18-001 Silicon Shores CITY CJF
No.
FY2018-21
CUFE�t"fllVO
RECREATION SERVICES AGIZEEMElVT
1. Parties.This contract is made and entered into as of 7/1/2018 ("Effective Date"),by and
bet�ween t11e City of Cupertino, a municipal corporation("City"), and with SILICON SHORES, 3160 N
SHORELINE BLVD., MOUNTAIN VIEW, CA, 94043 ("Contractor"), a CORI'ORATION for
WATERCRAFT SPORTS CAMPS AND CLASSES.
2. Services. Contractor agrees to provide the Services included in the Scope of Worlc and
in accordance with the Schedule of Performance attached in Exhibit A.
3. Terrn. This contract begins on the Effective Date and ends on 6/30/2021 ("`Contract
Tirne"),unless extended or ferminated as provided herein. Time is of the essence and Contractor must
have sufficient tirne, resources, and qualified staff to deliver the Services as required. Contractor must
promptly notify City of any acEual or potential delays to afford the Parties adequate opportunity to
address or rnitigate 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$114,000("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 Exhibif 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 inaintain 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 Contractor and not an employee,
partner, or joint venture of City. Contractor is solely responsible for the means and methods of
perforrning the Services and for the persons hired to work 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 health benefits, worl<er's compensation or any other benefit.
Contractor must have the slcills and qualifications to perforin the Services in a competent and
professional manner. Contractor will supply all tools, lnaterials and equipment required to perforrn
the Services under fhis Contract. Contractor is respollsible for obtaining permits and licenses required
by law and rnust obtain a City business license.
Recreation Services Agreementl Rev.3-27-2018
Page 1 of 6
6. Proprietary/Confidential Information.To the extent Contractor may have access to
private or confidential inforination owned or controlled by the City, Contractor agrees to treat it
confidential and use it solely to perform this Agreeinent. Contractor inust exercise the saine 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 connection wit11 this contract, City will have the property rights to those inaterials and all
copyrights,if any, to such worl<product will constitute City properfy.
�. Records. Confractor must maintain complete, accurate,and detailed accounting records
relating to its perforin�u�ce in accordance with generally accepfed accounting principles �nd
procedures. The records must include detailed informatioil abouf Contractor's services, benchrnarks,
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 rnaintained for four years frorn the date of City's
final payment.
9. Assignrnent. This Contract is not assignable. Contractor may not substitute another or
fransfer any rights or obligafions 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 Tirne and for one year thereafter must reference City contributions.
The words "Cify 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 Agreernent without prior written approval from City.
ll. Indemnification.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 attorney 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 rnay incur in erlforcing this provision and must
accept a tender of defense upon receiving notice from City. Contractor's payrnents may be deducted or
offset to cover any money the City lost due to a claim or counterclairn arising out of this Contract.
12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City
will not execute the Agreement until it has received and approved safisfactory certificates of insurance
and endorsements evidencing the type, ainount, and dates of coverage. Alternatively, City in its sole
Recreation Services Agreementl Rev. 3-27-2018
Page 2 of 6
discretion may purchase insurance atld deduct the costs from payinents to Contractor,or terininate the
contract.
13. Compliance with Laws and Other City Reqnirements.
Requirements for alI 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 Ainericans with Disabilifies Act of 1990,and other laws that pertain
to fair einployment and anti-discriminatioll praciices. Contractor rnust coinply with labor laws
pertaining to prevailing wages, worlcing hours, overtiine, payroll records, a11d otller requirements
imposed by the Department of Industrial Relations.If Contractor does not have employees,it must sign
the Affidavit of No Einployees, attached as Exhibit C. Contractor is responsible for verifying
employment eligibility of employees pursuatlt to the Immigration Reform and Control Act of 1986.
Contractor inust 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 adrninistrative rules
prohibifing gifts to City officials and employees.
Additional Requirements for Services Provided to Minors: Contractor and its employees
who provide services under fhis 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 i1z Exhibit D.
