14-001 Bricks 4 Kidz OFFICE OF THE CITY CLERK
CITY HALL
MCI 19
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
TELEPHONE: (408)777-1223• FAX: (408)777-3366
C U P E RT I N® WEBSITE:www.cupertino.org
August 21, 2014
Re: Agreement for contract services.
Enclosed is a fully executed copy of the above stated agreement with the City of Cupertino.
If you have any questions or need additional information, please contact the Recreation and
Community Services department at 408-777-31'20.
Sincerely,
Andrea Sanders
Senior Office Assistant
City Clerk's Office
Enclosure
cc: Parks & Recreation
i
FY 14-15
AGREEMENT BETWEEN THE CITY OF CUPERTINO AND Bricks 4 Kid Z FOR
CONTRACT SERVICES
This Agreement; for reference dated August 1,.,2014 is by and between,Ci of
Cupertino, a municipal corporation (hereinafter referred.to as "City"), and Bricks 4 Kidz,
a California Corporation whose address is
(hereinafter referred to as "Consultant"), and is made with reference to the following:
. . RECITALS: -
A. City is a municipal corporation duly organized and validly existing under
the laws of the State of California with the power to carry on its business as-it is now
being conducted under.the Constitution and the statutes of the State of California and
the Cupertino Municipal Code.
B. Consultant is specially..trained, experienced and competent to perform the
special services which will be required by this Agreement; and
C. Consultant possesses the skill, eXperience, ability., background,
certification.and knowledge to provide the services described in this Agreement.on-the.
terms and conditions described,herein,.
D. City and Consultant desire to enter into an.agreement for instruction of
Lego bricks program services,upon the,terms cind conditions herein.
NOW, THEREFORE, it is mutually-agreed by and between the undersigned,'
parties as.follows: .
1. TERM:
The term of this Agreement shall commi:nce on October 1, 2014, and shall
terminate on July 31, 2015, unless terminated taarlier as set forth herein.
2. SERVICES TO BE PERFORMED:
Consultant shall,perform each and evert service set.forth in Exhibit "A"which is ..
attached hereto and jncorporated-herein by thi:� reference. :
3. COMPENSATION TO CONSULTANT:
Consultant shall be compensated for services performed pursuant to this
Agreement in the amount set forth below. The total compensation under the Agreement
is not to exceed $40,000. ,
Compensation: 70% of resident fee for each participant, based on the final class
roster, minus a $10 administrative fee per participant.
The City will issue no more than two payments per quarter and, if needed, one final
payment at the end of this agreement to close the account.
4. ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS:
Consultant shall comply with the requirements of California Penal Code 11164-
11174.3 and as set forth in Exhibit"B" which is attached hereto and incorporated herein
by this reference.
5. FINGERPRINT AND TUEERCULOSISITB) CONSULTANT DECLARATION:
Consultant agrees that all individuals covered under this Agreement shall provide
fingerprintsJor criminal background test purposes and results of TB screening, pursuant
to the requirements asset forth in Exhibit"C" which.is attach hereto and;'incorporated
herein by this reference.
6. TIME IS OF THE ESSENCE:
Consultant and City agree that time is of the essence regarding the performance of this
Agreement.
7. 'STANDARD OF CARE: '
-Consultant agrees to perform�all services hereunder,in a manner commensurate,
with the prevailing standards of like professionals in the San Francisco Bay-Area and
agrees that all services shall be performed by qualified and experienced personnel who
are not employed by"the City nor have any contractual relationship with City.
8. INDEPENDENT PARTIES:
City and.-Consultant intend that the relationship between them created by this
Agreement:is that of an`independent!contractor. The manner an6 means of conducting.,
the work are under the control of Consultant, except to�the-extent they are limited by
statute, rule or regulation and the express terms of this Agreement. No civil service
status or other,right of-employment will�be'acquired'byvirtue of Consultant's services.
None of the benefits provided by City to-its employees, including but not limited to,
unemployment insurance, workers' compensation plans, vacation and sick leave are
available'from.City to Consultant, its employees or agents. Deauictions shall not be
made for any state or federal taxes, FICA payments, PERS payments, or other.
purposes normally associated with an employer-employee relationship from any fees
due Consultant. Payments of the above items, if required, are the responsibility of
Consultant: .
