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20-001 Jia ThompsonCITY OF N0. PY2020 - 2022 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties. This contract is made by and between the City 0f Cupertino, a municipal corporation (“City”), and JIA THOMPSON (“Contractor”), a for Dance Instruction and is effective on the last date signed below (Effective Date”). 2. Services. Contractor agrees t0 provide the Services included in the Scope of Work and in accordance with the Schedule 0f Performance attached in Exhibit A. 3. Term. This contract begins on the Effective Date and ends 0n 06/30/2022 (“Contract Time”), unless extended or terminated as provided herein. Time is 0f 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 0r potential delays to afford the Parties adequate opportunity t0 address 0r mitigate such delays. The City’s appropriate department head 0r 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 t0 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 t0 exceed $27,000.00 (“Contract Price”), based upon the Scope 0f 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 t0 receive payment. City will compensate Contractor within thirty (30) days after approval 0f 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 0f payrolls, expenditures, disbursements and other cost items charged t0 City 0r establishing the basis for an invoice, for a minimum of four (4) years from the date 0f the final payment. 5. Independent Contractor. 5.1 Contractor is an independent Contractor and not an employee, partner, or joint venture 0f City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement. N0 Civil service status 0r other right 0f employment will be acquired by Virtue 0f Contractor’s performance 0f the Services. Contractor is not entitled t0 City’s health benefits, worker’s compensation or any other benefit. Contractor must have the skills and qualifications t0 perform the Services in a competent and professional Recreation Services Agreement/ Rev. Sept. 2019 Page 1 0f 7 manner. Contractor will supply all tools, materials, and equipment required t0 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 0f employment taxes incurred under this Agreement and any similar federal 0r state taxes. Contractor and any 0f 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 0r employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, 0r charges applicable t0 Contractor’s business including, but not limited to, federal and state income taxes. City shall have n0 obligation whatsoever t0 pay or withhold any taxes or benefits 0n 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 0r the State Employment Development Division, determine that Contractor, 0r any 0f its employees, agents, 0r subcontractors, is an employee for any purpose, then Contractor agrees t0 a reduction in amounts payable under this Agreement, or t0 promptly remit t0 City any payments due by the City as a result 0f 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. 5. Proprietary/Confidential Information. To the extent Contractor may have access t0 private 0r confidential information owned 0r controlled by the City, Contractor agrees t0 treat it as confidential and use it solely to perform this Agreement. Contractor must exercise the same standard 0f care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 6. Ownership 0f Materials. T0 the extent Contractor prepares written material, drawings, 0r data in connection with this contract, City will have the property rights t0 those materials and all copyrights, if any, t0 such work product will, to the extent requested by City, constitute City property upon completion of the work t0 be performed hereunder 0r upon termination of this Agreement. 7. Records. Contractor must maintain complete, accurate, and detailed accounting records relating t0 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 t0 City. The records and supporting documents must be kept separate from other files and maintained for four (4) years from the date 0f City’s final payment. Recreation Services Agreement/ Rev. Sept. 2019 Page 2 0f 7 8. Assignment. This Contract is not assignable. Contractor may not substitute another 0r transfer any rights 0r obligations under this Contract without prior written approval of City. Only those persons whose names are included in Exhibit A may perform the Services. 9. 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 0f Cupertino” shall be displayed in all pieces 0f publicity, including flyers, press releases, posters, brochures, public service announcements, interviews, and newspaper articles. No signs may be posted, exhibited, 0r displayed on 0r about City property, except signage required by law 0r under this Agreement, without prior written approval from City. 10. