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19-001 Mobile Climb USA, LLC CITY OF No. FY2019-20 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties. This contract is made and entered into as of 7/6/2019 ("Effective Date"),by and between the City of Cupertino,a rn unicipal corporation("City"),and with MOBILE CLIMB USA,LLC, 7960B SOQUEL DRIVE #136, APTOS, CA 95003 ("Contractor"), a BUSINESS for CLIMBING WALL RENTAL,SETUP,AND CLEANUP. 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 9/30/2019 ("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 amount that will based upon actual costs but that will be capped so as not to exceed$4,620 ("Contract Price"),based upon the Scope of Services,budget,performance schedule,and rates included in Exhibit I 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 1 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. S. 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 u1 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 Iaw 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 Set-vices 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. B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training required under California Health and Safety Code Section 124235, AB2007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, https://www.cdc.gov/lieadsup/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 ii 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. For City: For Contractor: Name:David Chen Name: Gene Fischer Position:Community Coordinator Position: Owner,Mobile Climb USA,LLC Contact: davidc@cupertino.org,408-777-1308 Contact: gene@mobileclimbusa.com,831-818-8000 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. 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 maul 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 untended 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. ip 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 1 the persons listed below. The notices will be deemed effective on the date of personal delivery or the I 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. I I To City of Cupertino: To Contractor: Office of the City Manager Mobile Climb USA,LLC 10300 Torre Ave., Cupertino CA 95014 7960B Soquel Drive#136 cc:Representative/Coordinator: Aptos, CA 95003 David Chen cc:Representative/Coordinator: Email: davidc@ctipertino.org Gene Fischer Email: gene@mobileclimbusa.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 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. IN WITNESS WHEREOF, the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO Mobile Climb USA, L.LC A Municipal Corporation 2'�By(sign) By Name61r/V"4-' ��S Cr'f�n� Nam At, Title Date 1 Date Tax I.D. No.: APPROVED AS TO FORM: ATTEST: HEATHER M.MINNER GRACE SCHMIDT a- q Cupertino City Attorney City Clerk CotitractlEricuttibered Amount: $4620 Account No.: 100-62-640-700-702 Recreation Services Agreement/Rev. 3-27-2018 Page 6 of 7 EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide CLIMBING WALL RENTAL, SETUP,AND CLEANUP in, but not limited to, the following: MOBILE CLIMB USA WILL SET UP AND SECURE THEIR CLIMBING WALL UP TO 1 HOUR PRIOR TO THE SCHEDULED EVENT. MOBILE CLIMB USA WILL SUPPLY ALL SAFETY HARNESSES AND EQUIPMENT. PROFESSIONAL GUIDANCE AND INSTRUCTION WILL BE PROVIDED FOR ALL CUSTOMERS. MOBILE CLIMB USA WILL DISMANTLE ITS WALL AND CLEAN UP ITS DEBRIS AT THE END OF THE EVENT. INCLUDES TRANSPORTATION AND STAFF. 2 VOLUNTEERS WILL STILL BE NEEDED TO HELP AND ASSIST WITH RUNNING THE WALL. Location and Time of CONTRACTOR Services: Walls stand up to 30' tall and require a working area of approximately 20' x 20' that is flat and free of power lines.The event dates, times, and locations are confirmed below, but not limited to: July 6, 6:30pm 8:30pm at Creekside Park, 10455 Miller Ave July 13, 6:00pm-8:00pm at Creekside Park, 10455 Miller Ave July 18, 6:00pm-8:00pm at Monta Vista Park,22601 Voss Ave July 20, 6:30pm -8:30pm at City Center Amphitheater,20350 Stevens Creek Blvd August 30, 6:00pm-8:00pm at Wilson Park, 10200 Parkside Lane August 31,5:45pm-7:45pm at Creekside Park, 10455 Miller Ave September 7, 5:30pm-7:30pm at Library Field, 10400 Torre Ave Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement.Compensation shall consist of the following:$660 per event. A 50%deposit is required to reserve the wall, with $2,310 due upon the execution of this agreement by both parties,within 7 business days.The total compensation to the Contractor shall not exceed$4,620. List of all Contractor Employees working for the City of Cupertino (if no Employees,identify "self"): i i 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. 