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17-001 Grace Duval (2) - First Amendment FIRST AMENDMENT TO AGREEMENT 17-001 BETWEEN THE CITY OF CUPERTINO AND GRACE DUVAL FOR ADULT FITNESS INSTRUCTION This First Amendment to Agreement 17-001 between the City of Cupertino and Grace DuVal, for reference dated May 4, 2018, is by and between the CITY OF CUPERTINO, a municipal corporation (hereinafter "City") and Grace DuVal, a Sole Proprietor ("Consultant") whose address is and is made with reference to the following: RECITALS: A. On July 1, 2017, an agreement was entered into by and between City and Consultant (hereinafter "Agreement") for Adult Fitness Instruction. The agreement will expire on June 30, 2018. B. The Agreement and the First Amendment are collectively referred to as the "Agreement" unless otherwise indicated. C. 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. The Agreement's paragraph entitled "Compensation to Consultant" is amended to read as follows: Consultant shall be compensated for services performed pursuant to this Agreement in the amount set forth below and as described in Exhibit "A"which is attached hereto and incorporated herein by this reference. Compensation shall consist of the following: $40 per class. The total compensation to the Consultant shall not exceed $5,500.00. 2. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. GRACE AL CITY OF CUPERTINO By By Title: Adult fitness instructor Title: Assistant Director RECO MMENDEDXR PPROVAL PPR VEDA FORM B Title C City Att rney ATTEST City Clerk EXPENDITURE DISTRIBUTION PO =2017-568 580-63-620 700-702 Original Contract: $4,500 Amendment#1: $1,000 Total: $5,500 EXHIBIT A CONSULTANT SERVICES TO BE PERFORMED The CONSULTANT will provide ADULT FITNESS INSTRUCTION in,but not Iimited to,the following programs: ZUMBA,STRONG BY ZUMBA Location and Time of CONSULTANT Services: Refer to the Recreation Schedule dated SUMMER 17-SPRING 18 for agreed upon dates, times,and class locations. By the mutual agreement of both parties,class schedule may change. Eligible Participant Minimum and Maximums for CONSULTANT Services: Minimum: 5 Maximum: 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 Iisted 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. Consultants 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 Incident Report in the form approved by the City. The Incident Report must be submitted to the City within 24 hours of the injury occurring. FY 2017/2018 Short Form Agreement less than$5,000 6 POLICY NUMBER: SEP41026 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional InsuredPerson(s) Or Organization(s): City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants,Volunteers and Consultants For Certificate No.: 636519499118689253 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III —Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 6365-19499118689253 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED) Alliant Insurance Services,Inc.in conjunction with City of Cupertino Apex Insurance Services P.O.Box 6450 Amended certificate replaces certificate issued to you on Newport Beach,CA 92658 January 19, 2018 License No:OC 36861 NAMED INSURED(EVENT HOLDER): EVENT INFORMATION: Grace Duval TYPE: Aerobics LOCATION: Quinlan C--ily G-1.,10185 NOM Stelling Roarl,Cup -.CA 95014.C.,Mw Sen *Liquor Liability Yes No "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless amended as described in Special Conditions. INSURANCE CARRIER:Evanston Insurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: January01,2018 EXPIRATION: January 01,2019 COMMERCIAL GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $2,000,000 Products&Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal&Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance: Medical Payments(Any One Person) 5,000 MEGL1643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased 0 $1,000,000/$3,000,000 ® $2,000,00052,000,000 Property Damage(If purchased) No Property Damage Coverage The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 3/19/18 _• Liberty Mutual INSURANCE CERTIFICATE OF AUTOMOBILE INSURANCE THIS IS TO CERTIFY THAT the named insured is, at the date of this certificate, insured by the company with respect to the automobiles hereinafter described for the types of insurance and respective coverages hereinafter designated by entry of the limits of liability or a statement that the coverage is in effect and in accordance with the provisions of the Automobile Policy in use by said company. This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the policy. INSURED'S NAME AND ADDRESS FOR LIEN HOLDER INQUIRIES, CALL OR WRITE Grace Duval 1-800-409-0733 DESCRIPTION OF THE INSURANCE FOR WHICH THIS CERTIFICATE IS ISSUED Policy Number: Effective Date:04/21/2018 Expiration Date:04/21/2019 PART A PART B PART D—DAMAGE TO YOUR AUTO COVERAGE COVERAGES: LIABILITY MEDICAL COVERAGE FOR DEDUCTIBLE AMOUNT APPLICABLE TO EACH LOSS COVERAGE PAYMENTS LOSS CAUSED IN DOLLARS COVERAGE BY COLLISION INCLUDED Loss Caused by Collision Loss Other Than Loss Caused by Collision Limits of 100/300/100 NO COV No "ACV"indicates Actual "ACV"indicates Actual Liability Cash Value Less Cash Value Less Deductible Deductible Includes Accidental Death Benefit:$ Protection Against Uninsured Motorists Coverage—Limit Selected:$100/300 Medical Expense POLICY INCLUDES: ❑ BASIC NO FAULT COVERAGE ❑ OPTIONAL NO FAULT COVERAGE DESCRIPTION OF AUTOMOBILES Year of Model Trade Name Body Type Identification or Serial Number ADDITIONAL INTEREST NAME AND ADDRESS: Such insurance as is afforded under the