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole and active negligence or willful misconduct 0f City personnel, Contractor agrees t0 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 t0 City, from and against any liability for damages, claims, actions, causes 0f action, demands, Charges, losses, costs, and expenses (including attorney fees, legal costs, and expenses related to litigation, arbitrations, administrative, and regulatory proceedings), 0f every nature, arising out of 0r in any way related t0 Contractor’s 0r Contractor’s agents performance 0f this contract 0r the Services. This includes but is not limited t0 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 0r offset t0 cover any money the City lost due t0 a Claim or counterclaim arising out 0f this Contract. This Section 11 shall survive termination 0f the Agreement. 11. 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 0f insurance and endorsements evidencing the type, amount, and dates 0f coverage. Alternatively, City in its sole discretion, may purchase insurance and deduct the costs from payments t0 Contractor, or terminate the Agreement. 12. 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 0f 1990, and other laws that pertain t0 fair employment and anti—discrimination practices. Contractor must comply with labor laws pertaining t0 prevailing wages, working hours, overtime, payroll records, and other requirements imposed by the Department 0f Industrial Relations. If Contractor does not have employees, it must sign the Affidavit 0f N0 Employees, attached as Exhibit C. Consultant is responsible for verifying employment eligibility 0f employees pursuant to the Immigration Reform and Control Act 0f 1986. Contractor must comply with conflict 0f interest laws and regulations applicable to this Agreement and avoid conflicts 0f interest. Contractor may be required t0 file a conflict 0f interest form for engaging in governmental decisions 0r serving in a staff capacity, and is hereby advised t0 review the requirements 0f California Political Reform Act and the California Code Recreation Services Agreement/ Rev. Sept. 2019 Page 3 0f 7 0f Regulations. Services may only be performed by persons who are not employed by City and who d0 not have a contractual relationship with City other than this contract. Contractor agrees t0 abide by City policies and administrative rules prohibiting gifts t0 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 11164-111743 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/indexhtml). 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 t0 the City as required by Health and Safety Code Section 124235. Require coaches and administrators t0 successfully complete the concussion and head injury education at least once either online 0r in person, before supervising a participant. Contractor shall offer training, educational materials, or both to each Contractor administrator 0n 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. This contract requires services for Children. 13. Coordination 0f Services. The Parties designate the following persons as Services Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms 0f this Agreement. Contractor’s designation and any substitution are subject t0 City approval. For City: For Contractor: Name: Karen Levy Name: Jia Thompson Position: Recreation Coordinator Position: Dance Instructor Contact: karenl@cupertino.org Contact: 14. Abandonment. City may abandon 0r postpone the Activity 0r Program and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the date of abandonment upon submission 0f final invoices approved by City. 15. Termination. City may terminate this contract for cause 0r 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 0f final invoices approved by City. Recreation Services Agreement/ Rev. Sept. 2019 Page 4 0f 7 16. Governing Law, Venue, and Dispute Resolution. This contract is governed by the laws 0f the State 0f California. Any legal actions 0r 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 0f Santa Clara, State 0f California. At City’s request, Contractor is required to continue to provide Services pending resolution 0f any dispute. If the Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and include detailed written findings 0f law and fact. 17. Attorney Fees. If City is required to pursue litigation, arbitration or other administrative 0r regulatory proceeding t0 enforce its rights or the terms 0f this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. This Section 18 survives this Agreement. 