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 n a ;t 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. 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. 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. 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 subrogadQn 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. 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 Stale of California County of Santa Clara City of Cuperlino I,the undersigned,declare as follows: I am an independent contractor and the owner of / 1164l `111,o� OS4 LG 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 ofworkers'compensation insurance to the City ofCupertino for any and all employees I may have,pursuant to seetio»12 of the City of Cupen inci 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 tlw foregoing is truce and corrcci. Executed on this/H day of 4�J/ ,2019,at California. J i Gr/(/,c F1se-IA" PRINT NAME �I I SIGNATUR.' 1 I DATE _ CERTIFICATE OF LIABILITY INSURANCE 6/17/2019 v 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: Larry Cossio I -_. ..............--- Cossio Insurance Agency Phone (864)688-0121 Fax PO Box 5987 (A/C,No,Ext): (A/C No): Greenville,SC 29606 E-Mail: 1 taylor@cossioinsurance.com (864)688-0121 --- - -....-------- - INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Nationwide Mutual Insurance Company 23787 Mobile Climb USA,LLC INSURER B: Berkley Life&Health Insurance Company 64890 7960 B Soguel Drive Suite#136 Aptos,CA 95003 INSURER C: INSURER INSURER E: 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. INSR TYPE OF POLICY ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDDIYY) (MMIDDIYY). X COMMERCIAL GENERAL LIABILITY General Agg(Other than Products-C $5,000,000 ❑❑ CLAIMS MADE ❑X OCCUR Each Occurrence $1,000,000 Products and Completed Operations $1,000,000 ❑ Personal and Advertising Injury $1,000,000 A ❑ x X FWC0000030654900 5/31/2019 5/31/2020 Legal Liability to Participants $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER Professional Liability(for Event Plan $1,000,000 X POLICY ❑PROJECT ❑LOC Damages to Premises Rented to You $300,000 Participant Accident-ExcessMedica $10,000 ❑OTHER: Deductible None AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑ ANY AUTO (Ea accident) ALL OWNED SCHEDULED BODILY INJURY(Per Person) $ ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS NON-OWNED BODILY INJURY(Per accident) $ ❑ AUTOS ❑ ❑ PROPERTY DAMAGE $ (Per a c dent) ❑ UMBRELLA LIAS ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS-MADE ❑ DED ❑ RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below Accident Medical Deductible $100 Benefit Period 52 weeks B Accident Medical PAI L012010577102 6/31/2019 5/31/2020 Benefit Maximum $500,000 Applies During per Covered Accident Applies To Death&Dismemberment Benefits only DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Party Equipment Rentals Operations located at 7960 B Soquel Drive#136 Aptos,CA 95003.Certificate Holder is listed as additional insured per form CG2026.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 Amusement devices on file with the company for special event(s)dated 7/6/2019 to 5/31/2020 located at 10455 Miller Avenue,Cupertino,CA 95014.The City,its City Council, boards and commissions,officers,officials,employees,agents,servants and volunteers are to be covered as additional insureds. CERTIFICATE HOLDER: CANCELLATION City Of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10300 Torre Avenue THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cupertino,CA 95014 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: FWC0000030654900 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s): City Of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees,Agents, Servants and Volunteers 10300 Torre Avenue Cupertino, CA 95014 Re: Special event(s)dated 7/6/2019 to 