9. IMMIGRATION REFORM AND CONTROL ACT (IRCA):,
Consultant assumes any and all responsibility for Verifyingg'the-identity and
employment-authorization of all of�his/her.employees performing:work hereunder,
pursuant to all applicable IRCA or other"federal-, or'state rules and regulations.
Consultant shall indemnify and hold City harmless from and against any loss, damage,
liability, costs or expenses arising from any noncompliance of-this provision,by
Consultant.
10. NON-DISCRIMINATION:
Consistent with City's policy that harassment and discrimination are
unacceptable employer/employee conduct, Consultant agrees that harassment or
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discrimination directed toward A job applicant, a City employee or a citizen by
Consultant or Consultant's employee or subcontractor on the basis of race, religious,
creed, color; national origin, ancestry, handicap, disability, marital status, pregnancy,
sex, age, or sexual orientation-will not be tolerated. Consultant agrees that any andall
violations of this provision shall constitute a material breach of this Agreement.
11., HOLD HARMLESS:
A. Performance under this Agreement. Consultant shall, to the fullest extent
allowed:by law, with respect:-to all services performed in connection with the
Agreement, indemnify, defend, and hold harmless ,the:..City and its officers,
officials, agents, employees.and.volunteers from and against any and all liability,
claims, actions, causes of action or demands whatsoever against any of them,
including any injury to or death of any person or damage to property or other
liability of any nature, whether,physical, emotional,: consequential or otherwise,
arising out, pertaining to, or related to the performance of this Agreement by
Consultant or Consultant's employees, officers, officials,.agents or independent
contractors. Such costs and expenses shall include reasonable attorneys' fees
of:.counsel of City'.s choice, expert fees �ir�d.all other costs and fees of litigation.
B. Claims for Other Liability. Consultant shall, to the fullest extent allowed
by law, with respect to all services performed in connection with the Agreement,
indemnify,-defend, and hold harmless the .City and. its officers, officials, agents,
employees and volunteers against any and all liability, claims, actions, causes of
action or demands whatsoever from and against any of them, including any injury
to .or death of any person or damage to property,or other liability of any nature,
that arise, out of,.:-pertain to, or relate to the: negligence., recklessness,,or willful
misconduct of Consultant or Consultant's employees, officers, officials, agents or
independent contractors. Such costs and expenses shall,.include_ reasonable
attorneys' fees of counsel of City's choice, expert fees and all other costs and
fees of litigation. Consultant .shall not be obligated under this: Agreement to
indemnify City to the extent that the damage,is caused by the sole or -active
negligence or willful misconduct of City,.its agents or.employees.
C. Claims involving intellectual property: In addition to the obligations set forth in
(A),and (B) above, Consultant shall indemnify, defend, and hold the City,,its .
elected and appointed ,officers,°employees,,and volunteers, harmless from and.
against any Claim in which a violation of intellectual property, rights, including but
not limited to copyright or patent rights,,.,is alleged that arises.out of, pertains to,
or relates to Consultant's negligence, recklessness or willful misconduct under
this Agreement. Such costs and expenses shall include:reasonable attorneys'
fees of counsel of-City's choice, expert fees-and all other costs and fees of
.Litigation.
12. INSURANCE:
On or before the commencement-of the term of this Agreement, Consultant shall.
furnish City with certificates showing the type, amount, class of operations covered,
effective dates and dates of expiration of insurance coverage in compliance with
paragraphs 12 A, B, C, D and E. Such certificates, which do not limit Consultant's
indemnification, shall also contain substantially the following statement: "Should any of
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the above insurance covered by this certificate be canceled or coverage reduced before
the expiration date thereof, the insurer affording coverage shall provide thirty (30) days'
advance written notice to the City of Cupertino by certified mail, Attention: City
Manager." It is agreed that Consultant shall maintain in force at all times during the
performance-' of this.Agreement all appropriate'coverage of-insurance required by this-.1
Agreement"With an 7 insurance company that is acceptable to City andlicensed'to do
insurance business in the`State.of California. Endorsements naming the City as
additional insured shall'be°submitted with the ins urance-certificates.-
A. COVERAGE:
Consultant shall maintain the following insurance coverage::
(1) Workers'.Compensatiors:
'Statutory coverage,as,required by the State of California
(2) Liability._.
Commercial general liability coverage in the following minimum
.limits:
Bodily'lnjury: $500,000 each occurrence
$1,000,000 aggregate - all other
f: Property Damage: $100,000 each occurrence k.
$250;000 aggregate.