G 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 fo concussion evaluation, removal from
play, and return to play protocols. (Refer to Center for Disease Control & Prevention,
htt�s://www.cdc.gov/headsu�/index.htrnl�.
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 adininistrators 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 (linlc cited above).
E. If providing instruction, Contractor inust acl�nowledge and comply with all requirements
set forth in the Recreation&Community Services Instructor Manual.
Recreatian Services Agreementl Rev.3-27-2018
Page 3 of 6
Check one (if a�plicable):
� This contract requires services for children.
❑ 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`Exhibit 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 Corrununity Services and City Attorney.
14. Coordination of Services. The Parties designate t11e 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:
Name:Jeff Ordway Name: Christina Ferrari
Position:Recreation Coordinator Position:President
Contact:jeffo@cupertino.org;408-777-3327 Contact:christin�@shorelinelal<e.com;
650-965-7474
15. Abandonrnent. City may 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. Terrnination. 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 corulection with this
contract must comply with the governrnent 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 arbifrator'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.
Recreation Services Agreementl Rev. 3-27-2018
Page 4 of 6
20. Waiver.Neither acceptance of Services nor payinent thereof constitutes a waiver of any
contract provision. City waiver of a breach shall not constitute waiver of another term, provision,
covenailt or condition, or a subsequent breach,whether of the same or a different character.
21. Entire Agreement. This Agreeinent and all referenced Exhibits are hereby attached and
incorporated into the Agreement by this reference and represent the full and coinplete understanding
as to those matters contained herein, and supersede a�zy other contract or understanding,either oral or
written,between the Parties.This Agreement rnay 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 rnain 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 ornission 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 rernain 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 3160 N Shoreline Blvd.,Mountain View, CA,
10300 Torre Ave., Cupertino CA 95014 94043
cc:Representative/Coordinator: cc:Representafive/Coordinator:
Jeff Ordway Christina Ferrari
Email: jeffo@cu�ertino.org Ernail: christina@shorelinel�lce.com
Recreation Services Agreement/Rev.3-27-2018
Page 5 of 6
27. Validity of Contract. This contract is valid and enforceable only if it coinplies 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. T11e 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 collstitutes a legally bindi�lg 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.
IN WITNESS WHEREOF,the parties 11ave caused this contract to be executed.
CONTRACTOR CITY OF CUPERTINO
SILICON SHORES A Municipal Corporation
By �--� �-,--- By -�C'�..�.--��'
Name�C�,C������ Name�/!1�"/ /�/,�1�%�
Title�, �'�-�{i�t1 s �vv�1 �'� Title J��`�'"�� l..�'d�C�
Dates,�t�ll�'i � �... ���� Date (�sa""o��v`c�
Tax I.D.No.:Refer to W9
APPROVED AS TO FORM: ATTEST:
,�" ' �,�� (�Z����
� ����/� _ �lR �r �rl �
DOLPH STEVENSON HOM GRACE SCHMIDT
C pertino City Attorney City Clerk
Fiscal Year 2018-19
ContractlEncumbered Amount:$36,000
Account No.:580-63-620 700-702
Fiscal Year 2019-20
ContractlEncumbered Amount:$38,000
Account No.:580-63-620 700-702
Fiscal Year 2020-21
ContractlEncumbered Amount:$40,000
Account No.:580-63-620 700-702
Recreation Services Agreementl Rev. 3-27-2018
P�ge 6 of 6
EXHIBIT 1�
SCOPE OF WORIC,PERFORMANCE AND PAYMENT SCHEI�ULES
The CONTRACTOR will provide WATERCRAFT SPORTS CAlVIPS AND CLASSES iri,but not
limited to,the following:
CAMP SHORELINE,BEGINNING WINDSURFING AND SAILING CAMP,ADVANCED
WINDSURFING AND SAILING CAMP,INTRODUCTORY SAILING, INTRODUCTORY
WINDSURFING
Location and Tirne of CONTRACTOR Services:
Refer to the Recreation Schedule dated SUMMER 2018 THROUGH SPRING 2021 for agreed upon
dates,tiines, and class locations. The City, at its sole discretion,may change the agreed terms.
