HomeMy WebLinkAbout25-001 Dominique Couto Cerdeiral for Fitness InstructionCITY OF
CUPERTINO
RECREATION SERVICES AGREEMENT
No.
FY2026 - 2028
1. Parties. This contract is made by and between the City of Cupertino, a municipal
corporation ("City"), and Dominique Couto Cerdeiral ("Contractor"), a Sole Proprietorship/Individual
for Fitness Instruction and is effective on 07/01/2025 ("Effective Date").
2. Services. Contractor agrees to provide the Services included in the Scope of Work and
in accordance with the Schedule of Performance attached in Exhibit A.
3. Term. This contract begins on the Effective Date and ends on 06/30/2028 ("Contract
Time"), unless extended or terminated as provided herein. Time is of the essence and Contractor must
have sufficient time, resources, and qualified staff to deliver the Services as required. Contractor must
promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to
address or mitigate such delays. The City's appropriate department head or the City Manager may
extend the Contract Time through a written amendment to this Agreement, provided such extension
does not include additional contract funds. Extensions requiring additional contract funds are subject
to the City's purchasing policy.
4. Compensation. City will pay Contractor for satisfactory performance of the Services an
amount that will be based upon actual costs but that will be capped so as not to exceed $27,000.00
("Contract Price"), based upon the Scope of Services, performance schedule, and rates included in
Exhibit A. The maximum compensation includes all costs, expenses, and reimbursements and will
remain in place even if Contractor's actual costs exceed the capped amount. Contractor must submit
invoices and the information required in Exhibit A in order to receive payment. City will compensate
Contractor within thirty (30) days after approval of written invoices.
Invoices are subject to review and audit by City during regular business hours upon 24 hours'
notice. Contractor must maintain complete and accurate records of payrolls, expenditures,
disbursements and other cost items charged to City or establishing the basis for an invoice, for a
minimum of four (4) years from the date of the final payment.
5. Independent Contractor.
5.1 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. No
civil service status or other right of employment will be acquired by virtue of
Contractor's performance of the Services. Contractor is not entitled to City's health
benefits, worker's compensation or any other benefit. Contractor must have the skills
and qualifications to perform the Services in a competent and professional manner.
Recreation Services Agreement/ Rev. April 2025
Page 1 of 7
Contractor will supply all tools, materials, and equipment required to perform the
Services under this Contract. Contractor is responsible for obtaining permits and
licenses required by law and must obtain a City business license, if required by the
Cupertino Municipal Code.
5.2 Contractor is solely responsible for the payment of employment 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. In the event that Contractor or any employee, agent, or
subcontractor of Contractor providing services under this Agreement is determined
by a court of competent jurisdiction, arbitrator, or administrative authority,
including but not limited to the California Public Employees Retirement System
(PERs) to be eligible for enrollment in PERS as an employee of City, Contractor shall
indemnify, defend, and hold harmless City for the payment of any employee and/or
employer contributions for PERS benefits on behalf of Contractor or its employees,
agents, or subcontractors, as well as for the payment of any penalties and interest on
such contributions, which would otherwise be the responsibility of City, and actual
attorney's fees incurred by City in connection with the above.
6. Proprietary/Confidential Information. To the extent Contractor may have access to
private or confidential information owned or controlled by the City, Contractor agrees to treat it as
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 material, drawings,
or data in connection with this contract, City will have the property rights to those materials and all
copyrights, if any, to such work product will, to the extent requested by City, constitute City property
upon completion of the work to be performed hereunder or upon termination of this Agreement.
8. Records. Contractor must maintain complete, accurate, and detailed accounting records
relating to its performance in accordance with generally accepted accounting principles and
procedures. The records must include detailed information about Contractor's services, benchmarks,
deliverables, and costs/fees, and must be made reasonably available to City. The records and
supporting documents must be kept separate from other files and maintained for four (4) years from
the date of City's final payment.
Recreation Services Agreement/ Rev. April 2025
Page 2 of 7
9. Assignment. This Contract is not assignable. Contractor may not substitute another or
transfer any rights or obligations under this Contract without prior written approval of City. Only those
persons whose names are included in Exhibit A may perform the Services.
10. Publicity and Signs. Any publicity generated by Contractor related to this contract or
the Services during the Contract Time and for one (1) year thereafter must reference City contributions.
