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11-001 Jennifer BrownCUPERTINO September 6, 2011 Jennifer Brown Re: Agreement OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 WEBSITE: www.cupertino.org Enclosed is a fully executed copy of your agreement with the City of Cupertino. If you have any questions or need additional information, please contact the Parks & Recreation Department at 777-3120. Sincerely, Kirsten Squarcia City Clerk's Office Enclosure cc: Parks & Recreation CITY OF a CUPERTINO AGREEMENT CITY OF CUPERTINO 10300 Torre Avenue Cupertino, CA 95014 408-777-3200 BY THIS AGREEME 'f;-l'fl Cle and entered into this 30th day of August, 2011 by and between the CITY OF CUPERTINO (Hereinafter referred to as CITY) and; Jennifer Brown Address: (Hereinafter referred 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: Provide iPad and computer course instruction for adults aged 50 plus at the Cupertino Senior Center. EXHIBITS: The following attached exhibits hereby are made part of this Agreement: Exhibit A TERMS: The services and/or materials furnished under this Agreement shall commence on September 1st, 2011 and shall be completed before June 30th, 2012. COMPENSATION: For the full performance of this Agreement, CITY shall pay CONTRACTOR: $10.00 per hour of iPad and computer class instruction with a minimum enrollment of 3 students per lab session. · California Labor Code, Section 1771 requires the payment of prevailing wages to all workers employed on a Public Works contract in excess of $1,000.00. GENERAL TERMS AND CONDITIONS Hold Harmless. To the extent permitted by law CONTRACTOR agrees to indemnify, defend and hold harmless CITY, its officers, officials, employees, volunteers, agents and representatives, from and against any and all claims, demands, actions, causes of action, losses, damages, liabilities, or judgments known or unknown, and all costs and expenses, including reasonable attorneys' fees in connection with any injury or damage to persons or property to the extent arising directly or indirectly out of any negligence, error, omission, recklessness or willful misconduct of CONTRACTOR, or anyone for whom CONTRACTOR is legally liable in relation to the performance of services under this Agreement. Such defense and indemnification shall not apply in any instance of and to the extent caused by the sole negligence, recklessness or willful misconduct of CITY, its officers, officials, employees, volunteers, agents or representatives. 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. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, ancestry, religion or sex of such person. Interest of Contractor. It is understood and agreed that this Agreement is not a contract of employment in the sense that the relationship of master and servant exists between City and undersigned. 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. 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 CO-ORDINATOR and representative for CITY shall be: JfJ ENTERED NAME: Julia Lamy DEPARTMENT: Senior Center 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. CONT,RACTOR: i By~, , ,/ { Title rt I ~· so'~. Sec. CITY OF CUPERTINO: By :1(;/,•g... l£un¥ Title: Recreation Supervisor EXPENDITURE DISTRIBUTION ACCOUNT NUMBER AMOUNT 110-6549-6315 $400.00 II EXHIBIT A 1. The City reserves the right to terminate this Agreement with a 30-day notice. The contractor may terminate this Agreement with a 30-day written notice. 2. In the event that the Contractor has employees who will assist in the performance of this Agreement, Contractor shall file with City a Certificate of Worker's Compensation Insurance and for those instructing persons 18 years and younger, provide fingerprint clearance and current TB test. 3. In the event that less than the required minimum number of participant shall request and pay for services prior to the agreed upon time for the commencement of services to be preformed by Contractor, City may cancel and withdraw from this Agreement. 4. 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. 5. The 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. The Contractor shall not promote his/her business to participants registered in the City's programs. 7. In the event of an injury occurring to a participant, the Contractor will notify the City immediately and complete an ABAG Incident Report. The ABAG Incident Report must be submitted to the City within 24 hours of the injury occurring. The City will provide the contractor with copies of the ABAG form and instructions on how to properly complete them. Electronic Communications Policy City of Cupertino employees have access to computers, fax machines, and other electronic communications equipment; Computer programs available to employees include e-mail, the internet, telnet, and other communications available now and/or in the future. The use of electronic communications equipment and/or programs is for the purpose of official business of the City of Cupertino. The City of Cupertino has the right to access, disclose, and monitor all electronic communications. Under no circumstances is the City's electronic communication system to be used to send copies of documents in violation of copyright laws or which access to is restricted by workplace rules, regulations, and procedures, or by Federal or State security laws or regulations. I have read this Electronic Communications Policy. I have had the opportunity to ask questions concerning this policy. My questions have been answered completely. I have received a copy of the City of Cupertino's electronic Communications Policy. CITY OF CUPERTINO SENIOR CENTER 21251 Stevens Creek Boulevard Cupertino, Califomia 95014 (408) 777-3150 Instructor Guidelines and Agreement The Cupertino Senior Center is dedicated to providing an array of quality programs and services that insure and enhance independence for older adults. Instructors: Please read and initial each item indicating that you agree to each condition. JB Print Name Educational presentations are solely to provide information. There can be no solicitation of clients or distribution of company literature, prices, or promotional materials. Each class lecture is for the dissemination of oral information only. No client service of any kind is to be rendered. Any personal contact subsequent to the presentation is prohibited unless initiated by the Cupertino Senior Center students. Political candidates understand that approved presentations must be in panel format to provide a blend of information for students. Instructors are expected to allow time during an educational session for questions from the students. Telephone# ·i?od, \?c:d .ifhoY\Q. \'m lost ' I I Class Title Instructor guidelines.doc 10/2003 Form W•9 (Rev. October 2007) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give form to the requester. Do not send to the IRS. C\i (]) ~ 0. Business name, If different from above c 0 Q) I/) a. 5 ~+;; Check appropriate box: ·~-Individual/Sole proprietor D Corporation D Partnership D Exempt payee ... () D Limited liability company. Enter the tax classification (D=disregarded entity, c~corporatlon, P~partnership) "" _ .•.•• _ 0 2 !;~ a: -;; !E 0 Q) a. rn (]) Q) (f) D Other (see instructions) ., Requester's name and address (optional) List account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter. Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I arn no longer subject to backup withholding, and 3. I arn a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person ~ General lnstruc 10 Section references are to otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Date~ -30 \\ Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, If you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231X Form W-9 (Rev. 10-2007) ,._. ~iHEF;IFF'S DEPT,. /,ff:JT SIDE DEPARTMENT OF JUSTICE REQUEST FOR LIVE SCAN SERVICE $?01100 '.!!;_'.()" ()() lli~i~T~e (Maximum so Characters -;rasslgned by DOJ, use exact loUa assigned} 00 •cord I nforma!I on Applicant Information: £>ruwn Last Name .- Your Number: OCA Number {Maney ldan~fy;ng Number] If re-submission, list original ATI number: (Must provide proof of rejection) Employer (Additional response for agencies specified by statute): Employer Name Street Address or P.O. Box 00063 Mail Code (five-digit code assigned by DOJ) Jeff Trybus (408) 777-3310 Contact Telephone Number Driver's License Number • Suffix '(Olh~rld<liiUr.oauon Number) ~ _4 City Slate ZIP Code Level of Sef\lice: [8J DOJ 0 FBJ Orlginal ATI Number TOTAL ,.\ 1. :t20~00 $20a o'ci :~·~:r-1:. rn City State ZlPCode Telephone Number (optional) Live Scan Transaction Complete• Name of Operator Transmitting Agency Amount Collected/ 11ied ORIGINAL -live Scan Operator SECOND COPY -Applicant THIRD COPY (if needed) -Requesting Agency