Cornpensafiion for CONTRACTOR Services:
Contractor shall be compensated for services performed pursuant to this Agreement. Compensation
shall consist of the following: 80% OF THE RESIDENT REGISTRATION. The total compensation to
the Contractor shall not exceed$114,000.
Eligible Participant Minimurn and Maxirnurns for CONTRACTOR Services:
Minimum: 1
Maximum: VARIES
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 rnay cancel the particular class
and/or terminate this Agreement without additional notice or payment to Contractor.
List of all Contractor Ernployees working for the City of Cupertino (if no Ernployees,identify
"self"):
��e�s�,�r ��'������t s�-��:�r� ���I��►� l��.r k��;-��2
��►m�' �o,�P,2. ��r�n�P� i�a�s�qaf"
�61!St��'1 �G�^►y��!'-�' C. ��+t.a�i� t"�ff�rf
/�us¢��n �-��.�r� �`�,� �s�,rtb�:��
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 tal<e part in the program unless they are listed on
tlie class roster or can show proof of enrolhnenf.All participants and volunteers need to cornplete the
City"s Waiver of Liability form prior fo talcing part in the program. If applicable, contractors who are
responsible for supervising ininors must remain with the class until a parent of legal guardian has
arrived and all minors are released to thern.
In the event of an injury occurring to a parficipant, 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 withu124 hours of the injury occurring.
E�hibit B
Insurance Requarements for Recreatisan Gontrac�s
As required by Section 12 of the Agreemeut, Contractox shall procure and maintain the following insuraixce
for the duration of the confirac# agai�ist claims arising from or in connection with Contractor, its agents,
representatives,ein�loyees or subcontractors Services under this Agreement.
Minimum Scope and Limit of Insuranee. Caverage shail be at least as broad as:
1. C�mmercia�l Get�eral Liability {CGL): Insclrance Se1•vices O�ce Form CG 00 01 covering CCiL on an
"occ�rrence" basis, including property damage, bo�iily injury and personal & advei�tising ii�jury with
limits no less than $1,000,000 per occurrence. If a general aggregate limit ap�lies, it must apply
separately to this project/location (CG 25 03 ar 25 04}or be twice the re�uired occnrrence Iimit.
2. A�atomobiie Liability. ISO CA 00�1 covering Code l {aiay auto), or if Contractor has no owned autos,
Code 8 {hired) and 9(non-ownedj,��ith liinits no less t1�an�1,000,000 per accident for bodily injury and
proper�y damage.
❑ Required�automobide is used to perform work under this contract.
� Othe1-wise, proof of Contractof•'s �ersonal auto insurc�nce �vzth l.imits required by sZate lczw
suff"zces. Corttractor shull rtat tNansport or use its�personal vehzcle ta transpart�articipants or
per,f"oYm�vork u�der this co�sty�act
3. Worlcers' Compensation: As required by the State of Califc�rnia, with Statutory and Employer's
Liability Insurance limits of no less than$i,000,00{�per accid�nt for bodily injury or disease.
� Reqa�ir•ecl i,f Contractor has emplvyees.
❑ .If na employees, Contractor na�tst sign A�davat of No Employees.
4. Sexual AbuselMolestation: Insurance c�r the equivalent as required for activities/services involvulg
minors, (i.e., after school activities, recreational �rograms, athletics, st�.idy/training events and
�ransportation of minors}. Coverage inay be included under General Liability or be obtained in �separata
poiicy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 pe��
occurrence. If a general aggregate liinit applies, it mus� apply separately to this contract or be twice th.e
required occurrence limit.
� Requi�ed zf C'ontr•act involves services to chzlclren.
Insurance eoverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance.