The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press
releases, posters, brochures, public service announcements, interviews, and newspaper articles. No
signs may be posted, exhibited, or displayed on or about City property, except signage required by law
or under this Agreement, without prior written approval from City.
11. 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 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 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 Contract. This
Section 11 shall survive termination of the Agreement.
12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City
will not execute the Agreement until it has received and approved satisfactory certificates of insurance
and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole
discretion, may purchase insurance and deduct the costs from payments to Contractor, or terminate the
Agreement.
13. Compliance with Laws and Other City Requirements.
Requirements for all Contracts. This contract is subject to local, state and federal laws and
regulations prohibiting discrimination, including Title VII of the Civil Rights Act of 1964, the California
Fair Employment Practices Act, the Americans with Disabilities Act of 1990, and other laws that pertain
to fair employment and anti -discrimination practices. Contractor agrees to provide records and
documentation to the City on request necessary to monitor compliance with this provision.
Contractor must comply with labor laws pertaining to prevailing wages, working hours,
overtime, payroll records, and other requirements imposed by the Department of Industrial Relations.
If Contractor does not have employees, it must sign the Affidavit of No Employees, attached as Exhibit
C. Contractor is responsible for verifying employment eligibility of employees pursuant to the
Immigration Reform and Control Act of 1986. Contractor must comply with conflict of interest laws
and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be
required to file a conflict of interest form for engaging in governmental decisions or serving in a staff
Recreation Services Agreement/ Rev. April 2025
Page 3 of 7
capacity, and is hereby advised to review the requirements of California Political Reform Act and the
California Code of Regulations. Services may only be performed by persons who are not employed by
City and who do not have a contractual relationship with City other than this contract. Contractor
agrees to abide by City policies and administrative rules prohibiting gifts to City officials and
employees.
Additional Requirements for Services Provided to Minors. Contractor and its employees who
provide services under this Agreement must comply with these additional requirements:
A. Undergo fingerprints and a criminal background and verify all employees providing
services under this contract have met this requirement.
B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D.
C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with
the protocols, reporting, and training required under California Health and Safety Code
Section 124235, AB 2007, and other laws pertaining to concussion evaluation, removal from
play, and return to play protocols. (Refer to Center for Disease Control & Prevention,
httl2s://www.cdc.gov/headsul2/index.html).
D. Submit required forms and acknowledgments included in Exhibit D, and ensure its each
participant is provided with a concussion information sheet, signs and returns the forms to
the City as required by Health and Safety Code Section 124235.
Require coaches and administrators to successfully complete the concussion and head injury
education at least once either online or in person, before supervising a participant.
Contractor shall offer training, educational materials, or both to each Contractor
administrator on a yearly basis. (Training resources are available at the Center for Disease
Control & Prevention (link cited above).
E. If providing instruction, Contractor must acknowledge and comply with all requirements
set forth in the Parks & Recreation Services Instructor Manual.
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
fingerprinting and additional requirements under Paragraph 13. The contract will also require the
approval of the Director of Parks and Recreation and City Attorney.
14. Coordination of Services. The Parties designate the following persons as Services
Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of
this Agreement. Contractor's designation and any substitution are subject to City approval.
For City: For Contractor:
Name: Colleen Ferris
15. Abandonment. 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.
Recreation Services Agreement/ Rev. April 2025
Page 4 of 7
16. Termination. City may terminate this contract for cause or without cause at any time
and will notify Contractor as soon as possible. Contractor will be paid for satisfactory services rendered
through the date of termination upon submission of final invoices approved by City.
17. Governing Law, Venue, and Dispute Resolution. This contract is governed by the laws
of the State of California. Any legal actions or proceedings filed against City in connection with this
contract must comply with the government claims filing requirements and must be filed with the
Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is
required to continue to provide Services pending resolution of any dispute. If the Parties elect
arbitration, the arbitrator's award must be supported by law and substantial evidence and include
detailed written findings of law and fact.
18. Attorney Fees. If City is required to pursue litigation, arbitration or other administrative
or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will
be entitled to reasonable attorney fees and costs. This Section 18 survives this Agreement.
19. Third Party Beneficiaries. There are no third party beneficiaries under this Contract.
20. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver of any
contract provision. City waiver of a breach shall not constitute waiver of another term, provision,
covenant, or condition, or a subsequent breach, whether the same or a different character.