18. Third Party Beneficiaries. There are n0 third party beneficiaries under this Contract. 19. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver 0f any contract provision. City waiver 0f a breach shall not constitute waiver 0f another term, provision, covenant, or condition, or a subsequent breach, whether the same or a different character. 20. 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, 0r provision of the main contract and any term, clause, or provision 0f the attachments 0r exhibits thereto, the terms 0f the main contract shall prevail and be controlling. 21. Inserted Provisions. Each provision or clause required by law 0r this contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure any mistaken insertion 0r omission 0f a required provision. 22. Headings. The headings are for convenience only and are not a part of the contract or intended t0 affect, limit, or amplify the terms 0r provisions 0f this Agreement. 23. Severability/Partial Invalidity. If any contract term 0r provision, 0r their application t0 a particular situation, is found by the court t0 be void, invalid, illegal, 0r unenforceable, such term 0r provision shall remain in force and effect t0 the extent allowed by such ruling. A11 other contract terms and provisions and their application to specific situations will remain in full force and effect. 24. Survival. A11 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 0r termination of this Agreement. 25. Notices. A11 notices and instruments pertaining t0 material provisions 0f this contract 0r significant disputes which are required by law 0r under this contract to be in writing must be sent t0 the persons listed below. The notices will be deemed effective 0n the date 0f personal delivery or Recreation Services Agreement/ Rev. Sept. 2019 Page 5 0f 7 the date confirmed by a reputable overnight delivery service, 0n the fifth (5th) calendar day after deposit in the United States Mail, postage prepaid, registered 0r certified, 0r the next business day following electronic submission. T0 City of Cupertino: To Contractor: IIA THOMPSON Office 0f the City Manager Cc: Representative/Coordinator: Karen Levy Cc: Representative/Coordinator: Jia Thompson Email: karenl@cupertino.org Email: 26. 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 0r authorized designee, and is approved for form by the City Attorney’s Office. 27. Execution. The person executing this contract on behalf of Contractor represents and warrants that Contractor has full right, power, and authority t0 execute this contract and t0 carry out all actions and services required. This contract constitutes a legally binding obligation 0f Contractor, and may be executed in counterparts, each one 0f which is deemed an original and all 0f which, taken together, constitute a single binding instrument. SIGNATURES CONTINUE ON THE FOLLOWING PAGE Recreation Services Agreement/ Rev. Sept. 2019 Page 6 0f 7 IN WITNESS WHEREOF, the parties have caused this contract t0 be executed. CONTRACTOR By Name Title Date Tax ID. N0.: Refer t0 W9 CITY OF CUPERTINO A Municipal Corporation By Name Title Date APPROVED AS TO FORM: HEATHER M. MINNER Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date Page 7 0f 7 Recreation Services Agreement/ Rev. Sept. 2019 Jia Thompson Dance Instructor Aug 28, 2020 Jia Thompson Heather M. Minner Recreation Supervisor Aug 28, 2020 Jenny Koverman Aug 28, 2020 EXHIBIT A SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide Dance Instruction in, but not limited t0, the following: Ballet, Ballet 2, Ballet 3, Body By Barre Location and Time of CONTRACTOR Services: Refer t0 the City’s Publications for agreed upon dates, times, and locations 0f 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, 0r 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, 65% 0f resident fees (FY20-21=$12,000; FY21-22=$15,000). City and Contractor may mutually agree for Contractor t0 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 $27,000.00. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum:6 Maximum: 12 If less than the required minimum number 0f 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 0r payment t0 Contractor. List of all Contractor Employees working for the City 0f Cupertino (if no Employees, identify ”self”): Self Performance of CONTRACTOR Services: Class Cancellation Updated 04/15/20 Contractor will only receive compensation for a class that is performed. If performance 0f 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 0f certain meetings 0f 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 t0 immediately and without notice cancel the remainder 0f Classes offered and 0r performed by Contractor. COVID-19 Health Order Compliance Contractor acknowledges that its duty t0 comply with Laws, as stated in Section 13 0f the Agreement, includes compliance by Contractor with the restrictions 0n travel and the Social Distancing Requirements set forth in Section 13.1< 0f the health order issued by the County 0f Santa Clara Public Health Department 0n March 31, 2020, in response t0 the COVID-19 pandemic, and any subsequent amendments 0r superseding orders thereto (the “Health Order”), and any other local, state, 0r federal laws or policies that have been 0r 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 0f COVID-19. Contractor acknowledges that the need t0 comply with the Health Order and Health Laws may result in the City canceling performance of any Class 0r meetings 0f a Class referenced in this Agreement. Registration, Enrollment, and Supervision The Contractor shall follow all guidelines pertaining t0 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 0r can show proof 0f enrollment. A11 participants and volunteers need t0 complete the City’s Waiver 0f 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 0f legal guardian has arrived and all minors are released t0 them. Injury ofa Class Participant In the event of an injury occurring t0 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 0f the injury occurring. Updated 04/15/20 Exhibit B Insurance Requirements 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 0r 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 0n an ”occurrence” basis, including property damage, bodily injury and personal & advertising injury with limits n0 less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this project/location (CG 25 03 0r 25 04) 0r be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than 0r 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 0f insurance required may be satisfied by a combination 0f primary and umbrella 0r excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella 01' excess insurance shall contain 01' be endorsed t0 contain a provision that such coverage shall also apply on a primary basis for the benefit 0f City before the City’s own insurance 0r self- insurance shall be called upon t0 protect City as a named insured. 2. Automobile Liability: ISO CA 0001 covering Code 1 (any auto), 0r 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. 3. Workers’ Compensation: Contractor Must Sign Affidavit 0f N0 Employees 4. Sexual Abuse/Molestation: Insurance 0r the equivalent as required for activities/services involving minors, (i.e., after school activities, recreational programs, athletics, study/training events and transportation 0f minors). Coverage may be included under General Liability 01' 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 t0 this contract 0r be twice the required occurrence limit. Insurance coverage required may be satisfied by a combination 0f Primary and Excess/Umbrella insurance. OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Additional Insured Status The City 0f 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) 0r both CG 20 10 and CG 20 37 forms, if later editions are used). Exh. B Insurancefor Recreation Contracts Updated May 2020 Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees, 0r volunteers shall be excess 0f 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 t0 expire, except with written notice to City 30 days in advance or 10 days in advance if due t0 non-payment 0f premiums. Waiver 0f 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 0f City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether 0r not the City has received a waiver 0f subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or seIf-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; 0r Consultant must show proof 0f ability t0 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 0r the City. Acceptability ofInsurers Insurers must be licensed to do business in California with an A.M. Best Rating of A-VH, or better. Verification 0f Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements (0r copies 0f 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 t0 commencement of the Contract. City retains the right t0 demand verification of compliance at any time during the Contract term. Subconsultunts Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements 0f 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 0f Coverage City reserves the right to modify these insurance requirements/coverage based on the nature 0f the risk, prior experience, insurer 0r other special Circumstances, with not less than ninety (90) days prior written notice. 