,Sel,f-.�nsurerl Retentivr�s: Self-insured retentions must be approved by City. City may require Contractor to
provide proof of ability to �ay losses and related investigations, claim administration, and defense
expenses within the retention, The policy language must provide, ar be endorsed to provide, that fihe self-
insured retention inay be satisfied by either tl�.e na�ned ins�ared or City.
Acceptability ofdnsurersr Insurance rnust be issued by insurers acceptable to City and licensed to do business
in the State of Califarnia,with an A.M.Best's financial strength rating af"A"or better a.ud a financial size
rating of"VTI"or betl:er.
OTHER Il�TSUI2ANCE I'ROVISIONS: Ths CGL policy must contain, or be endorsed ta contain, the
following provisions:
1. The City, ii:s City Council, boards aud cominissioi�s, a�cers, of�icials, employees, agents, servants
and volunteers are ta be cavered as additional insureds with r�spect to liability arisi:ng out of w�rk or
Exh.B Ins��ance,fo�Recreatian Contracts Updated 3-26-18
1
operations performed by or on behalf of the Contractor including materials, parts or equipment
furnished in conneation with such work or operations.
2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 O1 04
i3 as respects the City, its ofFicers, officia(s,emptoyees,agents,and volunteers.
3. The Insurance Cainpany agrees to waive all ri�lhts of s�brogation against the City, iis elec#ed or
appo3tatec�o�cers,o�cials, agents, and employees for losses paid�.tnder the terms of any policy
whicli arise from work perforined by Contractor for C.ity. This provision also applies to the
Contractor's Worlcers' Compensatipn policy.
4. Each insurance policy required by this contract sl�all provide that coverage shall not be canceled,
except with natice to the City.
Primary Coverage: The Additional Insured coverage under Con�tractor's policy shall be primary non-
cc�ntributory and at least as broad as ISO CG 20 41 04 13 as respects the City and all the
insureds/indemnitees. If the lirnits of insurance rec�uired are satis�ed in part by Urr�brelta/Excess Ins�ra�ce,
the UmbrellalExcess Insurance sha11 contain or be endorsed to contain a provision that such coverage sha11
also apply on a"primary and non-cantributory" basis fox�the bene�t of the Adclitianal Insureds before City's
nwn insurance is triggered.
.Natace af Ca�recellatzor2:Each ins�ira�ce�olicy shall provide that coverage shall not be canceled or allowed tr�
expire witho�.rt writken �lotice to City 30 days in advance or 10 days in advance if due to non-payi3�eut of
premiums. Such notice must be sant#o Ci#y via ema�il or cer9:ified mai]to the attention ofthe Ci�y Manager.
Wi�iver of Subrogrataonr Con�ractor grants City a waiver of any right to subrogation whi�h any insurer�of said
Contractar 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 af subrogation, but this provision applies
regardless of whether or 2�at the City has received a waiver of subrogation endorsementi from the insurer.
T�er�cation of C"ouerage:Cantractor shali furnish the City with original ce�-tificates and amendatory
endorseinents effecti�ng coverage required by this clause.All certi�cates akld endorsements are ta be received
and approved by the City liefore�vvork comtnences. Tl�e Ci1y reserves the right to require compiete, certified
copies of a�l reyuired ii�surance policies, including endors�ments affecting the coverage required by these
speci�icatioils,at any time. At a aninimum CQntraetor must provirle acceptable capies af the policy
declarations ai�d endorsement page verifying the required insurance coverages.
�domeowner'�I�su�r���ce:Contractor's hameowner's liabiiity insurance may pravide cov�rage suf�"icient to
meet these reyuiz�ements.Contractor should provide these requirements to his or her agent to confirm and
provide veri�cation to City.
Speci�tl Evenls Caverage:Insurers may p�•ovide special events caver�age for a reduced f�e,or City may be
able ta offer this coverage.;Contractor should contact the City Manager's Office far inforrzlation or assisl:�nce.
Specia[Rasks or Circumstr�a�ces:City reserves the right to modify these reqLtirements based on the nature of
the risk,prior experience,insurer, coverage,or other special circumstancss.
