular class as identified in the schedule before the class is scheduled to start,the City may cancel the particular class and/or terminate this Agreement without additional notice or payment to Contractor. List of all Contractor Employees working for the City of Cupertino (if no Employees,identify"self'): self Performance of CONTRACTOR Services: In the case Contractor unilaterally cancels performance of a class,camp, activity or service without City approval,City reserves the right to immediately and without notice cancel the remainder of programs/services offered and or performed by Contractor. The Contractor shall follow all guidelines pertaining to registration procedures as listed in the quarterly recreation schedule.Participants may not take part in the program unless they are listed on the class roster or can show proof of enrollment.All participants and volunteers need to complete the City's Waiver of Liability form prior to taking part in the program.If applicable,contractors who are responsible for supervising minors must remain with the class until a parent of legal guardian has arrived and all minors are released to them. In the event of an injury occurring to a participant,the Contractor will notify the City within 1 hour and complete an Incident Report in the form approved by the City. The Incident Report must be submitted to the City within 24 hours of the injury occurring. i i i Exhibit B Insurance Requirements for Recreation Contracts As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurance I for the duration of the contract against claims arising from or in connection with Contractor, its agents, representatives, employees or subcontractors Services under this Agreement. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this project/location(CG 25 03 or 25 04) or be twice the required occurrence limit. 2. Automobile Liability: ISO CA 0001 covering Code 1 (any auto), or if Contractor has no owned autos, Code 8 (hired) and 9 (non-owned), with limits no less than $1,000,000 per accident for bodily injury and property damage. ❑ Required if automobile is used to perform work under this contract. 1� Otherwise, proof of Contractor's personal auto insurance with limits required by state law suffices. Contractor shall not transport or use its personal vehicle to transport participants or perform work under this contract. 3. Workers' Compensation: As required by the State of California, with Statutory and Employer's Liability Insurance limits of no less than$1,000,000 per accident for bodily injury or disease. ❑ Required if Contractor has employees. .X/ If no employees, Contractor must sign Affidavit of No Employees. 4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving minors, (i.e., after school activities, recreational programs, athletics, study/training events and transportation of minors). Coverage may be included under General Liability or be obtained in a separate policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the required occurrence limit. ❑ Required if Contract involves services to children. Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance. Self-Insured Retentions: Self-insured retentions must be approved by City. City may require Contractor to provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language must provide, or be endorsed to provide, that the self- insured retention may be satisfied by either the named insured or City. Acceptability of Insurers: Insurance must be issued by insurers acceptable to City and licensed to do business in the State of California,with an A.M. Best's financial strength rating of"A" or better and a financial size rating of"VII" or better. OTHER INSURANCE PROVISIONS: The CGL policy must contain, or be endorsed to contain, the following provisions: 1. The City, its City Council, boards and commissions, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds with respect to liability arising out of work or Exh. B Insurance for Recreation Contracts Updated 3-26-18 1 operations performed by or on behalf of the Contractor including materials, parts or equipment furnished in connection with such work or operations. 2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 0104 13 as respects the City, its officers, officials, employees, agents, and volunteers. 3. The Insurance Company agrees to waive all rights of subrogation against the City, its elected or appointed officers, officials, agents, and employees for losses paid under the terms of any policy which arise from work performed by Contractor for City. This provision also applies to the Contractor's Workers' Compensation policy. 4. Each insurance policy required by this contract shall provide that coverage shall not be canceled, except with notice to the City. Primary Coverage: The Additional Insured coverage under Contractor's policy shall be primary non- contributory and at least as broad as ISO CG 20 01 04 13 as respects the City and all the insureds/indemnitees. If the limits of insurance required are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a "primary and non-contributory" basis for the benefit of the Additional Insureds before City's own insurance is triggered. I I Notice of Cancellation: Each insurance policy shall provide that coverage shall not be canceled or allowed to expire without written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Such notice must be sent to City via email or certified mail to the attention of the City Manager. Waiver of Subrogation: Contractor grants City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City by virtue of payment of any loss under such insurance. Contractor will obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Verification of Coverage: Contractor shall furnish the City with original certificates and amendatory endorsements effecting coverage required by this clause. All certificates and endorsements are to be received and approved by the City before work commences. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications, at any time. At a minimum Contractor must provide acceptable copies of the policy declarations and endorsement page verifying the required insurance coverages. Homeowner's Insurance: Contractor's homeowner's liability insurance may provide coverage sufficient to meet these requirements. Contractor should provide these requirements to his or her agent to confirm and provide verification to City. Special Events Coverage: Insurers may provide special events coverage for a reduced fee, or City may be able to offer this coverage. Contractor should contact the City Manager's Office for information or assistance. Special Risks or Circumstances: City reserves the right to modify these requirements based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Exh. B Insurance for Recreation Contracts Updated 3-26-18 2 EXHIBIT C AFFIDAVIT OF NO EMPLOYEES State of California County of Santa Clara City of Cupertino I, the undersigned, declare as follows: I am an independent fitness instructor ,( I C� Iih w s 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. ��`` / Executed on this_Lday of /"�^Y� 2019, at yt W California. HWC -eT PRINT NAME I SIGNATURE I i i I I I �I A�o DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/27/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Mass Merchandising K&K Insurance Group, Inc. (A/C N Ext):NE 1-800-506-4856 A/c No): 1-260-459-5590 1712 Magnavox Way E-MAIL Fart Wayne IN 46804 ADDRESS: info@fitnessinsurance-kk.com PRODUCER CUSTOMER ID: INSURERS AFFORDING COVERAGE NAIC# INSURED 2001085210 CP#493 INSURER A: Nationwide Mutual Insurance Company 23787 Huichen Lin INSURER B: INSURER D: A Member of the Sports,Leisure&Entertainment RPG INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2000407034 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY X 02/15/19 02/15/21 EACH OCCURRENCE $1,000,000 12:01 AM 12:01 AM DAMAGE TO RENTED CLAIMS-MADE❑X OCCUR PREMISES Ea Occurrence $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE per year$5,000,000 POLICY ❑PROJECT❑LOC PRODUCTS—COMP/OP AGG per year$1,000,000 OTHER: PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAB TO PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea accident ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident X Not provided while in Hawaii MBRE LA OCCUR LIAg EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION N/A AND EMPLOYERS'LIABILITY PER STATUTE OTHER ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT EXECUTIVE OFFICER/MEMBER EXCLUDED?(Mandatory in NH) E.L.DISEASE—EA EMPLOYEE II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 02/15/19 02/15/21 PRIMARY MEDICAL 12:01 AM 12:01 AM EXCESS MEDICAL $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certified Instructor of:Aerobics,Children's fitness programs, Dance, Exercise, Fitness bootcamp,Personal training,Strength,Yoga,ZUMBA@ The certificate holder is added as an additional insured,but only for liability caused,in whole or in part,by the acts or omissions of the named insured. Sexual Abuse or Sexual Molestation Liability-$100,000 Each Occurrence(included above)/$300,000 Aggregate(included above) CERTIFICATE HOLDER CANCELLATION City of Cupertino, Its City Council,Boards and Commissions,Officers, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Officials, Employees,Agents,Servants,Volunteers and Consultants EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 10300 Torre Avenue THE POLICY PROVISIONS. Cupertino,CA 95014 Owner/Manager/Lessor of Premises AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to U.S.events and activities. **NOTICE TO TEXAS INSUREDS:The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 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 Persons Or Organization(s) City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants 10300 Torre Avenue Cupertino, CA 95014 Named Insured: Huichen Lin CP#493 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to include as an B. With respect to the insurance afforded to these additional insureds, additional insured the person(s)or organization(s)shown in the the following is added to Section III—Limits Of Insurance: Schedule,but only with respect to liability for"bodily injury", If coverage provided to the additional insured is required by a "property damage"or"personal and advertising injury"caused,in contract or agreement,the most we will pay on behalf of the whole or in part,by your acts or omissions or the acts or omissions additional insured is the amount of insurance: of those acting on your behalf: 1. In the performance of your ongoing operations;or 1. Required by the contract or agreement;or 2. Available under the applicable Limits of Insurance shown in 2. In connection with your premises owned by or rented to you. the Declarations; However: whichever is less. 1. The insurance afforded to such additional insured only This endorsement shall not increase the applicable Limits of applies to the extent permitted by law;and Insurance shown in the Declarations. 