18-001 Mission Academy of Music LLC CITY OF
lvo. 0 —�
F1'2018-20
CUPERTINO
RECREATION SERVICES AGREEMENT
1. Parties. This contract is made and entered into as of 7/1/2018 ("Effective Date"),by and
between the City of Cupertino, a municipal corporation ("City"), and with MISSION ACADEMY OF
MUSIC LLC, PALO ALTO, CALIFORNIA, 94303 ("Contractor"), a CALIFORNIA
CORPORTATION for MUSIC CLASSES.
2. Services. Contractor agrees to provide the Services included in the Scope of Work and
in accordance with the Schedule of Performance attached in Exhibit A.
3. Terrn. This contract begins on the Effective Date and ends on 6/30/2020 ("Contract
Time"),unless extended or terminated as provided herein. Tirne is of the essence and Contractor must
have sufficient time, resources, and qualified staff to deliver the Services as required. Contractor must
promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to
address or mitigate such delays.
4. Cornpensation. City will pay Contractor for satisfactory performance of the Services an
amount that will based upon actual costs but that will be capped so as not to exceed $10,000 FOR FY
18-19,$10,000 FOR FY 19-20("Contract Price"),based upon the Scope of Services,budget,performance
schedule, and rates included in Exhibit A. The maximum compensation includes all costs, expenses
and reimbursements and will remain in place even if Contractor's actual costs exceed the capped
amount. Contractor must submit invoices and the information required in Exhibit A in order to receive
payment. City will compensate Contractor within 30 days after approval of written invoices.
Invoices are subject to review and audit by City during regular business hours upon 24-hours'
notice. Contractor must maintain complete and accurate records of payrolls, expenditures,
disbursements and other cost items charged to City or establishing the basis for an invoice, for a
minimum of four (4) years from the date of final payment.
5. Independent Contractor.Contractor is an independent Coniractor and not an employee,
partner, or joint venture of City. Contractor is solely responsible for the means and methods of
performing the Services and for the persons hired to work under this Agreement.No civil service status
or other right of ernployrnent will be acquired by virtue of Contractor's performance of the Services.
Contractor is not entitled to City's health benefits, worker's compensation or any other benefit.
Contractor must have the skills and qualifications to perform the Services in a competent and
professional manner. Contractor will supply all tools, materials and equipment required to perform
the Services under this Contract. Contractor is responsible for obtaining permits and licenses required
by law and rnust obtain a City business license.
Recreation Services Agreement/Rev. 3-27-2018
Page 1 of 6
6. Proprietary/Confidential Inforrnation. To the extent Contractor may have access to
private or confidential information owned or controlled by the City, Contractor agrees to treat it
confidential and use it solely to perform this Agreement. Contractor rnust exercise the same standard
of care to protect City information as a reasonably prudent Contractor would use to protect its own
proprietary data.
7. Ownership of Materials. To the extent Contractor prepares written material, drawings
or data in connection with this contract, City will have the property rights to those materials and all
copyrights,if any, to such work product will constitute City property.
8. Records. Contractor must maintain complete, accurate, and detailed accounting records
relating to its performance in accordance with generally accepted accounting principles and
procedures. The records must include detailed information about Contractor's services, benchmarks,
deliverables and costs/fees,and must be made reasonably available to City.The records and supporting
documents must be kept separate from other files and maintained for four years from the date of City's
final payment.
9. Assignment. This Contract is not assignable. Contractor may not substitute another or
transfer any rights or obligations under this Contract without prior written approval of City.Only those
persons whose names are included in Exhibit A may perform the Services.
10. Publicity and Signs. Any publicity generated by Contractor related to this contract or
the Services during the Contract Time and for one year thereafter must reference City contributions.
The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press
releases, posters, brochures, public service announcements, interviews and newspaper articles. No
signs may be posted, exhibited or displayed on or about City property,except signage required by law
or under this Agreement without prior written approval from City.