I
Exh.B Insz�rance for Recreatian C'ontracts Upc�ated 3-26-I S
2
EXHIBIT D
Contractor's Mandated Reporter Declaration
The undersigned does hereby certify that:
1. I am a representative of SILICON SHORES;that I arn familiar with the facts herein and ain
authorized and qualified to execute this declaration.
2. I declare that SILICON SHORES has complied with fingerprinting and criminal background
investigation requirements with respecf 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 cornplete concussion
and head injury education at least once,eifher 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 parficipants 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 forrn 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 rnentioned 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 menfioned 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 Ernployees working for the City (if no Ernployees,identify"self"):
Ad9��'�w ��,��P�S-�"�a�3 ��'�a,� �tx�'��w�=��
���� L���,� ���,��.� a��l���
�l',�c� �c�► � � -� G������� ��r�'�r
��s�►� �,c� �`�r�,�� �C�s��,6�v�
8. The Contractor will notify the Cify of Cupertino in writing of any new employees and will be
added to the above list prior to beginning work at the City of Cupertino.
I declare under penalty of perjury that the foregoing is tr�e and correct.
SILICON SHORES
By._//�.,.�• ►�—„
Name � i� �,
Title � d'c�-�"�0. � +a • e1'
Dafe �vrr��,. l'� , 2�0�
,� SILISHO-01 MICHAELZIRNHELT
'�`�'�'�'�'" CERTBFICAI'E OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
'�*—�"'"`+ 06/05/2018
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,4DDITIONAL INSURED provisions or be endorsed.
If SUBROGATIOPI 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 coNrAcr Michael Zirnhelt
NAME:
Norman-Spencer A�ency inc �A oNN,Ext�:(209)205-4924 jAic,No 209 384-7025
8075 Washington V�Ilage Dr >�� �
Da ton OH 4545s E-MAIL mzirnhelt qlobalmarineinsurance.com
Y � ADDRESS: �
INSURER S AFFORDING COVERAGE NAIC#
msuReRn:NationalCasualt Com an 11991
INSURED INSURER B:
Silicon Shores Inc.ShorelineAquatic Center INSURERC:
DBA:Shoreline Aquatic Center
3160 N Shoreline Bivd INSURER�:
Mountain View,CA 94043 INSURER E:
INSURER F:
COVERAGES CER7IFICATE 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 TypE OF INSURANCE ADDL SUBR pOLICY NUMBER P�LICY EFF POLICY EXP
LTR IN D VJVD MM/DD YYY MM/DDIYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g �,OOO�OOO
CLAIMS-MADE X OCCUR OMOOO'I7H2O 'I2/12/2077 'I2I'IY/ZO'I8 DAMAGETORENTED 'IOO�OOO
X X PREMISES Ea occurrence $
MED EXP An one erson $ 1�,000
PERSONAL&ADVINJURY $ 1,000,000
GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000
X POLICY❑JECT � LOC PRODUCTS-COMP/OPAGG $ �,OOO�OOO
orHeR: Abuse&Molest $ Included
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANYAUTO BODILYINJURY Per erson $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
AUT OS ONLY AU�TOS ONL�Y Pe�accRdent AMAGE $ .
$
A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
X EXCESSLIAB CLAIMS-MADE X X XLODO3'I823 12/12/2017 'I2/'I2/2O1H AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y�N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED7 N�A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required
The City of Cupertino,its City Council,boards and commissions,officers,officials,employees,servants and volun�eers are named as additional insured with
respect to General Liability,including Abuse&Molestation arising out of the operations of the Named Insured.Waiver of Subrogation included.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cit of Cu ertino THE EXPIRATION �ATE THEREOF, NOTICE WILL BE DELIVERED IN
y p ACCORDANCE WITH THE POLICY PROVISIONS.
Parks&Recreation
10300 Torre Avenue
Cupertino,CA 95014 AUTHORIZED REPRESENTATIVE
-~�1 �l /
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
END��SEMENT
���it�tl�r �+�;��Ic�l#�/ �Clt11pli�C1'� NQ.
