18-001 SK Studios CITY OF
No.
F'Y2018-19
CUPERTINO
ItECREATION SERVICES AGREEMENT
L Parties.This contract is inade and entered itlto as of 7/14/2018 ("Effective Date"),by aiid
between the City of Cupertino, a inunicipal corporation("City"), and with SK STUDIOS,
SARATOGA, CA 95070 ("Contractor"), a SOLLYWOOD PERFORMERS for BOLLYWOOD
PERFORMANCE.
2. Services. Contractor agrees to provide the Services ulcluded it1 the Scope of Work atld
in accordance with the Schedule of Performance attached in Exhibit A.
3. Term. T11is contract begins on the Effective Date and ends on 7/14/2018 ("Contract
Time"),unless extended or terininated as provided 1lereul.Time is of the essence and Contractor inust
11ave sufficient tune, resources, and qualified staff to deliver the Services as required. Conhactor must
promptly notify City of any actual or potential delays to afford the Parties adequate opportiulity to
address or mitigate such delays.
4. Compensation. City will pay Contractor for satisfactory performance of the Services an
amourlt t11at will based upon actual costs but that will be capped so as 11ot to exceed$1,000 ("Contract
Price"),based upon the Scope of Services,budget,perforinance schedule, and rates included in Exhibit
A. The inaximuin coinpensation includes all costs, expenses and reimburseinents and will remain it1
place even if Contractor's actual costs exceed the capped amount. Contractor must submit ulvoices and
the ulforination required in Exhibit A uz order to receive payment. City will compensate Contractor
wit11u130 days after approval of written invoices.
Ilzvoices are subject to review and audit by City during regular business hours upon 24-hours'
notice. Contractor must maintaul complete and accurate records of payrolls, expenditures,
disbursements and ofller cost items charged to City or establishi�lg the basis for an invoice, for a
miniinuin of four (4)years from the date of fuzal payinenf.
5. Independent Contractor.Contractor is an independent Contractor and not ai1 einployee,
pariner, or joint venture of City. Contractor is solely responsible for the ineans and inethods of
performing the Services and for tlle persons hired to worl<under this Agreement.No civil service status
or other right of employment will be acquired by virtue of Contractor's perforrnance of the Services.
Contractor is not entitled to City's 1lealtll benefits, worker's coinpezlsation or any otller benefit.
Contractor must have the sl<ills and qualifications to perform the Services in a competent and
professional manner. Contractor will supply all tools, materials and equipment required to perforin
the Services under t11is Contract. Contractor is responsible for obtauz'v1g perinits and licenses required
by law and must obtai�l a City business license.
Rec��eation Services Agreen2ent/Rev. 3-27-2018
Page 1 of 6
6. Proprietary/Confidential Inforrnation. To fl1e extent Contractor rnay have access to
private or collfidential ulforination owned or controlled by the City, Contractor agrees to treat it
confidential and use it solely to perform this Agreement. Contractor must 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 inaterial, drawings
or data in corulection wit11 this contract, City will have the property rights to those materials and all
copyrights,if any, to suc11 work producf will constitute City property.
8. Records.Cont�actor must maultaul complete, accurate, and detailed accou�ltulg records
relating to its perforinance in accordance with generally accepted accountuzg principles and
procedures. The records must include detailed uzformation about Contractor's services, benchlnarks,
deliverables and costs/fees,and must be made reasonably available to City.The records and supportulg
documents must be kept separate from other files and maintained for four years from the date of Cify's
fu1a1 payment.
9. Assignrnent.This Contract is not assignable. Contractor may not substitute another or
transfer any rights or obligations tulder this Contract without prior written approval of City.Only those
persons whose names are ulcluded v1 Exhibit A may perform t11e Services.
10. Publicity and Signs. Any publicity generated by Contractor related to this contract or
the Services duruzg the Contract Time and for one year thereafter inust reference City contributions.
The words "City of Cupertulo" shall be displayed in all pieces of publicity, ulcluding 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 Agreeinent without prior written approval froin City.