If-submitted,,.combined single limit policy with,`aggregate limits in the
amounts of$1,000,000 will be considered equivalent to the
required.minimum limits shown-above.,.
:(3,)- Automotive,.,.' r
Proof of automobile-,insurance required at the California statutory
minimums.
132- 'SUBROGATION WAIVER:.
Consultant agrees*that in the event of-loss due to any of1he perils for which
he/she has agreed to provide`comprehensive general and automotive liability*insurance,
Consultant shall look,solely to his/her insurance for recovery. Consultant hereby grants
to City, on behalf of any insurer providing comprehensive general and-automotive
liability insurance to either Consultant-or City with respect to the services of Consultant
herein, a waiver of any right to subrogation which any such insurer of said Consultant
may acquire against'City by virtue of the payment-,of any loss under such insurance.
C. FAILURE TO SECURE:
If Consultant:at any time during the°te`rm hereof should:fail-to:secure„or. maintain
the foregoing insurance,.City shall be permitted,to obtain such insurance in the:
Consultant's name or as-an agent of the Consultant-and shall be compensated by the
Consultant for the costs of the insurance premiums at the maximum-rate.permitted by
law and computed from-the date written notice is received,that the premiums have not
been paid.
-D.- ADDITIONAL INSURED:.
City, its City Council, boards and commissions, officers, employees and.
volunteers shall be named as an additional insured under all insurance coverages,
except any professional liability insurance, required by this Agreement. The naming of
an additional insured shall not affect any recovery to which such additional:insured
would be entitled under this policy if not named as such-additional-insured. An
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additional insured named herein shall not-be held liable for any premium, deductible
portion.of any loss, or expense of any nature on this policy or any extension thereof.
Any other insurance held by an additional insured shall not be required-to contribute
anything toward any loss or expense covered.by the-insurance provided by this policy.
E.. , SUFFICIENCY OF INSURANCE:
The insurance limits required by City arE! not represented as being sufficient to
protect Consultant. Consultant is advised to confer.with Consultant's insurance broker
to determine adequate coverage for Consultant.
13. CONFLICT OF INTEREST:
Consultant warrants that it is not a conflict of interest for Consultant to perform
the services required by this Agreement. Consultant may be.required.to fill out-a conflict
of interest-form if the services provided under this Agreement require Consultant to
make certain governmental decisions or serve in a staff capacity as defined in Title 2,
Division 6, Section 18700 of the California Code of Regulations.
14. PROHIBITION AGAINST TRANSFERS:
Consultant shall not assign, sublease,:hypothecate; or transfer this.Agreem-ent,
or any interest therein, directly or indirectly, by operation of law or otherwise, without
prior written consent of City. Any attempt to do so without said consent-shall be null and
void, and any assignee, sublessee, hypothecate or transferee shall acquire no right or
interest by reason.of such attempted assignment; hypothecation or transfer. However,
claims for money by Consultant from City under this Agreement may be Assigned to a
bank, trust company or other financial institution.without prior written consent.. Written
notice of such assignment shall be promptly furnished to City by Consultant.,.
, The sale, assignment,-transfer or other disposition of.any of the issued and
outstanding capital°stock of Consultant, or of the interest of any general.partner or joint.
venture or syndicate member or cotenant, if Consultant is a partnership or joint venture
or syndicate or co-tenancy, which shall result in changing the.control of Consultant,
shall be construed-as an assignment.of this Agreement. Control means-fifty percent
(50%) or more of the-voting power of the corporation:
15. SUBCONTRACTOR APPROVAL:
-Unless prior written consent from.City is.obtained, only those people and
subcontractors whose.names and resumes.arE� attached to this Agreement shall be
used in the performance of this Agreement.
in the event,that Consultant employs subcontractors, such subcontractors shall
be.required to furnish proof of workers' compensation insurance and shall also,be
required to carry general liability insurance in reasonable conformity to the insurance
carried by Consultant. In addition, any work or services subcontracted hereunder shall
be subject to each provision of this Agreement,.
16. PERMITS.AND LICENSES:
Consultant, at his/her sole expense, shall obtain and maintain during the term of
this Agreement;all appropriate permits,.certificates and that may be required in
connection with the performance of services hereunder.