A7TACHED Tp AND ENDORS@MENT EFFECTIVE DATE
FORMING A PART OF (�p;p1 A.M.STANOARO TIMEj NAMED INSURED AGENi NO, -
POLICY NUMBER -
Silicon Shores Inc DBA: Shorelin�Aquatic Center '
OM00017820 34717
THIS ENDQRSEMENT CHANGES 7HE POLIGY. PL�ASE READ IT GAREFULLY.
ADDITIONAL 1NSURED--�ESIGNATED PERaON OR ORGANIZATfON
7his endorsement mpdifies insuranee provided under the fol(owing:
CUMMERCIAL MARtNE LIABILlTY COVEi�AGE FORM
LlQUOR LIABIL.ITY COVERAGE �ORM
SCHEDULE
Name Of Additional Insured Person(s}Or Organization(sj: ,
NY PERSQN OR(3RGANIZATION VVHEN YOU AND SUGH PERSON OR ORGAN(ZAl'I�N HAVE
GREED IN WR►TING IN A CONTRACT OR AGR�EMENT, EXECUTED PRIOR TU THE
'OCCURR�NCE"TO WH1Chi TNiS INSURANCE APPLIES, THAT SUCH PERS�N OR
RGANIZATION E3�ADDE�A8 AN ARDiI"IONAL INSURED O�t YOUR POLfCY.
Information r�quired ta complete this Sahedule,if not shown above,will be shown in the Declarafions.
A. SECTION 11—WMD IS AN INSUR�D is amended to lnciude as an additional insured the persan(s)ar
organization(s) shawn in the Schedule, but only with respect to liability far bodily injury, property
damage or persanal and advertising inJury caused, in whols or in part,by yaur acts or omissions
c�r the acts or omissians of those acting on your behalf:
1. In the performance of your ongoing opera#ians; or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided fio the �dditianal insured is required by a contraci or agreement, the insur-
, ance�fforded to such additional insured will not be broader than #hat which you are required by
ths contract or agreement to provide for such additional insured.
B. With respect ta the insurance afforded to these additional insureds, the following is added to SEG
TION ill—LIMITS O�1NSURANCE:
OM-38(12-15) Page 1 of 2
If coverage provided to the additianal insured is required by a contract or agreement, the mast we �
will pay on behaif of khe additional insured is the amount of insurance: ;
1. FZequired by the contract or agreement; or
2. Available under the appficable Limits of Insurance shown in the Declaratians; .
whichever is less.
;
This endorsement shall not increase the appiicable Limits of Insurance shown in the Declarations.
r
AUTHORIZEC)REPRESENTATIVE DATE
pM-38(12-15) Page 2 of 2
ENDORSEMEIVI'
National Casualty Company �o. ��
ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE
FORMING A PART OF (qy;01 A,M.STANDARD TIME) NAMED INSURED AGENT NO.
POLICY NUMBER
Silicon Shores Inc
OM00017820 6/4/2018 34717
In consideration of � no change in premium
additional premium of:
❑ return premium of:
it is agreed that this policy is amended as follows:
THE FOLLOWING FORM IS ADDED:
OM-75 (2-15)WAIVER OF TRANSFER OF RIGHT OF RECOVERY FOR THE FOLLOWING MUNICIPALITIES:
CITY OF CUPERTINO
CITY OF LOS ALTOS
CITY OF MOUNTAIN VIEW
CITY OF MENLO PARK
UT-3g (03-92)
ENDORSEIIIIENT
National Casualty Company No. o�
ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE
FORMING A PART OF �qZ;01 A.M.STANDARD TIME) NAMED INSURE� AGENT N0.
POLICY NUMBER
Silicon Shores Inc
OM00017820 6/4/2018 34717
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL MARINE LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
City of Cupertino; City of Los Altos; City of Mountain View and City of Menlo Park
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Under SECTION IV—COMMERCIAL MARINE LIABILITY CONDITIONS, the following is added to para-
graph 8.Transfer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against the person or organization shown in the Schedule
above because of payments we make for injury or damage arising out of your ongoing operations or your
work done under a contract with that person or orgariization and included in the products-completed
operations hazard. This waiver applies only to the person or organization shown in the Schedule above.
