15-062 Hongyun Art School for Utility Box Art ProgramFIRST AMENDMENT TO AGREEMENT 2015-485
BETWEEN THE CITY OF CUPERTINO AND
HONGYUN ART SCHOOL FOR UTILITY BOX ART
PROGRAM IMPLEMENTATION AND MAINTENANCE
SERVICES
This First Amendment to Agreement 2015-485 between the City of Cupertino and Hongyun
Ar1 School, for reference dated 4/10/2018, is by and between the CITY OF CUPERTINO, a
municipal corporation (hereinafter "City") and Hongyun A11 School, a California corporation
("Consultant") whose address is 10457 S . De Anza Blvd Cupertino , CA 95014, and is made with
reference to the following:
RECITALS:
A. On 5/1/2015, an agreement was entered into by and between City and Consultant
(hereinafter "Agreement") for utility box ai1 program implementation and maintenance. The
agreement will expire on 5/1/2020.
B. On 4/10/2018, City and Consultant agreed to the First Amendment for utility box art
program implementation and maintenance.
C. The Agreement and the First Amendments are collectively referred to as the
"Agreement" unless otherwise indicated.
D. City and Consultant desire to modify the Agreement on the terms and conditions set
forth herein.
NOW, THEREFORE, it is mutually agreed by and between and undersigned parties as
follows:
1. COMPENSATION TO CONSULTANT
Paragraph 1 of the Agreement is modified to read as follows: Consultant shall be compensated
for services performed pursuant to this Agreement in a total amount not to exceed twelve-
thousand dollars ($12,000) based on the rates and terms set forth in Exhibit " C", which is
attached hereto and incorporated herein by this reference.
2. The following Exhibits to the Agreement, are amended and replaced to read as shown in the
attachments to this Amendment:
a. Exhibit C with updated compensation not to exceed amount.
b . Exhibit D with updated insurance requirements .
3. Except as expressly modified herein , all other te1ms and covenants set forth in the
Agreement shall remain the same and shall be in full force and effect.
IN WITNESS WHEREOF, the patties hereto have caused this modification of
Agreement to be executed.
CITY ~ERTIN/L---
By ~
Title City Manager
RECOMMENDED FOR APPROVAL
~~,e ~~aWJ~
City Clerk
EXPENDITURE DISTRIBUTION
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Amendment #1:
Amendment #2:
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ACORD®
~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD /YYYY)
05/16/201 8
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON FERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CE RTIF ICATE DOES NOT AFFIR M ATIVELY OR NEGATI VE LY
AM END, EXTEN D OR ALTER TH E COV ERAG E AFF ORDED BY THE PO LICIE S BELOW. THI S CERTIFICATE OF INSURANCE DO ES NOT CON STITU TE A CO NTRACT BETWEEN THE ISSUING INSURER (S),
AUTHOR IZ ED REPRES ENTATI VE OR PROD UCER , AND THE CE RTIFICAT E HOLDER .
IMPORTA NT: If t he certificate holder i s an ADD IT IO NAL INSURED, t he po ll cy(ies ) must have ADDITIONAL INSURED provisions or be endorsed . If SUBROGATI ON JS WA IVED, subj ectto t h e terms and
co nd itions of t he policy, certain po licies may req uire an endors em ent. A statemen t on this certificate does not confer rights to t he certificat e hold er in lieu of such endors ement (s ).
PRODUC ER CONTACT
NA M E: Le e Gomez
Le e Gomez(969 136A) PHONE I FAX
11 00 Li ncoln Ave Ste 236 (A/C, NO, EXT): 408-22 3-0970 (A/C, NO ): 408-223 -0974
E-MAIL
Sa n Jose CA 95 125-3058 ADDRESS : lgomez 3@fa rmersagent.com
INSURE R(S) AFFORD ING COVERAGE NA IC #
INS URED INSURER A: Truc k Insurance Exc hange 21709
INSURER 8 : Fa rme rs Insurance Exc hange 2165 2
SURIWONG , HONGYUN 7 TO MMY
INSURERC : Mid Ce ntury Ins urance Company 2168 7
10457 S . DEANZA BLVD
INSURERD :
INSURER E:
CUPERTI NO CA 950 14
INSURER F:
COVERAG ES CERTIFICATE NUMBER: REVISION NU M BER :
THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANC E LI STED BELOW HAV E BEEN ISSUED TO TH E INSUR ED NAME ABOV E FOR TH E POLICY PERIOD IND ICATED . NOTWITHSTANDING ANY
REQUIREMENT, TERM OR COND ITION OF ANY CONTRACT OR OTH ER DOCUMENT WIT H RESPEC TTO WH ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE
POLIC IES DESCR IBED HEREIN IS SUBJECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS .
INSR TY PE OF INSURA NCE ADDTL SUBR POLIC Y NUMBER POLICY EFF POL ICY EXP LIMITS
LTR INSD WVD (MM /DD /YYYY) (M M /DD /YYYY)
X CO M M ERCIAL GENERAL LIA BI LI TY EACH OCCURRENCE $ I CLAIMS-MADE 0 OCCUR
DAMAGE TO RENTED $ PREMI SES (Ea Occurrence)
MED EXP (Any one person) $
A 604875397 01/12/2018 01/12/2019 PERSONAL & ADV INJURY $
GEN 'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ Zj POLICY D PROJECT D LOC PRODUCTS -COMP/OP AGG $
OTHER : $
AU TOM OBI LE LIABIL ITY COMB INED SINGLE LIM IT $ (Ea accident) -ANY AUTO ' BODILY INJURY (Pe r person) $ -~
B OWNED AUTOS X SCHEDULED BODILY INJURY (Per accident) $ ONLY AUTOS 60 4875397 0 1/12 /2 0 18 01/1 2/2019 -I-
HIRED AUTOS NON-OWNED PROPERTY DAMAG E
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ANY PROPRI ETOR /PAR TNER / YI N E.L. EACH ACC IDENT
EXECUTIVE OFFICER /MEMBER C N/A
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A Se x ual Ab use/Mol esta tio n 60 4875397 05/15/20 18 01 /12/2019
DES CRIPTI ON OF OPE RAT IONS/LOC ATI ONS/VEH ICLES (ACORD 101 , Ad d it ional Remarks Sc hedule, may be attached if more space is requ i red)
CERT IFI CAT E HOLD ER CA NCELLATIO N
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EXHIBITB
INSURANCE REQUIREMENTS
For Services and Activities Involving Children
Instmctor shall procure and maintain for the duration of the contract insurance against claims for injuries
to persons or damages to prope1iy which may arise from or in connection with the perfo1mance of the
work hereunder and the results of that work by the Instmctor, his agents, representatives , employees or
subcontractors .
MINIMUM SCOPE AND LIMIT OF INSURANCE
Coverage shall be at least as broad as:
1. Commercial General Liability (CGL): Insurance Services Office Fo1m CG 00 01 covering CGL
on an "occmTence" basis, including prope1iy damage, bodily injury and personal & adve1iising injury
with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, either the
general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the
general aggregate limit shall be twice the required occmTence limit.
2. Sexual Abuse/ Molestation insurance or the equivalent are required for contracts involving children
in after school activities, recreational programs, athletics, studies, transpo1iation of students. Covers
potential claims of abuse or child molestation. Sexual Abuse/Molestation coverage must be included
under General Liability or obtained in separate policies in an amount of not less than $1,000 ,000 per
occurrence ($2 ,000,000 aggregate) and $3,000 ,000 excess/umbrella coverage .
3. Automobile Liability: Insurance Services Office Fo1m Number CA 0001 covering, Code 1 (any
auto), or if Instmctor 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 prope1iy damage . (Note -required only if auto
is used in perf01mance of work)
4. Workers' Compensation insurance as required by the State of California, with Statutory Limits ,
and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily
injury or disease . (Note -required only if Instmctor has employees).
If the contractor maintains broader coverage and/or higher limits than the minimums shown above, the
Entity requires and shall be entitled to the broader coverage and/or higher limits maintained by the
contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and
coverage shall be available to the Entity.
Self-Insured Retentions
Self-insured retentions must be declared to and approved by the Entity. The Entity may require the
Instmctor to provide proof of ability to pay losses and related investigations , claim administration,
and defense expenses within the retention. The policy language shall provide, or be endorsed to provide,
that the self-insured retention may be satisfied by either the named insured or Entity.
Other Insurance Provisions
The general liability policy is to contain, or be endorsed to contain, the following provisions:
1. The Entity, its officers, officials, employees, agents, and volunteers are to be covered as
additional insureds with respect to liability arising out of work or operations perfo1med by or on
behalf of the Instmctor including materials , paiis or equipment furnished in connection with such
work or operations.
2. For any claims related to this contract , the Instructor's insurance coverage shall be primary insurance
coverage at least a s broad as ISO CG 20 01 04 13 as respects the Entity, its officers, officials, employees,
agents , and volunteers.
3 . The Insurance Company agrees to waive all rights of subrogation against the Entity, its elected or
appointed officers, officials, agents, and employees for losses paid under the terms of any policy which arise
from work performed by the Instructor for the Entity. This provision also applies to the Instructor's Workers '
Compensation policy.
4. Each insurance policy required above shall provide that coverage shall not be canceled, except with notice
to the Entity.
Acceptability of Insurers
Insurance is to be pla ced with insurers with a current A.M . Best 's rating o f no less than A : VII, unless
otherwise acceptable to the Entity.
Verification of Coverage
Instructor shall furnish the Entity with original certificates and amendatory endorsements effecting coverage
required by this clause. All certificates and endorsements are to be received and approved by the Entity
before work commences. The Entity reserves the right to require complete, certified copies of all required
insurance policies, including endorsements affecting the coverage required by these specifications, at any
time . We strongly recommend obtaining a copy of the policy declarations and endorsement page (make this
a requirement in your Contract) to facilitate verification of coverages and spot any undesirable policy
limitations or exclusions .