17. REPORTS:
A. Each and every report, draft, work product, map, record and other
document, hereinafter collectively referred to as "Report", reproduced, prepared or
caused to be prepared by Consultant pursuant to or in connection with this Agreement,
shall be the exclusive property of City. Consultant shall not copyright any Report
required by this Agreement and shall execute appropriate documents to assign to City
the copyright to Reports created.pursuant to this Agreement."Any,Report, information'
and data acquired or required by this Agreement shall.become the property of City; and
all publication rights-are reserved to City. Consultant may retain a.copy of any report
furnished-.to the City-pursuant to this-Agreement.
B. All Reports prepared by Consultant-may..be'.used by City in execution or
implementation of:
(1) The original Project-for Which Consultant'was hired;*
(2) Completion of the original Project.by,others;
(3) Subsequent additions to the original project; and/or
(4) Other City projects as appropriate.': Y
G. Consultant shall, at such time and Jn such form as City may"require,
furnish reports concerning the status of services required under thisAgreement.
D. . All Reports required to be'provided by�this-Agreement'shall be printed on,
recycled paper. All Reports shall be copied'.on both sides 'of the papet-except for one'
original, which shall be single sided.
E. No Report, information or other data given to or prepared or assembled by
Consultant pursuant to this Agreement shall be,made available'to any individual or
organization by.Consultant without,prior approval by City.
18: RECORDS:
Consultant shall maintain complete and accurate records with respect to sales,
costs, expenses, receipts and other such information required by City that relate to the
performance of services under this Agreement. :°
Consultant shall maintain adequate records of services provided in sufficient
detail to permit an evaluationof services. All such records shall.be rYiaintained.in
accordance with generally accepted'accounting principles and shall'be clearly identified
and readily accessible. Consultant-shall provide free access to such books and records
to.the representatives of City,or its designees at all.proper times, and'gives City the
right to examine and audit same, and'to make transcripts therefrom as necessary, and
to allow"inspedon ofall work, data; documents,`proceedings and activities related to
this Agreement. Such records, togetherawith-supporting:documents; shall be kept
separate from other documents and records and shall be maintained for a period of
three (3) years after receipt of final payment.
If supplemental=examination or-audit of the records'is'necessary-due to concerns
raised by City's,preliminary examination or audit of records;,and the City's supplemental
examination or audit of the records discloses a failure-to adhere to appropriate internal
financial controls°, -or other breach of contract-or.failure to act in good faith, then ,
Consultant shall reimburse-City for all reasonable costs and.expenses associated with.-
the supplemental examination or3audit:
19. NOTICES:
All notices, demands, requests or approvals to be given under this Agreement
shall be given in writing and conclusively shall be deemed;served when delivered:
personally or on the second business day after the deposit thereof-in the-United'States
Mail, postage prepaid, registered'or certified, addressed as hereinafter"provided. ,:
All notices, demands, requests, or approvals-from Consultant-'to.Cityshall.be.
addressed to City at:
,City of Cupertino `
1030,0 Torre Ave:
Cupertino,:CA, ;95014 -
t. !' F
Attention: Director of Recreation and Community Services
All notices, demands, requests, or approvals from City.to Consultant shall be
addressed to,Consultant at:
Bricks 4 Kidz }.
20. TERMINATION:
In.the event Consultant•fails or; refuses to perform any of;the provisions hereof at
the time and.in.the manner required-hereunder, Consultant.shall�be deemed;in default
in the performance of this Agreement. If such default is not cured within:the,time,�,;
specified after receipt by Consultant from City,of written-notice:of default; specifying the
nature of such default and the steps necessary to cure such default, City may terminate
the Agreement forthwith by giving to the Consultant written notice thereof..: r
. City�shall have the option, at,its.•sole discretion and without cause, of4erminating
this Agreement by giving..thirty (30) days' prior,written notice to Consultant as provided.
herein. Upon termination of this Agreement, each party shall pay to the other,party,,that,
portion of compensation specified in this Agreement that is earned and unpaid prior to
the effective date of termination.
City has no obligation to offer any of Consultant's services to participants, and,
unless minimum enrollment for a particular class identified in the Scope of Services is
met, City may cancel that class without further notice to Consultant or payment under
this Agreement. The City in its sole discretion may determine the type of classes, the
number of classes, and any assigned instructor. Consultant understands that this is an
non-exclusive agreement.
21. COMPLIANCES:
Consultant shall comply with all state or federal laws and all ordinances, rules
and regulations enacted or issued by City.