12232152 Exh. B Insurancefor Recreation Contracts Updated May 2020 r ® ACORDV CERTIFICATE OF LIABILITY INSURANCEm Insurance Plus New York, NY 10281 INSURED Jia Thompson 800-222-1 1 10 Willis of New York, |nc., Brookfield Place 200 Liberty Street, 6th Floor Ins. # DnTEtfinmwm 09/01/2020 Tm ONLY AND CONFERS N0 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. _ INSURERS AFFORDING COVERAGE :NSURER A; Aspen Specialty Insurance Company Report all claims to Insurance Plus Program via e-mail at Professiona|LiabiIityCIaims@aspen-insurance.com JNSURER B: WRER c- NAIc # _10717 congmgs THE POLIC1ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWFTHSTAN DING ANY REQUIREMENT. TERM OR CONDthON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICtES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSEONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION msa ADD'L mu TYPE 0F INSURANCE POLICY NUMBER DATEIMMIDDIWWJ nnemmronmvvl LIMITS GENERAL LIABILITY EACH OCCURRENCE 3 2.000.000 DAMAGE To RENTED ' x COMMERCIALGENERALLIABILITY 09/01/2020 09/01/2021 pammaomm _s memo CLAIMS MADE X OCCUR # MED EXP {Any one palson} 3 WA A PERSONAL & ADV INJURY 5 1000-000 X GENERAL AGGREGATE _ $ 1000-000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPJOP AGG _ 5 1000-000 x POLICY 5581; LDC BUS‘ PERS‘ PROP‘ AGG / DED $1.0m 5250 AUTOHOB'LE ”AB'L'TY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident} ALL OWNED AUTOS BODILY INJURY $ SCHEDULED nums (Per ”9'50”: H'RED AUTOS aomw INJURY s NON-OWNED AUTOS ‘PEF “mew PROPERTY DAMAGE $ (Per accident! GARAGE LIABILITY AUTO ONLY. EA ACCIDENT s ANY AUTO OTHER THAN EA Ace _ s AUTO ONLY: AGG $ EXCESS! UMBRELLA LmBIerY EACH OCCURRENCE _ s OCCUR CLAIMS MADE AGGREGATE $ s DEDUCTIBLE s RETENTaoN s s WORKERS COMPENSATION wc STATU— 0TH. AND EMPLOYERS' LIABrLITY Y _. N TORY L'M'TS ER - ANY PROPRIETompARTNERxExECUTIVE D E.L. EACH ACCIDENT S OFFICERIMEMBER EXCLUDED?' [Mandatory 'm NH) E.L. DISEASE . EA EMPLOYEE s If yes. describe under SPECIAL PRovrSIons below E L. DISEASE — POLICY LIMIT s A OTHER Professional Liahimy #LRAFVTX,I QAOM 2.000.000 per occurrence f $3,000,000 annual aggregate 09/01/2020 09/01/2021 DESCRIPTION OF OPERATIONS .I’ LOCATIONS u' VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS Holder named below is listed as an Additional Insured for the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C#NCELLED BEFORE THE EXPIRATION CityOfCupertinoltsCityCou”CilBoardS&C0mmiSSi0nSOff DATE THEREOF. THE Issume :NSURER WILL ENDEAVOR ‘ro MAIL 1a DAYS WRITTEN OfficialsEmployeesAgentsServantsVolunteers & Consultantsonce 1'0 THE CERTIFICATE HOLDER NAMED To THE LEFT. BUT FAILURE To Do so SHALL 10300 Torre Ave Cupertino’ CA 9501 4 IMPOSE N0 OBLIGATION 0R LIABILITY OF ANY KIND UPON THE INSURER, {TS AGENTS OR x(wfl R—E PRESE NTAT WES. AUTH ORIZED REPRESENTATIVE ACORD 25 (200mm) IN8025 (200901} © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLICY OCCURRENCE HEALTH, WELLNESS & BEAUTY PROVIDERS PROFESSIONAL LIABILITY INSURANCE POLICY In consideration of the premium charged, it is agreed that the defined term ”Insured” is hereby amended to include the following person(s) and/or entity(ies): 1, CityofcupertinoltsCityCouncilBoards&CommissionsOfficers ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. THIS ENDORSEMENT FORMS A PART OF POLICY NUMBER: Issued by: Aspen Specialty Insurance Company Issued to: Jia Thompson Effective date: 09/01/2020 ASPMT011 01 18 2018 ©Aspen Insurance U.S. Services Inc. All rights reserved. Page 1 of1 05 ’I 23000293039 Prepared on Apm 8, 2020 Page] of 4 Your Policy Declarations Nationwide“ is on your side Nationwide Auto Policy Policy Period: May H, 2020 — May H, 2021 Policy Number: Policyholder (Named Insured): Michael Thompson & Jia Thompson Keep these Declarations for your records. General Policy Information Issued: April 8, 2020 These Declarations are a part of the policy named above and identified by the policy number above. They supersede any Declarations issued earlier. Your policy provides the coverages and limits shown in the schedule of coverages. They apply to each insured vehicle as indicated. Your policy complies with the motorists’ financial responsibility laws of your state only for vehicles for Which Property Damage and Bodily Injury Liability coverages