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21-186 Safe Moves, Services Agreement, Bicycle Pedestrian Education for Safe Routes to School ProgramBicycle/Pedestrian Education for Safe Routes to School Program 1 of 5 Services Agreement ($5,000) / August 2021 SERVICES AGREEMENT ($5,000 OR LESS) 1. Parties. This Agreement (“Agreement”) is made by and between the City of Cupertino, a municipal corporation (“City”) and Safe Moves (“Contractor”), a Non-Profit, and is effective on the last date signed below (“Effective Date”). 2. Services. Contractor agrees to provide the programs, classes or activities (“Services”) set forth in detail in the Scope of Services, attached and incorporated here as Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. 3. Time of Performance. This Agreement begins on the Effective Date and ends on June 30, 2022 (“Contract Time”), unless terminated earlier as provided herein. Contractor must deliver the Services in accordance with the Schedule of Performance included or attached to Exhibit A. Time is of the essence for the performance of all the Services. Contractor must have sufficient time, resources, and qualified staff to deliver the Services on time. The City’s designated supervisor for this Agreement may extend the Contract Time by up to six (6) months through a written amendment to this Agreement, provided such extension does not include additional contract funds. 4. Compensation. 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 $2,250.00 (“Contract Price”), based upon the Scope of Services and the budget and rates included in Exhibit A. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. Upon City approval of written invoices, Contractor will be paid as follows: (check one; cross out others): ☒ A lump sum amount of $2,250.00 which shall not exceed the Contract Price. ☐ At the rate of $_______ per hour for a total not to exceed the Contract Price. ☐ Based on the payment schedule included or attached to Exhibit A which shall not exceed the Contract Price. 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 performing the Services and for the persons hired to work under this Agreement. Contractor is not entitled to health benefits, workers compensation or other benefits from the City. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner, and must be licensed, registered, and/or certified and have a City Business License. Contractor will supply all tools, materials and equipment required to perform the Services under this Agreement. 6. Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment Bicycle/Pedestrian Education for Safe Routes to School Program 2 of 5 Services Agreement ($5,000) / August 2021 taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Should any court, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS), the Internal Revenue Service, or the State Employment Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is an employee for any purpose, then Contractor agrees to a reduction in amounts payable under this Agreement, or to promptly remint to City any payments due by the City as a result of such determinati on, so that the City’s total expenses under this Agreement are not greater than they would have been had the determination not been made. 7. Assignment. This Agreement is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Agreement without prior written approval of City. Only those persons whose names are included in Exhibit A may perform the Services. 8. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and consultants (“Indemnitees”), through legal counsel acceptable to City, from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses related to litigation and dispute resolution proceedings), of every nature, arising directly or indirectly from this Agreement or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Negligent or willful acts or omissions committed during performance of the Services; (c) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors; Contractor must pay any costs City may incur in enforcing this provision and must accept a tender of defense upon receiving notice from 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 Agreement. 9. Insurance. Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit B, and must maintain the insurance for the duration of the Agreement, or longer as required by City. City will not execute the Agreement until City approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor’s compensation or terminating the Agreement. Bicycle/Pedestrian Education for Safe Routes to School Program 3 of 5 Services Agreement ($5,000) / August 2021 10. Compliance with Laws. Contractor shall comply with all laws and regulations applicable to this Agreement, included without limitation the following laws: Labor Laws. Contractor shall comply with all labor laws applicable to this Agreement. If the Scope of Services includes a “public works” component, Contractor is required to comply with prevailing wage laws under Labor Code Section 1720 and other labor laws. ☐ Sole Proprietor. If Contractor is a sole proprietorship/individual, it must sign the Affidavit of No Employees included in this Agreement. Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777 and 3077.5. Consistent with City policy, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor's employees or sub-contractors will not be tolerated. Contractor agrees to provide records and documentation to the City on request necessary to monitor compliance with this provision. Conflicts of Interest. Contractor shall comply with all conflict of interest laws applicable to this Agreement and must avoid any conflict of interest. Contractor warrants that no public official, employee, or member of a City board or commission who might have been involved in the making of this Agreement, has or will receive a direct or indirect financial interest in this Agreement, in violation of California Government Code Section 1090 et seq. Contractor may be required to file a conflict of interest form if Contractor makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of the California Code of Regulations. Contractor agrees to abide by the City’s rules governing gifts to public officials and employees. 11. Abandonment. City may abandon or postpone the Project at any time. Contractor will be compensated for satisfactory Services performed through the date of abandonment. 12. Termination. City may terminate this Agreement for cause or without cause at any time. City reserves the right to terminate the Agreement and the remainder of the Services offered by Consultant without notice based upon Contractor’s cancellation of a Service (i.e., program, class or activity) without giving advance notice or obtaining written approval from City. 13. Governing Law. This Agreement is governed by the laws of the State of California. Any lawsuits filed related to this Agreement must be filed with the Superior Court for the County of Santa Clara, State of California. Contractor must comply with the claims filing requirements under the Government Code prior to filing a civil action in court. If a dispute arises, Contractor must continue to provide the Services pending resolution of the 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. 14. Entire Agreement. This Agreement represents the full and complete understanding of every kind or nature between the Parties, and supersedes any other agreement or understanding, either oral or Bicycle/Pedestrian Education for Safe Routes to School Program 4 of 5 Services Agreement ($5,000) / August 2021 written, between the Parties. Any changes to this Agreement will be effective only if in writing and signed by each Party’s authorized representative. No verbal agreement or implied covenant will be valid to amend or abridge this Agreement. If there is any inconsistency between any term, clause, or provision of the main Agreement and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main Agreement shall prevail and be controlling. Each provision and clause required by law for this Agreement is deemed to be inserted and will be inferred herein. 15. Services Coordinator. The Parties designate the following persons as Services Coordinators for this Agreement. Contractor’s designation and any substitution are subject to City approval. For City: For Contractor: Cherie Walkowiak Pat Hines Safe Routes to School Coordinator President cheriew@cupertino.org phinesafety@aol.com 16. Contract Interpretation. There are no intended third party beneficiaries of this Agreement. Neither acceptance of the Services nor payment therefor shall constitute a waiver of any contract provision. City’s waiver of a breach shall not constitute waiver of another provision or breach. The headings in this Agreement are for convenience only. The Indemnification and Governing Law sections expressly survive this Agreement. 17. Severability. If a term or provision of the Agreement or its application to a particular situation is found by the court to be void, invalid, illegal, or unenforceable, such term or provision shall remain in effect to the extent allowed by such ruling. All other terms and provisions of this Agreement or their application to specific situations shall remain in full force and effect. 18. Notices. All notices, demands, requests, and approvals must be sent to the persons below in writing, and will be considered effective on the date of personal delivery, upon confirmation of delivery by a reputable overnight delivery service, on the fifth calendar day after deposit thereof in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino: Office of the City Manager 10300 Torre Ave. Cupertino, CA 95014 Attention: Cherie Walkowiak Email: cheriew@cupertino.org To Contractor: Safe Moves 15500 Ervin St, #1121 Van Nuys, CA 91411 Attention: Pat Hines Email: phinesafety@aol.com 19. Execution. Contractor’s signatory warrants that he or she is authorized to execute the Agreement and to legally bind Contractor. This Agreement may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. Bicycle/Pedestrian Education for Safe Routes to School Program 5 of 5 Services Agreement ($5,000) / August 2021 IN WITNESS WHEREOF, the Parties have caused the Agreement to be executed as of the Effective Date written above. CITY OF CUPERTINO A Municipal Corporation SAFE MOVES By: By: Name: Name: Title: Date: Title: Date: APPROVED AS TO FORM: By: CHRISTOPHER