11. Indernnification. To the fullest extent allowed by law and except for losses caused by
the sole negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend,
and hold harmless the City, its City Council, boards and commissions, officers, officials, employees,
agents, servants, volunteers and Contractors (collectively, "Indemnitees"), through legal counsel
acceptable to City, from and against any liability for damages, claims, actions, causes of action,
demands, charges, losses, costs and expenses(including afitorney fees,legal costs and expenses related
to litigation, arbitrations, administrative and regulatory proceedings), of every nature, arising out of or
in any way related to Contractor's or Contractor's agents performance of this contract or the Services.
This includes but is not limited to Liability resulting in personal injury, death, property damage, or
economic losses. Contractor must pay any costs City may incur in enforcing this provision and must
accept a tender of defense upon receiving notice frorn City.Contractor's payments may be deducted or
offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract.
12. Insurance.Contractor shall comply with the insurance requirements in Exhibit B. City
will not execute the Agreernent until it has received and approved satisfactory certificates of insurance
and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole
discretion may purchase insurance and deduct the costs from payments to Contractor, or terminate the
contract.
Recreation ServicesAgreement/Rev. 3-27-2018
Page 2 of 6
13. Cornpliance with Laws and Other City Requirernents.
Requirernents for all Contracts. This contract is subject to local, state and federal laws and
regulations prohibiting discrimination,including Title VII of the Civil Rights Act of 1964,the California
Fair Employrnent Practices Act,the Americans with Disabilities Act of 1990,and other laws that pertain
to fair employment and anti-discrimination practices. Contractor must comply with labor laws
pertaining to prevailing wages, working hours, overtime, payroll records, and other requirements
imposed by the Department of Industrial Relations.If Contractor does not have employees,it must sign
the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying
employment eligibility of employees pursuant to the Immigration Reform and Control Act of 1986.
Contractor must comply with conflict of interest laws and regulations applicable to this Agreement and
avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in
governmental decisions or serving in a staff capacity,and is hereby advised to review the requirements
of California Political Reform Act and the California Code of Regulations. Services may only be
performed by persons who are not employed by City and who do not have a contractual relationship
with City other than this contract. Contractor agrees to abide by City policies and administrative rules
prohibiting gifts to City officials and employees.
Additional Requirements for Service§ Provided to Minors: Contractor and its employees
who provide services under this Agreement must comply with these additional requirements:
A. Undergo fingerprinting and a criminal background check and verify all employees
providing services under this contract have met this requirement.
B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D.
C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with
the protocols, reporting, and training required under California Health and Safety Code
Section 124235, AB2007, and other laws pertaining to concussion evaluation, removal from
play, and return to play protocols. (Refer to Center for Disease Control & Prevention,
htt�s://www.cdc.gov/headsup/index.html�.
D. Submit required forms and acknowledgments included in Exhibit D, and ensure its each
participant is provided with a concussion information sheet, signs and returns the forms to
the City as required by Health and Safety Code Section 124235.
Require coaches and administrators to successfully complete the concussion and head injury
education at least once either online or in person, before supervising a participant.
Contractor shall offer training, educational materials, or both to each Contractor
administrator on a yearly basis. (Training resources are available at the Center for Disease
Control&Prevention(link cited above).
E. If providing instruction, Contractor must acknowledge and cornply with all requirements
set forth in the Recreation&Community Services Instructor Manual.
Check one (if applicable):
� This contract requires services for children.
Recreation Services Agreement/Rev. 3-27-2018
Page 3 of 6
❑ This contract currently does not require services for children. If in the future, services
for children are required,the contract will require a`written amendment' to include the
appropriate insurance coverages as required in`Exllibit B—Insurance Requirements for
Recreation Contracts', proof of finger printing and additional requirements under
Paragraph 13. The contract amendment will also require the approval of the Director of
Recreation and Community Services and City Attorney.
14. Coordination of Services. The Parties designate the following persons as Services
Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of
this Agreement. Contractor's designation and any substitution are subject to City approval.