�
AUTHORIZED REPRESENTATIVE DATE
Includes copyrighted material of ISO Properties,Inc.,with its permission.
Copyright, ISO Properties, Inc.,2009
OM-75(2-15) Page 1 of 1
� _ _ - - --- ----
' f _ �
;_e?;.a
A�!��''� CERTIFICATE OF LIABII_ITY INSURANCE os"i��a"ois'
THlS CERTIFICATE IS ISSUED AS A MATTER OF 1NFORMATION ONLY AND CONFERS NO RIGH7S UPON THE CERTIFICA7E HOLDER.TNI5
CERYIFIQATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE AOLICI6S BELOW. �
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRAC7 66TWEEN THE ISSUING IMSURER{S),AUTHORIZED REPRESENTATIVE
OR PROQUCER,AND THE CERTIFICATE HOLUER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subJect to the terms and conditions
of the policy,certain policies may repuire an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
_ _—.___-__..____..._..____.
AU II18t3Y3I1C@ S6Y'V'].C9S PHONE
10525 Old Mill Rd (aic,tvo,EM): (877)234-4420 �q�,No�: {gry'7)284-4421
E-MAIL
QIt18�18� ,NE 68154 AD�RESS:
PRODUCER
(877)234-4420 CUSTOMERID# __
__ __� __ INSURER{S)AFFOflDING COVERAGE I NAIC#
It+lSURED � INSUREflA: CS1ifOY'7118 III911Y8riC6 CO. r8865
------------.r.__--- -
INSURER B: I
55.�.].COri SZ10Y08 COY,CJOYB�.].OS'1
3160 N Shnreline $1VCl INSURF.R C:
_..._ _ - --_.._
Mountain View, CA 94043-1341 INSURER D:
INSURER E:
CTL 1273 1437461 iNsu��aF: �
�OVERAGES CERT1FiCATE NUM6ER: �EVISION NUM�ER:
THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATED, NOTWITIiSTANDiNG ANY REQUIftEMENT,TERM OR COf�DITION QF ANY CONTRACT�R OTHER DOCUMENT W1TH RESPECT TO
WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL
THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1NSR ADDL SUBR POLICY EFF P01.ICY EXP
L7R TYPE OF INSURANCE INSR WVD POLICY NUMBER � MM/DDNYYY MM/ODlYYYY LIMITS
GENERALLIABILITY I EACHOCCURRENCE �$
COMMERCIAL GENEflAL LIABILITY I—I I � ' ` DAMAGE TO RENTED
CLAIMS �� j � PREMISES�Ea occurrence �
MADE �OCCUR � MEO EXP An one erson $
PERSONAL&ADVINJURY $
GENERALAGGREGATE �
GEN'LAGGflEGATELIMITAPPLIESPER: � PRODUCTS-COMP/OPAGG �
POLICY PROJECT LOG $
AUTOMOBILE LlA81LITY � ,COMBINED SINGLE LIMIT
ANYAUTO ' I I {eaacc�eenq $
�i �
ALL OWNED AUTOS ! ' BODILY INJURY Per arson $ _
SCHEDULEDAUTOS � � � � 80DIlYlNJURY(Peraccident �$
HIRED AUTOS i PROPERTY DAMAGE
i � (PeracctAent . I$
NON-OWNED AUTOS � I �
' -- -
$
Ufl76RELLA LIAB OCCUR � EACH OCCUflAENCE S
E2G[:ESS LIAB __CLRIMS-MADE � ❑ - qGGREGq7E _
r �--
: DEDUCTIBLE � � �
� I$
RETENTION $ �
ANDEMPLO ERSELIABIL�ITY Y/N X TORYTLIMITSL EUR�i
ANY PROPRIETOR/PAflTNEFI t 1�g�Q'�Q�
� DCCLUDED�OFFICER/MEMBER � N/A I � 37-886847-02-01 O/�/O�.fZOS.H 04�O�.�ZOY9 E.L.EACHACCIDENT �$
�
{MandatoryinNH) E�.DISEASE-EAEMPLOYE� 1'aOOO�OOO
It yes,describe under ---"'--
SPECIALPROVISIONS below E.L.DISEASEPOUCYLiMl7 $ 1�OOO�000
❑ � I
DESCflIPTiON OF OPERATIONS/LOCATiONS/VEHICLES (Attach Acord 101,Additional Remarke Schedule,if more space is required)
CERTIFICATE HOLDER C/aNCELLATInN �
57.�.1.C�1 ,S�L]OY65 CbZ'pOx'dt].O¢3 SHOULD ANY 4F THE ABOVE DESCAIBED POLICIES BE CANCELLED BEFORE THE
3�.BO N aS"I10T6�.7319 H�.'VC3 E7�PIRATI�N DATE 7HEREOF,NOTICE WILL SC OELIVEAEO IN ACCORDANCE WITN
THE POLICY PROVISIpNS.