21. Entire Agreement. This Agreement and all referenced Exhibits are hereby attached and
incorporated into the Agreement by this reference and represent the full and complete understanding
as to those matters contained herein, and supersede any other contract or understanding, either oral or
written, between the Parties. This Agreement may not be modified or amended except in writing signed
by both Parties. If there is any inconsistency between any term, clause, or provision of the main contract
and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main contract
shall prevail and be controlling.
22. Inserted Provisions. Each provision or clause required by law or this contract is deemed
to be included and will be inferred herein. Either party may request an amendment to cure any
mistaken insertion or omission of a required provision.
23. Headings. The headings are for convenience only and are not a part of the contract or
intended to affect, limit, or amplify the terms or provisions of this Agreement.
24. Severability/Partial Invalidity. If any contract term or provision, or their application to
a particular situation, is found by the court to be void, invalid, illegal, or unenforceable, such term or
provision shall remain in force and effect to the extent allowed by such ruling. All other contract terms
and provisions and their application to specific situations will remain in full force and effect.
25. Survival. All provisions which by their nature must continue after the Agreement ends,
including without limitation Indemnification, Insurance, Ownership of Materials, Records, Governing
Law, and Attorney Fees, will survive the expiration or termination of this Agreement.
Recreation Services Agreement/ Rev. April 2025
Page 5 of 7
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 (5th) 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:
27. Execution. The person executing this contract on behalf of Contractor represents and
warrants that Contractor has full right, power, and authority to execute this contract and to carry out
all actions and services required. This contract constitutes a legally binding obligation of Contractor,
and may be executed in counterparts, each one of which is deemed an original and all of which, taken
together, constitute a single binding instrument.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
Recreation Services Agreement/ Rev. April 2025
Page 6 of 7
IN WITNESS WHEREOF, the parties have caused this contract to be executed.
CITY OF CUPERTINO
A Municipal Corporation
B
y
Name Rachelle Sander
Title Director of Parks and Recreation
Ju112, 2025
APPROVED AS TO FORM:
7e C16Zd uJaa
MICHAEL K. WOO
Senior Assistant City Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
Date Jul 12, 2025
CONTRACTOR
By
Name Dominique Couto Cerdeiral
Title Fitness Instructor
.
Date Jul 10, 2025
Tax I.D. No.: Refer to W9
Recreation Services Agreement/ Rev. April 2025
Page 7 of 7
I*A:611.10 .11
SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide Fitness Instruction in, but not limited to, the following:
Yoga, Subbing Services
Location and Time of CONTRACTOR Services:
Refer to the City's Publications for agreed upon dates, times, and locations of a class, camp, activity,
program, or service ("class"). The City, at its sole discretion, may change the agreed dates, times and
locations of a class, or may cancel a class.
Compensation for CONTRACTOR Services:
Contractor shall be compensated for services performed pursuant to this Agreement.
For a class taught in person, $40/hour.
City and Contractor may mutually agree for Contractor to teach a class online rather than in person,
provided that City and Contractor reach agreement for compensation for that online class.
Compensation for that online class shall be specified in writing in a separate side agreement before
online instruction for a class begins.
Eligible Participant Minimum and Maximums for CONTRACTOR Services:
Minimum: 20
Maximum: 45
If less than the required minimum number of participants enroll in and pay for a particular class as
identified in the schedule before the class is scheduled to start, the City may cancel the particular class
and/or terminate this Agreement without additional notice or payment to Contractor.
Performance of CONTRACTOR Services:
Class Cancellation
Contractor will only receive compensation for a class that is performed. If performance of a class is
cancelled by the City or Contractor before instruction begins, Contactor will not receive compensation
for the class. If the City or Contractor cancels performance of certain meetings of a class, Contractor
will only receive compensation for those meetings of the class that are performed.
In the case Contractor unilaterally cancels performance of a class without City approval, City reserves
the right to immediately and without notice cancel the remainder of classes offered and or performed
by Contractor.
Updated 04129125
Registration, Enrollment, and Supervision
The Contractor shall follow all guidelines pertaining to registration procedures as listed in the
quarterly recreation schedule. Participants may not take part in the program unless they are listed on
the class roster or can show proof of enrollment. All participants and volunteers need to complete the
City's Waiver of Liability form prior to taking part in the program. If applicable, contractors who are
responsible for supervising minors must remain with the class until a parent or legal guardian has
arrived and all minors are released to them.
Injury of a Class Participant
In the event of an injury occurring to a participant, the Contractor will notify the City within 1 hour
and complete an Incident Report in the form approved by the City. The Incident Report must be
submitted to the City within 24 hours of the injury occurring.