22. CONFLICT OF LAW:
This Agreement shall be interpreted under, and enforced by the laws of the State
of California excepting any choice of law rules which may direct the application of laws
of another jurisdiction. The Agreement and obligations of the parties are subject to all
valid laws, orders, rules, and regulations of the authorities having jurisdiction over this
Agreement (or the successors of those authorities.)
Any suits brought pursuant to this Agreement shall be filed with the courts of the
County of Santa Clara, State of California.
o
23. ADVERTISEMENT:
Consultant shall not post, exhibit, display or allow to be posted, exhibited,
displayed any signs, advertising, show bills, lithographs, posters or cards of any kind
pertaining to the services performed under this Agreement unless prior written approval
has been secured froml City to do•otherwise.'
24. WAIVER:
A waiver by City of any breach of any term, covenant, or condition contained
herein shall not be deemed to be a waiver of any subsequent breach of'the same or any
other term, covenant, or condition contained herein, whether of the same or--a different
character. ry z.
25. .INTEGRATED-CONTRACT:
This Agreement represents the full and complete understanding of every kind or,
nature whatsoever between the parties hereto, and all preliminary negotiations and
agreements of whatsoever kind or nature are merged herein. No verbal agreement or
implied covenant shall be held to vary the provisions hereof. Any modification of this
Agreement will be effective only by written execution signed by both City and
Consultant.
26. INSERTED PROVISIONS:
Each provision and clause required by law to be inserted into the:Agreement
9h411"be deemed W'be enacted herein,-and the Agreement'shall be^read.and'enforced
as though-each werefincludedf herein:.-•If through mistake-or othe'rwise,'anysuch
provision is'not inserted-w is not correctly inserted;'the Agreement shall`be amended to -
make-sucht,insertion on application•by either party: "
27. CAPTIONS: <:
The.captionsin this Agreement are`for convenience only,.ate not apart of the
Agreement andin or amplify the'terms or provisions of this
Agreement. ;r
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IN WITNESS WHEREOF, the parties hereto hC ve caused this modification of
Agreement to be executed. '
Bricks 4 Kidz CITY OF CUPERTINO
A Municipal Corporation
By - By. Rachelle Sander
Title: 5 r � Title: Recreation Coordinator
Date: n L4.
R COMM ',LADED FOR APPROVAL,..
Senior Recreation Supervisor
Date: ' --mil
APPROVED AS TO FORM:
AJ
City Morh ey
Date.
ATTEST:
r City Clerk
a. Date: _E3 u
EXPENDITURE DISTRIBUTION:
580-6349-7014. $40,000.00
Account Number Amount
i
3
EXHIBIT A
CONSULTANT SERVICES TO BE PERFORMED
The CONSULTANT will provide instruction of math programs iei, but not limited-
to, the following programs:
Bricks 4 Kidz lego models., -
Location and Time of CONSULTANT,Services: -
Refer to current.Fall & Spring Afterschool Enrichment Brochures for agreed upon dates,
times,-'and,class locations. By Mutual`agreement of both parties, class schedule may
change.
Eligible Participant Minimum and Maximums for CONSULTANT Services:
Minimum:*6-8
Maximum: 15-20
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 Consultant.
Performance"of CONSULTANT Services:
City shall have no right of control as to:.-the manner Consultant performs the services to
be performed. Nevertheless, City may, at any time, observe the manner in which such
services are being performed by the consultant.
The Consultant 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. Contractors are responsible for supervising minors after
class until a parent of legal guardian has arrived.
In the event of an injury occurring to a participant, the Consultant will notify the City
within 1 hour and.complete an ABAG Incident Report., The ABAG Incident Report must
be submitted to the City within 24 hours-of the-injury.occurring.
T 1
EXHIBIT 13
ACKNOWLEDGEMENT OF MANDATED.REPORTING REQUIREMENTS, RECEIPT
OF TRAINING, AND RECEIPT OF PENAL CCICES STATUTES
A mandated reporter is an individual who is;obligated by law to report suspected cases
of child abuse and neglect. In general, any individual who, in-the ordinary course of
their employment, has contact with children is a mandated reporter. Mandated
reporters include child care workers,.teachers.and coaches. (California Penal Code
11165.7).
If your job duties as an employee or an independent contractor of Bricks 4 Kidz include
contact.with children, you are a Mandated Reporter. Prior,to commencing employment
and as a.prerequis..ite of that employment,'California.law requires that you sign a
statement to the effect that you have knowledge of the provisions.of the M.andated
Reporter Law, and will comply with those provisions. (California Penal Code 11166.5).