Homeowner's Insurance
In some cases the Instructor's homeowner's liability insurance may provide coverage sufficient to meet these
requirements. Instructor should provide these requirements to his or her agent to confirm and provide
verification to the Entity.
Special Events Coverage for Instructors
Special events coverage is available for an additional fee to provide the liability insurance required by this
agreement. Instructor can obtain additional information and cost from the Entity.
Special or Low Risk Activities
Entity reserves the right to modify these requirements, including limits, based on the nature of the risk , prior
experience , insurer, coverage, or other special circumstances. The Entity reserves the right to modify or
waive insurance requirements for certain low risk recreational activities.
Exhibit C
Compensation
City shall compensate Consultant for professional services in accordance with the terms and conditions of this
Agreement. Compensation shall be full compensation for all work performed and services rendered under this
Agreement.
The compensation to be paid to Consultant under this Agreement for all services described in Exhibit "A" and
reimbursable expenses shall not exceed a total of twelve-thousand dollars ($12 ,000 .00), as set forth below. Any
work performed or expenses incurred for which payment would result in a total exceeding the max imum amount of
compensation set forth herein shall be at no cost to the City.
Invoices
Supplies
Project Management Oversight
Utility Box Art Maintenance
Total
Not to Exceed Amount
$4,000
$3,000
$5,000
$12,000
In order to request payment, Consultant shall submit a single invoice to City each year with receipts detailing
project-related expenditures.
Reimbursable Expenses
Administrative, overhead, secretarial time or overtime, word processing, photocopying, in house printing, insurance
and other ordinary business expenses are included· within the scope of payment for services and are not
reimbursable expenses. Suppl ies are the only reimbursable expense under this Agreement, not to exceed the amount
above.
Additional Services
Consultant shall provide additional services outside of the services identified in Exhibit A only by advance written
authorization from the City's Project Manager prior to commencement of any additional services. Consultant shall
submit, at the Project Manager's request, a detailed written proposal including a description of the scope of
additional services, schedule, and proposed maximum compensation.
2oIs--(
AGREEMENT BETWEEN THE CITY OF CUPERTINO AND
HONGYUN ART SCHOOL FOR
UTILITY BOX ART PROGRAM IMPLEMENTATION AND MAINTENANCE
SERVICES
THIS AGREEMENT, is entered into this 1st day of May, 2015, by and between the
CITY OF CUPERTINO, a California municipal corporation ("City"), and Hongyun Art School,
a California corporation whose address is 10525 South De Anza Boulevard, Suite 175,
Cupertino, CA 95014 (hereinafter referred to as "Consultant") (collectively referred to as the
Parties").
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.
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 utility box art program
implementation and maintenance upon the terms and conditions herein.
NOW, THEREFORE,the Parties mutually agree as follows:
1. TERM
The term of this Agreement shall commence on May 1, 2015, and shall terminate on May
1, 2020,unless terminated earlier as set forth herein.
2. SERVICES TO BE PERFORMED
Consultant shall perform each and every service set forth in Exhibit "A" pursuant to the
schedule of performance set forth in Exhibit"B," attached hereto and incorporated herein by this
reference.
3. COMPENSATION TO CONSULTANT
Consultant shall be compensated for services performed pursuant to this Agreement in a
total amount not to exceed six thousand dollars ($6,000)based on the rates and terms set forth in
Exhibit "C,"which is attached hereto and incorporated herein by this reference.
4. TIME IS OF THE ESSENCE
Consultant and City agree that time is of the essence regarding the performance of this
Agreement.
Pagel of22
Consultant contract- updated 2/2015
5. STANDARD OF CARE
Consultant agrees to perform all services required by this Agreement 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.
6. INDEPENDENT PARTIES
City and Consultant intend that the relationship between them created by this Agreement
is that of employer-independent contractor. The manner and 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 by virtue 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.
Deductions 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.
7. SPECIAL REQUIREMENTS
A. Mandated Reporting. 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.
B. Fingerprinting and Tuberculosis Declaration. Consultant agrees to complete
fingerprinting, criminal background checks, and tuberculosis screening for all individuals
covered under this Agreement pursuant to the requirements set forth in Exhibit "F" which is
attached hereto and incorporated herein by this reference.
8. IMMIGRATION REFORM AND CONTROL ACT(IBCA)
Consultant assumes any and all responsibility for verifying 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.
9. NON-DISCRIMINATION
Consistent with City's policy prohibiting harassment and discrimination, Consultant
agrees that it shall not harass or discriminate against 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,
sexual orientation, or any other protected class. Consultant agrees that any and all violations of
this provision shall constitute a material breach of this Agreement.
10. HOLD HARMLESS
Consultant shall, to the fullest extent allowed by law and without limitation of the provisions of
Page 2 of 22
Consultant contract- updated 2/2015
this Agreement related to insurance, 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 and all other costs and fees of litigation. The acceptance of the Services by City shall
not operate as a waiver of the right of indemnification. The provisions of this Section survive the
completion of the Services or termination of this Contract.