11. Indemnification. To t11e fullest extent allowed by law and except for losses caused by
the sole negligence or willful misconduct of City persorinel, Contractor agrees to uzdemnify, defend,
and hold harmless the City, its City Council, boards and coinmissions, officers, officials, employees,
agents, servants, volunteers and Contractors (collecfively, "I�ldeinnitees"), through legal coulzsel
acceptable to City, froin and against any liability for damages, claims, actions, causes of action,
dema��ds, charges, Iosses, costs and expenses (including attorney fees, legal costs and expenses related
to litigation, arbitratiolls, adinulistrative and regulatory proceedings), of every nature, arisitlg out of or
in a�1y way related to Contractor's or Contractor's agents perforinance of this contract or the Services.
This includes but is nof limited to Liability resulting in personal injury, death, property dainage, or
economic losses. Contractor must pay any costs City may uzcur in enforculg this provision and rnust
accept a tender of defense upon receivulg notice from City. Contractor's payments may be deducted or
offset to cover any money the City lost due to a claun or counterclaiin arising out of this Cont�act.
12. Insurance. Contractor sI1a11 coinply wit11 t11e insurance requirements u1 Exhibit B. City
will not execute t11e Agreeinent until it has received and approved satisfactory certificates of u�sura�lce
and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City uz its sole
discretion inay purchase insurance and deduct the costs from payinents to Contractor, or termulate the
contract.
Recreation Services AgNeenaent/Rev. 3-27-2018
Page 2 of 6
13. Compliance with Laws and Other City Requirernents.
Requirements for all Contracts. Tl�is contract is subject to local, state and federal laws and
regulations prohibititlg discrunulation,including Title VII of the Civil Rights Act of 1964,the California
Fair Einployinent Practices Act,the Ainericans with Disabilities Act of 1990,and otller laws that pertain
to fair ernployinent and anti-discrimiuzation practices. Contractor must coinply with labor laws
pertauling to prevailing wages, worlculg hours, overtune, payroll records, and otller requireinents
imposed by the Department of Industrial Relations.If Contractor does not have einployees,it inust sign
the Affidavit of No Einployees, attached as Exhibit C. Contractor is responsible for verifying
employment eligibility of einployees pursuant to the Iinmigration Reforin and Control Act of 1986.
Contractor must comply with conflict of uzterest laws and regulations applicable to this Agreeinent and
avoid conflicts of interest. Colltractor may be required to file a conflict of ulterest form for engagulg in
governrnental decisions or serving u1 a staff capacity,and is hereby advised to review the requireinents
of California Political Reforin Act and the California Code of Regulations. Services inay only be
performed by persons who are not employed by City and who do not 11ave a contractual relationship
with City otller than this contract. Contractor agrees to abide by City policies and administrative rules
prohibiting gifts to City officials and einployees.
Additional Requirements for Services Provided to Minors: Colltractor and its elnployees
who provide services under this Agreement inust comply with tllese additional requireinents:
A. Undergo fingerprinting and a crimulal background check and verify all employees
providuzg services under this contract have lnet this requireinent.
B. Complete a Tuberculosis screening test as required by law and as set fortll u1�xhibit D.
C. Coinply with the Mandatory Reporting Lulder California Penal Code 11164-11174.3 a�zd witlz
the protocols, reportuzg, and training required wlder California Health and Safety Code
Section 124235, AB2007, and other laws pertainulg to concussion evaluation, reinoval froin
play, and return to play protocols. (Refer to Center for Disease Control & Prevention,
htt�s://www.cdc.gov/headsu�/index.html�.
D. Subinit required forins aild aclalowledginents iticluded in Exhibit D, a�zd ensure its each
participant is provided with a concussion uzforination sheet, signs and returns fl1e forms to
the City as required by Healtll atld Safety Code Section 124235.
Require coaclles and admulistrators to successfully complete t11e concussion and head injury
education at least once either online or in person, before supervisulg a participant.
ConEractor shall offer training, educational materials, or both to each Contractor
adininistrator on a yearly basis. (Trainuzg resources are available at the Center for Disease
� Control&Prevention(lulk cited above).
E. If providitlg itlshuction, Contractor must acknowledge and comply with all requireinents
set forth uz the Recreation&Community Services Instructor Manual.
Checic 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 uz the future, services
for cllildren are required,the contract will require a'written ainendinent' to ulclude the
appropriate insurance coverages as required u1'Exhibit B—Insurance Requirernents for
Recreation Contracts', proof of fulger pritltuzg and additional requireinents wlder
Paragraph 13. Tl1e contract ainendment will also require the approval of the Director of
Recreation a�1d Community Services and City Attorney.