D. JENSEN City Attorney ATTEST: By: KIRSTEN SQUARCIA City Clerk Date: Pat Hines Executive Director Aug 9, 2021 Pat Hines Christopher D. Jensen Aug 9, 2021 Transportation Manager David Stillman Aug 9, 2021 •Sidewalks •Streets •Intersections •Houses with garages •Apartment buildings •Schools •Alleyways •Parking lots •Business district with stores •Cars •Railroad tracks •Traffic signs & signals Lessons plans are age-appropriate and administered by trained safety instructors. Lesson plans and traffic situations accommodate their “real life traffic challenges” and include the following: •Safe places to ride •Unsafe places to ride •Explanation of traffic signs and signals •Explanation of driver behaviors Safe Moves will provide the following: Safe Moves City •Sidewalk •Intersections •Residential Neighborhood •Business District •Railroad tracks •Railroad signs and signals •Stop Signs •Traffic Lights •Crosswalk Signs •Bike Lane Signs •Bike Lanes •Cars •Loaner bicycles and helmets Bike Obstacle Course •2 raised ramps •2 braking/avoidance board •1 tilt boards Set-Up / Registration / General •One (1) Table •Chairs •One (1) Traffic Sign Costume Character for photos •Certification of Additional Insured Staff •Two (2) Safe Moves Staff Deliverable: One (1) Bike Rodeo Bicycle Rodeo Safe Moves will conduct interactive bicycle safety rodeo allowing children to experience traffic situations as bicyclists in a traffic simulation course called “Safe Moves City.” By using a realistic traffic course, the ability of children to recognize and avoid traffic hazards is improved. “Safe Moves City” is a miniature city featuring: Compensation and Schedule The contractor, Safe Moves, will be payed a total of $2,250 for conducting their event on September 25, 2001. Exhibit A: Scope of Services 1 EXHIBIT B INSURANCE REQUIREMENTS For Services and Activities Involving Children Services Agreement ($5,000 or less) Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the Contractor, his agents, representatives, employees, or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1.Commercial General Liability (“CGL”): Insurance Services Office (“ISO”) Form CG 00 01 covering CGL on an “occurrence” basis, including property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a)It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (1) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b)Additional Insured coverage under Contractor's policy shall be "primary and non- contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO CG 20 10 04 13 c)The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-insurance shall be called upon to protect City as a named insured. 2.Sexual Abuse/ Molestation insurance or the equivalent are required for contracts involving children in after school activities, recreational programs, athletics, studies, transportation of students. Covers potential claims of abuse or child molestation. Sexual Abuse/Molestation coverage must be included under General Liability or obtained in separate policies in an amount of not less than $1,000,000 per occurrence ($2,000,000 aggregate) and $3,000,000 excess/umbrella coverage. 3.Automobile Liability: ISO Form Number 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. (Note – required only if auto is used in performance of work; otherwise proof of personal auto liability policy may suffice) 2 4. Workers’ Compensation insurance as required by the State of California, with Statutory Limits, and Employer’s Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. (Not required if Contractor provides written verification it has no employees). If the Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL and automobile liability policies with respect to liability arising out of the Services performed b y or on behalf of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Contract, the Contractor’s insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its officers, officials, employees and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of Contractor’s insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Waiver of Subrogation Contractor grants to City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. Contractor agrees to obtain any endorsement that may be necessary to affect 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. Self-Insured Retentions City may approve self-insured retentions and require proof of Contractor’s ability to pay losses and related investigations, claim administration and defense expenses within the retention. The policy shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or City. Acceptability of Insurers Insurers must be acceptable to City and licensed to do business in California, and each insurer must have an AM Best’s financial strength rating of “A” or better and a financial size rating of “VII” or better. 3 Verification of Coverage Contractor shall furnish the City with acceptable original certificates and mandatory endorsements (or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City prior to commencing the Services. City retains the right to demand verification of compliance at any time during the Contract. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. Insurance coverage shall not limit Contractor’s duties to indemnify, defend and hold City harmless. City reserves the right to modify these requirements based on the nature of the risk, prior experience, insurer, coverage or other special circumstances. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 7/27/2021 (805) 537-0111 (805)579-1916 42552 Safe Moves, Inc. 15500 Erwin Street #2457 Van Nuys, CA 91411 38342 A1122J 38245 A 1,000,000 X X CF1-ML-10000513-04 2/23/2021 2/23/2022 1,000,000 5,000 1,000,000 3,000,000 3,000,000 1,000,000B X BA040000040500 1/6/2021 1/6/2022 1,000,000A CF1-UM-10000093-04 2/23/2021 2/23/2022 1,000,000 10,000 C E&O/Professional Lia INT166792 10/3/2020 Aggregate 1,000,000 D Cyber Liability RPS-P-0896473M 1/28/2021 1/28/2022 Per Claim/Aggregate 1,000,000 Re: Event - September 25th, 2021 The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are named Additional Insureds as respects to General Liability and Auto Liability. General Liability insurance is primary and non-contributory with any other insurance of the additional insured, so long as a written contract or agreement to such exists prior to a loss. A Waiver of subrogation in favor of the additional insured applies as respects to General Liability coverage so long as written contract or agreement exists, per attached endorsement AGL09340717 and MCA85100817-CA. City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 SAFEMOV-01 NEHAVARSHA NFP Property & Casualty Services, Inc. 2450 Tapo Street Simi Valley, CA 93063 Suzan Columbia Suzan.Columbia@nfp.com NOVA Casualty Company California Automobile Insurance Company Lloyds of London BCS Insurance Company 10/3/2021 X X X X X X X X X 7/1/2021 7/1/2022 1,000,000 1,000,000 1,000,000 N 9017211-21 Policy # CFI-ML-10000513-04 Policy #BA040000040500 Confirmation of Coverage Dear: Esther Ceballos, Bolton & Company - Pasadena Date: Jul 13, 2021 Attached please find (Carrier/Mkt Co) quotation RPS has secured on your behalf for the above mentioned risk. Please review the attached and below carefully as coverage described herein may be different from the original application submitted, or prior policy if applicable. Insured: City of Cupertino DBA: Department of Recreation and Community Services, Public Works Department RPS Reference #: BK1366362A Mailing Address: 10185 N. Stelling Road, Cupertino,CA95014 Carrier: Underwriters at Lloyd's, London / Non-Admitted AM Best Rating: A XV Policy Number: MR214153 Policy Period: 7/1/2021 to 7/1/2022 Coverage: Special Casualty - Sexual Misconduct Limit: per Carrier terms attached Policy Premium: $31,500.00 Taxes: $1,023.75 (tax state Surplus Tax/Fee) Fees: (if any are fully earned) TRIA: Status: TOTAL: $32,523.75 Commission %: Minimum Earned Premium: 5% Home State: CA The State Surplus Lines Notice applies only if Insurance Carrier is shown as Non-Admitted in the Binder Information Section. Conditions/ Subjectivities: per Carrier terms attached Please see attached company quote for complete limits, terms, conditions, and exclusions. Please note: • You are responsible for reviewing and explaining the coverage to the client, including any options, available or not from our office. The terms hereon are not fully described and no assumption should be made as to the adequacy of the coverage of the risk to the client. • You are not an Agent of the insurer, and as such, cannot bind coverage nor make any commitments on behalf of the insurer, nor of us. This policy cannot be assigned to another without the written consent of the insurer or their Agent. • Th is document is intended for use as evidence that the insurance, as described herein, has been effected and shall be subject to all terms and conditions of policy(ies) which will be issued and that in the event of any inconsistency herewith, the terms and provisions of such policy(ies) shall prevail. • If this policy is issued on a non-admitted basis, your office is responsible for completing, collecting and delivery to RPS any required surplus lines forms, taxes and fees from the insured. RPS will remit the applicable taxes and forms to the state. If this policy is subject to the surplus lines laws in your state, you should make every effort to comply with any special provisions and regulations of your state. • By binding you commit to any provisions contained hereon, such as Minimum Earned Premiums. There are no flat cancellations allowed. • When requesting a policy change, addition, cancellation, endorsement, etc. you must provide every policy number/ coverage to which the request applies. • You are responsible for the issuance and review of Certificates of Insurance (COI). COIs cannot amend or alter the terms provided herein. • In the event of a claim please report immediately and visit the RPS Claims website: https://my.rpsins.com/claimsfnol • All premiums and any fees are due to RPS within 20 days of binding unless otherwise stipulated. Accounts with payments that are overdue and are not received within this time frame are subject to cancellation. If you have any questions, please feel free to call or email me. We look forward to our next opportunity to work with you. Sincerely, Shawn McCall Risk Placement Services, Inc. - PNP Phone: 630-773-3800 