For City: For Contractor:Mission Academy of Music
Name: Marilu Mejia Name:Melody Wu
Position: Recreation Coordinator Position:Principal
Contact: MarilitmC�cu�ertino.org, 408-777-3124 Contact:
15. Abandonrnent. City rnay abandon or postpone the Activity or Program and will notify
Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the
date of abandonment upon submission of final invoices approved by City.
16. Termination. City may terminate this contract for cause or without cause at any time
and will notify Contractor as soon as possible.Contractor will be paid for satisfactory services rendered
through the date of termination upon submission of final invoices approved by City.
17. Governing Law,Venue and Dispute Resolution.This contract is governed by the laws
of the State of California. Any legal actions or proceedings filed against City in connection with this
contract must comply with the government claims filing requirements and must be filed with the
Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is
required to continue to provide Services pending resolution of any dispute. If the Parties elect
arbitration, the arbitrator's award must be supported by law and substantial evidence and include
detailed written findings of law and fact.
18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative
or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will
be entitled to reasonable attorney fees and costs. This Section survives this Agreement.
19. Third Party Beneficiaries.There are no third party beneficiaries under this Contract.
20. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver of any
contract provision. City waiver of a breach shall not constitute waiver of another term, provision,
covenant or condition, or a subsequent breach, whether of the same or a different character.
21. Entire Agreernent. This Agreement and all referenced Exhibits are hereby attached and
incorporated into the Agreement by this reference and represent the full and complete understanding
as to those matters contained herein, and supersede any other contract or understanding, either oral or
Recreation Services Agreement/Rev. 3-27-2018
Page 4 of 6
written,between the Parties.This Agreement may not be modified or amended except in writing signed
by both Parties.If there is any inconsistency between the main contract and any attachments or e�ibits
thereto, the main contract shall prevail.
22. Inserted Provisions. Each provision or clause required by law or this contract is deemed
to be included and will be inferred herein. Either party may request an amendment to cure any
mistaken insertion or omission of a required provision.
23. Headings. The headings are for convenience only and are not a part of the contract or
intended to affect, limit or amplify the terms or provisions of this Agreement.
24. Severability/Partial Invalidity.If any contract term or provision,or their application to
a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or
provision shall remain in force and effect to the extent allowed by such ruling. All other contract terms
and provisions and their application to specific situations will remain in full force and effect.
25. Survival.All provisions which by their nature must continue after the Agreement ends,
including without limitation Indemnification,Insurance, Ownership of Materials,Records, Governing
Law and Attorney Fees, will survive the expiration or termination of this Agreement.
26. Notices.All notices and instruments pertaining to material provisions of this contract or
significant disputes which are required by law or under this contract to be in writing must be sent to
the persons listed below. The notices will be deemed effective on the date of personal delivery or the
date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the
United States Mail, postage prepaid, registered or certified, or the next business day following
electronic submission.
To City of Cupertino: To Contractor:
Office of the City Manager California, 94303
10300 Torre Ave., Cupertino CA 95014 cc:Representative/Coordinator:
cc: Representative/Coordinator: Melody Wu
Marilu Mejia Email:
Email: marilum@cupertino.or�
27. Validity of Contract. This contract is valid and enforceable only if it complies with the
provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or
authorized designee, and is approved for form by the City Attorney's Office.
28. Execution. The person executing this contract on behalf of Contractor represents and
warrants that Contractor has full right, power, and authority to execute this contract and to carry out
all actions and services required. This contract constittxtes a legally binding obligation of Contractor,
and may be executed in counterparts, each one of which is deemed an original and all of which, taken
together, constitute a single binding instrument.
Recreation Services Agreement/Rev. 3-27-2018
Page 5 of 6
IN WITNESS WHEREOF,the parties have caused this contract to be executed.