14. Coordination of Services. The Parties desig�zate the followulg persons as Services
Coordinators with tlle responsibility to oversee the delivery of Services u1 accordance wit11 fl1e terins of
this Agreeinent. Contractor's designation a�1d any substitution are subject to City approval.
For City: For Contractor:
Name:Kristula Hastings Name: Saineer A. Kausar
Position: Leisure Service Specialist Position: Owner
Contact:kristuzah@cupertulo.org Contact:
15. Abandonrnent. City may abandon or postpone the Activity or Program �1d will notify
Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered tllrougll the
date of abandonment upon submission of final ulvoices 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 t11e date of terinination upon submission of fuzal invoices approved by City.
17. Governing Law,Venue and Dispute Resolution.T11is contract is governed by the laws
of fihe State of California. Any legal actions or proceedings filed against Cify u1 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 t11e Parties elect
arbitration, the arbitrator's award inust be supported by law and substantial evidence and ulclude
detailed written fuzdings of law a71d fact.
18. Attorney Fee�. If City is required to pursue litigation,arbitration or other admulistrative
or regulatory proceedulg to enforce its rights or the terins of t11is Agreeinent, the prevailulg party will
be entitled to reasonable attorney fees atzd costs. This Section survives this Agreeinent.
19. Third Party Beneficiaries.There are no third party beneficiaries under this Contract.
20. Waiver. Neither acceptance of Services nor payinent tllereof constitutes a waiver of any
contract provision. City waiver of a breach shall 11ot constitute waiver of another terin, provision,
covenant or condition, or a subsequent breach,whether of the saine or a differenf character.
21. Entire Agreernent. This Agreeinent and all referenced Exllibits are 1lereby attached alzd
ulcorporated into tlle Agreeinent by t11is reference and represent the full alzd coinplete understanding
as to those matters contauled hereul, and supersede any other contract or understatzduzg,either oral or
Recreation Services Agr^eement/Rev. 3-27-2018
Page 4 of 6
written,between the Parties.This Agreeinent inay not be inodified or amended except uz writulg signed
by both Parties.If tlzere is any inconsistency between the maul contract and aily attacl�unents or exhibits
thereto, the inaul contract shall prevail.
22. Inserted Provisions.Each provision or clause required by law or this contract is deemed
to be ulcluded atld will be inferred hereul. Either party inay request an ainendment to cure any
mistaken i�zsertion or oinission of a required provision.
23. Headings. The 1leaduzgs are for convenience only and are not a part of the cont�act or
uztended to affect, limit or amplify fl1e terms or provisions of this Agreement.
24. Severability/Partial Invalidity. If a�zy contract term or provision, or tlleir application to
a particular situation, is found by the court to be void, vlvalid, illegal or unenforceable, such terin or
provision s11all remain in force and effect to the extent allowed by suc11 rulitlg. All other contract terins
and provisions and t11eu application to specific situations will remai�z uz full force and effect.
25. Survival.All provisiolls which by their nature must continue after the Agreement ends,
includi�lg without limitation Indeinnification, 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 pertauzing to material provisions of this contract or
significant disputes w11ic11 are required by law or under this contract to be in writing inust 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 fiftll calendar day after deposit in the
United States Mail, postage prepaid, registered or certified, or the next business day following
electronic subinission.
To City of Cupertulo: To Contractor:
Office of the City Manager Saratoga, CA 95070
10300 Torre Ave., Cupertino CA 95014 cc: Representative/Coorduzator:
cc: Representative/Coordinator: Saineer Kausar
Kristina Hastings Email:
EmaiL• kristit1a11@cupertitlo.org
27. Validity of Contract. Tl�is contract is valid atld enforceable only if it complies wit11 the
provisions of Cupertino Municipal Code Cllapters 3.22 and 3.23, is signed by the City Ma�zager or
authorized designee, and is approved for forin by the City Attorney's Office.
28. Execution. The person executulg this contract on bellalf of Contractor represents and
warrants that Contractor has full rigllt, power, and authority to execute this contract and to carry out
all actions a�zd services required. T11is contract constitutes a legally binding obligation of Contractor,
and inay be executed in counterparts, each one of wllicll is deemed an origulal and all of w11ic11, taken
together, constitute a suzgle binding instrument.