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 ©Insurance Services Office, Inc.,2012 Page 2 of 2 i Amended auto policy declarations WAUstate. Your policy effective date is September 14, 2018 You're in good hands. Page 1 of 4 Total Amount Due for the Policy Period Information as of December 13,2018 Please review your insured vehicles and verify their VINs are correct. summary Vehicles covered Identification Number(VIN) Premium Named Insured(s) Polic number *Your bill will be mailed separately.Before making a payment,please refer to your latest bill,which includes payment options and installment fee information.If you do Your policy provided by not pay in full,you will be charged an installment fee(s). Allstate Northbrook Indemnity See the Important payment and coverage information section for details about Company installment fees. Policy period Beginning September 14,2018 through March 14,2019 at 12:01 a.m.standard Discounts (included in your total premium) time Anti-theft $1.61 Good Driver(20%) $160.50 Your policy changes are effective Multiple Policy $33.79 Distinguished $56.68 November 25,2018 Driver Your Allstate agency is Specialized $26.68 All Plus Agency Professionals 1550 the Alameda 204 Total discounts $279.26 San Jose CA 95126-2304 (408)777-9888 s RAE@allstate.com,Mer"',151 him 7, Discounts per vehicle Some or all of the information'on your Policy Declarations is used in the rating $163.54 of your policy or it could affect your Anti-theft $.76 Good Driver(20%) $77.08 eligibility for certain coverages.Please Multiple Policy $16.23 Distinguished $56.68 notify us immediately if you believe that Driver any information on your Policy Specialized $12.79 Declarations is incorrect.We will make Professionals corrections once you have notified us, Good Driver(20%) $83.42 be made only for the current policy Multiple Policy $17.56 Specialized $13.89 period or for future policy periods. Professionals Please also notify us immediately if you believe any coverages are not listed or Listed drivers on your policy are inaccurately listed. Huichen Lin Yensheng Su Excluded drivers from your policy o None a 0 NMI0 a u Amended auto policy declarations Page 2 of 4 Policy number; Policy effective date: September 14, 2018 Coverage detail for Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $283.04 Bodily Injury $250,000 each person $500,000 each occurrence Property Damage $100,000 each occurrence AM Auto Collision Insurance Not purchased* Auto Comprehensive Insurance Actual cash value $100 $14.51 / Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance Not applicable $81.64 Q Bodily Injury $250,000 each person $500,000 each accident AM Property Damage $3,500 each accident !� Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Lease/Loan Gap Not purchased*__- - Repair or Replacement Cost Option - Not purchased*-- Sound System Not purchased* Tape Not purchased* Total premium for $379.19 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven 10-20 miles to work/school, married female licensed 32 years. Allstate uses mileage information as one factor to help determine your premium amount. f Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:12,500-12,999.The annual mileage figure applicable to this vehicle for the current policy period is:12,500-12,999. f The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. 001( O m c O m X � . I Amended auto policy declarations Page 3 of 4 Policy number: Q)Allstate. Policy effective date: September 14, 2018 g You're in good hands. Coverage detail for Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $253.15 Bodily Injury $250,000 each person $500,000 each occurrence Property Damage $100,000 each occurrence Auto Collision Insurance Not purchased* Auto Comprehensive Insurance Actual cash value $100 $16.14 t(' Rental Reimbursement Not purchased* - ---._.. ..--------- ------- - ------------------------------------ Towing and Labor Costs Not purchased* Uninsured Motorists Insurance Not applicable $64.36 ® Bodily Injury $250,000 each person $500,000 each accident W! Property Damage $3,500 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Lease/Loan Gap Not purchased* Repair or Replacement Cost Option Not purchased* - ------------- -------- AS Sound System Not purchased* Tape Not purchased* Total premium for $333.65 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss v coverage options and other products and services that can help protect WI inset you. t mAl 2!1 VIN Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven 3-9 miles to work/school, married male licensed 37 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:8,000-8,499.The annual mileage figure applicable to this vehicle for the current policy period is:8,000-8,499. The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. o a 0 0 a V MW Amended auto policy declarations Page 4 of 4 Policy number: Policy effective date: September 14, 2018 Additional coverages Automobile Death Indemnity Insurance Not purchased* Automobile Disability Income Protection Not purchased* Identity Theft Expenses Not purchased* *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list.Please keep these together. • Allstate Automobile Policy-AU104-3 California Amendatory Endorsement-AU14629-2 • Amendment of Policy Provisions-AU14626-1 Important payment and coverage information Here is some additional, helpful information related to your coverage and paying your bill: 00-Your rate is lower because you are insuring multiple cars. 1110-Your bill will be sent to you in a separate mailing and will list any payment option(s)available to you. If you are eligible to pay your premium in installments,your first bill will reflect your available payment options, including the option to pay in full or to pay in monthly installments. Please note that any amounts payable for the first renewal bill will not include an installment fee (unless you have an unpaid balance from a previous policy period, in which case the Minimum Amount Due will include