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20-001 Sheri Bortz CITY OF No. 13 M019-2021 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties. This contract is made by and between the City of Cupertino, a municipal corporation ("City"), and SHERI BORTZ ("Contractor"), a SOLE PROPRIETOR for YOGA INSTRUCTION and is effective on the last date signed below("Effective Date"). 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 6/30/2021 ("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. The City's appropriate department head or the City Manager may extend the Contract Time through a written amendment to this Agreement, provided such extension does not include additional contract funds.Extensions requiring additional contract funds are subject to the City's purchasing policy. 4. Compensation.City will pay Contractor for satisfactory performance of the Services an amount that will be based upon actual costs but that will be capped so as not to exceed $2,500 1 BETWEEN JANUARY 2020 AND JUNE 30,2020,AND$5,000 BETWEEN JULY 1,2020 AND JUNE 30, 2021. ("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 thirty(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 the final payment. 5. Independent Contractor. 5.1 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 Recreation Services Agreement/Rev.Sept.2019 Page 1 of 7 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,if required by the Cupertino Municipal Code. 5.2 Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes.Contractor and any of its employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority,vacation time,vacation pay,sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits,social security,disability,unemployment,workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor's business including,but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Should any court, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS), the Internal Revenue Service or the State Employment Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is an employee for any purpose, then Contractor agrees to a reduction in amounts payable under this Agreement, or to promptly remit to City any payments due by the City as a result of such determination, so that the City's ! total expenses under this Agreement are not greater than they would have been had i the determination not been made. 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 as 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,to the extent requested by City, constitute City property upon completion of the work to be performed hereunder or upon termination of this Agreement. 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(4)years from the date of City's final payment. Recreation Services Agreement/Rea.Sept.2019 Page 2 of 7 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(1)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 and active 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.This Section 11 shall survive termination of the Agreement. 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 j 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 Agreement. 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 VIE[of the Civil Rights Act of 19K 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, worldng 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. Consultant 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 Recreation Services Agreement/Rev.Sept.2019 Page 3 of 7 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 fingerprints and a criminal background 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,AB 2007,and other laws pertaining to concussion evaluation,removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, htWs://www.edc.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 Parks&Recreation Services Instructor Manual. Check one(if applicable): ❑ This contract requires services for children. Ll 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 Parks&Recreation 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:Jason Bisely Name:Sheri Bortz Position:Recreation Coordinator Position:Instructor Contact:JasonB@cupertino.org Contact: Recreation Services Agreement/Rev.Sept.2019 Page 4 of 7 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 18 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 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 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 any term,clause,or provision of the main contract and any term,clause,or provision of the attachments or exhibits thereto,the terms of the main contract shall prevail and be controlling. i 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. Recreation Services Agreement/Rev.Sept.2019 Page 5 of 7 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(5th) 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 Cc:Representative/Coordinator: Cc:Representative/Coordinator: Jason Bisely Sheri Bortz Email:JasonB@cupertino.org Email: 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 j together,constitute a single binding instrument. IN WITNESS WHEREOF,the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO SHERI BORTZ A Municipal Corporation By By r Name ✓51 Name YA m . �s Title Gf L� Title w Date r" a " Z Date 2, l� Tax I.D.No.:Refer to W-9 Recreation Services Agreement/Rev.Sept.2019 Page 6 of 7 APPROVED AS TO FORM: ATTEST: HEATHER M. MINNER KIRSTEN SQUARCIA 2-1 2-Li 12 Cupertino City Attorney erg City Clerk Contract/Encumbered Amount: $2,500 BETWEEN JANUARY 2020 AND JUNE 30,2020,AND $5,000 BETWEEN JULY 1, 2020 AND JUNE 30,2021. Account No.: 100-62-623 700-702 9 j li i J a i 1 Recreation Services Agreement/Rev. Sept.2019 Page 7 of 7 EXHIBIT A SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide YOGA INSTRUCTION in,but not limited to,the following: YOGA Location and Time of CONTRACTOR Services: Refer to the Recreation Schedule dated MARCH/APRIL 2020,MAY/TUNE 2020,DULY/AUGUST 2020, SEPTEMBER/OCTOBER 2020,NOVEMBER/DECEMBER 2020,JANUARY/FEBRUARY 2021, MARCH/APRIL 2021,AND MAY/JUNE 2021 for agreed upon dates,times,and class locations.The City,at its sole discretion,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:EIGHTY PERCENT(80%)OF REVENUE GENERATED PER SESSION BASED ON FINAL CLASS ROSTER PLUS SIXTY PERCENT(60%)OF REVENUE FOR DROP-IN PASSES.A TWENTY-FIVE($25)DOLLAR ADMINISTRATION FEE WILL BE DEDUCTED FROM THE FIRST PAYMENT OF EACH FISCAL YEAR.CONSULTANT SHALL PROVIDE ALL TEACHING SUPPLIES SUCH AS,BUT NOT LIMITED TO,DRY ERASE MARKERS, ERASERS,AND HANDOUTS.CONSULTANT PAYS FOR COPY SERVICE AT THE SENIOR CENTER AT$0.10 PER PAGE.The total compensation to the Contractor shall not exceed $7,500. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: 4 Maximum: 20 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 Requirenten.ts for Recreation Contracts As required by the Agreement, Contractor shall procure prior to commencement of Services and maintain the following insurance for the duration of the Agreement 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. a)It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy,whichever is greater. b)Additional Insured coverage under Consultant's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c)The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance,provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City's own insurance or self-insurance shall be called upon to protect City as a named insured. 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. X Otherwise,proof of Contractor's personal auto insurance with limits required by state lawsuffices. 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. I Required if Contract involves services to children. Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance. Exh.B Insurance for Recreation Contracts Updated Sept. 2019 1 OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Additional Insured Status The City of Cupertino, its City Council,officers, officials, employees, agents, servants and volunteers ("Additional Insureds")are to be covered as additional insureds on Consultant's CGL and automobile liability policies. General Liability coverage can be provided in the form of an endorsement to Consultant's insurance(at least as broad as ISO Form CG 20 10 (11/85)or both CG 20 10 and CG 20 37 forms,if later editions are used). Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees,or volunteers shall be excess of Consultant's insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire,except with written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Waiver of Subrogation Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically,the Workers' Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City. At City's option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, or better. Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements (or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior to commencement of the Contract. City retains the right to demand verification of compliance at any time during the Contract term. Subconsultants Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant's insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above,City shall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk,prior experience, insurer or other special circumstances,with not less than ninety(90)days prior written notice. Exh.B Insurance for Recreation Contracts Updated Sept. 2019 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 contractor and the owner of I wish to enter into a services contract with the City of Cuper o. 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 g g 1 is true and correct. 26 2a Executed on this day of Jr-x4-1 ;at A-eeJ,California. L � PRINT NAME � z SIGNATURE DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 12/20/2019 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Maguire Insurance Agency,Inc.FWI ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 Bala Plz Ste 100 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR Bala Cynwyd,PA 19004--1401 610.617.7900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Philadelphia Indemnity Insurance Company 18058 Sheri Bortz INSURER B: INSURER D: INSURER E: COVERAGES 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 CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L I POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS A X GENERAL LIABILITY 12/14/2019 12/14/2020 EACH OCCURENCE $2,000,000 TXPRCMEMCES'ONA' ERIA GENERALLIABILITY PREMISES Ea occurrence $100,000 CLAIMSMADE � OCCUR MED EXP(Any one person) $2,500 L LIABILITY PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $4,000,000 X POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (EA accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY—EA ACCIDENT ANYAUTO OTHERTHAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURENCE OCCUR ❑ CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION EMPLOYERS'LIABILITY Y N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUD El E.L.EACH ACCIDENT (Mandatory in NH) E.L.DISEASE—EA AMPLOYEE If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE—POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole negligence. The City of Cupertino,its City Council,officers,officials,employees,agents,servants and volunteers are added as Additional Insureds. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of Cupertino THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 10300 Torre Ave CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR Cupertino,CA 95014- LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) © 1988-2009 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY CHANGE DOCUMENT POLICY NO: CHANGE # 5 CHANGE EFFECTIVE: 12/17/2019 Philadelphia Indemnity Insurance Company PRODUCER: Maguire Insurance Agency, Inc. FWI NAMED INSURED: Sheri Bortz MAILING ADDRESS POLICY PERIOD: FROM 12/14/2019 TO 12/14/2020 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected, the policy is amended as indicated below: Add Certificate Holder and endorsements. City of Cupertino 10300 Torre Ave Cupertino, CA 95014 Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Total Prorate Additional/Return Additional/Return Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $0.00 Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s : Locations Of Covered Operations The City of Cupertino,its City Council,officers,officials, employees,agents,servants and volunteers 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 additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury"or "property damage"occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of 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 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: The city or Cupertino,its City Council,officers,officials,employees,agents, servants and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the"products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. ISO Properties, Inc. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 13 PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers Effective Date: 1 211 4/2 01 9 SECTION II—WHO IS AN INSURED is amended to include as an additional insured the person(s)or organization(s)shown in the endorsement Schedule, but only with respect to liability for"bodily injury," "property damage" or"personal and advertising injury" arising out of or relating to your negligence in the performance of"your work"for such person(s)or organization(s)that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III—LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. State Farm Mutual Automobile Insurance Company PO Box 853919 • Richardson, 7X 75085-3919 •• State Farm, AT2 A-6191 A BORTZ, SHERI L PREMIUM PAID: $373.85 DO NOT PAY. Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: Your State Farm Agent MIMI LAM INSURANCE AGENCY INC Policy Number: Office: 650-237-9168 Policy Period: January 19,2020 to July 19,2020 Address:2083 OLD MIDDLFLD WAY STE 206 Vehicle: MOUNTAIN VIEW, CA 94043-2466 If you have a new orddferent car,have added any drivers,orhave moved, Principal Driver: please contact your agent. SHERI L BORTZ Thank you for choosing State Farm. Your auto insurance rates are impacted by the mileage your When you provide a check as payment,you authorize us vehicle is driven.To ensure we've priced our insurance either to use information from your check to make a coverage accurately based on the number of miles you one-time electronic fund transfer from your account or to drive,we tried to obtain valid mileage information for this process the payment as a check transaction.When we use vehicle through a third party provider.We were unable to information from your check to make an electronic fund obtain odometer readings and have applied an average transfer,funds may be withdrawn from your account as soon annual mileage using information from a third party provider as the same day we receive your payment,and you will not and some of your vehicle and policy characteristics. Please receive your check back from your financial institution. contact your State Farm agent with questions. Policy Number: Page number 1 of 4 Prepared December 13,2019 1004583 143562 202 01-15-2018 Watch for Discounts Ahead. Your auto insurance premium is $373.85. Did you know you may qualify for a discount? " f1" Call State Farm° Agent MIMI LAM INSURANCE AGENCY INC at 650-237-9168 `Not all discounts are available in every state,and discount amounts may vary by state. :. StateFarm VEHICLE INFORMATION Review your policy information carefully. If anything is incorrect,or if there are any changes to your vehicle information,please let us know right away. Vehicle Identification Vehicle Description Number(VIN) Who principally drives this vehicle? How is this vehicle normally used? SHERI BORTZ, To Work,School or Pleasure. January 19,2020. The premium on the expiring policy term was based on Premium Adjustment 10,300 miles per year. Each year,we review our medical payments and personal The premium on the renewal policy term was based on injury protection coverages claim experience to determine 8,300 miles per year. the vehicle safety discount that is applied to each make and The premium for this renewal was determined using an model. In addition,we review the comprehensive,collision, annual mileage this vehicle is expected to be driven that bodily injury and property damage claim experience was developed from information we obtained or was annually to determine which makes and models have provided by you.The national average is more than 12,000 earned decreases or increases from State Farm's standard miles driven annually according to the U.S. Department of rates. If any changes result from our reviews, adjustments Transportation. Please contact us if you expect your annual are reflected in the rates shown on this renewal notice, mileage to change over the next year. DRIVER INFORMATION Assigned Driver(s) The following driver(s)are assigned to the vehicle(s)on this policy. Driving Experience as of Marital Name January 19,2020 Status SHERI L BORTZ Principal Driver&Assigned Drivers premium may be influenced by the information shown for For each automobile,the Principal Driver is the individual these drivers. who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that they most frequently drive.Your COVERAGE AND LIMITS See yourpolicy for an explanation of these coverages. A Liability Bodily Injury 250,000/500,000 Property Damage 100,000 $189.38 C Medical Payments 5,000 $12.09 D 100 Deductible Comprehensive $16.38 G 500 Deductible Collision $89.86 H Emergency Road Service $3.84 R1 Car Rental&Travel Expense 80% Per Day, $500 Max $12.88 (continued on next page) Policy Number: Page number 2 of 4 Prepared December 13,2019 . . StateFarm® COVERAGE AND LIMITS continued U Uninsured Motor Vehicle Bodily Injury 250,O00/500,000 $47.17 U1 Uninsured Motor Vehicle Property Damage $2.25 Total Premium $373.85 If any coverage you carry is changed to give broader you the broader protection without issuing a new policy, protection with no additional premium charge,we will give starting on the date we adopt the broader protection. DISCOUNTS These adjustments have already been applied to your premium. Multiple Line ✓ Driving Safety Record ✓ California Good Driver ✓ Loyalty ✓ Total Discounts $1,206.19 Other Available Discount(s) You may be eligible for additional discounts See the enclosed insert for more information. Mature Driver SURCHARGES AND DISCOUNTS Driving Safety Record Rating Plan insurer due to damage to any property in the amount of Your driving safety record,along with other rating factors, more than$1000. For accidents occurring prior to determines what you pay for Liability, Medical Payments, December 11,2011,an accident shall be chargeable Comprehensive, Collision,and Uninsured Motor Vehicle provided it resulted in death or in payment(s)by an insurer Coverages. Policyholders with no accidents and convictions due to damage to any property in the amount of more than pay less than those with accidents and convictions. $750. The Driving Safety Record Rate Level that is assigned to For applicants without prior insurance at the time of the your policy moves up,down,or stays the same every policy accident,an accident shall be chargeable provided it renewal,depending upon your driving record. For every 12 resulted in damage to any property in the amount of more months since the renewal following the occurrence of a than $1000(more than$750 if the accident occurred prior to chargeable accident or the conviction of a minor violation, December 11,2011). the initial assigned Driver Record Level for that chargeable Chargeable accidents for renewal business are those which accident or conviction shall be lowered by 1 level. For each resulted in bodily injury or death or State Farm claim 12 month period since the conviction of a major violation, payments totaling more than$1000(more than $750 for the initial assigned Driver Record Level for that conviction accidents occurring prior to December 11, 2011)under shall be lowered by 2 levels. The Rate Level is increased if property damage liability coverage and collision coverage there are subsequent chargeable accidents or convictions. combined. Definition of Chargeable Accidents For more information about the rating plan, please contact Chargeable accidents for new business are those which your State Farm agent. resulted in bodily injury or death or in payment(s) by an (continued on next page) Policy Number: Page number 3 of 4 Prepared December 13,2019