Rec�^eation Services Agreement/Rev. 3-27-2018
Page 5 of 6
IN WITNESS WHEREOF,t11e parties have caused this contract to be executed.
CONTRACTOR CIT1'OF CUPERTINO
SI<Studios A Municipal Corporation
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N ��,w�,-���r It.�w4S�r Naine t�;..�'l�'v7S�'i%�-�1i2'1��
Title I�- O c�'�-e'r Title ��`', ��j�"�-���'"
Date �6�a �� �' Date �� ��lt�
Tax I.D. No.: See W-9
APPROVED AS TO FORM: ATTEST:
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I� GRACE SCHMIDT �µ e-� � �'
Cuperti�lo City Attorney City Clerk `�
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ContractlEncumbe��ed An�ount:$1,000
Account No.: 100-G2-608 700-702
Recreation Ser�vices Agreement/Rev. 3-27-2018
Page 6 of 6
EXHIBIT A
SCOPE OF WORK,PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR wi11 provide LIVE MUSIC PERFORMANCE in,but not lirnited to,the
following:
1. Confirm technical needs to the City of Cupertino two weel<s prior to the show.
2. Arrive at least one and half (1.5) hours before performance start time.
3. Perform with without a stage for one hour between 7:30-8:30pm on July 14th, at
1000 S. Stelling RD, Cupertino, CA 95014,Jollyman Parl<.
4. SK Studios will start off with a 1inu1-2min perforinance t11en go ulto a Bhangra lesson.
5. T11ey will teach foundational steps and tllen inove on to teadling some choreographed
moves for the audience(teaching will be 30min-45inu1)
6. After the lesson, SK Studios will put on a 7mu1-8min routine ulcorporatulg different props
and styles of Bhangra. The dancers will be in full fits througllout fl1e event. Overall will be
an hour of entertainment.
7. Piovide a line-out to the fiont PA.
8. Maintain a volume level not to exceed 70 decibels at the nearest residence. �.
9. Provide their own meals and water during the event.
10. Will not bring alcohol or illegal diugs to the event.
The City of Cupertino will provide:
1. All u�surance and meet all insurance requireinents for the band in exhibit"B" of the
contract.
2. Main speakers to the crowd.
3. 16-charulel sowzdboard.
4. Generator power with power cables and power strips
Location and Tirne of CONTRACTOR Services:
Arrive at least one and half(1.5) hour before performance start time.
7:30-8:30pm on July 14th, at 1000 S. Stelling RD, Cupertino, CA 95014,Jollyman Parl<.
Compensation for CONTRACTOR Services:
Contractor shall be compensated for services perforined pursuant to t11is Agreement. Compensation
s11all consist of the following: A 100%payment will be given WITHIN 30 days after the day of the
perforinance. T11e total compensation to the Contractor s11all not exceed$1,000.
Cancelation by the Contractor:
a. No payinent will be given and performance can be rescheduled at fl1e City's discretion.
Cancelation by the City of Cupertino:
a. If the City notifies SK Studios of cancelation withu130 days of flZe event,the contract will be
voided or rescl�eduled at the City's discretion. No payment will be given.
b. If the City cancels the event less than 30 days froin the date of perforinance,t11e Contractor will
receive 50% of t11e performance fee.
c. If the City cancels the event less than 4 hours before official perforinance start time, Contractor
will be paid 100%performance fee.
List all Perforrners expected at the performance (if this is a solo performance,you may list"self").
NehaShekhar
Anushlca Pushpala
Akshay Kamal
Sameer Kausar
Performance of CONTRACTOR Services:
In the event of an injury occurruzg to a participant, the Contractor will notify the City within 1 hour
and coinplete an Incident Report in the forin approved by the City. The Incident Report inust be
submitted to the City within 24 hours of the uljury occurring.
' Exhibit B :'
Iasu�^a�ace Reqicire»ae�zts foY Recreatio�a 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:
l. Commercial General Liability (CGL): Insurance Services Office Form CG 00 O1 covering CGL on an
"occurrence" basis, including property damage, Uodily 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 Uodily injury and
property damage.
