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19-001 Starrz Dance, Dance Instruction CITY OF No. Im FY 18-20 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties.This contract is made and entered into as of 4/9/2019 ("Effective Date'),by and between the City of Cupertino, a municipal corporation("City"), and with STARRZ DANCE, 1111 S. Stelling Road, Cupertino, CA 95014 ("Contractor"), a SOLE PROPRIETOR for DANCE 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. 4. Compensation. City will pay Contractor for satisfactory performance of the Services an 1 amount that will based upon actual costs but that will be capped so as not to exceed$7,000 ("Contract I 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. +3 I 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, j 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. 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. 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 who provide services under this Agreement must comply 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. j 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 1 Section 124235,AB2007, and other laws pertaining to concussion evaluation,removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, htips://www.cdc.gov/headsup/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. 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. I For City: For Contractor: Name:Karen Levy Name: Swati Savale Position: Recreation Coordinator Position: Owner/Dance Instructor Contact: karenl@cupertino.org;408-777-3123 Contact: contact@starrzdance.com 15. Abandonment. City may abandon or postpone the Activity or Program am 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 18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. This Section survives this Agreement. 19. Third Party Beneficiaries.There are no third party beneficiaries under this Contract. 20. Waiver.Neither acceptance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall 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 Starrz Dance 10300 Torre Ave., Cupertino CA 95014 1111 S. Stelling Road, Cupertino, CA 95014 cc: Representative/Coordinator: cc: Representative/Coordinator: Karen Levy Swati Savale Email: karenl@cupertino.org Email: contact@starrzdance.com 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 Swati Sa ale A Municipal Corporation By B Name WA"7 1 Name h i1l� � G Title C�l.�,/lC'YTitleSSf /�eL�Z✓ Date Z Z 9 Date Tax I.D. No.: refer to W-9 on file APPROVED AS TO FORM: ATTEST: � r HEATHER M.MINNER �a r 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:$6,000 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 DANCE INSTRUCTION in,but not limited to,the following: BOLLY BEATS 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: Contractor shall be compensated for services performed pursuant to this Agreement.Compensation shall consist of the following: 65%of resident fees.The total compensation to the Contractor shall not exceed$7,000 (FY18-19=$1,000;FY19-20=$6,000). Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: 5 Maximum: 15 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. Exhibit B Insurance Requirements for Recreation Contracts As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurance for the duration of the contract against claims arising from or in connection with Contractor, its agents, representatives, employees or subcontractors Services under this Agreement. 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. i 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. ,K 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. j 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. ,tzl 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-I8 1 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 dance instructor Swati Savale I wish to enter into a services contract with the City of Cupertino. I am fully aware of the provisions of section 3700 of the California Labor Code, which requires every employer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that I must provide proof of workers' compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this 22 day of March 2019, at Cupertino , California. PRINT NAME i SIGNATURE EXHIBIT D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of Starrz Dance;that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. 1 declare that Starrz Dance has complied with fingerprinting and criminal background investigation requirements with respect to all Contractor's employees who may have contact with minors in the course of providing services pursuant to the Agreement,and the California Department of justice has determined that none of those employees has been convicted of a felony,as that term is defined in California Penal Code Section 11105.3. 3. I declare that each coach and administrator shall be required to successfully complete concussion and head injury education at least once,either online or in person,before supervising a participant,as required by California Health and Safety Code Section 124235,et seq. 4. On a yearly basis,all participants shall be required to sign and return a concussion and head injury information sheet in compliance with California Health and Safety Code Section 124235,which may be in the form attached as D-1. 5. That a complete and accurate list of Contractor's employees,who may come in contact with minors during the course and scope of the Agreement,are included below. 6. All of the below mentioned employees have tested negative for TB,or X-ray results for TB,and have current documentation on file with Contractor. 