Updated 04129125
Exhibit B
Insurance Requirements for Recreation Contracts
As required by the Agreement, Contractor shall procure prior to commencement of Services and maintain
the following insurance for the duration of the Agreement, at its own cost and expense, the following
insurance policies and coverage with companies doing business in California and acceptable to City.
Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as:
Commercial General Liability (CGL): Coverage at least as broad as Insurance Services Office ("ISO")
Form CG 00 01 with limits no less than $1,000,000 per occurrence and $2,000,000 general aggregate. The
policy shall include a per project or per location general aggregate endorsement as broad as CG 25 03 or
CG 24 04. If a per project/location endorsement is not available, the limit of the general aggregate shall
be doubled.
a. It shall be a requirement 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 (i) the minimum coverage/limits specified in this agreement; or (H)
the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater.
b. Additional Insured coverage under Contractor's policy shall allow and be endorsed "primary and
non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at
least as broad as the most recent edition of ISO Form CG 20 01.
c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess
liability insurance, provided each policy follows form of the underlying policy and 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. The City's own insurance or self-insurance shall not be called upon.
2. Automobile Liability: Coverage shall be provided using ISO CA 00 01 covering Code 1 (any auto), or if
Contractor has no owned autos, Code 8 (hired) and 9 (non -owned), with limits no less than $1,000,000
per accident for bodily injury and property damage. (Required if automobile is used to perform work under
this contract.)
LJ Not required. Contractor shall be fully remote and not use automobiles to provide the service.
In the event Contractor uses an automobile or automobiles in the operation of its business to
provide services under this Agreement, the Contractor shall, prior to such use, provide the City
with evidence of Business Automobile Liability insurance coverage in the amount required under
this Section 2 for owned, non -owned and hired autos (any auto -Symbol 1), or if Contractor does
not own autos (hired autos -Symbol 8 and non -owned autos -Symbol 9). Evidence shall be provided
with a Certificate of Insurance, along with an additional insured endorsement in favor of the City,
primary and non-contributory coverage and endorsement, and waiver of subrogation coverage
and endorsement under the policy prior to the use of any automobile.
F Contractor has provided written confirmation that it does not own any autos. Contractor shall
provide coverage for hired autos -Symbol 8 and non -owned autos -Symbol 9. Primary and Non -
Contributory coverage and Waiver of Subrogation coverage is waived under the Automobile
Liability hired and non -owned only coverage. In the event Contractor uses an owned automobile
or automobiles in the operation of its business to provide services under this Agreement, the
Contractor shall, prior to such use, provide the City with evidence of Business Automobile
Liability insurance coverage in the amount required under this Section 2 for owned, non -owned
and hired autos (any auto -Symbol 1).
Exh. Y Insurance f tr Recreation Contracts Updated May 2025
XIn lieu of Business Automobile Liability, Contractor shall maintain throughout the term of this
Agreement and provide the City with evidence (including the policy Declarations Page) of
personal automobile insurance coverage in accordance with the laws of the State of California. As
available under the policy, evidence shall be provided with the Certificate of Insurance, along with
an additional insured endorsement in favor of the City, primary and non-contributory coverage
and endorsement, and waiver of subrogation coverage and endorsement. City approval of
coverage is required prior to commencement of services.
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/disease.
XIf no employees, Contractor must sign Affidavit of No Employees.
4. Sexual Abuse/Molestation. Insurance is required for activities/services involving minors, (i.e., after
school activities, recreational programs, athletics, study/training events and transportation of minors) or
vulnerable populations. Coverage shall include bodily injury sexual abuse and molestation coverage,
personal injury, and property damage, including without limitation, blanket contractual liability. Sexual
Abuse/Molestation coverage must be included under General Liability or obtained in separate policies
with a limit of no less than $2,000,000 per occurrence and $4,000,000 aggregate. If a general aggregate
limit applies, it must apply separately to this contract or be twice the required occurrence limit.
XNot Required. Contract does not involve services to minors or vulnerable populations
Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance.
OTHER INSURANCE PROVISIONS
The aforementioned insurance shall be endorsed and have all the following conditions and provisions:
Additional Insured Status
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
("Additional Insureds") are to be covered as additional insureds on Contractor's CGL and automobile
liability policies. Endorsement of General Liability coverage shall be at least as broad as ISO Form CG 20 10
(11/ 85) or both CG 2010 and CG 20 37 forms, if later editions are used.
