20-001 Sonia Dogra___________________________________________________________________________________________________
Recreation Services Agreement/ Rev. Sept. 2019
Page 1 of 7
No. ___________
FY2020-2022
RECREATION SERVICES AGREEMENT
1. Parties. This contract is made by and between the City of Cupertino, a municipal
corporation (“City”), and SONIA DOGRA (“Contractor”), a FITNESS INSTRUCTOR for BOMBAY JAM
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 6/30/2022 (“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 $5,000.00
(“Contract Price”), based upon the Scope of Services, budget, performance schedule, and rates included
in Exhibit A. The maximum compensation includes all costs, expenses, and reimbursements and will
remain in place even if Contractor’s actual costs exceed the capped amount. Contractor must submit
invoices and the information required in Exhibit A in order to receive payment. City will compensate
Contractor within 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
and qualifications to perform the Services in a competent and professional manner.
___________________________________________________________________________________________________
Recreation Services Agreement/ Rev. Sept. 2019
Page 2 of 7
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
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/ Rev. Sept. 2019
Page 3 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
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 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. 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 4 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,
https://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 Parks & Recreation Services Instructor Manual.
Check one (if applicable):
This contract requires services for children.
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:
Name: Colleen Ferris
Position: Recreation Coordinator
Contact: colleenf@cupertino.org
For Contractor:
Name: SONIA DOGRA
Position: Fitness Instructor
Contact:
___________________________________________________________________________________________________
Recreation Services Agreement/ Rev. Sept. 2019
Page 5 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.
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.
Jennifer Koverman
Jun 9, 2020
Recreation Supervisor
Jennifer Koverman
___________________________________________________________________________________________________
Recreation Services Agreement/ Rev. Sept. 2019
Page 7 of 7
APPROVED AS TO FORM:
_____________________________
HEATHER M. MINNER
Cupertino City Attorney
Contract/Encumbered Amount: $5,000.00
Account No.: 570 63 621 700 702
ATTEST:
_____________________________
KIRSTEN SQUARCIA
City Clerk
Date _______________________
Heather M. Minner
Jun 9, 2020
Updated 4/15/20
EXHIBIT A
SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide FITNESS INSTRUCTOR in, but not limited to, the following:
BOMBAY JAM
Location and Time of CONTRACTOR Services:
Refer to the Recreation Schedule dated MONTHLY FITNESS SCHEDULE for agreed upon dates,
times, and locations of a class, camp, activity, program, or service (“class”). The City, at its sole
discretion, may change the agreed dates, times and locations of a class, or may cancel a class.
Compensation for CONTRACTOR Services:
Contractor shall be compensated for services performed pursuant to this Agreement.
For a class taught in person, $37/class.
City and Contractor may mutually agree for Contractor to teach a class online rather than in person,
provided that City and Contractor reach agreement for compensation for that online class.
Compensation for that online class shall be specified in writing in a separate side agreement before
online instruction for a class begins.
The total compensation to the Contractor shall not exceed $5,000.00.
Eligible Participant Minimum and Maximums for CONTRACTOR Services:
Minimum: 15
Maximum: 50
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 Contractor 2 Contractor 3 Contractor 4
Contractor 5 Contractor 6 Contractor 7 Contractor 8
Contractor 9 Contractor 10 Contractor 11 Contractor 12
Contractor 13 Contractor 14 Contractor 15 Contractor 16
Contractor 17 Contractor 18 Contractor 19 Contractor 20
Updated 4/15/20
Performance of CONTRACTOR Services
Class Cancellation
Contractor will only receive compensation for a class that is performed. If performance of a class is
cancelled by the City or Contractor before instruction begins, Contactor will not receive compensation
for the class. If the City or Contractor cancels performance of certain meetings of a class, Contractor
will only receive compensation for those meetings of the class that are performed.
In the case Contractor unilaterally cancels performance of a class without City approval, City reserves
the right to immediately and without notice cancel the remainder of classes offered and or performed
by Contractor.
COVID-19 Health Order Compliance
Contractor acknowledges that its duty to comply with Laws, as stated in Section 13 of the Agreement,
includes compliance by Contractor with the restrictions on travel and the Social Distancing
Requirements set forth in Section 13.k of the health order issued by the County of Santa Clara Public
Health Department on March 31, 2020, in response to the COVID-19 pandemic, and any subsequent
amendments or superseding orders thereto (the “Health Order”), and any other local, state, or federal
laws or policies that have been or may be enacted in response to the COVID-19 pandemic
(collectively, “Health Laws”). Contractor shall comply with these restrictions on travel and Social
Distancing Requirements when preforming work under this Agreement. If this Agreement specifies
work that cannot be performed in compliance with the Health Order or Health Laws, Contractor shall
refrain from conducting the work and immediately inform the City. Contractor shall likewise comply
with any City protocols designed to help prevent the spread of COVID-19. Contractor acknowledges
that the need to comply with the Health Order and Health Laws may result in the City canceling
performance of any class or meetings of a class referenced in this Agreement.