are provided. Policy Period: May 11, 2020 - May 11, 2021 but only if the required premium for this period has been paid and only for twelve month renewal periods if renewal premiums have been paid as required. This policy is initially effective at (1) the time the application for insurance is completed, or (2) 12:01 am‘ on the first day of the policy period, whichever is later. Each renewal period begins and ends at 12:01 am. standard time at the address of the named insured stated herein. This policy expires at 12:01 am. at the address of the named insured stated herein. Your carrier is Nationwide Insurance Company Of America, NAIC #25453. IMPORTANT MESSAGES: Your premium for this renewal is $258708. To maintain uninterrupted coverage, please pay your premium on or before May H, 2020. Your payment is due on this date unless you pay your bill under an installment payment plan. This includes any change you may have made to your policy. Premium Summary and Other Charges $ 1,478.74 Total For Policy Fees And Other Charges $ 3.52 Total Policy Premium $ 2,590.60 How You Saved on this Policy with Nationwide - Elite Driver - Good Driver - Passive Restraint - Multi Policy Thank you for being a long—term customer. Rated Driver(s) Name Date of Birth Marital Status Michael Thompson 12/10/60 Married Jia Thompson 12/21/73 Married A 4560 O7 16 Continued on the next page Nationwide“ is on your side For coverage definitions and descriptions. visit Nationwidecom Prepared on Apfl‘ 8‘ 2020 Page 2 of 4 Your Policy Declarations Nationwide Auto Policy Policy Period: May H, 2020 — May H, 2021 Policy Number: Insured Vehic|e(s) and Schedule of Coverages Coverages Limits of Liability Premium Bodily Injury Liability $ 100,000 Each Person $ 300,000 Each Occurrence $ 244.22 Property Damage Liability $ 100,000 Each Occurrence $ 257.58 Medical Payments $ 2,000 Each Person $ 30.00 Uninsured Motorists Bodily Injury $ 100,000 Each Person $ 300,000 Each Occurrence $ 174.92 See Endorsement Damage To Your Auto Actual Cash Value Less $ 100 $ 80.86 Other Than Collision (Comprehensive) Collision Actual Cash Value Less $ 1,000 $ 262.06 Waiver Of Collision Deductible $ 1240 Custom Equipment $ 3,000 Included Rental Reimbursement $ 50 Per Day $ 1,500 Per Accident $ 46.30 See Endorsement Total for this Vehicle $ 1,108.34 Coverages Limits of Liability Premium Bodily Injury Liability $ 100.000 Each Person $ 300,000 Each Occurrence $ 245.06 Property Damage Liability $ 100,000 Each Occurrence $ 266.54 Medical Payments $ 2,000 Each Person $ 32.20 Uninsured Motorists Bodily Injury $ 100,000 Each Person $ 300,000 Each Occurrence $ 175.58 See Endorsement Damage To Your Auto Actual Cash Value Less $ 100 $ 177.86 Other Than Collision (Comprehensive) With OEM See Endorsement Collision Actual Cash Value Less $ 1,000 $ 522.80 With OEM See Endorsement Waiver Of Collision Deductible $ 12.40 Custom Equipment $ 3,000 Included Rental Reimbursement $ 50 Per Day $ 1,500 Per Accident $ 46.30 See Endorsement Total for this Vehicle $ 1,478.74 Continued on the next page 05123000293046 Prepared 0n Apm 8, 2020 Page 3 Of 4 Nationwidew Your Policy Declarations is on your side Nationwide Auto Policy Policy Period: May H, 2020 — May H, 2021 Policy Number: Policy Level Fees and Other Charges Coverages Premium State Fraud Surcharge $ 3.52 Total for Policy Level Fees and Other Charges $ 3.52 Policy Form and Endorsements A 4500 O7 16 Your Nationwide Auto Policy A 4574 O7 16 Rental Reimbursement/Transportation Expenses — Rental Days Plus A 4577 O7 16 Loss Settlement Endorsement - Original Equipment Manufacturer Parts A 5004 O4 18 Special Provisions — California A 5104 O4 18 Uninsured Motorists Coverage — California For Office Use Only: 12/28/19 $ 0.00 Terr: 998 Issued By: Nationwide Insurance Company Of America How to Contact Us Your Nationwide Agent Ruby Van Dalen 1.408.725.1112 Customer Service 1.800.421.1444 Internet Nationwide.com 24-Hour Claims Reporting 13004213535 Hearing Impaired (TTY) 1.800.622.2421 71 Fenchurch Street London EC3M 4BS Telephone: +44 (0)20 3037 8000 Fax: +44 (0)20 3037 8010 T Y S E R S www.tysers.com CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE Form: SML Safeguard Wording - 623AFB00213 Policy Number: Renewal of: Named Insured: City 0f Cupertino — Parks and Recreation Department, Public Works Department Principal Address: 10300 Torre Avenue, Cupertino, CA 95014 Policy Period: From: 15‘ July 2020 T0: 15‘ July 2021 Both dates at 12:01 am. Local Time at the Principal Address stated in Item 1. Limit 0f 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—lirnit 