an installment fee, or unless you are participating in the Allstate Easy Pay Plan).The following applies to installment payments made after your first renewal bill. If you decide to pay your premium in installments, there will be a$3.50 installment fee charge for each payment due. If you make 6 installment payments during the policy period,and do not change your payment plan method,then the total amount of installment fees during the policy period will be$21.00. If you are on the Allstate' Easy Pay Plan,there will be a $1.00 installment fee charge for each payment due. If you make 6 installment payments during the policy period, and remain on the Allstate l Easy Pay Plan, then the total amount of installment a fees during the policy period will be$6.00, o a V If you change payment plan methods or make additional payments, your installment fee charge for each payment due and the total amount of installment fees during the policy period may change or even increase, 0 Please note that the Allstate" Easy Pay Plan allows you to have your insurance payments automatically deducted from your o V checking or savings account. o 0 0 v m Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook, o 0 Illinois. pl,v J4. ---- ✓�� �G7 o Phil Telgenhoff Susan L.Lees President Secretary X oCC) o m o O O Renewal auto policy declarations WAllstate., Your policy effective date is March 14, 2019 �t/. „ 1 � You're in good hands. Page 1 of 5 y� Total Amount Due for the Policy Period Information as of January 22, 2019 Please review your insured vehicles and verify their VINs are correct. Summary Vehicles covered Identification Number(VIN) Premium Named Insured(s) _ 341.85 Mailing address California Fraud Assessment Fee 1.76 Policy number *Your bill will be mailed separately.Before making a payment,please refer to your 934 252 961 latest bill,which includes payment options and installment fee information.I f you do Your policy provided by not pay in full,you will be charged an installment fee(s). Allstate Northbrook Indemnity Company Discounts (included in your total premium) Policy periodBeginning March 14,2019 through Anti-theft $1.57 Good Driver(20%) $157.69 September 14,2019 at 12:01 a.m. Multiple Policy $33.20 Distinguished $53.34 standard time Driver Your Allstate agency is Specialized $26.34 All Plus Agency Professionals 1550 the Alameda 204 Total discounts $272.14 San Jose CA 95126-2304 (408)777-9888 RAE@allstate.com Discounts per vehicle Some or all of the information on your $153.60 Policy Declarations is used in the rating of your policy or it could affect your Anti-theft $.71 Good Driver(20%) $72.23 eligibility for certain coverages. Please Multiple Policy $15.22 Distinguished $53.34 notify us immediately if you believe that Driver Specialized $12.10 any information on your Policy Professionals Declarations is incorrect.we will make corrections once you have notified us, $118.54 and any resulting rate adjustments,will Anti-theft $.86 Good Driver(20%) $85.46 be made only for the current policy Multiple Policy $17.98 Specialized $14.24 period or for future policy periods. Professionals Please also notify us immediately if you believe any coverages are not listed or Surcharge(included in your total premium) are inaccurately listed. 2000 Toyota Camry - Minor Violation:05/31/2016 Listed drivers on your policy Huichen Lin Yensheng Su o m 0 0 u Renewal auto policy declarations Page 2 of 5 Policy number; Policy effective date; March 14, 2019 Excluded drivers from your policy None 1010 0 00 o � O N N 0 X 0' Renewal auto policy declarations Policy number: Policy effective date: March 14, 2019 Page 3 of 5 Allstate,,, You're in good hands. Coverage detail for Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $270.57 Bodily Injury $250,000 each person $500,000 each occurrence Property Damage $100,000 each occurrence Auto Collision Insurance Not purchased* Auto Comprehensive Insurance Actual cash value $100 $13.56 Sp Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance Not applicable $75.64 Bodily Injury $250,000 each person $500,000 each accident Property Damage $3,500 each accident Automobile Medical Payments Not purchased* Coordinated M_edi_cal Prote_cti_o_n _ Not purchased* Lease/Loan Gap Not purchased* Repair or Replacement Cost Option Not purchased* a Sound System Not purchased* Tape Not purchased* Total premium for 2008 Toyota Prius $359.77 *This coverage can provide you with valuable protection. To helm,you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven 10-20 miles to work/school, married female licensed 33 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:12,500-12,999.The annual mileage figure applicable to this vehicle for the current policy period is:11,000-11,499. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. 0 m 0 s Q hR��+ ,y•N Renewal auto policy declarations Page 4 of 5 Policy number: Policy effective date: March 14, 2019 Coverage detail for Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $259.01 Bodily Injury $250,000 each person $500,000 each occurrence Property Damage $100,000 each occurrence Auto Collision Insurance Not purchased Auto Comprehensive Insurance-– Actual cash value – $100 - _ — $16.48 tJ' Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* _ - _ — _ Uninsured Motorists Insurance Not applicable $66.36 QN Bodily Injury $250,000 each person $500,000 each accident Property Damage — $3,500 each accident MEW OEM Automobile Medical Payments Not purchased* Coordinated Medical Protection_ Not purchased* Lease/Loan Gap Not purchased* Repair or Replacement Cost Option Not purchased* QD Sound System Not purchased* Tape Not purchased* Total premium for 2000 Toyota Camry $341.85) *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven 3-9 miles to work/school, married male licensed 38 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:8,000-8,499.The annual mileage figure applicable to this vehicle for the current policy period is:9,000-9,499. j The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. D G� � r . O O � O to N O X Renewal auto policy declarations Policy number: WAllstate. Policy effective date: March 14, 2019 Page 5 of 5 You're in good hands. Additional coverages Automobile Death Indemnity Insurance Not purchased* Automobile Disability Income Protection Not purchased* Identity Theft Expenses Not purchased* *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together. • Allstate Automobile Policy-AU104-3 California Amendatory Endorsement-AU14629-2 • Amendment of Policy Provisions-AU14626-1 Important payment and coverage information Here is some additional, helpful information related to your coverage and paying your bill: 00-Your rate is lower because you are insuring multiple cars. Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois. P,u J64w4--- -1151 Phil Telgenhoff Susan L. Lees President Secretary 0 m 0 0 a v Important notices Page 1 of 5 Policy number: Policy effective date: March 14, 2019 Reasons for Extension, Cancellation or However, please be aware that you still have options concerning coverage for damages to your insured auto that you Nonrenewal are legally entitled to recover from the owner or operator of an uninsured motor vehicle. California law requires Allstate to provide you with reasons why your policy may be extended, canceled or nonrenewed or The following options are available for each vehicle under your your premium increased. policy. Please see your Policy Declarations to determine your current coverages for each of your vehicles. Allstate may cancel or nonrenew your policy for one or more of • If your vehicle is insured for Auto Collision Insurance, we the following reasons: are offering a Waiver of your Collision Coverage • Nonpayment of premium; Deductible to apply when the vehicle is damaged in an • Fraud or material misrepresentation affecting the policy or accident caused by an uninsured motor vehicle. the insured;or • If your vehicle is not insured for Auto Collision Insurance • Substantial increase in the hazard we insure against. and is insured for Uninsured Motorists Insurance for bodily injury, we are offering you the opportunity to extend your In addition, your policy may be nonrenewed or your premium Uninsured Motorists Insurance to cover property damage. may be increased for any of the following reasons: • You still have the option of rejecting either the Waiver of • Accident involvement by an insured and whether the Collision Coverage Deductible or Uninsured Motorists insured is at fault in the accident; Insurance for property damage, or both coverages. • A change in,or addition of, an insured vehicle; If a vehicle insured under your policy is damaged by an • A change in, or addition of,an insured under the policy; uninsured motor vehicle and you are legally entitled to recover • A change in the location of garaging of an insured vehicle; damages,we will, depending on the coverage you purchase, • A change in the use of an insured vehicle; either: • Conviction for violating any provision of the Vehicle Code • Pay the collision deductible on the insured motor vehicle or Penal Code relating to the operation of a motor vehicle; when you have purchased collision coverage, or • The payment made by an insurer due to a claim filed by an • Pay for the damage to the insured motor vehicle when you insured or a third party; have not purchased collision coverage but have purchased • Any other reason that is lawful and not unfairly Uninsured Motorists Insurance for property damage. discriminatory. Payment shall not include damage to personal property or loss Accidents and convictions for violating any provision of the of use of a motor vehicle and shall not exceed the smaller of: Vehicle Code or Penal code relating to the operation of a motor • The amount of the collision deductible, vehicle that occur within the 36-month period ending on the • The actual cash value of the insured motor vehicle, effective date of the policy may lead to an increase of your . $3500. premium.You have the right to be informed, upon your request, of any increase in premium, in whole or in part, The law also permits you to reject these coverages completely. charged to you because of an accident or conviction. If you would like to purchase one of these coverages or make Under certain circumstances, if we fail to send your renewal any other changes concerning these coverage options, please offer at least 20 days prior to your renewal effective date or if call your Allstate Agent. we fail to send your nonrenewal notice at least 30 days prior to If You Have a Problem with Your Insurance the nonrenewal effective date, California law requires us to extend your existing policy term for 30 days from the date the Please contact your Allstate representative if you have any notice is mailed or delivered to you. questions or concerns about your insurance.If a problem Other Uninsured Motorist Coverage Options arises that you and your Allstate representative are unable to Your policy has been issued with the coverages and options resolve satisfactorily,please call or write to: you requested. Please refer to the enclosed Policy Declarations Allstate Customer Service to verify that your policy has been issued according to your PO Box 660598,Dallas,TX 75266-0598 requests. 1-800-ALLSTATE'm(1-800-255-7828) 1010 V r ro 0 0 oM E;N_ N 0 X 01