11. INSURANCE:
A. General Requirements. 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 the requirements listed in Exhibit "D". Such certificates, which do not limit Consultant's
indemnification, shall also contain substantially the following statement: "Should any of 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." Consultant shall maintain
in force at all times during the performance of this Agreement all appropriate coverage of
insurance required by this Agreement with an insurance company that is acceptable to City and
licensed to do insurance business in the State of California. Endorsements naming the City as
additional insured shall be submitted with the insurance certificates.
B. Subrogation Waiver. Consultant agrees that in the event of loss due to any of the
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 or maintain insurance. If Consultant at any time during the term
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 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
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Consultant contract- updated 2/2015
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.
F. Maximum Coverage and Limits. It shall be a requirement under this Agreement
that any available insurance proceeds broader than or in excess of the specified minimum
Insurance coverage requirements and/or limits shall be available to the additional insured City.
Furthermore, the requirements for coverage and limits shall be the minimum coverage and limits
specified in this Agreement, or the broader coverage and maximum limits of coverage of any
insurance policy or proceeds available to the named insured, whichever is greater.
12. CONFLICT OF INTEREST
Consultant warrants that it presently has no interest, and will not acquire any interest,
direct or indirect, financial or otherwise, that would conflict in any way with the performance of
this Agreement, and that it will not employ any person having such an interest. Consultant
agrees to advise City immediately if any conflict arises and understands that it 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.
1.3. PROHIBITION AGAINST TRANSFERS
Consultant shall not assign, sublease, hypothecate, or transfer this Agreement, 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, transferor other disposition of any of the issued and outstanding
capital stock of Consultant, or of the interest of any general partner or joint venturer or syndicate
member or cotenant, if Consultant is a partnership or joint venture or syndicate or cotenancy,
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.
14. 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, automobile and professional 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.
Consultant agrees to include with all subcontractors in their subcontract the same
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Consultant contract- updated 2/2015
requirements and provisions of this Agreement including the indemnity and insurance
requirements to the extent they apply to the scope of the subcontractor's work. Subcontractors
hired by Consultant agree to be bound to Consultant and City in the same manner and to the
same extent as Consultant is bound to City under this Agreement. Subcontractor further agrees to
include these same provisions with any sub-subcontractor. A copy of the Owner Contract
Document Indemnity and Insurance provisions will be furnished to the subcontractor upon
request. Consultant shall require all subcontractors to provide a valid certificate of insurance and
the required endorsements included in the agreement prior to commencement of any work and
will provide proof of compliance to City.
15. PERMITS AND LICENSES
Consultant, at his/her sole expense, shall obtain and maintain during the term of this
Agreement, all appropriate permits, certificates and licenses including, but not limited to, a City
Business License, that may be required in connection with the performance of services'
hereunder.
16. 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 City deems appropriate.
C. Consultant shall, at such time and in such form as City may require, furnish
reports concerning the status of services required under this Agreement.
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 paper 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.
17. 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, in sufficient detail to permit an evaluation of services. All such
records shall be maintained 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
Page 5 of22
Consultant contract- updated 2/2015
allow inspection of all work, data, documents, proceedings and activities related to this
Agreement. Such records,together with supporting documents, shall be kept separate from other
documents and records and shall be maintained for a period of three (3) years after Consultant
receives final payment from City for all services required under this agreement.
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 or audit.
18. NONAPPROPRIATION
This Agreement is subject to the fiscal provisions of the Cupertino Municipal Code and
Agreement will terminate without any penalty (a) at the end of any fiscal year in the event that
funds are not appropriated for the following fiscal year, or (b) at any time within a fiscal year in
the event that funds are only appropriated for a portion of the fiscal year and funds for this
Agreement are no longer available. This Section shall take precedence in the event of a conflict
with any other covenant,term, condition,or provision of this Agreement.
19. ENVIRONMENTALLY PREFERABLE PURCHASING
Consultant shall comply with the City's Environmentally Preferable Procurement Policy
whenever practicable in completing any work under this agreement, including but not limited to:
Using paper products made with recycled content and recycled/remanufactured toner
and ink jet cartridges;
Printing with soy or low volatile organic compounds(VOC) inks;
Using energy-star compliant equipment;
Using cleansers and .working with janitorial contractors to meet Green Seal's
Industrial and Institutional Cleaners Standard; and
Ordering supplies electronically and practicing other internal waste reduction and
reuse protocols.
20. 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 shall be addressed as follows:
TO CITY:
City of Cupertino
10300 Torre Ave.
Cupertino CA 95014
Attention: Erin Cooke
TO CONSULTANT:
Tommy Suriwong
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Consultant contract- updated 2/2015
Hongyun Art School
15025 South De Anza Boulevard, Suite 175
Cupertino, CA 95014
21. 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 Consultant fails to cure the default within the time specified and according
to the requirements set forth in City's written notice of default, and in addition to any other
remedy available to the City by law, the City Manager may terminate the Agreement by giving
Consultant written notice thereof, which shall be effective immediately. The City Manager shall
also have the option, at its sole discretion and without cause, of terminating this Agreement by
giving seven (7) calendar days' prior written notice to Consultant as provided herein. Upon
receipt of any notice of termination, Consultant shall immediately discontinue performance.