❑ Required if auto»zobile is used to peTfor»z work under this contract.
� Othe�^x�ise, p�oof of Cont��actor's pe�sonal auto insurance with Zz�nits �^equared by state law
suffices. Contracto�shall not transport or use its personal vehicle to transport pa�ticipants o�
pe�for»2 woNk u�2de�tlzis 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.
❑ Required if Cont��actor has eJ�aployees.
.�1 If no e�nployees, Contractor n2ust sigfa Affidavit of No Enzployees.
4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving
ininors, (i.e., after school activities, recreational programs, athletics, study/training events and
transportation of ininors). Coverage may be included under General Liability or be obtained in a separate
policy, such as Educators Legal LiaUility (ELL) policy, with a limit of no less than $1,000,000 per
occurrence. If a general aggregate limit applies, it must ap�ly separately to this contract or be twice the
required occurrence limit.
❑ Requirecl if Cont�act involves seNvices to clzild�en.
Insurance coverage required inay be satisfied by a combination of Primary and Excess/LhnUrella insurance.
Self-bzsuNed Rete�ztio�zs: Self-insured retentions inust be approved by City. City may require Contractor to
provide proof of ability to pay losses and related investigations, claim admiiiistration, and defense
expenses within the retention. The policy language must provide, or Ue endorsed to provide, that the self-
insi�red retention inay Ue satis�ed by either the named insured or City.
Acce�tability of InsureNs: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, or be endorsed to contain, the '
following provisions:
1. The City, its City Council, Uoards and coinmissions, officers, officials, employees, agents, servants
and volunteers are to be covered as additional insureds with respect to liability arising out of worlc or '
Exh.B Insura�ace for Recreation Contracts Updated 3-26-18
1
operations perforined by or on behalf of the Contractor including materials, parts or equipment
furnished in coimection 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 worlc perfoi7ned by Contractor for City. This provision also applies to the
Contractor's Workers' Coinpensation policy.
4. Each insurance policy required by this contract shall provide that coverage shall not be canceled,
except with notice to the City.
Pt^inaary 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/indeinnitees. If the limits of insurance required are satisfied in part Uy Umbrella/Excess Insurance,
the UmbrellalExcess Insurance shall contain or be endorsed to contain a provision that such coverage shall
also apply on a "priinary and non-contributory"basis for the benefit of the Additional Insureds Uefore City's
ovv�i insurance is triggered.
Notice of Cancellatio�a: Each insurance policy shall provide that coverage shall not Ue canceled or allowed to
expire without written notice to City 30 days in advance or 10 days in advance if due to non-payinent of
premiums. Such notice must be sent to City via email or certified mail to the attention of the City Manager.
Waiver of Sub�rogation: 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
oUtain any endorsement that inay 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 fi-om the insurer.
Verificatio�z of CoveNage:Contractor shall furnish the City with original certificates and amendatory
endorseinents effecting coverage required by this clause. All certificates and endorseinents are to be received
and approved by the City before worlc 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 tiine. At a miniinuin Contractor inust provide acceptable copies of the policy
declarations and endorsement page verifying the required insurance coverages.
Homeowner�'s I�asuNa�ace: Contractor's homeowner's liability insurance may provide coverage sufficient to
ineet these requirements. Contractor should provide these requirements to his or her agent to confii7n and
provide veri�cation to City.
S�ecial Evezzts Cove�^age: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 inforination or assistance.
Special Risks or Circu�astances: City reseives the right to modify these requirements based on the nature of
the rislc,prior experience, insluer, coverage,or other special circumstances.
Exh.B Insu�^ance for Recreatioia Conh�acts Updated 3-26-18
2
EXHIBIT C
AFFIDAVIT OF NO EMPLOYEES
State of Califo7�nia
County of Santa Cla��a
City of Cupel�tino
I, the undersigned, declare as follows:
I am an independent contractor and the owner/rnanager of �k S�c��,��s
I wish to enter into a services contract with the City of Cupertino. I am fully aware of the
provisions of section 3700 of the California Labor Code, which requires every employer to
provide Workers' Compensation coverage for employees in accordance with the provisions
of that Code. I am also aware that I must provide proof of workers' compensation insurance
to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the
City of Cupertino's contract.
