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17-001 Raychel Cruz - First Amendment FIRST AMENDMENT TO AGREEMENT 17-001 BETWEEN THE CITY OF CUPERTINO AND RAYCHEL CRUZ FOR FITNESS INSTRUCTOR This First Amendment to Agreement 17-001 between the City of Cupertino and Raychel Cruz for reference dated July 1, 2017 is by and between the CITY OF CUPERTINO, a municipal corporation (hereinafter "City") and Raychel Cruz, a sole proprietorship ("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 Fitness Instructor.The agreement will expire on June 30,2018. B. The Agreement is 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 60 minute class or 60%of completed personal training appointments. In the event that less than the required minimum number of participants shall request and pay for services prior to the agreed upon time for the commencement of services to be performed by Consultant, City may cancel and withdraw from this Agreement. The total compensation to the Consultant shall no6e-xceed$44,000.00. 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. RAY L C UZ CITY F CUPERTINO By _ B rl �nTitle Title A&.� RECOMMENDED FOR APPROVALED AS TO F RM By T e/-'"K-e ��zc_f. CiAtiomey ATTEST City Clerk EXPENDITURE DISTRIBUTION PO #2018-18 570-63-621700-702 Original Agreement Amount: $30,000 Amendment Amount: $14,000 Total: $44,000 DATE(MM/DD/YYYY) Av o® CERTIFICATE OF LIABILITY INSURANCE 04/19/2018 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Maguire Insurance Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 27201 Mission Puerta Real 2691--Ste HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR Mission Viejo,CA92691--7389 877.438.7459 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A:Philadelphia Indemnity Insurance Company 18058 Raychel Cruz INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L I POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS A X GENERAL LIABILITY PHPK1681124- 07/08/2017 07/08/2018 EACH OCCURENCE $2,000,000 DAMAGE TO RENTE X COM MERCIAL GENERAL LIABILITY 000 PREMISES Ea occurrence $100,000 CLAIMS MADE FX OCCUR MED EXP(Any one person) $2,500 X PROFESSIONAL LIABILITY PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $3,000,000 X POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (EA accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY—EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURENCE OCCUR ❑ CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION WORKERS MPEN A I N EMPLOYERS'LIABILITYY/N ANY PROPRIETOR/PARTNER/EXECUTIVE TORY LIMITS ERH OFFICER/MEMBER EXCLUDED? u E.L.EACH ACCIDENT (Mandatory in NH) E.L.DISEASE—EA AMPLOYEE If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE—POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole negligence.Sexual Abuse Limits of$100,000 per occurrence and$300,000 aggregate apply. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of Cupertino,its city council,boards and commissions,officers,officials,employees,agents,servants, THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE volunteers and consultants. CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR 10300 Torre Ave LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Cupertino,CA 95014-3202 AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) © 1988-2009 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) POLICY CHANGE DOCUMENT POLICY NO: CHANGE #4 CHANGE EFFECTIVE: 03/20/2018 Philadelphia Indemnity Insurance Company PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED: Raychel Cruz MAILING ADDRESS POLICY PERIOD: FROM 07/08/2017 TO 07/08/2018 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected, the policy is amended as indicated below: Amended Additional Insured: City of Cupertina to add specific verbiage. Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Total Prorate Additional/Return Additional/Return Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $0.00 Page 1 of 1 POLICY NUMBER: PHPK1681124-000 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 Insured Persons Or Organ izations : City of Cupertino, its city council, boards and commissions, officers, officials, employees, agents, servants, volunteers and consultants. 10300 Torre Ave Cupertino CA 95014-3202 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. Required by the contract or agreement; or 1. In the performance of your ongoing operations; or 2. Available under the applicable Limits of Insurance shown in the Declarations; 2. In connection with your premises owned by or whichever is less. rented to you. However: This endorsement shall not increase the applicable Limits of Insurance shown in the 1. The insurance afforded to such additional Declarations. insured only applies to the extent permitted by 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 W-surance Esurance Insurance Services, Inc. Esurance Property and Casualty Insurance Company P.O.Box 5250 650 Davis Street Sioux Falls,SD 57117-5250 San Francisco, CA 94111 1-800-ESURANCE(1-800-378-7262) Policy Declarations Page Personal Automobile Policy— Renewal Policy Number Effective Date Expiration Date Policy Term December 05,2017 1 June 05,2018@ 12:01 AM 6 Months Named Insured and Address Rated Operators Excluded Drivers Driver Type Year of Birth RAYCHEL RENEE BALCIONI CRUZ 1 Raychel renee Balcioni Named Insured cruz Vehicle# Year Vehicle Description Vehicle Identification Number Policy Coverage is provided only where a premium and limit or deductible are shown. LiabPremium BODILY INJURY 15,000/person 209.00 30,000/accdnt PROPERTY DAMAGE 10,000/accdnt 219.00 UM BODILY INJURY 15,000/person 30.00 30,0001accdnt CoveragesVehicle Vehicle i Vehicle Vehicle Vehicle Premium Deductible Premium Deductible Premium Deductible Premium Deductible UMPD/CDW 3.99 COMPREHENSIVE 53.00 1000 COLLISION 388.00 1000 CARMATCH RENTAL Standard 25.67 STATE MANDATED FEES 0.88 Important: Please read your California Personal Auto Policy carefully as it contains language that will restrict or exclude coverage, particularly to drivers of your vehicle who are not listed on the policy. The policy specifically addresses who may use your vehicle and under what conditions coverage will be provided. In some cases, an unlisted driver or permissive user will have liability limits reduced to the state's minimum requirements, which, in California are currently $15,000 per person 1$30,000 per accident for both bodily injury and $5,000 for property damage.You may purchase additional coverage by contacting the company. FULL TERM PREMIUM $929.54 This policy is effective at 12:01 AM on the date shown or the time the policy was purchased,whichever is later. 7001 CA 12 15 Page 1 of 2