Email: shawn_mccall@rpsins.com CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE Form: SML Safeguard Wording - 623AFB00213 Policy Number: TBA Renewal of: MR204153 Named Insured: City of Cupertino g Parks and Recreation Department, Public Works Department Principal Address: 10300 Torre Avenue, Cupertino, CA 95014 Policy Period:From: 1st July 2021 To: 1st July 2022 Both dates at 12:01 a.m. Local Time at the Principal Address stated in Item 1. Limit of Liability: a)USD 5,000,000 for all Claims for Wrongful Acts against any one Victim b)USD 5,000,000 for all Claims for Wrongful Acts against all Victims, but sub-limited to: c)USD 50,000 for all Safeguard Costs resulting from all Circumstances Such Sub-limit of Liability shall be part of, and not in addition to, the overall Limit of Liability stated in 3.b) above. Retention: USD 35,000 any one Victim Premium: USD 31,500 Notification pursuant to Clause IX. shall be given to: Claims Department Beazley 30 Batterson Park Road, Farmington, CT 06032. claims@beazley.com (860) 677 3765 (phone) (860) 679 0247 (fax) Retroactive Date: 1st July 2018 Pending or Prior Litigation Date: 1st July 2018 Service of Suit: Foley & Lardner LLP, 555 California Street, Suite 1700, San Francisco, CA 94104- Choice of Law: New York Conditions: Application Dated: TBA #California Surplus Lines Notice 1- LMA9098A California Complaints Notice - LMA9136A Small Additional or Return Premiums Clause (U.S.A.) g NMA 1168 Nuclear Incident Exclusion Clause-Liability-Direct g NMA 1256 Radioactive Contamination Exclusion Clause-Liability - NMA 1477 War and Terrorism Exclusion g NMA 2918 Several Liability Notice g LSW1001 Sanctions Limits Clause - LMA 3100 Beazley Safeguard Education Document Tysers Safeguard Enhancement Endorsement Cyber Acts Clarification Amended Definition of Independent Contractor Endorsement g as attached U.S Classification: Surplus Lines Broker and State filed in: Risk Placement Services, 2850 Golf Road, Rolling Meadows, IL 60008 License Number: 0C66724 State of Filing: CA Subject to: 1) Renewal application to be resigned and dated within 30 days of inception 2) Confirmation of the Surplus Lines Broker. Including name of individual, company name, address and license number. All subjectivities to be received within 7 working days of binding otherwise Underwriters reserve the right to amend terms or cancel ab initio. Brokerage: 20% or same net equivalent downwards, plus taxes as applicable Information: Employees g 294 Independent Contractors -70 Exposure Units g 97,000 Nature of Business g Municipality Cancellation by an Insured may result in a short rate calculation to determine the return premium, subject to 5% minimum earned of the total premium. Safe Moves for Bicycle/Pedestrian Education for Safe Routes to School Program Final Audit Report 2021-08-09 Created:2021-08-05 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAtzkgxZ7hVzw9mu9C2oQXLnIw2Hx-FqBw "Safe Moves for Bicycle/Pedestrian Education for Safe Routes to School Program" History Document created by City of Cupertino (webmaster@cupertino.org) 2021-08-05 - 11:54:25 PM GMT- IP address: 35.229.54.2 Document emailed to Julia Kinst (juliak@cupertino.org) for approval 2021-08-05 - 11:57:30 PM GMT Document approved by Julia Kinst (juliak@cupertino.org) Approval Date: 2021-08-05 - 11:57:48 PM GMT - Time Source: server- IP address: 216.198.111.214 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2021-08-05 - 11:57:51 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2021-08-06 - 2:04:11 AM GMT - Time Source: server- IP address: 73.170.27.253 Document emailed to Pat Hines (phinesafety@aol.com) for signature 2021-08-06 - 2:04:14 AM GMT Email viewed by Pat Hines (phinesafety@aol.com) 2021-08-06 - 4:31:04 AM GMT- IP address: 69.147.89.254 Email viewed by Pat Hines (phinesafety@aol.com) 2021-08-08 - 4:30:32 PM GMT- IP address: 69.147.89.254 Email viewed by Pat Hines (phinesafety@aol.com) 2021-08-09 - 5:47:11 PM GMT- IP address: 69.147.91.62 Document e-signed by Pat Hines (phinesafety@aol.com) Signature Date: 2021-08-09 - 5:48:15 PM GMT - Time Source: server- IP address: 130.44.211.177 Document emailed to Christopher D. Jensen (christopherj@cupertino.org) for signature 2021-08-09 - 5:48:17 PM GMT Email viewed by Christopher D. Jensen (christopherj@cupertino.org) 2021-08-09 - 5:59:12 PM GMT- IP address: 104.47.73.126 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2021-08-09 - 6:01:32 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to David Stillman (davids@cupertino.org) for signature 2021-08-09 - 6:01:34 PM GMT Email viewed by David Stillman (davids@cupertino.org) 2021-08-09 - 6:04:29 PM GMT- IP address: 174.194.131.118 Document e-signed by David Stillman (davids@cupertino.org) Signature Date: 2021-08-09 - 10:56:46 PM GMT - Time Source: server- IP address: 73.71.179.253 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2021-08-09 - 10:56:49 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2021-08-09 - 11:28:09 PM GMT- IP address: 174.194.135.223 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2021-08-09 - 11:28:20 PM GMT - Time Source: server- IP address: 174.194.135.223 Agreement completed. 2021-08-09 - 11:28:20 PM GMT