Liability Coverage of the policy shall also apply, with respect to covered autos, to each interest hereinafter named, as an insured; but such inclusion of additional interest or interests shall not operate to increase the limit of the company's liability. The insurance described herein is in effect on the date of this certificate and shall remain in force until canceled in accordance with the terms of the policy. Loss PAYEE and ADDRESS Secretary Presid� Dated: 05/07/2018 at:03:58 PM Countersigned AUTHORIZED REPRESENTATIVE PS485 12 10 Liberty Mutual Fire Insurance Company Page 1 of 2 'OkLibert ., Mutual.. INSURANCE LOSS PAYEE Such insurance as is afforded by the policy for loss of or damage to the automobile is payable, as interest may appear, to the named insured and the Loss Payee indicated on the previous page in accordance with the terms of the Loss Payable Clause. Term of Loan: From: To: LOSS PAYABLE CLAUSE Loss or damage, under this policy, shall be paid as interest may appear to you and the loss payee shown on the front of this certificate. This insurance covering the interest of the loss payee shall not become invalid because of your fraudulent acts or omissions, unless the loss results from your conversion, secretion or embezzlement of your covered auto. However, we reserve the right to cancel the policy as permitted by policy terms, and the cancellation shall terminate this agreement as to the loss payee's interest. We will give the same advance notice of cancellation to the loss payee as we give to the named insured shown in the declarations. When we pay the loss payee, we shall, to the extent of payment, be subrogated to the loss payee's rights of recovery. NOTICE TO OTHERS IF CANCELLATION OCCURS "We"will not cancel "Your" Policy or reduce the insurance under any of its coverages until at least 10 days after we have mailed a written notice of such cancellation or reduction to the person(s) named as additional interest on reverse side. AS1019 (ed 12-89) PS485 12 10 Page 2 of 2 Liberty Mutual, INSURANCE CERTIFICATE OF AUTOMOBILE INSURANCE THIS IS TO CERTIFY THAT the named insured is, at the date of this certificate, insured by the company with respect to the automobiles hereinafter described for the types of insurance and respective coverages hereinafter designated by entry of the limits of liability or a statement that the coverage is in effect and in accordance with the provisions of the Automobile Policy in use by said company. This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the policy. INSURED'S NAME AND ADDRESS FOR LIEN HOLDER INQUIRIES, CALL OR WRITE Grace Duval 1-800-409-0733 DESCRIPTION OF THE INSURANCE FOR WHICH THIS CERTIFICATE IS ISSUED Policy Number: Effective Date:04/21/2018 Expiration Date:04/21/2019 PART A PART B PART D—DAMAGE TO YOUR AUTO COVERAGE COVERAGES: LIABILITY MEDICAL COVERAGE FOR DEDUCTIBLE AMOUNT APPLICABLE TO EACH LOSS COVERAGE PAYMENTS LOSS CAUSED IN DOLLARS COVERAGE BY COLLISION INCLUDED Loss Caused by Collision Loss Other Than Loss Caused by Collision Limits of 100/300/100 NO COV Yes "ACV"indicates Actual "ACV"indicates Actual Liability Cash Value ACV Less Cash Value ACV Less $1,000 Deductible $100 Deductible Includes Accidental Death Benefit:$ Protection Against Uninsured Motorists Coverage—Limit Selected:$100/300 Medical Expense POLICY INCLUDES: ❑ BASIC NO FAULT COVERAGE ❑ OPTIONAL NO FAULT COVERAGE DESCRIPTION OF AUTOMOBILES Year of Model Trade Name Body Type Identification or Serial Number ADDITIONAL INTEREST NAME AND ADDRESS: Such insurance as is afforded under the Liability Coverage of the policy shall also apply, with respect to covered autos, to each interest hereinafter named, as an insured; but such inclusion of additional interest or interests shall not operate to increase the limit of the company's liability. The insurance described herein is in effect on the date of this certificate and shall remain in force until canceled in accordance with the terms of the policy. Loss PAYEE and ADDRESS Secretary Presid� Dated: 05/07/2018 at:03:58 PM Countersigned AUTHORIZED REPRESENTATIVE PS485 12 10 Liberty Mutual Fire Insurance Company Page 1 of 2 QLibcrtl, Mutual, INSURANCE LOSS PAYEE Such insurance as is afforded by the policy for loss of or damage to the automobile is payable, as interest may appear, to the named insured and the Loss Payee indicated on the previous page in accordance with the terms of the Loss Payable Clause. Term of Loan: From: To: LOSS PAYABLE CLAUSE Loss or damage, under this policy, shall be paid as interest may appear to you and the loss payee shown on the front of this certificate. This insurance covering the interest of the loss payee shall not become invalid because of your fraudulent acts or omissions, unless the loss results from your conversion, secretion or embezzlement of your covered auto. However, we reserve the right to cancel the policy as permitted by policy terms, and the cancellation shall terminate this agreement as to the loss payee's interest. We will give the same advance notice of cancellation to the loss payee as we give to the named insured shown in the declarations. When we pay the loss payee, we shall, to the extent of payment, be subrogated to the loss payee's rights of recovery. NOTICE TO OTHERS IF CANCELLATION OCCURS "We"will not cancel "Your" Policy or reduce the insurance under any of its coverages until at least 10 days after we have mailed a written notice of such cancellation or reduction to the person(s) named as additional interest on reverse side. AS1019 (ed 12-89) PS485 12 10 Page 2 of 2 � r z ai�� k.;_ _ r � �-