HomeMy WebLinkAbout25-001 Michael Westlaken for Feldenkrais InstructionCITY OF
CUPERTINO
RECREATION SERVICES AGREEMENT
No.
FY2026 - 2030
1. Parties. This contract is made by and between the City of Cupertino, a municipal
corporation ("City"), and Michele Westlaken ("Contractor"), a Sole Proprietorship/Individual for
Feldenkrais Instruction and is effective on the last date signed below ("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 06/30/2030 ("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 $15,000.00
("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: Kris Garcia
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:
Office of the City Manager
10300 Torre Ave., Cupertino, CA 95014
Cc: Representative/Coordinator: Kris Garcia
Email: krisg@cupertino.org
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 CONTRACTOR
A Municipal Corporation
Name Rachelle Sander Name Michele Westlaken
Title
Director of Parks and Recreation Title Feldenkrais Teacher
Ju128, 2025
APPROVED AS TO FORM:
�r�e uJaa
MICHAEL K. WOO
Senior Assistant City Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
Date Jul 28, 2025
Date Jul 28, 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 Feldenkrais Instruction in, but not limited to, the following:
Feldenkrais Instruction
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, 70% of revenue generated from the member rate per participant, plus
70% of the revenue for drop -in passes.
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: S
Maximum: 25
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.
Updated 04129125
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.
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
The Feldenkrais Guild of North America
ADDITIONAL INSURED COVERAGE VERIFICATION
Ensured:
American Massage Therapy Association
Enrolled Member Number:
1349334
500 Davis Street
Evanston, I L 60201
Master Policy Number: HPG 028995555E
Additional Insured Coveraoe Effective Dates:
01/0112025 10 1213112025
Michele Westlaken
Healthcarc Providers Senice Organization
Affinity Insurance Senices. Inc.
1 tOO Virginia Drive. Suite 250
Fort Washington. PA 19034
insurance Comnanv:
Columbia Casualty Company
A CNA Company
iA'opal Insured:
n 01 L uper ino, Us council, boards, oMcers,
Each Claim- $2.000.000
commissions, employees, and volunteers
103fH1 Torre Ave
Aggregate: $E,00D,OD0
Cupertino, CA 951114
Fire & Water Legal Liability sublimiL $100,000
Subject to the Master Policy Aggregate
X
Professional Liability Coverage Extension for Additional Insureds
The coverage set forth in Section 1, Coverage Agreement is extended to any additional insured but only as respects such
additional insured's liability arising out of a medical incident by the enrolled member, and solely to the extent that:
1. a professional liability claim is made against the enrolled member and the additional insured: and
2. in any ensuing litigation arising out of such claim, the enrolled member and the additional insured remain as co-
defendants.
In no event is there any coverage provided under this policy for acts, errors or omissions of the additional insured.
Additional Insured means any person or entity that an enrolled member is required to add as an additional insured by written
contract or agreement for professional services. The written contract or agreement must be:
1. Currently in effect or become effective during the term of the enrolled member's certificate period: and
2. Executed prior to the injury or damage.
X
General Liability Coverage Extension for Additional Insureds
The coverage set forth in Section 1, Coverage Agreement is extended to any additional insured but only as respects such
additional insured's liability arising out of premises they own, maintain or control while the enrolled member leases or occupies
these premises, and solely to the extent that:
1. a general liability claim is made against the enrolled member and the additional insured; and
2. in any ensuing litigation arising out of such claim, the enrolled member and the additional insured remain as co-
defendants.
In no event is there any coverage provided under this policy for an occurrence that is the direct liability of the additional insured.
The written contract or agreement must be:
1. Currently in effect or becoming effective during the term of this policy; or
2. Executed prior to the injury or damage.
Additional Insured means any person or entity that an enrolled member is required to add as an additional insured by written
contract or agreement.
AI0117F
amr CSAA insurance Exchange
Z.0.@ox 22221
insurance Oakland, CA 94623-2221
7. !Jame and Address or Msured
MICHAEL WILSON
Automobile Policy Declarations
&lease keep with your policy. See Important Notice on reverse.
For questions or changes call: 800.922.8228
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1PeflO� Tond 12!01 A.M. Staard Time at the address of the
07-19-2026 Named Ensured.
Alternate Address Oceupatian Alternate Number rekphone Number
Engineer/Scientist (408) 858-2315
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Medical Payments
Uninsured Motorists
--- — -- —
500_000
I$71
II$97
$182
—500,000—
— —
0
I
NO COV
I
NO CmV
I
NO COO
I
Uninsured Motorist
Property Damage
T
I
I
Property Damage
100,000
$294
$428
$699
500 I $32
I
500 I $151
I
500 $228
Comprehensive Actual Cash Value Less Deductible
Full Comprehensive Safety Glass Endorsement
I
I
g
($0 deductible)
NO COV
NO COV
NOOCOV
LU
1,000 I
1,000
Collision Actual Cash Value Less Deductible
$278
S964
$774
u'
Collision Deductible Waiver
INCL I
INCL I
INCL
Car Reimbursement Coverage
aRental
�
$50/30 1 $52
$50130 1 $52
$50130 1 $65
1
7
$ Limit per day 1 max days
II Risks Actual Cash Value Less Deductible
No Coverage
No Coverage
No Coverage
I
Vehicle Loan/Lease Protection Endorsement
No Co
ierage
No C erage
No Co erage
New Car Added Protection Endorsement
No Co
erage
No Co erage
No Coerage
Original Equipment Manufacturer Parts (OEM) Endorsement
No Coverage
No Coverage
No Coverage
I
Ride -sharing Coverage Endorsement
No Coverage
No Coverage
No Coverage
TOTAL &REMIUM &ER VEHICLE
$922
$1,903
$2,331
* Automobile Death Benefits $15,000 per deceased insured person
Premium
$6
Premium Summary
This is not a bill.
