22-001 Alicia Escott-Entertainment Agreement for Mayor's Cup Challenge
SHORT FORM ENTERTAINMENT AGREEMENT
CITY OF CUPERTINO
Recreation and Community Services Department
10185 N. Stelling Road
Cupertino, CA 95014
408-777-3120
--USE OF THIS FORM IS ONLY VALID FOR AGREEMENTS UP TO $3,500.00--
Contractor Name:
Contractor Authorized Representative: CITY OF CUPERTINO
By the signature of its Authorized Representative below, Contractor hereby agrees to the following:
A. SCOPE OF SERVICES. Contractor shall provide or furnish the following specified
services and/or materials: Artists will showcase and describe their art pieces made from plastic
materials collected from the waste arriving at the Recology San Francisco recycling and transfer
station
Location and Time of Contractor Services:
Location: 10800 Torre Ave, Cupertino, CA 95014
Time: May 14TH 2022, 10:00AM- 2:00PM
B. TERM. The services and/or materials furnished under this Agreement shall be provided from
5/14/2022 to 5/14/2022.
C. COMPENSATION. For the full performance of this Agreement, the City of Cupertino shall
pay Contractor a total of $500 in a lump sum to be paid
following receipt of Contractor’s invoice.
D. EXHIBITS. The following attached exhibits hereby are made part of this Agreement:
☐ Exhibit “C”- Affidavit of no Employees
GENERAL TERMS AND CONDITIONS
1. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole
negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend, and
hold harmless the City, its City Council, boards and commissions, officers, officials, employees,
agents, servants, volunteers and Contractors (collectively, “Indemnitees”), through legal counsel
acceptable to City, from and against any liability for damages, claims, actions, causes of action,
demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses
related to litigation, arbitrations, administrative and regulatory proceedings), of every nature,
arising out of or in any way related to Contractor’s or Contractor’s agents performance of the
Scope of 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 agreement.
2. Compliance with Laws. Contractor shall comply with all laws applicable to this Agreement
including, without limitation, laws regarding workers’ compensation, antidiscrimination, and
conflict of interest. If Contractor has no employees an affidavit to that effect shall be attached to
this agreement. If the scope of work involves providing services to children, the City of
Cupertino, Consultant Declaration shall be attached
3. Assignment. Contractor may not assign, transfer, or subcontract this Agreement or any portions
thereof, without prior written consent of City.
4. Termination. City may terminate this agreement at any time. In the event of cancellation within
24 hours of the time Contractor is to begin providing services City shall pay contractor one half
of the total agreement amount unless cancellation occurs after Contractor’s personnel have
arrived at the location where services are to be performed in which case the total contract amount
shall be paid.
5. Interest of Contractor. It is understood and agreed that this Agreement is not a contract of
employment and, at all times, Contractor shall be deemed to be an independent contractor and
Contractor is not authorized to bind the City to any contracts or other obligations in executing
this Agreement. Contractor certifies that no one who has or will have any financial interest under
this Agreement is an officer or employee of City. City shall have no right of control as to the
manner Contractor performs the services to be performed. Nevertheless, City may, at any time,
observe the manner in which such services are being performed by the contractor. Contractor
shall comply with all applicable Federal, State, and local laws and ordinances including, but not
limited to, unemployment insurance benefits, FICA laws, and the City business license ordinance.
6. Changes. No changes or variations of any kind are authorized without the written consent of the
City.
CONTRACT COORDINATOR and representative for CITY shall be: Ursula Syrova.
Mayor’s Cup Challenge, May 2022
IN WITNESS WHEREOF, the parties have executed this Agreement effective the date last signed
below.
CITY OF CUPERTINO
A Municipal Corporation
By ________________________
Name______________________
Title ______________________
Date_______________________
CONTRACTOR
By ________________________
Name______________________
Title ______________________
Date_______________________
APPROVED AS TO FORM:
CHRISTOPHER D. JENSEN
Cupertino City Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
Date
Alicia escott
artist
May 10, 2022
Christopher D. Jensen
Ursula Syrova (she/her)
Environmental Programs Manager
May 10, 2022
May 10, 2022
Revised 2.03.22
Contractor/Consultant 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 Cupertino. I am fully aware of the provisions
of section 3700 of the California Labor Code, which requires every employer to provide Workers'
Compensation coverage for employees in accordance with the provisions of that Code. I am also
aware that I must provide proof of workers’ compensation insurance to the City of Cupertino for any
and all employees I may have, pursuant to Section 12 of the City of Cupertino’s contract.