I hereby certify that I do not have any employees nor will I have any employees worl<ing for
me or my business during t11e term of any service contract with the City of Cupertino. I am
not requiied to have Worlcers' Compensation insurance.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
Executed on this ��'day of 6`'� 2018, at ����"�`a , California.
�G.v1n e�r �cw��c��
PRINT NAME
ATU
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: -
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED)
Alliant Insurance Services,Inc.in coiijluiction with
Apex Insurance Services
P. O.Box 6450
Newport Beach,CA 92658
License No: OC 36861
NAMED INSURED(EVENT HOLDER): EVENT INFORMATION:
City of Cupertino,Its City Council,Boards and Commissions TYPE: 2018 NeiEhborhood Events
Officers,Officials,Employees,Agents,Servants,Volunteers DATE(S): See attached listing
and Consultants LOCATION: See attached listing
10300 Torree Ave *Liquor Liability Yes❑ No�
Cu ertino,CA 95798 **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)far the policy
period indicated. The insurance descriUed 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: JANUARY 1,2018 EXPIRATION:JAN[JARY 1,2019
COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE
General Aggregate Limit $2,000,000
Products&Completed Operations 1,000,000 SPECIAL CONDITIONS:
Personal&Advertising Injuiy 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 Reuted To You(Auy One Premises) 104,000 Certificate Of Insurauce:
Med'rcal Payments(Any One Person) 5,000 MEGL643
Liquor Liability (If purchased) t,000,000
Optfonal Limits Purchased
❑ $1,000,000/$3,000,000
❑ $2,000,000/$2,000,000
Dainage To Property(If purchased)
The limits of iusurance apply separately to each event iusured by this policy as if a separafe policy of insurauce has been issued for that eveut.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with tlie policy
provisions.
,�,��.,��,:��..�.��.____
AUTIIORIZED REPRESENTATIVE:
DATE ISSUED: 6/14/18
Dates
6/30/18
7/7, 11, 14, 25, 28/18
8/3, 8, 12,18, 22, 25/18
9/1, 5, 8, 14, 19, 22, 29/18
Locations
Creekside Park, 10455 Miller Ave, Main Street Park, 19469 Stevens Creek Blvd, Monta Vista
Park, 22601 Voss Ave, Jollyman Park, 1000 S. Stelling Road, Portal Park, 10225 N. Portal Ave,
Three Oaks Park, 7535 Shadowhill Ln, Wilson Park, 10200 Parkside Ln, Linda Vista Park,
11097 Linda Vista Dr., Memorial Park Amphitheater, 20350 Stevens Creek Blvd, Cupertino, CA
95014
POLICY NUMBER: SEP41026 COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDI�'IONAL lNSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
City ofi Cupertino, Its City Council, Boards and Commissions, Officers,
Officials, Employees,Agents, Servants,Volunteers and Consultants
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 �r 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 additionai 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 O Insurance Services Office, Inc., 2012 Page 1 of 1
PreparedonMay22,2018 Page1of4
Na$iOnwide� Your Policy Declarations
is on your side Personal Auto Policy
Policy Period:Sep 6,2017-Sep 6,2018
Policy Number: PPC 0053884525-2
Policyholder(Named Insured): Account Number: 7294235459
Anjali Kausar
Saratoga,CA 95070-3948 Keep these Declarations for your records.
General Policy Information
Issued:May 22,2018
These Declarations are a part of the policy named above and identified by the policy number above.They supersede any
�''� Declarations issued earlier.Your policy provides the coverages and limits shown in the schedule of coverages.They apply
o to each insured vehicle as indicated.Your policy complies with the motorist's financial responsibility laws of your state
� only for vehicles for which Property Damage and Bodily Injury Liability coverages are provided.
�
N
o Policy Period:September 6,2017-September 6,2018 but only if the required premium for this period has been paid
� and only for twelve month renewal periods if renewal premiums have been paid as required.This policy is initially
M effective at(1)the time the application for insurance is completed,or(2) 12:01 a.m.on the first day of the policy period,
c whichever is later.Each renewal period begins and ends at 12:01 a.m.Standard time at the address of the named insured
r" stated herein.This policy term expires at 12:01 a.m.at the address of the named insured stated herein.