Primary and Non -Contributory Coverage
Except Workers' Compensation coverage, Contractor's insurance coverage shall allow and be endorsed
primary coverage at least as broad as the most recent edition of ISO CG 20 01. Any insurance or self-
insurance maintained by City, its officers, officials, employees, agents, 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. If a carrier will
not provide the required notice of cancellation or policy modification, the Contractor shall provide written
notice to the City of a cancellation or policy modification no later than 30 business days in advance or 10
days in advance if due to non-payment of premiums.
Waiver of Subrogation
Contractor waives any right to subrogation against City/Additional Insureds for recovery of damages to the
extent said losses are covered by the insurance policies required herein. Specifically, the General Liability,
Automobile Liability and Workers' Compensation policies shall allow and be endorsed with a waiver of
Exh. B Insurancefir it Recreation Contracts updated May 2025
2
subrogation in favor of City for all work performed by Contractor, its employees, agents, volunteers and
subcontractors. This provision applies regardless of whether or not the City has received a waiver of
subrogation endorsement from the insurer.
Deductibles and Self -Insured Retentions
Any deductible or self -insured retention must be declared to and approved by the City (Insert on the
Certificate of Insurance, if .zero, insert "$0"). At City's option, either: the insurer must reduce or eliminate
the deductible or self -insured retentions as respects the City/Additional Insureds; or Contractor must show
proof of ability to pay losses and costs related investigations, claim administration and defense expenses.
The policy shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either
the insured or the City.
Acceptability of Insurers
Insurance shall be placed with insurers admitted in the State of California and with an AM Best rating of A-
VII or higher.
Verification of Coverage
Contractor must furnish acceptable insurance certificates and amendatory endorsements (or copies of the
policies effecting the coverage required by this Contract), including a copy of the Declarations and
Endorsement Page of the CGL policy listing all policy endorsements prior to commencement of the Contract.
City retains the right to demand verification of compliance at any time during the Contract term.
Subcontractors
Contractor shall require and verify that all subcontractors maintain insurance that meet the requirements of
this Contract, including indemnification, defense, and naming the City as an additional insured on
subcontractor's insurance policies.
Higher Insurance Limits
If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City shall
be entitled to coverage for the higher insurance limits maintained by Contractor.
Adequacy of Coverage
City reserves the right to modify these insurance requirements/coverages based on the nature of the risk,
prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written
notice.
Exh. R Insurance f tr Recreation Contracts Updated May 2025
3
ACaRO"
DOMICOU-01
CERTIFICATE OF LIABILITY INSURANCE
DATE lMM1DDIYYYYI
612312025
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 riahts to the certificate holder in lieu of such endorse mentfsl.
PRODUCER
gxmr—
Alliant Insurance Services, Inc. PHONE F►uc
4530 Walney Rd Ste 200 (AIC, No, Ext): (855) 827-9642 q1c No :(703] 583-151,D
Chantilly, VA 20151-2285 EMAIL yoga-questions@alliant.com
INSURER A: Lloyd's Syndicate 609 (Atrium Underwriters Limited) 00000
INSURED INSURER B :
Dominique Couto Cerdeiral INSURER C :
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
2,000,000
X I CLAIMS -MADE ❑ OCCUR
X.
3/5/2025
3/5/2026
DAMAGE TO RENTED
100,000
ME EXP (Any one arson
2,500
H'
PERSONAL & ADV INJURY
Included
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
4,000,000
ii POLICY 0 jE O LOC
PRODUCTS - COMPIOP AGG
2,000,000
OTHER:
AUTOMOBILE LIABILITY
COMBINE" SINGLE LIMIT
ANY AUTO
BODILY INJURY(Per erson
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY Per accident
�2OPERTY AMAGE
er aceldeni
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
HCLAIMS-MADE
AGGREGATE
EXCESS LIAR
DE❑ I I RETENTION $
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY Y N
ANY CPROPRIETORIPARTNERIEXICUTIVE H 1 A
�AAandER!rM' NH) EXCLUDED?
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYE
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
A Professional Liab
Professional Liab 3/5/2025 3/5/2026
Aggregate
4,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more apace is required]
THIS CERTIFICATE OF INSURANCE SERVES A EVIDENCE OF COMBINED PROFESSIONAUGENERAL LIABILITY COVERAGE.