CONTRACTOR CITY OF CUPERTINO
Mission Academy of u ic A Municipal Corporation
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Name �� � V�� Name �.�'l�''�-S��Cs �I G�'l�l
Title 1��1'1�C ` ol � Title ��-�"�' �UJ���-�''r
Date .�(1s��'� Date �v`�r�l�"
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Tax I.D. No.: � — S � ��G
APPROVED AS TO F Mj� /�ZU��g�� ATTEST:
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RAN OLPH STEVENSON HOM RACE SCHMIDT
Cup rtino City Attorney City Clerk �¢ � ��
ContractlEncumbered Amount:
$10,000 FOR FY 18-19 - - -
$10,000 FOR FY 19-20
Account No.:580-62-613-700-702
Recreation Services Agreement/Rev. 3-27-2018
Page 6 of 6
EXHIBIT A
SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide MUSIC CLASSES in,but not lirnited to, the following:
PIANO, FLUTE, UKULELE, AND OTHER MUSIC CLASSES
Location and Time of CONTRACTOR Services:
Refer to the Recreation Schedule dated SUMMER 2018—SPRING 2020 for agreed upon dates,
times, and class locations. The City, at its sole discretion,may change the agreed terms.
Cornpensation for CONTRACTOR Services:
Contractor shall be cornpensated for services performed pursuant to this Agreement. Compensation
shall consist of the following: 70% of resident fee per participant based on final roster,minus a$10
administration fee per participant. The total compensation to the Contractor shall not exceed$10,000
FOR FY 18-19, $10,000 FOR FY 19-20.
Eligible Participant Minirnurn and Maximurns for CONTRACTOR Services:
Minimurn: 3
Maximum: 10
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 Contractor.
List of all Contractor Employees working for the City of Cupertino (if no Ernployees,identify
"self"):
/o ✓ G.. �' Cf7 �'4�U �io � �.
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Performance of CONTRACTOR Services:
In the case Contractor unilaterally cancels performance of a class, camp, activity or service without
City approval, City reserves the right to immediately and without notice cancel the remainder of
programs/services offered and or performed by Contractor.
The Contractor 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. If applicable, contractors who are
responsible for supervising minors must remain with the class until a parent of legal guardian has
arrived and all minors are released to them.
In the event of an injury occurring to a participant, the Contractor 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.
Exhibit B
Insu�ance Requz�ements for Recreation Contracts
As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurance
for the duration of the contract against claims arising from or in connection with Contractor, its agents,
representatives, employees or subcontractors Services under this Agreement.
Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as:
1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 O1 covering CGL on an
"occurrence" basis, including property damage, bodily injury and personal & advertising injury with
limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply
separately to this project/location(CG 25 03 or 25 04)or be twice the required occurrence limit.
2. Automobile Liability: ISO CA 0001 covering Code 1 (any auto), or if Contractor 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
property damage.
� Required if automobile is used to perform work undeN this contv�act.
❑ Otherwise, proof of ContractoN's personal auto insurance with li�nits required by state law
suffices. Contracto�shall not transport o� use its personal vehicle to transpo�t participc�nts or
perform work unde�this cont�^act.
3. Workers' Compensation: As required by the State of California, with Statutory and Employer's
Liability Insurance limits of no less than$1,000,000 per accident for bodily injury or disease.
__ __ _ ____ __ ___W_ RequiNed_if-ContNacto�has employees.
❑ If no employees, Cont�acto�must sign Affidavit ofNo Employees.
4. Sexual Abuse/1VIolestation: Insurance or the equivalent as required for activities/services involving
minors, (i.e., after school activities, recreational programs, athletics, study/training events and
transportation of minors). Coverage may be included under General Liability or be obtained in a separate
policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per
occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the
required occurrence limit.
� Required if Contract involves se�vices to children.
Insurance coverage required may be satisfied by a combination of Primary and Excess/LTmbrella insurance.
Self-Insured Retentions: Self-insured retentions must be approved by City. City may require Contractor to
provide proof of ability to pay losses and related investigations, claim administration, and defense
expenses within the retention. The policy language must provide, or be endorsed to provide, that the self-
insured retention may be satisfied by either the named insured or City.