7. All of the below mentioned employees have received training and understand their responsibilities under the Mandated Reporter laws of this state and are willing and able to comply. List of all Contractor Employees working for the City(if no Employees,identify"self"): self 8. The Contractor will notify the City of Cupertino in writing of any new employees and will be added to the above list prior to beginning work at the City of Cupertino. I declare unde penalty of perjury that the foregoing is true and correct. By: Swati Savale Title: Owner/Dance Instructor Date: 3 2- I ACC> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `.� 12/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A 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 CONTACTNAME: Joe Chan Eversafe Insurance Agency,Inc. PHONE Ext): (626)821-4900 FAX XNo: (626)821-4907 10508 Lower Azusa Rd AIL ADDRESS: commercial@eversafeins.com Suite 202 INSURERS AFFORDING COVERAGE NAIC# EI Monte CA 91731 INSURERA: United States Liability Insurance Company 25895 INSURED INSURERS: Gurudatta S.Savale INSURERC: DBA:Starrz Dance INSURER D: 1111 S Stelling Rd INSURER E: Cupertino CA 95014 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBERPOLICYY EFF POLICY jyy EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A CL1871083 05/16/2018 05/16/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO ❑ POLICY 171 E] PRODUCTS-COMP/OP AGG $ Included PRO- OTHER: Professional Liability $ Included AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 7T UTEEMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE F7E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Molestation or Abuse Liability Each Claim 1,000,000 A CL1871083 05/16/2018 05/16/2019 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The certificate holder is an additional insured pursuant to the attached endorsement L 723(02-09). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Cupertino,Its City Council,Boards and Commissions, ACCORDANCE WITH THE POLICY PROVISIONS. Officers,Officials,Employees,Agents,Servants,Volunteers AUTHORIZED REPRESENTATIVE and Consultants 10300 Torre Ave.,Cupertino CA 95014 ` @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: UNITED STATES LIABILITY INSURANCE GROUP WAYNE, PENNSYLVANIA This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM BLANKET ADDITIONAL INSURED ENDORSEMENT Section II — Who Is An Insured is amended to include as an insured any person(s) or organization(s) who you are required to add as an additional insured under written contract(s), written permit(s) or written agreement(s), that require such person(s) or organization(s) to be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury", "property damage" or"personal and advertising injury" occurring after the effective date of such written contract(s), written permit(s) or written agreement(s)that is caused, in whole or in part by: { 1. Your acts or omissions; or j 2. The acts or omissions of those acting on your behalf; j EXCLUSIONS 1 , There is no coverage under this endorsement for loss or expense, including but not limited to the J cost of defense for "bodily injury", "property damage" or "personal and advertising injury" occurring: (1) After all of"your work", including materials, parts or equipment furnished in connection with "your work" and performed under the above referenced written contract(s), written permit(s) or written agreement(s)has ended; or (2) When that portion of your work out of which the bodily injury", property damage" or "personal and advertising injury" arises and performed under the above referenced written contract(s), written permit(s) or written agreement(s) has been put to its intended use by any person(s) or organization(s); whichever occurs first. Coverage is not provided for "bodily injury", "property damage" or "personal and advertising injury"arising out of the sole negligence of an additional insured under this endorsement. j Coverage provided by this endorsement will be excess over any insurance available to any additional insured under this endorsement unless a written contract(s), written permit(s) or written agreement(s) specifically requires that coverage under this endorsement is primary. All other terms and conditions of this policy remain unchanged. This endorsement is a part of your policy and takes effect on the effective date of your policy unless another effective date is shown. I i L 723 (02-09) Page 1 of 1 FARMERS Auto Insurance Declaration Page INSURANCE Policy Number: Premi.ums/Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Effective: 10/20/2018 12:01 AM Policy Premium $667.00 Expiration: 4/20/2019 12:01 AM Fees(*also see Information on Additional $0.88 Named Insured(s):Gurudatta Savale Fees below) Swati G Savale 1111 S Stelling Rd 001 Policy Premium and Fees $667.88 Cupertino,CA 95014-5020 e-mail gsavale@yahoo.com This is not a bill. Address(es): Your bill with the amount due will be mailed separately. Underwritten By: Farmers Insurance Exchange 6301 Owensmouth Ave. Woodland Hills,CA 91367 Household Drivers All persons who drive or will occasionally be driving any of the cars on the policy should be listed below.If anyone is missing or needs to be added,such as a newly licensed driver,you should contact your agent orthe company to add that person before they begin to drive any of the cars covered on the policy. Norne DriverStatus Name DriverStatus ------ — -- - — ---------- ----._......... ------ Covered Vehicle Information Veh.# Year/Make/Model/VIN Coverage Deductible Limit 1 Collision: $1,000 Additional Equipment: $1,000 Coverage Information Limits ___.._....._.... ... ....._ ... ..............PremiumsbyVehicle Coverage a licoble to oil vehicles) _ ___ Vehicle I ......---......g...._.._.... _..--... ._.__.. .__ ._(...PP — — .. ....—. ......_..... .. —_........__..._._..._..__._..............._. ........._.._. _ Bodily Injury Liability $100,000 each person $174.30 $300,000 each accident .._.......... ... ....._._....__...................._..._..._............_..._..._..._... ..........._.._.........._......................_.._...._._..._... ..._.. ......._...._._.........._.._._......