Registration, Enrollment, and Supervision
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.
Injury of a Class Participant
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.
Exh. B Insurance for Recreation Contracts Updated May 2020
1
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. law
2. Automobile Liability (select one):
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.)
Proof of Contractor’s personal auto insurance with limits required by state law. (Contractor shall
not transport or use its personal vehicle to transport participants or perform work under this
contract.)
Automobile insurance is waived. (Contractor shall never use a vehicle while working under this
contract, other than to commute to and from the work site. Contractor shall not use a vehicle to
travel between City sites, between classes, etc.)
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.
Exhibit B
Insurance Requirements for Recreation Contracts
Exh. B Insurance for Recreation Contracts Updated May 2020
2
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/coverages based on the nature of the risk, prior
experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice.
1223215.2
The Medical Protective Company®
A STOCK INSURANCE COMPANY
5814 Reed Road, Fort Wayne, Indiana 46835
Strength. Defense. Solutions. Since 1899.
MULTI–SPECIALTY HEALTHCARE PROFESSIONAL – CERTIFICATE
Policy
Period: 09/10/2019 To: 09/10/2020
at 12:01 a.m. Standard Time at the address of the First Named Insured. Certificate Number: W14950
Item 1(a) Named Insured: Student Non-Insured acting in the capacity of an Administrative
First Named Insured
Professional Services Specialty: Fitness Professional (Group Fitness Instructor)
Classification: 39
First Named Insured Address: Item1 (b) Additional Insureds:
Sonia Dogra
New Business X Renewal Business
COVERAGES: POLICY TYPE*
Occurrence Standard
Claims Made
Convertible
Claims Made
RETROACTIVE DATE LIMITS OF LIABILITY
Per Claim / Aggregate
PROFESSIONAL LIABILITY
A. Professional Liability (PL) &
B. Good Samaritan Acts
C. Assault Upon You
D. First Aid
E. Medical Payments
F. Deposition Fees
- Administrative Hearing Expense
- Sexual Misconduct Expense
- Loss of Earnings
- HIPAA Proceeding Expense
X
$1,000,000
$25,000
$15,000
$25,000
$10,000
$25,000
$25,000
$2,500
$25,000
$3,000,000
$25,000
$15,000
$100,000
$10,000
$100,000
$25,000
$35,000
$25,000
WORKPLACE LIABILITY
A. Healthcare Professional Premises
Liability &
B. Personal Injury Liability
X
Included in Professional Liability Limit
Workplace Liability does not apply if the General Liability Insuring Agreement is made part of your coverage.
EMPLOYMENT PRACTICES LIABILITY**
CYBER LIABILITY
- Network Security & Privacy
- Regulatory Fines & Penalties
- Patient Notification & Credit
Monitoring Costs
- Data Recovery Costs
- General Cyber Annual Aggregate
BILLING ERRORS & OMMISSIONS
COMMERCIAL GENERAL LIABILITY
- Each Occurrence Limit
- Damages to Premises Rented
to an Insured Business
- Personal & Advertising Injury
- General Aggregate Limit
- Product Completed Operations Aggregate
- Hired and Non–Owned Auto
General Liability does not apply if the Workplace Liability Insuring Agreement is made part of your coverage.
FORMS & ENDORSEMENTS: 18511 18519 18522 18528 18550 18709
19510
Master Policy Number: MMPOC20000
RISK PURCHASING GROUP NOTICE: An insurance policy purchased from The Medical IN WITNESS WHEREOF, The Medical Protective Company has caused
this policy to be signed by its President and Corporate Secretary (and
countersigned by its duly Authorized Representative, where necessary).
President
Secretary
Protective Company through a risk purchasing group may not be subject to all state insurance laws and
regulations. No claim against a risk purchasing group, or its members, shall be entitled to payments from any
state insurance insolvency guaranty fund, or similar mechanism. A purchasing group, or its members, or
claimants against the group or its members, may not receive any benefit from such guaranty fund, or similar
mechanism, for claims arising under the insurance policies procured through the purchasing group.
Premium: $ 82.00
Surcharges:
Taxes: $ 0.00
TOTAL: $ 82.00
For Service or questions, please call:
Program Administrator CPH & Associates,
312.987.9823 or Toll-Free 1-800-875-1911
NOTICE
*THIS POLICY CONTAINS CLAIMS-MADE COVERAGE.