I hereby certify that I do not have any employees nor will I have any employees working for me or
my business during the term of any service contract with the City of Cupertino. I am not required to
have Workers’ Compensation insurance.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
Executed on this ____day of ____________, 2022, at , California.
______________________________
PRINT NAME
______________________________
SIGNATURE
Exhibit C
self
cupertinomay14
AGREEMENT, WAIVER AND RELEASE
Onsite Entertainment
In consideration of the services I am providing the City of _____________, I hereby waive, release and
discharge any and all claims for damages for personal injury or property damage which I may have, or
which may hereafter accrue to me, as a result of providing said service. This release is intended to
discharge in advance the City of __________ (its officers, and/or officials, employees, volunteers and
agents) from any and all liability arising out of or connected in any way with my services, unless caused
by the active negligence of the City. It is further agreed that this waiver, release and assumption of risk
is to be binding on my heirs and assigns. I agree to indemnify and to hold the above persons and
entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the
result of my injury or property damage that I may sustain while participating in said activity.
I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER AND RELEASE AND FULLY UNDERSTAND ITS
CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF
AND THE CITY OF __________.
__________________________________________ __________________________
Participant/Parent or Guardian Date
Cupertino
Cupertino
Cupertino
May 10, 2022
Alicia Escott-Entertainment Agreement for
Mayor's Cup Challenge
Final Audit Report 2022-05-11
Created:2022-05-10
By:City of Cupertino (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAA5kbkPzy9zQe2rkkQ5V6fM8uZ66m_IP5s
"Alicia Escott-Entertainment Agreement for Mayor's Cup Challen
ge" History
Document created by City of Cupertino (webmaster@cupertino.org)
2022-05-10 - 7:24:21 PM GMT- IP address: 216.198.111.214
Document emailed to Julia Kinst (juliak@cupertino.org) for approval
2022-05-10 - 7:26:36 PM GMT
Document approved by Julia Kinst (juliak@cupertino.org)
Approval Date: 2022-05-10 - 7:26:57 PM GMT - Time Source: server- IP address: 216.198.111.214
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2022-05-10 - 7:26:58 PM GMT
Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Date: 2022-05-10 - 8:13:48 PM GMT - Time Source: server- IP address: 73.170.27.253
Document emailed to Alicia escott ( for signature
2022-05-10 - 8:13:50 PM GMT
Email viewed by Alicia escott (
2022-05-10 - 8:20:54 PM GMT- IP address: 157.131.121.247
Document e-signed by Alicia escott (
Signature Date: 2022-05-10 - 8:25:51 PM GMT - Time Source: server- IP address: 157.131.121.247
Document emailed to Christopher D. Jensen (christopherj@cupertino.org) for signature
2022-05-10 - 8:25:54 PM GMT
Email viewed by Christopher D. Jensen (christopherj@cupertino.org)
2022-05-10 - 8:58:22 PM GMT- IP address: 104.28.124.87
Document e-signed by Christopher D. Jensen (christopherj@cupertino.org)
Signature Date: 2022-05-10 - 11:18:13 PM GMT - Time Source: server- IP address: 136.24.42.212
Document emailed to Ursula Syrova (she/her) (ursulas@cupertino.org) for signature
2022-05-10 - 11:18:15 PM GMT
Email viewed by Ursula Syrova (she/her) (ursulas@cupertino.org)
2022-05-11 - 0:02:15 AM GMT- IP address: 104.47.73.254
Document e-signed by Ursula Syrova (she/her) (ursulas@cupertino.org)
Signature Date: 2022-05-11 - 0:03:34 AM GMT - Time Source: server- IP address: 98.45.180.112
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2022-05-11 - 0:03:36 AM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2022-05-11 - 0:15:38 AM GMT- IP address: 172.225.89.145
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2022-05-11 - 0:15:50 AM GMT - Time Source: server- IP address: 172.225.89.144
Agreement completed.
2022-05-11 - 0:15:50 AM GMT