Your carrier is Allied Property&Casualty Insurance Company,NAIC#42579.
HowYou Saved on this Policywith Allied
• Multi-Policy • Multi-Car Discount • Good Student
�Jw� • Air Bag Discount • Anti-Theft Device • Good Driver Discount
��
• Group/Occupational Discount • Elite Driver Discount
Insured Drivers
Name Date of Birth Marital Status License Number
Anjali T.Kausar
Changes Made to Your Policy
• Added Loss Payee-15 Bmw
Effective date for all changes May 21,2018
16243(12-08) Continued on the next page
Prepared on INay 22,2018 Page 2 of4
Nationwide� Your Policy Declarations
is on your side Personal Auto Policy
Policy Period:Sep 6,2017-Sep 6,2018
Policy Number: PPC 0053884525-2
For coverage definitions and descriptions, Account Number: 7294235459
visit www.alliedinsurance.com
Insured Vehicles and Schedule of Coverages
2004
Coverages Limits of Liability Premium
Bodily Injury Liability $500,000 Per Person $529.32
$500,000 Per Occurrence
Property Damage Liability $100,000 Per Occurrence $429.86
Medical Payments $2,000 Per Person $29.06
Uninsured Motorist Bodily Injury $250,000 Per Person $142.20
$500,000 Per Accident
Comprehensive Actual Cash Value Less A$500 Deductible $62.92
Collision Actual Cash Value Less A$500 Deductible $451.38
Waiver Of Collision Deductible $7.62
TotalforthisVehicle $1,652.36
Coverages Limits of Liability Premium
Bodily Injury Liability $500,000 Per Person $756.66
$500,000 Per Occurrence ...
Property Damage Liability $100,000 Per Occurrence $862.32 �
Medical Payments $2,000 Per Person $36.60
Uninsured Motorist Bodily Injury $250,000 Per Person $182.90
$500,000 PerAccident
Uninsured Motorist Property Damage $3,500 Per Occurrence $22.66
Liability
TotalforthisVehicle $1,861.14
Coverages Limits of Liability Premium
Bodily Injury Liability $500,000 Per Person $503.46
$500,000 Per Occurrence
Property Damage Liability $100,000 Per Occurrence $374.50
Medical Payments $2,000 Per Person $29.06
Uninsured Motorist Bodily Injury $250,000 Per Person $135.36
$500,000 Per Accident
Uninsured Motorist Property Damage $3,500 Per Occurrence $13.56
Liability
TotalforthisVehicle $1,055.94
16243(12-08)
Prepared on May 22,2018 Page 3of 4
Nationwide Your Policy Declarations
is on your side Personal Auto Policy
Policy Period:Sep 6,2017-Sep 6,2018
Policy Number: PPC 0053884525-2
Account Number: 7294235459
Insured Vehicles and Schedule of Coverages
Coverages Limits of Liability Premium
Bodily Injury Liability $500,000 Per Person $198.86
$500,000 Per Occurrence
Property Damage Liability $100,000 Per Occurrence $139.30
Medical Payments $2,000 Per Person $11.06
Uninsured Motorist Bodily Injury $250,000 Per Person $48.60
$500,000 Per Accident
Comprehensive Actual Cash Value Less A$500 Deductible $83.70
o Collision Actual Cash Value Less A$500 Deductible $476.74
M Waiver Of Collision Deductible $6.18
O TotalforthisVehicle $964.44
rn
N
� Coverages Limits of Liability Premium
� Bodily Injury Liability $500,000 Per Person $214.86
M $500,000 Per Occurrence
Property Damage Liability $100,000 Per Occurrence $153.28 ...
Medical Payments $2,000 Per Person $12.66
Uninsured Motorist Bodily Injury $250,000 Per Person $61.10
$500,000 Per Accident
Comprehensive Actual Cash Value Less A$500 Deductible $55.80
Collision Actual Cash Value Less A$500 Deductible $481.40
Waiver Of Collision Deductible $6.18
Total for this Vehicle $985.28
'"'` Loss Payee-Bmw Bank Of North America
�
Policy Level Schedule of Coverages
Roadside Assistance Up to 100 Miles/$100 Lockout $38.62
Allied Extra Coverages See Endorsement
Total for Policy Coverages $38.62
Continued on the next page
16243(12-08)