Acceptability of Insurers: Insurance must be issued by insurers acceptable to City and licensed to do business
in the State of California,with an A.M. Best's financial strength rating of"A"or better and a financial size
rating of"VII"or better.
OTHER INSURANCE PROVISIONS: The CGL policy must contain, ar be endorsed to contain, the
following provisions:
1. The City, its City Council, boards and commissions, officers, officials, employees, agents, servants
and volunteers are to be covered as additional insureds with respect to liability arising out of work or
Exh.B Insurance foY Recreation Contracts Updated 3-26-18
1
operations performed by or on behalf of the Contractor including materials, parts or equipment
furnished in connection with such work or operations.
2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 O1 04
13 as respects the City, its officers, officials, employees, agents, and volunteers.
3. The Insurance Company agrees to waive all rights of subrogation against the City, its elected or
appointed officers, officials,agents, and employees for losses paid under the terms of any policy
which arise from work performed by Contractor for City. This provision also applies to the
Contractor's Workers' Compensation policy.
4. Each insurance policy required by this contract shall provide that coverage shall not be canceled,
except with notice to the City.
Primary Coverage: The Additional Insured coverage under Contractor's policy shall be primary non-
contributory and at least as broad as ISO CG 20 O1 04 13 as respects the City and all the
insureds/indemnitees. If the limits of insurance required are satisfied in part by Umbrella/Excess Insurance,
the UmbrellaJExcess Insurance shall contain or be endorsed to contain a provision that such coverage shall
also apply on a"primary and non-contributory" basis for the benefit of the Additional Insureds before City's
own insurance is triggered.
Notice of Cancellation: Each insurance policy shall provide that coverage shall not be canceled or allowed to
expire without written notice to City 30 days in advance or 10 days in advance if due to non-payment of
premiums. Such notice must be sent to City via email or certified mail to the attention of the City Manager.
Waiver of Subrogation:Contractor grants City a waiver of any right to subrogation which any insurer of said
Contractor may acquire against City by virtue of payment of any loss under such insurance. Contractor will
obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies
regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer.
- _ _ _ -- - - -
Verif cation of Coverage:Contractor shall furnish the City with original certificates and amendatory
endorsements effecting coverage required by this clause. All certificates and endorsements are to be received
and approved by the City before work commences. The City 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. At a minimum Contractor must provide acceptable copies of the policy
declarations and endorsement page verifying the required insurance coverages.
Homeowner's Insurance: Contractor's homeowner's liability insurance may provide coverage sufficient to
meet these requirements. Contractor should provide these requirements to his or her agent to confirm and
provide verification to City.
Special Events Coverage:Insurers may provide special events coverage for a reduced fee, or City may be
able to offer this coverage. Contractor should contact the City Manager's Office for information or assistance.
Special Rislrs or Circumstances: City reserves the right to modify these requirements based on the nature of
the risk,prior experience,insurer, coverage, or other special circumstances.
Exh.B Insurance for Recreation Contracts Updated 3-26-18
2
EXHIBIT D
Contractor's Mandated Reporter Declaration
The undersigned does hereby certify that:
1. I am a representative of MISSION ACADEMY OF MUSIC; that I am familiar with the
facts herein and am authorized and qualified to execute this declaration.
2. I declare that MISSION ACADEMY OF MUSIC has complied with fingerprinting and
criminal bacl<ground investigation requirements with respect to all Contractor'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. I declare that each coach and administrator shall be required to successfully complete
concussion and head injury education at least once, either online or in person,before
supervising a participant, as required by California Health and Safety Code Section
124235, et seq.
4. On a yearly basis, all participants shall be required to sign and return a concussion and
head injury information sheet in compliance with California Health and Safety Code
Section 124235, which may be in the form attached as D-1.
5. That a complete and accurate list of Contractor's employees, who may come in contact
with minors during the course and scope of the Agreement, are included below.
6. All of the below mentioned employees have tested negative for TB, or X-ray results for
TB, and have current documentation on file with Contractor.
