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09-001 Philip Lenihan CITY QF AGREE~IIENT CITY OF CUPERTINO 10300 Torrey Avenue Cupertino, C:A 95014 l (408) 77i'-3200 NO. %/yl/ J CUPERTIN \ /~~j Fiscal Year 2009-2010 BY THIS AGREEM T YYY a and entered into on the 27th day of February, 2009 by and between the CITY OF CUPERTINO (Hereinafter referred to as CITY) and (1) Lenihan Address: 21841 Almaden Avenue. Cupertino, CA, 95014 Phone: (408) 996-8302 Hereinafter referred to as CONTRACTOR), in consideration of their mutual covenants, the parties hereto agree as follows: CONTRACTOR shall provide or furnish the following specified services and/or materials: Inline Skating Instruction EXHIBITS: The following attached exhibits hereby are made Fart of this Agreement: Exhibit A TERMS: The services and/or materials furnished under this Agreement shall commence on July 1, 2009 and shall be completed by June 30, 2010. COMPENSATION: For the full performance of this Agreement:, CITY shall pay CONTRACTOR: $17.50 Per Participant GENERAL TERMS AND CONDITIONS: Hold Harmless. CONTRACTOR agrees to save and hold h~~rmless the CITY, its officers, agents, and employees from any and all damage and liability of every nature, including all costs of defending any claim, caused by or arising out of the performance of this Agreement. CITY shall not be liable for acts of CONTRACTOR in performing services described herein. Insurance. Should the CITY require evidence of insurability, CONTRACTOR shall file with CITY a Certificate of Insurance before commencing any services under this Agreement. Said Certificate shall be subject to the approval of CITY'S Director of Administrative Services. Non-Discrimination. It is understood and agreed that this Al~reement is not a contract of employment in the sense that the relation of master and servant exists between CITY and undersigned. At all times, CONTRACTOR shall be deemed to be an independent contractor and CONTRACTOR is nc~t 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. Changes. This Agreement shall not be assigned or transferred without the written consent of the CITY. No changes or variations of any kind are authorized without the written consent of the CITY. CONTRACT COORDINATOR and representative for CITY sh~rll be: ~ i NAME: Jeff Ordway DEP~~RTMENT: Parks 8ti Recreation j This Agreement shall become effective upon its execution by CITY. In witness thereof, the parties have executed this Agreement the day and year first written above. CONTRACTOR: CITY OF PERTINO: By: ~ t~~.,~ ~ ~ By: ~ , Title: i ~ S-t'lu~c-~2 Title: Recreatio Coor Inator Social Security/Tax ID f 1 ~W 'Z~ ~~1r7(o APPROVALS E:><PENDITURE DISTRIBUTION DEPA EAD ATE ACCOUNT NUMBER AMOUNT 3 / a 580-6449-7014 $350 CITY CLE D E ~ g CUPERTINO City of Cupertino Contractor Affidavit The undersigned does hereby certify that: 1. I am a representative of ~N (~i ~.c. N i t~~l q~ (contract or company name); that I am familiar with the fact herein certified and am authorized and qualified to execute this certificate. 2. I verify that ~Nc ~P ~.EN'I ~tAu~contract or company name) has complied with fingerprinting and criminal background investigation requirE~ments with respect to all Contractor's employees who may have contact with minors in the course of providing services pursuant to the Contract, and the California Department of Justice has determined that none of those employees has been convicted of a felony, as that term is dei~ined in California Penal Code Section 11105.3 3. That a complete and accurate list of Contractor's employees who may come in contract with minors during the course and scope of the contract is included below 4. 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. A list of all Contractor Employees Working for the City of Cupertino: ~1-4c~~P LLcy~ NAc.I 5. The City of Cupertino will be notified by Contractor of any new employees and will be added to the above list prior to beginning work for the City of Cupertino. Contractor Signatur~,,~~ Date: 3 cf dE Staff Title: ~ AS sT2~czo2 ACORD~, CERTIFICATE OF LIABILITI' INSURANCE iii2i2o o' PRODUCER (317) 634-4400 FAX: (317) 972-7142 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cit Securities Cor ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Y p • HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 30 S . Meridan Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Indiana olis IN 46204 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Ca 1t01 S ecialt United Skate Schools Group and wsuRER B: PHILIP LENIHAN INSURER C: P 0 BOX 19153 INSURER D: Thousand Oaks CA 91319 !NSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. A AT I H MAY HAV N R Y PA IM . INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER GATE MMIDD/YY DATE MM/DDIYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 X COMMERCIAL GENERAL LIABILITY PREM SESOEa occurrence $ 100 , 000 A CLAIMS MADE ~ OCCUR CS00217968/56099 1 ~1~2009 1~1~2010 MED EXP An one erson $ 5 r 000 X INCLUDES ATHLETIC PERSONAL&ADVINJURY $ 1,000,000 PARTICIPANTS GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PR DUCTS - OMP/OP AGG $ 2 , 000 , 000 PRO- POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN A A $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EA H RREN E $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PHILIP LENIHAN EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 21841 ALMADEN AVENUE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT CUPERTINO, CA 95014-2855 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ 1?atrick O'Connor/MJL ~-"L~~•" ACORD 25 (2001108) ©ACORD CORPORATION 1988 IAICl17S rn~no, no.. Ponc 1 of ~