0f 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 30,000 t0 be paid within 25 days 0f attachment Notification pursuant t0 Clause IX. shall be given t0: Claims Department Beazley 30 Batterson Park Road, Farmington, CT 06032. claims beazle .com (860) 677 3765 (phone) (860) 679 0247 (fax) Retroactive Date: 15‘ July 2018 Pending 0r Prior Litigation Date: 15‘ July 2018 Service 0f Suit: Foley & Lardner LLP, 555 California Street, Suite 1700, San Francisco, CA 94104- Choice 0f Law: New York Conditions: Application Dated: 30th June 2020 California Surplus Lines Notice 1- LMA9098A California Complaints Clause — LMA9136 Small Additional 0r 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 Several Liability Notice — LSWl 001 Sanctions Limits Clause - LMA 3 100 BeazleV Safeguard Education Document Tvsers Safeguard Enhancement Endorsement Amended Definition 0f 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 Brokerage: Information: Employees — 296 Independent Contractors i 70 Exposure Units i 97,000 Nature 0f Business — Municipality Cancellation by an Insured may result in a short rate calculation to determine the return premium, subj ect t0 5% minimum earned 0f the total premium. Underwriting Security: 100% Lloyd’s (Information about Lloyds) AMENDED DEFINITION OF INDEPENDENT CONTRACTOR TO INCLUDE SUB- CONTRACTORS AND DELETES FULL-TIME BASIS This endorsement modifies insurance provided under the following: BEAZLEY SAFEGUARD In consideration 0f the premium charged for this Policy, it is hereby understood and agreed that Clause III. DEFINITION H. is deleted in its entirety and replaced with the following: H. “Independent Contractor” means any natural person independent contractor 0r sub- contractor who performs labor or service for the Insured Organization pursuant t0 a written contract or agreement, where such labor 0r service is under the exclusive direction 0f the Insured Organization. The status of an individual as an Independent Contractor shall be determined as of the date of an alleged Wrongful Act. A11 other terms and conditions of this Policy remain unchanged. EXHIBIT C AFFIDAVIT OF NO EMPLOYEES State 0f California County 0f Santa Clam City 0f Cupertino I, the undersigned, declare as follows: I am an independent contractor and the owner 0f JIA THOMPSON. Iwish t0 enter into a services contract with the City 0f Cupertino. I am fully aware 0f the provisions 0f 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 t0 the City 0f Cupertino for any and all employees I may have, pursuant t0 Section 12 of the City of Cupertino’s contract. Ihereby certify that I do not have any employees nor will I have any employees working for me 0r my business during the term of any service contract with the City 0f Cupertino. I am not required t0 have Workers’ Compensation insurance. I declare under penalty 0f perjury under the laws of the State 0f California that the foregoing is true and correct. Executed on this day of , 2020, at . California. PRINT NAME SIGNATURE Jia Thompson San JoseAugust27 Jia Thompson EXHIBIT D Contractor’s Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of JIA THOMPSON; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that JIA THOMPSON has complied with fingerprinting and criminal background investigation requirements with respect t0 all Contractor’s employees who may have contact with minors in the course of providing services pursuant t0 the Agreement, and the California Department 0f Justice has determined that none 0f those employees has been convicted 0f 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 t0 successfully complete concussion and head injury education at least once, either online 0r 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-l. 5. That a complete and accurate list 0f Contractor’s employees, who may come in contact with minors during the course and scope 0f the Agreement, are included below. 6. A11 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. A11 0f the below mentioned employees have received training and understand their responsibilities under the Mandated Reporter laws 0f this state and are willing and able t0 comply. List 0f all Contractor Employees working for the City (if no Employees, identify ”self”): Self 8. The Contractor will notify the City 0f Cupertino in writing 0f any new employees and will be added t0 the above list prior t0 beginning work at the City of Cupertino. I declare under penalty of perjury that the foregoing is true and correct. CONTRACTOR By Name Title Date Updated 4/15/20 Jia Thompson Dance Instructor Aug 28, 2020 Jia Thompson