CA Surcharge: $0
CA Special Fraud Assessment Fee: $5.28
Total gremium:
$5,167.28
Total Premium shown is
for the Member Advantagerm Program,
EXCLUSIONS
There is no coverage provided by this policy while the following individual(s) operate a motor
vehicle:
None
rn
5chwule of changes
ua
0
2
Q
2
u
55 150012 15
(Continued on back}
item Rawdf"r
0
LU 1
of codes.
ENVISION HONDA OF MILNITAS
You may qualify for other products
w
' z 920 THOMMSON ST
and discounts. for more info call
MIL2ITAS CA 95035
your Insurance Agent
LA
House Agent AAA NCNLI
D
J
(800) 922-8228
IMPORTANT NOTICE: THIS IS A PART OF YOUR DECLARATIONS
The insurance afforded is only with respect to such of the preceding coverages as are indicated by specific premium charge or charges.
The limit of the Exchange's liability under each such coverage shall be as stated herein, subject to all the terms of the policy. The purpose
for which the automobile Is to be used is pleasure or business, subject to the exclusions in the policy, including the exclusion for
wholesale and retail delivery.
RENEWAL CERTIFICATE - Extends this policy for the period shown under Rolicy geriod upon payment of the premium.
AMENDED DECLARATIONS - In consideration of the premium adjustment indicated herein this policy is hereby amended only with
respect to such changes as are indicated in the schedule of changes. The limit of the Exchange's liability under such amended coverage
shall be as stated herein.
LOSS ZAYEE(S) - Any loss under Rhysical Damage coverages is payable as interest may appear to the named insured and the Loss Rayee in
accordance with the loss payable agreement.
For your protection, California law requires that you be made aware of the following: Any person who knowingly presents false or
fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may
be subject to fines and confinement in state prison.
RATING INFORMATION DISCLOSURE EXXLANATION
(From Discounts/Messages Section on Zrevious gage)
ITEM (ITEM NUMBER): Item number is the number assigned to the vehicle shown on the Declarations.
RATED DRIVER: The driver assigned to a vehicle whose attributes (e.g., years driving experience, driving safety record and marital status) are used
to develop the premium.
DRIV SAFETY RECORD (DRIVING SAFETY RECORD): The total number of points assessed the driver for "principally at fault chargeable
accidents" with or without injury and/or vehicle code violation convictions (tickets). A "principally at fault chargeable accident" occurs
when the driver of a vehicle is at least 51 % at fault for an accident and the total monetary damages (whether paid or not) in the
accident exceed:
$750 or the accident resulted in death for losses occurring prior to 12/11/11
$1,000 or the accident resulted in death for losses occurring 12/11/2011 or after
Additional information on the number and types of incidents can be provided on request. Carriers use different point count systems for
rating purposes. The number of points shown on your declarations would not necessarily match the number of points assigned by
another carrier.
YRS DRIV EXA (YEARS DRIVING EXZERIENCE): The number of years a driver has been licensed to drive a motor vehicle anywhere in the
world. However, a driver must have at least 18 months current driving experience in the United States, U.S. Territories, or Canada,
before foreign country driving experience can be counted.
ZRIOR ANN MILES (ARIOR ANNUAL MILES ❑RIVEN): The estimated number of total miles a vehicle was driven during the year just past.
FUTURE ANN MILES (FUTURE ANNUAL MILES DRIVEN): The estimated number of total miles a vehicle will be driven in the coming year.
VEH GARAGE Z121 (VEHICLE GARAGED TIH CODE): The 21S code of the location where the vehicle is garaged.
VEHICLE USAGE: Vehicles are assigned to one of five usage designations: Business Use, Work Commute, Farm Use, Farm Business Use
or Zleasure.
MARITAL (MARITAL STATUS): "M." stands for Married, and " S " stands for Single.
DISCOUNTS: A reduced rate applies for each Discount listed.
55 1500 12 15
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 MICHELE WESTLAKEN.
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 28 day of July 2025, at , California.
Michele Westlaken
PRINT NAME
0
SIGNATURE
Updated 06/23/21
Feldenkrais Instruction
Final Audit Report 2025-07-28
Created: 2025-07-24
By: Webmaster Admin (webmaster@cupertino.org)
Status: Signed
Transaction ID: CBJCHBCAABAAQMnHYX2KLIDxuvcTlvE5HDB5iuQ-anTE
"Feldenkrais Instruction" History
Document created by Webmaster Admin (webmaster@cupertino.org)
2025-07-24 - 4:05:45 PM GMT- IP address: 35.229.54.2
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
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Signer entered name at signing as Michele Westlaken
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Document e-signed by Michele Westlaken (
Signature Date: 2025-07-28 - 3:45:34 PM GMT - Time Source: server- IP address: 99.44.171.41
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Document e-signed by Michael Woo (michaelw@cupertino.org)
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