The following are the Mandated Reporter responsibilities under,California law. You are
also being provided with a separate informational document which includes the text of
the California Mandated.Reporter Law.and contact information for,,Child Abuse and
Neglect Reporting for the County of Santa Clara. Please review this information
carefully and acknowledge your'receipt,and.understanding where indicated. If you have
questions or concerns about this form or your.Mandated Reporter responsibilities,
please,contact the Recreation.Supervisor at 40!6-777-3120.
I understand that:
• By virtue of my employment or"independenf contractor status with Bricks 4
Kidz and because my employment requires me'to have contact with
children, I. am a Mandated Reporter: as defined by California Penal Code
11165.7.•
• The following situations trigger mandatory reports: a) Physical Abuse_
(willful harming of a child); b) Sexual abuse including sexual assault, child
exploitation, pornography, and trCafficking; c) Severe or General Neglect;
and d) Extreme Corporal Punishment (resulting in injury). (Cal. Pen. Code
11165 et. seq.) I further understand that I may, but'am'not required to,
report suspected Emotional Abuse.
• If I reasonably suspect that a child is being abused, I must immediately
make a telephone report. I must follow up with a written report within 36
hours. This report may be made to local law enforcement, or County
Sheriffs Department, Probation Department or Child Welfare Agency.
(Cal Pen. Code 11166(a)).
• 1 am not required to, but I may, share information about suspected abuse
with my supervisor or management or the parents of the alleged victim.
• When I make a mandated report, I will be required to give my name.
However, my identity will be kept confidential unless I either consent to
disclosure or if the disclosure is made pursuant to a court order. Further,
agencies investigating the mandated report may disclose my identity to
one another. (Cal Pen. Code 11167(d)).
The'°following agencies and individuals receiving or investigatinFg
mandated reports may disclose my'identity to one another: r
` o Prosecutors in a criminal prosecuting or in an action initiated under
section 602 of the Welfare and Institutions Code arising-from
alleged child abuse;
o Counsel appointed pursuant to subdivision (c)'of Section 317 of`the
Welfare and Institutions Code;
o A licensing agency when abuse or neglect in out-of-home care is
,
reasonably-suspected. (Cal Pen. Code 11167.5)
1 may not-be disciplined, dismissed; retaliated against, discriminated
against or harassed for making a mandated report of reasonably
suspected child abuse.
As a Mandated Reporter, I have civil and criminal immunity when making.
'a report (Cal Pen. Code 11172)*: '
As a Mandated Reporter, it isla misdemeanor to fail to'comply with
Mandated Fkeportin-g'laws and I can be held criminally'liable for
failing to report suspected abuse: The penalty for-this is up to six
months in County'jail, a.fine of not more than-$1000,'or both'. I further
understand I could be civilly`liable for failure to'report. (Cal. Pen. Code
11166(c))• t.
I have been provided with a copy of California Penal Code sections 11164-11174.3
(Mandated Reporter Law). f
,
I understand that I am a legally Mandated-Reporter. I am aware of and understand
my responsibilities under the Mandated Reporter laws of this state and am willing
and able to comply. I understand that a copy of this Acknowledgement will be
kept wit.h my consultant agreement:
t X21
Name ( `' Date
0
Namel(Print) -.
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EXHIBrr C
City of Cupertino Consultant Declaration
The undersigned does hereby certify that:
1. 1 am a representative of Bricks 4 Kidz (consultant or company name); that I am
familiar with the facts herein and am authorized and qualified to execute this
declaration.
2. 1 declare that Bricks 4 Kidz (consultant or company name) has complied with
fingerprinting and criminal background investigation requirements with respect to
all Consultant'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 tho:De employees has been convicted of a
felony, as that term is defined in California Penal Code Section 11105.3.
3. That a complete and accurate list of Consultant's employees, who may come in
contact with minors during the course and scope of the Agreement, are 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 Consultant.
5. 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.
A List of all Consultant Employees Workings in the Bricks 4 Kidz program:
-A L A-w V KCA-
A-L`11L- 2
Le- - EEPe- ro Q C z-
t,,A.04 lec-c,-O
6. The City of Cupertino will be notified by Consultant in writing of any new
employees and will be added to the above list prior to beginning work.
I declare under penalty of perjury t at the foregoing is true and correct:
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ate