City shall pay Consultant for services satisfactorily performed up to the effective date of
termination. If the termination if for cause, City may deduct from such payment the amount of
actual damage, if any, sustained by City due to Consultant's failure to perform its material
obligations under this Agreement. Upon termination, Consultant shall immediately deliver to the
City any and all copies of studies, sketches, drawings, computations, and other material or
products, whether or not completed, prepared by Consultant or given to Consultant, in
connection with this Agreement. Such materials shall become the property of City.
22. COMPLIANCE
Consultant shall comply with all state or federal laws and all ordinances, rules, policies
and regulations enacted or issued by City.
23. 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 Superior Court of the County of Santa Clara, State of California.
24. 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 from City to do
otherwise.
25. 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.
Page 7 of22
Consultant contract- updated 2/2015
26. INTEGRATED CONTRACT
This Agreement represents the full and complete understanding of every kind or nature
whatsoever between the Parties, 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.
27. AUTHORITY
The individual(s) executing this Agreement represent and warrant that they have the legal
capacity and authority to do so on behalf of their respective legal entities.
28. INSERTED PROVISIONS
Each provision and clause required by law to be inserted into the Agreement shall be
deemed to be enacted herein, and the Agreement shall be read and enforced as though each were
included herein. If through mistake or otherwise, any such provision is not inserted or is not
correctly inserted, the Agreement shall be amended to make such insertion on application by
either party.
29. CAPTIONS AND TERMS
The captions in this Agreement are for convenience only, are not a part of the Agreement
and in no way affect, limit or amplify the terms or provisions of this Agreement. All unchecked
boxes do not apply to this Agreement.
30. NON-EXCLUSIVE CONTRACT
This is a non-exclusive contract. The City may contract with other schools and/or
businesses for painting additional utility boxes.
Page 8 of22
Consultant contract- updated 2/2015
IN WITNESS WHEREOF,the parties have caused the Agreement to be executed.
CONSULTANT CITY OF CUPERTINO
Name of Consultant A Municipal Corporation
By I0W&I U i w
Title W"-*- - o UPKL V r 4 By
Date S .- Title qtr
Date Y
Over$175,000-Council Approval Required
Over$45,000-Department Head Approval Required
Up to$45,000-Designated Supervisor Approval Required
7:t7 ED FOR APPROVAL
z—
biivid Brandt, City Manager
AP ROVED AS TO FORM:
ity Attorney
ATTEST:
i Clerk
Exhibits:
Exhibit"A"- Scope of Services
Exhibit`B"- Schedule of Performance
Exhibit"C"- Compensation
Exhibit"D"-Insurance Requirements and Proof of Insurance
Exhibit"E"-Mandated Reporting Acknowledgement
Exhibit"F"-Background/Fingerprint/TB Declaration
Page 9 of 22
Consultant contract- updated 2/2015
Contract No.
Exhibit A
Scope of Services
Cupertino"Energized by Art"Utility Box Pilot Project
The City of Cupertino is piloting a new community environmental art program,-titled"Energized
by Art," to decorate up to five (5) utility (electric or traffic signal controller) boxes in public
areas with student-designed images:The utility boxes are property of PG&E (electricity) and the
City(traffic signal controllers), which have each given pre-approval to proceed with this project.
The City will partner with local art school and certified green business Hongyun Art to
implement this pilot. Hongyun Art will collect submissions and oversee the application to and
future maintenance of the selected utility boxes.
Scope of Services
Consultant will receive Project contest submissions, provide submissions to City's Art
Commission for approvals, and arrange for the installation of the art, including securing
appropriate authorization from PG&E (electric utility boxes) and/or the City (traffic controller
utility boxes). Consultant shall perform ongoing maintenance of the art.
In advance of the installation date, the City will prepare the utility boxes for artwork with anti-
graffiti/UV coatings and provide Hongyun with the type of paint medium, application guidelines
e.g. no painting over nameplates,keyholes, ID numbers, minimize use of dark colors, etc.), and
care instructions for protecting the surrounding area (sidewalk and pedestals) from paint
drippings.
Provide Submissions to City's Art Commission
Consultant will select a maximum of ten (10) project submissions for consideration and approval
by the City's Art Commission. Consultant may not select artwork submitted by a family
member. Those designs selected by the Art Commission will be installed on the designated
utility boxes
Arrange for the Installation of Art
Consultant will furnish all tools, supplies, and labor necessary to install the selected designs onto
the respective utility boxes identified by the City in a good and workmanlike manner to the
satisfaction of the City." Consultant may not place its name or logo onto any of the designated
utility boxes as part of the installation of art. Prior to the installation of art, Consultant shall
distribute and collect a Release and Assumption of Risk Agreement, included below, completed
for each participant involved in the installation of art.