5/31/2020 located at 10455 Miller Avenue, Cupertino, CA 95014 The city,state or governmental agency or subdivision shown in the Schedule is subject to the following provision: 1.This insurance applies only with respect to operations performed by you or on your behalf for which the city, state or governmental agency or subdivision has issued a permit or authorization. Coverage does not extend to the negligence or errors &omissions of the additional insured 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by your acts or provide for such additional insured. omissions or the acts or omissions of those acting B. With respect to the insurance afforded to these on your behalf: additional insureds, the following is added to 1. In the performance of your ongoing operations; Section III—Limits Of Insurance: or If coverage_ provided to the additional insured is 2. In connection with your premises owned by or required by a contract or agreement, the most we rented to you. will pay on behalf of the additional insured is the However: amount of insurance: 1. The insurance afforded to such additional 1. Required by the contract or agreement; or insured only applies to the extent permitted by 2. Available under the applicable Limits of law; and Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 DATE(MM/DDlYYYY) ACORV VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE 06/06/2019 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. This form is used to report coverages provided to a single specific vehicle or equipment.Do not use this form to report liability coverage provided to multiple vehicles under a single policy.Use ACORD 25 for that purpose. PRODUCER CONTACT NAME: NATI-iAN JONES _ StateFarm STATE FARM,NATHAN JONES AGENT PHONE 831-763-4200 FAX 831-763A250 A/C No Ell): A/C No �� 2000 FREEDOM BLVD ADDRESS: lilly.hernandez.nant@statefarm.com FREEDOM CA 95019 PRODUCER CUSTOMER ID#: 1NSURER(S)AFFORDING COVERAGE NAIC 0 INSURED INSURER A: State Farm Mutual Automobile Insurance Company 25178 GENE FISCHER INSURERB: 655 SAINT ANDREWS DR INSURER C: APTOS,CA95003-5424 INSURER D: INSURER E: DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MAKE 1 MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 1999 DODGE RAM 2500 PICKUP IB7KC2362XJ503822 DESCRIPTION VEHICLE/EQUIPMENT VALUE SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICY(IES)OF INSURANCE LISTED BELOW HASIHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S)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 POLICY(IES)DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR Aoot POLICY EFFECTIVE POLICY EXPIRATION LTR INSR. TYPE OF INSURANCE POLICY NUMBER DATE(MMJDD/YYYYI DATE(MMIDD/YYYY) LIMITS X VEHICLE LIABILITY COMBINED SINGLE LIMIT S S 094 3059-C13-05D 03l13/2019 09/1312019 BODILY INJURY(Perperscn) 250,000 BODILY INJURY(Per accident) S 500,000 PROPERTY DAMAGE S 100,000 GENERAL LIABILITY EACH OCCURENCE $ OCCURRENCE GENERAL AGGREGATE S CLAIMS MADE S! INSR LOSS POLICY EFFECTIVE POLICY EXPIRATION LTR PAYEE TYPE OF INSURANCE POLICY NUMBER DATE(MMIODIYYYY) DATE(MMIDDIYYYY) LIMITS I DEDUCTIBLE VEH COLLISION LOSS ❑ACV ❑AGREED AMT $ LIMIT ❑ ❑STATED AMT S BED X VEH COMP VEH OTC ❑ACV ❑AGREED AMT S LIMIT 094 3059-C13-05D 03l13/2019 09/13I2019 ❑ ❑STATED AMT $ 500 DED EQUIPMENT ACV ❑AGREEDAMT BASIC El BROAD ❑PC ❑STATED AMT $ LIMIT SPECIAL ❑ $ DEO REMARKS(INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES)(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ADDITIONAL INTEREST CANCELLATION Select one of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The additional interest desenbed below has been added to the pollcy(ies)listed herein by policy number(s) BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE A request has been submitted to add the additional Interest described below to the policy(ies) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Itsled herein by policynumber M VEHICLE I EQUIPMENT INTEREST: LEASED FINANCED DESCRIPTION OF THE ADDITIONAL INTEREST NAME AND ADDRESS OF ADDITIONAL INTEREST ADDITIONAL INSURED LOSS PAYEE LENDER'S LOSS PAYEE LOAN I LEASE NUMBER AUTHORIZED REPRESENTATIVE 01997-2015 ACORD CORPORATION.All rights reserved. ACORD 23(2016103) The ACORD name and logo are registered marks of ACORD 1004361 142987.3 01.26.2016