**EPLI COVERAGE CONTAINS A SEPARATE LIMIT FOR DEFENSE COSTS AND INDEMNITY
ONLY.
**DEFENSE COSTS ARE PAID WITHIN THE DEFENSE COSTS LIMIT OF LIABILITY
LIMITS MAY CHANGE BY COVERAGE PROVISION OR ENDORSEMENT.
PLEASE READ YOUR POLICY AND ENDORSEMENTS CAREFULLY.
DISCUSS WITH YOUR INSURANCE AGENT IF NEEDED.
Countersignature / Authorized Representative:
18004 08/13
The Medical Protective Company ®
A STOCK INSURANCE COMPANY
5814 Reed Road, Fort Wayne, Indiana 46835
Strength. Defense. Salutions. Since 1899.
MULTI-SPECIAL HEALTHCARE PROFESSIONAL
MASTER POLICY
ADDITIONAL INSURED ENDORSEMENT
ADD/DELETE/AMEND
First Named Insured: Sonia Dogra
Effective Date: 09/10/2019
Expiration Date: 09/10/2020
Issue Date: 09/12/2019
Master Policy Number: MMPOC20000
Certificate Number: W14950
All effective dates are 12:01 a.m. Standard Time at the address of the First Named Insured.
In consideration of a modification of premium, if any, it is understood and agreed:
Item 1(b) Additional Insured stated in your Certificate is amended as listed on the Schedule of Additional Insured Change(s)
below.
All other terms and conditions of the Policy remain unchanged.
19068 08/13
SCHEDULE OF ADDITIONAL INSURED CHANGE(S)
ADD
DELETE
OR
AMEND
ITEM 1(b) ADDITIONAL
INSURED
AFFILIATED
ITEM 1(a)
NAMED
INSURED
RETRO-
ACTIVE
DATE
(If Applicable)
EFFECTIVE
DATE
PREMIUM/
SURCHARGE/
TAXES
(If Applicable)
ADD
The City of Cupertino, Its City Council, Boards and
Commissions, Officers, Officials, Employees,
Agents, Servants and Volunteers.
21111 Stevens Creek Blvd
Cupertino, CA 95014
09/12/2019
19068 08/13
Form_SCTNID_CTGRY.CA01186489_DECPAGE
60751793 Q IC94549 INS DECPAGE E POLWHITEFONT EZIPN7AEHXBWULG7JHDMEMKLTD0001 RPUID TRACWHITEFONT
Policy Number:
Underwritten by:
United Financial Cas Co
December 27, 2019
Policy Period: Jan 29, 2020 - Jul 29, 2020
Page of 1 3
Make payments, check billing activity, update
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progressive.com
policy information or check status of a claim.
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1-800-776-4737
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
SONIA DOGRA AJAY DOGRA
Auto Insurance
Coverage Summary
This is your Renewal
Declarations Page
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on January 29, 2020 at 12:01 a.m. This policy expires on July 29, 2020 at 12:01 a.m.
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for a vehicle
may not be combined with the limits for the same coverage on another vehicle. The policy contract is form 9611D CA (09/16). The
contract is modified by form Z357 CA (12/15).
Your email address
Any policy-related emails will be sent to the email address currently listed on your policy: sdogra1@gmail.com.
If you want to update your email address, please call us.