Ongoing Maintenance
10
Cupertino Staudad Fow Cmct-updated 212015
Contract No.
Consultant is responsible for all parts and workmanship for the term of this Agreement after the
acceptance of the Work by the City and will replace any defective parts or rework any defective
craftsmanship in a timely fashion at no cost. Consultant is not responsible for and will not be
held liable for any damage to the Work, its surfaces, or environment caused by personnel of the
City or by contracted employees, visitors or others, beyond the control of, the consultant.
Consultant is not responsible for and will not be held liable for any damages to the Work by
weather conditions, acts of God, or other acts abnormal to the site. City retains the right to
request maintenance by Consultant of the artwork during the term of this Agreement and the
right to remove the artwork in its entirety before the end of the term.
11
Cupertino Standard Form Contract-updated 212015
Contract No.
Cupertino "Energized by Art" Utility Box Pilot Project CUPERTINO GREEN
A community art pilot program conducted in partnership with local Hongyun Art School
Pilot Overview
The City of Cupertino seeks to pilot a new community environmental art program to both showcase our youth's
creative talents and to promote a culture of conservation in Cupertino inspired by local art.This demonstration
effort,titled"Energized by Art",will decorate up to 5 utility(electric or traffic signal controller)boxes in public
areas with student-designed images inspired by this theme: What can I do to conserve resources in Cupertino?
The "Energized by Art"project will transform these utility elements of our cityscape in to works of art that will not
only decorate our roadways but demonstrate the energy,water,and resource conservation leadership and
knowledge of Cupertino's youth.As elements of our electrical and transportation infrastructure,the boxes lend
themselves well to this kind of messaging.The utility boxes are property of PG&E(electricity)and the City(traffic
signal controllers),which have each given pre-approval to proceed with this project.Painting each individual box
must be approved on a box-by-box basis,as maintenance and liability considerations are site-specific.
The City proposes to partner with local art school and certified green business Hongyun Art to implement this
pilot.Hongyun Art is a private art school for children located in Cupertino,who has teamed with the City on
various projects in our recent past(e.g.,paperless plan recycled tree located in City Hall).The school pitched the
idea for the project as a contribution to this years Earth Day festival,yet one that would have permanence
beyond the event itself.Hongyun Art will collect submissions and oversee the application of artwork to the
selected utility boxes,each orchestrated in concert with its City partners.
This pilot could easily scale in future years to include additional boxes,schools,and recurring competitions.In
this first year,while any Cupertino student can participate in the utility box design,for ease of implementation,
Hongyun Art will coordinate painting the boxes.
Proposed Timeline
Task Date
City staff will work with PG&E/City to identify up to 5 utility boxes in public areas March
City staff and Hongyun Art introduce project to Cupertino Fine Arts Commission March 23rd
Hongyun Art will collect entries until the contest deadline of 5/15/15 April-May
Entries displayed at City's Annual Earth Day Festival to inspire students to enter contest April 111h
Contest deadline May 15,2015
City staff and Hongyun art will collaborate on determining eligibility of entries May
Fine Arts Commission makes final selections May
Hongyun Art coordinates utility box painting May/June
Contest Rules
Artists must be Cupertino residents.Non-residents are not eligible.
One piece per student.Students can collaborate on artwork,but can submit only one piece per group.
Artwork must be done on the template provided.
Artwork must be 2D;artists may use a medium of their choice.
Artwork must fit the contest theme and above parameters or it will not be considered.
12
Cupedino Standard Form Contract-updated 712015
Contract No.
Artwork must be submitted in person to Hongyun Art,10457 S.De Anza Blvd.(W-F 3pm-8:30pm,Sat-
Sun 9:30am-5:00pm).
Artwork must be the original design and work of the entrant.
Artwork must be submitted together with a signed entry and authorization form.
Submissions must be submitted by May 15,2015 at 5:00pm.
Selection
Submissions will be divided for selection according to the following age groups:
K-2nd grade
3rd-51h grade
61h-8th grade
9-1211,grade
At least one winner will be chosen from each group.Multiple winners may be chosen from each group pending
PG&E/City approval of individual boxes.Beyond artistic merit,selections will be made based on how well the
submission fits the contest theme.Submissions that do not follow any one of the contest rules will NOT be
considered.Submissions will be made to Hongyun Art in person:each artist will submit their design on the
provided template,together with a signed waiver.After the deadline on May 15th,the City and Hongyun will
meet to review the entries and disqualify any that do not meet the contest rules above.Entries collected by Earth
Day will be displayed at the festival on April 111h,and visitors will be able to pick up entry forms.Final decisions
will be made at the May 2015meeting of the Cupertino Fine Arts Commission.Winners will be notified by letter
in May/June of 2015,and will be able to take part in painting the utility boxes over the summer of 2015.