7. 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.
List of all Contractor Employees working for the City (if no Employees, identify "self"):
,
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8. The Contractor will notify the City of Cupertino in writing of any new employees and
will be added to the above list prior to beginning worl<at the City of Cupertino.
I declare under penalty of perjury that the foregoing is true and correct.
MISSION ACADEMY OF MUSIC
By: MEL Y WU
Title: PRINCIPAL
Date: .�/ ��/ �� �
. _ __ _ _ _ ___ _ _
�-"""1 MISSI-3 OP ID: BP
A'co��� CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY)
�+■--�^''� 04/23/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
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).
PRODUCER 650-328-1000 coNracr grenda Aldaco Parra
Insurance b Allied Brokers-1 NAME:
Lic#0525309 (A/�NNo,eXc�:650-328-1000 �A�c,No�:650-324-1142
630 Cowper Street E-MAIL
Palo Alto,CA 94301 ADDRE :
Brenda Aldaco Parra INSURER S AFFORDING COVERAGE NAIC#
iNsuReR a:Colony Insurance Company 39993
iNsuReo Mission Academy of Music LLC
INSURER B:
i INSURER C:
Palo Alto,CA 94303
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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
CERTIFICATE 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE DDL UBR ppLICY NUMBER POLICY EFF POLICY EXP LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000
CLAIMS-MADE o OCCUR X �( 101GL0097101-00 �4�2��201$ 04/20/2019 pREMISES�Eaoocurr�e ce ���'���
MED EXP An one erson 5,���
PERSONAL&ADV INJURY 3,000,000
GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE 4,000,000
POLICY�PE� � LOC PRODUCTS-COMP/OP AGG Included
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea ccident $
ANYAUTO BODILYINJURY Per erson $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
AUTOS ONLY AU�TOS ONLY Pe�accident AMAGE $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$
WORKERS COMPENSATION �
AND EMPLOYERS'LIABILITY OTH-
Y!N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N�A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
p AbuselMolestation 101GL0097101-00 04/20l2018 04/20/2019 3,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached if more space is required)
The holder of this certificate The City of Cupertino, its City Council,
boards and commissions,o�ficers,ofFicials,employees,agents,servants and
volunteers,are to be covered as additional insurecfs with respect to
liability arising out of work or operations performed by or on behalf of the
Contractor including materials, parts or equipment furnished in connection
CERTIFICATE HOLDER CANCELLATION
CITYCUP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS.
Recreation and Community
Services Department AUTHORIZED REPRESENTATIVE
10185 N.Stelling Road � j , ��
Cupertino,CA 95014 ,,.-d4�...
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
NOTEPAD. HOLDERCODE CITYCUP MISSI-3 PAGE 2
INSURED'S NAME Mission Academy of Music LLC OP ID: BP Date 04/23/2018
with such work or operations. This insurance is primary and non-
contributory. Waiver of subrogation applies in favor of certificate
holder. 30 day written cancellation notice will be given, 10 day notice
for non-payment.
101 GL 0097101-00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
OWNERS, LESSEES �R CONTRACTORS - SCHEDULED
PERSON OR ORG�4NIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCMEDULE
�larne ofAdditional Insured Person(s)or
Organization(s)
(Additoonal Insured): Location(s) of Covered Operations:
AS DESIGNATED IN WRITTEN CONTRACT AS DESIGNATED IN WRITTEN CONTRACT
WITH THE NAMED INSURED WITH THE NAMED INSURED
The insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary
insurance and we will not seek contribution from any other insurance available to that additional insured.
A. SECTION II—WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s)shown in the Schedule for whom you are perForming operations when you and such person
or organization have agreed in writing in a contract or agreement that such person or organization be
added as an additional insured on your policy. Such person or organization is an additional insured only
with respect to liability for"bodily injury", "property damage"or"personal and advertising injury" caused, in
whole or in part, by:
�. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operatians for the additional insured(s)at the location(s) designated
above.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional insureds,the following additional exclusions
apply:
This insurance does not apply to:
Additional Insured Contractual Liability
"Bodily injury"or"property damage"for which the additional insured(s)are obligated to pay damages by
reason of the assumption of liability in a contract or agreement.