_......._. ....... ... ..._. property Damage Liability $100,000 each accident Included ....... .........................-.. ......................................_.._....... ._............-.......... ................... ........... ... _. ... ......._... ....._ ... .......................... .........._... ..._..._.. Permissive User Limit of Full(See Permissive User Included Liability** Limit of Liability in your policy) ...... .. . ...... _ . .......-. _ ... ..._... ....... ... ........ ...... ..... ... ... . .._... ..._.. ... ..._. ....... . _ Medical CoverageNot Covered_ . . ..._..._.. ... ... ._....... _ _ _ _. ................_._.. .......-.......... .. ....... ..._..._..._.._.._... ........... ... .. _ . _. . _ _ _ Uninsured Motorist Bodily $100,000 each person $19.20 Injury $300,000 each accident farmers.com Policy No. Questions? Manage your account: Call your agent Peter Kuo at(408) Go to www.farmers.com to access 216-0883 or email your account any time! pkuo@farmersagent.com 56-6176 1st Edition 4-15 8/24/2018 Page 1 of 3 Declaration Page(continued) Policy and Endorsements This section lists the policy form number and any applicable endorsements that makeup your insurance contract.Any endorsements that you have purchased to extend coverage on your policy area Iso listed in the coverages section of this declarations document: 56-5684 1st ed.;CA125 1st ed.;J6960 3rd ed.;25-8531 10-12 Other Information • "YOUR POLICY INCLUDES THE FULL PERMISSIVE USER LIMIT OF LIABILITY.PLEASE SEE PERMISSIVE USER LIMIT OF LIABILITY IN YOUR POLICY FOR FURTHER INFORMATION. • You maybe eligible for ad ifferent rate but with different coverage from Farmers Specialty Insurance Company.Please contact your Farmers agent to discuss your options. • The Attorney-In-Fact(AIF)or management fee for your renewed policy wi I I never exceed 20%of the policy's premiums and wil I be paid out of the premiums.You may wish to consider this information in deciding whether to acceptor decline this offer to renew your policy. • You have the right to designate an additional third party to receive any notice of cancellation for nonpayment of your premium for this policy. Please contact your Farmers®agent if you would like to add,change,or remove a designee. • Farmers Friendly Reviews area great way to make sure you are receiving all the discounts for which you qualify,and identify any potential gaps in coverage.Contact your agent to learn more about the policy discounts,coverage options,and other product offerings that may be available to you. i *Information on Additional Fees The"Fees"stated in the"Premium/Fees"section on the front apply on a per-policy,not an account basis.The following additional fees also apply: 1. Service Charge per installment(In consideration of our 2. Late Fee:$10.00(applied per account) agreement to allow you to pay in installments): 3. Returned Payment Charge:$25.00(applied per check, For Recurring Electronic Funds Transfer(EFT) and fully electronic transaction,or other remittance which is not enrolled online billing(paperless): $0.00(applied per honored byyourfinancial institution for any reason including account) but not limited to insufficient funds or a closed account) For other Recurring EFT plans:$2.00(applied per account) g - Reinstatement Fee:$18.40(applied pervehicle,20% For all other payment plans:$5.00(applied per account) 4. 1 discount will apply for Good Drivers) If this account is for more than one policy,changes in these fees are not effective until the revised fee information is provided for each One or more of the fees or charges described above may be deemed a part of premium under applicable state law. policy. Countersignature Authorized Representative farmers.com Policy No. Questions? Manage youraccount: Call your agent Peter Kuo at(408) Go to www.farmers.com to access 216-0883 or email your account any time! pkuo@farmersagent.com 56-6176 1st Edition 4-15 Paue 3 of 3 ARCH ' INTERMEDIARIES CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE Form: SML Safeguard Wording-623AFB00213 i Policy Number: � 1 Renewal of: N/A i Named Insured: City of Cupertino—Dept of Recreation&Community Services i 1 Principal Address: 10185 N Stelling Road,Cupertino,CA,95014 Policy Period: From: I"July 2018 To: 15f July 2019 Both dates at 12:01 a.m. Local Time at the Principal Address stated in Item 1. i Limit of Liability: a) USD 5,000,000 for all Claims for Wrongful Acts against any one Victim b) USD 5,000,000 for all Claims for Wrongful Acts against all Victims,but sub-limited to: c) USD 50,000 for all Safeguard Costs resulting from all Circumstances Such Sub-limit of Liability shall be part of,and not in addition to,the overall Limit of Liability stated in 3.b)above. Retention: i i USD 35,000 any one Victim Premium: USD 27,000 to be paid within 25 days of attaclu-nent Notification pursuant to Clause IX.shall be given to: Claims Department Beazley 30 Batterson Park Road, Farmington, 1 CT 06032. claimsna,beazley.com (860)677 3765(phone) (860)679 0247(fax) Retroactive Date: I't July 2018 i Pending or Prior Litigation Date: I"July 2018 AMENDED DEFINITION OF INDEPENDENT CONTRACTOR TO INCLUDE PART-TIME INDEPENDENT CONTRACTORS This endorsement modifies insurance provided under the following: BEAZLEY SAFEGUARD In consideration of the premium charged for this Policy, it is hereby understood and agreed that Clause III. DEFINITION H. is deleted in its entirety and replaced with the following: H. "Independent Contractor" means any natural person independent contractor who performs labor or service for the Insured Organization on a full-time or part-time basis pursuant to a written contract or agreement, where such labor or service is under the exclusive direction of the Insured Organization. The status of an individual as an Independent Contractor shall be determined as of the date of an alleged Wrongful Act. All other terms and conditions of this Policy remain unchanged.