Underwriting Company
United Financial Cas Co
Drivers and household residents Years licensed Years experienced Marital status ………………………………………………………………………………………………………………………………………………………..Sonia Dogra 19 23 Married
Additional information: Named insured ………………………………………………………………………………………………………………………………………………………..Ajay Dogra 19 25 Married
Additional information: Named insured
Outline of coverage
Garaging ZIP Code: Annual miles: Vehicle use:
VIN: 12530 Pleasure
Limits Deductible Premium………………………………………………………………………………………………………………………………………………………..Liability To Others $286
Bodily Injury Liability $100,000 each person/$300,000 each accident
Property Damage Liability $50,000 each accident………………………………………………………………………………………………………………………………………………………..Uninsured/Underinsured Motorist $100,000 each person/$300,000 each accident 30………………………………………………………………………………………………………………………………………………………..Uninsured Motorist Property Damage $3,500 each accident 5………………………………………………………………………………………………………………………………………………………..Total premium for 2005 HONDA $321
Form 6489 CA (01/18)4
Continued
60751793 Q IC94549 INS DECPAGE E POLWHITEFONT EZIPN7AEHXBWULG7JHDMEMKLTD0001 RPUID TRACWHITEFONT
Policy Number: 60751793
Sonia Dogra
Ajay Dogra
Page of 2 3
Garaging ZIP Code: Annual miles: Vehicle use:
VIN: 10000 Commute
Limits Deductible Premium………………………………………………………………………………………………………………………………………………………..Liability To Others $155
Bodily Injury Liability $100,000 each person/$300,000 each accident
Property Damage Liability $50,000 each accident………………………………………………………………………………………………………………………………………………………..Uninsured/Underinsured Motorist $100,000 each person/$300,000 each accident 20………………………………………………………………………………………………………………………………………………………..Comprehensive Actual Cash Value $500 15………………………………………………………………………………………………………………………………………………………..Collision Actual Cash Value $500 418………………………………………………………………………………………………………………………………………………………..Total premium for $608
Garaging ZIP Code: Annual miles: Vehicle use:
VIN: 12000 Commute
Limits Deductible Premium………………………………………………………………………………………………………………………………………………………..Liability To Others $323
Bodily Injury Liability $100,000 each person/$300,000 each accident
Property Damage Liability $50,000 each accident………………………………………………………………………………………………………………………………………………………..Uninsured/Underinsured Motorist $100,000 each person/$300,000 each accident 42………………………………………………………………………………………………………………………………………………………..Comprehensive Actual Cash Value $500 48………………………………………………………………………………………………………………………………………………………..Collision Actual Cash Value $500 513………………………………………………………………………………………………………………………………………………………..Total premium for $926………………………………………………………………………………………………………………………………………………………..Subtotal policy premium $1,855.00 ………………………………………………………………………………………………………………………………………………………..
Anti-Fraud fee 2.64 ………………………………………………………………………………………………………………………………………………………..Total 6 month policy premium $1,857.64
Payment schedule
Jan 29, 2020 .......................$319.87
Feb 29, 2020 .......................$317.16
Mar 29, 2020 ......................$317.16
Apr 29, 2020 .......................$317.16
May 29, 2020 ......................$317.16
Jun 29, 2020 .......................$317.13
An installment fee of $8.00 has been included in each payment. You may avoid paying installment fees by paying your
premium of $1,857.64 in full by January 29, 2020. You may reduce the amount you pay in installment fees by paying
your premium in larger amounts and fewer installments. Please call 1-800-776-4737 for details.
The following additional fees may apply:
Late payment fee $10.00
Fee for returned checks or refused payments $20.00
Premium discounts
………………………………………………………………………………………………………………………………………………………..Policy
60751793 Multi-Car
………………………………………………………………………………………………………………………………………………………..Driver
Sonia Dogra Good Driver
Ajay Dogra Good Driver
………………………………………………………………………………………………………………………………………………………..Vehicle
2019 TESLA
MODEL 3
Vehicle Tracking System
Lienholder and additional interest information
Vehicle Lienholder Additional interest………………………………………………………………………………………………………………………………………………………..
2019 TESLA MODEL 3
5YJ3E1EB6KF199719
US BANK
OSHKOSH, WI 54903
Form 6489 CA (01/18)4
Continued
60751793 Q IC94549 INS DECPAGE E POLWHITEFONT EZIPN7AEHXBWULG7JHDMEMKLTD0001 RPUID TRACWHITEFONT
Policy Number: 60751793
Sonia Dogra
Ajay Dogra
Page of 3 3
Vehicle Lienholder Additional interest………………………………………………………………………………………………………………………………………………………..
ACAR LEASING
MINNEAPOLIS, MN 55439
ACAR LEASING
MINNEAPOLIS, MN 55439
Your right to advance notice of renewal
California law requires insurers to provide either an offer to renew at least 20 days before policy expiration or a written
notice of nonrenewal at least 30 days before expiration. If we fail to give this offer or notice in the specified timeframes
listed above, the existing policy with no changes in its terms and conditions, will remain in effect for 30 days from the date
that either the offer to renew or the notice of nonrenewal is mailed to you. However, your policy shall terminate on the
effective date of any other replacement or succeeding automobile insurance policy with respect to any automobile
designated in both policies, even if you do not receive a timely offer to renew or notice of nonrenewal.
Company officers
President Secretary
Form 6489 CA (01/18)
CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE
Form: SML Safeguard Wording - 623AFB00213
Policy Number:
Renewal of:
Named Insured: City of Cupertino – Dept of Recreation & Community Services
Public Works Department
Principal Address: 10185 N Stelling Road, Cupertino, CA, 95014
Policy Period: From: 1st July 2019 To: 1st July 2020
Both dates at 12:01 a.m. Local Time at the Principal Address stated in Item 1.