Finished Operations at Work
"Bodily injury" or"property damage"occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the
project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
2. That portion of'your work"out of which the injury or damage arises has been put to its intended use
by any person or organization.
Negligence of Additionai Insured
U156-0310 Includes copyrighted material of ISp Properties, Inc., Page 1 of 2
with its permission.
101 GL 00971Q1-00
"Bodily inJur�'° or"property damage" arising directly or indirectly out of the negligence of the additional
insured(s).
ALL OTHER TERMS ANl7 CqNDITIONS OF THE POLICY REMAIN UNCHANGED.
U156-0310 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2
with its permission.
101 GL 0097101-00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFIJLLY.
TRANSFER (JF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GEN�RAL LIABILITY COVERAGE PART
PROQUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The foilowing is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section
IV—Conditions:
We waive any rights of recovery we may have against any person or organization because of payments we
make for injury or damage resulting from your ongoing operations or"your work"done under a contract with
that person or organization and included in the "products-completed operations hazard" if:
a. you agreed to such waiver;
b. the waiver is included as part of a written contract or lease; and
c. such written contract or lease was executed prior to any Ioss to which this insurance applies.
ALL OTHER TERMS AND CONQITIONS OF THE POLICY REMAIN UNCFiANGED.
U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1
with its permission.
-,"""',1
A,��'�' CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DU/YYYY)
OS/10/2018
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
LISA YEN ALLSTATE AGENCY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
1131 S DE ANZA BLVD CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
SAN JOSE CA 95129 COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: ALLSTATE INSURANCE COMPANY
MISSION ACADEMY OF MUSIC LLC INSURER B:
INSURER C:
SAN JOSE,CA 95129
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 CERTIFICATE 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR INSR DATE(MM/DD/Y`n DATE(MM/DDIYY
❑ GENERAL LIABILITY EACH OCCURENCE $
❑COMMERICAL GENERAL LIABILITY DAMAGE TO RENTED $
�❑CLAIMS MADE � OCCUR PREMISES Ea occurrence
❑ MED EXP(Any one person) $
❑ PERSONAL&ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
❑POLICY❑ PROJECT O LOC PRODUCTS-COMP/OP AGG $
$
� AUTOMOBILE LIABILITY 648734512 11/04/2017 11/04/2018 COMBINED SINGLE LIMIT
❑ANY AUTO (Each Occurrence) $2>000,000
�ALL OWNED AUTOS
BODILY INJURY $2�000,000
�SCHEDULED AUTOS (Per person)
❑HIREDAUTOS BODILYINJURY
❑ NON-OWNED AUTOS (Per accident) $2,000,000
O PROPERTYDAMAGE $1,000,000
(Per accident)
❑ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
❑ANY AUTO EA ACC
❑ OTHERTHAN $
AUTO ONLY: AGG $
� EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
❑OCCUR ❑CLAIMS MADE AGGREGATE $
❑DEDUCTIBLE $
❑ RETENTION $Enter Amount $
$
❑ WORKERS COMPENSATION AND ❑ORY LAMITS ❑OER
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECU- E.L.EACH ACCIDENT $
TIVE OFFICER/MEMBER EXCLUDED?