Below are examples of painted utility boxes from neighboring.cities:
711
j eM
z
C
5
A f
Campbell San Jose San Jose
13
Cupertino Stan"Fu®Contract-updated V2015
Cupertino "Energized by Art"Utility Box Project
Entry Form CUPERTINO GREEN
The City of Cupertino is piloting a new community environmental art program to showcase our youth's creative talents
and to promote a culture of conservation in Cupertino inspired by local art.The"Energized by Art"project will decorate
up to five utility boxes in public areas with student-designed images inspired by this theme: What can I do to conserve
resources in Cupertino?This demonstration will transform these utility elements of our cityscape in to works of art that
will demonstrate the energy,water, and resource conservation leadership and knowledge of Cupertino's youth.As
elements of our electrical and transportation infrastructure,the boxes lend themselves well to this kind of messaging.
CONTEST RULES:
Artists must be Cupertino residents,in grades K-12.Non-residents are not eligible.
One piece per student.Students can collaborate on artwork,but can submit only one piece per group.
Artwork must be done on the template provided on the back of this sheet.
Artwork must be 2D;artists may use a medium of their choice.
Artwork must be the original design and work of the entrant.
Artwork must be submitted together with a signed entry and authorization form.
Artwork must fit the contest theme and above rules or it will not be considered.
DEADLINE for submission is May 15,2015 at 5:00pm.
TO SUBMIT:
Submissions must be made to Hongyun Art in person at 10457 S.De Anza Blvd. (W-F 3pm-8:30pm,Sat-Sun 9:30am-
5:00pm).The authorization to use artwork below must be signed.Submissions will be divided for selection according to
the following age groups:K-2nd grade,3rd-51h grade,611,-81h grade,and 9-121h grade.At least one winner will be chosen from
each group.Selections will be made by the Cupertino Fine Arts Commission based on artistic merit and how well the
submission fits the contest theme.Late submissions or those that do not follow any one of the contest rules will NOT be
considered.Winners will be notified by letter in May/June of 2015. Artist support of painting will occur this summer.
ENTRY FORM:
First Name Last Name
Age Grade School
Address City
Email Phone
AUTHORIZATION to use artwork(for students under 18,a guardian must sign):
I represent that this is my original artwork and I am the author and contributor of all of the art in this submission.I understand that,by entering this
contest,I waive any and all rights to compensation for the artwork submitted.I hereby grant to the City of Cupertino,Hongyun Art,and PG&E and
their authorized agents and employees the right to use my artwork,the rights in all copyright in this artwork,and the right to enhance and modify the
artwork for the"Energized by Art"project,or any other publicity deemed necessary and appropriate for the event as well as any other materials
produced or provided by the City of Cupertino,Hongyun Art and PG&E.I understand that my submission will not be returned.I understand that my
artwork,if applied to a utility box,may be altered from its original design or removed in the future for any reason,and I further understand that the
City of Cupertino,Hongyun Art,nor PG&E shall have any duty,obligation,or liability to restore the artwork if it is defaced or painted over.I also
authorize the City of Cupertino,Hongyun Art and PG&E to use my name in conjunction with the artwork whenever it is used,including during any
publicity deemed necessary and appropriate for these programs.I understand no monetary or other compensation will be offered to the winners or
anyone entering this contest,and that I will have no financial gain or benefit from the production,distribution,and/or sale of artwork. I hereby release
the City of Cupertino,Hongyun Art,and PG&E from any claims or demands associated with the artwork including,without limitation,the right of
privacy or publicity.I understand that there is no guarantee that my artwork will be applied to a utility box or City improvement.
SIGNED:Contestant
IF UNDER THE AGE OF 18:I am the parent or legal guardian of the Contestant.I have read the foregoing Authorization to Use Artwork and
understand its terms.I represent and warrant that I have the legal authority to enter into this Authorization for Use of Artwork.
Parent or Guardian
14
Cupertino Standard Form Contuxt-updated L2015
Top
Please use this template to create your art.Note that there are four sides to each utility box,
and your design will need to cover all sides.Your design can either be continuous or vary
on each side.Please know each utility box size varies, so some stretching or condensing of
your design may occur(this template is not to scale)
Front Side 1 Back Side 2
Artist Name Address
School Phone Age/Grade
CUPERTINO
City of Cupertino
RELEASE AND ASSUMPTION OF RISK AGREEMENT
Name of Participant: Participant)
Name of Parent or Guardian:
I am the Parent or Legal Guardian of the Participant above and represent and warrant that I am
authorized to make this Release and Assumption of Risk Agreement on behalf of Participant. I
HEREBY WAIVE, RELEASE, AND DISCHARGE the City of Cupertino and its officials,
officers, agents, contractors, and employees from and against any and all liability for any loss,
personal injury, including death, or property damage that may arise out of, or in any way be
connected with my child's participation in the installation of artwork as part of the"Energized by
Art" utility box project, even though that liability may have arisen out of negligence or
carelessness on the part of the persons or entities mentioned above and herein released, but I do
not release the above mentioned persons or entities from their fraudulent or intentional acts or for
their negligent violations of statutory law.