FURTHER, THE CERTIFICATE HOLDER IS ADDED AS ADDITIONAL INSURED PER ATTACHED ENDORSEMENT.
Aggregate Limit of Liability for all coverages set forth above: $4,000,000
City of Cupertino, Its City Council, Officers, Officials,
Employees, Agents, Servants and Volunteers
10300 Torre Ave.
Cupertino, CA 95014
.I
ACORD 25 (2016103j
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS -
AUTHORIZED
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ADDITIONAL INSURED ENDORSEMENT
(with primary and non-contributory warding and waiver of subrogation)
Specified Member: Dominique Couto Cerdeiral
Policy Number: YOGA1932447-2
Endorsement Effective Date: 06/23/2025
It is hereby agreed and understood that for the additional premium charged the person(s) or entityjiesj
listed below is/are included as Additional Insured(s) under the combined Professional/General Liability
policy number referenced above, but only with respect to claims or damages arising solely out of
professional services rendered by the Specified Member:
City of Cupertino, Its City Council, Officers, Officials, Employees, Agents, Servants and Volunteers
10300 Torre Ave.
Cupertino, CA 95014
The coverage provided hereunder to the above -named Additional Insured shall be primary and non-
contributory to any insurance or self-insurance maintained by the Additional Insured.
It is further agreed that Underwriters waive all rights of subrogation against the Additional Insured with
respect to claims or damages arising out of the Named Insured's actions
Additional Premium: $50.00 + 2.25% (surplus lines tax) + 0.0225% (state fee)
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
Date: 6/23/2025
Authorized Representative
Alliant Insurance Services, Inc.
AMENDATORY ENDORSEMENT
Specified Member: Dominique Couto
Policy Number: YOGAI932447-2
Endorsement Effective Date: 06/16/2025
It is hereby noted and agreed in respect of City of Cupertino, Its City Council, Officers, Officials, Employees,
Agents, Servants, and Volunteers, should any of the described policies be cancelled before the expiration
date thereof, the issuing Insurer will mail written notice in accordance with the policy provisions to the
certificate holder named within the stated time frames of 30 days, except for reason of non-payment of
premium at 10 days. Failure to do so shall impose no obligation or liability of any kind upon the Insurer,
its Agents or Representatives.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
Date: 06/23/2025
BY:
Authorized Representative
Alliant Insurance Services, Inc.
State Farm Mutual Automobile Insurance Company
PO Box 2358
Bloomington If_ 61702-2358
A State Farm
AT2 A-23131 A
CERDEIRAL, FABIO & DOMINIQUE
Policy Number: 505 9173-D21.05A
Policy Period: April 21, 2025 to October 21, 2025
Vehicle:
Principal Driver:
FABIO T CERDEIRAL
Notice of insurance information collection practices -
personal, family, or household insurance transactions:
We may collect customer information from persons other
than the individual or individuals applying for coverage.
Such customer information as well as other personal or
privileged information subsequently collected may, in certain
circumstances, be disclosed to third parties without your
authorization as permitted by law.
Policy Number: 505 9173-D21-05A
Prepared February 27, 2025
1004583
PREMIUM PAID: $904.72
DO NOT PAY.
Your premium is billed through the State Farm Payment Plan
State Farm Payment Plan Number: 1189524002
Your State Farm Agent
C BUICH INS AND FIN SVS INC
Office: 831-464-4300
Address: 2222 E CLIFF DR STE 200
SANTA CRUZ, CA 95062-4739
lfynuhave a newordifferent car, have added anydrivers, orhave moved,
please contact your agent.
Thank you for choosing State Farm.
You have the right to submit a written request to access,
correct, amend, or delete your personal information and the
right to receive a response within 30 days of submitting your
request. If we deny your request, you have the right to file a
statement with us containing the information you feel is
accurate and fair along with the reasons you disagree with
our denial. Instructions on how to file such request and our
full privacy notice can be found
(continued on next page)
Page number 1 of
143562 202 01-15.2018
Thanks for being part
of our neighborhood.
You mean a lot to us. If you need anything,
call State Farm Agent C BUICH INS AND
FIN SVS INC at 831-464-4300.
TP31
:• State Farm
www.statefarm.com/customer-care/privacy-security/privacy
or contact your State Farm Agent.