If yes,describe under E.L.DISEASE-EA EMPLOYEE $
SPECIAL PROVISIONS below
E.L.DISEASE-POLICY LIMIT $
❑ OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/V�HICLES/EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
2016 VOLVO XC90,YV4A22PK9G1023201
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATNE
ACORD 25(2001/08) �O ACORD CORPORATION 1988
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
The Certificate of Insurance on the reverse side of this form does not constitute a contact 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(2001/08)
A�o!`z�'� CERT�FICATE OF LIA�lLITY i�VSU�4,11iC� °o6iosi2o$'
THiS CERTlFICAi'E IS ISSUED AS A i1ffIATTfR OF lNFORMATION ONLY ANQ COWFERS NO RIGiiTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMA'fIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFpRDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSUfYANCE DOES NOT CONSTITUTE A CONTt2QCi' BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATiVE OR PROWCER,AND THE CERTIFICATE Hp�DER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be sndors+ed. if SUBROGATION IS WAIVED,suhject to the
terms and condi6ons of the policy, certain policies may require an endorsemenG A statement on this certificata does not confer rights to the
cert3ficate holder in tieu of such endorsement(s).
PRODUCER CATHERINE CHEN)NSUftANCE AGENCY INC NA��ACT C8fIt6I111E CIl@Il
AGENT LICENSE�lUMBER: OE83624 PHONE ,4 s3.0000 a�c No:408. 63.123
20132 STEVENS CREEK BLVD E-MAIL
aooRess:catherine.chen.' statefarm.com
OCUPERTINO, CA 95014 INSURERS AFPORDlNOSOVERAGE NAIClF
` iNsuReR a:State Farm General insvrance Com an 25t51
INSURED MISS90t�lACADEMY OF MUSIC LLC INSURERB:
INSURER C:
PAL�ALTO CA 94303-4162 INSURER 0:
INSURER E:
INSURER F:
COVERAGES CERTIFfCATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLlCIES Of INSURANCE LISTED BELOW HAVE 6EEN ISSUED TO THE INSUR£D NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTiMTHSTANDiNG ANY REQUIREMENT, TERM OR COND�TfON OF ANY CON7RACT OR OTHER DOCUMENT 1MTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�LTR T1?E OF�NSURANCE �� BR POLICY NUMBER M /M D�DY� � PM%DDy� IIMITS
A GENERALUABlUiY ❑❑ 97-BT-W486-3 05/03/201$ 05/03/2019 EACH OCCURRENCE $ 2,000,900
X COMMERCIAL GENERAI.LL4BILITY PREMISES Ea occurrence $ 300,000
CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $
GENERALAGGREGATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLiES PER: pRO0UCT5-COMP/OP AGG $ 4,000,000
X ppLICY PR� LOC g
. AUTOMOBILE LIA811JTY ❑❑ � COM INED IN I � -
Ea accident S
ANY AUTO 80DILY INJURY(Per persan) �
ALL OWNEO SCHEDULED — ---- — -—
AUTOS AUTOS BOOILY INJURY(Per accident) $
HIREDAUTOS NONANMED PROPERttDAMAGE
AUTOS Per accident $
$
UMBRELLA lIAB pCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MAOE AGGREGATE $
DED RETENTION$ $
� WORKERS COMPENSATION WC STATU- OTH- �
AND EMPLOYERS'LtAB1UTY y�N T _EL
ANYPROPRIETORlPARTNER/EXECUTIVE E.L.EACHACCiDENT $ 1,000,000
OFFICEIMEMBER EXCLU�ED? a N�A❑ 97-C.�-Y802^6 05/0312018 0510312019
(Mandatory In NH) E.I.,DISEASE-EA EMPLOYEE $ 1,000,0�0
lf yes,describe under
E.L.D�SEASE-POLICYL�MIT $ 1,000,000
��
DESCRIPTfON OF OPERATIONS/IOCATIONS 1 VEHICLES (Attach ACORD 101,AddtUonal Remarks Schedule,if more spaca Is reqWrad)
CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED,ENDORSEMEtVT CG 20 10
CERTIFICATE HOLDER CANCELLATION
City of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POI.ICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THER@OF, NOTICE WILL BE DEUVERED IN
Cupertino Recreation and Community Services ACCORDANCE WITH THE POI.ICY PROVISIONS.
Department
AUTHORI28D REPRESENTATIVE
10185 N.S#elling Road,Cupertino,CA 95014
OO 1988-2 0 ACORD CORPORATI N, All rig reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 10014 132849 7 03-01-2012