�71111tc11.t1 v19W� CA 94043-1341 pUTHORIZED REPRESEN7ATIVE
Attn: Project Nlariager ��—,.�/� � '`� p D 7�
ACORD 25(2009l09} The ACORD name and iogn are registered marks of ACORD 01988-2009 ACORD CORPOflAT10N,All rights resenred.
_.._ ..__ - _._
�. . .. -��: � -._�. __ _, !...... _._.. _._. _� `......_........ ._._ .��: (._.. -- .- --; }__ __. -__ _._.., I_- ..-- _ -' �-- -. .__ - -- --..:
. .� _ ..,. � ,-_ .. _-,
� : ; 1 l_
Jeff Ordway
From: USAA <USAA.Customer.Service@mailcenter.usaa.com>
Sent: Tuesday,June 19, 2018 3:11 PM
To: Jeff Ordway
Subject: Auto Insurance Confirmation
,
Tt�2nsuc���Fsvery to you�tnbcrx;�lease�adtl[�5��.��s�.�i�er��r,�iretn��a�icEiat�r.usaa:corrf ta ygur.a�dresa bi��k
Al9$O ItISUf 1t1Ce
,. � '� �011'�ICI'1i121t6�11
���� � Privacy Promise �
: ; Please use this as confirmation af auto insurance; however, this does not take the place
K.:
! of an insurance identification card.
Registered owner : JEREMY APPLE
Address:
PALO ALTO CA 94303
Policy #: GAR 023055493 7101
Palicy effective: March 29, 2018
` Policy expiration: September 29, 2018
�"' Vehicle:
Bodily injury liability limit: $1,000,000
each person /
$1,000,000 each accident
Property damage liability limit: $500,000 each accident
Comprehensive deductible: $500
Collision deductible: $500
� Meets California minimum statutory liability requirements '
' This confirmation af coverage neither affirmatively nor negatively amends, extends or
: alters the coverage given by the policy issued by Garrison Property and Casualty
' Insurance Company.
' Thank you for choosing us for your auto insurance needs. If you have questions, please
call us at 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722.
Thank you,
' Garrison Property and Casualty Insurance Company
t
'Garr9son Property and Gasualtp`insurance Campanjr,980(3 Fredericksbcirg}toad,San Antonio,Texas,78288
Garrisorr Property and Gasu�lty Insurarice Company,a subsitliary of USAA Casci�lty Insurance Gompany, is authorized to
'! use the USAA logo,a registerad traderrmark of'Unifed Seruice5 Automobile AsSociation,
1
I
Pti�acy Rromise ' '
Rlea�e do nafi.repiy to this e maii:To contact USAA,v�sit our secure cQntaet oacie.
� �,` � _ �" � " , � _
�:
� �� � , � � . -� �� � -
. . <, . 93127 Ofii '
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