When you provide a check as payment, you authorize us
either to use information from your check to make a
one-time electronic fund transfer from your account or to
process the payment as a check transaction. When we use
VEHICLE INFORMATION
information from your check to make an electronic fund
transfer, funds may be withdrawn from your account as soon
as the same day we receive your payment, and you will not
receive your check back from your financial institution.
Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please
let us know right away.
Vehicle Identification
Vehicle Description Number (VIN) Who principally drives this vehicle? How is this vehicle normally used?
Other Household Vehicle(s)
Your premium may be influenced by other State Farm
policies that currently insure the following vehicle(s)
in your household:
The premium on the expiring policy term was based on
9,600 miles per year.
The premium on the renewal policy term was based on
9,600 miles per year.
Premium Adjustment
Each year, we review our medical payments and personal
injury protection coverages claim experience to determine
the vehicle safety discount that is applied to each make and
DRIVER INFORMATION
Other Household Driver(s)
In addition to the Principal Driver(s) and Assigned
Driver(s), your premium maybe influenced by the
drivers shown below and other individuals permitted to
drive your vehicle. This list does not extend or expand
coverage beyond that contained in this automobile
policy. The drivers listed below are the drivers reported
to us that most frequently drive other vehicles in your
household.
DOMINIOUE COUTO CERDEIRAL
model. In addition, we review the comprehensive, collision,
bodily injury and property damage claim experience
annually to determine which makes and models have
earned decreases or increases from State Farm's standard
rates. If any changes result from our reviews, adjustments
are reflected in the rates shown on this renewal notice.
Policy Number: 505 9173-D21-05A Page number 2 of 4
Prepared February 27, 2025
:. Stag Farm
Principal Driver & Assigned Drivers
For each automobile, the Principal Driver is the individual
who most frequently drives it.
Each driver is designated as an Assigned Driver on the
household automobile that they most frequently drive. Your
premium may be influenced by the information shown for
these drivers.
COVERAGE AND LIMITS See your policy for an explanation of these coverages
A Liability
Bodily Injury 50,0001100,000
Property Damage 50,000
$327.15
C Medical Payments 5,000
$27.91
❑ 500 Deductible Comprehensive
$99.77
G 500 Deductible Collision
$380.36
H Emergency Road Service
$6.14
u Uninsured Motor Vehicle
Bodily Injury 50,0001100,000
$57.36
Ul Uninsured Motor Vehicle
Property Damage
$6.03
Total Premium
$904.72
If any coverage you carry is changed to give broader
protection with no additional premium charge, we will give
DISCOUNTS These adjustments have already been applied to your premium.
you the broader protection without issuing a new policy,
starting on the date we adopt the broader protection.
Multiple Line
f
Multicar
f
Vehicle Safety
f
Driving Safety Record
California Good Driver
f
Total Discounts
$2,411.46
SURCHARGES AND DISCOUNTS
Driving Safety Record Rating Plan
Your driving safety record, along with other rating factors,
determines what you pay for Liability, Medical Payments,
Comprehensive, Collision, and Uninsured Motor Vehicle
Coverages. Policyholders with no accidents and convictions
pay less than those with accidents and convictions.
The Driving Safety Record Rate Level that is assigned to
your policy moves up, down, or stays the same every policy
renewal, depending upon your driving record. For every 12
months since the renewal following the occurrence of a
chargeable accident or the conviction of a minor violation,
the initial assigned Driver Record Level for that chargeable
accident or conviction shall be lowered by 1 level. For each
12 month period since the conviction of a major violation,
the initial assigned Driver Record Level for that conviction
(continued on next page)
Policy Number: 505 9173-D21-05A
Prepared February 27, 2025
Page number 3 of 4
EXHIBIT C
AFFIDAVIT OF NO EMPLOYEES
State of California
County of Santa Clara
City of Cupertino
I, the undersigned, declare as follows:
I am an independent contractor and the owner of Dominique Couto Cerdeiral.
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 working for
me or my business during the term of any service contract with the City of Cupertino. I am
not required to have Workers' 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 10 day of JULY , 2025, at , California.
Dominique Couto Cerdeiral
PRINT NAME
SIGNATURE
Updated 06/23/21
Fitness Instruction
Final Audit Report 2025-07-12
Created: 2025-07-09
By: Webmaster Admin (webmaster@cupertino.org)
Status: Signed
Transaction ID: CBJCHBCAABAAewgz-zUr5sY8DYUW1CN2b1z1U_FZdo7s
"Fitness Instruction" History
Document created by Webmaster Admin (webmaster@cupertino.org)
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