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:
USD 35,000 any one Victim
Premium:
USD 27,000 to be paid within 25 days of attachment
Notification pursuant to Clause IX. shall be given to:
Claims Department Beazley
30 Batterson Park Road,
Farmington,
CT 06032.
claims@beazley.com
(860) 677 3765 (phone)
(860) 679 0247 (fax)
Retroactive Date:
1st July 2018
Pending or Prior Litigation Date:
1st July 2018
Service of Suit:
Foley & Lardner LLP, 555 California Street, Suite 1700, San Francisco, CA 94104-
Choice of Law:
New York
Conditions:
Application Dated: TBA
California Surplus Lines Notice 1- LMA9098A
California Complaints Clause – LMA9136
Small Additional or Return Premiums Clause (U.S.A.) – NMA 1168
Nuclear Incident Exclusion Clause-Liability-Direct – NMA 1256
Radioactive Contamination Exclusion Clause-Liability - NMA 1477
War and Terrorism Exclusion – NMA 2918
Sanctions Limits Clause - LMA 3100
Beazley Safeguard Education Document
Arch Safeguard Enhancement Endorsement
Amended Definition of Independent Contractor Endorsement – as attached
U.S Classification:
Surplus Lines Broker and State filed in: Risk Placement Services, 2850 Golf Road,
Rolling Meadows, IL 60008
License Number: 0C66724
Subject to:
1) Re-signed and dated renewal application – to be dated within 30 days of inception
All subjectivities to be received within 7 working days of binding otherwise Underwriters
reserve the right to amend terms or cancel ab initio.
Brokerage: 22.5% or same net equivalent downwards, plus taxes as applicable
Information: Employees – 41 Full time + 255 Part Time + 70 ICs
Exposure Units – 97,000
Nature of Business – Municipality
Cancellation by an Insured may result in a short rate calculation to determine
the return premium, subject to 5% minimum earned of the total premium.
Underwriting
Security: 100% Lloyd’s (Information about Lloyds)
Updated 4/15/20
EXHIBIT D
Contractor’s Mandated Reporter Declaration
The undersigned does hereby certify that:
1. I am a representative of Sonia Dogra; that I am familiar with the facts herein and am
authorized and qualified to execute this declaration.
2. I declare that Sonia Dogra 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 Contractor 2 Contractor 3 Contractor 4
Contractor 5 Contractor 6 Contractor 7 Contractor 8
Contractor 9 Contractor 10 Contractor 11 Contractor 12
Contractor 13 Contractor 14 Contractor 15 Contractor 16
Contractor 17 Contractor 18 Contractor 19 Contractor 20
Sonia Dogra Contract
Final Audit Report 2020-06-09
Created:2020-06-09
By:Kevin Khuu (KevinK@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAQxzdgbXuQ77Rcyhb46uKb3yaT81l_MAJ
"Sonia Dogra Contract" History
Document created by Kevin Khuu (KevinK@cupertino.org)
2020-06-09 - 3:27:41 PM GMT- IP address: 73.158.53.147
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2020-06-09 - 3:30:35 PM GMT
Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Date: 2020-06-09 - 3:50:23 PM GMT - Time Source: server- IP address: 24.23.184.82
Document emailed to Heather M. Minner (minner@smwlaw.com) for signature
2020-06-09 - 3:50:25 PM GMT
Email viewed by Heather M. Minner (minner@smwlaw.com)
2020-06-09 - 8:28:08 PM GMT- IP address: 45.41.142.51
Document e-signed by Heather M. Minner (minner@smwlaw.com)
Signature Date: 2020-06-09 - 8:28:42 PM GMT - Time Source: server- IP address: 52.39.49.65
Document emailed to Jennifer Koverman (jennyk@cupertino.org) for signature
2020-06-09 - 8:28:45 PM GMT
Email viewed by Jennifer Koverman (jennyk@cupertino.org)
2020-06-09 - 8:29:25 PM GMT- IP address: 104.47.46.254
Document e-signed by Jennifer Koverman (jennyk@cupertino.org)
Signature Date: 2020-06-09 - 8:30:25 PM GMT - Time Source: server- IP address: 96.74.111.97
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2020-06-09 - 8:30:27 PM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2020-06-09 - 8:31:31 PM GMT- IP address: 104.47.46.254
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2020-06-09 - 8:31:41 PM GMT - Time Source: server- IP address: 148.64.105.190
Signed document emailed to Araceli Alejandre (aracelia@cupertino.org), Jennifer Koverman
(jennyk@cupertino.org), cyrahc@cupertino.org, Kirsten Squarcia (kirstens@cupertino.org), and 2 more
2020-06-09 - 8:31:41 PM GMT