Furthermore, I assume all responsibility and agree to indemnify the City of Cupertino and its
officials, officers, agents, contractors, and employees for any loss, damage or injury to my
property or to my child which may have been caused by negligence, or any act, of any'person
connected in any way with the aforementioned event. I understand that the City of Cupertino,
and its officials, officers, agents, contractors, and employees do not guarantee the condition, or
safety of the site, facilities or any equipment used during the course of the "Energized by Art"
utility box project and that this Release and Assumption of Risk Agreement is binding on me, the
Participant, his/her executor, administrators, heirs, successors, assigns, and next of kin, to the
terms of this Release and Assumption of Risk Agreement his or her heirs and assigns.
I HAVE READ THE ABOVE, UNDERSTAND ITS MEANING AND VOLUNTARILY SIGN
IT.
Emergency Contact: Signature of Parent
Name (please print) Name of Parent(Print)
Phone Number Date
Exhibit B
Schedule of Performance
Task Date
City staff and Hongyun Art introduce project to Cupertino Fine Arts Commission March 23,d
Hongyun Art collects entries until the contest deadline of 5/15/15 April-May
Contest deadline May 15,2015
City staff and Hongyun art determine eligibility of entries and narrow for May
Commission review
Fine Arts Commission makes final selections May
Hongyun Art coordinates utility box painting May/June
Exhibit C
Compensation
City shall compensate Consultant for professional services in accordance with the terms and
conditions of this Agreement. Compensation shall be full compensation for all work performed
and services rendered under this Agreement.
The compensation to be paid to Consultant under this Agreement for all services described in
Exhibit "A" and reimbursable expenses shall not exceed a total of six-thousand dollars
6,000.00), as set forth below. Any work performed or expenses incurred for which payment
would result in a total exceeding the maximum amount of compensation set forth herein shall be
at no cost to the City.
Not to Exceed Amount
Supplies 2,500
Project Management Oversight 1,000
Utility Box Art Maintenance 2,500 ($500 per year)
Total 6,000
Invoices
In order to request payment, Consultant shall submit a single invoice to City each year with
receipts detailing project-related expenditures.
Reimbursable Expenses
Administrative, overhead, secretarial time or overtime, word processing, photocopying, in house
printing, insurance and other ordinary business expenses are included, within the scope of
payment for services and are not reimbursable expenses. Supplies are the only reimbursable
expense under this Agreement,not to exceed the amount above.
Additional Services
Consultant shall provide additional services outside of the services identified in Exhibit A only
by advance written authorization from the City's Project Manager prior to commencement of any
additional services. Consultant shall submit, at the Project Manager's request, a detailed written
proposal including a description of the scope of additional services, schedule, and proposed
maximum compensation.
Exhibit D
Insurance'Reauirements and Proof of Insurance
Proof of insurance coverage described below is attached to this Exhibit, with City named as
additional insured.
Consultant shall maintain the following minimum insurance coverage:
A. COVERAGE:
1) Workers' Compensation:
Statutory coverage as required by the State of California.
2) Liabili :
Commercial general liability coverage in the following minimum limits:
Bodily Injury: 500,000 each occurrence
1,000,000 aggregate-all other
Property Damage: $100,000 each occurrence
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:
Comprehensive automotive liability coverage in the following minimum limits:
Bodily Injury: 500,000 each occurrence
Property Damage: $100,000 each occurrence
or
Combined Single Limit: $500,000 each occurrence
EXHIBIT E
ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS,
RECEIPT OF TRAINING,AND RECEIPT OF PENAL CODES 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 Hongyun Art Foundation
include contact with children,you are a Mandated Reporter. Prior to commencing
employment and as a prerequisite of that employment, California law requires that you sign a
statement to the effect that you have knowledge of the provisions of the Mandated Reporter
Law, and will comply with those provisions. (California Penal Code 11166.5).
The following are the Mandated Reporter responsibilities under California law.
rom
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 408-777-3120.
I understand that:
By virtue of my employment or independent contractor status with Hongyun Art
Foundation, 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 trafficking; 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 Sheriff's Department,
Probation Department or Child Welfare Agency. (Cal Pen. Code 11166(a)).
I 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 investigating mandated
reports may disclose my identity to one another:
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)
I 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 is a misdemeanor to fail to comply with
Mandated Reporting 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)).
I have been provided with a copy of California Penal Code sections 11164-11174.3
Mandated Reporter Law).
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 in my
personnel file.
Name (Si atur Date
Name (Print)
Exhibit F
City of Cupertino Consultant Declaration
Fingerprinting & Tuberculosis Testing
The undersigned does hereby certify that:
1. I am a representative of Hongyun Art Foundation; that I am familiar with the facts herein
and am authorized and qualified to execute this declaration.
2. I declare that Hongyun Art Foundation 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 those
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.
A List of all Consultant Employees Working for the City of Cupertino:
NA V%Iw ICA)
5. The City of Cupertino will be notified by Consultant of any new employees and will be
added to the above list prior to beginning work for the City of Cupertino.
I declare under penalty of perjury that the foregoing is true and correct:
G 7 , LoC/d
Date Place Consult nt Signature
Staff Title: